untitled

Dear Readers:

I am pleased to present the Health Care Agency’s 2008 Business Plan. It is my hope that our

Business Plan will provide you with a comprehensive overview of the many programs and services

that are provided for children, adults and seniors by your Health Care Agency (HCA) to improve

the health of the community. Examples include our efforts to control the spread of disease, ensure

that recreational waters are safe, and help people deal with addictions.

The 2008 Business Plan is intended to document HCA’s progressive actions to ensure the health

of Orange County’s residents, visitors, and employees. Our continuing aim is to provide high-

quality services with a focus on improving the quality of life for our residents. The plan reﬂ ects

the commitment of our Agency to ensure a solid ﬁ nancial foundation on which we can build these

services and programs. It also provides a brief description of the opportunities, challenges and

current health service issues faced by HCA. In 2008-09, as in recent years, HCA will face a

signiﬁ cant number of challenges. One of our potential challenges is the proposed Health Care

Reform. However, times of great change also provide extraordinary opportunities, such as the

new and enhanced indigent health care services made possible by the Coverage Initiative.

The Business Plan acknowledges the role of our public and private partners in serving the

community. Working collaboratively, we will continue to make progress towards improving

health outcomes in our communities. Finally, the Business Plan provides the opportunity to

acknowledge the Agency’s exceptional group of committed and dedicated staff. The knowledge

and skills demonstrated by HCA’s employees enable our Agency to provide quality service to

the community. The Business Plan is developed with input from HCA staff and their interest in

contributing to our vision for the future once again shows that our employees are truly our most

valuable resource.

Thank you for taking the time to learn more about the Health Care Agency, its programs, and

services by reviewing our Business Plan. We welcome your comments on how HCA can better

serve Orange County.

Juliette A. Poulson, RN, MN

Director

Health Care Agency 2008 Business Plan

Executive Summary .................................................................................. 1

Section I: Agency Overview...................................................................... 4

Core Services ............................................................................................................... 4

Section II: Operational Plan ...................................................................... 8

A. Environment ............................................................................................................. 8

Clients ................................................................................................................. 8

Challenges .......................................................................................................... 9

Resources ........................................................................................................ 11

B. Action Plan ............................................................................................................. 12

Strategic Goals, Strategies to Accomplish Goals, Performance Measures ...... 12

Appendices

Appendix A - Health Care Agency 2008 Organizational Chart .................................. 21

Appendix B - Signiﬁ cant Accomplishments ................................................................ 22

Appendix C - Critical Demographics/Service Expectations ........................................ 24

Health Care Agency Business Plan — Executive Summary 1

Executive Summary

AGENCY OVERVIEW

The Health Care Agency (HCA) is a large and

dynamic public agency, comprised of approximately

2,775 employees and numerous community-based

contractors who are responsible for providing a wide

range of services to protect and promote the health

of the Orange County community. The Agency is

very active in building and maintaining partnerships

to ensure the highest quality of life standards are

available to our residents. The staff of HCA remains

focused on the Vision, Mission, and Values of the

organization.

OPERATIONAL PLAN

This section is composed of two parts, the

environment and action plan. Environment

describes the agency’s clients, challenges and

resources. The action plan describes the agency’s

strategic goals, speciﬁ c strategies to accomplish

goals, and the key performance measures and

results.

ENVIRONMENT

Clients

The Health Care Agency’s primary focus is to

protect and promote the health and safety of the

community as a whole. Therefore, our ultimate

client is the entire County population, as well as

the millions who visit Orange County for business

or recreation each year. The Health Care Agency’s

programs and services can be broadly divided into

three types:

• Services for the Community at Large, includes

ocean recreational water protection, food

sanitation, hazardous waste management,

animal care services, control of communicable

diseases, response and recovery from

disasters, and health promotion services.

• Preventive Services for At-risk Individuals,

includes substance abuse services, mental

health services, identiﬁ cation and protection

of individuals from speciﬁ c health problems

(i.e., diabetes, obesity, and other acute or

chronic diseases), and initiatives to increase

access to health care services.

• Intervention/Treatment Services for Individuals,

includes behavioral health services, increased

access to health care, support services for

persons with HIV/AIDS, and therapeutic

services for disabled children.

Challenges

HCA has crafted new performance plans for FY

2008-09 that recognize current and projected ﬁ scal

constraints, in addition to identifying new funding

sources. However, there are other ongoing and

potential challenges that may inhibit progress.

These challenges can be divided into three

categories: ﬁ nancial, workforce, and regulatory.

Financial – HCA continues to face ﬁ nancial

challenges to the Agency at both the State and

Federal levels. The major anticipated challenge

for FY 2007-08 is continuing to provide essential

• Partnerships

• Community Leadership

• Assessment of Community

Needs

• Planning & Policy

Development

• Prevention & Education

• Quality Services

2 Health Care Agency Business Plan — Executive Summary

services with limited resources. There is an

increased “cost of doing business” due to increases

in salary, retirement, medical insurance, and other

expenses, while most program and County General

Fund revenues have increased very little. At the

same time, Realignment funding, HCA’s largest

single revenue source, has not kept pace with

program costs.

Workforce – HCA has a need to recruit, hire

and maintain qualiﬁ ed staff for jobs that require

speciﬁ c certiﬁ cation or expertise such as nurses,

physician specialists, and microbiologists. Another

workforce challenge is responding to the changing

demographics of the Orange County community,

including growth in adolescents, older adults,

Hispanic and Asian/Paciﬁ c Islander populations.

Regulatory – The Federal Health Insurance

Portability and Accountability Act (HIPAA) continues

to be a challenge for HCA because it imposes

sweeping system-wide changes to health care

industry standards for the storage, transmission

and processing of health care information.

Federally imposed deadlines for HIPAA standards

will continue through at least 2010 with continual

auditing and monitoring for compliance.

Resources

HCA’s adopted budget for FY 2007-08 is $568 million

in net expenditures. There are 2,775 budgeted

positions and approximately 200 different funding

sources. State and federal funding allocations and

locally generated fees account for 84% of Agency

funding; County General funding comprises the

remaining 16%. Private sector service contracts

make up almost one-half of the Agency budget

expenditure.

ACTION PLAN

Strategic Goals and Strategies to Accomplish

Goals

The Health Care Agency’s 2008 Business Plan

contains goals and performance strategies

developed with the input of all HCA service areas.

They support the vision, mission and goals of

the Agency and the priorities of the Board of

Supervisors as outlined in the Strategic Financial

Plan and approved budget. The Agency’s six goals

include:

1. Prevent Disease and Disability and

Promote Healthy Lifestyles

2. Promote and Ensure a Healthful

Environment

3. Assure Access to Quality Healthcare

Services

4. Recommend/Implement Health Policy

and Services based on Assessment of

Community Health Needs

5. (Business Strategy #1): Encourage

Excellence by Ensuring a Healthy Work

Environment that Values Employees

6. (Business Strategy #2): Support the

Workforce through the Effective Use of

Technological and Other Resources.

For a complete listing of the speciﬁ c strategies

to accomplish our strategic goals please see the

Agency’s 2006-2010 Strategic Plan at http://www.

ochealthinfo.com/docs/admin/strategicplan/2007-

StrategicPlan.pdf (pages 6-9).

Accomplishments

HCA was successful in accomplishing most of the

objectives set forth in the 2007 Business Plan.

The following provides a brief summary of key

accomplishments:

• Agency-wide, 250 staff responded to the 2007

Santiago Canyon wildﬁ re incident.

• Increased access to health care by providing

insurance application assistance and

incentives for community clinics to enroll

eligible persons.

• Implemented Proposition 63, the Mental

Health Services Act, to improve and expand

mental health services for adults, older adults

and children.

• Completed construction of the Shellmaker

Water Quality Laboratory, which will allow the

Orange County Public Health Laboratory to

offer rapid and high quality water testing to

help detect and eliminate pollution sources in

Orange County.

• HCA collaborated with the Court, Probation

Department, Public Defender and District

Attorney to implement two new Family

Violence Collaborative Courts, one in West

Court and one in North Court.

• Increased education and outreach efforts

to promote a safe environment. Education

programs were provided to food workers to

Health Care Agency Business Plan — Executive Summary 3

increase awareness and compliance with

food safety practices. Fats, oils, and grease

(FOG) inspections were conducted to reduce

the amounts of fats, oils and grease disposed

of in the sewage system.

• Improved HCA’s ability to coordinate health

care resources, volunteers, and municipal/

community partners in the event of an

emergency or disaster.

• Improved care for patients in an institutional

setting through a digital x-ray screening

program to improve screening rate for

tuberculosis within the adult correctional

facilities and provide education and support

for new mothers in Juvenile Hall in the

areas of prenatal care, nutrition, childbirth,

breastfeeding, child development, child safety,

and setting personal goals.

• Implemented a Leadership Development

Program for staff.

• Public Health Services tested and implemented

the IRIS (Cerner) Enterprise Data System,

which streamlines patient registration and

tracks laboratory results ordered at the various

Public Health Clinics.

4 Health Care Agency Business Plan — Agency Overview

Section I:

Agency Overview

The Health Care Agency (HCA) performs a variety

of functions to protect and promote the health of the

general public, serve special needs populations,

assist local business and industry, and facilitate the

work of community-based organizations and other

County agencies.

The Health Care Agency updated its Strategic

Plan in 2006, which reafﬁ rmed its Vision, Mission,

Values and Strategic Goals, and established new

Strategies and Performance Measures. These

statements serve as the Agency’s foundation for

setting priorities and making decisions.

Core Services

The services provided by the Health Care Agency

to County residents are delivered through three

core services: (1) Community Health, (2) Healthful

Environment, and (3) Healthcare Access. The

following is a description of each of the three core

services and the service areas within the Health

Care Agency that support each of the core services.

The Agency’s current organizational chart can be

found in Appendix A.

COMMUNITY HEALTH

This core service is to prevent disease and disability,

and promote healthy lifestyles. Services include

monitoring the health of the community, developing

and implementing health policy, and controlling and

preventing diseases. The Health Care Agency’s

Public Health Services provide Community Health

core services.

PUBLIC HEALTH SERVICES: Monitors the

incidence of disease and injury in the community

and develops preventive strategies to maintain

and improve the health of the public. Divisions

in Public Health that support Community Health

core services are Family Health, Public Health

Nursing, Public Health Laboratory, Disease Control

& Epidemiology, and Health Promotion. A brief

overview of the major functions of each division as

it pertains to this core service is provided below.

Family Health programs include Clinical Services,

Community Programs, and Nutrition/WIC Services.

Family Health Clinics offer a variety of services

to speciﬁ c target populations, such as childhood

physical examinations and immunizations

(including inﬂ uenza and travel shots), and family

planning. The clinics also provide dental health

services for people living with HIV and children,

as well as emergency dental services. Community

Programs administer and manage the Child Health

& Disability Prevention Program and Treatment

Unit, the Childhood Lead Poisoning Prevention

Program, the Adolescent Family Life Program

and Cal-Learn (both of which provide guidance

and resources to pregnant and parenting teens),

the Immunization Assistance Program and

Immunization Registry, the Perinatal Hepatitis B

Project, the Comprehensive Perinatal Services

Program including Prenatal Care Guidance, and

the Children’s Dental Disease Prevention Program.

Nutrition Services is responsible for a variety of

services and programs focused on healthy eating

and physical activity, including the administration of

WIC clinics, to improve the nutritional status of the

general community and several priority subgroups.

Public Health Nursing provides community and

in-home public health nursing assessments, health

education, case management, referral and follow-up

services to people at high risk for health problems

associated with the aging process, communicable

disease, active tuberculosis, and adverse outcomes

of pregnancy and childbirth (including teenage

pregnancy and nursing care to high risk infants

and children). Specialized Public Health Nursing

Services are also provided. Examples include Foster

Care Public Health Nursing, CalWORKs (welfare

to work), Child Abuse Services Team (CAST),

Perinatal Substance Abuse Service Initiative/

Assessment and Coordination Team, Preventive

Health Care for the Aging, and the Senior Health

Outreach and Prevention Program.

Public Health Laboratory provides laboratory

support services for programs within the Agency

to help identify and control diseases and identify

unsafe conditions in the environment. The laboratory

provides food outbreak detection testing and is a

partner with the Centers for Disease Control and

Prevention for bioterrorism testing. The laboratory

also provides reference laboratory services to

Orange County hospitals and health care providers.

The water quality section of the laboratory

supports testing and research of recreational water

pollution problems to help improve water quality in

Orange County.

Disease Control and Epidemiology protects the

health of Orange County residents by investigating

individual cases of infectious diseases to determine

the source of infection and prevent further spread

Health Care Agency Business Plan — Agency Overview 5

of disease. Communicable disease outbreaks from

inﬂ uenza, Tuberculosis, HIV, etc. are investigated

and reported to the State Department of Public

Health. This provides information for the State and

the general public on important diseases that affect

the health of the community. This division also

coordinates county-wide HIV care and prevention

services.

Health Promotion protects the health and safety of

Orange County residents by educating individuals,

organizations and communities in the prevention of

disease, disability and premature death. Services

include community health education, professional

training, coalition building, and media outreach.

Programs focus on injury prevention, chronic

diseases (such as diabetes and cancer), alcohol,

tobacco and drug awareness, maternal and child

health, multi-ethnic health education, health access,

and communicable disease.

HEALTHFUL ENVIRONMENT

The Health Care Agency provides services that

promote and ensure a healthful environment

for the community. The Health Care Agency’s

Medical and Institutional Health Service’s Health

Disaster Management and Public Health Service’s

Environmental Health Services and Animal Care

Services provide Healthful Environment core

services.

HEALTH DISASTER MANAGEMENT: The goal

of Health Disaster Management is help the local

medical community to prepare for, respond to, and

recover from disasters and medical emergencies.

This Division assists in the development of health

related emergency plans, conducts disaster

exercises, and administers emergency related

state and federal grant programs. The Division

includes the Bioterrorism Program and Emergency

Medical Services (EMS). The Bioterrorism Program

provides guidance on appropriate measures to

prepare for any disaster or bioterrorism incident.

EMS coordinates medical disaster planning and

monitors the availability of pre-hospital and hospital

emergency services and disaster response

services. EMS provides oversight to all providers

of emergency medical services, including ﬁ re

departments, medical transportation providers,

base hospitals, hospital emergency departments,

trauma centers, and to the emergency medical

technician and paramedic training programs in the

County.

ENVIRONMENTAL HEALTH SERVICES:

Administers programs that protect public health and

safety from harmful conditions in the environment.

Services include restaurant inspections to ensure

the safety of the food served to the public, ocean

water quality monitoring, and inspections regarding

the safe handling and disposal of hazardous

materials and medical waste. Environmental Health

enforces laws and regulations and uses education

to inform the community about environmental health

issues and thereby ensure food safety and protect

water quality.

ANIMAL CARE SERVICES: Provides services

to 22 cities and all unincorporated areas of the

County to prevent animal-related injury, nuisance

and disease through enforcement of health and

safety standards. These services may include

pet licensing, patrol services, and animal shelter

services, depending on the city or location. The

Orange County Animal Care Center houses and

provides medical care for impounded dogs, cats

and exotic animals. Adoption services are also

available.

HEALTHCARE ACCESS

The Health Care Agency facilitates access to

healthcare by providing low cost or free health,

dental and behavioral health services, facilitating

access to other available health services, and

increasing insurance and healthcare coverage

to eligible populations. HCA’s Behavioral Health

Services, Medical and Institutional Health Services

and Public Health’s California Children Services

provide Healthcare Access core services.

BEHAVIORAL HEALTH SERVICES: Provides

culturally competent services for eligible county

residents in need of mental health care and/or

treatment for alcohol and other drug abuse. Services

are provided countywide via county-operated and

contracted programs. Behavioral Health Services

is comprised of four distinct service areas: Adult

Acute Services, Adult Recovery Services, Children

and Youth Mental Health Services, and Alcohol and

Drug Abuse Services. A brief overview of the major

functions of each of these services is provided

below.

Adult Mental Health Outpatient and Crisis

Services (AMHS-Outpatient/Crisis) provides

outpatient recovery services, crisis stabilization,

and hospital diversion for adults, 18 years and

older. Such services include crisis intervention and

evaluation in the community and through a 24-

6 Health Care Agency Business Plan — Agency Overview

hour evaluation and treatment unit, assessment,

medication management, individual and group

therapy, as well as family services at County-

operated clinics.

Adult Mental Health Inpatient Services (AMHS

– Inpatient/Residential) provides inpatient

management, residential treatment, and supportive

housing services to adult clients in intermediate

and long-term care facilities and clients receiving

outpatient services in contracted programs. Such

services include short-term episodic outpatient

treatment, longer term rehabilitative and recovery

services, residential rehabilitation programs, and

supportive housing services.

Children and Youth Services (CYS) provides a

broad range of services for behaviorally, emotionally

or mentally disordered children and adolescents,

which include evaluation, therapy, medication,

crisis intervention and collateral services to

parents and families. Also provided are referrals for

hospitalization or residential treatment, consultation

to schools and other agencies, coordination with

private and public services, and case management

for those placed in hospitals or other 24-hour

settings. CYS operates clinics in ﬁ ve geographic

areas within Orange County.

Alcohol and Drug Abuse Services (ADAS)

provides outpatient and residential treatment

programs designed to reduce or eliminate the

abuse of alcohol and other drugs in the community.

Services include crisis intervention, assessment

and evaluation, individual, group and family

counseling, and referrals to other programs when

indicated. Specialized programs provide services

for pregnant and parenting persons who require

methadone maintenance and detoxiﬁ cation,

persons who have been diagnosed with both

substance abuse and mental health problems (dual

diagnosis), and individuals referred by the Orange

County Drug Court.

MEDICAL AND INSTITUTIONAL HEALTH

SERVICES: Medical and Institutional Health

Services provides essential medical services to

persons whom the county has responsibility, by

law. Medical and Institutional Health Services

is comprised of four distinct service areas, with

Institutional Health Services and Medical Services

Initiative providing Healthcare Access core services.

A brief overview of these two service areas is

provided below.

Institutional Health Services includes Correctional

Medical Services, Correctional Mental Health,

Juvenile Health Services, and Conditional Release

Program. Correctional Medical Services (CMS)

provides medical and dental care to individuals

held in custody at ﬁ ve adult County correctional

institutions: The Men’s and Women’s Jails, the Intake

and Release Center, and the Theo Lacy and James

A. Musick branch facilities. Correctional Mental

Health (CMH) provides mental health services

including 24-hour emergency triage and crisis

intervention, suicide prevention, treatment beds,

individual and group therapy, substance abuse

counseling and a 12-step program, medication

assessment and discharge planning to all adult

inmates in the County’s ﬁ ve correctional institutions.

Juvenile Health Services (JHS) provides medical,

dental, nursing, and pharmaceutical services at a

community standard of care for children who reside

in the county’s six residential facilities operated by

Social Services and Probation Departments and

contracts with hospitals for inpatient and specialty

care. Conditional Release Program (CONREP) is

an Institutional Health Services grant funded special

program targeted toward mentally ill offenders who

reside in the community. The Conditional Release

Program is part of the Department of Mental Health’s

statewide system of community-based services for

judicially committed mentally disordered offenders.

Medical Services Initiative (MSI) is a safety net

program responsible for the provision of medical

care to Orange County’s medically indigent adults.

The Medical Services Initiative (MSI) acts as a

Health Care Agency Business Plan — Agency Overview 7

payer to hospitals, clinics, physicians, ambulance

companies, home health providers and other

providers that serve eligible low-income patients.

Through contracts with hospitals throughout Orange

County, MSI provides for necessary medical care

for patients for which the county is responsible.

CALIFORNIA CHILDREN SERVICES: Provides

diagnostic and treatment services, medical case

management, and physical and occupational

therapy services to children under age 21 with

qualifying medically fragile and physically disabling

conditions such as chronic medical conditions,

cystic ﬁbrosis, cancer, heart disease, traumatic

injuries and cerebral palsy. Services are provided

through a network of specialty physicians and

centers. Licensed program staff at specially

equipped Medical Therapy Units located at public

schools provide occupational and physical therapy

services.

Pacific Ocean

Orange County

Unincoporated

San Bernardino

Riverside

San Diego

Los Angeles

Irvine

Anaheim

Orange

Santa Ana

Fullerton

Brea

Tustin

Yorba Linda

Costa Mesa

San Clemente

Garden Grove

Newport Beach

Seal Beach

Cypress

Huntington Beach

Mission Viejo

Lake Forest

Laguna Niguel

Aliso Viejo

Buena Park

Westminster

La Habra

Placentia

San Juan Capistrano

Laguna Beach

Dana Point

Fountain Valley

Coto de Caza

Rancho Santa Margarita

Laguna Hills

Newport Coast

Tustin Foothills

Stanton

Los Alamitos

Foothill Ranch

Laguna Woods

Villa Park

Las Flores

La Palma

Rossmoor

Portola Hills

San Joaquin Hills

8 Health Care Agency Business Plan — Operational Plan

Section II:

Operational Plan

A. Environment

CLIENTS

HCA’s broad range of programs impacts the entire

County population, as well as the many tourists

and business travelers who visit Orange County

each year. While also providing direct services to

individual clients or patients in need, the Agency’s

primary focus is to protect and promote the health

and safety of the community as a whole.

HCA’s programs and services can be broadly

divided into three major types: services for the

community at large, prevention services for at-risk

individuals and intervention/treatment services to

those in need of care. A subcategory of the latter

consists of treatment services to persons residing

in County correctional facilities or other institutions.

Additional information regarding caseload data is

located in Appendix C.

Services for the Community

Many of the Agency’s programs provide services

for the community at large. These services include

ocean recreational water protection, food sanitation,

hazardous waste management, animal care

services, response and recovery from natural or

man-made disasters and control of communicable

disease. Also, the Agency maintains a continuing

emphasis on advocating safe and healthy lifestyles,

with many efforts centered on prevention, disease

management and health education efforts.

Preventive Services for At-Risk Individuals

Preventive services for at-risk individuals include

substance abuse and mental health services for

adults and children, prevention services for prenatal

substance exposure and perinatal HIV infection

for at-risk pregnant women, and initiatives to

increase access to healthcare services for children

and families. Several Agency programs currently

provide services designed to identify and protect

individuals who are at risk of developing health

problems, both acute and chronic. These services

include in-home and senior center assessments,

neighborhood well-child and maternal health

clinics, immunizations, nutrition counseling, and

food vouchers.

Intervention/Treatment Services for Individuals

HCA programs also provide services designed to

prevent individuals from progressing to more serious

health problems. These services include behavioral

health services for individuals with serious mental,

emotional disturbances and/or substance abuse

problems, and prevention services for those who

may pose a threat to themselves or to others

in the community. The Preventive Health Care

for the Aging Program and other senior services

promote healthy lifestyles, and increase access to

health care to improve the quality of life of Orange

County’s over-55 population. The Medical Services

Initiative provides for the care of eligible medically

indigent adults who have no other source of medical

care. Other programs provide support services for

persons with HIV or AIDS, and provide medical and

other therapeutic services for disabled children.

Emergency dental services are also available for

low-income persons.

Treatment Services in Institutional Settings

HCA is responsible for medical, dental, and

behavioral health services to adults in the County’s

correctional facilities, and minors in juvenile

institutions/camps, or Orangewood Children’s

Home. In fulﬁ lling these responsibilities, HCA

supports the Sheriff-Coroner, the Probation

Department and the Social Services Agency.

Health Care Agency Business Plan — Operational Plan 9

Changing Demographics

HCA continues to plan for the future in light of our

changing population. For example, as the number

of senior citizens increases, the number of County

residents with chronic diseases that contribute

to death and disability will likely increase as well.

As the size of the teenage population grows, the

number of County residents prone to health risk

behaviors (e.g., alcohol, tobacco, poor diet and

insufﬁ cient exercise) will also grow. The number

of at-risk individuals requiring prevention services,

such as low-income families, the elderly and

children, are likely to increase. Individuals requiring

medical and/or behavioral health intervention and

treatment services will inevitably increase.

CHALLENGES

The environment in which the Health Care Agency

operates continues to be quite demanding and

unpredictable. Consistent with recent history,

the major challenge anticipated in FY 2007-08 is

ﬁ nancial – speciﬁ cally, the challenge of continuing

to provide essential services with limited resources.

Other challenges, however, also remain. A summary

of major challenges for FY 2007-08 include:

Financial

• HCA, along with all County agencies and

departments, has again had to absorb

signiﬁ cant increases in the basic “cost of

doing business” – unavoidable increases in

salaries, retirement, medical insurance, and

other expenses – in building the budget. At

the same time, most program revenues and

available County General Fund revenues

have increased very little. An exception to this

is increased funding for the Coverage Initiative

which provides new and enhanced indigent

health care services.

• Realignment funding, which is HCA’s largest

single revenue source, remains a major

issue. Realignment funding is made up of two

components – sales taxes and vehicle license

fees (VLF), both of which tend to increase and

decrease depending on the State’s economy.

Realignment funds have not kept pace with

program costs, and this discrepancy will likely

remain for the foreseeable future.

• Additionally, Orange County is under equity, in

comparison to other counties, in Realignment

revenue. The outdated funding formulas

that the State uses to distribute these funds

do not reﬂ ect the true need for services in

Orange County. HCA receives funding for

Mental Health Services through the passage

of Proposition 63, which helps mitigate the

funding disparity; however, this funding cannot

be used to supplant existing programs and

services.

• The State’s ongoing structural deﬁ cit continues

to result in budgetary uncertainty for the

Agency and the County.

• Both the Governor and Legislative Leaders

have proposed extensive health reform

packages. If either of these two plans is

enacted it will have major ramiﬁ cations in

terms of costs. If the Governor’s plan goes

through as proposed, all counties in California

will have to contribute funding to equal $1

billion.

• The entire Statewide allocation of $55 million

($1.1 million for Orange County) for Services

for Integrated Homeless Mentally Ill (AB 2034)

has been eliminated in the State’s adopted

FY 2007-08 budget. The program targets

a broad range of the population including

adults, transitional age youth, veterans, older

adults and women with children who are

homeless or at risk of homelessness and who

are chronically and persistently mentally ill.

Mental Health Services Act funding has been

provided as a one-time ﬁ x for counties; a long-

term solution has not been identiﬁ ed.

10 Health Care Agency Business Plan — Operational Plan

• For FY 2007-08, Orange County will receive

approximately $8.3 million for both Proposition

36 (Substance Abuse Crime Prevention Act,

SACPA) and the Offender Treatment Program

(OTP). This allocation funds treatment,

probation, court monitoring, vocational

training, and certain other costs for non-violent

drug abusers. The number of eligible Orange

County participants, the severity of addiction,

and the extent of their criminal history have

all consistently exceeded initial expectations;

consequently annual funding has fallen short

of requirements.

• The voter approval of Proposition 1A in 2004

on local government ﬁ nancing will provide an

increased degree of ﬁ scal stability for HCA.

This ballot measure afﬁ rms the utilization

of a dedicated share of Vehicle License

Fee Revenue to fund health, mental health

and social services programs that were

realigned from the State to counties in 1991.

In addition, the measure requires the State

to fund mandated programs or to repeal the

mandate.

Workforce

• The Agency continues to experience

difﬁ culties in hiring qualiﬁ ed staff, especially

for jobs that require speciﬁ c certiﬁ cation or

expertise. Examples include nurses, of which

there is a nationwide shortage, physician

specialists, and public health microbiologists.

Recent salary adjustments should enhance

our ability to recruit for these positions.

• Another continuing workforce challenge

is the ability to respond to the changing

social and demographic factors that affect

Agency services. The expected growth

in both adolescents and older adults and

the increase in Hispanic and Asian Paciﬁ c

Islander populations require working with

the local educational system, recruiting for

professionals, and increasing the number of

culturally-competent workers attending and

graduating from college.

• The Agency continues to focus on workforce

training in collaboration with Central Human

Resources, local colleges and universities.

In addition, the Agency has a well-developed

Cultural Competency program to provide

assistance to staff in the effective delivery of

services to all clients.

Regulatory

Compliance with the Federal Health Insurance

Portability and Accountability Act (HIPAA) continues

to be a challenge for HCA and the County, ﬁ nancially

and organizationally, and will be for several more

years. These regulations impose sweeping, system-

wide changes to health care industry standards for

the storage, transmission and processing of health

care information. Federally imposed deadlines for

compliance with HIPAA standards began in 2003

and will continue through at least 2010. These

activities require continual review and modiﬁ cation

of policies and procedures, on-going workforce

training, technological upgrades, and data systems

modiﬁ cations as well as auditing and monitoring for

compliance.

Overcoming Challenges

The Agency continues its practice of carefully

monitoring expenditures and revenues and the

deployment of resources, advocating for additional

outside funding, and optimizing efﬁ ciency and

effectiveness, as follows:

• The passage of Proposition 63, the Mental

Health Services Act, resulted in signiﬁ cant new

funds for mental health programs in Orange

County. None of these funds can be used

to support existing programs by supplanting

current funding levels. However, it will expand

and enhance adult, older adult, and children’s

mental health services in the community. The

estimated FY 2007-08 revenue for Community

Services and Support is $36 million. In future

years, HCA will also receive new MHSA

funds for workforce education and training,

community services and support, prevention

and early intervention, and for capital and

technology improvements.

• Advocating for legislation and pursuing grant

opportunities to increase non-County funding

for existing and new programs, in coordination

with the County Executive Ofﬁ ce.

• Reviewing fees and other revenues on a

regularly scheduled basis to ensure full cost

recovery for Agency programs.

• Continuing to work with our many community

partners, through formal and informal

mechanisms, to best meet the needs of the

citizens of Orange County.

Health Care Agency Business Plan — Operational Plan 11

State -

Realignment

31%

County

16%

Fees

17%

Federal

State -

Other

29%

FY 2007-08 Funding

Private Sector

Services

48%

Purchase

Goods/

Equip.

11%

Employee Costs

41%

FY 2007-08 Budgeted Expenditures

• Continuing a focus on staff training and

development, succession planning,

appropriate contracting for support services,

and optimizing the organizational structure.

Additionally, the implementation of new

technologies such as the Cerner Lab Module,

the enterprise-wide clinical information system

and other management information systems,

will support revenue generation and meet

compliance objectives, including HIPAA.

RESOURCES

HCA’s adopted budget for Fiscal Year 2007-08 is

$568 million in net expenditures, including $246

million for Behavioral Health Services, $160 million

for Public Health Services, $156 million for Medical

and Institutional Health Service. There are 2,775

budgeted positions, numerous community-based

contractors and approximately 200 different funding

sources. HCA currently operates under 200 State

and Federal mandates. State and Federal funding

allocations and locally generated fees account

for 84 percent of Agency funding; County general

funding comprises the remaining 16 percent. Private

sector service contracts make up almost one-half

of the Agency budget. HCA’s largest single revenue

source is known as State Realignment Funding,

and accounts for 31 percent of Agency funding.

Realignment was established in 1991 by the State

Legislature as an independent funding source for

County health, mental health and social services

programs. Funds are derived from Statewide sales

taxes and vehicle license fees, and are apportioned

by formula to counties and certain cities.

Other major sources of Agency revenue include:

Medi-Cal, Mental Health Services Act (Proposition

63), Substance Abuse Block Grant, Tobacco

Settlement Revenue, AB 3632 (Specialized

Children’s Mental Health), and fees for services.

12 Health Care Agency Business Plan — Operational Plan

Percentage of OC Teens and Adults

Overweight/Obese

(2003 and 2005)

12-19 Years 20+ Years

2003 2005

Percentage

Age

Percentage of Low Income

Children Overweight or Obese (PedNSS)

0-4 Years 5-19 Years

2002

2003

2004

2005

2006

Percentage

Age

B. Action Plan

Strategic Goals, Strategies to Accomplish Goals, Performance Measures

HCA’s strategic goals and performance indicators describe how the Agency will achieve our Vision and Mission and deliver

efﬁ cient and effective core services to the community. The criteria for identifying these selected performance indicators

focused on being consistent with the Agency Strategic Goals, anticipated new funding or service mandates, and made a

realistic assessment of available resources.

GOAL #1: Prevent Disease and Disability and Promote Healthy Lifestyles

Strategies to meet Goal #1:

• Reduce the prevalence of overweight/obese residents.

• Reduce the incidence/prevalence of communicable diseases such as Tuberculosis and Chlamydia.

• Improve capacity for disease detection, surveillance, investigation, and control.

• Increase community and in-custody health education and training.

• Increase coordination with primary care to reduce impact of chronic illnesses and infectious diseases.

PERFORMANCE MEASURE: Overweight/Obese Residents

What: Reduce the prevalence of overweight/obese residents.

Why: Overweight and obesity are major contributors to many preventable causes of death and chronic

diseases.

FY 06-07 Results FY 07-08 Plan FY 07-08 Anticipated Results FY 08-09 Plan

In 2005, 11% of teens and

51% of adults (20+ years) were

overweight or obese.

In 2006, 14% of low income

0-4 years old and 21% of 5-19

years old were overweight or

obese.

Increase Public Health

and community capacity to

promote physical activity

through development of a

comprehensive tool kit binder

and distribution of this binder to

at least 50 planners of “Walk to

School Day.”

Additionally, staff in Public

Health’s Family Health Division

and Public Health Nursing

Division routinely provide

obesity messages related to

breastfeeding, healthy eating,

and physical activity at well over

150,000 encounters with the

public each year.

“Walk to School Day” toolkits

have been created and 98

toolkits have been distributed.

As a result of the toolkits, 72

schools report conducting

“Walk to School Day” and using

components of the tool kit.

Have provided assistance on

joint use agreements between

Santa Ana Uniﬁ ed School

District in collaboration with

Latino Health Access, which

allow schools to be open for

play space.

Increase community capacity

to promote physical activity

through distribution of at least

50 comprehensive tool kits to

planners of “Walk to School

Day” in Orange County.

Continue providing obesity

messages related to

breastfeeding, healthy eating,

and physical activity to

residents served by the Family

Health Division and Public

Health Nursing Division.

How are we doing?

The prevalence of teens who were overweight or obese decreased by 1% and the prevalence of adults (20+ years) who were

overweight or obese remained unchanged (left graph). In 2006, the prevalence of overweight or obese low-income children 0-4 and 5-

19 years showed a decline for the ﬁ rst time since 2002 (right graph).

Health Care Agency Business Plan — Operational Plan 13

PERFORMANCE MEASURE: Communicable Disease: Tuberculosis and Chlamydia

What: Reduce the incidence/prevalence of communicable diseases such as Tuberculosis and

Chlamydia.

Why: Tuberculosis (TB) is a chronic bacterial infection and a serious public health concern because

persons with infectious TB lung disease can spread the infection to others. Chlamydia infections

are asymptomatic, going undiagnosed by clinicians, and therefore untreated. Untreated

Chlamydia infection can result in pelvic inﬂ ammatory disease which is a leading cause of

preventable infertility in the U.S. Chlamydia may also contribute substantially to the spread of

heterosexually acquired HIV infection by making persons more prone to infection.

FY 06-07 Results FY 07-08 Plan FY 07-08 Anticipated Results FY 08-09 Plan

Orange County reported

226 cases of TB and 7,948

Chlamydia cases in calendar

year 2006.

Develop and implement an

electronic disease reporting

system to improve capacity

for disease detection,

surveillance, investigation and

control.

Develop digital x-ray

screening program and

improve screening rate for

tuberculosis within adult

correctional facilities.

Coordinate with primary care

providers to reduce impact

of chronic and infectious

diseases.

Orange County reported

217 TB cases in calendar

year 2007, a 4% decrease

from 2006. Chlamydia cases

increased to 8,330 in calendar

year 2007.

Continue implementation

of an electronic disease

reporting system to improve

capacity for disease

detection, surveillance,

investigation and control

by integrating the use of a

laboratory reporting module.

How are we doing?

The rate of new TB cases continues a downward trend – speciﬁ cally a decrease of 4% from the 226 cases reported in 2006 to 217

cases reported in 2007. There has been an overall trend of declining cases over the past 10 years.

The number of reported Chlamydia cases has nearly tripled, from 2,693 cases in 1996 to a high of 8,330 cases in 2007. On average,

there has been a 17% annual increase over the past 10 years. The increase in Chlamydia cases have been, in-part, due to increased

reporting efforts and not due to increased incidence of disease. Similar increases are also evident at state and national levels due to

increased awareness and wider availability of improved, non-invasive testing.

14 Health Care Agency Business Plan — Operational Plan

GOAL #2: Promote and Ensure a Healthful Environment

Strategies to meet Goal #2:

• Ensure that Orange County is well-prepared and equipped to respond to an emergency, disaster, or other

hazard.

• Reduce the number of beach mile day closures due to sewage spills.

• Reduce the incidence of conﬁ rmed foodborne illness cases and the number of violations that are likely to

contribute to foodborne illness.

PERFORMANCE MEASURE: Disaster Preparedness

What: Ensure that Orange County is well-prepared and equipped to respond to an emergency, disaster, or

other hazard.

Why: To reduce mortality and morbidity that could result from natural or man-made disasters.

FY 06-07 Results FY 07-08 Plan FY 07-08 Anticipated Results FY 08-09 Plan

The annual Centers for Disease

Control and Prevention (CDC)

assessment resulted in overall

rating of AMBER meaning some

areas of preparedness needed

improvement. [Rating scale:

Red-unprepared, Amber–

improvement needed, Green

– prepared].

Orange County Medical

Reserve Corps (OC MRC)

started recruiting volunteers

in May 2005. By July 2006

186 volunteers were recruited.

The OC MRC enhances the

emergency preparedness and

response capabilities of Orange

County by establishing teams

of local volunteer medical and

public health professionals

to contribute their skills and

expertise throughout the year

as well as during times of

community need.

Conduct 15 exercises with

interagency and community

partners. Emergency

preparedness exercises move

the agency towards better

emergency preparedness. The

exercises provide insight into

what does and does not work

for each response agency by

testing the implementation

of emergency management

procedures and protocols, ﬁ ne-

tuning the internal coordination

of the emergency plan, and

practicing coordinating with

external response sectors.

Increase the number of

registered Orange County

Medical Reserve Corps

volunteers to 500. The focus in

FY 07-08 is on pharmacists and

veterinarians.

A total of 6 exercises have been

completed to date.

As of January 2008, OC MRC

has a total of 500 medical and

non medical volunteers enlisted

into the Medical Reserve Corps.

Participate in 15 exercises, to

meet grant deliverables and

support the OC Operational

Area (OA), including GOLDEN

GUARDIAN, California’s annual

statewide Homeland Security

exercise.

Sustain the current number of

OC MRC volunteers and add

an additional 300 volunteers

to increase the number of

registered Orange County

Medical Reserve Corps

volunteers from 500 to 800.

Public Health Lab will

participate in continued

Inﬂ uenza-Like-Illness

surveillance program, in

collaboration with Epidemiology

and Assessment, by testing

an average annual amount

of 150 samples with a 4-day

turnaround time.

How are we doing?

Due to the change in the CDC’s rating system, it will not be possible to compare measures. Although the FY 07-08 results are not yet

available, CDC’s verbal overview indicates that HCA met most of the objectives.

Health Disaster Management (HDM) and other HCA units have completed 6 exercises and participated in coordinating over a dozen

training exercises with local, state, and federal stakeholders. HCA staff were also activated in response to the 2007 Santiago wildﬁ re.

Health Care Agency Business Plan — Operational Plan 15

Ocean Water Quality

Days of Closure

(2000 - 2007)

FY00-01 FY01-02 FY02-03 FY03-04 FY04-05 FY05-06 FY06-07

Beach Mile Days

Water Closures

Days of Closure

Fiscal Year

PERFORMANCE MEASURE: Ocean and Recreational Water Quality

What: Reduce the number of Beach Mile Days (BMDs) closures due to sewage spill contamination. BMDs

of closure are calculated by multiplying the number of days of closure by the number of miles of

beach closed.

Why: To reduce and eliminate environmental threats to community health that are associated with unsafe

ocean and recreational water.

FY 06-07 Results FY 07-08 Plan FY 07-08 Anticipated Results FY 08-09 Plan

3.07 Beach Mile Days (BMDs)

and 15 closures for FY06-07.

Conduct fats, oils and grease

(FOG) inspections at food

facilities within 15 cities that

have an agreement with

the OC Sanitation District

and Environmental Health.

Inspections assist with reducing

amounts of FOG disposed of

in sewage system. FOG can

contribute to sewage blockages

and subsequent sewage spills.

From 7/01/07 to 10/01/07,

741 FOG inspections were

conducted.

From 7/01/07 to 10/19/07, 2

out of 6 sewage closures were

known to be caused by grease

blockages.

Continue to conduct FOG

inspections at speciﬁ ed food

facilities to assist with reducing

the amount of fats, oils and

grease disposed of in the

sewage system.

How are we doing?

The number of BMDs in 2006-07 was the lowest since the inception of this measure as a primary outcome indicator.

Beaches and bay areas were closed for use only 0.008% of the available time.

16 Health Care Agency Business Plan — Operational Plan

PERFORMANCE MEASURE: Food Safety

What: Reduce the incidence of conﬁ rmed foodborne illness cases and the number of foodborne illness

complaints received, and reduce the number of major violations that are identiﬁ ed as those most

likely to contribute to foodborne illness.

Why: Foodborne illness imposes a burden on public health and contributes signiﬁ cantly to the cost of

health care.

FY 06-07 Results FY 07-08 Plan FY 07-08 Anticipated Results FY 08-09 Plan

Foodborne illness rates are

approximately 24 out of 100,000

population in 2006.

575 complaints received in

2006.

The violation rate increased

slightly to 63% compared to the

previous year.

Implement food worker

education to increase

awareness and compliance with

food safety practices.

Distribute a quiz to food workers

to determine the awareness

level of food safety practices.

Also, assess compliance

with regulations by using the

Environmental Health database

to evaluate the number of

violations at retail food facilities.

More than 70 quizzes were

distributed at food safety

trainings.

From 7/01/07 to 10/01/07, 5,471

major violations at retail food

facilities were issued.

Continue food worker education

program. Food safety quizzes

will continue to be distributed at

food worker trainings. Number

of violations will continue to be

tracked.

In addition, there will be a

self audit program, available

on-site to food facilities, to

offer guidance and instruction

on food safety practices and

regulations.

How are we doing?

The rate of foodborne illness cases reported to HCA’s Reportable Diseases has systematically decreased by 56% over the past nine

years. The number of foodborne illness complaints has averaged about 590 a year over the past ﬁ ve years. The increase in violations

and violation rate can be due to a number of factors, including a heightened focus on risk factors, an increase in the number of retail

facilities throughout the County, and an increase in stafﬁ ng levels.

Selected OC Foodborne Illness Rate (1996-2006)

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Rate Per 100,000 Population

Number of Complaints Recieved by

Environmental Health’s Food Protection Program

2002 2003 2004 2005 2006

Number of Complaints Recieved

700

600

500

400

300

200

100

Major Food Safety Violation by Year

2004 2005 2006

Count

30000

25000

20000

15000

10000

5000

No Major Violations

Major Violations

Health Care Agency Business Plan — Operational Plan 17

Total Enrollments in Government and Privately-Funded

Health Insurance Programs in Orange County

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Number of Children

Year

300k

250k

200k

150k

100k

50k

To ta l

Medi-Cal

Healthy Families

Child Health Plan

California Kids

Health Insurance Coverage

In Orange County Children

CHIS

Survey

Results

2001 2003 2005

Number

and

Percentage

of OC

Children

Insured

700,000

(90.3%)

713,000

(90.4%)

741,000

(91.8%)

Number

and

Percentage

of OC

Children

Uninsured

76,000

(9.7%)

75,000

(9.6%)

66,000

(8.2%)

GOAL #3: Assure Access to Quality Healthcare Services

Strategies to meet Goal #3:

• Reduce the number of children without health insurance.

• Increase the number of children with publicly-funded health insurance such as Medi-Cal and Healthy Families.

• Improve the behavioral health level of adults and children receiving mental health and substance abuse treatment

services.

• Increase designated mental health beds for inmates.

• Facilitate access to available health care services through Public Health Nursing, outreach, health access

coordinators, and care managers and/or social workers.

PERFORMANCE MEASURE: Healthcare Access for Children

What: Reduce the number of children without health insurance.

Why: Individuals who are insured are more likely to receive preventive services and health care when

needed, resulting in improved health outcomes.

FY 06-07 Results FY 07-08 Plan FY 07-08 Anticipated Results FY 08-09 Plan

In 2005, 8.2% (or 66,000) OC

Children were uninsured.

To screen 100% of clients seen

in the Public Health pediatric

immunization, children’s

medical, and WIC clinics at the

17th Street, Santa Ana clinic,

for health insurance status and

assist those without health

insurance to apply for health

insurance and ultimately access

health care.

Maintain or increase the number

of children covered by health

insurance.

Between March 1, 2006 and

November 30, 2007, 7,598

children, screened to have no

insurance, were assisted with

applications; 4,131 have been

approved (54% approval rate),

with the others pending. Of

those that were approved, 1,585

have actually accessed health

care through their new medical

homes.

Continue to screen 100%

of clients seen in the Public

Health pediatric immunization,

children’s medical, and WIC

clinics at the 17th Street, Santa

Ana clinic, for health insurance

status and assist those without

health insurance to apply

and ultimately access health

care. In addition, efforts will be

integrated and expanded to the

new Buena Park clinic site.

Anticipate increasing the current

overall number of people

screened and referred for health

insurance application by 3,500

children.

How are we doing?

The number of uninsured children has systematically declined since 2001. However, the number of children enrolled in public- and

privately-funded health insurance has leveled off which may result in an increase of uninsured.

Screening children for health insurance at the Santa Ana Clinic and helping those without health insurance to apply for health insurance

has increased the number of children with health insurance. 7,598 children received application assistance at Public Health Clinics and

over 50% were approved for health insurance programs including Medi-Cal, Healthy Families, Kaiser, Child Health Plan and Cal Kids.

18 Health Care Agency Business Plan — Operational Plan

PERFORMANCE MEASURE: Behavioral Health Level of Functioning

What: Improve the behavioral health level of functioning of adults and children receiving mental health

and substance abuse treatment services.

Why: Mental disorders and substance abuse are the leading causes of disability, as measured by years

of lost productivity. Mental illness can affect persons of any age, race, religion or socioeconomic

status, and is treatable through pharmacological and psychosocial treatment supports.

FY 06-07 Results FY 07-08 Plan FY 07-08 Anticipated Results FY 08-09 Plan

Children – As shown in the

graph below, the number of

children requiring intensive

services such as psych-

hospitalization continues to

be reduced through the use of

innovative and less restrictive

treatment alternatives such

as Therapeutic Behavioral

Services (TBS) and

Wraparound Services.

Adults – Psychosocial

assessments were administered

to 5,684 (62%) of HCA clients

at intake (CESI). Clients scored

above national norms. Most

notably, during treatment/at

discharge, 75% or more of

HCA clients scored at or above

the national average for social

support and counseling rapport.

Children - TBS has increased

enrollment 42% in the last year

and will seek to serve 619

children this FY. Wraparound

services, which enrolled 572

families in the ﬁ rst four years,

will provide services to an

estimated 520 youth in FY07-

08.

352 psychological

hospitalizations are projected,

a decline of about 5%. Day

treatment admissions are

projected to remain level at

about 25.

Adults – Increase the

number/percentage of adults

who receive CESI intake

assessments. Maintain

psychosocial scores at or above

national norms.

Children - As of December 2007

enrollment was 338 in TBS and

373 in Wraparound.

Midway through FY07-08,

the number of psychiatric

hospitalization and day

treatment admissions are 162

and 19, respectively.

Adults – As of Dec. 07, 3,712

(79%) HCA clients had received

CESI intake assessments.

Psychosocial scores during

treatment/at discharge were

above national norms. Most

notably, during treatment/at

discharge, 75% or more of

HCA clients scored at or above

the national average for peer

support, social support, and

counseling rapport.

Children - Expand behavioral

health services to the North

and West Justice Centers by

providing assessment and

referral services to children and

families experiencing domestic

violence.

Continue to reduce the number

of psych hospital admissions

required.

Adults – Increase/maintain

the number/percentage of

adults who receive CESI

intake assessments. Maintain

psychosocial scores at or above

national norms.

A Wellness and Recovery

Center will be implemented. The

Center will provide persons with

chronic mental illness a client

centered location to receive

education, training, employment

and supportive services.

How are we doing?

Children – Psychosocial functioning has improved as indicated by the reductions in the number of seriously emotionally disturbed

children and adolescents requiring intensive and costly mental health services. Severely emotionally and behaviorally disturbed children

served by the Children and Youth Services (CYS) division are frequently at risk for hospitalization, out of home placement, or require

intensive day treatment services.

Adults – The proportion of clients receiving psychosocial assessments at intake is increasing. Additionally, clients’ level of motivation,

rapport with counselors, participation in treatment, peer support, and social support during treatment/at discharge were found to be

better than national norms.

Scores

ADAS Client Psychosocial Scores At Follow-Up

Compared with National Norms (FY06-07)

Health Care Agency Business Plan — Operational Plan 19

GOAL #4: Recommend/Implement Health Policy and Services based on Assessment of Community Health Needs

Strategies to meet Goal #4:

• Build a comprehensive database or clearinghouse of County health indicators data.

• Collaborate with community partners on behavioral health issues, including Mental Health Services Act

planning.

• Work with community partners to promote public policy alternatives for a smoke-free environment.

PERFORMANCE MEASURE: Assessment of Community Health Needs

What: Assessment of health indicators and best practices to ensure community health needs and policies

are met.

Why: To reduce mortality and morbidity that could result from gaps in the safety net.

FY 06-07 Results FY 07-08 Plan FY 07-08 Anticipated Results FY 08-09 Plan

Partnered in the tri-annual

Orange County Health Needs

Assessment – 2007.

Contributed to the 12th Annual

Conditions of Children Report.

Continue to collaborate

with community partners on

assessing community needs.

Conduct MHSA Prevention and

Early Intervention Community

and Organizational Needs

Assessment Surveys.

Complete Substance Exposed

Baby Study and 13th Conditions

of Children reports.

Assess the results of the 2007

Orange County Health Needs

Assessment (OCHNA) and

2007 California Health Interview

Survey (CHIS) data once it

becomes available in 2008.

Conduct the Prevention and

Early Intervention Assessments

for MHSA Initiative.

How are we doing?

HCA epidemiology, research and planning staff are actively analyzing and assessing health indicator data to support various health

needs assessment initiatives and studies.

HCA also has two internal Business Strategy Goals

Goal #5 – (Business Strategy #1)

Encourage Excellence by Ensuring a Healthy Work Environment that Values

Employees

Strategies to meet Goal #5 (Business Strategy #1):

• Maintain a qualiﬁ ed workforce through staff development, training, education, recruitment and retention.

• Plan for upgrading and replacing facilities based upon current and future service delivery and business

processes.

• Ensure staff has equipment and training to perform job duties in a safe manner.

PERFORMANCE MEASURE: Maintain a qualiﬁ ed workforce.

What: Provide leadership development, training and education to workforce.

Why: To prepare HCA’s next generation of leaders.

20 Health Care Agency Business Plan — Operational Plan

FY 06-07 Results FY 07-08 Plan FY 07-08 Anticipated Results FY 08-09 Plan

The Leadership Development

Program* was launched in

calendar year 2007 and courses

began in February 2007.

By the end of December 2007,

enroll at least 5% of the Health

care Agency’s 2,569 employees

(includes regular and limited

term employees who have

passed new employee

probation) in the Leadership

Development Program.

As of December 2007, the

program exceeded expectations

with 297 or 11.6% of HCA staff

participating. There were 202

employees enrolled in Level I

and 95 employees enrolled in

Level II. First graduating class

in January 2008, will have 42

Level I graduates and 1 Level II

graduate.

Maintain participation level of

10% of entire HCA workforce

in the Leadership Development

Program.

How Are We Doing?

The Leadership Development Program enrollment exceeded expectations. 71% of Level I graduates (not yet supervisors or managers)

have identiﬁ ed a project to lead or a lead role in current assignment to be eligible to attend the Advanced Level II courses. 10.7% (32

participants at both Level I & II combined) were promoted, either temporarily or permanently, during 2007.

Goal #6 – (Business Strategy #2)

Support the Workforce through the Effective Use of Technological and Other

Resources

Strategies to meet Goal #6 (Business Strategy #2):

• Improve abilities of support service departments to respond to program needs.

PERFORMANCE MEASURE: Improve abilities of support service departments to respond to program needs.

What: Provide necessary technological support to internal programs.

Why: To provide internal support to programs so that they can effectively provide core services to the

community.

FY 06-07 Results FY 07-08 Plan FY 07-08 Anticipated Results FY 08-09 Plan

Information Technology’s

Voice Over IP technology is

being utilized and tested in

HCA’s Bioterrorism unit.

Human Resources will

develop NEOGOV, the on-line

hiring center, to include an

automated Request to Fill

(RTF) process.

Implement the IRIS (Cerner)

Enterprise Data System. The

system will greatly streamline

patient registration and the

tracking of laboratory results

ordered at the various Public

Health Clinics.

NEOGOV is being completed

ahead of schedule. Project

pilot rolled out Feb-07 to

one service area, followed

by three additional areas by

November-07. Completion

date of Jan-08.

IRIS (Cerner) Enterprise Data

System was successfully

tested and the rollout to

Public Health was initiated.

The role of IRIS (Cerner) in

Public Health was completed

in December of 2007.

All Divisions/programs will

be utilizing the automated

Request to Fill (RTF) process.

The priority for the IRIS team

is to implement Scheduling

for BHS as well as continuing

to expand on the work done

in PHS in FY 07/08. By the

end of 2008, 50 locations will

be live with the Scheduling

application.

Also, using Cerner’s Power

Forms solution, Pulmonary

Disease plans to build a

Client Visit Record and Public

Health Nursing plans to build

a Targeted Case Management

documentation.

How Are We Doing?

HCA continues to meet technological needs of the agency through automation and adoption of proven technologies through the use of

NEOGOV and IRIS (Cerner) Enterprise Data System.

*This program contains 3 developmental levels. Level I is open to all employees and contains 8 core courses geared toward foundational

skills and competencies. Level II is open to supervisors and managers and Level I graduates who have identiﬁ ed a project or leadership

role they will assume during the program. Level II consists of 18 advanced courses in leadership skills and competencies. Finally, Level

III, considered the mastery level, consists of 8 core courses and will be offered to managers and supervisors who have completed Level II

core courses.

Health Care Agency Business Plan — Appendix A 21

Appendix A

HEALTH CARE AGENCY 2008 ORGANIZATIONAL CHART

Health Care Agency

2008 Organizational Chart

Approved

Office of Compliance*

Assistant Director

Behavioral Health Services

Behavioral Health Operations

Chief

Behavioral Health Operations

Medical Director

Quality Improvement

& Program Compliance

Alcohol & Drug Abuse

Services

AMHS-Inpatient/Residential

AMHS-Outpatient/Crisis

Children & Youth Services

Financial/Administrative Svcs.

Central Operations

Contract Development/

Management

Financial/Program

Support Services

Human Resources

Information Technology

IRIS Project

HCA Accounting**

Medical & Institutional

Health Services

Medical & Institutional

Health Operations

Institutional Health Services

* Dual reporting relationship to Internal Audit

** Dual reporting relationship to Auditor-Controlller

Revised 02/27/08

Health Disaster Management

Medical Services Initiative

Public Health Services

Animal Care Services

Environmental Health Svcs.

Public Health Operations

Chief

California Children’s

Services

Disease Control

& Epidemiology

Family Health

Health Promotion

Public Health Laboratory

Public Health Nursing

Public Health Services

Health Officer

Public Health Operations

Chief Medical Officer

Infection Control

Pharmacist

Quality Improvement

and Compliance

Office of Quality Management

Municipal/Community Relations

Health Care Agency Director

22 Health Care Agency Business Plan — Appendix B

Appendix B

SIGNIFICANT ACCOMPLISHMENTS

The Health Care Agency’s 2007 Business Plan contained four Goals, two Business Strategies and 44

Performance Indicators. Most of the Performance Indicators were accomplished or partially accomplished

except for three, which were placed on hold or cancelled due to changes in circumstances. The following is

a summary of the signiﬁ cant accomplishments completed in support of the 2007 goals and core services.

1. In response to the 2007 Santiago Canyon wildﬁ re

incident, approximately 250 Health Care Agency

staff responded to the disaster in collaboration with

other local, state and federal agencies. Staff actively

monitored and reacted to county-wide health and

emergency resource requests and worked through

the County Operational Area Emergency Operations

Center (EOC) to provide mutual aid to San Diego

County. Below is a summary of the support efforts

and resources that were provided:

• Health Disaster Management – provided

assessment and coordination of resources and

provided timely health care and critical information

to the community.

• Emergency Medical Services – continuously staffed

the County Operational Area Emergency Operations

Center at Loma Ridge and the Emergency Medical

Services Department Operations Center.

• Public Health Services – Public Health Nurses were

deployed to both El Toro and El Modena shelters

to provide assessment and triage in coordination

with the American Red Cross. Epidemiology staff

explored possibilities for monitoring illness at

shelters and evaluated reports of illness.

• Behavioral Health Services – Mental health staff

responded to the needs of victims in the immediate

aftermath at evacuation shelters, in the ﬁ eld and at

Local Assistance Centers and continued providing

assistance to the community during the recovery

period.

• Animal Care Services – provided shelter and

food for evacuees’ pets at the Red Cross shelters

and the Animal Care Center. Field Ofﬁ cers helped

evacuees and their animals. They also responded to

loose pets and pets left behind in evacuated areas.

• Environmental Health Services – Food protection

staff visited shelters and provided education to

ensure food safety. Hazardous Materials staff

coordinated with state representatives to ensure

that ﬁ re debris and hazardous waste were properly

handled during the recovery. Water Quality staff

monitored area water systems to ensure delivery

systems were not damaged by the ﬁ re.

• Public Information and Communications – served

on the Public Information team at the Emergency

Operations Center and issued Agency press

releases on public health concerns including air

quality, food handling and clean-up of ﬁ re debris.

• Planning and Research – staff provided

Geographic Information Systems (GIS) maps and

data regarding existing resources as part of the

mutual aid response to San Diego County.

2. Public Health Services and Medical Services

Initiative continues to increase access to health

care for Orange County residents.

• Family Health increased the number of people

receiving health insurance. As of November 30,

2007, 7,598 children have received application

assistance and over 50% have been approved for

health insurance programs, including Medi-Cal,

Healthy Families, Kaiser and Cal Kids. Referrals

to application assistors are received from Public

Health Pediatric Immunization, Children’s Medical,

Children’s Dental and WIC clinics at the 17th Street,

Santa Ana clinic site.

• The Medical Services Initiative Program

expanded the number of persons eligible for health

care services through the use of incentives for

community clinics to enroll eligible persons. Since

implementing the community clinic incentives, the

number of new applications taken is 1,835 and

the number of renewal applications taken is 2,135.

New applications now average 200 per month and

renewal applications average 380.

3. Behavioral Health Services, Mental Health

Services Act (MHSA) - The implementation of

Proposition 63, the Mental Health Services Act, is

improving and expanding mental health services for

adults, older adults and children in accordance with

the initiative.

• Developed and implemented in-service training

to advance the goals of developing cultural

competence. A total of 3,289 persons were trained

in FY 2006-2007 and 2,950 persons during the ﬁ rst

ﬁ ve months of FY 2007-2008. Trainings were on

28 different topics, covering eight different general

categories, as speciﬁ ed in the county MHSA plan.

• All but one of the 16 programs included in the

original three-year Community Services and

Supports (CSS) Plan has or will be implemented by

December 2007.

• The CSS Growth Funding Plan for $9.3 million was

approved by the Department of Mental Health in

July. It includes expansion of four existing programs

(Children’s and Transitional Age Youth Full Service/

Health Care Agency Business Plan — Appendix B 23

Wraparound Programs and two programs for Older

Adults – OASIS and Mental Health Recovery

Services.)

• The CSS Growth Funding Plan also included four

new programs: Mentoring for Children, Mentoring

for Transitional Age Youth, Program of Assertive

Community Treatment (PACT) and the Consumer-

run Wellness/Recovery Center.

• Between the time that the original CSS Plan was

approved in April 2006 and the end of September

2007, MHSA funds have provided many services to

our target populations. These include:

• 384 Children and Transitional Age Youth (TAY)

enrolled in Full Service Partnerships (FSP’s)

• 410 Adults and Older Adults enrolled in

FSP’s

• 1,013 contacts through our Outreach and

Engagement Programs and 137 people linked

to treatment

• 2,821 attendees at trainings, and a variety of

other services for 1,521 individuals

• The Mental Health Services Act has brought

(and will continue to bring) a signiﬁ cant amount of

funding to Orange County to provide a wide array of

services:

• Prevention and Early Intervention ($9,755,200

for FY 07/08 and $16,400,00 in FY 08/09)

• Workforce, Education and Training ($8,267,000

for FY 07/08 and FY 08/09 combined.)

• CSS ($36,307,136 for FY 07/08 - total of

original CSS and CSS Growth Funding)

4. Public Health Services’ Shellmaker Water

Quality Laboratory construction was completed

in September 2007. The new laboratory facility will

allow the Orange County Public Health Laboratory to

continue to offer rapid and high quality water testing

to help detect and eliminate pollution sources in

Orange County and protect public health.

5. Behavioral Health Services, in collaboration with

the Court, the Probation Department, the Public

Defender and District Attorney, developed and

implemented two new Family Violence Collaborative

Courts, one in West Court and one in North Court. The

two new courts are currently in operation. Dedicated

HCA staff has been assigned and substance abuse

treatment services are now being provided to

individuals referred from these courts. This will be an

ongoing project.

6. Environmental Health Services increased

education and outreach efforts.

• A food worker education program was

implemented to increase awareness of and

compliance with food safety practices and

regulations.

• Environmental Health Services continues to

increase coordination with community partners to

reduce the impact of sewage spills on recreational

water quality. Inspections at speciﬁ ed food facilities

are aimed at reducing the amount of fats, oils and

grease (FOG) disposed of into the sewer system.

FOG is one of the leading causes of sewage spills,

which often result in beach closures. From July to

October 2007, 741 FOG inspections were conducted

within cities that have agreed to participate in

the program. In addition to FOG inspections, an

evaluation of the number of sewage spill beach

closures caused by grease is ongoing.

7. Health Disaster Management Division improved

HCA’s ability to coordinate health care resources,

volunteers, and municipal/community partners in the

event of an emergency or disaster:

• The ‘Cities Readiness Initiative’ planning and

exercising has improved the collaboration between

HCA and public and private community partners to

prepare for a health emergency.

• The Emergency Medical System provides a high

standard of pre-hospital care and maintains efﬁ cient

EMS response for the Orange County community.

• The 2007 FEMA Graded San Onofre Nuclear

Generating Station (SONGS) exercise was a

success.

8. Institutional Health Services improved care for

patients.

• Correctional Medical Services implemented a

digital x-ray screening program to improve the

screening rate for tuberculosis within the adult

correctional facilities.

• Juvenile Health Services partnered with

Community Nursing to assist new mothers (minors

in Juvenile Hall) by providing education and support

in the areas of prenatal care, nutrition, childbirth,

breastfeeding, child development, child safety, and

setting and reaching personal goals. JHS is regularly

referring to the Nurse Family Partnership Program.

The nurses from that program come to Juvenile Hall

to visit the girls and begin prenatal education.

9. Human Resources implemented a Leadership

Development Program that will result in certiﬁ cation

upon completion of core courses. The Leadership

Development Program was rolled out to Health Care

Agency employees in January 2007. As of December

2007, the program exceeded expectations with 297

or 11.6% of HCA staff participating. There were 202

employees enrolled in Level I and 95 employees

enrolled in Level II. First graduating class, scheduled

January 2008, will have 42 Level I graduates and 1

Level II graduate.

10. IRIS (Cerner) Enterprise Data System was

successfully tested and the roll-out to Public Health

Services was initiated. The system will streamline

patient registration and tracking of laboratory results

ordered at the various Public Health Clinics.

24 Health Care Agency Business Plan — Appendix C

Appendix C

CRITICAL DEMOGRAPHICS/SERVICE EXPECTATIONS

The following table provides a brief description of client groups and caseload information for programs selected

to represent the range of services provided by the Agency. The data provided are the most recent available from

each program for ﬁ scal year 2006-07.

Program Service Recipient Type of Service Fiscal Year 2006-07

1. Animal Care Services

Residents of 19 cities &

unincorporated areas

Animal licenses 166,137

2. Animal Care Center

Residents of 22 cities &

unincorporated areas

Live animals impounded 30,671

3. Behavioral Health - Adult

Adults with mental illness and/or

substance abuse problems

Persons served in the community 37,522

4. Behavioral Health - Older Adult

Older adults with mental

illness and substance abuse

problems; frail elderly at risk

of out-of-home placement

Persons served in the community 2,788

5. Behavioral Health - Children

Seriously emotionally or

behaviorally disturbed children,

substance abusing adolescents

Persons served in the community 9,976

Persons served in County

institutions (Orangewood,

juvenile justice facilities)

5,942

6. California Children’s Services

Children with disabling or

potentially disabling conditions

Case Management Services 13,377

Medical Therapy Program

Occupational and Physical

Therapy visits provided

61,741

7. Family Health

Low income children

Child health clinic visits 9,890

Child linkages to Child Health

and Disability Prevention

program community providers

70,000

Children and adults

Immunizations clinic visits 45,095

Vaccines given 79,753

Low income pregnant women Prenatal care referrals 2,191

Low income pregnant or parenting

teenagers and siblings

Case Management 1,034

Low income women

and their parents

Visits for contraception education/

methods for women & partners

12,905

8. Epidemiology and Assessment All County residents Communicable disease reports 8,883

9. Emergency Medical Services

All County residents and visitors

Total 9-1-1 EMS responses 147,067

Paramedic transports

to designated ER

53,607

Trauma patients served

by trauma center

4,692

Emergency Medical

Technicians-1 (EMT-1)

Certiﬁ cation/ re-

certiﬁ cation of EMT-1s

372

Paramedics County licensure of EMT-1s 1,303

Ambulance companies

and ﬁ re departments

Local accreditation of paramedics 61

Inspection and licensure of public

and private ambulance vehicles

393

EMT-1 and paramedic

training programs

Review and approval of EMT-1

and paramedic training programs

Trauma Centers

Designation of Trauma Centers

serving Orange County

Health Care Agency Business Plan — Appendix C 25

Program Service Recipient Type of Service Fiscal Year 2006-07

10. Dental Health

Low income residents Emergency dental care visits 4,410

Low income children General dentistry visits 1,055

Persons with HIV or AIDS

without resources

General dentistry visits 1,420

11. Employee Health County employees

Initial/routine/return-to-work

examinations and/or follow-up

10,769

12. Environmental Health All County residents

Retail food facility inspections 30,701

Hazardous waste inspections 6,371

13. Health Promotion All County residents

Public education 226,109

Target group education / technical

assistance (includes former

separately reported staff education

& training technical assistance)

31,870

Patient education /

screening / referrals

31,833

14. HIV Test Sites Persons at risk of HIV infection HIV testing and counseling 9,126

15. HIV Clinic

Persons with HIV infection or AIDS

w/o resources for medical care

Medical care and case

management visits

16,175

16. Institutional Health

Incarcerated adults

Medical screening assessments 78,840

Sick-call visits (medical/dental) 194,768

Behavioral Health face-

to-face assessments

44,948

Detained juveniles

Comprehensive intake

assessments

9,876

Sick-call visits (medical/dental) 35,586

17. Medical Services Initiative Low income adults

Total MSI enrolled users 21,236

Hospital unduplicated counts 10,155

Paid hospital inpatient days 23,140

Total emergency room (ER) visits 13,127

Outpatient encounters 17,196

Total physician visits 173,015

18. Nutrition Services

Low income pregnant,

postpartum, and breastfeeding

women and children to age 5

Nutritional counseling and food

vouchers given to women

99,773

Vouchers given to

infants and children

307,371

19. Public Health Community Nursing

Infants, families or individuals,

primarily low income, at high

risk of health problems

Home visits for assessment,

counseling / teaching,

case management

25,001

2,444

Medically high risk newborns 10,800

Persons in need of preventive

health teaching and referral

Nursing consultation and case

management and referral services

1,887

26 Health Care Agency Business Plan — Appendix C

Program Service Recipient Type of Service Fiscal Year 2006-07

20. Specialized Public Health Nursing

Pregnant substance abusing

and/or HIV infected women

Home visiting case management,

assessment, counseling,

teaching and referral services

4,373

Children and youth who

have allegedly been sexually

or physically abused

Forensic or physical

examination and consultation

to medical professionals and

law enforcement ofﬁ cials

431

Children and youth in foster

care/out-of-home placement

Nursing consultation and case

management services, social

worker and foster parent training

27,570

Adult CalWorks clients with

barriers to self sufﬁ ciency

Home visitation and case

coordination activities

12,573

Older adults with unmet

health care needs

Home visits for assessment,

counseling / teaching, and case

management. Home visits

and phone visit contacts

2,929

Older adults, 50 years of age and

older with health monitoring needs

Community clinic visits for physical

assessment, counseling / teaching,

case management, special

screening, health education

17,355

21. STD Clinic

Persons, primarily low income,

with sexually transmitted diseases

Clinic visits for diagnosis and

treatment of sexually transmitted

diseases other than AIDS

11,146

22. Tuberculosis (TB) Control

Persons with TB infection

but not active disease

Clinic visits for treatment

of latent TB infection

7,892

Persons with active TB disease

Directly observed therapy visits for

active disease or latent infection

38,837

Clinic visits for treatment

of active TB disease

10,302

Working Together

for a

Healthier Tomorrow

County of Orange

Health Care Agency