Human Services Organization & Governance: A Changing Landscape

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The content discusses the evolving landscape of human services organization and governance, touching on topics such as consolidation law changes, social services regionalization, and the roles of agencies, directors, and state governance.

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Human Services Organization & Governance: A Changing Landscape Jill D. Moore & Aimee N. Wall Legal Basics for Human Services Administrators March 2018

Why are we talking about this? S.L. 2012- 126 (H 438) Consolidation law changes in counties S.L. 2017-41 (H 630) Social services regionalization & supervision working group

What are we talking about? Agencies Directors Employees Organization Local boards and advisory committees Role of state Governance

General Framework Requirement: Counties must provide public health and social services Organizational options: Single-county separate PH & SS agencies Single-county consolidated human services agencies Multi-county agencies Other (authority models, interlocal agreements) Governance options for single-county agencies: Appointed governing board(s), or BOCC may assume powers and duties of board(s) 4

G.S. 153A-77 (S.L. 2012-146, H 438) CONSOLIDATION

Consolidation Law Timeline 1973 1995 2012 Large counties may abolish boards (Mecklenburg) Large counties may establish CHSAs (Wake) All counties authorized to abolish boards and/or establish CHSAs 6

Options Stay the same Options in PH & SS laws Options in consolidation law

Options in Consolidation Law 2 1 Board of County Commissioners Board of County Commissioners Consolidated Human Services Board Department of Social Services and/or Public Health Consolidated Human Services Agency Board of County Commissioners as a Consolidated Human Services Board 3 Consolidated Human Services Agency

PH and SS Organization and Governance June 2012 Not consolidated Consolidated human services agency (CHSA) with a consolidated human services board (Wake) CHSA with BOCC as governing board (Mecklenburg)

PH and SS Organization and Governance Resolutions as of February 1, 2018 SS & PH agencies with appointed governing boards Option 1 with both SS & PH agencies governed by BOCC (Graham, Stokes, Sampson [eff. April 1, 2018]) Option 1 with SS agency governed by BOCC, PH agency with appointed governing board (McDowell, Mitchell, Watauga, Wilkes, Surry, Columbus) Option 2 with consolidated HS agency including SS & PH, appointed CHS board (Jackson, Haywood, Buncombe, Gaston, Union, Stanly, Rockingham, Wake, Nash, Edgecombe, Carteret, Dare) Option 2 with consolidated HS agency include SS and other human services but not PH, governed by appointed CHS board (Polk) Option 3 with consolidated HS agency including SS & PH, governed by BOCC, health advisory committee (Clay, Swain, Yadkin, Mecklenburg [no advi. comm.], Guilford, Montgomery, Richmond, Bladen, Brunswick, Pender, Onslow) Option 3 with consolidated HS agency including SS & other human services but not PH, governed by BOCC (Cabarrus)

Key Differences Agency Board Hire Agency Director Personnel Separate Appointed; 3-5 mem. Board hires SHRA DSS Separate Appointed; 11 mem. Board hires SHRA PH Separate Elected* BOCC hires SHRA One Consolidated (any combo of human services) Appointed; up to 25 mem. Elected* Manager hires with advice & consent of CHS board Manager hires with advice & consent of BOCC SHRA Optional Two Three Consolidated (any combo of human services) SHRA optional * If public health affected, must appoint health advisory committee (except in Mecklenburg)

What goes in a CHSA? Law does not require any particular mix of human services May include: Public health Social services Other county human services departments or programs Gaston County Public Health, Social Services, Transportation, Aging, Youth Services, Child Advocacy Center, Battered Women s Shelter Guilford County Public Health, Social Services, Transportation, County Veterans Affairs Cabarrus County Social Services, Aging, Transportation

CHS Board Membership (if appointed) Powers and duties Assume all powers and duties of PH/SS boards, except hiring director Other powers and duties Advise and consent to hiring/firing of director Plan and recommend a budget Assure compliance with state/federal laws Recommend creation of human services programs Perform public relations and advocacy functions County commissioner 4 consumers of human services Professionals: psychologist, pharmacist, engineer, dentist, optometrist, veterinarian, social worker, registered nurse, two physicians (one must be a psychiatrist) Up to 12 others 13

Board of Social Services Membership (if appointed) Powers and duties Consult with director in preparing agency budget Authority to inspect social services and public assistance records Authority to make some decisions related to Work First, Special Assistance, and services funded through the Social Services Block Grant Review suspected cases of fraud for some public assistance programs Two members appointed by BOCC Two members appointed by NC Social Services Commission One member appointed by the other members 14

Board of Health Membership (if appointed) County commissioner Physician Dentist Optometrist Veterinarian Registered nurse Pharmacist Professional engineer 3 general public members Powers and duties Make policy for local public health agency Adopt local public health rules Adjudicate disputes regarding local rules or locally imposed public health administrative penalties (fines) Impose local public health fees Satisfy state accreditation requirements for local boards of health 15

Common threads Statutorily required Statutes and regulations grant authority Agency director not a member Role in advising the director Role with regard to agency employees

Key differences Appointment Size and composition Removal Vacancies Fees Budget Appointing agency director Rulemaking Adjudications Accreditation-related duties Social services program related duties Access to records Assure compliance

BOCC as governing board Process 30 days notice of public hearing Resolution adopted after public hearing Membership Conferred by election to board of commissioners Not required to meet statutory requirements for particular professions Powers & duties Board of commissioners acquires; multiple sources of law Some may be delegated; some may not Advisory committee(s) Advisory committee on health required if BOH duties assumed Expanded committee or additional committees allowed

Role of advisory committees No guidance or specific grant of authority in consolidation statute PH accreditation expressly allows certain duties to be delegated from the local board of health to an advisory committee, such as Review and report on community data Receive community input Foster partnerships with the community Advocate for public health

Lessons Learned Organizational structure Flexibility, but still must comply with state and federal mandates Employees Advance discussion about implications of change Update HR policies/ ordinance in advance to comply with federal merit personnel standards Open legal question about transitioning career status employees Advisory committees Define roles, including appropriate delegation Information sharing Don t assume a components of a CHSA will be able to share information more freely than they could before consolidation Budget impact Don t assume creating a CHSA will save money

SOCIAL SERVICES WORKING GROUP

Overview S.L. 2017-41 (H 630)

SSWGs Puzzle Piece Stage One Stage Two Once reform is underway at the State level, how should a new and improved State system use regional offices to provide oversight and support for the county departments administering the social services program? In the county- administered system, what change is needed to improve coordination and collaboration at the county level? What would a regionally-administered system look like?

SSWGs Focus Stage One The WHOLE enchilada Child welfare Adult services Public assistance, including Medicaid, Food and Nutrition, State- County Special Assistance, Work First, Energy programs, program integrity, etc. Child support enforcement Adult care home oversight Other programs

Not SSWGs Focus Organization of the state agencies overseeing local administration Services What services are being delivered Who is delivering services Who is receiving services Finance Who is paying for services How much do services cost

Discussions Supervisory functions What is involved in supervising social services administration? Who does what? Central v. Regional v. County Staffing model What types of staff should be in the regional offices? Maps What factors are important when designing regions? Relationship with Board of County Commissioners Should the BOCC have an expanded role in supervision of DSS when there are challenges facing the agency?

Timelines Stage One Report 4/15/2018 Stage Two Report 2/1/2019 DHHS Plan 11/15/2018 NCGA and/or DHHS Acts? NCGA Acts? Regional Supervision? 3/1/2020