County Board creates new department

A new Beltrami County Health and Human Services Department created Tuesday combines prevention with delivery of social services.

"I was skeptical at first," Beltrami County Commissioner Joe Vene said Tuesday night of merging the County Public Health Nursing Services Department with the County Human Services Department.

"After I studied the concept, I became excited about building into our process a better public policy result that raises the bar in both areas with a combined department that brings efficiencies," Vene said.

In a series of motions, commissioners Tuesday night combined the two county departments and created the position of health and human services director to head the joint operation, giving authority to County Administrator Tony Murphy to waive usual county policy to post for the position and to immediately hire a director.

"We do have an internal candidate," Murphy said. "With approval of the resolution, it is my intention to announce that Mary Marchel will fill that position."

Marchel, long-time County Public Health Nursing Services director, had surfaced in previous discussions by commissioners as a possible director of any joint department when former County Human Services Director Deb Allison announced her resignation four months ago.

Commissioners used three motions to merge the two county departments into the new Health and Human Services Department, to create and authorize filling the new health and human services director, and to authorize Murphy to hire four sub-directors of new departments that will handle day-to-day operations of the merged department.

Only three commissioners attended Tuesday's meeting -- Chairman Quentin Fairbanks, Jim Heltzer and Vene -- while Commissioners Ron Otterstad and Jack Frost were absent.

Fairbanks, however, said he had talked to both Frost and Otterstad and that they were supportive of the effort that the three remaining commissioners unanimously approved.

The Human Services Department is the county's largest, with nearly 106 full-time equivalent positions and a 2008 budget of $16.7 million.

The County Public Health Nursing Services Department has about 44 full-time equivalent positions and a 2008 budget of $2.49 million, much of it funded by government grants and fees for services.

"My biggest worry about the merger is that it involves two departments with different philosophies," said Murphy, who presented the proposal to commissioners. "It is prevention versus the process of service delivery, but I'm seeing that gulf narrowing. I can only see benefits for those philosophies."

A series of recent developments only made sense to combine the departments, Murphy said.

Aside from Allison's departure, the county on March 1 began a new system of delivering health services to indigent county residents. Through a contract with the multi-county Prime West Health Systems, Beltrami County now contracts with Prime West to administer a county-based purchasing/managed care model of managing health care for county residents enrolled in or eligible for Medical Assistance, General Assistance Medical Care and MinnesotaCare, moving away from a fee for services health care model.

"It is becoming more and more apparent that it is necessary to get health and human services functions working together," Murphy said. "Here in our county they already work closely together, while elsewhere there are a lot of territorial issues."

The move to Prime West has meant the county needs both more social workers and public health nurses, he said, as a holistic care approach focuses on preventive health measures and stronger case management. "We will be introducing a level of care in moving to self-sufficiency."

Also affecting county services, he said, is the closure of state institutions that provide mental health care, instead sending clients back to community-based services "which puts pressure on our system."

Under Murphy's plan, the new health and human services director would report to the county administrator. The position would direct four separate divisions, what Murphy calls "business units," whose supervisors would provide the day-td-day management of the new department.

"It's not possible for that person to be an expert in all the minutia of the department, and that's a good thing," he said. "It will need a director with leadership, someone to steer the ship, someone to oversee the department-wide culture and service philosophy."

The County Board authorized Murphy to hire directors for the four areas: social services director to oversee adult services and children's services, economic assistance director to oversee income maintenance and child support, business manager to oversee fiscal accounting and managerial accounting, and a public health director to oversee family health and community health.

"We will look internally to fill the positions first," Murphy said. "Then we will go out and publicly recruit."

Murphy's organizational plan calls for the creation of a health and human services advisory committee that would work between the new director and the four "business units."

Heltzer wanted to go ahead and authorize that committee to be appointed, but Murphy asked commissioners to hold off until a better description can be made for what the panel will do and membership.

He envisions a sounding board of non-profit organizations that work with county human services to recommend policy and fee schedules, similar to advisory panels already set up for parks and trails. The County Board, as the County Board of Health and County Human Services Board, would retain final decision-making, Murphy said.

Fairbanks said such an advisory panel will be useful in cutting down on agencies providing duplicative services. "People will jump around," he said. "When they can't get something from one, they will go to another.."

Murphy said over the past four months he had met with numerous staff in both departments with officials of other counties over the provision of health and human services.

"It is broadly supported, and I think this is a structure that will work," he said. "We have some wonderful staff who will rally embrace this."