►
From YouTube: Health and Human Services Meeting - December 14, 2012
Description
The monthly meeting of the Health and Human Serivces Board, which took place on December 14, 2012.
Health and Human Services Board Meetings will air on BCTV, Charter Channel 2, on Saturday nights at 8pm every week!
A
Human
services
board
meeting
daughter,
hello,
everybody,
hello,
hello,
as
you
can
see,
we
sort
of
readjusted
the
setup,
because
the
last
time
it
didn't
seem
to
work
properly
and,
as
a
result,
we've
made.
We've.
We've
hid
the
staff
behind
us,
but
I'm
sure
we'll
be
hearing
from
them
whenever
the
appropriate
time
is
there.
A
I
would
like
to
say
that
dealing
with
the
state
process
of
how
we
set
up
this
committee,
we
have
the
opportunity
to
have
two
consumer
people
on
this
board
and
at
the
next
board
meeting
our
good
friend
terry,
is
gonna.
Do
will
be
introduced
and
put
on
this
particular
board.
Would
you
like
to
tell
us
a
little
bit
about
yourself
and
so
because
we
shared
ourselves
the
last
time.
Would
you
tell
us
about
even
though
you're
not
a
member
of
this
point,
but
you're
going
to
be
well.
B
Thank
you.
I
I
am
very
honored
to
be
considered
for
membership
on
this
board.
I
am
very
proud
to
be
a
resident
of
london
county.
I've
had
I've
lived
here
for
about
20
years,
I'm
a
retired
systems
analyst.
That
means
I
develop
programs
for
large
companies
back
in
the
70s
80s
and
90s,
and
since
I
moved
to
asheville,
I've
been
involved
with
a
number
of
non-profits
organizations
like
musical
legal
services
and
the
council
on
aging
and
children.
First,
and
I
love
the
word
advocate,
so
I'm
really
pleased
to
to
be
here.
B
B
A
A
It
was
and
since
there's
nothing
added
to
it,
I
would
like
to
remind
you
that,
in
accordance
with
the
state
government,
that's
exactly
the
duty
of
every
board
member
to
avoid
both
conflicts
of
interest
and
appearance
of
conflict.
Does
anyone
have
anything
of
that
nature?
From
looking
at
the
president
again
most
of
his
agenda
today
is
going
to
be
dealing
with
finances,
but
anyway
very
nicely
a
little
a
little
bit
last
year
we
will
approve
the
agenda
until
I
have
a
motion
to
approve
that.
A
A
A
C
Thank
you,
mr
chairman,
good
afternoon.
It's
a
pleasure
to
be
here
for
you
today
and,
as
I
was
thinking
about
what
how
they
introduced
talking
about
budget
and,
of
course,
it's
a
fascinating
subject
to
me,
but
one
of
the
things
that
I
was
thinking
about
in
terms
of
what
this
does
is
providing
orientation
for
the
board
members
and
when
I
went
back
and
thought
back
to
what
it
was
like
when
I
had
new
employee
orientation,
I
had
a
nice
big,
thick
notebook
and
they
went
over.
C
All
these
policies
and
procedures
filled
my
head
with
them,
and
I
signed
off
saying
that
I
understood
and
agreed
to
abide
by
every
single
one
of
them,
and
I
can
remember
now
looking
back
on
that
and
thinking
that
was
crazy.
I
had
no
way
to
know
what
all
those
were,
but
I
did
it.
Unfortunately,
part
of
orientation
is
sitting
back
and
being
given
information
for
you
to
digest,
and
so,
unfortunately,
that
will
be
part
of
what
this
presentation
is
about.
C
C
One
of
the
things
I
hope
that
you'll
see
in
this
process
is
that
we
do
look
at
it
from
a
balanced
perspective
and
that
we
have
brought
the
budget
to
a
point
that
it
is
an
iterative
process
that
we
have
a
dialogue
of
what
we
do
and
how
we
present
things.
So
with
that
with
that
in
mind,
and
hopefully
with
your
feedback
and
your
your
discussion
today,
that
will
help
us
both
in
understanding
the
budget
and
going
forward.
It
will
be
a
wonderful
presentation
for
you,
because.
C
D
C
D
C
C
D
C
Balance
our
perspectives,
we'll
talk
about
what
that
is,
we
reallocate
resources
to
meet
needs.
We
build
partnerships
both
internally
and
externally.
We
use
information
technology
to
bridge
gaps
that
we
may
have
and
we
communicate
now.
Do
we
do
all
of
these
perfectly
well?
Well,
no,
no
organization
does
all
of
these
perfectly
well,
but.
C
Is
to
make
sure
that
we
do
those
in
the
most
effective
way
that
gets
the
best
results
for
the
people
that
we
serve.
So
if
we
think
about
focusing
on
core
the
things
that
what
this
really
does
is
allow
us
to
say
when
we
go
back
to
the
law
policy
and
statutes
those
things
that
are
required
absolutely
by
law
policy
statute
or
commissioner
directive,
those
are
the
things
that
we're
going
to
do.
C
If
those
things
are
not
part
of
what
our
or
we're
mandated
to
do
but
may
be
important,
then
we
make
sure
that
we
do
core
first,
because
nothing
else
can
get
done
unless
we
assure
that
court
gets
done,
and
so
that's
where
we
put
our
primary
focus
by
doing
that.
What
that
allows
us
to
do
is
and
you'll
see.
Some
things
that
we've
been
able
to
do
is
to
take
resources
where
we
may
not
have
been
focused
on
the
specific
core,
but
it
was
important
to
support
those
organizations
or
those
particular
projects
in
the
community.
C
Staying
balanced,
you
know,
that's
a
good
maxim
for
anybody
to
do
to
agree
to
state
balance,
but
when
you're
looking
at
it
from
the
standpoint
of
health
and
human
services,
it's
a
process
that
probably
many
of
your
organizations
do,
whether
consciously
or
unconsciously,
it's
about
making
sure
that
in
this
case,
physical
doesn't
make
all
the
decisions
based
solely
on
a
money.
Perspective
and
program
doesn't
make
all
the
decisions
based
solely
on
program
giving
example.
C
If,
if
we
made
all
of
our
decisions
based
solely
on
the
picture
that
we
have
right
now
on
financials,
we
may
not
have
been
able
to
do
innovative
things.
We
may
not
have
been
able
to
do
those.
We
may
have
said,
on
the
other
hand,
from
a
program
standpoint
that
it's
the
best
practice
to
make
sure
that
we
have
one
case
worker
for
every
per
citizen
in
this
county.
Well,
that's
absolutely
maybe
the
best
practice,
but
that's
absolutely
not
going
to
be
what
you're
going
to
be
able
to
do
long
term
and
sustain
any
organization.
C
C
C
Any
of
the
boards
previously
or
if
you've
been
a
member
of
the
community
and
seen
what
we've
done
we've
the
county
has
made
a
significant
investment
in
doing
just
that
by
creating
at
40
cox
avenue
where
we
created
the
integrated
service
model
of
health
and
dss
of
linking
those
public
health
systems
with
income
maintenance
programs.
We
built
a
system,
a
foundational
system
that
allows
a
customer
to
access
their
services.
We
also
put
in
infrastructure
related
to
both
building
and
renovation,
and
also
from
an
information
technology
standpoint
to.
C
The
resources
that
we
have
there,
the
staff
that
we
have
there,
so
that
we
can
also
make
sure
that
the
experience
from
a
client
or
patient
perspective
is
positive
because,
ultimately,
as
you'll
see,
that's
the
most
important
one.
The
next
process
that
we
look
at
is
from
an
internal
business
process.
What
is
it
that
we
do
and.
D
C
Do
we
do
it?
There
are
lots
of
things
that
we
may
do,
but
we
want
to
make
sure
that
we're
doing
it
in
the
best
way
that
provides
the
best
outcome
for
the
client
that
goes
back
to
also,
if
you're
only
focused
on
one
of
those,
you
only
focus
on
the
internal
business
process.
Without
the
other
perspectives,
you
may
you
may
lose
your
perspective
overall
and
have
a
large
adjustment
financial
stewardship.
C
C
But
if
it
weren't
for
our
food
and
lodging
and
doing
those
and
health
inspections,
there
may
be
a
serious
public
health
issue
related
to
that.
If
we
didn't
do
that,
so
those
are
the
ones
that
that's
the
top
one.
Now,
how
do
we
do
those
together?
How
do
you
keep
all
those
perspectives
in
balance?
Well,
what
we've
done
is
we
do
a
budget
process
that
doesn't
look
at
one
particular
perspective.
C
So
they
are,
they
are
specifically
equipped
to
have
overall
perspective
of
what's
happening
within
the
organization,
both
from
a
programmatic,
as
well
as
a
fiscal
standpoint.
So,
when
you're
looking
at
developing
a
budget,
what
they
do
is
they
meet
with
the
particular
divisions
and
they
go
over
what
their
priorities
are
they
see
if
those
priorities
are
being.
D
C
If
they're
being
met
in
the
way
that
they
like
being
having
them
met
or
if
there
are
different
ways
to
approach
implementing
or
achieving
those
priorities,
then
they
look
to
see
okay.
What
is
in
all
those
initiatives
that
you're
doing?
What
is
your
priority
in
those?
How
do
you?
How
do
you
rank
each
one
of
those?
C
What
are
the
things
that
we
need
to
do
that's
below
that
line
that
our
resources
don't
allow.
Do
we
need
to
shift
resources?
Do
we
need
to
move
the
priorities?
Do
we
need
to
change?
That's
where
that
can
happen
and
where
also
the
planner
evaluators
have
the
perspectives
of
knowing
what's
happening
within
the
overall
organization
to
see
where
there
may
be
other
opportunities
in
those
priorities
have
got
to
be
funded
and
there's
no
other
alternative.
Then
that's
where
the
broader
perspective
of
looking
to
see
how
you
can
take
resources
or
reallocate
resources
from
somewhere
else.
C
So
this
balanced
approach
has
helped
us
his
service
very
well
to
make
sure
that
our
primary
focus
is
the
customer
client
patient
stakeholder,
but
all
of
those
perspectives
have
to
remain
in
balance.
If
you
get
out
of
balance
or
focus
on
any
one
of
those
perspectives
to
the
detriment
of
the
others,
you
will
always
have
to
make
a
strong
correction
and
a
strong
correction
means
pain.
It
needs
pain
either
internally.
It
means
pain
externally
to
the
people
that
we
serve.
C
You
don't
want
to
get
in
a
situation
where
we're
having
to
make
a
strong
correction
based
on
decisions
that
we've
made.
There
may
be
some
external
ones
that
come
our
way
that
cause
us
to
do
that,
but
internally
we
don't
want
to
have
to
be
the
ones
we
want
to
be
in
balance
and
stay
in
balance
and
that's
how
we
approach
our
budget
and
perspectives.
C
Reallocating
resources
is
a
great
slide
and
mandy
points
out
to
me.
You
know
if
we,
if
this
slide
would
be
perfect
because
we
do
reallocate
resources
we
do
take
if
we're
doing
a
program
in
one
area
or
we're,
seeing
that
something
is
not
effective
in
one
area
we
and
we
see
something-
needs
to
be
done
in
another
area.
C
If
we
have
resources
we're
going
to
reallocate
this,
whether
that's
dollars
staff
space
positions,
no
matter
what
it
is,
we're
going
to
reallocate
those,
but
we
always
always
do
that
with
in
mind-
and
this
is
where
mandy
says
we
need
to
have
a
graph
that
shows
a
safety
net
under
there
we
don't
ever
reallocate
resources,
we
don't
ever
change
the
way.
We
do
things
without
making
sure
that
there's
a
safety
net.
C
We
were
providing
primary
care
for
children
and
adults,
and
also
prenatal
care
for
children
and
adults
in
a
completely
unsustainable
model,
based
on
the
numbers
of
people
that
needed
to
be
seen.
The
federal
government
was
going
and
has
stressed
and
continued
to
stress
that
the
federally
qualified
health
center
is
the
model
that
they
support
for
access
to
care
for
the
under
and
uninsured
in
our
country
and
they've
provided
financial
mechanisms
to
help
to
support
that.
But.
C
But
we
also
wanted
to
make
sure
that
when
we
reallocated
those
resources
that
we
had
a
safety
net
available,
so
that,
if
something
didn't
work,
that
we
could
pull
that
back
and
we
could
be
able
to
provide
those
services
to
it
so
that
the
citizens
that
depended
on
those
some
for
their
lives
would
be
able
to
get
that.
And
so
we
were
able
to
through
the
process
that
we're
going
through
here
to
build
a
contingency
to
build
resources
to
be
able
to
have
in
case
that
happened.
Fortunately,
it
didn't
happen.
C
We
want
to
do
that,
and
so
we
engage
in
community
smart
partnerships
all
over
as
many
as
we
can,
and
one
of
the
great
things
about
being
on
this
board
is
that
we
would
love
to
to
hear
from
you.
Are
there
things
that
you're
working
with
in
your
organizations
or
your
nonprofits
or
your
or
your
particular
areas
of
expertise
that
maybe
help
us
to
engage
in
partnerships?
That
will
not
only
support
the
community,
but
that
will
also
enable
us.
D
C
So
here's
this
this
is
by
no
means
all
of
our
partners,
but
just
hopefully
you'll.
If
your
organization
is
not
represented
here,
please
let
me
know
and
I'll
make
sure
I
get
that
up
there
in
your
slide,
but
most
of
most
organizations.
We
have
strong
partnerships
with
many
of
these
organizations
to
not
only
provide
services
but
either
to
provide
working
agreements
around
sharing
of
information
or
to
actually
do
services
that
we
normally
not
have
been
able
to
provide.
C
So
what's
our
criteria,
it's
to
provide
or
assure
services
through
performance
contracts
that
the
county
would
otherwise
be
required
to
provide
performance
contracts
has
been
read
for
a
very
important
reason,
because
we
don't
ever
enter
to
a
contract
with
an
organization
without
specific
performance
measures
in
place.
We
want
to
make
sure
that
we
hold
ourselves
accountable.
We
want.
C
So
our
our
smart
partnerships
and
our
process
for
doing
that
a
lot
of
times.
We
will
begin
with
the
competitive
examination
process.
Sometimes
that's
done
through
a
request
for
proposals.
Sometimes
that's
done
through
our
own
internal
process
of
looking
to
see
who
are
the
partners
that
are
out
there
that
may
be
able
to
help
us
in
accomplishing
our
mission.
We.
D
C
Look
at
a
performance-based
process.
We
always
provide
continuing
ongoing
evaluation
of
those
contracts
to
make
sure
that
they're
delivering
this
process
much
to
the
delight
of
the
people
in
the
agencies
that
get
to
review
those
contracts
on
a
regular
basis,
everybody
loves
to
review
contracts,
that's
one
of
the
most
favorite
things
for
people
to
do,
but
we
do
that
and
we
do
that
also,
as
I
said
just
appended
to
a
little
bit,
it's
about
fostering
community
ownership.
C
If
we
said
let
us
handle
this,
let
us
take
care
of
the
masses,
then
what
does
that
do
for
fostering
community
ownership
and
for
helping
to
create
and
support
the
organizations
that
are
in
this
community
that
help
us
that
we
couldn't
do
it
alone?
That's
and
also
it
provides
simplified
access
to
services
for
working
citizens,
an
example
I
I
can
think
of.
We
have
partnerships
with
abccn,
evelyn
charity
swan
and
olga
christian
ministries,
and
you
do
that
specifically
around
crisis
intervention
programs
for
heating
and
cooling
assistance.
C
Now
we
could
have
everybody
come
to
dss
and
do
that,
but
those
folks,
especially
where
they
are
in
their
communities
those
folks
go
to
those
places
for
assistance
now.
So
why
does
it
make
sense
for
us
to
say,
go
to
abccm
and
they'll
pay
fifty
dollars
on
your
electric
bill
and
then,
if
you'll
go
to
emma
they'll,
add
another
50
and
then
come
to
us
and
we'll
do
another
50
and
we'll
pay
the
150
bill
for
you.
C
C
C
C
Southwestern
provides
that
service
for
a
seven
county,
seven
county
region
in
the
west
already
were
doing
that.
They
were
both
an
operator
of
a
child
care
facility
and
they
were
also
the
administrator
for
the
dss's
seven
western
county
region.
They
came
and
presented
and
said
you
know
this
is
what
we
do
that
was
in
april
by
july,
1
we
had
a
contract
in
place
for
them
to
do
the
administration
of
our
child
care
subsidy
program.
C
The
reason
that
we
jumped
on
that
was
twofold.
Some
of
those
were
our
own
reasons,
but
one
of
the
main
reasons
was
because
they're
an
expert
at
it
they've
got
the
process
down.
They
do
it
every
day,
all
that
they
have
great
relationships
with
the
state,
particularly
around
funding,
particularly
around
policy
development.
C
They
also
have
the
ability
to
allow
us
to
reallocate
resources.
The
dss
budget
is
a
weird
animal.
When
you
do
the
dss
budget
it
is.
It
is
one
that
allocates
it's.
A
cost
allocation
system,
essentially,
is
what
it
is.
It's
a
modern,
it's
a
big
cost
allocation
system.
So
when
programs
do
a
particular
work,
part
of
the
cost
is
not.
The
cost
is
not
just
attributed
to
what
it
takes
to
do.
The
child
care
subsidy
piece
by
itself.
C
It
takes
it,
allocates
all
of
the
other
overhead
administrative
space
operating
expenditures
and
looking
at
it
by
the
number
of
people
that
do
that
program
allocates
cost
to
it.
Well,
that
can
be
very
good
when
you
have
a
revenue
stream
that
is
open-ended
and
it
is
not
a
capped
allocation.
Child
care.
Subsidy
is
not
one
of
those
there's,
never
enough
money
both
either
for
the
provision
of
the
service
of
the
subsidy
and
there's
never
enough
money
to
accurate
adequately
administer
it
when
we
were
doing
it
because
of
the
overhead
that
was
attributed
to
that.
C
D
C
Southwestern
said:
hey,
we'll
take
the
amount
of
money
that
the
feds
are
gonna.
Give
you
and
smartstart
are
gonna,
give
you
to
administer
the
program
and
we'll
do
it
for
that.
That's
all
we'll
take
that
freed
up,
10
positions,
10
county
positions
and
then,
when
we
reallocated
those
10
county
positions
to
the
mandated
core
services
that
only
county
government
can
provide
the
feds
say
that
there
is
no.
You
cannot
contract
out
the
administration
of
food
assistance
or
income
maintenance
programs.
It
has
to
be
a
government
narrative
workman.
That
does
that.
C
C
The
fiscal
component
is
met
and
that
we
were
able
to
save
dollars
and
resources,
but
we
were
actually
able
to
improve
the
outcome
for
the
citizens
that
we
serve
both
in
the
child
care
subsidy
world
and
in
the
income
maintenance
world,
because
we
were
not
going
to
have
applications
time
standards
increasing
an
exorbitant
amount
of
time,
because
we
didn't
have
the
staff
to
process
those.
So
it
was
a
great
a
great
example.
I
love
that
example.
C
C
I
can't
emphasize
that
enough,
because
what
that
has
allowed
us
to
do
additionally
in
other,
instead
of
doing
things
just
like
we
talked
about
with
child
care
subsidy,
it's
allowed
us
to
engage
and
to
provide
the
technology,
that's
necessary
for
us
to
be
able
to
serve
more
people
with
the
staff
that
we
have.
We've
been
able
to
develop
a
case
management
system
for
child
welfare.
C
We've
been
able
to
purchase
a
case
management
or
document
management
system
for
our
income
maintenance
world
that
for
the
first
time
in
the
history
of
income,
maintenance
has
allowed
us
to
not
have
each
case
worker
had
five
five
door
bomb
cabinets
in
their
office,
full
of
paper
files
and
a
over
100
000
file
file
room
to
maintain
those
files.
We're
now
completely
electronic
we're
reducing
our
file
room
footprint,
we're
reducing
the
amount
of
space,
that's
required
for
a
caseworker
to
have
an
office.
C
C
C
C
There's
no
requirement,
but
that
plus
a
management
system
for
for
cueing
for
patient
flow
client
flow,
plus
the
investment
that
we're
making
an
electronic
health
record
for
the
health
department
has
allowed
us
to
be
able
to
use
efficiencies
and
use
resources
in
a
way
that
that
would
be
translated
into
additional
space
additional
time.
Additional
resources.
D
C
We
don't
have
to
be
able
to
do
that.
Finally,
communication
communication
is
a
great,
a
great
tool.
It's
also
one
of
the
things
that
can
trip
you
up
the
most.
If
you
don't
communicate,
you
don't
communicate
well,
you
don't
communicate
often,
and
you
don't
make
sure
that
those
lines
are
available
to
everyone.
Have
we've
been
100
successful
in
that?
No,
we
have
not.
We
have
done,
I
think,
a
very
strong
job
and
we
are
building
and
continue
to
build
the
infrastructure
to
make
sure
that
we
communicate.
D
C
That's
where
we're
going
to
go.
Everything
that
we're
doing
is
about
results
that
matter.
We
talked
a
little
bit
about
this
with
our
partnership
with
primary
care
in
western
north
carolina
community
health
dominion
jones
health
center.
When
we
were
doing
that,
it
was
an
unsustainable
model.
We
were
spending
about
four
and
a
half
million
dollars
a
year
to
serve
9
000
primary
care
patients.
We
were
able
to
leverage
because
of
the
full
cost
reimbursement
model
that
an
fqhc
federally
qualified
health
center
has.
D
C
Did
that
rest
of
that
money
go?
It
was
reinvested.
We
reinvested
that
money
in
adding
additional
disease
control
nurses.
We
reinvested
that
money
in
making
sure
that
the
public
health,
the
core
public
health
that
we're
that
we
are
required
to
provide
and
assure
was
built
up
so
that
we
could
meet
the
needs
that
only
we
could
meet.
C
So
trust.
I
love
this
slide,
because
it's
it's
really
talking
about
building
trust
trust
is
is
built
from
a
lot
of
different
perspectives.
Trust
is
built,
hopefully
we'll
build
that
trust
with
you
that
you
will
trust
that
we
go
through
and
how
we
go
through
the
process
so
that
we
can
further
build
that
cement.
Trust
that
we
have.
It's
also
trust
internally,
that
kind
of
going
back
to
the
changes
that
we're
going.
C
It's
about
building
trust
with
the
people
that
don't
ever
come
in
contact
directly
with
our
services,
but
their
tax
dollars
fund
our
services.
It's
about
making
sure
that
we
are
responsible
and
by
doing
so,
building
a
trust
to
allow
us
to
do
the
things
that
we've
talked
about.
It's
about
building
trust
with
county
administration,
so
that
the
county
trusts
us
with
resources
and
knows
that
when
we
get
those
resources,
it's
not
about
simply
using
those
to
spend
money.
It's
about
improving
outcomes
and
access
to
citizens
that
critical
component.
C
This
is
going
to
represent,
what's
in
the
county
portion
of
the
budget,
so
expenditures
for
social
services,
public
health,
pg,
r
parks,
families
and
recreation,
community
contracts
and
other
services
that
we
that
we
fund
to
support
that
total
80
million
dollars.
The
county
contribution
to
that
is
almost
is
a
little
over
40
million.
When
you
look
at
that
in
perspective
of
the
overall
county
budget,
you'll
see
that
health
and
human
services
is
the
largest
single
component
of
the
county
budget.
C
So
that
means
we
get
a
lot
of
attention,
and
that
means
that
there's
a
lot
of
scrutiny.
That
means
that
there's
a
lot
of
accountability
that
we
have
for
those
dollars
and
what
you
just
saw
has
allowed
us.
The
processes
that
we've
put
into
place
has
allowed
the
county
and
we've
built
that
trust
and
hopefully
cemented
that
trust
with
the
county
computing
side.
C
D
C
Budget,
I
said
it's
a
weird
animal,
because
the
dss
vote
not
only
has
county
expenditures
that
are
involved
in
it,
but
it
also
leverages
additional
resources
from
the
federal
and
state
government
that
are
not
specifically
directly
attributed
to
to
counter
cost.
You
see
under
the
total
line,
the
total
amount
of
dollars
that
it
costs
to
administer
and
operate
buncombe
county
dss
for
fy
200
2013,
it's
397
million
total
and
that's
not
all
budgeted
in
the
county.
We
get
282
million
dollars
from
the
federal
government.
C
Remember
when
I
talked
about
audits,
that's
the
part
that
can
keep
you
awake
at
night
that
we
have
over
270
million
dollars
in
benefits
that
we
issue
and
if
there
are
problems,
if
we
determine
eligibility
incorrectly,
if
we
provide
something
wrong,
the
state
comes
back
to
us
and
say
it's
your
fault.
You
authorize
this.
We
just
simply
wrote
a
check,
so
thank
you
very
much
for
the
payment
back.
So
we
have.
C
We
implement
the
policies
that
the
state
creates
and
they
contribute
90
million
to
that
county.
When
you
see
the
county
budget,
that's
the
number
that
is
in
the
county
budget,
23.6
million
dollars.
That's
the
county
contribution
towards
dss.
Well,
what
does
that
look
like?
Well,
if
you
look
at
it,
what
I
said
is
public
assistance.
That's
food
assistance
in
medicaid,
primarily
billions
takes
up
almost
86
a
little
over
86
percent
of
the
total
expenditures
for
the
dss
budget
admitted
to
administer
those
programs.
C
C
Well,
if,
if
you
were
going
to
come
to
us
or
the
commissioners
were
going
to
come
to
us
and
say
country,
but
we
can't,
we
can't
do
this
well,
okay,
but
here's
an
example
here.
This
is
another
example.
This
is
real
life
of
the
budget
that
we
have
the
red
represents.
We
don't
have
any
choice.
We're
going
to
do
this,
there's
a
there's
an
example
that
mandy
had
told
me
a
long
time
ago.
C
C
Our
optional
services
are
very
small,
but
they
support
those
core
services
that
if
we
did
not
provide
those,
our
core
services
cost
would
increase
dramatically
revenue.
Just
another
picture
of
that
graphically
you
see,
71
percent
of
our
revenue
is
from
federal,
23
from
state
and
6
from
county
economic
impact,
great
spot.
The
economic
impact
of
the
benefits
that
we
authorize
in
this
county
and
these
multiple
effects
are
by
national
standards
that
we've
researched
to
be
able
to
determine
done
this
and
determine
what
the
economic
impact
of
those
benefits
are.
C
So
we
issued
364
million
dollars
in
benefits,
either
issuance
or
child
support
enforcement
through
collections
from
absent
parents.
When
you
take
the
multiplier
effect
into
that,
in
other
words,
for
every
dollar
of
medicaid,
you
gain
an
additional
72
cents
of
benefit.
So
when
you
multiply
that
the
total
benefit
to
the
economic
impact
of
this
community
is
almost
622
million
dollars,
so
you
see
there's
any
things
that
happen
at
a
federal
level
relating
to
these
programs
can
have
a
significant
economy.
D
C
C
D
C
C
C
The
reason,
as
many
as
said
to
you
before,
is
that
the
county
believes
in
health
and
human
services,
builders
that
there's
a
critical
component
related
to
health
and
wellness
that
parks,
human
race
and
recreation
provides
and
that
having
that
sit
within
the
health
and
human
services
budget
provides
a
natural
opportunity
to
both
utilize,
the
expertise
of
wellness
activity,
physical
activity,
parks,
reviews
and
recreation
and
allow
public
health
and
dss
to
work
more
closely
with
them
valley.
Child
care
center
is
the
only
child
care
center
that
we
currently
still
operate.
C
We
used
to
operate
others,
that's
one
of
those
smart
partnerships
that
we
engaged
with.
We
got
out
of
the
business
of
doing
something
that
we
were
not
the
best
ones
to
provide
but
valley.
Child
care
center
is
an
example
where
we
partner
and
have
the
facility
at
a
school
so
that
we're
able
to
help
team
mothers
who
have
had
children
to
be
able
to
attend
that
school
and
let
their
children
attend
that
daycare.
C
So
it
not
only
helps
build
the
bonds
with
that
parent,
but
it
also
keeps
that
team
mom
in
school
and
helps
that
team
mom
to
graduate
recreation
programs.
We
have
in
place
throughout
the
county.
You've
probably
seen
those
you've
seen.
Maybe
you've
gone
to
the
visit,
the
festival
of
lights
at
lake
jolene,
if
you've
not
done
that,
you
ought
to
do
that.
It's
a
great
thing
to
do
and
to
help
support
parks,
streamers
and
recreation.
C
Lake
julian
park
is
one
of
those
areas.
That's
not
just
festival
lights,
but
it's
also
a
recreation
activity.
That's
very
well
used
throughout
the
county,
particularly
in
south
nashville
zordner
center
in
it
represents
the
indoor
pools
ordinary
indoor
pool,
as
well
as
our
five
county
pools
that
we
have
throughout
the
county
and
inca
sports
park
is
the
soccer
fields
in
west
asheville
at
sandhill
venable
we
contract
with
abyssa,
who
maintains
those
soccer
fields
for
us
again,
another
small
partnership.
C
Other
areas
within
the
health
and
human
services
budget
are
community
contracts.
Community
contracts
represent
those
contracts
and
those
services
that
were
that.
We
provide
that
we
contract
with
organizations
to
help
support
our
core
core
programs
in
bunken
county,
as
well
as
what
the
commissioners
have
designated
as
programs
that
they
believe
support
the
sustainability
plan
that
they
recently
adopted
so
the
process.
C
Those
resources
across
the
county,
behavioral
health
is
a
large
investment.
Dr
richard
montgomery
is
here
somewhere.
He
is
the
leader
of
that
program.
Six
hundred
thousand
dollars
of
that
behavioral
health
budget
represents
our
maintenance
of
effort
that
we
are
required
that
every
every
county
is
required
to
provide
to
the
local
managed
care
organization,
formerly
known
as
their
local
management
entity,
western
highlands.
So
we
provide
that
money
to
them.
We
designate
those
funds
for
specific
outcomes
so
that
we
get
specific
results
and
monitor
those
results.
C
In
addition,
the
county
also
provides
additional
money
that
the
county
doesn't
have
to
do
towards
that.
We
use
a
lot
towards
jail
diversion
services
and
for
helping
people
that
are
disabled
that
are
not
receiving
social
security
benefits
to
get
into
a
program
to
be
able
to
allow
them
to
get
those
benefits.
C
You'll
also
see
in
this
document
the
infection,
ecology,
history,
doc,
where
there's
millions
of
dollars
in
benefits
that
come
to
leverage
as
a
result
of
those
investments,
human
services
support
team
represents
the
functions
that
are
set
within
health
and
human
services
that
provide
the
support.
Those
represent
the
histories
of
planetary
evaluators
that
we
call
histories
to
support
the
physical
and
programmatic
components
and
that
have
helped
us
realize,
as
you'll
see
in
the
document
over
seven
million
dollars
in
savings
and
reinvestments
and
cost
awarenesses,
both
internment
and
community
and
animal
services.
Animal
services.
C
C
That's
larger
in
total
than
the
total
county
budget
at
20
about
you'll
see
here
next
slide.
You'll
see
an
example
of
how
we
leverage
for
a
40
million
dollar
contribution,
not
insignificant.
I
don't
need
to
not
say
that
it's
not
significant,
but
for
a
40
million
dollar
investment
that
the
county
provides.
We
leverage
an
additional
379
million
dollars
in
services
and
benefits
for
the
citizens
to
get
to
that
419.
C
Here's
a
breakdown
of
all
of
that
together.
So
a
little
over
two-thirds
of
the
funding
comes
from
the
federal
government
at
22
and
the
county
pays
about
10
of
those
costs.
Well,
it
comes
back
to
trust.
It
comes
back
to
building
trust.
It
comes
back
to
what
is
it
that
we
do,
that
has
allowed
us
to
hopefully
have
a
positive
impact
on
the
citizens
of
our
community
and
it's
been
about
building
trust
and
that
can't
be
overemphasized,
because
that's
a
hard-fought
battle
that
you
know
in
your
own
organizations.
C
He
said
you
know
I
I
was
thinking
listening
to
this
and
hearing
all
the
ideas
that
were
coming
about,
and
I
thought
about
this
one
that
we're
in
partnership
with
a
discussion
with
with
mayheck
in
particular
about
providing
transportation
services
for
a
medical
corridor,
so
using
the
bus
system,
starting
at
cox,
avenue
and
providing
bus
service
that
goes
by
the
jones
health
clinic,
goes
up
to
mission
hospital
and
then
goes
up
to
mayhem.
If
you've
been
to
mayhem.
You
know
right
now.
C
Man
is
not
directly
on
the
bus
line,
so
we're
trying
hard
to
get
that
very
well
and
so
we're
trying
to
get
work,
a
plan
to
get
that
on
the
bus.
Well,
what
does
that
do
what
a
great
opportunity
we
have
a
strong
investment
in
making
sure
that
the
citizens
that
we
serve
get
to
make
amendments,
especially
now
soon
they
had
family,
because
the
contract
that
we
have
with
minnie
jones
to
provide
prenatal
health
care
services.
C
We
refer
many
of
those
high-risk
pregnancies
to
mayheck
women's
to
handle
those
may
have
to
handle
those
harvest
pregnancies.
It
wouldn't
be
a
good
thing
for
those
women
to
walk
up
that
hill,
so
it
makes
sense.
That's
that's
what
a
great
example
we're
so
glad
that
he
came
and
brought
that
to
us
for
us
to
be
able
to
engage
in
a
partnership
to
be
able
to
do
that,
because
that
helps
not
only
mayheck.
C
C
C
There
are
two
separate
things:
the
323
000
represents
323
000
savings
related
to
child
care,
subsidy
implementation,
the
the
difference
in
4.5
and
2.3
for
western
north
carolina
that
what
we
would
call
that
is
a
saving
slash
abortions.
So
we
didn't
take
that
money
off
the
table.
It
wasn't
something
that
the
county
said
put
that
money
back
in
fund
balance
now.
Thank
you
very
much.
It
was
about
saying,
okay.
C
C
Program,
it's
all
federal
funding
they
take.
The
federal
government
gives
money
to
the
state
and
then
the
state
allocates
that
on
a
formula
that
they
devised.
They
look
at
steve
and
can
help
me
with
this,
but
they
look
at
that
based
on
what
your
population
is.
They
look
at
that,
based
on
the
number.
D
C
Children
that
might
be
eligible
for
the
program
they
look
at
what
what
your
waiting
list
is,
that
you
currently
have
their
children
not
able
to
get
over
that
subsidy
program
that
those
dollars
are
never
enough
across
the
state
for
the
subsidy,
the
administration
part.
They
changed
the
formula
drastically
this
past
year.
They
said
based
on
the
census,
but
when
we
actually
went
back
and
looked
at
it,
we
didn't
quite
agree
with
what
they
were
saying
in
their
in
their
in
their
process.
C
C
We
realize
that
we
won't
have
this
nearly
this
much
time
every
month
to
be
able
to
devote
to
the
financial
aspect
of
the
budget,
but
we
want
to
make
sure
that
you
have
enough
to
make
decisions
and
understand
it.
The
finance
and
executive
committee
is
charged
with
going
over
the
details
of
the
budget
and
we
meet
monthly
to
talk
about
the
individual
strategies
that
we're
employing
related
to
the
budget
challenges
opportunities.
C
C
So
you'll
see
salaries
are
about
right
on
target
at
42
operating
is
a
little
bit
low
human
services
assistance.
A
little
bit
is
low
contracts
is
higher.
Well,
we'll
go
over
in
detail
with
the
exact
committee,
the
specific
reasons
for
those,
but
I'm
happy
to
go
over
that
with
you
to
tell
you
that
what
those
reasons
are
a
lot
has
to
do
with
spending
patterns.
C
Sometimes
you
spend
more
at
the
beginning
of
the
year
like
with
contracts,
because
we
front
end,
some
of
our
contracts
and
operating
expenditures
are
lower
because
we
have
more
expenses
that
happen
in
the
later
part
of
the
year
overall,
and
we
also
try
to
manage
those
effectively
so
that
we
don't
so
that
we
have
enough
to
be
able
to
do
some
of
the
things
that
we've
talked
about
today
and
then
to
the
right
of
that.
We
have
remember
the
accounting
units.
Those
are
the
broad
divisions
by
light
function.
C
Do
the
same
thing
the
green
represents
spending
last
year.
The
bar
represents
where
we
are
where
we
could
be
in
terms
of
percentage
of
the
fiscal
year
and
the
individual
bars
represent,
where
we
are
actually
here
today.
The
only
thing
I'd
point
out
to
you,
as
you
see,
on
child
care
subsidies,
we
spent
zero
percent
through
the
end
of
november.
C
Please
don't
be
alarmed
that
doesn't
mean
that
we've
not
provided
child
care
subsidy.
That
line
actually
represents
child
care
subsidy
administration
because
of
the
examples
that
we
had
working
at
the
legislature.
We
didn't
do
anything
with
that
until
we
were
firmly
solid
with
what
our
allocation
was.
Now
that
that's
done,
you'll
see
in
december's
results
that
we've
paid
we're
current
now
through
the
end
of
november,
in
our
contract
that
represents
our
country,
subsidy.
D
C
C
You
know
now
contracts,
I
just
after
I
got
through
saying
that
we
find
in
some
of
our
contracts.
You
see.
Contracts
for
public
health
is
is
way
above
where
we
are
that
represents
a
lot
of
that
that
we
have
in
contracts
are
for
specific
initiatives
that
we
are
either
in
the
process
of
developing
or
have.
C
C
A
regional
public
health
just
to
point
out
where
that's
low,
the
regional
public
health,
is
what
we
call
the
state
lab
if
you're.
If
you
have
heard
north
carolina,
just
built
a
new
state
lab
in
raleigh
and
it
will
replace
all
of
the
regional
state
labs.
So
this
state
lab
is
actually
closed
now
and
all
those
the
great
facility
and
raleigh
that
they
built
with
conservative
space
for
expansion.
C
So
that's
what
that
is,
and
then,
if
you
look
at
park,
trainways
and
recreation
you'll
see
where
we
are
grants
not
being
spent,
because
those
are
processes
that
they're
just
now
undergoing
and
sending
out
requests
to
get
those
grants.
Those
are
grants
that
they
allocate
to
organizations
and
communities.
C
A
A
A
F
Data
today
I
want
you
to
focus
on
the
process
and
what
we're
going
to
do
next
with
it,
I'm
going
to
give
you
some
data
just
to
give
you
a
broad
straight
picture
of
what's
in
the
community
health
assessment,
but
I
didn't
really
want
people
diving
into
the
data.
I've
actually
done
a
couple
of
presentations
so
far
and
that's
exactly
where
people.
F
But
that
was
the
rationale
I'm
not
sending
this
out
before
assessment,
as
you
can
see,
is
one
of
the
core
public
health
functions
and
in
north
carolina.
Local
health
departments
are
required
both
by
statute
and
by
accreditation,
to
do
a
community
health
assessment
every
four
years.
So
hopefully
that's
not
a
new
concept
to
you.
F
Hopefully,
you've
had
the
opportunity
to
look
at
community
health
assessments
in
the
past
and
they're,
usually
due
in
december,
and
what
the
state
does
is
break
us
up
into
25
25,
25
25,
so
they're
only
reviewing
25
a
year,
there's
a
community
health
improvement
process
that
we're
part
of,
and
it
starts
with,
the
assessment.
So.
D
F
Assessment
is
the
first
part:
it's
not
the
whole
process.
The
collection
of
data
is
just
an
opportunity
to
help
you
work
with
your
community
to
figure
out
what
your
priorities
are,
but
then
you've
got
to
put
together
an
implementation
plan
and
implement
it
and
evaluate
it.
So
it's
an
iterative
process.
It
doesn't
stop
in
between
the
two
four
year
periods.
F
D
F
F
F
A
community
health
assessment
that
will
allow
us
to
meet
their
timeline
that
the
affordable
care
act
required.
We
bumped
up
our
process
by
two
years
to
do
that,
but
in
addition
to
that,
we
decided
instead
of
doing
one
just
in
the
county,
that
we
were
going
to
do
a
regional
community
health
assessment.
So.
D
F
F
Primary
data,
which
we
did
through
a
telephone
interview,
process
that
every
county
in
western
north
carolina
has
so
the
assessment
that
you'll
see
on
our
website
will
look
almost
exactly
like
the
assessment
on
15
other
county
health
department
websites.
The
data
is
put
together
the
same
way.
We
now
have.
F
D
F
F
One
is
demographic
socio-economic
data
and
you
can
see
the
issues
that
are
included
under
that
health
status.
It
looks
at
the
community
health
rankings
that
we
receive
from
the
national
level
through
robert
wood,
johnson
and
the
university
of
wisconsin
every
year,
along
with
these
other
issues
that
we're
looking
at,
we
have
health
behaviors
that
we
look
at
as
well
as
clinical
care,
demographics
and
data,
physical
environment
and
quality
of
life
data.
In
addition
to
that,
the
document
includes
a
gap,
analysis
of
services
in
our
community
and
then
the
prioritization
of
issues.
F
D
F
Do
is
look
at
the
data
in
those
specific
areas
to
see
if
our
priorities
still
remain
what
they
were
before
and
that's
what
what
I'm
going
to
share
with
you
today
so
leading
causes
of
death.
What
you
have
here
is
both
county
ranking
rate
in
western
north
carolina
and
north
carolina.
The
three
things
just
to
point
out
here:
ours
are
fairly
similar,
similar
to
western
north
carolina
and
the
state
some
of
the
differences,
chronic
lower
respiratory
disease.
F
We
have
higher
rates
there
as
well
as
alzheimer's
disease
and
suicide,
just
issues
for
us
to
pay
attention
to,
but
you
can
also
break
that
down
by
age
group
and
again,
you'll
see
the
similarities
across
falcon
county
western
north
carolina
north
carolina
in
terms
of
the
leading
causes
of
death.
Although
when
you
get
to
the
40
to
64
year
old
age
group,
chronic,
lower
respiratory
disease,
pops
up
for
buncombe
county,
so
again,
something
for
us
to
pay
attention
to.
F
F
African-American
girls
and
african
hispanic
girls
giving
birth
in
north
carolina.
Some
of
that
in
the
hispanic
community
may
be
cultural,
but
we
do
know
that
pregnancy
in
our
teens
impacts,
birth
outcomes
and
that's
something
we
need
to
pay
attention
to
gotta
reiterate:
five
racial,
ethnic,
ethnic
groups
and
again
we
have
data
for
north
carolina
county
number,
one.
F
Our
rates
are
higher
across
the
board
than
north
carolina
rates,
but
you
can
also
see
the
huge
disparities
in
our
african-american
community,
which
greatly
impacts
how
we
focus
and
target
the
services
that
we
provide
the
populations
that
we
need
to
focus
on
when
we
look
at
the
area
of
healthy,
healthy
living.
It's
no
news
to
anybody
that
obesity
is
an
issue
in
our
country.
F
These
came
from
the
survey
that
we
did.
We
contracted
with
prc,
which
is
a
national
organization
that
does
day
collection
and
there
there's
one
of
their
specialties.
Is
doing
telephone
surveying,
they
did
the
same
questionnaire
across
all
of
our
16
counties.
They
did
sufficient
numbers
in
every
county
for
the
data.
D
F
F
Your
work
is
having
an
impact,
that's
a
good
thing
to
see,
but,
as
you
can
see,
we
still
have
more
heart
disease
in
this
community
and
that's
from
it
than
we
need
it
now.
So
still
very
infirm
focus
cerebral
vascular
disease.
We
see
sort
of
the
same
thing,
we're
a
little
just
barely
higher
than
the
regional
name,
but
again
diabetes
compared
to
western
north
korea,
north
carolina
and
the
u.s.
Our
diabetes
rates
are
higher
as
well.
D
F
F
Question
was
interesting
about
how
many
people
have
worried
in
the
past
year
about
food
running
out
before
they
get
money
to
purchase
any
and
if
you'll,
look
at
this
block
over
here
over
25
percent
reported
that
that
was
sometimes
true
or
often
true
for
them.
So
when
we're
talking
about
food
security
and
we're
talking
about
people
eating
healthy
fruits
and
vegetables,
which
are
usually
more
expensive
than
the
potatoes
or
mice
and
the
pasta
that
people
can
get,
this
is
an
issue
for
us
too.
F
F
There's
good
support
in
our
community
for
physical
activity
spaces
available
to
the
public
after
hours,
so
we're
we're
trying
to
be
creative
about
making
sure
that
we
have
these
spaces
in
our
communities
and
then
access
to
farmers,
markets
and
tailgate
markets.
There's
support
for
these
things.
We've
just
got
to
figure
out
how
to
make
them
happen
in.
F
Than
they
already
do,
when
we
look
at
children's
health
and
school
readiness
again,
the
overweight
and
obesity
issue,
pops
up,
obviously
in
buncombe
county-
and
this
is
not-
this
is
not
self-reported
data.
This
is
data
that
comes
from
our
school
systems.
Every
year
we
have
been
tracking
bmis
in
kindergarten
through
fifth
graders,
for
over
five
years
in
baltimore,
county
and
all
of
our
schools,
and,
as
you
can
see,
44.4
of
our
kids
are
either
overweight
or
indeed,
and.
D
F
D
F
At
this
is
this
is
indication
of
poverty
for
children
under
the
age
of
18..
We
usually,
we
often
do
this
in
five-year
increments,
because
it
takes
some
of
the
instability
out
of
data.
The
first
set
is
20
205
to
29..
The
second
is
206
to
210.
You
see
the
numbers
starting
to
creep
out
then,
when
we,
when
we
look
at
these
last
three
years,
we
know
that
those
numbers
will
go
up
here.
Further
average
weightless
time
for
children
for
child
care,
subsidy
in
buncombe
county
has
gone
up
over
the
past
year,
so
the.
F
Of
those
dollars
and
the
need
for
it,
when
you
put
those
two
things
together,
the
way
time
has
gone
up
and
the
number
of
children
enrolled
in
licensed
early
care
in
the
education
program
has
gone
down,
which
is
directly
related
to
the
fact
that
those
dollars
aren't
available
to
everybody
that
needs
them
and
when
we're
looking
at
child
development
ready
for
readiness
for
school.
This
is
this
is
huge
access
to
care
interesting,
a
lot
enough.
F
The
majority
of
the
people
in
buncombe
and
even
in
western
north
carolina,
consider
cost
quality
number
of
options
and
availability
that
we
have
a
good
child
care
system
in
our
community.
So
that's
positive,
but
then,
if
you
look
especially
our
adults
1964,
we
still
have
quite
a
few
people
who
don't
have
health
insurance,
we're
hoping
that
the
affordable
care
act
will
help
with
that
and
then
we're
hoping
that
the
medical
care
community
will
be
able
to
accommodate
all
of
those
extra
people
that
have
insurance
access
to
care.
F
F
We
probably
need
to
dive
into
the
data
a
little
bit
more,
do
a
little
more
explanation
to
really
understand
fully
what
some
of
the
answers
were
and
why
what
we
might
be
able
to
do
about
some
of
those
things
you
saw
that
I
put
the
chronic
respiratory
disease.
It
showed
that
it
was
one
of
our
leading
causes
of
death,
especially
in
that
middle
age
group.
F
It
didn't
rise,
so
the
top
is
one
of
our
primary
priorities
through
our
health
assessment,
but
we
know
it's
one
of
the
leading
causes
of
death
and
it's
the
leading
cause
of
preventable
death
in
the
united
states.
So
the
line
is
the
healthy
people
2020
target.
You
can
see
that
we
are
in
better
shape
than
the
state
and
in
western
north
carolina,
but
still
have
a
way
to
go
to
meet
that
target,
and
this
is
smokeless
tobacco
products.
F
Western
north
carolina
and
falcon
county
are
ahead
of
the
united
states
in
that
area
and
that's
again,
an
area
that
we
need
to
stay
focused
on,
especially
with
our
youth,
and,
if
you
remember,
the
dollars
that
were
taken
out
of
the
master
settlement
settlement.
The
focus
on
tobacco
use
in
youth
and
preventing
tobacco
use
and
youth
was
wiped
out
by
the
general
assembly
license
last
year.
So
again,
we're
having
to
stay
focused
on
that
and
figuring
out.
How
we'll
continue
to
bring
that
down,
because
we
have
seen
a
significant
decrease
in.
D
F
Youth
in
tobacco
use,
but
with
the
dollars
going
away
for
that
prevention,
work
we'll
have
to
keep
on
on
top
of
that.
So
what
we
did
is
we
took
those
six
priorities
that
we
had
before
and
we
repackaged
them
a
little
bit
by
art
and
and
made
them
a
little
more
specific.
These
are
the
proposed
community
health
priorities
for
the
moving
forward
for
the
next
several
years:
women's
preconception
health.
F
Living
obviously,
there's
lots
of
work
that
we
need
to
do
there:
children's
health
and
early
child
development.
All
of
the
data
that's
coming
out-
is
really
showing
that
you
don't
focus
on
that.
When
these
children
are
young,
they
will
not
have
the
outcomes
that
be
the
productive
individuals.
We
need
them
to
be
as
we
would
hold
and
then
access
to
primary
mental
health
care
as
an
ongoing
issue
for
us
we're
in
better
shape
than
lots
of
others
in
the
community.
F
F
F
Right
now,
the
plan
is
over
220
pages,
long
with
lots
of
charts
and
graphs
good
bedtime
reading,
but
it's
also
set
up
on
the
web
in
a
way
that
if
you
go
to
the
table
of
contents,
there's
specific
data,
you
want
to
see
you
click
on
that
it
takes
you
to
those
pages.
So
hopefully
it's
user
friendly-
and
this
is
the
website.
F
G
There
needs
to
be
a
newsletter
that
goes
out
to
each
client.
I'd
say
that
you
serve
and
have
a
way
of
communicating
back
and
forth,
even
on
the
blog
or
some
way,
because
technology
today
is
very
useful
and
if
each
department
did
that,
I
think
we'd
get
a
lot
better
surveys
than
what
you
get
from
these
national
companies,
because
every
community
is
different.
As
you
know,
a
hospital
has
a
different
way
of
operating
than
other
agencies.
G
G
The
word
trust
you
saw
many
times
mention
until
you
gain
the
trust
of
that
person.
You
will
not
get
sufficient
information
to
go
forward
with
what
you're
doing,
if
you're
always
telling
them
what
you're
doing,
instead
of
asking
them
what
they
need.
Then
you're
not
going
to.
Thank
you
so
much.
Thank.