health and human services committee there is a problem stop pointing fingers get all parties...

Date & Time of Meeting: Thursday, June 25, 2015 immediately following the joint meeting Meeting Location: North Central Health Care Board Room, 1100 Lake View Dr., Wausau

Health & Human Services Committee Members: John Robinson, Chair, Ken Day, Vice-chair, John Bandow; Matt Bootz; Joanne Leonard; Russ Michalski; Maynard Tremelling

Marathon County Mission Statement: Marathon County Government serves people by leading, coordinating, and providing county, regional, and statewide initiatives. It directly or in cooperation with other public and private partners provides services and creates opportunities that make Marathon County and the surrounding area a preferred place to live, work, visit, and do business. (Last updated: 12-20-05) Health & Human Services Committee Mission Statement: Provide leadership for the implementation of the strategic plan, monitoring outcomes, reviewing and recommending to the County Board policies related to health and human services initiatives of Marathon County.

1. Call Meeting to Order

2. Public Comment (15 minute limit)

3. Approval of the May 28, 2015 Health & Human Services Committee Minutes

4. Educational Presentations/Outcome Monitoring Reports A. Community Response (Tylka)

5. Policy Issues Discussion and Committee Determination to the County Board for its Consideration A Fair Housing Proclamation B What are the Emerging Needs in Health and Human Service Programs that will Require More

Investment in the Next 3-5 Years? 1. What can we do less of?

C NCHC Proposal for Providing Mental Health Services to the Criminal Justice System

D Update on CIP Projects

E Purchase of Animal Impoundment and Quarantine Services (Theurer)

6. Next Meeting Logistics and Topics:

A. Committee Members are asked to Bring Ideas for Future Discussion B. Next Scheduled Meeting: Thursday, July 30, 2015

7. Announcements

8. Adjournment

“Any person planning to attend this meeting who needs some type of special accommodation in order to participate should call the County Clerk’s Office at 715-261-1500 or e-mail [email protected] one business day before the meeting.

SIGNED /s/ John Robinson Presiding Officer or Designee

FAXED TO: Wausau Daily Herald, City Pages, and NOTICE POSTED AT COURTHOUSE FAXED TO: Other Media Groups FAXED BY: M. Palmer BY: M.. Palmer FAXED DATE: DATE: FAXED TIME: TIME:

HEALTH AND HUMAN SERVICES COMMITTEE

AMENDED AGENDA

Overarching goals for Health and Vulnerable Populations Program Area: Health Ranked from highest to lowest priority.

1. People practice proactive behaviors, prevention and early intervention to delay or lessen the impacts of aging, disease and chronic physical and mental health conditions.

2. People with life threatening health emergencies are responded to in a timely and effective

manner. 3. Systems are in place that rapidly identify and control the spread of infectious disease. 4. People reach their optimal physical, mental and social health potential.

Program Area: Vulnerable Populations Ranked from highest to lowest priority.

1. People who are at risk are identified early and receive interventions that promote their safety and well being.

2. Marathon County’s systems will assure access to basic needs programs on a timely basis.

3. Vulnerable populations live in safe and healthy social, emotional, and physical environments. 4. Families and their support systems provide for the safety and well being of vulnerable

populations.

5. Residents know how to access services available for vulnerable populations. 6. Vulnerable populations are provided the opportunity to reach their full social, educational and

emotional development.

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MARATHON COUNTY HEALTH AND HUMAN SERVICES COMMITTEE MEETING

MINUTES

Thursday, May 28, 2015 – 3:30 p.m. Assembly Room – B105 – Courthouse, Wausau WI

Attendance: Present Absent

John Robinson, Chair X Ken Day, Vice Chair X John Bandow X Matt Bootz X Joanne Leonard X Russ Michalski X Maynard Tremelling X

Also Present: Brad Karger, Deb Hager, Kurt Gibbs, Vicki Tylka, EJ Stark, Joan Theurer, Gary Bezucha,

Brian Kowalski, Jean Burgener, Peter Weinschenk, Dayton Hamann, Nora Hertel, Mary Palmer

1. Call Meeting to Order The Health & Human Services meeting was called to order at 3:34 p.m. by Chair Robinson.

2. Public Comment – None

3. Approval of the Minutes of April 30 and May 11, 2015, Health & Human Services Committee

Meeting MOTION BY DAY; SECOND BY MICHALSKI; TO APPROVE THE MINUTES OF THE APRIL 30 AND MAY 11, 2015, HEALTH & HUMAN SERVICES COMMITTEE MEETINGS. MOTION CARRIED.

MOTION BY LEONARD; SECOND BY BOOTZ TO CORRECT THE APRIL 30TH MINUTES TO ADD THE WORDS “THE 51.42 BOARD RUNNING” UNDER 5C BULLET 5 UNDER COMMENTS TO: LEONARD HAS BEEN OPPOSED TO THE 51.42 BOARD RUNNING THE NURSING HOME. MOTION CARRIED.

Although no action was taken, Supervisor Bandow noted that the May 11th, 2015 Minutes show that under 3A the vote on the Motion to Delay was 5 yes and 2 no.

4. Educational Presentations/Outcome Monitoring Reports A. None

5. Policy Issues Discussion and Committee Determination to the County Board for its

Consideration A Status of Capital Projects Involving North Central Health Care (NCHC) (Nursing Home, Aquatic

Therapy Pool) 1. What are the barriers to passing borrowing resolutions? 2. How have we contributed to the problem? 3. What can be done to improve relationships?

Discussion: At the Independent Mental Health Panel the 51.42 statute was discussed and Corporation Counsel interprets it to say that the County determines what services are provided by the Health Care Center, not the North Central Community Services Program (NCCSP) Board a.k.a. 51.42 Board.

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A statement was made that when the Bounty Board passes the budget, they are approving what services, for whom, at what cost. Expectations and alignment with cost happen at the budget process.

Our responsibilities as a county versus the authority of the NCCSP Board are in conflict.

Are the new County Board members aware enough to make an informed decision?

How can we as a committee work differently in the future?

Below is a partial list of questions and comments: We need to get past behind us and work forward. The Task Force needs to fix issues in charter There should be at least quarterly meetings with NCCSP Board Get relationship with NCHC in tact Fix problems before voting or moving forward a contract Admit there is a problem Stop pointing fingers Get all parties involved on the same page moving forward. Issues need to be understood at the committee level. If we aren’t sold on it here we can’t

advocate and move it to County Board. When there is a vote here, make sure we are comfortable with the vote.

Administrative issues have overtaken the infrastructure issue. What is the county’s role and how do we go about performing that and what are the

resources? We are the problem – this committee – if we are unhappy it’s our fault. How do we move

ahead? This committee will take ownership. Where does the money go? This committee needs to be more comfortable with all areas of

jurisdiction. What are the other program issues other than mental health in the jail? How do you fix things with only suspicions and no facts? Work on communication and understanding. Define expectations and outcomes –

ADRC was brought up and the raise in rent from $100,000 to $190,000 without any discussion with the Executive Director.

Action: No action was taken.

Follow Through: Scott Corbett will be asked to speak on the 51.42 Statute.

B NCHC Capital Improvement Program (CIP) Requests for the 2016 Budget Year for Approval and Referral to the CIP Committee

Discussion: Gary Bezucha went through the list of 2016 CIP Requests:

Crack Seal Parking Lots - $35,000 Lakeview Center Window Replacement - $175.000 Main Road Replacement (NCHC Campus) - $85,000 MVCC Window Replacement - $425,000 Nurse Cally System (Legacies Program) - $152,000 Behavioral Health Services Remodel - $225,000 Mini Van – 7 Passenger (3 vans) – replacement - $79,500 Mini Bus – replacement - $78,000 Cargo Van – replacement - $28,000 Bus – additional - $55,480 Primary Care Renovation - $576,000

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TOTAL: $1,914,380 The joint meeting on the 25th will go over the Primary Care Renovation. It is to create an area for specialty physicians and primary care from Bridge Clinic. This is part of the comprehensive plan that

Action: MOTION BY BOOTZ; SECOND BY DAY TO APPROVE THE NCHC CIP REQUESTS AND FORWARD TO CIP FOR RANKING WITH PRIMARY CARE RENOVATION SUBJECT TO FURTHER REVIEW BY HEALTH & HUMAN SERVICES BY JULY 1, 2015. MOTION CARRIED.

Follow Through: No follow through needed.

C Review and Approval of the Following Agreements:

1. Joint County Agreement 2. Campus Use Agreement 3. Nursing Home Agreement

Discussion: The three Agreements were sent out on Tuesday May 26. Supervisor Day briefly went through the Agreements. Due to the short time for the committee to review the agreements, it will be brought back in June.

The request was made to have bullets of key points – what’s being done differently, what are the county’s roles and responsibilities and what are NCHC’s role and responsibilities? Call out those provisions to better understand for County board. This committee should understand every line in the agreements or how can we support it? This committee will determine the bullets.

The NCHC Board requested that the effective date of the master campus agreement be changed to January 1st of whatever year to keep it consistent with finance. This committee can endorse that without approving them.

There are no major modifications. This committee or task force may make major revisions if needed.


Follow Through: Supervisors Day and Robinson will collaborate and come up with requested information for the next meeting.

D Healthy Teens Initiative

Discussion: Deadline for submission is tomorrow, May 29, at 4:00 p.m.

Action: MOTION BY BOOTZ; SECOND BY LEONARD TO DELEGATE AUTHORITY TO THE COUNTY ADMINISTRATOR TO HANDLE THE REVIEW AND SELECTION OF THE HEALTHY TEENS INITIATIVE GRANT RECIPIENT. MOTION CARRIED. .


E Mental Health Services in Corrections 1. NACO Stepping Up Program

Discussion: Should Marathon County be one of those Counties participating in the Stepping Up program? Evidence Based Decision Making (EBDM) is a similar process. Stepping Up would allow access to national trends and we could learn from them. There are resources and opportunities to interact with others.

Action:

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MOTION BY DAY; SECOND BY MICHALSKI TO SUPPORT THE JOINT RESOLUTION WITH PUBLIC SAFETY TO JOIN THE STEPPING UP PROGRAM AND TO TAKE THE RESOLUTION TO COUNTY BOARD. MOTION CARRIED.


F Emerging Community Human Service Needs that will Require Greater Resource Allocations in the Next 3 – 5 Years. 1. Needed Funding Reallocations within Human Services: What are the Tradeoffs?

Discussion: One thing that is not discussed at County Board is: When you grow something, you shrink something else. Considerations for the future:

Sports tourism – we will need to make a larger financial commitment County property assessment – will probably be brought back – more allocation of resources Out of county jail inmates – jail and child welfare – 70% directly related to drugs Education & Economic Development – globalization/nationalization are detriment to the

county. How can we stimulate local businesses? Health & Human Services – public transportation – it’s not succeeding in our county.

Discussions need to happen at committee over the next 3-5 years. In June department directors will key up some issues with estimated cost.


Follow Through: Chair Robinson requested that ADRC and Veterans Affairs be invited.

G. Strategic Plan 1. Water Quality 2. Health Impact Statements 3. Farm to Market – Local Food

Discussion: Water Quality - Supervisor Robinson shared that the Department of Natural Resources just developed their water quality strategic plan. He will share it with the Health Officer. Health Impact Statements – what are our next steps? Expand to other committees? Farm to market – does the county have a role providing a facility? Quality of Life - LP gas to run county vehicles, sell to fleets, cleaner air – should this be looked at?


Follow Through: Bring back in June or July.

6. Next Meeting Logistics and Topics:

A. Committee members are asked to bring ideas for future discussion Humane Society (Joan)

B. Next Meetings: Thursday, June 25, 2015 Noon for a joint meeting with NCHC Board and at 2:00 p.m. at NCHC Board Room for Health & Human Services committee.

7. Announcements - None

8. Adjournment

There being no further business to discuss, MOTION BY BOOTZ; SECOND BY MICHALSKI; TO ADJOURN THE HEALTH & HUMAN SERVICES COMMITTEE MEETING. MOTION CARRIED. Meeting adjourned at 5:36 p.m.

Respectfully submitted by Mary Palmer

Marathon County’s Community Response Program A child protective services early intervention

Is the County’s investment in the program worth it?

Background:

The Community Response (CR) Program is an early intervention program designed to support families

who have risk factors so that they do not enter the formal Child Protective Services (CPS) system. The

program promotes self‐sufficiency, improves function and increases family social support systems.

Families are eligible for CR when they are reported to DSS for child maltreatment concerns that do not

rise to the level of screening in for investigation, but they have identified risk factors present. This is a

voluntary program and DSS has a 62% participation rate, which exceeds state average program

participation.

DSS has operated the CR program from 2008 to present. The program began with grant funding and

currently all case management services provided are funded 100% by levy, approximately $75,000

annually. We acknowledge Greenheck Foundation for also investing in the Community Response

Program with flexible funding to support eligible families with essential needs.

In the fall of 2014, Katie Maguire‐Jack, MSW, MPA, PhD and Tori Campbell, MSW, completed a study on

the effectiveness of the Community Response Program in Marathon County. The report states that the

“initial study results indicate that when families participate in Marathon County CRP, they are less likely

to experience the formal child protection service system”.1 The finding “provides evidence that the

program may effectively prevent CPS recidivism, which has the potential to significantly reduce child

welfare costs that occur in the deep‐end system.” 2 Ibid

The question, then, is the county’s investment worth the outcomes we are seeing?

Clear Cost Savings – Analysis through May 2014

Over the span of the program, 177 families participated in CR, as compared to 174 families who declined

or were not offered the program. The long term data (2009‐2014) clearly shows that families are twice

as likely to have children placed in out of home care who do NOT participate in CR than those who do.

Comparing the populations, 16 additional children would have been placed in foster care if not for the

CR Program.

1 Maguire‐Jack, Katie, & Campbell, Tori. (2014). Marathon County Community Response: Child Abuse Prevention

Findings

The average monthly cost of foster care per month is $769 and the average annual cost of additional

services (such as supervised visitation and parenting classes) to a child and family is $3,835. This means

that each child in care costs about $7,442 in foster care funds and $3,835 in services costs, totaling over

$11,275 on average annually. The average length of placement is 9.7 months. Since 16 children were

not placed in care who received the CR program, this is a savings of $180,432. Over the 6 years of full

operation of the program, this is a savings of $ 30,072 annually.

Also factored in to the cost analysis is a projected expense for a percentage of social work time that

would have been required to serve children in the CPS system had they not been diverted to CR. This

brings the investment ratio of cost savings to DSS is 69 cents per dollar spent for CR. While the

investment in the DSS budget may not have 100% return on investment, additional savings can be

drawn across more partner systems to have a larger impact.

Other System Savings

It is difficult to measure the cost savings on other systems, although they clearly exist. The Children’s

Court, Corporation Counsel, and law enforcement are positively affected by the diversion of these 16

children from foster care. There is less demand on those corresponding services over and above the

savings in the DSS budget.

In addition, we are at capacity for foster home placements in Marathon County. Had those 16 children

needed to be placed, we would have additional costs in recruiting and training new foster parents to

address capacity needs.

The Real Savings

The significant savings in the early intervention program are not the dollars saved in foster care,

although those are real. The real savings are in the reduction of children involved in the foster care

system. We provide excellent foster care placements in Marathon County. At the same time, it is

known that foster care inherently impacts children over time, the majority of situations resulting in poor

outcomes for children who remain in care long term. Placing children in out of home care is

traumatizing. Per federal and state law, it must only be done when safety cannot be controlled for in

their family home.

Children in foster care have a higher rate of challenges through life, including utilizing very costly

systems such as health care, mental health, and incarceration. The CR program works with families to

ameliorate risk and is successful in reducing out of home placements needs for those who participate.

Just as importantly, those who have been served to date (177 families) benefit greatly from the social

work assistance they receive in meeting their own goals which strengthen their families. Through

support of flexible funds and many referrals and connections to community resources, these families

become stronger and clearly have a better chance of not entering the CPS system.

This outcome is immeasurable in terms of long term systems savings over the life of a child; and it is life

changing for many of the families who participate in the CR Program.

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f services.

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ployment andwell-being w

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ome

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Marathon Cpenses, inclun average pa

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References

1. English, D., Marhsall, D., Brummel, S., & Orme, M. (1999). Characteristics of repeated referrals to Child Protective Servicesin Washington State. Child Maltreatment, 4(4), 297-3907.

2. Ethier, L.S., LEmelin, J.P., & Lacharite, C. (2004). A longitudinal study of the effects of chronic maltreatment on children’s behavioral and emotional problems. Child Abuse & Neglect, 28(12), 1265-1278.

3. Fluke, J., Yuan, Y., Edwards, M. (1999). Recurrence of maltreatment: an application of the National Child Abuse and Neglect Data System. Child Abuse & Neglect, 23(7), 633-650.

4. Gershater-Molk, R.M., LEtzker, J.R., & Wesch, D. (2002). Using recidivism data to evaluate Project SafeCare: Teaching bonding, safety, and health care skills to parents. Child Maltreatment, 7(3), 277-285.

5. Hussey, J., Chang, J., Kotch, J. (2006). Child maltreatment in the United States: Prevalence, risk factors, and adolescent health consequences. Pediatrics, 118(3), 933-941.

6. Ireland, T.O., Smith, C.A., & Thornberry, T.P. (2002). Developmental issues in the impact of child maltreatment on later delinquency and drug use. Criminology, 40(2), 359-400.

7. Lawson, M., Alameda-Lawson, T., & Byrnes, M. (2012). A multilevel evaluation of a comprehensive child abuse prevention program. Research on Social Work Practice, 22(5), 553-566.

8. Lipien, L. & Forthofer, M. (2004). An event history analysis of recurrent child maltreatment reports in Florida. Child Abuse& Neglect, 28(9), 947-966.

9. Loman, A. Shannon, C., Sapokaite, L., & Siegel, G. (2009). Minnesota Parent Support Outreach Program Evaluation: Final Report. Retrieved from: http://www.iarstil.org/papers/PSOPFinalReport.pdf.

10. Maguire-Jack, K., Slack, K.S., & Berger, L. (2014). Community Response: a child maltreatment prevention program for families not served by the child welfare system. Child Welfare, 92(4), 95-121.

11. Manly, J., Kim, J., Rogosch,, F., & Cicchetti, D. (2001). Dimensions of child maltreatment and children’s adjustment: Contributions of developmental timing and subtype. Development and Psychopathology, 13(4), 759-782.

12. Marathon County Department of Corporation Counsel. (2014). D. Meulemans, Deputy Corporation Counsel, personal communication, April 3, 2014.

13. Marathon County Department of Social Services. (2013). Social Services. Retrieved from: http://www.co.marathon.wi.us14. Marathon County Government. (2013). Marathon County District Attorney’s Office. Retrieved From:

http://www.co.marathon.wi.us/Departmetns/DistrictAttorney/aspx15. Morley, L. & Caplan, K. (2011). Issue Brief #3: Formal Public Child Welfare Responses to Screened-Out Reports of

Alleged Maltreatment. National Quality Improvement Center on Differential Response in Child Protective Services, Washington, DC.

16. Olds, D.L. (2006). The nurse-family partnership: An evidence-based preventive intervention. Infant Mental Health Journal,27(1), 5-25.

17. Prinz, R., Sanders, M., Shapiro, C., Whitaker, D., & Lutzker, J. (2009). Population-based prevention of child maltreatment:The U.S. Triple P System population trail. Prevention Science, 10(1), 1-12.

18. Reed, D. & Karpilow, K. (2009). Understanding the Child Welfare System in California: A Primer for Service Providers and Policymakers. Center for Research on Women and Families: Oakland, CA.

19. Reynolds, R. & Robertson, D. (2003). School-based early intervention and later child maltreatment in the Chicago Longitudinal Study. Child Development, 74(1), 3-26.

20. United States Census. (2013). 2010 Interactive Population Search. Retrieved from: http://www.census.gov 21. United States Department of Agriculture. (2013). Food and nutritional service national school lunch program. Retrieved

from: http://www.fns.usda.gov/cnd/lunch/ 22. United Way of Marathon County. (2013). United Way’s 2-1-1. Retrieved from: http://www.unitedwaymc.org/211.htm23. United States Census Bureau. (2013). American FactFinder. Retrieved from:

http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml 24. Wisconsin Department of Health Services (2013). Economic Support. Retrieved from www.dhs.wisconsin.gov/em/rsdata25. Wisconsin Department of Children and Families. (2012). Child Abuse and Neglect Program. Retrieved from: http://dcf.wi.gov/children/CPS/index.HTM26. Wisconsin Department of Public Instruction. (2013). Wisconsin Informational Network for Successful Schools. Retrieved

from: http:///winss.dpi.wi.gov27. Wisconsin Department of Transportation. (2013). Drunken Driving. Retrieved from: http://www.dot.wisconsin.gov28. Wisconsin Office of Justice Assistance. (2011). Crime in Wisconsin. Retrieved from: http://oja.wi.gove/sites/default/files/crimes2011.pdf

PROCLAMATION

WHEREAS, this Country was founded by persons seeking the right to live their lives and to raise their families as they saw fit without undue interference from authority, and; WHEREAS, one of the ways we can continue this tradition is to ensure that everyone has the opportunity to live at the location of their choosing, in order to raise a family and seek to better themselves, and; WHEREAS, some would prevent others from living where they please, and keep others from access to education and jobs, and: WHEREAS, the County of Marathon is empowered and committed to promote the concepts and realities of Fair Housing and negative impact that discrimination, in all its forms, has on all of us, I, , County Board Chairman of Marathon County, do declare the Month of June 2015, with its traditions of independence and freedom, as Fair Housing Month in the County of Marathon. , County Board Chairman

Marathon County Department of Social Services Prevailing issue – Child Protective Services

Prepared for the Health and Human Services Committee – June 2015

Issue:

The prevailing issue is the growing demand on social work time to respond to, and ensure the safety of,

children who have been abused or neglected and are in need of protection and services.

Background:

Since 2012, our community has presented with growing needs for child protective services (CPS) to keep

kids safe; and our resources (social work time) have remained basically static. During this same time

period, documentation and requirements for serving children in out of home care have increased. The

demand for service and the requirements on our staff, as well as the professional responsibility to keep

kids safe when balancing these demands has resulted in 100% turnover in our CPS ongoing unit in a two

year period; and in decreasing performance in a number of federally required performance standards.

Since 2012:

Child protective services screened in reports (those we must respond to ) – 19% increase

Children in need of Protection and Services court petitions (CHIPS) – 125% increase

Children in out of home placements‐ 21% increase

Access and Initial Assessment

The social workers who record maltreatment reports and complete child safety assessments have been

required to respond to a large growth in reports over the last few years and the trend continues. From

2012 to 2015, the number of cases that Initial Assessment workers manage monthly steadily grew from

10 to 16 cases per worker. The recommended caseload size by the Child Welfare League of America

(CWLA) is 12 cases. Marathon County is 33% above that standard work load recommendation.

Child Protective Services Ongoing

When it is determined a child has been maltreated and requires protection and/or services, a court

(CHIPS) petition is filed. In 2012, 51 CHIPS petitions were filed. In 2013, the number increased to 82, and

in 2014, 115 CHIPS petitions were filed. By June 10, 2015, 47 CHIPS petitions have been filed. We have a

firm long term trend of increase in serious cases requiring court intervention.

The number of children being served in the CPS ongoing unit has grown since 2012, primarily for those

requiring out of home care. In 2012, an average case load had 18 children in out of home care; in 2015

an average case load has 21 children in out of home care AND 10 children residing in the care of a

parent or caretaker’s home. The recommended caseload size for social workers providing services to

children and families in the foster care system is 12‐15 children (CWLA). The current caseload, only

counting the out of home care cases for Marathon County DSS is 56% higher than the CWLA caseload

recommendation.

An evaluation completed from 09/01/2012 to 12/31/2013 shows that of the 116 CPS children placed in

out of home care, 51% (59) children were removed due to parental alcohol or drug use causing safety

concerns. This continues to be the primary cause for young children to be placed in foster care.

While our community works diligently to combat the usage of heroin and meth in Marathon County, as

an emergency responder, DSS must be adequately staffed to meet our statutory requirements and

ultimately to keep kids safe.

Reference:

Child Welfare League of America

(CWLA) http://66.227.70.18/newsevents/news030304cwlacaseload.htm

Marathon County Health Department Marathon County Program Prioritization 2015 June 12, 2015

Issue: Lifelong Health by Preventing or Decreasing the Impact of Chronic Disease

Background: Americans live shorter lives and suffer more health problems than peers in other

high‐income countries, ranking 34th in life expectancy. The epidemic of chronic disease is not

only taking a human toil, it is having an economic impact due to lost productivity. A healthy

workforce is a productive workforce and will be critical to the long‐term viability of Marathon

County. Rising health care costs highlight the need to focus efforts on prevention. Common

factors for the leading causes of chronic diseases include: unhealthy diet, insufficient physical

activity, tobacco use and secondhand smoke exposure, excessive alcohol use.

The LIFE Report over the past decade has identified alcohol and drug misuse, obesity, and

tobacco as community priorities. The Health Department in partnership with private and public

organizations are working together to collectively address these complex social and cultural

problems. In recent years, work is underway to:

Increase access to locally grown foods

Increase opportunities for physical activity

Preventing kids from using tobacco and increase options for smoke‐free housing

Promote safe use of alcohol and drugs

In looking to the future, Marathon County’s Comprehensive Plan has draft goals under the

“Health of Community” and “Environment & Ecosystem Management” in support of preventing

or reducing chronic disease. Draft goals include:

Prevent or decrease the effects of chronic disease on the Marathon County population.

People living in Marathon County have access to quality, accessible, affordable recreation opportunities.

People living in Marathon County have access to safe, healthy, affordable food.

Protect and promote local food growing systems.

Marathon County plays a leadership role in promoting a healthy work environment and workforce for employees and employee’s families.

Enhance community livability.

Fiscal Impact: The work of the Health Department in area of Chronic Disease Prevention is

supported by short‐lived grants (51%) and tax levy (49%). In October of 2017, a $98,992 grant

to increase access to locally grown foods and physical activity will end. Wisconsin ranked 46th

in state public health funding in 2014.

Marathon County Health Department Marathon County Program Prioritization 2015 June 12, 2015

Issue: Investing in Our Children by Reducing the Impact of Adverse Experiences during

Childhood

Background: With the release of the 2013‐2015 LIFE Report, there has been increase

awareness of the importance of childhood experiences to lifelong well‐being. Research informs

us adverse experiences during childhood increases the risk of physical, mental and behavioral

problems later in life.

Marathon County’s Comprehensive Plan has a draft goal under the Health of Community that

states, “Every child living in Marathon County makes it to adulthood with health, stability,

education, growth opportunities to be successful and achieve their potential”. Strategies in

support of this include;

Develop a plan to reduce childhood trauma,

Create a trauma informed care system,

Develop a comprehensive approach to address juvenile offenders to reduce the

likelihood of recidivism, and

Develop a framework for building resilient children.

The work of reducing the impact of adverse experiences during childhood in Marathon County

is being done through private and public partnerships. One example of this is the Early Years

Coalition, which includes 55 individuals representing 30 local organizations serving young

children and their parents coordinated by the Health Department and United Way of Marathon

County. Efforts are underway to further understand the impact, create systems of care, and

create communities that build resilient children.

A number of programs, services and community initiatives in support of children are being

carried out by Health, Social Services, Library, Special Education and Justice Programs. To date,

the county’s investment in current programs, services and initiatives have not been mapped in

terms of common goals, type of prevention strategies, target audience being served, and

impacts.

Fiscal Impact: Given this is a new focus area for the Marathon County, it is not known what re‐

investments or additional investments will need to be made on the part of Marathon County

government at this time.

FEASIBILITY STUDY

PRELIMINARY RESULTS

JUNE 1, 2O15

The Connections Place, Inc.

WISCONSIN’S AGINGPOPULATION

Benchmark Data

Wisconsin’s Aging Population

Preparation by David Egan-RobertsonUW Applied Population LabDecember 2013

MARATHON COUNTY’SAGING POPULATION

Benchmark Data

4,238 4,190 4,360 4,380 4,380 4,340 4,310

4,361 4,580 4,700 4,830 4,830 4,770 4,680

4,468 4,520 4,880 4,970 5,100 5,050 4,950

4,433 4,190 4,330 4,640 4,730 4,840 4,790

3,407 3,460 3,250 3,340 3,580 3,630 3,710

4,138 3,870 3,950 3,680 3,770 4,010 4,040

3,887 4,290 4,130 4,170 3,880 3,940 4,160

4,050 3,990 4,530 4,320 4,360 4,020 4,060

4,654 4,070 4,110 4,630 4,420 4,430 4,070

5,161 4,600 4,110 4,130 4,650 4,420 4,420

5,118 5,060 4,590 4,080 4,100 4,610 4,380

4,554 4,950 4,980 4,500 4,000 4,020 4,520

3,693 4,360 4,830 4,850 4,380 3,900 3,920

2,787 3,490 4,200 4,630 4,660 4,220 3,760

2,207 2,590 3,280 3,940 4,360 4,400 4,000

1,882 1,980 2,350 2,980 3,600 4,000 4,050

1,665 1,560 1,670 2,000 2,560 3,110 3,480

1,267 1,170 1,130 1,230 1,490 1,930 2,370

785 910 950 980 1,060 1,240 1,580

2010 2015 2020 2025 2030 2035 2040

0‐4

5‐9

10‐14

15‐19

20‐24

25‐29

30‐34

35‐39

40‐44

45‐49

50‐54

55‐59

60‐64

65‐69

70‐74

75‐79

80‐84

85‐89

90 +

Marathon County Population Projections - Female

Marathon County Population Projections - Male

0‐4 4,533 4,390 4,580 4,590 4,590 4,540

5‐9 4,525 4,890 4,940 5,080 5,060 4,990

10‐14 4,852 4,690 5,230 5,230 5,360 5,280

15‐19 4,872 4,670 4,660 5,160 5,150 5,250

20‐24 3,693 3,850 3,720 3,680 4,070 4,040

25‐29 4,249 4,080 4,310 4,130 4,070 4,440

30‐34 4,089 4,380 4,370 4,580 4,370 4,250

35‐39 4,263 4,180 4,650 4,600 4,790 4,520

40‐44 4,745 4,290 4,350 4,800 4,740 4,890

45‐49 5,379 4,710 4,400 4,430 4,890 4,780

50‐54 5,307 5,300 4,740 4,410 4,440 4,870

55‐59 4,741 5,110 5,210 4,640 4,310 4,340

60‐64 3,665 4,460 4,940 5,000 4,460 4,150

65‐69 2,706 3,370 4,200 4,640 4,720 4,210

70‐74 1,975 2,420 3,080 3,830 4,250 4,340

75‐79 1,515 1,650 2,060 2,620 3,300 3,680

80‐84 1,185 1,160 1,290 1,620 2,090 2,640

85‐89 716 710 720 820 1,040 1,370

90 & over 298 370 420 455 520 660

Age Group 2015 2020 2025 2030 2035 2040

Marathon County Population Projections - Total

Age Group 2010 2015 2020 2025 2030 2035 2040

8,771 8,580 8,940 8,970 8,970 8,880 8,830

8,886 9,470 9,640 9,910 9,890 9,760 9,570

9,320 9,210 10,110 10,200 10,460 10,330 10,120

9,305 8,860 8,990 9,800 9,880 10,090 9,950

7,100 7,310 6,970 7,020 7,650 7,670 7,810

8,387 7,950 8,260 7,810 7,840 8,450 8,360

7,976 8,670 8,500 8,750 8,250 8,190 8,750

8,313 8,170 9,180 8,920 9,150 8,540 8,420

9,399 8,360 8,460 9,430 9,160 9,320 8,650

10,540 9,310 8,510 8,560 9,540 9,200 9,320

10,425 10,360 9,330 8,490 8,540 9,480 9,140

9,295 10,060 10,190 9,140 8,310 8,360 9,300

7,358 8,820 9,770 9,850 8,840 8,050 8,100

5,493 6,860 8,400 9,270 9,380 8,430 7,680

4,182 5,010 6,360 7,770 8,610 8,740 7,900

3,397 3,630 4,410 5,600 6,900 7,680 7,840

2,850 2,720 2,960 3,620 4,650 5,750 6,460

1,983 1,880 1,850 2,050 2,530 3,300 4,140

1,083 1,280 1,370 1,435 1,580 1,900 2,450

0‐4

5‐9

10‐14

15‐19

20‐24

25‐29

30‐34

35‐39

40‐44

45‐49

50‐54

55‐59

60‐64

65‐69

70‐74

75‐79

80‐84

85‐89

90 & over

Purchase of Animal Impoundment & Quarantine Services HSMC – June 2015 Page 1

Purchase of Animal Impoundment and Quarantine Services between the County of Marathon and the

Humane Society of Marathon County

June 2, 2015 Report

Background: Given the anticipated expenditures in 2014 and for 2015, the contract between Marathon

County and HSMC provided one formal meeting to occur by April 30, 2015. The purpose of the meeting

was to review the adequacy of compensation to cover the costs of services and analysis of revenues as

defined in Schedule A of the contract, anticipated Dog License Tax Revenues and effect of additional

municipal humane and animal control officers employed by political subdivisions and other than County

on the number of stray dogs being brought to shelter and in light of the increase number of quarantines

in 2014.

A formal meeting was held on May 14, 2015 with representatives from the Marathon County Health

Department (Joan Theurer, Health Officer and Dale Grosskurth, Director of Environmental Health &

Safety) and the Humane Society of Marathon County (Linda Berna‐Karger, President and Mary Kirlin,

Director). Summary of the meeting along with the policy issue for the county is outlined below.

Policy Issue: In 2014, the Humane Society of Marathon County (HSMC) net costs in providing

impoundment and quarantine services per contract terms was $137,950.18. The HSMC received

$80,000 from Marathon County, resulting in short fall of $57,950.18. To make the HSMC whole for

2014, fundraising revenues and private donations were utilized.

The intent of the contract between the County of Marathon and the HSMC was to have municipal dog

license fees along with owner reclaim fees pay for impoundment and quarantine services. In 2014, dog

license fees were $83,993.50 compared to $83,281.00 in 2013. Per state statute, a minimum of $1,000

is to be left in the dog license account. Marathon County’s expenses associated with municipal dog

licenses were $3,011 in 2014 and $2,993 in 2013. Owners’ reclaim fees for impoundment and

quarantine services were $15,105.82 in 2014.

In the meeting with the HSMC on May 14, 2015, the HSMC indicated they do not plan to supplement

Marathon County’s 2015 contract for county mandated services. The HSMC stated the revenues

obtained from fundraising and private donations need to be used to support other services that are

keeping with their mission. For 2015, in addition to the $80,000 contract base, $16,525.36 from the

balance of dog license fees not previously paid will be paid to the HSMC. Based upon current utilization

of services, the HSMC anticipates a short fall to occur again in 2015.

Revenue from the municipal dog license fees along with owner reclaim fees currently do not cover the

HSMC impoundment and quarantine expenses. Attached, find Schedule A Rate Structure for Stray Dogs

and Quarantine of Dog and Cat Services.

The following are 2014 financial figures provided by the HSMC for net costs in providing quarantine and

impoundment services.


Quarantine Utilization in 2014

The HSMC saw an increase in the number of quarantines, from 54 in 2013 to 77 in 2014. Average cost

for quarantine (minus owner reclaimed fee revenue) was $372 per animal.

‐ 255% increase in the number of cat quarantines from 2013 to 2014

39 cats quarantined in 2014 compared to 11 in 2013

54% (21 of 39) cat quarantines had no owner

35% (14 of 39) cat quarantines paid $200 reclaim fee

‐ 9% increase in the number of dog bites from 2013 compared to 2014

38 dogs quarantined in 2014 compared to 35 in 2013

3% (1 out of 38) dog quarantines had no owner

79% (30 of 38) dog quarantines paid $200 reclaim fee

Since April 30, 2015, 17 animals have been quarantined, compared to 18 at the same point last year.

Impoundment Utilization in 2014

The HSMC saw a decrease in the number of dogs impounded, from 348 in 2014 compared to 409 in

2013. Average cost per dog impounded (minus owner reclaimed fee revenue) was $314 per dog.

‐ 15% decrease in the number of dogs impounded

Average owner reclaim fee revenue was $17.87 Submitted by, Joan Theurer, Health Officer

CONTRACT AMOUNT: $80,000.00

2014 QUARANTINE COSTS: $37,520.00

2014 OWNER RECLAIM FEES COLLECTED: $8,885.82

2014 NET QUARANTINE COSTS: $28,634.18

2014 STRAY DOGS IMPOUNDED 348

2014 SCHEDULE A IMPOUND FEES:

Adm. Fee $60.00

Daily Rate 7 x $16.00 $112.00

Dispo Fee $160.00

Total Impound Fee Per Dog $332.00 $332.00

2014 IMPOUNDMENT COST FOR STRAY DOGS: $115,536.00

2014 OWNER RECLAIM FEES COLLECTED FROM STRAYS: $6,220.00

2014 NET IMPOUNDMENT COST: $109,316.00

2014 TOTAL NET COST OF IMPOUNDMENT & QUARANTINE $137,950.18


SCHEDULE A

RATE STRUCTURE FOR STRAY DOG AND QUARANTINE DOG AND CAT SERVICES 1.0 The following rate structure may be used for informational purposes only to calculate actual costs for Stray Dog Impound Services: Term Admission

Fee Max billable days

Daily Rate Disposition Charge (Day 8) Vet Bills

Year 1 $60.00 7 $16.00 $160.00 Billed at cost 2.0 The following rate structure may be used for informational purposes only to calculate actual costs for Quarantine Services: Term Admission

Fee Max billable days

Daily Rate Disposition Charge (Day 8) Vet Bills

Year 1 $90.00 10 $30.00 $160.00 Billed at cost 3.0 ALL SCHEDULES ABOVE ARE SUBJECT TO THE FOLLOWING:

3.1 Exceptional or emergency veterinary services provided by non-HSMC staff, which exceeds $500.00 per animal, may also be tracked for informational purposes only to calculate actual costs.

3.2 Any calculation of actual cost shall also contain an analysis of revenue, which is generated by reclaimed stray dogs or quarantined dogs and cats as well as any court-ordered reimbursement or restitution, and may also be used for informational purposes only.

3.3 County will work with HSMC and District Attorney’s office for the inclusion of “restitution costs” in any criminal prosecution.

* 2015 Note: While HSMC experienced a 1.5% budget increase, there will be no adjustment reflected in Schedule A rates for either “Impound” or “Quarantine” services.

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