Business Plan 2001

Juliette A. Poulson, RN, MN
Interim Director
February 20, 2001

HEALTH CARE AGENCY
2001 BUSINESS PLAN

TABLE OF CONTENTS
I. Executive Summary .................................................................................... 1
II. Client Profile ............................................................................................. 5
III. Service Environment ............................................................................... 10
IV. Operational Plan...................................................................................... 14
Appendix A – Current Organization Chart ..................................................... 28
Appendix B – Proposed Organization Chart for 2001 .................................... 29
Appendix C – Legal Mandates....................................................................... 30
Appendix D – Business Plan 2000 Accomplishments ..................................... 31

Executive Summary HCA 2001 Business Plan Page 1
I. EXECUTIVE SUMMARY
The Health Care Agency (HCA) adopted a Vision, Mission and Goals for the year 2000 and beyond.

Vision "Orange County –The Healthiest Place on Earth"

Mission
Create and support an environment that promotes the achievement of optimal individual, family and community health.

Our Vision: "Orange County --the Healthiest Place on Earth." Health is the realization of complete physical, emotional, intellectual and spiritual well being.

Our Mission: "The Health Care Agency is dedicated to creating and supporting an environment that promotes the achievement of optimal individual, family and community health."

The Agency's Vision and Mission provided the framework for the development of six overarching Agency goals. For 2001, a seventh Agency goal was added in recognition of the importance of technology to the success of HCA's goal attainment and compliance efforts. HCA's goals are:
1. Improve family and individual health

2. Assure the availability of integrated services

• Prevention
• Treatment
• Rehabilitation

3. Reduce environmental threats to health

4. Provide service with a focus on quality

5. Create a working environment that encourages excellence

6. Acknowledged in the community as the leader in health care
planning

7. Implement advanced technology solutions for optimal use of
information and resources.

To accomplish our mission and goals, we perform a variety of public health, medical, behavioral, and regulatory health functions that protect the general public, serve special need populations, assist business and industry and facilitate the work of other government entities and community-based service providers.

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Executive Summary HCA 2001 Business Plan Page 2
93% of Business Plan 2000 performance objectives were
accomplished in whole or in part.

Ninety-three percent of HCA's Business Plan 2000 performance objectives were accomplished in whole or in part. Major accomplishments of the 2000 Business Plan year include:

Improved family and individual health: A countywide Steering Committee was established to conduct joint planning and coordinate efforts aimed at increasing the number of children with health insurance coverage. The Agency increased the number of individuals served in outpatient behavioral health services by 8%, and initiated a program to promote breastfeeding at three local hospitals for at least 1500 women. The Agency also increased the rate of persons identified with latent tuberculosis infection who initiate preventive treatment.

Availability of integrated services – prevention, treatment, and rehabilitation: Through collaborative efforts with County and community stakeholder groups, the number of adolescents receiving substance abuse treatment services increased to 1750, while the number of children and youth receiving mental health services rose for the fifth straight year, from 10,157 to 11,089. A new Health Promotion and Prevention Division was developed to ensure integration of services and an Agency-wide approach to health promotion, and the Agency received State funding to  greatly expand Children's System of Care programs for emotionally disturbed children and youth.

Reduced environmental threats to health: During 2000, the Agency implemented a 24-hour response capability for ocean water closures/ postings, and developed a new foodborne illness surveillance system to more effectively identify foodborne illness outbreaks.

Providing service with a focus on quality: Public access to information on restaurant and beach closures, food facility inspection and medical waste management were all significantly improved. The Animal Care Center expanded its hours of service operation, and implemented two very popular new features on the Agency's website – the Adopt-A-Pet and Lost and Found service modules. The Phase I Agency Restructuring recommendations approved by the Board of Supervisors were implemented, and the Phase II consultant study completed.

Creating a working environment that encourages excellence: The Performance Incentive Program (PIP) and Management Performance Plan (MPP) were successfully implemented, and an agency-wide Employee Recognition Program was begun. Animal

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Executive Summary HCA 2001 Business Plan Page 3
Over the next decade, teens and older adults will become
Orange County's fastest growing population sub-groups

Care Services staff were provided customer service training, resulting in much improved consumer satisfaction ratings, and the application phase for accreditation of juvenile detention medical facilities was completed.

Acknowledged in the community as the leader in health care planning: Agency staff and managers devoted significant time and effort to important health care planning efforts, such as: the work of the Children and Families (Proposition 10) Commission; development of a plan with the community for use of County Tobacco Settlement funds; and, planning for the second Orange County Health Needs Assessment (OCHNA), to be conducted in 2001.

Implementing advanced technology solutions: During 2000, the Agency increased its number of network users from 1450 to 1950, and completed nearly twice the number of projects and new system feasibility studies as originally planned.

CLIENT PROFILE
The Health Care Agency's ultimate "client" is the entire County population. While direct services are provided to individual clients or patients, the Agency's primary focus is to protect and promote the health and safety of the community as a whole.

To accomplish this, the Agency provides a broad range of programs and services, directly and through contracts, often in response to legal mandates. HCA's clients can be broadly divided into three categories: the community, at-risk individuals (for prevention services), and mandated service groups (for intervention and treatment services).

Orange County continues to grow and become more ethnically diverse. Over the next decade, teens and older adults will become Orange County's fastest growing population sub-groups. In response to demographic and cultural diversity, the Agency has developed a Cultural Competency program to assist in the effective delivery of services to all clients.

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Executive Summary HCA 2001 Business Plan Page 4
The Health Care Agency operates with 164 funding
sources and over 200 mandates.

SERVICE ENVIRONMENT
The Health Care Agency protects and promotes optimal individual, family and community health through coordination of public and private sector resources. Private sector service contracts make up over half (51%) of the Agency's Fiscal Year (FY) 00-01 budget.

HCA's service environment is complex, with 164 different funding sources and over 200 State and Federal mandates. The mandates under which HCA operates require the County to provide for or regulate certain health services. Most also carry specific requirements for staffing, operations, claiming and record-keeping.
The year 2001 promises to provide continuing opportunities and challenges for HCA. These include: implementing the final phase of the Agency's restructuring plan; a heightened focus on established strategic priorities through collaborative ventures, and, continued participation in countywide and regional planning efforts. The Agency will also continue to develop a working environment that encourages excellence through refinement of the PIP and MPP processes, and the development of a formal Agency professional development and training plan.

Development of the 2001 Business Plan involved all
sections of the Agency.

OPERATIONAL PLAN
The Health Care Agency's 2001 Business Plan contains over 40 major projects that will be addressed over the next year to advance the Agency's mission and goals. Development of the 2001 Business Plan involved all sections of the Agency in identifying major projects, setting performance objectives and developing service plans.

This section details: The Agency's Key Outcome Measures-a comprehensive set of benchmarks by which Agency progress will be gauged over the next three to five years Major Projects and Performance Objectives for 2001 HCA efforts toward "Closing the Gap" Anticipated 2001 Operational Plan challenges.
The Health Care Agency looks forward to working with all of its County and community partners, including consumers, toward successful attainment of its 2001 Performance Objectives.

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Client Profile HCA 2001 Business Plan Page 5
II. CLIENT PROFILE
The ultimate client of the Health Care Agency (HCA) is the entire County population. Agency clients also include other county departments and the millions who visit Orange County for business or pleasure each year. While providing direct services to individual clients or patients, the Agency's primary focus is to protect and promote the health and safety of the community as a whole.

To accomplish this, the Agency provides a broad range of programs and services, directly and through contracts, often in response to legal mandates. HCA's clients can be broadly divided into three major groups: the community, at-risk individuals (for prevention services) and mandated service groups (for intervention and treatment services).

Orange County is likely to continue to grow and become more ethnically diverse over the next decade, with the fastest growing population groups expected to be teens (up 46%) and older adults (up 37%). The Hispanic teen population is expected to almost double by the end of the decade, followed by Asian/ Pacific Islander teens at 53%. For adults age 60 and older, the greatest increases are projected to be among American Indians, African Americans, and Asian/ Pacific Islanders (all up nearly 90%), followed by Hispanics (up 65%) and Whites (up 25%). The anticipated increases in these two age groups could result in increased numbers of at-risk individuals requiring prevention services, and individuals requiring medical and behavioral health intervention and treatment services.

In recognizing the demographic and cultural diversity of the population of Orange County, the Agency has developed a Cultural Competency program to assist in the effective delivery of services to all clients. Cultural competency is a key component in the development of new services and programs as the Agency continues its collaborative efforts with many community partners.

SERVICES FOR THE COMMUNITY
Regulatory Health's programs, such as ocean recreational water protection, food sanitation, hazardous waste management and Animal Care Services, focus directly on the prevention of threats to health in the physical environment through monitoring and inspection, licensing, and statutory regulation. Public Health's communicable disease programs focus on intervention in the transmission of tuberculosis and sexually transmitted diseases, including human immunodeficiency virus (HIV). The Agency also monitors acute communicable disease trends and investigates and intervenes in outbreaks and other unusual occurrences. The Agency's emphasis on advocating safe and healthy lifestyles and practices has increased with the formation of the Health Promotion and Prevention Division. While located in Public Health Services, the Health Promotion and Prevention Division serves the entire Agency, assisting with prevention, disease management and health education efforts. This Division includes the Alcohol and Drug Education and Prevention Team (ADEPT) and the Tobacco Use Prevention Program (TUPP), focusing on substance use and abuse as major risk factors for many health problems.

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Client Profile HCA 2001 Business Plan Page 6
Health Promotion and Prevention Division programs also collaborate with a variety of public and private organizations and community agencies to prevent injury, chronic disease, and communicable disease and promote personal and family health.

PREVENTIVE SERVICES FOR AT-RISK INDIVIDUALS
Behavioral Health's programs focus on prevention in the areas of substance abuse and mental health services for adults and children. These efforts are often in partnership with community organizations and contract providers and are provided in response to legislative mandates.

Initiatives to increase access to healthcare services for children and families will make health screenings and early identification of potential health risks possible for many more Orange County residents. Multiple Agency programs currently provide services designed to identify and protect individuals who are at risk of developing health problems. These services include in-home assessments by public health nurses and behavioral health professionals, neighborhood well-child and maternal health clinics, immunizations, nutrition counseling, and food vouchers. In addition, one goal of the county's Older Adults initiative will be to prevent and reduce the debilitating complications of chronic diseases.

INTERVENTION/ TREATMENT SERVICES FOR INDIVIDUALS
Community. HCA programs also provide services designed to prevent individuals from progressing to more serious health problems. Behavioral Health serves children, adolescents, adults, and older adults with serious mental, emotional and/ or substance abuse problems. Behavioral Health operates under its statutory authority to detain and evaluate individuals and provide crisis stabilization to persons with mental disorders. Prevention services are provided to those who may pose a threat to themselves or to others in the community.

Medical Services for Indigents provides for the care of eligible medically indigent adults who have no other source of medical care. There also are clinical and support services provided by Public Health for persons with HIV or acquired immune deficiency syndrome (AIDS), and other communicable diseases; medical and other therapeutic services for disabled children coordinated through California Children's Services; and emergency dental services for low income persons.

Institutional Setting. The Health Care Agency is responsible for medical, dental, pharmaceutical and behavioral health services to adults and minors in the County's adult correctional facilities, juvenile institutions, and Orangewood Children's Home. In fulfilling these responsibilities, the Health Care Agency supports the Sheriff-Coroner, the Probation Department, and the Social Services Agency.

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Client Profile HCA 2001 Business Plan Page 7
PROFILE OF SERVICE RECIPIENTS
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 and reflect a 12 month period, either calendar or fiscal year:

PROGRAM: Animal Care Services
SERVICE RECIPIENT: Residents of 19 cities & unincorporated areas
TYPE OF SERVICE: Animal licenses
ANNUAL COUNT: 151,280

PROGRAM: Animal Care Center
SERVICE RECIPIENT: Residents of 21 cities & unincorporated areas
TYPE OF SERVICE: Live animals impounded
ANNUAL COUNT: 29,101

PROGRAM: Behavioral Health – Adult
SERVICE RECIPIENT: Adults with mental illness and/ or substance abuse problems
TYPE OF SERVICE: Persons served in the community
ANNUAL COUNT: 25,250

PROGRAM: Behavioral Health – Older Adult
SERVICE RECIPIENT: Older adults with mental illness and substance abuse problems; frail elderly at risk of out-of-home placement
TYPE OF SERVICE: Persons served in the community
ANNUAL COUNT: 2,850

PROGRAM: Behavioral Health -Children
SERVICE RECIPIENT: Seriously emotionally or behaviorally disturbed children, substance abusing adolescents
TYPE OF SERVICE: Persons served in the community, Persons served in County institutions (Orangewood, juvenile justice facilities)
ANNUAL COUNT: Community 10,605, Institutions 5,892

PROGRAM: California Children's Services
SERVICE RECIPIENT: Children with disabling or potentially disabling conditions
TYPE OF SERVICE: Active cases & referrals for case management
ANNUAL COUNT: 18,000

PROGRAM: Child Health
SERVICE RECIPIENT: Low income children
TYPE OF SERVICE: Child health clinic visits
ANNUAL COUNT: 23,902
TYPE OF SERVICE: Child linkages to Child Health and Disability Prevention program community providers
ANNUAL COUNT: 192,200
TYPE OF SERVICE: Immunizations
ANNUAL COUNT: 52,468

PROGRAM: Communicable Disease Control / Epidemiology
SERVICE RECIPIENT: All County residents
TYPE OF SERVICE: Communicable disease reports
ANNUAL COUNT: 5,980

PROGRAM: Emergency Medical Services
SERVICE RECIPIENT: All County residents and visitors
TYPE OF SERVICE: Paramedic supported patient transports to designated ERs/ trauma centers
ANNUAL COUNT: 44,835

PROGRAM: Employee Health
SERVICE RECIPIENT: County employees
TYPE OF SERVICE: Initial/ routine/ return-to-work examinations and/ or follow-up
ANNUAL COUNT: 16,600

PROGRAM: Environmental Health
SERVICE RECIPIENT: All County residents
TYPE OF SERVICE: Retail food facility inspections
ANNUAL COUNT: 30,035

PROGRAM: Environmental Health
SERVICE RECIPIENT: All County residents
TYPE OF SERVICE: Hazardous waste inspections
ANNUAL COUNT: 5,900

PROGRAM: Health Promotion
SERVICE RECIPIENT: All County residents
TYPE OF SERVICE: Businesses & community agencies receiving technical assistance
ANNUAL COUNT: 405

PROGRAM: HIV Test Sites
SERVICE RECIPIENT: Persons at risk of HIV infection
TYPE OF SERVICE: HIV testing and counseling
ANNUAL COUNT: 14,800

PROGRAM: HIV Clinic
SERVICE RECIPIENT: Persons with HIV infection or AIDS w/ o resources for medical care
TYPE OF SERVICE: Medical care and case management
ANNUAL COUNT: 1,400

PROGRAM: Institutional Health
SERVICE RECIPIENT: Incarcerated adults
TYPE OF SERVICE: Medical screening assessments
ANNUAL COUNT: 69,196
TYPE OF SERVICE: Sick-call visits (medical/ dental)
ANNUAL COUNT: 130,000

PROGRAM: Institutional Health
SERVICE RECIPIENT: Detained juveniles
TYPE OF SERVICE: Comprehensive intake assessments
ANNUAL COUNT: 9,061

PROGRAM: Maternal Health
SERVICE RECIPIENT: Low income pregnant women
TYPE OF SERVICE: Prenatal care referrals
ANNUAL COUNT: 2,402

PROGRAM: Maternal Health
SERVICE RECIPIENT: Low income pregnant or parenting teenagers and siblings
TYPE OF SERVICE: Case management
ANNUAL COUNT: 1,283

PROGRAM: Maternal Health
SERVICE RECIPIENT: Low income women and their partners
TYPE OF SERVICE: Contraception education and methods for women and partners
ANNUAL COUNT: 14, 411

PROGRAM: Medical Services for Indigents
SERVICE RECIPIENT: Low income adults
TYPE OF SERVICE: Hospital inpatient days
ANNUAL COUNT: 21, 983
TYPE OF SERVICE: Hospital emergency department visits
ANNUAL COUNT: 8,846
TYPE OF SERVICE: Unduplicated number of patients
ANNUAL COUNT: 17,051
TYPE OF SERVICE: Patient encounters
ANNUAL COUNT: 146,844

PROGRAM: Nutrition Services
SERVICE RECIPIENT: Low income pregnant, postpartum, and breastfeeding women and children to age 5
TYPE OF SERVICE: Nutritional counseling and food vouchers for women
ANNUAL COUNT: 137,000
TYPE OF SERVICE: Food vouchers for infants/ children
ANNUAL COUNT: 434,000

 PROGRAM: Preventive Health Care for Adults
SERVICE RECIPIENT: Senior citizens 55 years and older
TYPE OF SERVICE: Total client encounters
ANNUAL COUNT: 3,500

PROGRAM: Public Health Field Nursing
SERVICE RECIPIENT: Infants, families or individuals, primarily low income, at high risk of health problems
TYPE OF SERVICE: Home visits for assessment, counseling/ teaching, case management
ANNUAL COUNT: 29,009

PROGRAM: STD Clinic
SERVICE RECIPIENT: All County residents
TYPE OF SERVICE: Sexually Transmitted Diseases diagnosed and treated
ANNUAL COUNT: 1,682

PROGRAM: Tuberculosis (TB) Control
SERVICE RECIPIENT: Persons with TB infection but not active disease
TYPE OF SERVICE: Visits for treatment of latent TB infection
ANNUAL COUNT: 41,705

PROGRAM: Home Visits for TB Direct Observed Therapy
SERVICE RECIPIENT: Persons with active TB disease
TYPE OF SERVICE: Directly observed therapy visits for active disease or latent infection
ANNUAL COUNT: 51,324

PROGRAM: Tuberculosis (TB) Control
SERVICE RECIPIENT: Persons with active TB disease
TYPE OF SERVICE: Visits for treatment of active TB disease
ANNUAL COUNT: 8,880

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Client Profile HCA 2001 Business Plan Page 8

CASELOAD TRENDS
The following caseload information graphs have been selected to reflect the diversity of Agency programs and service issues: uninsured children, Children and Youth Services clients, sick calls for adults in correctional facilities, deaths due to coronary heart and cerebrovascular disease, a measurement of the impact of ocean and bay water closings, and tuberculosis cases county-wide.

Uninsured Children. A major Agency focus is increasing health care access for children. A 1998
Countywide survey (OCHNA) found that 13% of Orange County children did not have health insurance coverage. Since that time, individual County agency and community-based efforts to increase the number of children enrolled in Medi-Cal and Healthy Families programs has resulted in slow but steady growth (Graph 1). With County and community-based programs' recent commitment to better coordinate enrollment efforts, the numbers of enrolled Orange County children and youth are expected to increase more rapidly. Source: Department of Health Services, MediCal Eligibility Branch and Healthy Families.

Graph 1: Children's Health Plan Enrollment
Individuals Enrolled:
Medi-Cal under Age 18 from January 1999 to June 2000 remained nearly the same with 120,000
Healthy Families under Age 18 from January 1999 to June 2000 increased by 20,000+
Totals January 1999 to June 2000 increased from 120,000 to 140,000+

Children and Youth Services (CYS) Clients. Since 1994, program expansion focusing on
seriously emotionally disturbed children and the development of multidisciplinary service centers
for high risk children and youth have resulted in a 150% increase in the number of children and
adolescents receiving behavioral health services (Graph 2). With Orange County's adolescent and
teen population expected to increase at a rate more than three times greater than the total county
population during the next decade, the need to expand services is expected to continue.
Source: Children and Youth Services.

Graph 2: Number of Children Served by CYS
1994/95 - 4,429
1995/96 - 4,654
1996/97 - 5,456
1997/98 - 7,550
1998/99 - 10,151
1999/00 - 11,089

Correctional Medical Services (CMS) Sick Call Visits. Expansion of facilities at the Theo Lacy and James Musick jails will result in the need for expansion of Correctional Medical Services. CMS is responsible for medical, dental, and pharmaceutical care for all adults in the custody of the Sheriff-Coroner Department. Sick call visits increased by approximately 5 percent from 1998 to 1999 and are expected to continue to increase with facility expansion (Graph 3). Source: CMS Annual Statistical Comparison Report.

Graph 3: Correctional Medical Services Adult Sick Call Visits
Sick Call Visits
1995 - just under 130,000
1996 - 130,000
1997 - almost 140,000
1998 - just over 130,000
1999 - almost 140,000
2000 -just over 130,000

Sick Call Visits Linear (Sick Call Visits)
Steady increase from under 130,000 in 1995 to over 130,000 by the year 2000

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Client Profile HCA 2001 Business Plan Page 9
Graph 5: Ocean & Bay Water Closures

Older Adults Chronic Disease and Injury Prevention. The Agency is joining a collaborative effort with other
county agencies, health care providers, advisory boards and older adult advocacy groups to coordinate efforts
to reduce the impact of chronic disease and prevent injuries. Available indicators show recent increases in
deaths from two major chronic diseases affecting older adults, coronary heart disease and cerebrovascular
disease. Orange County's current death rates due to coronary and cerebrovascular disease are both above
the Healthy People 2010 targets (Graph 4). Source: HCA/ Public Health Services.

Graph 4: Coronary Heart and Cerebrovascular Disease Death Rates
Deaths per 100,000 population (95-97)
* Coronary Heart Disease 227
(166 is the Healthy People 2010 target)
*Cerebrovascular Disease 60.1
(48 is the Healthy People 2010 target)

Ocean Recreational Water Protection Program. Ocean water quality is a strategic initiative for the County
of Orange. HCA's Ocean Recreational Water Quality Program posts warnings when bacterial levels exceed
health standards and closes ocean or bay waters when an immediate health hazard is identified. In addition
to tracking total numbers of closures, the program is using a new measurement of closures by beach mile
days. This companion measure takes into account the length and severity of each closure to provide a more
meaningful comparison of ocean water availability to the public from year to year (Graph 5). Ongoing
efforts include projects to identify the sources of bacteria and refine laboratory testing procedures to
provide earlier notice of potential health hazards. Source: Ocean Recreational Water Protection Program.

Graph 5: Ocean & Bay Water Closures
1st-3rd Quarters of 1999
14 Water Closures
111.4 Beach Mile Days

1st-3rd Quarters of 2000
33 Water Closures
49.6 Beach Mile Days

Tuberculosis (TB) Cases and Estimated Persons with TB Infection. Following a local and nationwide
resurgence of TB in the late 1980s and early 1990s, renewed TB control efforts have resulted in a
gradual decline in reported cases locally (Graph 6) and nationally. To control TB and further reduce
the number of new cases, increased efforts are needed to identify and provide preventive therapy
to the estimated 275,000 individuals with latent TB infection in Orange County.
Source: HCA/ Disease Control Assessment Services.

Graph 6: New Tuberculosis Cases by Year
1992 - 411
1993 - 430
1994 - 364
1995 - 336
1996 - 273
1997 - 330
1998 - 298
1999 - 246

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Service Environment HCA 2001 Business Plan Page 10
III. SERVICE ENVIRONMENT
INTRODUCTION
The Health Care Agency (HCA) is dedicated to creating and supporting an environment that promotes the achievement of optimal individual, family, and community health. To accomplish this mission, it
performs a variety of public health, behavioral, and regulatory health functions.

SERVICES
HCA is composed of the following major service areas:

Public Health -Monitors the incidence of disease and injury in the community and develops and applies preventive strategies to maintain and improve the health of the public.

Behavioral Health -Provides a culturally competent and client-centered system of behavioral health services for all eligible county residents in need of mental health care and/ or treatment for alcohol and other drug abuse.

Medical and Institutional Health -Coordinates emergency medical care, provides medical and behavioral health care to adults and children in institutional settings, and contracts for essential medical services for patients for whom the County is responsible.

Regulatory Health -Ensures food safety and water quality and protects the public's health and safety from harmful conditions in the environment, from animal-related injury, and from disease and nuisance
hazards through the enforcement of health and safety standards.

Financial and Administrative Services -Promotes and provides for the fiscal and operational integrity of the Agency through sound management principles and practices, and provides support services to
Agency programs.

An Agency organization chart is presented in Appendix A.

2000/ 2001 Budgeted Appropriations
*Private Sector Payments 51%
*Employee Costs 35%
*Purchased Goods & Equipment 14%

FUNDING
The HCA adopted budget for Fiscal Year 2000/ 2001 includes $361 million in net appropriations with 2,415
positions and 164 different funding sources. State and Federal revenue and fees comprise 89% of Agency
revenue; County funding comprises the remaining 11%. Two-thirds of the County funding in the Agency budget is
match that is required by the State to receive $138.4 million in State revenue. Private sector service contracts
make up over one-half of the Agency budget.

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Service Environment HCA 2001 Business Plan Page 11
The largest single revenue source is State Realignment Funds, which accounts for 37% of Agency revenue. 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.

Other major sources of Agency revenue include: Medi-Cal, Substance Abuse Block Grant, California Children's Services, Proposition 99, SB 90, and fees for services. New revenue sources for community-based programs
include Tobacco Settlement, Proposition 10 and AB1913 funding, discussed further in Section IV.

2000/ 2001 Budgeted Revenues
State Realignment 37%
Fees 21%
Federal 8%
State -Other 23%
County (including match funds) 11%

MANDATES
HCA operations are guided by over 200 State and Federal mandates, many of which carry specific requirements regarding staffing, claiming, operations, and record-keeping.

These mandates require the County to provide for or regulate certain health services. Examples of mandates (see Appendix C) include criteria for ocean water monitoring, restaurant inspections, the provision of health services to the indigent, the type and level of medical and mental health services provided to County jail inmates, the timing of mental health evaluation and treatment provided to children who need special education and adults requiring involuntary treatment.

SERVICE ISSUES
In response to changing program needs and County and Agency initiatives, the coming year promises to be one of opportunities and challenges for HCA. These include: implementing the final phase of the Agency's restructuring plan; developing a corporate compliance office; a heightened focus on established strategic priorities through collaborative ventures; and continued participation in countywide and regional health planning efforts.

Agency Restructuring: In calendar year 2000, the Health Care Agency continued its efforts to refine and change its organization structure to be more efficient and accountable and to provide improved
customer service. These efforts have included implementing portions of the Phase I Agency restructuring plan (based on a comprehensive internal organizational assessment), and completion of the
Phase II study, conducted by an outside consultant, involving a more in-depth study of selected management issues.

The Phase II restructuring report completed in November 2000 by DMG Maximus is very complimentary of the Agency's "self-study" efforts, and independently validates most of the Phase I
study findings. The consultant effort found that HCA has fewer supervisors and managers as a percentage of total staff than other large and medium sized County departments, is equal to or better
than the comparison counties in productivity, and that spans of control are generally appropriate. Future

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Service Environment HCA 2001 Business Plan Page 12
challenges for the Agency were highlighted and strategies recommended to assist in successfully meeting them. Examples include greater emphasis on strategic planning at the Agency level versus within individual service areas, the development of an Agency-wide performance measurement system, and an Agency professional development and training plan. Upon CEO/ Board approval, implementation of approved Phase II strategies and action plans will begin.

Enhanced Collaboration: The Health Care Agency operates in an increasingly collaborative environment – nearly every major project included in the 2001 Operational Plan involves entities outside the Agency, including consumers. Collaboration is necessitated both by program requirements and the desire to provide a coordinated continuum of services for clients. Coordinated services can reduce duplication, improve efficiency, and produce better outcomes for consumers. Examples of the types of collaborative efforts in which the Health Care Agency will be engaged in 2001 include:

Continued efforts with the Sheriff, Courts, Probation and others to develop alternatives to incarceration for drug abusers and the mentally ill, and to expand treatment alternatives for juveniles on probation.

Collaborating with the County Executive Office (CEO), Probation, District Attorney, Public Defender, Social Services (SSA), and the Courts to implement Proposition 36 and provide a broader continuum of drug treatment and supervision services as an alternative to incarceration.

Partnering with SSA, Probation, Regional Center, Orange County Department of Education, and others to develop a comprehensive continuum of services for children with mental illness and children who have been or are at risk of being placed outside the home.

Working with SSA, the CEO, the Community Services Agency (CSA), and other public and private organizations to develop and coordinate services to older adults with mental health and substance abuse issues, and to frail elderly at risk of out-of-home placement.

Joining with CSA, SSA, and other public and private organizations to develop a Conditions of Older Adults Report and to identify strategic priorities for improving/ expanding services.

Participating with the Public Facilities and Resources Department, the Regional Water Quality Control Board, and other public and private organizations to address watershed and urban runoff concerns and improve ocean water quality.

Serving as a collaborative partner with the Sheriff, Probation, SSA, and community-based organizations on the Community Revitalization program to provide direct services to four targeted County Islands – El Modena, La Colonia Independencia, Midway City, and Southwest Anaheim.

Countywide and Regional Planning: The Health Care Agency plays a key role in countywide and regional health planning efforts. Examples include:
Working with a countywide Steering Committee to increase access to healthcare for children and families.
Coordinating the development of plans for the allocation of Tobacco Settlement funds.
Participating in the development and implementation of the tri-annual Orange County Health Needs Assessment, to be conducted in 2001.

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Service Environment HCA 2001 Business Plan Page 13
Serving on the Children and Families Commission (Proposition 10), and its Technical Advisory and Evaluation Committees. The Commission sets priorities and funds programs to address the needs of Orange County children from birth to age five.
Continuing participation in the joint powers authority consisting of Orange, Riverside, Los Angeles, San Bernardino, and San Diego counties to plan and build an 18-bed secure detention facility for seriously emotionally disturbed juvenile offenders, and seek operating funds for it.

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Operational Plan HCA 2001 Business Plan Page 14
IV. OPERATIONAL PLAN – 2001

The Health Care Agency’s 2001 Business Plan contains over 40 major projects that will be worked on over the next year to further achieve the Agency’s vision, mission and goals. During an all-day off-site meeting, HCA’s executive and middle management developed key outcome measures, prioritized major projects, assigned project responsibilities, and established specific project performance objectives for 2001. The criteria for identifying major projects included consistency with County and Agency strategic goals, anticipated new funding or service mandates, and a realistic assessment of the resources available for individual projects.

Following the offsite meeting, the list of major projects and anticipated accomplishments for 2001 were shared with program managers and staff to obtain their input regarding needed additions to the major project list, and to develop detailed service plans. For each major project identified in HCA’s Operational Plan for 2001, program staff have prepared and submitted service plans outlining the specific activities, key players and timelines necessary to achieve Agency performance objectives by year’s end. Service plans also identify the Agency goal(s) and major project(s) to which they are related, the responsible HCA manager, and specific challenges to be addressed and overcome during the implementation effort.

HCA managers will report implementation progress on at least a quarterly basis within their chain of command. This will assure that timely corrective action can be taken if a project has fallen behind the milestones set in the service plans. Key performance objective data also will be entered into a database that will facilitate formal project reporting to HCA’s Executive Team at mid-year and year’s end.

The Health Care Agency utilizes a variety of different measures of performance outcome to meet the mandates of its funding sources and regulatory agencies, and to ensure compliance with established administrative and clinical best practices. HCA currently has 164 distinct revenue sources and over 200 state and federal mandates, all of which require different levels and types of performance measurement and reporting. These mandates and quality assurance requirements have previously consumed most of HCA’s planning and performance measurement resources.

As part of the Phase I restructuring process, HCA strengthened its Agency level planning and research capabilities and developed a more strategic focus. During 2000, an Agency level strategic planning process was initiated, and a framework was developed to monitor progress toward the accomplishment of annual Business Plan performance objectives.

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Operational Plan HCA 2001 Business Plan Page 15

The following list of proposed Key Outcome Measures provides a comprehensive set of benchmarks by which to gauge progress towards achieving Agency goals over the next three to five years. (The specific goals to which each Key Outcome Measure is related are listed parenthetically.)

1. Work toward removing a major barrier to health care access for children, evidenced by an annual increase in the proportion of eligible Orange County children/youth enrolled in Medi-Cal and Healthy Families health insurance programs. (Goals 1, 6 and 7)
2. Work toward achieving Healthy People 2010 target objectives for chronic disease and injury indexes, evidenced by declining annual rates of death and hospital admissions for Orange County. (Goals 1, 2, 4, 6, and 7)
3. Work toward realizing the Healthy People 2010 target objective of reducing the incidence of tuberculosis, evidenced by declining annual rates of new tuberculosis cases for Orange County. (Goals 1, 2, and 4)
4. Work toward improving the behavioral health of Orange County youth, by expanding the capacity to provide needed services to seriously emotionally or behaviorally disturbed children/youth who are Juvenile Court wards or dependents, special education students, or Medi-Cal/EPSDT beneficiaries, commensurate with the projected growth in Orange County’s juvenile population. (Goals 1, 2, and 6)

5. Reduce environmental threats to health associated with foodborne illnesses, evidenced by an increase in the proportion of the total number of restaurants inspected on an annual basis receiving Awards of Excellence. (Goals 1, 3, 4, and 7)

(Note: Awards of Excellence are given to facilities that have had no critical violations in a calendar year and have at least one current employee who has passed an approved food safety certification program.)

During 2001, the Agency will also be evaluating the development of several new Key Outcome Measures for future use to better reflect the breadth of Agency operations. New measures under consideration (and their related goal areas) include creation of an indicator/index for monitoring: the level of Agency compliance with Federal, State, and local mandates (Goals 4 and 5); local opportunities for HCA employee training and professional development (Goals 1, 4, 5 and 7); staff retention rates (Goal 5); and, the effectiveness of Animal Care Services’ care and control operations (Goals 3, 4, and 5).

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Operational Plan HCA 2001 Business Plan Page 16
GOALS, MAJOR PROJECTS, AND PERFORMANCE OBJECTIVES
The Health Care Agency defines a "major project" as a project that may be accomplished over one or more years and will help the Agency achieve its goals and key outcomes. "Performance objectives" are quantifiable projections of how much or what percentage of each major project will be accomplished during calendar year 2001. These represent critical Project milestones.

The Health Care Agency's major projects and performance objectives for 2001 stated below are organized by Agency goal. Agency strategic priorities are also included in this section and are
denoted with an asterisk(*). Projects funded at least in part by Tobacco Settlement funds are noted as "( TSF)."

Goal #1: Improve family and individual health
Major Projects / Performance Objectives
*1.1 Increase access to health care for children and families. a. Develop a broader set of indicators to annually review progress toward improved access to
health care for children – by June 2001.
b. Develop a community action plan by September 2001.
c. Develop Agency procedures to ensure that HCA direct service clients are assessed for health
insurance status and provided enrollment assistance as indicated by September 2001.
*1.2 Establish an 80-bed local Mental Health Rehabilitation Center / Psychiatric Health
facility (TSF).
a. Eliminate the use of 40 out-of-county Institute for Mental Disease (IMD) beds by July 2001.
b. Decrease the number of acute hospital administrative days by 5%, from 3576 days to
3398 days, by December 2001.
*1.3 In collaboration with County and community stakeholders, develop an
additional perinatal residential treatment program (TSF).
Survey potential sites by December 2001.
*1.4 Expand community-based substance abuse treatment services (TSF). a. Develop a scope of work and request for proposals for a 60-bed adolescent detoxification
recovery and 40-bed inpatient adolescent facility by December 2001 (TSF)

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Major Projects / Performance Objectives
b. Provide outpatient services to an additional 120 clients by December 2001, increasing the
number served from 7,056 to 7,176 (TSF).
c. Partner with CEO, Probation, other criminal justice agencies and local treatment providers to develop and implement programming to comply with the provisions of Proposition 36, by July 2001, with no net county cost increase.
*1.5 Enhance/ expand preventive services (TSF). a. Develop new contracts with community clinics for medical and dental services to the uninsured by November 2001.
b. Develop a contract for medical transportation to improve access to medical care by the uninsured, including senior citizens, by November 2001.
c. Establish formal monitoring procedures for the management of hepatitis C virus case information by December 2001.
d. Through improved screening procedures, identify and provide treatment to 458 additional individuals at high risk of active TB infection, increasing the number served from 5,942 to 6,400, by December 2001. 1.6 Increase compensation for uncompensated emergency services provided by physicians and hospitals (TSF). Develop or amend master contracts with hospitals and the Orange County Medical Association to increase compensation by $4 million by April 2001.

1.7 Provide Preventive Health Care for Adults (PHCA) Services (TSF). a. Complete comprehensive health assessments for 1000 older adults by December 2001.
b. Conduct 100 education programs for older adults by December 2001.
c. Conduct 6 diabetes screening clinics for at risk older adults by December 2001.
d. Train an additional 20 individuals to be Chronic Disease Self Management training leaders/ facilitators by December 2001.

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Major Projects / Performance Objectives
1.8 Expand or enhance nutritional services.
a. Conduct a survey of women to determine local barriers to successful breastfeeding by December 2001.
b. Develop and distribute an information packet to promote breastfeeding among County staff by December 2001.
c. Present information at four schools on the benefits of physical activity and the consumption of fruits and vegetables, by December 2001.

Goal #2: Assure the availability of integrated services – Prevention, Treatment, Rehabilitation
Major Projects / Performance Objectives
*2.1 Targeted health education and promotion – chronic disease. Award contract for an older adults chronic disease education campaign by December 2001.
*2.2 Develop services commensurate with the expansion of Theo Lacy and Musick Jails.
a. Hire staff and procure equipment to implement medical and mental health services upon
completion of construction at Theo Lacy, by October 2001.
b. Develop service programs and resources for medical and mental health care to expanded
population at Musick by December 2001.
2.3 Expand Adult System of Care services through outreach and intensive integrated
services to homeless mentally ill adults. Enroll 100 homeless mentally ill adults into services by December 2001.
2.4 Expand the Children's System of Care to coordinate services from multiple agencies
to seriously emotionally and/ or behaviorally disturbed (SED) children.
a. Develop a full-time co-located interagency Case Management Council by June 2001.
b. Conduct interagency assessments for 50 SED children and their families by December 2001.
2.5 Implement an in-custody alcohol and drug treatment pilot project at Theo Lacy Jail. a. Provide services to 90 participants by December 2001.
b. Link 60% of participants completing the in-custody program to aftercare services and/ or
community resources by December 2001.

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Major Projects / Performance Objectives
2.6 Implement services funded by the Children and Families Commission (Proposition 10).
a. Initiate Field Nursing pilot project at the Santa Ana Youth and Family Resource Center by June
2001.
b. Expand Field Nursing services to four additional Family Resource Centers by October 2001.
2.7 Expand services to County Islands residents. Contact 300 women at El Modena and La Colonia Independencia Family Resource Centers regarding their eligibility for the Women, Infants, and Children (WIC) program, by December 2001.
2.8 Develop Foster Care Public Health Nurse role in the implementation of the Health and Education Passport, which contains essential information that goes with a foster care child whenever he/ she moves to a new home.
a. Define the role of the Foster Care Public Health Nurse by March 2001.
b. Review and advise on the medical information to be entered into the Health and Education Passport, beginning in June 2001.

Goal #3: Reduce environmental threats to health
Major Projects / Performance Objectives
*3.1 Participate and collaborate with, and support efforts by the Public Facilities and Resources Department (PFRD) to address watershed and urban runoff issues.
Develop laboratory capabilities for bacterial pollution source tracking and initiate two pilot
watershed studies by December 2001.

*3.2 Enhance the ocean recreational water protection program a. Conduct a survey to determine whether current methods of disseminating water quality
information to the public are adequate, by December 2001.
b. Partner with the Regional Water Quality Control Board to increase education, outreach, and
enforcement activities regarding unauthorized discharge of waste from private property owners
and businesses by December 2001.
c. Distribute pamphlets regarding sewage spills, grease reduction, and environmental effects of pollution to restaurants, homeowner associations, and apartments by December 2001.

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Major Projects  / Performance Objectives
d. Partner with the City of Newport Beach and the California Department of Fish and Game to develop a plan for a centralized water quality laboratory by December 2001 (TSF).
3.3 Assist and advise the El Toro Master Lease program to comply with environmental regulations. Provide assistance and advice to work towards compliance with 1) environmental health permit and plan check requirements; 2) requirements for a plan to respond to spills of hazardous waste, fuel, or other chemicals; and 3) obtaining permission for sublessees to store or use hazardous or toxic materials on site, by June 2001.
3.4 Increase awareness of how to prevent foodborne illnesses. a. Develop and pilot a K-2 food safety curriculum with a school district, by December 2001.
b. Partner with two cities to develop a presentation for food facility operators to increase food safety awareness among specific industry groups, by December 2001.
c. Develop, print, and distribute a disaster manual to food facilities that outlines the actions necessary to ensure the safety of food distributed to the public, by December 2001.
d. Implement a new retail food facility inspection report by June 2001.
3.5 Make information regarding Underground Storage Tank Cleanup cases available through the State Water Resources Control Board (SWRCB) web site.
Provide complete and accurate data, in accordance with contractual requirements, to the
SWRCB for inclusion on their Geographical Environmental Information Management System
(GEIMS) database by December 2001.

Goal #4: Provide service with a focus on quality
Major Projects / Performance Objectives
*4.1 Relocate or remodel the Animal Care Center. Complete an Animal Care Center study on constructing a facility at a new site compared to remodeling the existing facility by April 2001.

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Major Projects / Performance Objectives
4.2 Establish an Agency corporate compliance program consistent with funding source, CEO and Board directives to ensure compliance with governmental regulations and standards.
a. Develop a Compliance Procedures Manual by June 2001.
b. Train all agency staff in compliance matters by November 2001.
c. Develop a set of Agency risk factors and create an index for possible use as a future Agency Key Outcome Measure by December 2001.
4.3 Achieve accreditation of Juvenile Health facilities. a. Develop a Policy and Procedure Manual for all program participants by March 2001.
b. Schedule site survey accreditation team visit by June 2001.
4.4 Implement consultant recommendations for agency restructuring. Specific targets will be added after the restructuring recommendations are approved by the Board of Supervisors.
4.5 Conduct Classification studies Work with CEO/ Human Resources to address classification issues associated with the Agency's restructuring efforts and participate in the countywide reviews for Information Technology
and Office Services classes. Coordinate with CEO/ Budget to identify strategies, within budget parameters, to fund the costs of implementation of recommendations associated with these studies, by December 2001.

Goal #5: Create a working environment that encourages excellence
Major Projects / Performance Objectives
5.1 Develop an Agency training/ professional development plan, budget, and tracking system design.
Complete a Training and Professional Development Plan in concert with MPP and PIP
that includes identification of resources, budget, and a data management/ tracking system by
December 2001.
5.2 Implement an on-going strategic planning process. Develop an Agency-level Strategic Plan for 2001-2005 by December 2001, following approval of the Phase II restructuring recommendations by the CEO and the Board of Supervisors.

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Major Projects / Performance Objectives
5.3 Establish a new Agency Headquarters. Finalize space design, complete construction and initiate relocation of personnel by June 2001.
5.4 Establish a mechanism for meaningful and timely communications between Behavioral Health employees and management. Identify collaborative strategies to improve the rate of employee retention and satisfaction by
December 2001.

Goal #6: Acknowledged in the community as the leader in health care planning
Major Projects / Performance Objectives
*6.1 Participate in the development of the County's Older Adults Strategic Initiative
(CSA lead). (First Phase of HCA's Older Adults Chronic Disease and Injury
Prevention Strategic Initiative)
a. Provide health care input to the Conditions of Older Adults Report being developed by the
Community Services Agency (CSA).
b. Implement an Older Adults Service Coordination Project as part of the new Behavioral Health funding to enhance the Older Adults System of Care, by December 2001.
6.2 Lead development of an interagency Bioterrorism Plan Develop an operational plan focusing on the essential areas of bioterrorism surveillance, communication, and critical response protocols by October 2001.
6.3 Continue participation on the Orange County Health Needs Assessment Executive and Steering Committees.
Provide support for the design of the content and administration of the community health survey by December 2001.
6.4 Provide planning and technical support to the Children and Families Commission. Continue participation on the Children and Families Commission and its Technical Advisory and Evaluation Committees throughout 2001.
6.5 Provide leadership in the development and enhancement of the annual Conditions of Children Report.
Issue the Seventh Annual Conditions of Children Report by August 2001.

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Goal #7: Implement advanced technology solutions for optimal use of information and resources
Major Projects / Performance Objectives
7.1 Assess feasibility, develop, acquire, and implement new and replacement agency-wide administrative or individual program systems. Complete at least three of the feasibility/ requirements studies and at least six of the annual projects included in the Information Technology work plan by December 2001. These projects may
include:
*HCA Intranet
*Environmental Health Management Information System
*Emergency Medical Services (EMS) system
*Upgrade of methadone system
7.2 Acquire and implement an integrated HCA Enterprise Information System. a. Develop a long-range strategy and plan for Agency-wide implementation by December 2001.
b. Begin implementation of the Behavioral Health Management Information System component by
December 2001.
c. Begin implementation of the Public Health Laboratory Information System by December 2001.
7.3 Expand the Agency's enterprise network and its resources, including e-mail, County Intranet and Internet, to additional Agency staff. Increase the number of Agency network users from 1,950 to 2,250 by December 2001.
7.4 Participate in Countywide advanced technology pilot projects. Participate in the development of three Countywide advanced technology projects by December 2001: Automated timekeeping Electronic agenda item transmittal (AIT) pilot project Automated staff recruitment
7.5 Maintain and enhance the availability of public information on the Agency web page. a. Develop and implement public access to HCA's "Guide to Services" brochure by December 2001.
b. Create a Residential Care and Housing Web Site, detailing the program's operations in the areas of
residential care, shelter/ bed programs and residential rehabilitation facilities by October 2001.

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Operational Plan HCA 2001 Business Plan Page 24
Major Projects Performance Objectives
c. Expand available public information regarding the Tobacco Use Prevention Program (TUPP) to
include program description, brochures, scheduled events, and resources by November 2001.
d. Enhance HCA's web site with information regarding Orange County beaches to include
locations, fees, and available activities by December 2001.

CLOSING THE GAP
The Health Care Agency continually strives to improve the efficiency and effectiveness of its operations. Examples of current activities include:

Anticipation of additional efficiencies and streamlining of Agency operations through implementation of the Phase II Agency restructuring recommendations.

Continued focus on appropriate use of extra help and contract positions, as well as by contracting out for professional services. (Contracts currently account for 51% of the HCA budget, or $175 million in services with the private or non-profit sector.)

Implementing new technologies, such as a management information system that will collect client information across HCA service areas, to support service delivery and program development and provide for more timely revenue/ reimbursement claiming. Other applications under development in association with corporate efforts include document imaging, virtual timesheets, and automated purchasing systems.

Review of fees on a regularly scheduled basis to ensure full cost recovery for Agency programs.

Advocating for legislation and pursuing grant opportunities to increase non-County funding for existing and new programs, in coordination with the County Executive Office.

OPERATIONAL PLAN CHALLENGES
Although it is anticipated that all the performance targets can be achieved in 2001, there are some potential challenges that may inhibit progress. These include:

Many of the projects are collaborative and can only be accomplished with the cooperation of all of the partners in the project. Although the Health Care Agency is experienced with working collaboratively, the very nature of these projects introduces an element of

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Operational Plan HCA 2001 Business Plan Page 25
uncertainty. HCA facilitates the success of collaborative efforts by providing leadership, active participation, and skilled staff support.

The rapid and effective implementation of new programs such as Tobacco Settlement and State and Federal grants will continue to be a challenge due to funding and position approval requirements. In close coordination with the CEO, HCA will develop methods to increase the speed and latitude for the Agency to quickly expand or reallocate resources, as they become available.

To implement Proposition 36, Orange County will receive $3,991,505 this fiscal year and over $7.9 million annually through 2005-06 for treatment, probation, court monitoring, vocational training, and other miscellaneous costs. Collaboratives have been initiated among the stakeholder agencies and with the provider community. The preliminary estimate of the number of eligible participants is 4500 adults. Based on estimates by the Rand Corporation of possible average treatment costs, the price tag for the needed treatment services alone could exceed $9 million annually. A needs assessment is in process to better estimate the types of treatment, needed treatment capacities and intensity of probation supervision required. Additionally the provider community is being surveyed to determine the current treatment modalities available in Orange County, and the capacity of each for potential expansion. The goal is to develop an implementation plan that meets the intent and requirements of Proposition 36 for service initiation by July 1, 2001, while sustaining no increase in net county costs. Toward this end, other revenue sources are also being explored.

In the current job market with its low rate of unemployment, it can be difficult to hire qualified staff, especially for jobs that require specific certification or expertise. The Health Care Agency's Human Resources Office actively recruits to fill new and vacant positions and will participate in a pilot project for automated staff recruitment this year, which should enhance the Agency's ability to efficiently attract and hire qualified applicants. HCA also promotes participation in MPP and PIP as a benefit of employment with the Agency. Additionally, the Agency will work with CEO/ Human Resources to address classification issues associated with the Agency's restructuring efforts and participate in the Countywide reviews for Information Technology and Office Services classes.

The Agency faces a major fiscal challenge due to the potential of a State claim reduction of SB 90 reimbursement for State mandated children's mental health services for children with special education. SB 90 is the major funding source for these services, which are mandated by State law. This issue also affects other California counties providing special education mental health services.

Another potential fiscal challenge relates to Realignment funding, which is the largest single agency funding source. The two funding sources for Realignment— Sales Taxes and Vehicle License Fees— are directly impacted by the State economy. An economic downturn affecting these funding sources would reduce Realignment funding at a time when the need for county health and mental health services would probably be increased.

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Page 27
HEALTH CARE AGENCY
2001 BUSINESS PLAN

APPENDICES

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Page 28

Health Care Agency
Organization Chart

Appendix A

Director
Health Care Agency

Assistant Agency Director

• Information Technology
• Human Resources
• Quality Management

Deputy Agency Director
Regulatory Health

• Environmental Health Services
• Animal Care Services

Deputy Agency Director
Public Health (Health Officer)

• Epidemiology & Disease Control
• Adult & Child Health Services
• Health Promotion & Prevention

Deputy Agency Director
Medical & Institutional Health Services

• Emergency Medical Services
• Medical Services For Indigents
• Institutional Health

Deputy Agency Director
Behavioral Health Services

• Children & Youth Mental Health Services
• Adult Mental Health Services
• Alcohol & Drug Abuse Services

Chief Financial Officer
Financial & Administrative Services

• Financial and Program Support Services
• Management Services/Facility Support Real Estate
• Contract Development & Management

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Page 29

Health Care Agency
Organization Chart
Proposed for 2001

Appendix B

Director
Health Care Agency

Compliance Officer

Assistant Agency Director

• Information Technology
• Human Resources
• Quality Management

Deputy Agency Director
Regulatory Health

• Environmental Health Services
• Animal Care Services

Deputy Agency Director
Public Health (Health Officer)

• Epidemiology & Disease Control
• Adult & Child Health Services
• Health Promotion & Prevention

Deputy Agency Director
Medical & Institutional Health Services

• Emergency Medical Services
• Medical Services For Indigents
• Institutional Health

Deputy Agency Director
Behavioral Health Services

• Children & Youth Mental Health Services
• Adult Mental Health Services
• Alcohol & Drug Abuse Services

Chief Financial Officer
Financial & Administrative Services

• Financial and Program Support Services
• Management Services/Facility Support Real Estate
• Contract Development & Management

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Page 30

APPENDIX C
LEGAL MANDATES

SERVICE CATEGORY: Community Prevention

SERVICE DELIVERY: Animal Care Services
LEGAL AUTHORITY COMPONENT:
 H& SC §§ 1650 et seq., 121575-121710
F& AC §§ 17001 et seq., 30501 et seq., 31101 et seq., 31601 et seq.
 Civ. Code § 1834 et seq.
PC § 597 et seq.

SERVICE DELIVERY: Communicable Disease Control
LEGAL AUTHORITY COMPONENT:
 PC § 7500 – 7555, 1524. 1, 1202. 1
H& SC §§; 121050 – 121070, 120145, 120175, 120195, 120540,
120555, 120560,
CCR Title 17, Section 2500
PL 101-381 (42 USC § 201 et seq.)

SERVICE DELIVERY: Environmental Health
LEGAL AUTHORITY COMPONENT:
 H& SC §§ 17000-17995.5, 25100-25386. 5, 25404-25404. 6, 105275-105310, 106600-106735, 109875-114475, 117600-118360

SERVICE DELIVERY: Epidemiology
LEGAL AUTHORITY COMPONENT:
H& SC §§ 120130, 120175, 120210 et seq., 120275,

SERVICE DELIVERY: Health Assessment (Birth & Death Registration)
LEGAL AUTHORITY COMPONENT:
 H& SC § 102275 et seq.; EC § 2205

SERVICE DELIVERY: Prehospital Care System
LEGAL AUTHORITY COMPONENT:
 H& SC §§ 1797 et seq., 1798 et seq.
OCCO 4-9-1 et seq.

SERVICE CATEGORY: Prevention Services for Individuals

SERVICE DELIVERY: Alcohol & Drug Abuse Services
LEGAL AUTHORITY COMPONENT:
 PL 102-321 (42 USC § 201 et seq.)
H& SC Div's. 10.5 & 10.7

SERVICE DELIVERY: Child Health
LEGAL AUTHORITY COMPONENT:
 H& SC §§ 102865, 120325-120380, 104395, 125080-125105
W& IC §§ 16934 et seq.

SERVICE DELIVERY: Dental Health
LEGAL AUTHORITY COMPONENT:
 O. C. Bd. Res. 80-1343.

SERVICE DELIVERY: Health Promotion and Prevention
LEGAL AUTHORITY COMPONENT:
 VC §§ 27360 et seq., 27362( b) et seq. PHS 96. 125
H& SC 11755( o), (p), 11758.29 (e) R& TC §§ 30461.6( b)-30461( l)

SERVICE DELIVERY: Maternal Health
LEGAL AUTHORITY COMPONENT:
 H& SC §§ 101050, 101055, 123475-123575, 123380, 124175-124200

SERVICE DELIVERY: Nutrition
LEGAL AUTHORITY COMPONENT:
PL 94-105; PL 101-381
H& SC § 123275 et seq.

SERVICE DELIVERY: Tobacco Use Prevention
LEGAL AUTHORITY COMPONENT:
 H& SC § 104375 et seq.
LC § 6404.5

SERVICE CATEGORY: Treatment Services For Individuals (Community)

SERVICE DELIVERY: Adult Mental Health
LEGAL AUTHORITY COMPONENT:
W& IC §§ 11325.7 & 11325.8, 5000 et seq., 5150, 5600 et seq.
PC § 4011.6

SERVICE DELIVERY: Children's Mental Health
LEGAL AUTHORITY COMPONENT:
 W& IC § 5600 et seq., 14132( v)
GC § 7570
PL 94-105; PL 101-381
42 USC § 1396 et seq.
20 USC § 1400 et seq.

SERVICE DELIVERY: Indigent Medical Care
LEGAL AUTHORITY COMPONENT:
 H& SC §§ 1797.98a et seq.
W& I Code § 16940 et seq., 17000 et seq.

SERVICE CATEGORY: Treatment Services for Individuals (Institutional)

SERVICE DELIVERY: Adult Medical Services
LEGAL AUTHORITY COMPONENT:
 GC § 29602 PC §§ 4000 et seq., 6030

SERVICE DELIVERY: Adult Mental Health
LEGAL AUTHORITY COMPONENT:
 W& IC §§ 4360( A)( B), 11325.7 & 11325.8, 5000 et seq., 5150, 5600 et seq.

SERVICE DELIVERY: Child Mental Health
LEGAL AUTHORITY COMPONENT:
 GC § 7570
W& IC §§ 5000 et seq., 5600 et seq., 14132( v)
W& I 369.5 and 16010
42 USC § 1396 et seq.
20 USC § 1400 et seq.

SERVICE DELIVERY: Juvenile Health
LEGAL AUTHORITY COMPONENT:
 W& IC §§ 207.1( h), 209, 210, 319( d), 361.2( b),
850, 852, 1712, 1752. 7, 10553-10554,16501 et seq.

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Appendix D
HCA Business Plan 2000 Accomplishments HCA 2001 Business Plan Page 31
Business Plan 2000 Accomplishments
Summary and Highlights

The Health Care Agency’s Business Plan 2000 contained seven goals with five Executive Indicators and 55 consolidated projects. Details are provided on the attached matrix. A tally and highlights are provided below.

Accomplishments: Significant progress was made on the five Executive Indicators, but because they are multi-year projects, none of them were fully accomplished in 2000. Of the 55 projects, 36 (66%) were accomplished by the end of the year and 15 (27%) were partially accomplished. Additionally, four projects had significant unanticipated accomplishments over and above those planned.

Highlights of accomplishments associated with each of the seven major goals are as follows:

1. The goal to improve family and individual health was furthered by:

• Certification of a new 40-bed residential substance abuse treatment facility for abusing pregnant and parenting women with children, and moving negotiations ahead on an additional 80-bed behavioral health residential facility

• An 8% increase in the number of individuals receiving behavioral health services who are seriously emotionally disturbed children, adolescents transitioning to adult services, monolingual Spanish speaking adults, or adults in need of vocational training
• Completion of oral health assessments in targeted school districts to develop a baseline for current dental health status
• Development and implementation of a program at Garden Grove Community Hospital, UCI Medical Center, and Western Medical Center to promote the health benefits of breastfeeding to an estimated 1,500 women
• Establishment of the Children and Weight Task Force, which focuses on improved nutrition and fitness

• Collaboration with the TUPP Coalition to develop a Proposition 10 proposal for a comprehensive program of tobacco use prevention and cessation for pregnant women and parents of young children

2. The goal to assure the availability of integrated services - Prevention, Treatment, and Rehabilitation was furthered by:

• Refinement of the Domestic Violence (DV) Court pilot program. Caseloads increased by a total of 420 cases in DV Court and Drug Courts combined - 100 more than originally targeted.

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HCA Business Plan 2000 Accomplishments HCA 2001 Business Plan Page 32

• Providing substance abuse services to an additional 1,750 high risk adolescents including youth in Juvenile and Dual Diagnosis programs. This is over 1,500 additional cases more than planned.
• Receiving State Department of Mental Health approval for Children's System of Care funding
• Establishing the new Health Promotion and Prevention Division in Public Health Services
• A 5% increase in the rate of persons identified with latent TB infection who initiate preventive treatment
• Completing staffing and facility compliance phases of the Correctional Treatment Center for mentally ill individuals in County jail
• Identifying and scheduling needed facility Americans with Disabilities Act improvements

3. The goal to reduce environmental threats to health was furthered by:

• Implementation of 24-hour a day response capability for beach closures/postings and removal of closures/postings
• Implementation of a new foodborne illness surveillance system
• Development of an administrative enforcement order program for hazardous waste generators as an alternative to the criminal/civil complaint process
• Establishment of protocols to rank leaking underground storage tank cleanup cases based on MTBE concentrations and potential threat to groundwater

4. The goal to provide service with a focus on quality was furthered by:

• Completing the application phase to obtain accreditation of the Juvenile detention health facility
• Increasing the number of hours the Animal Care Center is open to the public and providing animal adoption counseling services
• Enhancing public access to information regarding:

• Food facility inspection information and food safety tips through implementation of the Award of Excellence program and introduction of the use of the Inspection Notification sticker
• Beach closures via posting on the Agency web site
• Medical waste management, through publication of a newsletter and training

• Evaluating the public's satisfaction with responses to food-related complaints through conducting and analyzing surveys and initiating procedures to address identified issues
• Completion of the Phase II Health Care Agency restructuring report consultant/study

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HCA Business Plan 2000 Accomplishments HCA 2001 Business Plan Page 33

• Establishing a baseline measure and achieving a 10% improvement in internal Agency customer service satisfaction
• Creating a new Revenue and Forecasting unit to maximize Agency revenue collection and develop new funding sources

5. The goal of creating a working environment that encourages excellence was furthered by:

• Implementing the Enlightened Leadership Program to maximize employee performance
• Successfully implementing the PIP and MPP programs
• Developing and implementing an employee recognition system
• Identifying a new Agency headquarters building, developing space plans, and entering into negotiations anticipated to allow for move-in by June 2001

6. The goal of the Health Care Agency being acknowledged in the community as a leader in health care planning was furthered by:

• Participating in development of a Proposition 10 strategic plan for use in determining the needs for early childhood programs for children, ages 0-5 years
• In participation with the community, identifying programs to meet health care needs in the community, some of which could be funded by Tobacco Settlement Funds
• Establishing a program of ongoing communication regarding Health Care Agency programs

7. The goal of implementing advance information technology systems for optimal use of information and resources was furthered by:

• Defining new initiatives in an updated Information Technology Strategy report
• Upgrading the Agency's computer network
• Increasing the number of the Agency's network computer users to 1950 of the roughly 2,500 Agency employees
• Completing eleven single year and five multi-year projects in the Agency Information Technology work plan and seven feasibility and requirements studies, all far in excess of the number planned

Projects not accomplished as planned: Only 4 (7%), of the planned major Agency projects were not accomplished. Two were dependent on the allocation of Tobacco Settlement funding, which did not become available in 2000 as anticipated. One was deferred until 2001 pending final CEO approval of the HCA organizational restructuring plan. The scheduled completion of the remaining one, to staff the medical component of the jail expansion, was delayed to coincide with a revised jail construction schedule. All four projects are expected to be completed in 2001.

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HCA Business Plan 2000 Accomplishments HCA 2001 Business Plan Page 34

Unanticipated accomplishments: Frequently, projects develop during a calendar year that were not anticipated when the Business Plan was prepared. Three major projects that provided unanticipated accomplishments for the Health Care Agency in 2000 are described below:

• Adopt-a-Pet / Lost and Found web site – in June, HCA inaugurated its Adopt-a-Pet web site – www.ocpetinfo.com. The Lost and Found feature was added in August. Orange County residents looking for a lost pet or a pet to adopt can view pictures of lost/adoptable animals on the internet. These sites receive over 3000 visitors each week.

• Therapeutic Behavioral Services – in late 1999, Behavioral Health Services / Children and Youth Services launched this new service for seriously emotionally disturbed youth who have been or are at risk of placement outside the home. The service consists of a one-to-one intensive behavioral intervention that can be provided up to 24 hours per day, seven days a week, if necessary. During 2000, 111 youth received Therapeutic Behavioral Services. It is estimated that this service avoided over 500 days of hospitalization for these youth.

• Community Revitalization Program – throughout 2000, HCA has participated in a collaborative with Probation, the Sheriff, SSA, and community-based organizations to provide direct services to the four targeted County Islands – El Modena, La Colonia Independencia, Midway City, and Southwest Anaheim. Services provided by HCA include mental health and substance abuse services, comprehensive health screenings for seniors, flu shots, public health nurse home visitations, and nutritional assistance through the Women, Infants, and Children (WIC) program.

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Business Plan 2000 Accomplishments
Goal #1: Improve family and individual health (Continued)

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Goal #2: Assure the availability of integrated services – Prevention, Treatment, Rehabilitation

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Goal #2: Assure the availability of integrated services – Prevention, Treatment, Rehabilitation (Continued)

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Goal #2: Assure the availability of integrated services – Prevention, Treatment, Rehabilitation (Continued)

Goal #3: Reduce environmental threats to health

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Goal #3: Reduce environmental threats to health (Continued)

Goal #4: Provide service with a focus on quality

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Goal #4: Provide service with a focus on quality (Continued)

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Goal #4: Provide service with a focus on quality (Continued)

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Goal #4: Provide service with a focus on quality (Continued)

Goal #5: Create a working environment that encourages excellence

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Goal #6: Acknowledged in the community as the leader in health care planning

Goal #7: Implement advanced information technology systems for optimal use of information and resources

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Goal #7: Implement advanced information technology systems for optimal use of information and resources (Continued)

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