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Health Services Department (HSD)

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Title: Health Services Department (HSD)


1
Health Services Department(HSD)
2
HEALTH SERVICES DEPARTMENT
  • Largest County Department
  • Fully Integrated Health Care Delivery System
  • Composed of Ten Operating Divisions and Six
    Special Funds

3
DEPARTMENTOPERATING DIVISIONS
  • Regional Medical Center Health Centers
  • Health Plan
  • Mental Health
  • Public Health
  • Alcohol and Other Drugs
  • Environmental Health/Hazardous Materials
  • Detention Inmate Care
  • Homeless Programs
  • Conservatorship
  • California Childrens Services

4
SPECIAL FUNDS
  • Ambulance Service Area
  • Tobacco Tax Fund
  • Emergency Medical Services
  • Major Risk Insurance
  • Domestic Violence Assistance
  • Substance Abuse Crime Prevention (Proposition
    36)

5
DEPARTMENTS MISSION
  • Contra Costa Health Services cares for, and
    improves, the health of all people in Contra
    Costa County with special attention to those who
    are most vulnerable to health problems.

6
CONTRA COSTA POPULATION
  • The population is growing and becoming more
    diverse. 18-22 increase since 1990.
  • Our patients and clients speak more than 20
    different languages.
  • Twenty percent of the County population lives
    below 200 of the Federal poverty line.
  • African Americans, Latinos/Hispanics and those in
    low-income communities are at far greater risk
    for poor health outcomes.

7
CONTRA COSTA RESIDENTS WITHOUT HEALTH INSURANCE
  • One in ten residents age 18-64 years old does not
    have health insurance.
  • Hispanic/Latinos and African Americans are 2 to 3
    times more likely than Whites to be without
    health insurance.
  • People without health insurance are more likely
    to be sicker and die earlier than those who have
    coverage.

8
MISSION MANDATE
  • Section 17000 of the Welfare and Institutions
    Code places a general duty on the County to
    provide medical care for indigents.
  • The Conservatorship program is a State mandated
    function.
  • Hospital staffing ratios are State mandated.
  • The Mental Health Services Act requires county
    funding at no less than the 2004/05 level.

9
MISSION MANDATE
  • The provision of inmate medical care is a County
    legal obligation.
  • The California Childrens Services program
    requires a State-defined county match.
  • Every county in California is required to have a
    Public Health Program.

10
HSD 2004/05 BUDGET (In Millions)
  • Total Expenditures All Units 687.4
  • Total Revenue All Units (87) (596.5)
  • General Fund Contribution 90.9

11
HSD 2005/06 REQUIRED EXPENDITURE INCREASES (In
Millions)
  • Wages
  • Salary COLA Growth 1.8
  • Employee Benefits
  • Pension 8.5
  • Health Insurance 1.7
  • Workers Compensation 3.2
  • Total Benefit Increase 13.4
  • Total SEB COLA Growth 15.2

12
HSD 2005/06 Expenditure Increases(In Millions)
  • Services Supplies
  • Pharmacy Medical Supplies
    6.3
  • Mental Health Prop. 63
    12.0
  • Reduction in AB-3632 Services (2.8)
  • Reduction in payments to outside
  • providers, Agency Expense, Miller
  • Centers Misc. (3.6)
  • Total Net Services Supplies Increase
    11.9

13
HSD2005/06 REVENUE CHANGES (In Millions)
  • Revenue Increases
  • Proposition 63
    12
  • Third Party Payors
    6
  • CCHP Premiums
    4
  • All Other Revenues
    1
  • Less Miller Centers Revenue Decline (4)
  • Total Net Revenue Increase 19

14
2005/06 NET COUNTY COST REQUIREMENT(In Millions)
  • Cost Increases 27.1
  • (SEB 15.2 SS 11.9)
  • Less Revenue 19.0
  • BASELINE SHORTFALL (8.1)

15
2005/06CAO RECOMMENDEDNET COUNTY COST(In
Millions)
  • Baseline Shortfall 8.1
  • CAO Reduction of Existing
  • 2004/05 General Fund Support 6.6

  • Total HSD Reduction Required 14.7

16
HSD NET COUNTY COST COMPARISON(In Millions)
  • HSD 2004/05 Budget 91.0
  • CAO Recommended 84.4
  • REDUCTION 6.6
  • HSD 2005/06 Baseline 99.1
  • CAO Recommended 84.4
  • REDUCTION 14.7

17
NET COUNTY COST2004/05 BUDGET vs. 2005/06
RECOMMENDED(In Millions)
Functional Area 2004/05 Budget 2005/06 Recommended Change Change
General Government 77.2 77.4 0.2 0
Law Justice 122.7 133.1 10.4 8
Health Human Services 123.4 114.9 (8.5) -7
GRAND TOTAL 323.3 325.4 2.1 1
18
NET COUNTY COST2005/06 BASELINE vs. 2005/06
RECOMMENDED(In Millions)
Functional Area 2005/06 Baseline 2005/06 Recommended Change Change
General Government 78.7 77.4 (1.3) -2
Law Justice 143.6 133.1 (10.5) -7
Health Human Services 141.4 114.9 (26.5) -19
GRAND TOTAL 363.7 325.4 (38.3) -11
19
NET COUNTY COST2003/04 ACTUAL vs. 2005/06
RECOMMENDED BUDGET(In Millions)
Functional Area 2003/04 Actual 2005/06 Recommended Change Change
General Government 66.6 77.4 10.8 16
Law Justice 106.7 133.1 26.4 25
Health Human Services 116.0 114.9 (1.1) -1
GRAND TOTAL 289.3 325.4 36.1 12
Includes 10.0 Million Contingency Fund
20
HEALTH SERVICES DEPT PROPOSED REDUCTIONS
  • Reduction Process Focused On
  • Preserving legally mandated services
  • Maintaining regulatory compliance
  • Protecting revenue generating programs
  • Reducing non-direct patient care areas to the
    extent possible

21
HSD BUDGET BALANCING PLAN SUMMARY (In Millions)
  • Increase Revenue (1-5) 3.0
  • Implement Health Plan Co-Pays (6,7) .3
  • Reduce Administrative Positions (8,9) .5
  • Eliminate EHSD nursing support (10) .1
  • PAGE TOTAL 3.9
  • refers to pages 274-280 of the Preliminary
    Recommended Budget

22
HSD BUDGET BALANCING PLAN SUMMARY (In Millions)
  • Reduce Public Health Programs
  • e.g. Outreach, Clinic Services (11-14)
    .2
  • Eliminate All Hospital Transportation (15) .1
  • Reduce GSD Requested Maintenance (16) .6
  • Reduce Public Health Homeless Programs
  • e.g. Nutrition, Crisis Hotline (17-21)
    .7
  • PAGE TOTAL 1.6
  • CUMULATIVE TOTAL 5.5

23
HSD BUDGET BALANCING PLAN SUMMARY (In Millions)
  • Eliminate Juvenile Hall Mental
  • Health Services (22) .3
  • Reduce Public Health Programs,
  • e.g. Oral Health, CHDP (23,24) .4
  • Reduce Hospital Housekeeping Staff
  • by 20 (25) .8
  • Close West County Detention Medical (26) 1.4
  • PAGE TOTAL 2.9
  • CUMMULATIVE TOTAL 8.4

24
HSD BUDGET BALANCING PLAN SUMMARY (In Millions)
  • Eliminate All Public Safety
  • Officers (27) 2.3
  • Reduce the STAND Comm.
  • Violence Contracts (28) .2
  • Reduce/Ration clinic appointment
  • slots for Indigent Patients (24) 2.0
  • PAGE TOTAL 4.5
  • CUMMULATIVE TOTAL 12.9

25
HSD BUDGET BALANCING PLAN SUMMARY (In Millions)
  • Reduce Public Health Homeless Programs e.g.
    TB, Immunization Clinics, 25 Beds
  • Concord Shelter (30-37) 1.4
  • Contract out Detention Medical
  • Services(38) 1.0
  • Close the Hospital Pediatric Unit (39) .5
  • Reduce additional Public Health Programs
  • e.g. Senior Nutrition, Clinic Services (40-44)
    .8
  • PAGE TOTAL 3.7
  • CUMMULATIVE TOTAL 16.6

26
HSD BUDGET BALANCING PLAN SUMMARY (In Millions)
  • Close the Homeless Shelters (45, 46) 1.1
  • Eliminate the Advice Nurses (47)
    1.0
  • PAGE TOTAL 2.1
  • Proposition 36 Proposed State
  • allocation change Impact
  • unknown N/A
  • GRAND TOTAL 18.7

27
REDUCTIONS / SAVINGSBY DIVISION (In Millions)
Description Amount FTEs
Hospital/Clinics 7.9 54.5
Contra Costa Health Plan 2.4 9.6
Public Health 3.6 69.7
Alcohol Other Drugs .5 N/A
Homeless Programs 1.4 5.0
CCS .1 1.0
Detention 2.8 54.3
TOTAL 18.7 194.1
Mental Health (AB-3632) 2.8 N/A
GRAND TOTAL 21.5
28
NET COUNTY COSTFY 2003/04, 2004/05, 2005/06 (a)
29
FY 2005/06Health Services Department
  • Program Reduction List

30
PROGRAM REDUCTION LIST
Order Reference to Mand / Discr List Programs / Budget Units Services Number of Positions Net County Cost Savings Impact
1 15 Mental Health Eliminate AB3632 Services to the School districts tbd N/A See Impact
2 1-7 Hospital Increase Hospital ongoing Revenue forecast --- 1,250,000 None
3 5-13 Health Plan Increase Health Plan ongoing Revenue forecast --- 1,000,000 None
4 22-29 Public Health Increase Public Health ongoing Revenue forecast --- 250,000 None
5 31-38 Substance Abuse Increase Substance Abuse ongoing Revenue forecast --- 500,000 None
6 10 Health Plan Implement CCHP county employee Pharmacy co-pay --- 150,000 None
7 10 Health Plan Implement CCHP county employee ER Clinic Visit co-pay --- 200,000 None
8 1 Hospital Reduce Hospital Administrative positions 5 350,000 See Impact
9 27 Public Health Reduce Hospital Administrative positions .5 FTE 112,000 See Impact
31
PROGRAM REDUCTION LIST
Order Reference to Mand / Discr List Programs / Budget Units Services Number of Positions Net County Cost Savings Impact
10 28 Public Health EHSD Nursing Support 1 FTE 145,000 See Impact
11 28 Public Health PH Outreach, Education Collaborations (PHOEC) Unit .5 FTE 52,000 See Impact
12 50 CCS California Children Services (CCS) 1 FTE 50,000 See Impact
13 28 Public Health Community Assessment Program Evaluation (CHAPE) 1 FTE 70,000 See Impact
14 28 Public Health PH Clinic Services (PHCS) .3 FTE 45,000 See Impact
15 2 Hospital Eliminate all Hospital transportation contracts N/A 75,000 See Impact
16 3 Hospital Reduce requested Hospital maintenance from the General Services Department tbd 600,000 See Impact
17 23 Public Health Community Wellness Prevention Program (CWPP) Food Nutrition 1.5 FTE 136,000 See Impact
18 54 Homeless Homeless Program 1 FTE 136,000 See Impact
32
PROGRAM REDUCTION LIST
Order Reference to Mand / Discr List Programs / Budget Units Services Number of Positions Net County Cost Savings Impact
19 57 Homeless Homeless Program Homeless Hotline Crisis Center Contact Hotline 76,000 See Impact
20 23 Public Health Teen Age Program (TAP) 8 staff 240,000 See Impact
21 21 Public Health Pregnancy Testing Clinic 1 FTE 125,000 See Impact
22 45 Detention Eliminate Mental Health screening services provided to Juvenile Hall youth 3.5 FTE 261,000 See Impact
23 28 Public Health Childrens Oral Health Program 2 FTE 164,000 See Impact
24 24 Public Health Child Health Disability Prevention Program (CHDP) 7-10 positions 200,000 See Impact
25 1 Hospital Reduce Hospital Housekeeping staff by 20 13 FTE 850,000 See Impact
26 44, 45 Detention Close West County Detention Medical Services 10.3 FTE 1,400,000 See Impact
27 1 Hospital Eliminate Public Safety Officers and cancel Sheriff Management contract 28 FTE 2,300,000 See Impact
33
PROGRAM REDUCTION LIST
Order Reference to Mand / Discr List Programs / Budget Units Services Number of Positions Net County Cost Savings Impact
28 43 Detention Reduce STAND Domestic Violence contract N/A 50,000 See Impact
29 2 Hospital Reduce available clinic appointment slots to Basic Adult Care (Indigent) patients by 15 N/A 2,000,000 See Impact
30 28 Public Health Tuberculosis Control Program 1.3 Staff 150,000 See Impact
31 28 Public Health Immunization Program Oversight 1 FTE 143,000 See Impact
32 28 Public Health Immunization Clinics .8 FTE 100,000 See Impact
33 24 Public Health Medically Vulnerable Infant Program (MVIP) 1 FTE 100,000 See Impact
34 53 Homeless Homeless Programs Single Adult Shelters 2 FTE 86,000 See Impact
35 28 Public Health Limited English Access Program (LEAP) 4.5 FTE 303,000 See Impact
36 24 Public Health Eliminate Medically Vulnerable Infant Program (MVIP) 3 FTE 162,000 See Impact
34
PROGRAM REDUCTION LIST
Order Reference to Mand / Discr List Programs / Budget Units Services Number of Positions Net County Cost Savings Impact
37 28 Public Health Tuberculosis Program 3 FTE 346,000 See Impact
38 44, 45 Detention Contract out Martinez Detention Facility Medical and Psychiatric services 40.5 FTE 1,000,000 See Impact
39 6 Hospital Close the Pediatric Unit 8.5 FTE 500,000 See Impact
40 28 Public Health Immunization Clinics .8 FTE 100,000 See Impact
41 24 Public Health Child Health Disability Program (CHDP) 5-8 FTE 100,000 See Impact
42 28 Public Health Limited English Access Program (LEAP) 5 FTE 186,000 See Impact
43 29 Public Health Senior Nutrition Program 1 FTE 100,000 See Impact
44 28 Public Health Public Health Clinic Services (PHCS) 17.5 FTE 300,000 See Impact
35
PROGRAM REDUCTION LIST
Order Reference to Mand / Discr List Programs / Budget Units Services Number of Positions Net County Cost Savings Impact
45 54 Homeless Homeless Programs Single Adult Shelters 2 FTE 85,000 See Impact
46 51, 54, 57, 58, 59, 62, 63 Homeless Eliminate all subsidy to the Homeless Program N/A 1,000,000 See Impact
47 9 Health Plan Eliminate the CCHP Advice Nurse Program 9.6 FTE 1,000,000 See Impact
GRAND TOTALS GRAND TOTALS GRAND TOTALS GRAND TOTALS 191.1-197.1 18,660,000
36
IMPACT NOTES
Program Impact
1 Mental Health Budget assumes a 2.8 million reduction in net county cost through either a reduction in staff or in increased revenue from the Schools for the provision of services the budget further assumes that 1.1 million in IDEA is used by the Schools to purchase services from Mental Health. Return
6 Health Plan May require Labor Agreement Co-pay (5 generic, 10 brand 15 non-formulary). Return
7 Health Plan may require Labor Agreement ER Co-pay of 25, Outpatient visit Co-pay of 5. Return
37
IMPACT NOTES
Program Impact
8 Hospital With the elimination of these administrative positions, there will be a loss of efficiency in operations. Return
9 Public Health This savings comes from several service and supply reductions, restructuring to maintain existing staffing levels for the Developmental Disabilities council. Return
10 Public Health EHSD Nursing works in the Aging Adult Services Bureau to provide skilled nursing assessments and clinical consultations to approximately 50 social workers serving older adults and persons living with disabilities. Programs supported include Information Assistance, Adult Protective Services, In-Home Supportive Services, Linkages, and Multi-purposes Senior Services Program. Reduction will eliminate approximately 300 assessments for alleged victims of elder abuse/neglect and approximately 300 assessments and consultations for IHSS clients . Return
38
IMPACT NOTES
Program Impact
11 Public Health Reduce outreach staff working directly in the most underserved communities of east and west county. Staff work with residents to strengthen ties between high-risk communities and key Health Services programs, improve access to health services, and build community skills to utilize county health services and to address community health problems. Return
12 CCS Reduce one therapist in the CCS Medical Therapy Units. This will restrict the times that medical therapy will be available to CCS clients and limit the availability of therapy scheduling to CCS children. Return
39
IMPACT NOTES
Program Impact
13 Public Health CHAPE develops data on the health status and needs of Contra Costa County and its communities and evaluates the effectiveness of County health programs and services. This reduction will decrease our ability to secure and maintain grant funding, particularly in the areas of homelessness, diabetes and obesity, and chronic disease control. Decrease capacity to provide community health data and funder-required program evaluations. Return
14 Public Health Reduce nursing time available to the First 5-funded home visiting consultation and response team to the amount directly funded by First 5 . Return
15 Hospital The elimination of transportation contracts will mean that patients will have great difficulty getting to and from their medical care. Return
40
IMPACT NOTES
Program Program Impact
16 Hospital The reduction in hospital maintenance will result in physical plants that are in some state of disrepair. Depending upon the actual building problems, this could prevent effective use of the facilities. Return The reduction in hospital maintenance will result in physical plants that are in some state of disrepair. Depending upon the actual building problems, this could prevent effective use of the facilities. Return
17 Public Health The developing obesity epidemic threatens to decrease life expectancy in the U.S. for the first time in history. Reductions will decrease capacity to plan and implement programs that improve access to healthy food in low-income communities. Eliminates technical assistance and funds to small grocery owners in Richmond who want to sell fresh fruit and vegetables, and ends support to farm stands selling fresh produce in North Richmond. Associated loss of federal matching funds will decrease nutrition education sessions for low-income residents and eliminate training for physicians at the Richmond and Pittsburg Health Centers on nutrition and physical activity counseling for their patients. End support for West County faith organizations that are working to improve the nutrition of their congregations. Return The developing obesity epidemic threatens to decrease life expectancy in the U.S. for the first time in history. Reductions will decrease capacity to plan and implement programs that improve access to healthy food in low-income communities. Eliminates technical assistance and funds to small grocery owners in Richmond who want to sell fresh fruit and vegetables, and ends support to farm stands selling fresh produce in North Richmond. Associated loss of federal matching funds will decrease nutrition education sessions for low-income residents and eliminate training for physicians at the Richmond and Pittsburg Health Centers on nutrition and physical activity counseling for their patients. End support for West County faith organizations that are working to improve the nutrition of their congregations. Return
41
IMPACT NOTES
Program Impact
18 Homeless Savings come from the elimination of one shelter staff FTE in the 100-bed West County adult shelter, and the realization of some unanticipated grant revenue. The staff reduction places additional responsibility on the homeless shelter manager to provide more direct supervision and to ensure there is no compromise in client or staff safety. If there appears to be safety problems, we will reduce the number of beds operated in the shelter. Return
19 Homeless The Homeless Hotline receives 14,000 to 18,000 calls per year from homeless persons in need of shelter and information. The recent implementation of Homeless Management Information System will allow the emergency shelter staff to operate the Homeless Hotline service in addition to their other duties. The expanded Homeless Outreach Teams now provide a major source of shelter referrals as part of the Homeless Ten-Year Plan, and provide a connection to services for homeless individuals. Return
42
IMPACT NOTES
Program Impact
20 Public Health The Program provides health education presentations in local high schools focusing on responsible decision making, substance abuse, tobacco prevention, reproductive health and contraception, drinking and driving risks, communication skills, etc., that currently reach close to 16,000 students per year. This reduction will eliminate presentations to about 9,000 students per year and close our youth development project, Empowerment Through Action, at Middle College High School campus in Richmond. Reduce staff to the Pegasus Mentoring Project, a joint effort with Richmond High School which links 60 to 75 high school students with mentors. Return
21 Public Health Eliminate specific pregnancy testing-only clinics. Pregnancy testing would be available in CCHS through Family Practice clinics or Womens Health clinics only, or through Planned Parenthood. Return
43
IMPACT NOTES
Program Impact
22 Detention This program is responsible for the mental health status screening and assessment of youth at Juvenile Hall and mental health support of youth who have been detained at the Juvenile Ranch facility in Byron. Without these services, youth at both facilities will have no mental health assessment or intervention. Since risk of self-harm and suicidal behavior is one of the elements that these staff screen for, there may well be a corresponding rise in incidents or deaths at these facilities. Increased rate of transfers to a psychiatric inpatient unit for mental health intervention is also highly likely. Return
23 Public Health The Childrens Oral Health Program currently provides educational services to 20,000 children in preschool and elementary school settings and dental screenings for 16,000 school children. This reduction would eliminate 9,000 dental screenings annually and reduce our educational classroom visits from twice a year to one yearly visit per class. Return
44
IMPACT NOTES
Program Impact
24 Public Health The reduction will lead to an additional loss of 400,000 to 600,000 in matching funds. The major impact would be upon reaching children and families with the information and resources regarding health care coverage, health access, and necessary health services, as well as providing translation services to facilitate access for non-English speaking families. Priorities of the remaining CHDP staff would be directed toward those activities, to the extent allowed by the State CHDP requirements. Return
25 Hospital The reduction in hospital and clinics housekeeping will result in a physical plants that are less sanitary and, therefore, more likely to promote infectious disease. Return
26 Detention The closure of medical services at West County would require that all inmates with medical needs be housed in Martinez. This would mean that the sheriff would have to reduce the census in the West County Detention facility. The medical and mental health care would return to a pattern similar to 1990. This change could result in negative medical outcomes for inmates. Return
45
IMPACT NOTES
Program Impact
27 Hospital This action would eliminate all of the public safety officers in the HSD. Police and security activities would, after this action, be relegated to the appropriate police agencies covering the HSD facilities. This action would cause a delay in responses to emergencies. Return
28 Detention This action would limit our ability to provide domestic violence education and training. Return
29 Hospital This action would essentially ration the outpatient care that is available to patients who quality as Basic Health Care clients. We can anticipate that this action would cause individuals to use the Emergency Room more often and to report disease processes later in their course. This would result is inferior access to care for these patients. Return
46
IMPACT NOTES
Program Impact
30 Public Health Reduce the ability to provide TB case management to persons with active TB, including visiting TB patients and testing their contacts, as well as decreased oversight of directly observed therapy (DOT) for TB patients at-risk of non-compliance. Some patients may not complete treatment, leading to the possibility of the emergence of multiple drug-resistant TB. Fewer contacts will be identified and given preventive treatment, with the risk of more TB cases developing. Return
31 Public Health State immunization funding of 250,000 and the provision of State-funded vaccine for children to CCHS and community providers requires very specific and extensive program oversight and community immunization promotion activities. Those activities would have to be redistributed to existing staff and would lead to a deterioration in important activities, including providing technical assistance to public and private medical providers, daycare centers, and schools outreach to under-immunized populations and campaigns to promote immunizations in Contra Costa. No existing immunization clinics will be eliminated as the result of this reduction. Return
47
IMPACT NOTES
Program Impact
32 Public Health Public Health currently operates 11 Immunization Clinics per week throughout the county. Some of these clinics would be eliminated, maintaining services at the most heavily utilized clinics. There would still remain opportunities for targeted immunization clinics around school opening, or other times. Return
33 Public Health MVIP provides long-term home visiting by specially trained pediatric nurses for over 250 infants throughout the county born in neonatal intensive care units, and who are at-risk for developmental and other disabilities. This reduction would eliminate services to about 60 infants annually. Return
34 Homeless Reduce 25 beds in the Concord Single Adult Shelter. This means that as many as 75 individuals per year will not be served at the shelters or placed in permanent supportive housing. Single adult shelters/transitional housing is the key link in the Countys Ten-Year Plan to end chronic homelessness, which is the basis for 7.7 million dollars annually in federal funding for County homeless services. Currently there are over 2,000 single adults on the waiting list to access a shelter bed. Return
48
IMPACT NOTES
Program Impact
35 Public Health This program provides translation and services to newly arriving refugees and immigrants as well as others with limited English, to assure needed health care. These staff work in clinics at CCRMC and Public Health, as well as in the community. These reductions will limit the ability to make services available to non-English speaking persons and decrease capability to provide outreach and client navigation to non-English speaking patients. This reduction will impact the Departments legal mandate to make language services available. Return
36 Public Health Further reductions in MVIP will leave us unable to meet the State requirements for the 250,000 in State funding for this program and will require the elimination of the program. The remaining 190 high-risk infants from neonatal intensive care units will not receive long-term home visiting services from the specially trained pediatric MVIP nurses. Return
49
IMPACT NOTES
Program Impact
37 Public Health This further reduction will severely limit the ability of the TB Program to provide TB case management for persons with active tuberculosis. Contact investigation and directly observed therapy will be restricted to a very limited number of TB patients, and home visiting to persons with TB and their contacts will be minimal. These programs have been effective in controlling and decreasing the number of tuberculosis cases in the county with these reductions we can anticipate an increase in the number of tuberculosis cases seen in the county. These reductions will also jeopardize 350,000 in State funding to the County for TB control. TB staff also provide a second line of response to major outbreaks of communicable disease, emerging infections, or potential bioterrorism events. That capability would be diminished. Return
50
IMPACT NOTES
Program Impact
38 Detention In previous years, the Board has looked at the option of providing medical and psychiatric detention services via an RFP. This approach could, in theory, offer similar care to inmates at a reduced cost. There are a number of legal and political hurdles to overcome before this option is a reality. Return
39 Hospital The Pediatric Unit has an average daily census of less than two children. Its closure would mean that those patients would have to be transferred to an alternative hospital. Since we are the only Medi-Cal pediatric unit in the county, this would mean a reduction in access to care for these patients. Return
40 Public Health This second reduction in Immunization Clinics would lead to a further decrease in the total amount of immunization clinics available throughout the county. Immunization clinic services will be concentrated at the most utilized sites, or special immunization clinics around school opening. Immunization services for children will continue to be available through pediatric and family practice clinics in Health Services. All children under 300 of poverty are eligible for pediatric services through Basic Health Care. Return
51
IMPACT NOTES
Program Impact
41 Public Health This reduction would also involve a loss of 600,000 to 800,000 federal matching funding and would require program concentration on the absolute mandated CHDP functions. CHDP efforts in working with children and families to enroll them in health coverage would be severely curtailed. CHDP activities in the local schools to enroll children in health coverage, translation services for Spanish, Laotian, Vietnamese speaking clients would be eliminated. Return
42 Public Health The remaining LEAP interpreters would be eliminated, along with a loss of 100,000 State funding. This reduction will severely curtail services available to non-English speaking persons with health needs. Outreach to non-English speaking patients/immigrants/refugees would no longer be available at all through this program. There will be a major impact on the Departments legal mandate to make language services available to the people we serve. Return
52
IMPACT NOTES
Program Impact
43 Public Health The Senior Nutrition Program currently provides 190,000 meals to seniors at group sites and 240,000 home delivered meals annually. This reduction eliminates essentially all the County funding from a 3 million federally funded program and reduces the administrative oversight of this complex program. In addition, highly successful fundraising efforts would end, which would lead to the loss of funding for thousands of meals annually. Return
44 Public Health Reductions in PH Clinic Services would lead to major loss of targeted case management or federally qualified health center revenue for an estimated decrease matching funding of 1 million to 2 million. There would be major reductions in nurses providing home visiting of mothers and babies just discharged from the hospital, pediatric clinic services, and womens health and family planning services. We are working on further quantifying the impact. Return
53
IMPACT NOTES
Program Impact
45 Public Health Further loss of an additional 25 beds in the homeless shelters for single adults, with the continued compromise of the Homeless Ten-Year Plan and the ability to maintain federal funding for homeless programs in Contra Costa. Return
46 Public Health Reduces services including the emergency shelter. Return
47 Public Health CCHP uses the Advice Nurse service to meet its contractual obligations to provide after hours nursing/physician availability. Development of other programs to meet the requirements will be necessary. In addition, CCHP will have to cancel contracts to provide advice nurse services to patients in other organizations. The Advice Nurse service provides prevention and self-care services that reduce costs in CCHP and in other divisions of Contra Costa Health Services. Return
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