LA CROSSE COUNTY NOTICE OF MEETING COMMITTEE OR BOARD: Health & Human Services Board DATE OF MEETING: TUESDAY, JANUARY 12, 2021 TIME: 6:30 PM MEETING PLACE: La Crosse County Administrative Center

County Board Room 1700 212 6th Street North La Crosse, WI 54601

PURPOSE OF MEETING: See Attached Agenda

NOTICES FAXED/MAILED/EMAILED TO: NEWS MEDIA COUNTY DEPARTMENTS COMMITTEE MEMBERS La Crosse Tribune County Board Chair Tina Tryggestad, Chair Coulee News County Administrator Kim Cable, Vice-Chair WKBH County Clerk Noelle Weber-Strauss WLSU Corporation Counsel Jamie O’Neill WKBT-TV Health Director Maureen Freedland WIZM Human Services Director Tom Jacobs WLFN Ebony Hyter WXOW-TV OTHER Laurie Logan Onalaska Community Life Peg Isola Vacant Holmen Courier Bob Kellerman Fox News TV Kathie Knoble-Iverson Andrea Richmond Marilyn Hempstead Bryan Jostad David Trapp

MEMBERS: If unable to attend, call County Clerk’s Office at (608) 785-9581.

* PUBLIC COMMENT: The Board may receive information from the public, but the Board reserves the right to limit the time that the public may comment and the degree to which members of the public may participate in the meeting. PERSONS WITH DISABILITY: If you need accommodation to attend this meeting, please contact County Clerk’s Office at (608) 785-9581 as soon as possible. PUBLIC ACCESS TO BUILDING: The east entrance to the Administrative Center will be the only door to the building open after 4:30 p.m. DATE NOTICE FAXED/MAILED/EMAILED AND POSTED: January 7, 2021 Following is the link for the public to livestream the meeting: https://www.facebook.com/LaCrosseCounty/ Note: County staff will not be responding to comments in the chat box of the livestream.

NOTE TO BOARD MEMBERS: If you have questions re: Director Reports or Consent Agenda Items, you are encouraged to contact the appropriate Dept Head before the board meeting to get additional information.

Health Dept: Jennifer Rombalski, 785-6425, jrombalski@lacrossecounty.org Human Services Dept: Jason Witt, 785-6095, jwitt@lacrossecounty.org

LA CROSSE COUNTY NOTICE OF MEETING HEALTH & HUMAN SERVICES BOARD

Date: Tuesday, January 12, 2021 Time: 6:30 PM Place: La Crosse County Administrative Center

County Board Room 1700 212 6th Street North La Crosse, WI 54601

1. Announcements

A. December County Board Action B. Board Members Report on Conferences/Meetings/Workshops C. County Recognition of Health Department Staff in February

2. Public Comment (See * on page 1 of this notice)

3. Board Education

A. Policy, Practice, People of Health – Vector Control B. COVID-19 Question and Answer

4. Director Reports

A. Health Department Written Director’s Report B. Human Services Written Director’s Report

5. Consent Agenda

A. Minutes 1. Health & Human Services Board 12/8/20 2. Criminal Justice Management Council 11/18/20 3. Aging & Disability Resource Center Advisory Committee 12/10/20 4. Family Policy Board 12/7/20 5. Integrated Support & Recovery Services Advisory Council 12/16/20

B. Department Reports 1. Vendor Audit Report

6. Items for Future Agendas

7. Adjournment to the next meeting to be held on Tuesday, February 9, 2021

Start time for agenda items

6:30

6:45

6:50 7:10

7:25

7:30

7:35

AGENDA ITEM NUMBER: 3A MEETING DATE: 1/12/21

REPORT TO THE HEALTH & HUMAN SERVICES BOARD

DEPARTMENT: Health X INFORMATION/DISCUSSION SECTION: Vector Control SUBJECT:

2020 Mosquito Abatement Program

PREPARED BY: Jen Rombalski (with Joey Writz of

Driftless Region Vector Control LLC) FILING ID:

REVIEWED BY: Jen Rombalski IMPLEMENTATION DATE:

Policy: The goal of the mosquito abatement program is to decrease the presence of vectors and vectorborne disease transmission throughout the region. This was done by identifying and monitoring locations that may contain potential habitats for disease-related mosquitoes in close proximity to outdoor human activity. We also take a closer look and treat the habitat with a safe larvicide. All information was recorded as sites were checked monthly from May through October. Driftless Region Vector Control LLC follows Integrated Pest Management (IPM) for an effective maintenance of a safe environment. By following IPM practices, we are able to increase the effectiveness and efficiency of services and also reduce the risk of causing a negative impact on non-target organisms. Communication and education plays a major role in the mosquito abatement program. If public awareness of disease-related mosquito habitats (e.g. unrimmed tires and containers) increases, then the prevention of this issue in the future will also increase. We encourage residents and business owners to use source reduction. This involves removing water sources that are needed to sustain the life cycles of mosquitoes. Although the pesticides we use to treat containers are safe to non-target organisms, it is only a temporary solution until the property owner fixes the issue. Because of this, education is the most important and longest lasting method of abatement. Practice: Public education, habitat control, and surveillance are essential pieces of the abatement program. The following are typical steps throughout the mosquito season:

1. Sites are identified for monthly monitoring throughout the season. This includes properties with tires, trash cans, and other various containers as well as properties in close proximity to outdoor human activity such as parks.

2. When water-holding containers are found, we look for the presence of mosquito larvae. If possible, the containers are dumped and flipped over. Otherwise, they are treated with a safe larvicide which is non-toxic to organisms other than the targeted mosquito species. This treatment is meant as a temporary solution (about 30 days) until the property owner can properly manage the issue.

3. Information gathered for each site includes date/time, habitat found, presence of larvae, and treatment type. Steps are then repeated for each monthly check.

STATISTICS FOR 2020 MOSQUITO ABATEMENT ACTIVITIES Total Sites Monitored includes 204 unique sites (924 checks total) broken down as follows: Automotive/Tractor: 105; Waste Disposal: 8; Parks: 42; Other: 49 People: Joey Writz of Driftless Region Vector Control, LLC, our contracted mosquito control program provider, will present an overview of the program from 2020.

2020 Mosquito Abatement OverviewLa Crosse County

This report provides an overview of the program, including goals, historical context, and information about vectors the program aims to address to prevent disease. Also included is a breakdown of mosquito abatement activities for the 2020 season as well as program improvement ideas and recommendations from the state health department.

PROGRAM GOALS:

The goal of the mosquito abatement program is to decrease the presence of vectors and vector-borne disease transmission throughout the region. This was done by identifying and monitoring locations that may contain potential habitats for disease-related mosquitoes in close proximity to outdoorhuman activity. We also take a closer look and treat the habitat with a safe larvicide. All information was recorded as sites were checked monthly from May through October. Driftless Region Vector Control LLC follows Integrated Pest Management (IPM) for an effective maintenance of a safe environment.

By following IPM practices, we are able to increase the effectiveness and efficiency of services and also reduce the risk of causing a negative impact on non-target organisms. Communication and education plays a major role in the mosquito abatement program. If public awareness of disease-related mosquito habitats (e.g. unrimmed tires and containers) increases, then the prevention of this issue in the future will also increase. We encourage residents and business owners to use source reduction. This involves removing water sources that are needed to sustain the life cycles of mosquitoes. Although the pesticides we use to treat containers are safe to non-target organisms, it is only a temporary solution until the property owner fixes the issue. Because of this, education is the most important and longest lasting method of abatement.

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HISTORY:

Vector control work has been performed in the counties of Western Wisconsin and Southeastern Minnesota for the past 41 years. La Crosse virus (LACV), West Nile virus (WNV), and Lyme disease are endemic within this region. Control of mosquito-borne arboviruses and tick-borne diseases can be difficult, but we have the best opportunity for ongoing prevention of these diseases with the cooperation of multiple health departments. This region has historically accounted for the highest number of clinically documented cases of La Crosse Encephalitis (caused by LACV) in the United States.

In 1980, Winona and Houston Counties in Minnesota and La Crosse, Monroe, Vernon, and Crawford Counties in Wisconsin formed a multi-county arboviral control program. This program targeted the mosquito vectors of LACV named Aedes triseriatus. These counties historically reported the highest number of clinically diagnosed cases of LACV in Wisconsin and Minnesota.

From 1969 to 1979, the annual number of clinically diagnosed cases of LACV reported from these counties ranged a low of 20 to a high of 40 with an average of approximately 27 cases annually. Inthe 10 years following the formation of the multi-county program, these counties averaged approximately 7.6 clinically diagnosed cases of LACV annually. Since 1990, the average number of reported cases has been less than three annually. La Crosse Encephalitis is a disease of long standing in our region. LACV was first isolated and identified as a new arbovirus in the early 1960's after it was found in the brain tissue of a young girl who passed away as a result of her infection. LACV now poses disease consequences for residents in over 30 states of the eastern and central United States. According to several studies showing the cost of an average clinical case of La Crosse Encephalitis, the expense of one case could fund a multi-county mosquito abatement program for several years. The funds historically provided for this program by the participating governmental bodies involved has saved their residents not only a tremendous amount of pain and suffering, but also potentially millions of dollars of medical costs associated with LACV, WNV, Lyme disease, and other vector-borne diseases.

DISEASE VECTORS:

The diseases and mosquito species targeted have changed since 1980, and these focuses will continue to adapt to changes in the future. Minnesota and Wisconsin are home to over 50 species of mosquitoes, but only a select few are of significant importance to human health. Culex species of mosquitoes are vectors for WNV that primarily lay their eggs in stagnant water, but can also lay eggs in containers. Aedes triseriatus & Aedes japonicus are vectors for LACV that primarily lay their eggs in tree holes or containers. These mosquitoes commonly begin to emerge for the season in April or May with viral activity peaking in August or September. Aedes japonicus is a cold weather tolerant species, meaning it can stay active later in the year and increase the viral season into November. This species also travels further in its lifetime than Aedes triseriatus, increasing the chance for disease transmission. Another mosquito species which could have an impact on public health is Aedes albopictus. This specieshas been found breeding at tire sites in Minnesota and at sites in Dane County, Wisconsin in 2017. Testscompleted in 2018 suggested they did not survive the winter. It should be noted that this mosquito is a vector for LACV, WNV, Zika virus, and other arboviruses and also feeds more aggressively on humans with an increased flight range. Because of climatic and environmental changes, there is potential for it tobecome more established and cause many issues in the future.

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DISEASES:

Due to the fact that containers play a major role in the transmission of each of the following diseases, it should come as no surprise that they are the main target in mosquito abatement. Items such as buckets, kiddie pools, and other containers are perfect habitats for breeding disease-carrying mosquitoes. Unrimmed tires are especially problematic because they are able to retain water and heat particularly well. This allows for many more generations of mosquitoes to be created compared to other containers.

La Crosse EncephalitisThis disease is caused by the La Crosse virus which is carried by Aedes mosquitoes. This virus

can be naturally found in small mammals, such as chipmunks and squirrels, with humans being an incidental host. It takes 5-15 days for symptoms to emerge including fever, headache, nausea, vomiting, fatigue, and lethargy. More serious cases can lead to severe neuroinvasive disease with symptoms including encephalitis, seizures, coma, and paralysis. Neuroinvasive disease occurs most frequently in children under the age of 16. Less than 1% of clinical cases are fatal, however, this disease can lead to long-term effects such as recurring seizures, hemiparesis (partial paralysis one side of body), and cognitive and neurobehavioral abnormalities. There is currently no vaccine or specific antiviral treatments available, so care is limited to supportive treatments for symptoms like seizure control. As of 2018, the average cost for a mild case is about $40,000, while severe cases can cost up to $450,000.

West Nile VirusThis vector-borne disease is carried by both Aedes and Culex mosquitoes with natural hosts

being birds, such as crows and jays. When a human is infected, it takes 3-14 days for symptoms to emerge. In 70-80% of cases, people are asymptomatic and it is inapparent that they are infected. About 20-30% of cases develop West Nile Fever with symptoms including headache, body aches, skin rash, and fever. West Nile Neuroinvasive Disease is found in 1% of cases and symptoms can include meningitis, encephalitis, high fever, neck stiffness, disorientation, coma, tremors, convulsions, and

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paralysis. Of the patients with West Nile Neuroinvasive Disease, 10% of cases are fatal. Long-term effects of this disease can include persistent disabling neurological issues like tremors, movement disorders, and cognitive problems. Currently there is no vaccine or specific antiviral treatments available, and supportive treatment is used to reduce fever and relieve some symptoms. According to a 2014 study published in The American Journal of Tropical Medicine and Hygiene, the initial cost for a patient infected with West Nile virus averages from $7,500 to $82,500 depending on the severity of the case. Depending on patient needs, long-term costs of care, such as physical and speech therapy, medication, and medical appointments, average from $7,000 to $76,700 yearly.

Jamestown Canyon EncephalitisThis illness is caused by the Jamestown Canyon virus carried by both Aedes and Culex

mosquitoes. White-tailed deer and other ruminants such as elk, sheep, and cows, are natural reservoirs for the virus. Most cases are asymptomatic and it takes 2-14 days for symptoms to appear. Symptoms can range from sore throat, runny nose, cough, fever, headache, nausea, and vomiting to severe neuroinvasive disease. These severe cases occur in 68% of clinically reported cases with symptoms like severe headache, neck stiffness, coma, encephalitis, and meningitis. Long-term effects of this disease can include central nervous system issues, similar to other arboviral diseases. Similarly to other vector-borne diseases, there is currently no vaccine or antiviral treatments available, so the only option is supportive treatment and managing complications. The cost for a patient infected with this disease is similar to that for West Nile virus and La Crosse Encephalitis since they share symptoms which may be present.

These diseases followsimilar patterns throughout themosquito season. In spring, thedisease is amplified and spreadthroughout the natural hosts andmosquitoes. In the late summerand into fall, transmission tohumans occurs more frequentlywith females needing a bloodmeal to be able to lay eggs. LaCrosse virus and JamestownCanyon virus are bothtransovarian, meaning the disease can be passed on from the female to her offspring. Because these viruses always have a host population in nature, it is important to reduce breeding habitats in close proximity to humans in order to limit exposure to vector-borne disease.

A NOTE ON TICKS:

Although ticks are currently not the primary focus of this program, it is important to keep them and the diseases they may carry in mind. Ixodes scapularis, also known as the black-legged tick or deer tick, is the primary vector for Lyme Disease, Anaplasmosis, Babesiosis, and Powassan virus in our region. Another tick called Dermacentor variabilis, commonly called the wood tick or dog tick, can carry Rocky Mountain Spotted Fever and Tularemia. The third tick species we can be exposed to in our area is Amblyomma americanum, or the Lone Star Tick, which is a vector for Ehrlichiosis, Rocky Mountain Spotted Fever, and Tularemia. These tick species are active between March and November

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and progress through the life stages of larva, nymph, and adult by getting a blood meal from a host. These hosts vary from small mammals to humans depending on the tick's species, life stage, and host availability. Personal protection is a big factor in tick-borne disease prevention. This can be accomplished by educating the public about avoiding tick habitat such as long grass, using repellents, and checking for ticks after spending time outdoors. When removing ticks, avoid crushing the tick's body and do not use petroleum jelly, a hot match, nail polish, or other products to get the tick to back outof the bite site. These actions may traumatize the tick and cause it to regurgitate its gut contents, including the bacteria, into the wound. Instead, use a fine-tipped tweezers to grasp the tick as close to the skin's surface as possible. Then, carefully pull the tick upwards and out of the skin and clean the bite area with soap and water.

ENVIRONMENTAL CHANGES:

Climate change is widely accepted throughout the scientific community. Shifting seasonal temperatures and weather make a huge impact on which mosquito species can survive in our region and what times of the year they are active. In recent years, mosquito eggs have been captured in traps earlier in the spring and later into the fall. This means a longer mosquito season and a longer period during the year with potential for disease transmission. Scientists also predict an increase in extreme weather such as severe storms and flooding due to climate change. Because the mosquito relies on aquatic life stages for development, rain and flooding provide a large amount of habitat options for eggs. Warming conditions will promote the spread and establishment of Aedes japonicus, Aedes albopictus, and other disease vectors as well as the diseases they carry. Having a vector control program such as this is important for disease prevention and preparation for what may come in the future.

ABATEMENT STEPS:

Public education, habitat control, and surveillance are essential pieces of our abatement program.The following are typical steps throughout the mosquito season.

1. Sites are identified for monthly monitoring throughout the season. This includes properties with tires, trash cans, and other various containers as well as properties in close proximity to outdoor human activity such as parks.

2. When water-holding containers are found, we look for the presence of mosquito larvae. If possible, the containers are dumped and flipped over. Otherwise, they are treated with a safe larvicide which is non-toxic to organisms other than the targeted mosquito species. This treatment is meant as a temporary solution (about 30 days) until the property owner can properly manage the issue.

4. Information gathered for each site includes date/time, habitat found, presence of larvae, and treatment type. Steps are then repeated for each monthly check.

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STATISTICS FOR 2020 MOSQUITO ABATEMENT ACTIVITIES:

Total Sites Monitored:Automotive/Tractor: 105Waste Disposal: 8Parks: 42Other: 49

Total: 204 unique sites (924 checks total)

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Based on data collected during site checks in La Crosse County in 2020, the average number of containers for all checks was calculated for each site. Similarly, the average container index (decimal percentage of infested containers) was found. By multiplying these two numbers, a risk factor number was shown to be able to make comparisons between the various sites. After looking at the risk factor

Category Description

1 No Containers or Site Fixed/No Longer Issue

2 Containers & No Breeding, Known Weekly Removal

3 Containers & No Breeding

4 Containers & Breeding Low (RF = 1.000 or less)

5 Containers & Breeding Medium (RF = 1.001 to 5.000)

6 Containers & Breeding High (RF = 5.001 or more)

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Recommendations for the Future:

From what I have observed throughout my time working in vector control, there are many areas of the program which could be improved. I have discussed vector control with a member of the State Health Department who works with vector-borne and communicable diseases. He shared information from the Centers of Disease Control and Prevention (CDC), the National Association of County and City Health Department Officials (NACCHO), and the American Mosquito Control Association (AMCA). From these sources, it is stated that 84% of local agencies are not prepared for a mosquito-borne disease outbreak. Priorities for a vector control program include treatment based on surveillance data and thresholds, species identification, and non-chemical control such as source reduction and water management. It is also important to enforce laws and ordinances, evaluate the program to make necessary improvements, and ensure current scientific information is being used. Public education and outreach is the most effective and safest tool for mosquito disease abatement.

Taking a closer look at our program specifically, I believe the continued monitoring of this year'ssites is an important step towards decreasing the potential risk of virus transmission. The site list can be further expanded and refined in the future depending on changing situations. Another option for further expansion would be to canvass residential areas in search of man-made habitats. As a result, this would include more education of residents as well as source reduction.

In order to gain more information on the mosquitoes present in an area, identification can be done especially through the use of traps. Primary uses for traps include tracking mosquito population, egg collection, and adult identification. One example is an ovitrap, which is a simple and time efficient trap for collecting eggs of container-breeding mosquitoes. This type of trap encourages mosquitoes to lay their eggs here where they are disposed of instead of seeking out other habitat. The amount of eggs present can provide us with an idea of where there are higher densities of mosquitoes. There are other types of traps that use CO2 and light to attract adult mosquitoes for identification. These traps show us population and species, but they are time consuming and much more expensive than ovitraps. Mosquito traps can provide us with a significant amount of information and allow for better abatement methods if the funding to do so is available.

In conclusion, it is stated that the goal of Public Health is to promote and protect the health and well-being of people and their communities. The focus of this program is not and should not be about simply treating sites with insecticides, and should rather be concentrated on educating the public and disease prevention. The IPM methods that the Driftless Region Vector Control LLC uses provides a safer environment for the communities involved. The funds provided for these services cover expenses including cost of larvicide, printing, insurance, licenses, and largely travel and wages. Continuing this mosquito abatement program not only protects residents from current health threats, but also provides communities with preventative knowledge for the future.

Thank you for your time,

Joey WritzOwnerDriftless Region Vector Control LLC

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2020 - Year in Review: Early 2020 - started the year off with normal public health activities: Radon Action Month in January, recognizing Healthy Living Heroes, promoting rabies vaccinations and dog licenses, education on e-cigarettes and 2nd hand smoke exposure, education on using caution during flood and storm clean up, WIC (Women Infants and Children) Program was operating full-time in person, serving 1800 people per month. On February 28th - Department activities began to change. On this day, Wisconsin saw its 1st case of COVID-19 and the La Crosse County Health Department (LCHD) issued its 1st press release. Our message then was "Let's Be Ready" and urging local residents to protect themselves by washing hands, covering their mouths, avoid touching eyes, nose and mouth, and staying home from work while sick. On March 9th - the La Crosse County Health Department hosted a media conference with media partners, Andrea Palm, Dr. Abby Deyo at UWL, Gundersen and Mayo. A key part of LCHD's mission is to protect the health of all La Crosse County residents. It was our intention with these early press conferences and information sharing to best inform La Crosse County residents of the risks at hand and prepare them for what might be to come. On March 12th - Jen issued a call for La Crosse County to avoid any events that attract 250+ people and consider postponing or canceling such events. Additionally, travel guidance was expanded for residents who have travelled to various areas of the United States and internationally to quarantine upon their return to reduce the risk of spread. On March 13th, we alerted area media about how we would communicate the 1st case of COVID-19 in our county. Several days later Governor Evers issued executive order #72 and Department of Health Services (DHS) Order #5. This order banned gatherings of 10 or more people, including operations of bars and restaurants. On March 18th, we had our 1st positive case of COVID-19 and hosted an in-person briefing with the press. We were not yet wearing masks at this time but were practicing social distancing. This briefing was the 1st to be live streamed on our Facebook page. Through the remainder of the month of March, we began to see additional cases, and were able to determine that we had a level of community spread in our County. In April we were hosting 3 media briefings per week to provide situational updates to our community related to COVID-19. These briefings served as a way for us to inform the community, because we know if community members had the right and accurate information that they could make the best decisions for themselves and their families. One of the biggest successes of our Health Department in April was the addition of Food Drive Fridays in partnership with The Hunger Task Force. Our community stepped up in a big way. In total over $300,000 was raised and almost 70,000 pounds of food was collected. Our local media partners and community groups and organizations played a big role in this success. Despite there being so many negatives from COVID-19, this was a positive. In May, our community began hosting routine COVID-19 testing sites in partnership with the Wisconsin National Guard. This took a lot of time and effort from our team, and to date, we have tested thousands and thousands of community members. Our public health team couldn't do this without the National Guard and many community volunteers. This filled a large gap for testing in our community, and for that we are thankful. We continue to provide this testing weekly and will do so for as long as the funding is approved and is needed. In late May, we launched the COVID-19 Compass, a tool that used local data to help guide businesses and individuals as they made decisions related to the level of risk in our community.

La Crosse County Health & Human Services Board

Health Department – Director’s Report

January 2021

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In June, our county began to see increasing levels of community spread of COVID-19. Because of this, our department launched an Outbreaks and Investigation page. This was meant to educate the public about locations that have seen a number of cases, and if they have been at these locations to be extra vigilant about monitoring for their symptoms and to seek out testing. During this time, we also launched a new initiative called Check the Spread. This webpage remains active, and to date we've had over 200 local businesses take a pledge to keep community members safe and follow COVID-19 public health guidelines. La Crosse County experienced its 1st death of COVID-19 in July. This was a difficult day for our team. Our team worked diligently for 5 months and were fortunate to not experience any COVID-19 deaths in our County from March-July. Unfortunately, to date we now have more than 50 deaths due to COVID-19, with the majority of those happening since October 1st. In August, our health department announced that we would be moving to a collaborative path forward, and the Coulee COVID-19 Collaborative was launched along with a new website. This group continues to meet routinely and continues to provide guidance to community members, businesses, and schools with the most up to date COVID-19 data available using the Harvard Model. Our County saw the biggest jump in community spread in September, which coincided with the return to schooling by the 18-24-year-old age group. This level of spread in our County was alarming, and quickly had wide reaching impacts as these community members are vital to our infrastructure and work in areas like long term care, daycare facilities, our hospital systems, and more. Fortunately, we made it through this level of surge without having significant levels of impacts to our healthcare systems, though we did begin to see a rise in resident deaths during this time period despite our best efforts to slow the spread. November saw the biggest surge in cases that our County had seen to date, putting a level of strain on our healthcare systems that was most alarming. This triggered LCHD and the Coulee COVID-19 Collaborative to recommend all residents stay home and only go outside of their homes for the essentials. This type of language and recommendations hadn't been seen since the beginning of the pandemic during Stay at Home protocols in the Spring. It was necessary. Our community stepped up, and while we did see some impacts from the Thanksgiving Holiday, case rates have steadily decreased as have hospitalizations. On December 21st, vaccines and hope arrived in La Crosse County. Both healthcare systems accepted deliveries of the Pfizer vaccine. This is a huge public health and scientific accomplishment. Our 1st case in La Crosse was in March, and we now have a vaccine in December. We remain hopeful, but we cannot let up now. La Crosse County could continue to see dire consequences if we do not continue to follow the public health recommendations that have not changed since March. There is a light at the end of the tunnel, but we must continue following recommendations. Staffing Changes: The Health Department currently has 114 people on staff including full time, part time, and limited term employees. Our typical staffing, prior to COVID response, includes 62 full and part time employees representing 14 different public health professions. Over the past couple of months, we have had received resignations from 2 Community Health Nurses and 1 Health Educator. We are currently recruiting for the Community Health Nurse position and will be working on the recruitment for the Health Educator in the near future. We are also recruiting for LTE Health Educator position(s) to support grant work that cannot be completed due to staff being redeployed to COVID response. In addition, after a total of 29 years of service, our Office Supervisor Diane Panzer (aka “The Rock”) is retiring. Her last work day is February 5th. We will greatly miss Diane, including her ability to keep all the details aligned across the many requirements, deadlines, and functions of our department. We have hired Eric Gowey who will start on January 25th. Eric has a Bachelor’s degree in marketing and an Associate’s in graphic design. He has worked in various roles for over 8 years at Kaplan Professional, comes with a passion for servant leadership, and has experience working with data and evaluation.

A Note of Gratitude: In light of being nominated and selected to be the 2020 Person of the Year through the La Crosse Tribune, I wish to acknowledge that this honor is in large part possible due to many people who support me and the Health Department. A special thanks to all staff in the Health Department; County partners including Administration, Human Resources, Finance, IT, Human Services, Corporation Counsel, Emergency Management, GIS, Facilities; and community partners. Also, I am so grateful to have a Health & Human Services Board and County Board whose members care about this community and work to support the Health Department’s efforts to serve our community. Thank you!

DIRECTOR’S REPORT TO HEALTH & HUMAN SERVICES BOARD JANUARY 2021 REPORT FOR DECEMBER 2020 ACTIVITY

Goal 1: Assess Public Health Nursing Manager Jacquie Cutts and Health Educator Rachel King continue working together to produce

weekly COVID-19 data and reports. Public Health Nursing Manager and Director participated in the Compass NOW community health assessment

meeting with Great Rivers United Way and other partners. The community health assessment is expected to be completed in Q1 of 2021.

Goal 2: Investigate

Goal 3: Inform & Educate Health Education staff working with the Tobacco Prevention and Control grant was asked to share experiences

working to achieve smoke-free Pride Fest and smoke-free parks with City of Milwaukee Tobacco-Free Alliance. COVID Response Coordinators (Testing, Data, Communications, Disease Control), Health Officer, Associate County

Administrator continue to meet with Coulee COVID-19 Collaborative partners (Mayo and Gundersen) to review data and share evidence-based recommendations with the public.

Director participated in media briefing on vaccinations with providers from Mayo and Gundersen.

Goal 4: Community Engagement Health Education staff, working as the Program Lead in Data, coordinated a small group discussion with

representatives from the Coulee COVID-19 Collaborative to discuss blending local data points with data available from the state to support local data driven decision making.

Health Education, Nutrition and Environmental Health staff working in the Communications Team for the COVID-19 public health response program were highlighted as one of two counties in a Zen City update having a successful campaign in keeping residents informed. Zen City is a service which tracks engagement of the public on a variety of social media platforms.

Health Education staff working with the Overdose Fatality Review Team hosted a meeting in December strategizing implementing 2 of the 5 recommendations from previous death reviews to action in 2021 utilizing additional funding available through the Department of Justice.

Goal 5: Policies & Plans Strategic Planning for Health Department continues – full team met to review draft themes from the SCOT analysis

and potential priority areas.

Goal 6: Public Health Laws

Goal 7: Access to Care

Goal 8: Workforce Active recruitments for Community Health Nurse and Office Supervisor positions. Director, Health Education

Manager, and Leadership Team conducted phone screenings and interviews. Health Education staff, working as Daily Manager in COVID Disease Investigation, is training and orienting new staff

to the Disease Investigation Team. Health Department Leadership Team met with Human Resources to discuss staffing – this will occur on a regular

basis to maintain effective and strategic communications around the Department’s vision, talent acquisition, and talent management.

Numerous staff completed required bi-annual Basic Life Support/CPR training (trainer: Brenda Hanson).

Goal 9: Quality Improvement Health Education staff, working as Daily Manager in COVID Disease Investigation, is working with the Disease

Investigation Team to put into practice a Quality Assessment and Quality Improvement process for charting WEDSS information on COVID cases.

Goal 10: Evidence-Based Practice Vaccine freezer has been installed and tested. Health Education staff, working as Daily Manager in COVID Disease Investigation, is working with PHN staff to

develop a comprehensive Resource Guide for Investigation and Contact Tracing. Health Ed staff working as Daily Manager in COVID Disease Investigation is working with Fiscal staff to create a

master schedule for Disease Investigation to evaluate staff coverage for disease investigation. Health Ed staff working with UW-La Crosse Health Education program to complete a literature review associated

with school-based settings and COVID best practices.

Goal 11: Administrative & Management Medical Reserve Corps (MRC) Coordinator (Brenda Hanson) and Director met with Corporation Counsel to discuss

liability protections relating to MRC volunteers.

Goal 12: Governance HHS Board Chair Tina Tryggestad becomes new member of the Strategic Planning Committee and participated in the

December meeting.

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Human Services Director’s Report To the Health & Human Services Board

January 2021

Activity Program/ Section

Brief Description

Contact Person Attach-

ment

Transportation Services

Aging & Disability Resource Center (ADRC)

The ADRC is an annual recipient of Specialized Transportation Assistance funds as authorized by Wisconsin Statute 85.21. Any unspent funds are held in a trust for future expenses or the acquisition or maintenance of transportation equipment. Given the balance of the trust, the ADRC sought applications/requests from local non-profit service providers to assist with the purchase or maintenance of equipment used for specialized transportation. As a result, the ADRC was pleased to grant funds to three local agencies:

• $2,700 to Aptiv for various equipment/maintenance • $5,200 to Benedictine Living Community for wheelchair lift • $2,125 to Lakeview for various equipment/maintenance

Carissa Pagel-Smith 785-6172 cpagel@lacrossecounty.org

No

Caregiver Support Aging & Disability Resource Center (ADRC)

The ADRC is excited to announce a new program to the area, Savvy Caregiver. This six-week program focuses on helping family/friend caregivers of people living with dementia to acquire and strengthen knowledge, skills and attitudes that are appropriate for the community-based caregiving role they have undertaken. Classes will be held every Tuesday from 9:30 - 11:00 AM, February 9-March 16. Register by February 4 by calling the ADRC at 608-785-5700.

Carissa Pagel-Smith 785-6172 cpagel@lacrossecounty.org

No

FoodShare Update Economic Support (ES)

In response to the COVID-19 pandemic, the Wisconsin Department of Health Services (DHS) is continuing to suspend most FoodShare interviews. The suspension, which would have ended December 31, 2020, will now continue through June 30, 2021. Applicants who only provide a name, address, and signature when they apply will still need to complete an interview. DHS is able to continue this suspension as a result of provisions in the federal Continuing Appropriations Act, 2021 and Other Extensions Act. When renewals resume for FoodShare, interviews may again be required.

Lorie Graff 785-6061 lgraff@lacrossecounty.org

No

4B 4B

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Activity Program/ Section

Brief Description

Contact Person Attach-

ment

Grant Award Justice Support Services (JSS) – System of Care

Youth System of Care Administrator Bridget Todd-Robbins was awarded a grant in the amount of $3,286 from the Department of Justice to support the use of a consistent Youth Assessment Tool (Child and Adolescent Functional Assessment Scale – CAFAS) and database across several youth serving agencies within the community including: La Crosse System of Care, La Crosse Family YMCA, The Good Fight, and Boys and Girls Club of Greater La Crosse. By utilizing a shared assessment tool across youth serving agencies, it is expected that the needs of youth, especially youth of color, will be better identified and met, resulting in less involvement with the youth justice system.

Mandy Bisek 792-4275 mbisek@lacrossecounty.org Bridget Todd-Robbins 386-7264 btodd-robbins@lacrossecounty.org

No

Media Praise Justice Support Services (JSS) – System of Care

Youth System of Care Administrator Bridget Todd-Robbins was highlighted in the La Crosse Tribune as a local “hometown hero” for her work to bring Christmas cheer to teens in the La Crosse area. Link to article here: https://lacrossetribune.com/news/local/hometown-heroes-update-making-sure-students-get-gifts-this-year/article_18a9968e-7909-58f1-8c83-63d46806e4b3.html?fbclid=IwAR3n8kUKMA2e5gJ2Yu2jCjoR-PJdIztLM7d9kNar3pj_HDNTw3e3X3PVIH8

Mandy Bisek 792-4275 mbisek@lacrossecounty.org Bridget Todd-Robbins 386-7264 btodd-robbins@lacrossecounty.org

No

HEALTH AND HUMAN SERVICES BOARD Tuesday, December 8, 2020 County Board Room 1700 6:30 P.M. MEMBERS PRESENT: Tina Tryggestad (Chair), Kim Cable, Maureen Freedland,

Ebony Hyter, Jamie O’Neill, Noelle Weber-Strauss, Laurie Logan, Tom Jacobs

MEMBERS EXCUSED: None MEMBERS ABSENT: None OTHERS PRESENT: Steve O’Malley, Jason Witt, Jen Rombalski, Audra Martine,

Karla Snyder, Nicole Kragness, Diane Oines, Anneliese Skoda, Lanae Nickelotti, Carol Engle-Drury, Jane Klekamp, Renee Weston

CALL TO ORDER Chair Tina Tryggestad called the meeting to order at 6:31 p.m. ANNOUNCEMENTS

A. November County Board Action The County Board approved the 2021 budget.

B. Board Members Report on Conferences/Meetings/Workshops: NONE

C. 2021 Meeting Dates January 12 February 9 March 9 April 13 May 11 June 8 July 6 August 10 September 7 October 12 November 2 December 7 All meetings will be held at 6:30 p.m. Please check meeting notices for location. Meeting dates are subject to change.

D. 2021 HHS Board Draft Work Plan Input Every year a work plan is developed including agenda items, board education, recognition and announcements. If anyone has any input to the work plan, please contact Chair Tryggestad.

PUBLIC COMMENT: NONE BOARD EDUCATION

A. Policy, Practice, People of Health – Environmental Health & Lab Nicole Kragness is a Sanitarian/Health Inspector for the Health Department and since March she has been involved in COVID-19 response. The Health Department developed a COVID-19 Communications Team to provide information to the general public through social media and the COVID-19 website. A COVID-19 Business Team was also created to be a liaison for COVID-19 questions, complaints, concerns,

HEALTH AND HUMAN SERVICES BOARD Tuesday, December 8, 2020 Page 2

investigations and enforcement. In March the Business Team contacted all licensed facilities to help them interpret the Wisconsin Safer at Home Order and also created resources to help businesses safely reopen when able. The Business Team created an interview questionnaire to counsel businesses when an employee tests positive for COVID-19 such as cleaning practices, contact tracing and closure if needed. A public notification process was developed to alert La Crosse County residents to potential public health risk relating to COVID-19 exposures. To date the Business Team has made over 1,700 calls to businesses to discuss their concerns, answer questions, and provide guidance. Complaints received from the public or law enforcement may include establishments not following public health guidance related to COVID-19. Since March, the Health Department has issued 8 orders to businesses for non-compliance with public health practices and the Department has the option to issue citations as part of a stepped enforcement process. Karla Snyder, owner of Chances R tavern in La Crosse, presented to the HHS Board to provide insight into the benefit of coordination between local businesses and COVID-19 information in La Crosse County. In March the Chances R tavern closed and has only been open about 2.5 months total since then. Karla said this is really hard for businesses. Karla’s main concern is keeping people safe so when Chances R re-opens this week, they will follow all recommendations and guidelines including requiring masks, social distancing, hand sanitizer, extra cleaning/sanitizing, and using plastic cups to help prevent further spread of COVID-19 in our community. Karla hopes other businesses will comply as well because this is serious and we need to keep everyone safe and stop the spread. Supervisor Cable thanked Karla for being here and presenting to the HHS Board.

B. COVID-19 Question and Answer

Jen Rombalski, Health Director, presented a COVID-19 update. There has been a change in quarantine guidance from the Centers for Disease Control and a press release came out from the Health Department on December 7 with all the details. For individuals who have had close contact, the safest option is to quarantine for 14 days to reduce spread. There are two alternative strategies to shorten quarantine when other non-pharmaceutical interventions are being followed:

Quarantine can end after day 10 if no symptoms are present. Daily symptom monitoring must continue through day 14. No test is required for this option.

Quarantine can end after day 7 if the result of a COVID-19 test on day 6 or later is negative and no symptoms are present. Daily symptom monitoring must continue through day 14. A pending test result on day 7 is not sufficient.

If symptoms develop at any time between days 7 and 14, even if the individual has tested negative, the individual should immediately isolate at home, contact their healthcare provider, and be tested. Vaccines: An emergency use authorization (EUA) decision on the Pfizer vaccine is anticipated this week to be followed by an EUA decision for the Moderna vaccine. Wisconsin is expected to receive 49,000 doses of the Pfizer vaccine the week of December 14 and 16,000 doses of the Moderna vaccine the week of December 21. These are two-dose vaccines with about 90% efficacy. Thereafter continued doses will be delivered with volumes rising with time. The first to be vaccinated will be

HEALTH AND HUMAN SERVICES BOARD Tuesday, December 8, 2020 Page 3

health care workers, predominately completed by health care providers. Phase 1A will also include long-term care residents and staff, and the administration of those doses will be in conjunction with pharmacy partnerships. There’s about 400,000 health care providers and 5,070 long-term care facilities with staff and residents. The Health Department’s assurance role is to meet with partners locally to find out who is doing what, identify gaps and how to cover them, and assure coverage for all in our community. Testing Sites: The National Guard officially extended testing into March, so the Health Department hopes to continue three to four testing sites per week.

C. Homeless Voucher Program Audra Martine gave an overview of this program that was created when the Econo Lodge program came to an end. The Homeless Voucher Program offers temporary housing options at the Gundersen Lutheran Hotel for homeless individuals who are COVID positive, have been exposed to COVID, or are awaiting testing or testing results. This program started about two weeks ago and we have housed three individuals so far. Residents receive meals delivered outside their door as well as other items that we can provide for a comfortable stay. County crisis staff call to check on individuals throughout the day and also communicate regularly with hotel staff. To access this service, call 784-4357 (HELP). Calls are answered 24/7 and crisis staff are available to provide information and authorize a stay. Steve O’Malley advised that $25,000 will be transferred from contingency to fund this service, and that additional funds are available if the need grows. Supervisor Cable thanked the county for taking the lead in this very collaborative effort, and also advised that if we receive requests for out-of-county emergency shelter, Couleecap has funding for this and will take those referrals.

RESOLUTION A. Resolution Re: Authorizing Purchases Related to Treatment and Supplies in

Accordance with State Opioid Response (SOR) Funding 2020-2021 The Wisconsin Department of Health Services has awarded a State Opioid Response grant in the amount of $405,000, with no match requirement, to La Crosse County effective September 30, 2020 through September 29, 2021. Such funding is to be used to fund services and supports for individuals suffering from opioid and meth addiction (recovery housing, residential treatment, withdrawal management, medication assisted treatment, educational resources) and to cover case management to assess needs and connect to appropriate treatment services and supports. It is recommended that the grant fund the creation and hiring of a 1.0 FTE Human Services Social Worker position to fulfill the authorized case management activities under this grant. Additional staff authorized under this resolution will be retained only so long as they can be supported with dollars related to the State Opioid Response Grant. MOTION by Logan/Jacobs to approve. Motion carried unanimously.

DIRECTOR REPORTS A. Health Department Written Director’s Report B. Human Services Written Director’s Report

MOTION by Hyter/O’Neill to approve the Director Reports. Motion carried unanimously.

HEALTH AND HUMAN SERVICES BOARD Tuesday, December 8, 2020 Page 4 CONSENT AGENDA MOTION by Jacobs/Logan to approve the following Consent Agenda/Minutes. Motion carried unanimously.

A. Minutes: 1. Health and Human Services Board 11/3/20 2. Family Policy Board 11/2/20 3. Criminal Justice Management Council 10/21/20

B. Department Reports: 1. Vendor Audit Report

ITEMS FOR FUTURE AGENDAS: NONE ADJOURNMENT TO THE NEXT MEETING TO BE HELD TUESDAY, January 12, 2021 MOTION by Cable/Logan to adjourn. Motion carried unanimously. The meeting adjourned at 7:50 p.m. Disclaimer: The above minutes may be approved, amended or corrected at the next committee meeting. Renee Weston, Recorder

CRIMINAL JUSTICE MANAGEMENT COUNCIL RETREAT NOVEMBER 18, 2020 MEETING HELD VIA ZOOM MEMBERS PRESENT: Judge Horne, Kim Cable, Tom Jacobs, Araysa Simpson, Jeff

Wolf, Lisa Kruse, Jerri Hertel, Tim Gruenke, Avrie Schott, Margaret Larson, Troy Harcey, Sutha Veerasamy, Jason Witt, Joella Striebel, Andrew Alvaro Rasmussen, Monica Kruse, Charles Ashbeck, Keonte Turner

MEMBERS EXCUSED: Toya Reynolds, Jean Young, Jayne Rifenberg, Angel Lee OTHERS PRESENT: Mandy Bisek, Jane Klekamp, Jenna Theler

CALL TO ORDER Chair Tim Gruenke called the meeting to order at 5:03 p.m. via Zoom. APPROVAL OF OCTOBER 21, 2020 MINUTES OF THE CRIMINAL JUSTICE MANAGEMENT COUNCIL MOTION by Scott Horne/ Tom Jacobs to approve the October 21, 2020 minutes of the Criminal Justice Management Council. Motion carried unanimously; Reynolds, Young, Rifenberg, Lee excused. PUBLIC COMMENT: There was no public comment.

RETREAT ITEMS:

a. PROCEDURE: Jane Klekamp gave the Council an update on County procedure considerations for virtual meetings of all standing committees, that includes audio recordings of meetings to be made available as a link within the minutes beginning, hopefully, in January. Consideration of a live streaming option in a safer format was considered, with requests for public to register to receive live links proposed. Alignment with other County committees will be considered.

- Council membership participated in break out groups to review the current agenda and meeting structure and completed a “Stop, Start, Continue” exercise. Report out to the group at large upon completion, with feedback that included:

Stop Start Continue Updates, although helpful, takes up time

Submit updates ahead of time to review prior to meeting – allows members to consider questions and discussion Make specific to significant, new initiatives, or “high alert items” significantly relevant to mission

Zoom as platform – user friendly, compatibility, and stream on YouTube

Doing agency updates at the beginning of

Move agency updates to end of agenda

meeting – tend to get wrapped up in these Using system language that is not well understood

Consideration of membership and public to give context to the updates shared – transparency

Use words that are clear Make agendas more

accessible and clear to the public – i.e. post to County FB page, “opt in” emails for updates, etc.

Consideration of live stream option

Register public to speak

b. 2021 STRATEGIC PLANNING:

- Standing subcommittee updates: o School Resource Officer Subcommittee as reported by Dr. Lisa Kruse:

Currently in the write up phase which will include such areas as: research around SRO programs, community feedback, current use of SRO’s throughout the County, and La Crosse School District’s work on this issue. Dr. Kruse is hoping to have the report completed by January and distributed to committee to review. The group will then present to the Council. The intention is to have this report as a resource for schools within the county at large regarding considerations for SRO programs. La Crosse School District’s decision as it relates to the work of this subcommittee will be included within the report.

o Training of Law Enforcement Subcommittee as reported by Chief Ashbeck: At this time, the group is focusing on getting the subcommittee back together to meet.

o Citizen Advisory Subcommittee as reported by Joella Streibel: The work of this committee will likely go well into 2021, perhaps beyond. The presentation at last month’s CJMC meeting was extremely helpful to the subcommittee. The focus now is input from different interested parties – Chief Ashbeck shared some of his input for example, Sheriff Wolf and Chief Kudron are also invited to provide feedback, as well as some City Council members. The subcommittee is looking at how to communicate more frequently and transparently on the intention of the subcommittee with the community. They are also working on an online survey to go out to the community for feedback – hoping to go out in December or after 1st of year and the subcommittee will bring back data to the CJMC to share. Once this feedback is received then the subcommittee will need to get into details of how the committee would be structured and work.

Next the Council broke into breakout groups to discuss: What topics are crucial for CJMC to remain tuned in to or complete specific action on in 2021? Feedback included the following:

- Available treatment resources for substance abuse, mental health, and victims of crime

- Diversity training across all agencies including police, county employees, etc. - Reevaluate use of Compas - Training on cultural sensitivity, microagressions, and addressing people they

want to be addressed across all agencies - How are people picked for jury service to ensure fairness - Input on the perspective of law enforcement on different matters - More resources for substance abuse, homeless and mental illness - Drug court evaluation - Bail reform - Fresh start outcomes and sustainability plan - Disparities in pre and post diversion opportunities - Innovative approaches to public safety – proactive approaches instead of

reactive approaches to mental health, mobile crisis teams, focus on impacted neighborhoods/get their input on what they need. Shifting funds vs. defunding the police

- Level of supervision in sober living facilities - Mental health services for calls to police for out of control people - Disproportionate minority arrests. Look into the reasons why beyond the

police - Revocation and bail jumping issues particularly with substance use disorders

and domestic violence - Identify racist policies, their history, why we are doing what we are doing, the

consequences and advantages of the policies – we know they are disadvantaging certain people but are also advantaging others. Must also talk about that

- Increase problem with gun crimes and strategies for enforcement - Case study. Start case from beginning to end - Education and reflection of our country’s history with slavery and racism, its

generational impact, impact on our community. Stories from local speakers to increase awareness, keep revisiting this issue frequently and keep at the forefront to take action. (Noted that we must be careful when making requests of others to share their stories as we may retraumatize by asking this)

- Marsy’s law discussion - Hate crimes / incidents in the area, the face of racism in our community, how

the council can take action / stand up against these acts - Reentry issues – better support for reentry and education on reentry (such as

rights) - Immigrant and refugee justice - Contextualizing how power is distributed in conversations about laws and

policies

Tim, Lisa, and Mandy will use this list to prioritize the agenda for 2021. Should further feedback be needed from the council in order to do this it will be done in the form of a survey to the council. The CJMC will not meet in December and will reconvene in January

ADJOURN: There being no further business, Chair Gruenke adjourned the meeting at 7:00 p.m.

Disclaimer: The above minutes may be approved, amended or corrected at the next committee meeting. Recorded by Mandy Bisek

AGING AND DISABILITY RESOURCE CENTER OF LA CROSSE COUNTY PUBLIC HEARING ON 2021 SPECIALIZED TRANSPORTATION ASSISTANCE PROGRAM AND ADVISORY COMMITTEE Thursday, December 10, 2020 La Crosse County Health & Human Services Building, Basement Auditorium 2:00 PM MEMBERS PRESENT: Diane Brose, David Hundt, Cindy Jensen, Kathy Lucey, Rhonda Staats,

Margaret Wood MEMBERS EXCUSED: MEMBERS ABSENT: Sr. Kathy Stuttgen OTHERS PRESENT: Peggy Herbeck, Carissa Pagel-Smith CALL TO ORDER Meeting was called to order at 2:03 pm. PUBLIC HEARING/COMMENT The purpose of the hearing was to receive public comment on the 2021 Specialized Transportation Assistance Program for La Crosse County (under s85.21 of the Wisconsin Statutes). Carissa Pagel-Smith, ADRC Manager/Director, provided an outline of the 2021 Specialized Transportation Assistance Program Application. No public were present. No written comments were received. APPROVAL OF MINUTES Minutes from the meeting held August 3, 2020 were approved. ADRC REINVESTMENT PROJECT Carissa Pagel-Smith, ADRC Manager/Director, reviewed “Aging and Disability Resource Center (ADRC) Reinvestment” document produced/distributed by the Wisconsin Counties Association (WCA) and discussed the potential impact of additional dollars locally. Committee members were asked to share this information as appropriate, help to advocate in general and pass along any contacts for potential testimonials and/or stories of those who successfully worked with the ADRC. Carissa also discussed a related resolution that is slated to go to Health & Human Services Board in January. 2022-2024 AGING PLAN Carissa Pagel-Smith, ADRC Manager/Director, provided an overview of aging plans and its unique role to capture community input in order to create its goals. Given that traditional methods of community input/engagement will be limited due to the pandemic, Carissa led brief brainstorm to generate new ideas. Committee members discussed the importance of partnering with other organizations/agencies, asking them to help share a survey or collect information on our behalf. Additionally, committee members talked about interviewing older adults, those with lived experience and the “wisdom of life” (i.e., 85+) to identify what the interviewees felt they would have needed. DIRECTOR’S REPORT/UPDATES Carissa Pagel-Smith, ADRC Manager/Director, provided current updates. Updates included:

• Per the request of the Health & Human Services Board, the Forest Park and Stokke meal sites will remain open to allow for further evaluation however, the Bangor site will close at year end.

• The meal site located at Harry J Olson relocated to the new Saint Andrew site in September. Activity kits have been/will be developed/distributed quarterly since site is not currently open.

• The Holmen meal site relocated to the new Holmen Area Community Center in October. • In lieu of annual banquet, thank you gifts/bags were given to recognize 2019 volunteers. • We are actively recruiting additional volunteers for meal packaging (9-11 am) and delivery

(10:30 am-12:30 pm). Any interested individuals can call us at 608-785-5700 to inquire.

• Staying Active Together, virtual exercise class taught by Diane Brose, is held virtually every Monday and Wednesday from 10:30 am to 11:30 am; currently roughly 60 people registered.

• Purchased license to facilitate Bingocize® which is a 10-week program (2, 1-hour sessions per week) that combines bingo-like game with exercise and health education; will offer in 2021.

• Soon to pilot new referral system that allows City of La Crosse Fire Department to send referral to ADRC should patient who has fallen within home, and not in need of care, consent.

• Established new La Crosse County Falls Prevention Coalition brochure; please help distribute! • Dementia Care Specialist continues to add programming to events calendar on ADRC website. • Developed/distributed another round of self-care bags to caregivers; many thanks received. • Promoting use of trualta.com, free self-paced, skills-training modules for caregivers.

FUTURE AGENDA ITEMS None ADJOURNMENT TO THE NEXT MEETING TO BE HELD MONDAY, FEBRUARY 1, 2021 Disclaimer: The above minutes may be approved, amended or corrected at the next committee meeting. Carissa Pagel-Smith, Recorder

FAMILY POLICY BOARD Monday, December 7, 2020 Meeting Held via Zoom 12:00 p.m. MEMBERS PRESENT Kristi Arenz, Karolee Behringer, Nicole Brei, Hetti Brown, Mandy Bisek, Chris Crye, Isaac Hoffman, Lauren Journot, Ann Kappauf, Catherine Kolkmeier, Sue Mathison, Vie Matty, Melisa Myers, Heidi Odegaard, Roberto Partarrieu, Teresa Pierce, Ryan Stotts, Bridget Todd-Robbins, Tina Tryggestad, Jodi Widuch, Jason Witt, Mary Kay Wolf, Elizabeth Wright, Tita Yutuc GUESTS/OTHERS PRESENT Katie Rommes with the Family & Children’s Center CALL TO ORDER Chairperson Tita Yutuc called the meeting to order at 12:02pm APPROVAL OF MINUTES MOTION by Mary Kay Wolf, seconded by Hetti Brown to approve the November 2, 2020 minutes as presented. Motion carried unanimously. HUMAN SERVICES DEPARTMENT AND BOARD UPDATES HHS Board Update: Tina Tryggestad – October and November have been mainly budget discussions. A resolution was recently passed in support of Opioid Response Funds. Jason Witt shared with the group that this year the Opioid Response Funds brought about $350,000 into the community. Next year there will be about $400,000 which will also bring a new case manager to help those dealing with substance abuse issues. HS Director Update: Jason Witt – The federal funding that was available for the County to support the homeless population at the Econolodge site ended in October. In recent weeks, the County initiated a new program to provide for homeless individuals who are COVID positive or waiting for results that didn’t have a place to go. These individuals are now being offered shelter in the Gundersen hotel for quarantining or while waiting to receive their test results. Meals for these individuals are being provided by the Aging and Disability Resource Center (ADRC). Daily check-ins by phone are being provided by Mental Health Crisis Intervention employees. Jason gave a special “Thank You” to all our partners for working together during this tough time. Family and Children’s Section Update: Tracy Puent – no update PRESENTATION: Home Visiting Programs Serving the La Crosse Area: Parents as Teachers (Jodi Widuch) & Healthy Families (Katie Rommes)

• Parents as Teachers (through The Parenting Place) – this program has been around for a very long time and is available starting at prenatal to 5 years old. Outcomes show that the program increases family’s knowledge of child development and parenting strategies. This program also identifies developmental delays earlier in a child’s life. Currently there has been a decrease in participation and there is room in the program for about 8 families.

• Healthy Families (through The Family and Children’s Center) – Katie shared a PowerPoint with the group, which can be viewed here: https://www.lacrossecounty.org/humanservices/docs/Family%20Policy%20Board/12%2007%202020%20Healthy%20Families%20PowerPoint%20Presentation.pdf. Healthy Families, a program of Family & Children's Center, partners around intake/referrals with the Parents as Teachers program offered at The Parenting Place. This partnership makes it easy for clients to get services. There is "no wrong door" to enter either program. Referrals come in and are appropriately placed based on the need(s) of the clients. This program has been available in La Crosse County for about 30 years. To be eligible for this program the mother must be pregnant, or the child must be 3 months old or younger. Outcomes for this program are for children to achieve milestones in development and early learning, children to be healthy, and children to live in a safe environment. This program also addresses mental health concerns like depression.

Leadership Transition – La Crosse Area Family Policy Board

• Incoming Chairperson effective January 1, 2021 – Ann Kappauf will take over this position.

5A4

• Nominations for new Vice Chairperson – Tita nominated Hetti Brown. MOTION by Jodi Widuch, seconded by Catherine Kolkmeier to approve the nomination of Hetti Brown as the new Vice Chairperson. Motion carried unanimously.

Continued Development of Policy Priorities – Jason shared with the group what the next few months could look like:

• January-March we would discuss our priorities and proposal developments • April-June we would focus on Advocacy Activities which include:

o A possible press conference o Biennial legislative meeting o Letters to Governor & Joint Finance Committee

• Past priority criteria were: o Our local voice can add to the discussion and be impactful in winning approval o Fits within at least one FPB area of focus for children, youth and their families o We can articulate specific and significant benefits to FPB agencies and the community we serve o Includes a balance of items important to our diverse membership

• The following lists of items for consideration are being uploaded to the FPB shared folder: o Wisconsin Association of Family & Children’s Agencies (WAFCA) o Wisconsin Counties Association (WCA) o Small group discussion follow-up from October La Crosse Area Family Policy Board

Any other items you wish to be considered can be emailed to Jason Witt (jwitt@lacrossecounty.org). Hetti asked if we want to consider the COVID proposals from the governor and legislators – she

will send this to Jason for consideration. AGENCY ROUNDTABLE – No updates The meeting ended with members taking the “How would you rate the past week?” survey by Mentimeter at the request of Catherine Kolkmeier. Mentimeter (https://www.mentimeter.com) is a company that provides real-time polling tools for groups. This poll showed a snapshot in time of how members were feeling. Below are results for the instant feedback survey.

ADJOURNMENT TO THE NEXT MEETING TO BE HELD MONDAY, JANUARY 4, 2021, AT NOON

Chairperson Tita Yutuc adjourned the meeting at 1:00pm. Disclaimer: The above minutes may be approved, amended or corrected at the next committee meeting. Tiffany Cornell, Recorder

INTEGRATED SUPPORT & RECOVERY SERVICES ADVISORY COUNCIL Wednesday, December 16, 2020 La Crosse County Human Services ‐ Microsoft Teams Meeting 3:00 PM   

MEMBERS PRESENT:  Ryan Ross, Julie Dietz, Marilyn Huckenpoehler, Jill Mason, Tracy Puent, Pam Radtke, Phil Stegemann, Curt Teff, Shelly Tollefson, Angela Welch, Aimee Zabrowski 

MEMBERS ABSENT:  Jackie Gunderson, Emma Peterson, Brenda White 

OTHERS PRESENT:  Ann Kelley‐Kuehmichel, Michele Padesky, Renee Weston‐Recorder 

 CALL TO ORDER   Chair Ryan Ross called the meeting to order at 3:03 p.m.  APPROVAL OF MINUTES MOTION by Stegemann/Teff to approve the minutes from June 8, 2020 and September 14, 2020.  Minutes approved.    PUBLIC COMMENT None      OFFICIAL BUSINESS Review Purpose of Committee To oversee the development and implementation of coordinated services and supports provided to children and families involved in multiple systems of care including those involved in special education, children with disabilities, mental health needs, and/or out of home care services  (per DHS 46.56 and 46.272).  Updates on programs will help us identify where there are gaps in services and areas that we can improve on.  Per statute, this committee provides oversight for the three programs bulleted below:  Birth to Three (B3), Children’s Community Options Program (CCOP), and Coordinated Service Teams Initiatives (CST).   Program Specific Updates 

Birth to Three (B3)  Shelly Tollefson and Marilyn Huckenpoehler provided an update.  The Socio Emotional Innovation Grant that was awarded last fall for $140,000 covers Circle of Security training for staff through The Parenting Place and technical assistance to develop a Safe Babies Court in La Crosse County.  Human Services hired a new Community Coordinator for the Safe Babies Court Team and B3 team meetings begin next week to start collaboration.    Circle of Security training is being provided and all Parenting Place direct service staff attended in August.  Several of these staff moved into a year‐long cohort for weekly consultations, each choosing families on their caseload to practice Circle of Security methodology with.  Circle of Security is great at understanding and decoding what behaviors children are trying to communicate so their parents can focus on addressing issues.  Human Services staff also received a one‐day training including many CPS staff along with CCS/CLTS staff.       

 

INTEGRATED SUPPORT & RECOVERY SERVICES ADVISORY COUNCIL Wednesday, December 16, 2020 Page 2 

 

Children’s Community Options Program (CCOP)  Angie Welch provided an update.  The state waived the annual plan requirement this year, so an annual plan doesn’t need to be submitted.  The state moved towards state level budgeting which opens up funds to eliminate wait lists.  This week Human Services hired a new social worker to continue efforts to eliminate wait lists.  There are currently about 370 in the waiver program, so the number of cases continues to grow.   

Coordinated Service Teams Initiatives (CST) DHS Site Review:  Ryan Ross updated that Human Services had a site visit from the Department of Health Services (DHS) that evaluated things like quality of care, principles of wrap around services, engaging with individuals, best practice and evidence‐based models, and collaboration.  Feedback from the state indicated La Crosse is far ahead in terms of collaborating internally across Human Services, utilizing teaming structures and partnering with the School District and area providers.    2021 Work Plan:  In the coming year the state would like to see data from the county level, and Ryan shared the list of data points.  The data will be reported semi‐annually  and some examples of data points identified are recidivism rates, service satisfaction, changes in behaviors and school attendance before and after programs, types of services/cost, cost comparisons, and how we are reducing length of out‐of‐home stays. The data is currently being collected, but we need to work on how the different systems are talking to each other.  The state is aware that our goal this year will be to build a system to generate this data for reporting and not necessarily that we’ll have all the data to report.  Ryan met with the Human Services fiscal staff to begin setting up tracking mechanisms to pull the data and set up cross‐correlation between sections of the department.  Curt Teff advised he appreciates these measures and that it speaks to the greater good of what we’re trying to do here, not just making placements, but working with youth and families so they can thrive and succeed. 

Discussion on Current Systems of Care 

Alia Innovations and La Crosse County Human Services   Ryan updated on the work Human Services is doing with Alia Innovations to look at how we approach out‐of‐home care differently and how we can improve communication and collaboration.  Several county workgroups are discussing different aspects of these components.  Phil Stegemann updated his group is focusing on decreasing the use of out‐of‐home care as a first response to family needs, and instead approach with wraparound supports to build relationships for families to support each other to keep kids safely in communities.  Tracy Puent advised that Human Services is making an effort to remove silos and approach families with a coordinated effort to bring everyone to the table to determine the best way to strengthen and preserve them.  Out‐of‐home care adds trauma and breaks the family down, so we’re exploring other options when possible and when safety is maintained to keep as much normalcy as possible for the child.  Ryan updated on the mental health side and looking at how we transition to strengthening natural supports by strengthening parents, caregivers, neighbors, and teachers who have daily contact with youth vs. relying on outside resources.     

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 What do direct care services look like right now for families/youth?  Youth Justice uses video if possible but will have face‐to‐face contacts whenever necessary to meet family needs.  Child Protective Services never stopped going out to meet with families even through COVID due to state requirements, especially in Initial Assessment.  Ongoing staff and foster care pulled back a little.  Mental health services are being provided by telehealth whenever possible to limit face‐to‐face, but crisis will go out if there’s a risk of inpatient hospitalization.  Some contracted vendors are providing services via telehealth and others are providing face‐to‐face, depending on the family’s comfort level and the best way to make the connection.  A higher number of families are using self‐supports if they are comfortable with that type of situation.  The School District is committed to virtual learning through January 18.  The School District anticipates the metrics from the Harvard Global Health may change soon to allow some type of reopening after January 18 to bring back some or all of the students.     

Discussion on Area Family Needs and Impacts of COVID‐19 on Services   Curt updated on work the School District is doing within their community schools and discussions with science coaches who say that so much of what we do in Human Services and education is transactional, for example, if kids are cold we warm them and if they are hungry we feed them.  Curt is talking with his team about how coordinated services could be more transformational with a philosophy of care to make sure all our agencies have a shared mission with the long‐term goal of independence.  Food distribution, for example, if the school sees food insecurity we would mitigate initially to solve, but in order to sustain we should look at a transformational philosophy that in 5 years it puts our families in a much better spot in a trajectory for independence.  If we continue to see doubling needs, we’re heading in the wrong direction because that cannot be sustained.  This ties in nicely with what Human Services is working on with Alia (relationship work, making connections, moving families forward and not just getting them things).    For the next meeting: 

o Bring forward more information on the work Human Services is doing with Alia. o Refine this committee’s mission/focus and talk about creating a philosophy of 

care. o Continue exploring the possibility of a shared social worker position with the 

School District and Human Services utilizing CST grant money if approved.  Future Planning 

Discussion on Areas to Grow and Explore in 2021  ADJOURNMENT TO THE NEXT MEETING TO BE HELD WEDNESDAY, MARCH 17, 2021 AT 3:00 P.M.  MOTION by Puent/Teff to adjourn.  The meeting adjourned at 4:03 p.m.  Disclaimer:  The above minutes may be approved, amended or corrected at the next committee meeting.  Renee Weston, Recorder  

AGENDA ITEM NUMBER: 5B1 MEETING DATE: 1/12/21

EXCEPTION ANALYSIS/REPORT

TO THE LA CROSSE COUNTY HEALTH & HUMAN SERVICES BOARD DEPARTMENT: Human Services Department X INFORMATION/DISCUSSION SECTION: Contract Unit SUBJECT: Vendor Audit Policy Step #3 Notification PREPARED BY: Chris Sander FILING ID: REVIEWED BY: Jason Witt IMPLEMENTATION DATE: 1/1/2021

Background: The Human Services Vendor Audit Policy states “As La Crosse County Human Services enters into Steps 2-4, information will be regularly forwarded to the La Crosse County Health and Human Services Board”. Step 3 of the Vendor Audit Policy states “If the Provider’s Audit report is not received by 365 days after the Provider’s year-end, the Provider will stop receiving payment for services until the Provider provides La Crosse County Human Services with the audit report.” Exception: No exception to the Vendor Audit Policy. Analysis At the time this report was prepared (1/5), the following vendors had the year end of 12/31 and did not have their audit report turned in for 2019 yet and will have future payments held until the audit is received. Audits Needed: AMS of Wisconsin – (provides medication assisted treatment services for the Opioid Grant). An engagement letter was received from the auditors and the audit is being finalized. Blackberry Hill – (provides CCS residential services). An engagement letter was received from the auditors and the audit is being finalized. Person First Homes and Person First Supportive Services – (provides CCS and CLTSW residential and community services). An engagement letter was received from the auditors and the audit is being finalized. Action Needed: No action is needed by the Health and Human Services Board at this time.