Item A
Exhibits: Group Benefits Program & Salary Issues
A - Letter of June 17 regarding Group Benefits Program
B _ Salary Increases Cost split between Ad Valorem and Non- Ad
Valorem at various percentages
C - Letter of May 1, 2003 to Commissioner Neugent regarding Request
for Salary Information
D - Letter of May 1, 2003 regarding to Mayor Spehar regarding
Request for Salary Information
E - Group Insurance Administration Recommendation - Approved
4/17/2003
MEMORANDUM
TO: Mayor Dixie Spehar
FROM: James L. Roberts
County Administrator
DATE: June 17,2003
SUBJECT: Group Benefits Program
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On Monday, June 9, 2003, you met with the Administrator and staff from OMB and the
group benefits program. You expressed concern in reference to the impact of the changes by the
Board of County Commissioners and asked that we look at some issues to alleviate those
impacts. The staff has looked at the issues we discussed and below is a calculation of some
adjustments that could be made.
Please be reminded that the actions taken by the Board of County Commissioners resulted
in a $3 million ad valorem savings to the County and the citizens. If the County Commission
decides to implement any or all of the changes below, that will require additional taxation to
cover the costs. As I discussed with you earlier today, the Administration is confident that we are
going to be able to meet the County Commission's goal of no more that 2.4% over roll back
when the draft budget is presented in July. The issues we discussed last week and their impacts
are summarized below:
Cost to County/
Savings to Participants
1. Change in the deductible from $400 per individual/$1200 per family
to $350 per individual/$1050 per family
$ 50,000
2. Change the medical co-pay and out of pocket limit from 75% of the
first $30,000 and 100% thereafter for the remainder of the year to
80% of the first $30,000 and 100% thereafter for the remainder of the
year
$375,000
3. Change the pharmaceutical co-pay of$10 generic/$60 preferred brand/$90
non-preferred brand to a co-pay of $1 0 generic/$50 preferred brand/$70
non-preferred brand
$475,000
4. Change the retiree contribution for health coverage of $1 00 per month to
a retiree contribution of health coverage of$75 per month (this will $ 75,000
increase the County's long term liability). $975,000
(This equates to $760,000 in ad valorem impact.)
A
You also requested information concerning the impact of reducing the proposed 2.4%
compensation increase to assist in covering the increased cost (especially ad valorem). The
following are the impacts:
a. Reduce from 2.4% to 1.4%
Savings
$560,000
($500,000 ad valorem)
b. Reduce from 2.4% to 1 %
$784,000
($700,000 ad valorem)
c. Reduce from 2.4% to 0%
$1,344,000
($1,200,000 ad valorem)
Hopefully this responds to all the information you requested. If you would like to review
any further options, please let us know and we will work with you.
James L. Roberts
County Administrator
JLR:dlf
Cc: Board of County Commissioners
Sheila Barker
Jennifer Hill
Maria Fernandez
2
% Increase
1.0%
2.0%
2.4%
3.0%
4.0%
5.0%
Ad Valorem
Cost
$500,000
$1,000,000
$1,200,000
$1,500,000
$2,000,000
$2,500,000
Office of Management & Budget
Salary Increases
(Including Constitutional Officers)
Non-Ad Valorem
Cost
$60,000
$120,000
$144,000
$180,000
$240,000
$300,000
Total Comments
Cost
$560,000
$1,120,000
$1,344,000 Currently Budgeted
$1,680,000
$2,240,000
$2,800,000
B
7/17/2003
/"~4
/.C/
MEMORANDUM
TO: Commissioner George Neugent
FROM: James L. Roberts
County Administrator
DATE: May 1,2003
SUBJECT: Request for Salary Information
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You requested information concerning the impacts of the possible adjustment to the
proposed compensation increases. Specifically, you asked what would be the impact if raises
were to be 4% rather than the 2.4% which is presently proposed.
If the 2.4% cost of living increase were raised to 4%, the additional budget increase
would be approximately $900,000 ($800,000 ad valorem taxes). This would bring the total cost
of a 4% salary increase to $2,240,000 ($2,000,000 ad valorem taxes).
Please be reminded that the numbers pertain to increases for all County employees
(approximately 1,375) including those under the 'Constitutional Officers and the Board of County
Commissioners.
There has also been a request for consideration of raising the starting salary of Sheriffs
positions to that level of the City of Key West Police Department. The question that is not yet
answered is what would happen to the balance of the Sheriffs salaries that would need to be
adjusted to maintain some sense of fairness among the ranks and to recognize longevity. The
International Association of Fire Fighters has raised similar issues during negotiations with us.
This information will be provided in the near future.
) ~.' ~ iD ~
, James L. Roberts' !~'
County Administrator
JLR:dlf
cc: BOCC
Sheila Barker
Jennifer Hill
c
/' ~e)#~
MEMORANDUM
TO: Mayor Dixie Spehar
FROM: James L. Roberts
County Administrator
DATE: May 1,2003
SUBJECT: Request for Salary Information
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You requested information concerning an adjustment of the 2.4% proposed salary
increase in order to offset some of the impact of the adjustments to the group benefits program.
Based upon my understanding of your request, the following is provided for your consideration.
.
Current Direction from the BOCC: The 2.4% cost ofliving increase that we are planning
on putting in the tentative budget is estimated to cost $1,344,000 ($1,200,000 ad valorem taxes).
If the cost of living increase were reduced from 2.4% to 1.4%, the budget reduction
would be approximately $560,000 ($500,000 ad valorem taxes). This would bring the total cost
of the 1.4% salary increases to $784,000 ($700,000 ad valorem taxes).
Please be reminded that the numbers pertain to increases for all County employees
(approximately 1,375) including those under the Constitutional Officers and the Board of County
Commissioners.
If you have any further questions, please let me know.
df(fi~?~/j/U
James L. Roberts
County Administrator
JLR:dlf
cc: BOCC
Sheila Barker
Jennifer Hill
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Existina
9. Dependent Subsidy County subsidizes coverage by approximately 75%
Per pay day rate Monthly Rate
One Dependent $110 $238
Two or more Dependents $130 $282
16
Spouse Only
Each Child
Family Cap
* A minimum
Proposed
County subsidizes coverage by 60%
Per pay day rate* Monthly Rate
$163 $353
$54 $117
$244 $528
rate of $110 per pay day for dependent coverage would apply I
$280,000
Additional Cost
Group Insurance Program Comparison
Dependent Coverage Proposal
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1M E M 0 RAN DUM
To:
Board of County Commissioners
From:
James L. Roberts, County Administrator
Date:
July 14, 2003
RE:
Funding Requests from Outside Agencies
The Human Service Advisory Board is reviewing $1,461,000 in funding requests from a
variety of human and social service agencies. They will ultimately make a recommendation to the
Board of County Commissioners for slightly under $1,065,000, as you directed.
In addition there are entities that are funded directly by the Board of County
Commissioners. As a result the Board receives applications for such direct funding. The enclosed
shows the status of projects for which applications have been made and for which applications are
generally not required because of the recurring nature of the funding.
There is time on the Commission's agenda to consider these issues on the morning of July 18,
2003. If you require any additional information please let us know.
. / -e:::-" f) (
.'u ' '-. C _~ ~--L..->
James L. Roberts
County Administrator
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June 17, 2003
Mr, James L. Roberts
County Administrator
1100 Simonton Street, Room 2-205
Key West, FL 33040
Dear Mr, Roberts,
We have just been notified that our reduction in state funds for this upcoming
fiscal year has increased to $20,000 over the $87,000 loss of funds we
experienced in the last half of the prior fiscal year. That brings our total funding
loss in one year to $107,000, Since fiscal year 2000-2001, our total decrease in
state funds through the Department of Juvenile Justice is $137,789, This
continued decline in funding pushes our anticipated expenses over contracted
revenues for fiscal year 2003-2004 to a loss of $203,160,
We are asking the Board of County Commissioners to cover the anticipated
loss of $200,000. We have a commitment from Sheriff Rick Roth to cover the
three-month delay between the ending of the state fiscal year (June 30) and the
beginning of the county fiscal year (October 1) - a total of $50,000 - if the BOCC
agrees to continuation funding, This request is apart from the historical support
received through the county's Human Services Advisory Board. That amount
totaled $35,000 last year.
As you know, residential work with unaccompanied children and youth is highly
regulated by both the state and federal governments and dictates staffing levels,
staff gender per shift, staff qualifications, nutritional and residential safety
requirements and many, many other standards that must be met to maintain
state and federal contracts, While our contracts have always contained
significant community match requirements from 10% for federal dollars to 30%
for some state funds, we have tried to lessen the burden through minimal
staffing, maintaining as small an administrative infrastructure as possible while
still meeting contractual requirements, and raising as much money through
1999 Florida Network of Youth and Family Services Agency of the Year
A Department of Juvenile Justice Deemed Status Agency
Florida Keys Children's Shelter, Inc,
73 High Point Road
Tavernier, FL 33070
305-852-4246
FAX 305-852-6902
special events as possible, (We currently raise more money than any other
Florida Network of Youth and Family Services agency in the State of Florida,)
In the past year we have been forced to layoff four community-based counseling
staff members and close our satellite office in Key West (relocated to the
Juvenile Justice Building), Employees have not received pay increases in five
years, Senior staff members each donated three days of vacation pay back to
the organization, Employees are now paying a 25% percent more of their health
care benefits,
The Board of Directors has explored the option of merging with a local partner.
However, there are none that do the work that this organization does, and those
that are remotely similar are in a declining funding environment themselves, We
have also explored large organizations outside the county for potential
partnership, This would lead to the disintegration of the local focus,
administration and identity of the Florida Keys Children's Shelter and would raise
the possibility that a percentage of any additional monies raised in our county
would be used to support an administrative infrastructure elsewhere,
The Board of Directors has initiated a Donor Development plan using the support
of our local estate planning and accounting professionals. It is our expectation
this work will eventually provide significant financial support but it is a long-range
plan that will not begin to bear fruit for several years,
I believe that we have, in good faith, sought all other options of fiscal support, It
has never been the intention of the state and federal governments that those
entities could or would provide full funding for emergency residential services for
the community's abandoned, abused, neglected, runaway and ungovernable
children and youth, While our costs are upwards of $150 per bed per day,
depending on the behavioral needs of each child, our contracted rates are $75
per bed per day, These rates have not increased to keep pace with increasing
costs, but are actually declining. Voluntary fundraising cannot be expected to
absorb either the decline in funding or the increase in the costs of doing
business. Funds raised through voluntary donations can be used to augment
programs or meet emergency needs (equipment replacement and repair,
hurricane evacuation costs, etc,), but they should not be used to meet primary
business expenses such as payroll or paying utilities or transportation costs,
While adults may find themselves in adverse situations due to either their own
actions or actions outside of their control, the services we provide are for minors
who should not and cannot be expected to provide for themselves, The Florida
Keys Children's Shelter is an exemplary organization that has continued to meet
increasing community needs, has opened two programs to provide services for,
infants and young children and to care for those not likely to have successful
1999 Florida Network of Youth and Family Services Agency ofthe Year
A Department of Juvenile Justice Deemed Status Agency
Florida Keys Children's Shelter, Inc,
73 High Point Road
Tavernier, FL 33070
305-852-4246
FAX 305-852-6902
placements elsewhere, and has exceeded the quality assurance standards of
reviewing agencies, despite the continued drain on funding,
I am enclosing supporting statistical documentation that shows that the
organization provides residential services for children and youth from throughout
the county, budgetary information, audits, etc, Please let me know if there is any
other information that might be required by the Board of County Commissioners
in their deliberations,
Thank you for your support throughout this difficult process, and for your concern
for the vulnerable children of Monroe County,
Sincerely,
~M
Executive Director
Cc: Board of County Commissioners
Rick Roth, Monroe County Sheriff
Keith Douglass, President, Board of Directors
Members, Board of Directors
1999 Florida Network of Youth and Family Services Agency of the Year
A Department of Juvenile Justice Deemed Status Agency
Florida Keys Children's Shelter, Inc,
73 High Point Road
Tavernier, FL 33070
305-852-4246
FAX 305-852-6902
FLORIDA KEYS CHILDREN'S SHELTER, INC.
BUDGET
Fiscal Year 7/1/03-6/30/04
REVENUE
Contracted Revenue:
CINS/FINS & Title IV-E
FL Dept. of Children & Families
US Health & Human Services
Truancy Intervention
Monroe Co, (Last year's contracted amount)
US Dept. of Education
$631,879
593,790
110,000
66,848
35,020
10,000
Other Revenue:
United Way
Total Budgeted Revenue
EXPENDITURES
Personnel:
Salaries
Payroll Taxes
Employee Benefits
$ 986,299
79,896
101,108
Operating Expenses:
Program Supplies & Expenses
Insurance-Corporate
Insurance-Workman's Comp & Other Personnel Exp,
Fundraising Expenses
Utilities
Travel (Mileage and Out-of- Town)
Repairs and Maintenance-Building
Telephones
Office Supplies
Professional Fees
Equipment Repair and Maintenance
Other Operating Expenses
$177,316
48,804
41 ,200
37,000
36,000
31,574
26,903
26,593
17,438
17,200
15,819
57,527
Total Expenses
Excess of Budgeted Expenses over Budgeted Income
$1,447,537
50,000
$1,167,303
533,374
$1,497,537
$1,700,677
$ (203,140)
S ~~61~~
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All information presented is from fiscal year
01-02 unless otherwise indicated.
Monroe FKCS Intakes by Zip
Code
Residential and Non-Residential lJ Key Largo
. Tavernier
o Islamorada
9%
3%
o Marathon and
Middle Keys
. Lower Keys
24%
~)
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DKeyWest
1
All Intakes for FKCS
CJ Monroe County:
II Out of Courty
Florida Residents:
o Out of State:
89%
i)
......
Monroe County Population by
Race 2000 (all ages)
03%
.5%
o White
II Black
o Hispanic
o Other
~)
......
.hlm
2
Monroe County Student Ethnic
Composition 2000-01
~)
~
Ell \Nhite non-hispanic
. Black non-hispanic
o Hispanic
o MUtiracial
. Asian
CI Native American
Girl S<:oulI2002 Council PertllnDance AIIeumenI preIiminIry report
FKCS Demographics:
Race
o Asian: . AAlBlack
<1 % 11 %
. Other:
1%
o Multi:
5%
~)
~
o \M1ite:
82%
3
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FKCS Demographics:
Ethnicity
o Non-Hispanic
&I Hispanic
o Haiti an
o Other
FKCS Demographics:
Gender
44%
o Female:
56% . Male:
4
Ages of Children Served
70
60
50
40
30
20
10
o -
----
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ e ~
~ ~ m m m m m m m m m m m m m m m m
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
~~~~~~~~~~~~~~~~
::: ..- N (f) ~ LO co ,... CX) 0) 0 ..- N (f) ~ LO co ,...
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Trends
· Weare seeing a steady increase in the
number of youth served
· At the end of the Third Quarter we have
already served 95% of the total youth
served in fiscal 01-02
~)
..-""
5
Trends
3rd Quarter compared to last year's total
· Residential
- DCF (Jelsema) 1530,,10 of last year's total
- DJJ 50% of last year's total
- HHS (out-of-state nmaways) 750/0 of last year's total
- DCF (Poinciana) 139% of last year's total
· Community-Based Counseling
~) · 113% of last year's total
?-""""
Trends
· At the current rate it is estimated that the
agency will have 78 more intakes agency
wide than last year
· This equals 126% more intakes than fiscal
year 0 1-02
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Rural Celebrating 10 Years of 5eroice in Monroe County
Health 1993-2003
Network of Monroe County, Florida, Inc.
P.o. Box 4966, Key West, Florida 33041-4966 ,-
PRIMARY MEDICAL CARE PROGRAM
BUDGET PROPOSAL FOR FISCAL YEAR 2003-2004
Especially Prepared for
The Monroe County Board of County Commissioners
Administration, Community Outreach, Finance, or Health Services
VOICE 305-293-7570; FAX 305-293-7573; Dental Clinic 305-295-3115
Healthy Kids/KidCo.re -VOICE 305-517-9002; FAX 305-517-9004
www.ruralhealth-floridakeys.org
Ftmded in part by:
Florida Depmhu=t
of Health
u.s. Department ofHHS:
Health Resoun:es
Selvices Administmtion
Health Fotmdation of
South Florida, Inc,
Monroe County Board of
County Commi~oners
U.S, Deportment of
Housing And Urban
Development
Catholic Charities of the
Archdiocese of Miami, Inc.
MonroeCOlDlty
Sheriff's Dqmtment
Monroe County
Health Department
Board Officers:
Chairman
Mr. Robert H Lose
Vice-Chair
Robert Rutherford., MD
Treasurer
Debbie Premaza., RN
&cretary
COIDDl. Dixie Spehar
Officer-at-Large
& Former Chairman
David p, Rice. Ph.D,
Executive Director
& PreSIdent
Mark L. Szurek., Ph.D,
Rural
Celebrating 10 Years of Service in Monroe
Health 1993-2003
Network of Monroe County, Florida, Inc.
P.o. Box 4966, Key West, Florida 33041-4966
April 22, 2003
Mr. James Roberts
Monroe County Administrator
The Historic Gato Cigar Factory
1100 Simonton St.
Key West, FL 33040
Dear Jim:
On behalf of the Rural Health Network, we are grateful to the Monroe
County Commission for providing $150,000 to help fund the primary care
medical program we offer to citizens of our county that are unable to afford
other health care options. We thank you for your assistance and that of your
county stafffor supporting this successful public/private partnership,
"
As we discussed, the Rural Health Network of Monroe County Florida
would again ask that an additional $150,000 be placed in the upcoming
2003-2004 budget for review by the County Commission, to support our
primary care program. I have enclosed a copy of our Quarterly Activities
Report (January - March FY -02-03) that staff receives, for your review, as
supporting evidence for the success of the investment the county has made
supporting the primary care program.
Please contact me if you have any questions regarding our request or
progress to date and again thank you for your interest and support of this
vital endeavor to benefit our less fortunate citizens,
Cc: Mark Szurek, Ph,D.
Keith Douglass
KidCare Director
Administration, Finance, Outreach., or Health Services
VOICE 305-293-7570; FAX 305-293-7573
Healthy KidslKidCare -VOICE 305-517-9002; FAX 305-517-9004
WWW,ruralhealth-tloridakeys,org
RHNMC Quarterly Report 7
FL OOH: ORli, COR83 renewed
Objective 5. RHNMC will effect a comprehensive county-wide oral health care program
for persons unable to afford this service.
Activity Plan
1. By July 8, 2002, RHNMC will secure Board approval for executing this
comprehensive dental plan.
Activity Report: The RHNMC Board of Directors unanimously approved the plan as
presented in its meeting held on July 8, 2002.
2 By October 1, 2002, RHNMC will begin oral health are services in Key West
at the Juvenile Justice Building location.
Activity Report: RHNMC oral health care services began on January 8, 2003 in Key
West, FL
3. By June 30, 2003, RHNMC will serve 2,500 persons for oral health care, or 250
persons per month.
Activity Report: There were 220 persons served at the RHNMC dental facility between
January and March 2003. (N.B. The dental facility is operational only 3.5 days per week.
The 250 patients per month goal is based on a 100% time utilization or 40 hours per
week. 3.5 days = 28 hours per week or 70% fie. 70% x 250 patients per month = 175 x 3
months Oan-Mar] = 525. If there were 220 patients seen in this time frame, then the
project has actualized 42% of its goal for the timeframe.)
4. By May 31, 2003, RHNMC with its project partners (Monroe Co. Health
Dept, Miami Olildren's Hospital, and Monroe County School District) will see 100
children in the dental sealant program in Monroe County.
Activity Report: The dental sealant partn.er~project conducted 116 sealant and 67
aftercare treatments for eligible children to date.
Objective 6 (Addendum). RGNMC will evaluate the effectiveness of its primary health
and oral health care projects, and its health insurance task force planning.
Activity Plan
1. By June 30, 2003, RHNMC will have evaluated its primary and oral health
care projects no less than quarterly and annually during the fiscal year.
Activity Report: A contract with a professional evaluator has been signed. The first
meeting of the advisory panel was held on December 11, 2002. The first quarter dental
(formative) evaluation report was issued in March 31, 2003. The primary care
evaluation component will begin on Aprill, 2003.
Activity Plan:
2 By December 1, 2002, RHNMC will have developed a plan of action for its
local health insurance task force.
Activity Report: The health insurance task force made a formal report to the RHNMC
Board in 1/6/03 and were approved to proceed per plan An RFP was issued for
actuarial determinations in February 2003. The final determinations on selection of the
firm to complete the actuarial analysis was determined on March 25, 2003, and is subject
to Board approval on April 7, 2003.
Rural Health Network of Monroe Co,. FL, Inc" PO Box 4966, Key West, FL 330414966; Administration, Finance,
Community Outreach, and Health Services: 305-293-7570; (fax) 305-293-7573; KidCare: 305-517-9002; (fax) 305-517-9004
137/11/213133 113:135
3135-289-2535
PLANNING DEPT
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PAGE Ell/En
07/11/2003 10:05
305-289-2535
PLANNING DEPT
PAGE 02/07
BP AA Proposed Budget 2003- Expenditures
AMOUNT i
EXPENDI'I1JRES
Salaries $38,904.00
Payroll T llXe$ $ 2,976,00
Employee Benefits 0
SUBTOTAL PERSONNEL $41,880,00
Advertising $ 300.00
Office Supplies $ 2,000.00
(i neludes tlOSlage)
wurance $ 8,000,00
SponsorShip & Sport $ 2,500.00
Prolll'llms Suooort
L&.PFces $ 1,500.00
Community $ 1,000.00
AclivitieslSuooort
Fundraisina $ 2,000.00
Instructors $ 3,700.00
Repairs, Maintenance $ 2,000,00
& Cleaninll
Security $ 450.00
Recreational and $ 1,500,00
Educational suoo/ies
Monthly Expenses $ 2,200,00
(phones, AOL,
OQrtable toilet rentan
MealslSnacksiDrinks $ 6.000.00
Field Tlips (ine:, $ 1,500,00
Trans,)
CPR/FirSt Aid $ 250.00
Trllininll
Swim Team (ine, $ 8,000,00
instructor fees)
TOTALuPENSES $84,780.00
REVENUE' OVF.RIVNDER $ 20,00
E~rrtJ:tttS
07/11/2003 10:05
305-28'3-2535
PLANNING DEPT
PAGE 03/07
BP AA Proposed Budget 2003 - Revenues
REVENUE SOURCE ,
AMOUNT
Monroe County S 40,000,00
Membership Dues $ 3,000,00
Summer Progrlun Fees $14,000.00
Swim Team Pem $ 2,400.00
Swjm Team Fundraising $ 6,300.00
Donations $ 1,500.00
Sponsorships S 2,000,00
Fundraising $3,500,00
Sheriff Asset Forf. Fund S 5,000,00
United Way S 6,700,00
Coke MlIChine $ 200,00
Interest $ 50.00
Science Club Pees $150.00
TOTAL $84.800,00
REVENUE
07/11/2003 10:05
305-289-2535
PLANNING DEPT
PAGE 04/07
Abstra~
We are sure you agree, out-of-school programs positively impact the mental and
physical health of our youth. With funding from Monroe County and the United Way,
and grants the Big Pine Athletic Association is able to operate after-school and summer
programs at the Blue Heron Park in Big Pine Key, At the park the children learn valuable
social and conflict resolution skills in a supervised, wholesome tobacco, drug and
alcohol-free setting, The Blue Heron Park Youth Development programs are
successful and growing. When our after-school program was reinitiated in the 2000-
200 I school year, we served at most 12 children per day, In school year 2002-2003, 88
children were registered for the after-school program. The average daily attendance
was approximately 35 children. Summer camp attendance has steadily increased,
Although we welcome the success of our programs, the greater number of children
represents an increase in expenditures in terms of staffmg and supplies, This fmancial
support allows us to direct our other limited resources to operational costs and to allocate
much needed fmancial assistance to qualified families for our summer program and
spans programs,
A. Introduction
The Big Pine Athletic Association (BPAA) is a 501 (c) (3) non-profit organization that
provides organized sports as wen as a variety of other activities for youth. Twenty-five
years ago, the BP AA was established to organize sporting activities for the youth of our
community, While the DP AA maiotains its commitment to the sports activities,
currently Big PiDe Little League, Keys Cudas Swim Team, A YSO and Big Pine
Sailing Club, it has expanded its services to offer a wide variety of activities for
youtb including an After-School Prognm, Summer Day Camp, naycare on School
Professional Days, and now a Cultural and Natunl History Museum at the Blue
Heron Youth Center and Park.
The Blue Heron Park and Youth Center is located on Lytton's Way on Big Pine Key, The
two-acre county park includes a lighted basketball court, picnic pavilions, a "beach"
volleyball court and children's play area. The park grounds are open from 7:30 a,ffi. to
8:30 p,m. Inside the youth center is a snack barlkitchen area, T.V./game room, restrooms
and an office for the administration of the BP AA. Under the youth center is a lighted
game area with six game tables (2 each of ping pong, air hockey and foosball) that is
enclosed by fencing. The youth center is open every weekday from 3:00 to 6:00 p,m, for
after school activities, Elementary and middle school buses from Sugarloaf School stop at
Wilder and Lytton's Way, just a short walk from the park, ,
07/11/2003 10:05
305-28'3-2535
PLANNING DEPT
PAGE El5/El7
Blue Heron Park was the site of very successful Summer 2000, 2001, 2002 Day Camp
Programs. Fifty-eight children ages 5 to 12 participllJed l/lSt summer The program
a/so utilized several teen volunteers. This year our 2003-Day Camp ;s more successful
than ever. As this is writ/en we are only in week 5 of 0'" 9-week program and have 99
campen and teen counselors be;"g served, Due to reduced state funding to Wesley
House, last summer we did not receive TEC funds as we had the previous two summers.
Although it stretches our resources severely, we offered fmancial assistance to 12
children to attend the summer camp for $40.00 per week instead of $80.00 per week,
Teen counselors are tuition-free and receive lunch, entrance to aU field trips as weU as the
accumulation of documented community service hours. The Monroe School District is
helping us out with salaries fur the summer employees during the 4 weeks of the school
summer recreation program
The Big Pine Athletic Association is run by dedicated volunteers who serve as board
members, sport directors, coaches, referees, activity coordinators, etc. many of whom
serve in several capacities. The employees are: 1) The Executive Director who also
serves as the Director of Blue Heron Park, who works 30-40 hours per week. In January
2003, Scott Wade assumed this position 2) The After-School Program Assistant who
works 3 to 6 p.m. on weekdays during the school year. Kimberly McDowell holds this
position, 3) The Summer Program Director - fuJI-time for 9 weeks of summer vacation
4) 1 summer program assistant, full-time for 9 weeks of summer vacation
B. Goals and Objectives
1) To further enhanre tbe out-of-sebool programs offered at BluC' Heron Park,
conununity events and local schools.
2) To serve more rbildren; additional study materials ensures further participation
of area youth which allows BP AA the opportunity to provide wholesome
structured environment to more children.
c. Barkground and Sipificance
Our changing society requires a safe place for children to spend their out of school time,
Children need a place where they can develop conflict resolution skills, good hygiene
skills, learn co-operation and good sportsmanship. They need a place to work on
homework, practice computer skills and interact with other children and (:aring adults.
The Blue Heron Park Programs provide such a place for the children of Big Pine and the
Lower Keys. The Park and Youth Center are a safe haven for children; unlike some
homes, the park is free from alcohol, tobacco or drug use. Botb eeonomically
advantaged aDd disadvantaged ebildren eould otherwise become "latch-key kids",
wbo are significantly more likely to be a victims or perpetrators of crime..
2
07/11/2003 10:05
305-289-2535
PLANNING DEPT
PAGE 05/07
D. T8rget Population
Big Pine Key and the Lower Keys youth, ages 6 through 13, We particularly target lower
income families who are unable to afford other after-school daycare programs, We offer
these same fiunilies reduced rates for our summer and all-day programs.
E. Approa~h Method
When funding is received, the Executive Director and the board of the BP AA will direct
the spending of the funds, In the case of partial funding, the Board of the BP AA will
prioritize the needs.
F. Resources aDd C08tS -
Blue HeroD Park Youth Programs
The payroll and some of the operational costs of Blue Heron Youth Center and Park are
provided by Monroe County. Additional funds come from the United Way, fundraisers,
grants and donations,
G. SU8t.iuability
The Big Pine Athletic Association has had a long track record of providing activities for
young people. The future looks very bright as more and more options become available
to meet the needs of the youth of this community. Most of the requests in this grant are
for one-time expenditures that would be used for many years to come. The BP AA has
increased its number of fundraisers this past year and will continue to do so in the future.
3
07/11/2003 10:05
305-289-2535
PLANNING DEPT
PAGE 07/07
2003 Big Pine Athletic Association Board of Dir~tors
President Steve Miller 872-2882 (II)
2924S Oleander Street
Big Pine Key, FL 33043
Bpkmayorsteve76@aol,com
Vice-President Patty Roman 74S-2558 (H)
66 Colson Drive
Cudjoe Key, FL 33042
nickkate@earthlink,net
Treasurer: Tanya Torna 872-5082 (II)
P,O, Box 420574
Summerland Key, FL 33042
ttoma@ourmarinebank,com
Recording Secretary: Angie Rodriguez 872-4500 (H)
P.O. Box 430621
Big Pine Key, FL 33043
Director of Little League: Ian Calderwood 872-5504 (H)
30981 Bayshore Dr.
Big Pine Key, FL 33043
coachian@bellsouth.net
Head of Swimming: Rosalinda Hally 872-0514 (H)
28566 Arica Road
Little Torch Key, FL 33042
hallyclan@aoJ com
Sailing Conunodore: Marvin I Perry 304-7544( cell)
P,O, Box 430338
Big Pine Key, Fl 33043
4
Jeb Bush
Governor
I~
John O. Agwunobi, M.D., M,B.A,
Secretary
Date: July 10, 2003
./1;; 7
I
"- ?OOJ
To:
Jennifer Hill
Monroe County,
Office of Management and Budget ,.........., -=-//~
Christopher R. Smith j1 J - ~~. ~-
Operations Manager ~"'" r
From:
Subject:
2003-04 Budget Request
In our continuing effort to provide for the health needs of the population of Monroe County, we
at the Monroe County Health Department are requesting the following funding for the 2003-2004
fiscal year.
County Tax Revenue -
Small Quantities Waste Generator Contract-
School Health Pilot Initiative-
$305,660.00 (5.4% increase) -<
$ 73,843.93 (2.4% increase)
$200,000.00 (new funding) +".
The additional 5.4% in the tax revenue line item represents a 3% that was requested during the
previous budget cycle that was lost in the discussion of larger monetary issues (see attached) and
2.4% in keeping with the consumer price index.
The 2.4% for the Small Quantities Waste Generator Contract is also consistent with the
consumer price index.
The new funding for the School Health Pilot Initiative represents the efforts of the Health
Department and the School Board to continue a project formerly funded through local trust fund.
Attached is a letter from Dr. Rutherford further explaining the cuts that this project has
experienced this fiscal year and the efforts to streamline service delivery while maintaining the
structure built over the past two years of the pilot.
Thank you for considering our request for the funding of these important public health activities
and it is out hope that they will be viewed favorably and as important to the well being of the
citizens of Monroe County,
MONROE COUNTY HEALTH DEPARTMENT
Gato Building
1100 Simonton Street
P,O, Box 6193
Key West, Florida 33041-6193
(305) 293-7500. FAX (305) 292-6872
O,~~4:~~E
Monroe County
Board of County Commissioners
Office of the County Administrator
The Historic Gato Cigar Factory
1100 Simonton Street, Suite 205
Key West, FL 33040
(305) 292-4441 - Phone
(305) 292-4544 - Fax
October 28, 2002
Dr, Jake Rutherford,l\ID, MPH
Director
Monroe County Health Department
P. O. Box 6193
Key \Vest, Florida 33041-6193
Dear Dr, Rutherford:
BOARD OF COL~"TY COMMISSIOl'.ERS
~L-\ YOR Charles "Somty" McCoy, District 3
Pro tem Di:<ie M, S~har, District 1
George !'o" eugem. District 2
Em Jimenez, District 4
Murray E, ~e1son, District S
I understand that you are concerned about a three percent increase from the County for
Health Department functions, That was included within your letter to the Board of County
Commissioners during the budget cycle, I have reviewed the minutes of the meeting ,on July 19,
2002 in which you made a presentation to the BOCC. .
In the minutes of that meeting, there is no reference to any consideration or action taken
by the County Commission. There were votes on funding for other parts of your request but that
issue was not addressed. Therefore, it is my understanding that the three percent was not granted
by the County Commission for the Health Department.
Apparently, in discussing the other higher cost issues, the three percent issue was lost, I
know it represents only a few thousand dollars but I am sure that the Health Department could
have used those funds for a very good purpose,
Ifwe may provide any further information for you, please let me know,
JLR: dlf
Very truly yours,
James L. Roberts
County Administrator
Dear Friend of School Health: 7-7-03
The following are some preliminary school health figures for your thinking. The DOH
budget to us is still going through final throes of adjustments. However, we have been informed
there is no extra trust fund moneys, non-recurring dollars used in the past pilot projects, to fund
this year's pilot project. However, we are allowed to use any trust fund money we have in
Monroe County to fund the program. We are required by DOH to keep a minimum of 8.5% as a
means to pay ongoing bills. We have hovered right around this minimum for the last year,
because in the past we have been at 30+% and the legislature removed the excess to use out of
county. It is not a source to save the pilot programs.
As you probably know our dept. lost our youth-oriented tobacco program, which
primarily supplements our school health efforts. We also funded a wellness program, again
primarily for the school staff to curtail rising health care costs, for $75,000 out of trust funds in a
"use it or lose it" situation last spring.
The $400,000 for the school nurse/tech pilot program from the trust fund and $75,000 for
the school wellness pilot program have been cut. These funds were contracted with the School
Board and with FKAHEC, respectively. The staffing and programs, for the most part, expanded
the overall school health program in the Middle and Upper Keys. The DOH "Comprehensive"
and "Basic" program-funded employees- techs and nurses- are still apparently funded at
$389,000, although we have not received our final budget due in July. DOE and the School Board
fund small parts of the overall program, In summary, our overall program was funded at about
$950,000 ($400, + 400, + 75, + 60, +) and is now at $400,000 (42%).
On the positive side, we have been able to recoup Medicaid reimbursements for nursing
services at almost $60,000, but after contract billing for $60,000, the services net $0. We have
several grant requests in review to salvage the tobacco, teen pregnancy and wellness projects as
does FKAHEC with whom we team to carry out the projects. We have energetic school and other
volunteers for tobacco, wellness, and student screening activities. We have the opportunity to
enlist Miami Children's Ambulatory Pediatric "PediVan" team and shared Medicaid
Reimbursements for kids in the Lower Keys who have no "medical home" now that our pediatric
capacity has been cut in halfwith the departure ofJim and Bonnie Foster. Dr Isales will work
with the Miami Childrens team, if the reimbursement and payment framework can be worked out
properly; he was overwhelmed with uninsured and underinsured patients before the Foster's
departure.
Our recommended rationale is to focus on the elementary schools where most visits and
student screening occurs by far. Secondly, preserve our nurses and their reimbursements to spread
our dollars the furthest. We also recommend reducing the hourly rate between DOH and DOE to
the DOH level for about $15,000 in savings, Ifwe were to fund as in the following page and were
to realize the above savings, we would require about $ 200.000 more dollars ( for 5 staff nurses:
2 more RNs for the Upper Keys, I more RN for the Middle Keys, 1 more RN for the Lower
Keys, and 1 more techlLPN for the Lower Keys),
The school health program saw more than 60,000 vlSitS. Without school health personnel,
we can conservatively expect that 10% of these visits would require a parent to come pick up the
child, losing up to 6-8 hours from work. Many of these 6,000 kids would end up at the emergency
department for want of insurance or of an immediate doctor's appointment. This would adversely
impact families, hospitals and employer insurances,
, , ",dr jake rutherford
SCHOOL STUDENTS %FREE/ AVERAGE STAFF SUGGESTED
ENROLLED REDUCED VISITS DURING STAFF 03-04 - -
- .
LUNCH MONTHLY PILOT & FUNDED
DOH STAFF
UPPER KEYS (BOLD)
KEY LARGO FTRN FTRN
SCHOOL 1,112 45 815 FT TECH
PLANTATION FTRN FTRN
KEY SCHOOL 641 31.3 361 FT TECH
CORAL .5RN
SHORES HS 801 19.6 63 .5RN
TOTAL 2,554 na 1,239 2.5 RN 2.5RN
2 TECH
MIDDLE KEYS
S. SWITLIK 714 54 768 FTRN FTRN
ELEMENTARY FT TECH
MARATHON 694 38.1 270 .5RN .5RN
MIDDLE & HS FT TECH
1,408 ." 1,038
TOTAL na 1.5 RN 1.5RN
2 TECH
LOWER KEYS
G. ADAMS 598 59.3 860 .5 RN .5RN
Ff TECH FT TECH
POINCIANA 583 31.3 607 FTRN FTRN
FT TECH
G.ARCHER 386 63.9 227 .5 RN .5RN
FT TECH/LPN
SIGSBEE 326 28.5 386 FT TECH FT LPN
SUGARLOAF 900 28.3 558 FTRN FTRN
ELEM,& MIDDLE FT TECH (school funds)
HOB MIDDLE 874 44.3 795 .5RN .5RN
FT TECH FT TECH
KEY WEST HS 1,301 25,8 419 .5RN .75RN
FT TECH
SCHOOL HEALTH PROGRAM COORDINATOR FTRN FTRN
TOTAL 4,968 na 3,852 4RN 4,25 RN(3.25)
7 TECH 3+ TECH(2)
GRAND TOTAL 8,930 na 6,129 7,5 RN 9.25 RN(4.25)
11 TECH 3+ TECH(2)
eo Cc- -
{lvnLeat
BOARD OF COUNTY COMMISSIONERS
Application for Funding
Fiscal Year 2004
TABLE OF CONTENTS
RECEIVED JUN 2 0 2003
CRITERIA FOR ELIGIBILITY AND ATTACHMENT LIST.....,.,.................,.......,...............,...,....., 1
AGENCY PROFILE & CERTIFiCATION.........,........................,....,.............................. ............., 2
SUMMARY OF SIGNIFICANT CHANGE......................................,...........,............................ 3-4
NARRATIVE OVERVIEW OF REQUESTED FUNDING................................................... ....... .5-5A
BOARD OF DI RECTORS...............................................,.................."..................,................ 6
V 0 LU NTEE RS , . . . . .. .. . . .. .. . ... . .. .. .. .. . . .. . . .. . . . .. . . .. . , .. .. .. .. . . . . .. . . . .. .. . . . . , , . . . . , . .. . . , . . .. . .. . . . . . . . . . . . .. . . . . .. .. . . ., 7
AGENCY OPERATIONS............................................................................................ ......,...., 7
FINANCIAL INFORMATION ............................ ......... ........ ,........"...""....................,.........,..." 8
DETAILS OF SPECIFIC PROGRAM ......................................,............................................ 8-10
PROGRAM UNIT COST................................,...................",..."..",...",.,..",...........,...,.. 11-11 A
Attachment A - Board I nformation Form...........................................................................,.. 1 2
Attachment B - Agency Salary Detail............................,..............,....,............................., 13-14
Attachment C - Profile of Clients Served.......................................................................... 1 5-1 6
Attachments D & E - Program Budget Information (Expense/Revenue)..........................,...... 17-20
Attachments F & G - Agency Budget Information (Expense/Revenue)....,......,...................... 21-22
BOCC Application 2004
AGENCY NAME: Guidance Clinic of the Middle Keys, Inc.
--
THIS AREA FOR H.S.A.B. AND STAFF NOTES ONLY. ....", ,
-.
. .. '. .' >.. ., .'.".' , ,.. .' ". ..... . . '{O:' . .,
LABEL AND A TTACHIIiE FOlL.oWINGINTIiE:rq~[) ...\.....................'.. j /" .
SH.oWN, AFTERTHELAST PAGE .oF THE APPLl.9AT
;'\':' , ..,., ... .0>
IF NOT APPLlCABLE;PLEASESO INDICATE ANDi:XPL ........VE:S> ','. ....'.r ..."..
NJA s
,.,..
A, Board Information Form X
B, Agency Salary Detail X
C. Profile of Clients Served X
D - G. Financial Information X
..
H, Copy of most recent CPA Audit Report or financial statement * X
I. Copy of most recent IRS Form 990 X
J, Copy of current fee schedule X
K, Copy of IRS Tax Exempt 501 (c)(3) Certificate X
L. Copy of Current Monroe County and City Occupational Licenses X
M, Copy of Florida Dept, of Children And Families License or X
Certification
N, Copy of any other Federal or State Licenses X
0, Copy of Florida Dept, of Health Licenses/Permits X
p, Copy of Florida Consumer's Certificate of Exemption X
Q, Florida Dept, of Agriculture & Consumer Services Reg, No, X
R. Copy of front page of Agency's EEO Policy/Plan X
S, Copy of front page of Agency's ADA Transition Plan X
T, Copy of Summary Report of most current Evaluation/Monitoring X
*
CRITERIA FOR ELIGIBILITY AND A TT ACHMENT CHECKLIST
* must include summary of deficiencies and suggested corrective action
1
APPLICATION FOR FUNDING
MONROE COUNTY
Board of County Commissioners
October 1, 2003 - September 30, 2004
GENCYPROFILE
Operating Since 1973
Agency Name: GUIDANCE CLINIC OF THE MIDDLE KEYS, INC.
Mailing Address: 3000 41 st Street-Ocean
City, State, Zip: Marathon, FL 33050
gency Phone: 305-289-6150
Fax: 305-289-61 58
Email: marinanne,benvenuti@qcmk,orq or deb,barsell@gcmk,org
hom should we contact with questions regarding this application (name and phone number):
Marianne K. Benvenuti, MBA, Chief Financial Officer; 305-289-6150, x2
AMOUNTC REClU ESTED
COUNTY FISCAL YEAR ENDING
9/30/04
AMTRECD
CURRENT FISCAL YEAR ENDING
9/30103
AMT RECD
PRIOR FISCAL YEAR ENDING
9/30/02
$429,697
$429,697
$396,415
CERTIFICATION
To the best of our knowledge and belief, the information contained in this application and attachments is true and
correct, Monroe County is 'hereby authorized to verify all ,information contained herein, and we understand that any
inaccuracies, omissions, or any other information found to be false may result in rejection of this application, This
certifies that this request for funding is consistent with our organization's Articles of Incorporation and Bylaws and
has been approved by a majority of the Board of Directors.
We affirm that the Agency will use Monroe County funds for the purposes as submitted in this Application for
Funding, Any change will require written approval from the Monroe County Board of County Commissioners,
We understand that the agency must substantially meet the eligibility criteria to be considered for Monroe County
funding and that any applicable attachments not included disqualify the agency's application,
We further understand that meeting ,the Eligibility Criteria in no way ensures that the agency will be recommended for
funding by the Human Services Advisory Board, These recommendations are determined by service needs of the
community, availability of funds, etc, Approval of HSAB funding recommendations is granted by the Monroe County
Board of County Commissioners,
Typed Name of
Executive Director:
Typed Name of Board President/Chairman:
Signature
")
~_ I - //-:
iii / ?//Y, //>
;&L-//~~c--0/
Debra C, 'Barsell, SW, CAP
Executive Vice President
Signature
apes, Presidenta~d Chairman
1 \j
06/19/03
Date:
\J
06/19/03
Date:
2
SUMMARY OF SIGNIFICANT CHANGE
he questions in this section pertain to major changes that have occurred within the organization's past fiscal year, If
here has been a change, answer the question with a brief summary, If there has been oochange, check "NO,"
YES NO
Significant change in staffing and/or management
(including the Executive Director)?
In FY03, GCMK hired compliance coordinator/privacy officer to handle ever-increasing regulatory demands - particularly
hose related to the implementation of the Health insurance and Portability Act (HIPAA), An executive assistant was
dded to work directly with the executive vice president, There was a change in the project director at the Safeport
program in January, No other change in key program staff was realized. There was no attrition at the senior
management level in FY03, No major changes in current staffing are expected in FY04,
x
Board/Volunteer Governance and/or Structure?
x
Funding Sources (Loss or Addition of Revenue)?
FY03 Losses, DCF cuts realized in FY02 continued in FY03
Y03 Gains, GCMK was successful in the DCF Challenge Grant competition conducted by SHAL that provided $115K to
put toward the replacement of the Personal Growth Center facility for clients with persistent and serious mental illness,
hese grant funds in combination with a mortgage loan will allow for the building of a new facility that will replace the
ged-out, triple-wide trailer that now houses PGC and substance abuse services, GCMK was successful this year in
ecuring a HRSA federal award providing $200K per year for 3 years to the community. The award was made to GCMK
with Rural Health Network and Catholic Charities as partners. HRSA funds expand services to the homeless in Key West
t St. Francis Community Services Center. In mid-February, GCMK received additional DCF children's mental health and
hildren's substance abuse funding,
x
rganization . Mission/Strategic Direction?
x
Change in Programs/Services (Addition or Deletion of Programs)?
x
Safeport residential services have been eliminated and the program is now operated on an outpatient model. This is a
esult of evaluation research and implementation realities that made continued use of KWHA housing on the Safeport
ampus untenable due to the chasm between clinical practice and HUD regulation,
Significant Change in .Service Delivery, Costs, and/or Effectiveness Measures?
x
Client Base/Client Demographics?
x
CMK services in Key West will focus on homeless substance abusers and those at risk of homelessness that need
ay/night/outpatient treatment and aftercare services. Additional outpatients can be seen at Safeport for substance
buse treatment as a result of this model change; specifically, 120 adults can be treated in a year rather than the
revious 27, The replacement of PGC building will allow for a 25 percent increase in day treatment and/or drop-in
lients.
ollaborative Efforts/Relationships with other Service Providers?
x
A close, collaborative relationship between GCMK and the Care Center has always been present. This year GCMK
initiated negotiations to transfer jail services held by contract with GCMK to the Care Center to increase coordination
mong all jail behavioral health programs, GCMK, Wesley House Family Services and the Florida Keys Children's Shelter
allied together around planning for community-based care for children in the dependency system, GCMK works with the
South Florida Provider Coalition to increase coordination and collaboration between Monroe County and Miami-Dade
3
ICounty behavioral health providers.
Relationships \lVitfr'Patent';" Na"tionalOr State "Affiliates ? ., /) >1 I X
..
Accreditation, Certification, and/or Licensing? I I X
Significant Change in Equipment and/or Facilities? I X I
he 1,800 square-foot Personal Growth Center building - the service site for day treatment and drop In for adults with
persistent and serious mental illness and adults in residence at Keys to Recovery, a 6-month substance abuse treatment
program - has been replaced with a 2,880 square-foot building that allows for a 25 percent increase In participation
~aily, Keys to Recovery was relocated to headquarters facilities from rented space, CSU was reduced from 1 8-1 1
licensed beds, and detoxification unit from 10-8 licensed beds. These steps were taken in order to consolidate
residentia I/i npatient services within GCMK owned facilities In an effort to reduce operating costs, Reductions in CSU and
!detoxification beds were approved by DCF and AHCA.
OTHER:
4
NARRATIVE OVERVIEW. OF REQUESTED FUNDING
1, Provide your agency's board-approved written mission statement,
[The Guidance Clinic of the Middle Keys, Inc. (GCMK) is a nonprofit, charitable organization dedicated to the provision
of high-quality and cost-effective behavioral healthcare services throughout the Florida Keys, GCMK seeks to provide
~ervices in a timely and affordable manner for persons with or at risk of mental health and/or substance use disorders,
GCMK demonstrates its commitment to the community by embracing growth, expansion, and diversification of its
services in a manner that is accountable and responsive to its stakeholders,
2, Explain specifically how your agency plans to use the money you are requesting, e,g, rent, salaries,
expansion of services or service area, or general agency operations,
Matching funds are required by Baker Act statute to receive support to operate crisis stabilization and dictates that
"'ounties are responsible for providing Baker Act transportation as requested herein. See page 5A for details.
Baker Act Services - $335,390, Baker Act services include mental health crisis stabilization and transportation, The
crisis stabilization unit of se~vice is a 24-hour day. Crisis stabilization services are provided on an 11-bed, inpatient unit
icensed by the Agency for Health Care Administration (AHCA), The 11-bed unit is a DCF designated Baker Act Receiving
Facility" It is the only publicly funded Baker Act Receiving Facility in Monroe County, It serves persons in acute psychiatric
crisis throughout the county, When a client is received at the facility, the following services are provided: preliminary intake
nterview, orientation to the unit, nursing assessment, history and physical, diagnostic assessment, medication evaluation,
shelter, three meals per day and snacks, medication management, nursing care, educational/life skills groups, treatment
and discharge planning, If a client is in need of treatment beyond the initial involuntary psychiatric evaluation period of 72
hours and is unwilling or unable to voluntarily agree to continued treatment, GCMK files a petition with the court for an
nvoluntary commitment for an additional 6 months, This additional 6-month commitment allows the client the opportunity
or further treatment and GCMK to develop an appropriate placement beyond the stabilization period, Involuntary
commitment court hearings are convened at GCMK headquarters, usually by a special master, to mitigate additional client
stress that would be created by a transport to the court building, A multidisciplinary team of psychiatrists, nurses,
counselors, mental health technicians, and a discharge planner provide services on the unit. The average crisis
stabilization length of stay is 8-10 days,
Baker/Marchman Act Transportation - $94,307, Transportation to a Baker Act Receiving Facility or a State hospital is
he responsibility of the County according to the Bake Act legislation, Monroe County has historically chosen to
contract this transportation service out to the mental health care system, This function was expanded last year to
'nclude the transport of persons that are need of substance use detoxification services who fit the Marchman Act
criteria, The Marchman Act deals with criteria for involuntary evaluation of persons with substance use disorders.
GCMK's residential detoxification unit accepts clients under the Marchman Act, GCMK has two Baker/Marchman Act
vehicles; one is stationed in Marathon at headquarters and one is located in Key West, These vehicles are operated by
Jessrica Corporation and are dispatched by GCMK's crisis stabilization unit, This arrangement ensures driver and
escort availability thoughout the county 24 hours a day, 365 days per year. GCMK completes each Baker/Marchman
Act transport with a driver and an escort for the safety of the client, driver, and escort, The availability of the vehicle
in Key West reduces the response time significantly, The Marathon vehicle is available to assist the Key West vehicle
when more than one transport is required at the same time, The Marathon vehicle is also dispatched routinely for
pickups in the Middle and Upper Keys, GCMK has two properly equipped backup vehicles for the BA cars in its
ommunity transportation fleet, one in Key West and one in Marathon, Backup vehicles are used when regular BA
vehicles are off the road for routine maintenance or in the rare occasion of vehicular breakdown, The unit of service
or Baker/Marchman Act transportation is a 1-way trip. The number of Baker/Marchman Act trips increased in FY02
by more than 30 percent, Another 9 percent increase is projected this year this year based on current utilization.
. .. ,', ---c ..",,' " ...... .. "',,' ...'.'
If you plan to use the funds as match, you mustlist the title of each grantyou.are matching, the so~rce, and
the percentage of matching funds required, based on the.total of gram and match (for example, ifthe" total of
grant and match is $100,00 and therequired match is $25.00, you would indicate a match percentage .
requirement of 25%), If you are requesting funding formore than one program, be sure to outline what is
being purchased for each program. Include specific activities that will be carried out by the program. For
example, if funding is for a new position, explain the change in staffing requirements.
5
BOARD OF COUNTY COMMISSIONERS
Agency Name: Guidance Clinic of the Middle Keys, Inc, Application for FY 2004
Local Match Calculations Grant Match Total Match %
Department of Children and Families $1,094,963 $364,988 $1,459,951 25%
Monroe County SA Transportation Requirement 0 94,307 94,307 100%
$1,094,963 $459,295 $1,554,258
5A
3, Summarize your organization's financial sustainability plan (one-half page max,),
GCMK has been in business since 1973. In 30 years, it has grown from an agency with two employees to an agency
with over 100 staff, In the past 6 years the operating budget has increased over 50 percent, This increase in
evenues is primarily due to program development and successful marketing of the program, GCMK hasrecetved
t;ontinuation funding of nearly a million dollars in federal grant awards to provide services during the last year; plus
one new federal grant at $63K/per year for 3 years and a state homeless grant for $115K for one year. GCMK
ontinues to attract and retain an extremely qualified staff, both clinical and administrative, that provides and
promotes high-quality services, Consumers and other stakeholders seek quality in the services they utilize or
otherwise support, GCMK has an active program development agenda and attends to performance improvement
"ssues, allowing for growth and the enhancement of quality care, The financial health of the agency is managed by a
f'hief financial officer and is"guided by an experienced management team, An active board of directors has fiduciary
esponsibility. GCMK continues to trim operating expenses whenever possible, For example, this year GCMK seeks to
efinance its pooled loan to reduce the monthly and long-term operating costs, Staff is encouraged to bring forward
development ideas and cost-saving strategies, Partnerships with other agencies are critical to continued financial
stability and growth, GCMK has partnered with Rural Network of Monroe County (RHNMC) on several successful
ederal proposals and one successful proposal with Catholic Charities, GCMK is actively involved in the continuum of
are for the homeless that is developed and managed by the Southernmost Homeless Assistance League, Inc,
(SHAL), which provides access to potential funding streams,
4, Summarize your organization's strategic plan (one-half page max,),
~o add services supporting the agency's mission, To help to fill service gaps by active involvement in community
planning organizations, To further diversity funding sources through focused program development. To increase
revenues generated by at least 4 percent per year, To attract and retain professional staff, To continue to work
oward national accreditation, To ensure HIPAA full compliance by October 2004, To maintain accountability through
nternal and external review of standards of care,
5, If your request is greater than last year, explain in detail what the increase is expected to fund, If the
increase is for more than one additional item, list the items in order of priority with the amount of each, Do
not list your agency's budget by line item here - that information will be requested in the attachments,
FY04 is equal to that of FY03, ,"
BOARD OF DIRECTORS
6, What is the authorized number of Board positions specified in your by-laws? 11
-
6
7. 42 Volunteers contributed a total of 791
hours to our agency this .past year,
Programs:
791 hours
Programs:
791 hours
Programs:
791 hours
8. How do you utilize volunteers in the operation of your agency? GCMK board members are a rich source of volunteer
contributions to the agency and contribute through their board work, GCMK works with individuals who need to
provide community service hours as a condition of probation, Such individuals are utilized in areas that are compatible
with their skills, yet they do not have direct client contact, GCMK has a significant group of volunteers that routinely
bring meetings and services into our treatment programs, Nursing students provided almost 100 hours of care for our
clients.
9. Briefly describe the training the volunteers receive, All volunteers receive an overview of the agency and specific
instruction regarding confidentiality and privacy rules. Those volunteers that have direct and ongoing contact with
clients are interviewed, screened, and oriented through the Human Resources Department. New board members
receive board orientation, and education regarding the operations of the organization is consistently presented at board
meetings.
AGENCY OPERA TrONS;' ,
10. Does agency have a formal grievance procedure for clients? If yes, briefly describe, How are clients made aware
of the procedure?
YES. Clients of all GCMK services have the option to seek informal redress of grievances through agency
supervisors and senior managers or to initiate formal internal grievance procedure in accordance with written agency
policies and procedures, Procedures for initiating a grievance are posted in program areas that are immediately
accessible to clients.
Additionally, clients may initiate a grievance or complaint through the relevant licensing agency, They may file
complaints with the Florida Advocacy Committee (FLAC) [a.k.a., Human Rights Advocacy Committee (HRAC)).
Clients of all services are notified of their right to file gri,evances at admission and posters with information and
telephone numbers are placed at all program locations. Persons receiving CSU or detoxification services have direct
phone access to FLAC and need not inform staff or ask staff permission to make such a call.
11. How do you network with other organizations? Describe any sharing of costs, referrals of clients, etc, We
are looking for more detail than your membership in Interagency Council. An example of an appropriate answer'is
"one of Agency X'S employees works out of our branch" or "we jointly fund X positions with ABC Agency,"
GCMK is the only community mental health center in the Middle Keys area; its outpatient services are not
duplicated by any other public sector funded agency in this area, We coordinate with other agencies to provide
outpatient children's psychiatric services to any county resident in need, as GCMK employs the only full-time
child psychiatrist in the county,
GCMK has the only PATH grant in Monroe County under which it provides supported housing services. This
program is designed to help homeless persons with mental health disorders to secure or retain transitional or
permanent housing. GCMK coordinates with a number of other agencies to implement the PATH program
including Samuel's House, USFF, and other programs offering shelter/housing to this target population,
GCMK provides the only public sector crisis stabilization and detoxification inpatient services in Monroe County
and works closely with the Care Center for Mental Health in Key West and the Guidance Center of the Upper
Keys to ensure continuity of care for shared clients. We work closely with the three hospitals throughout the
county, GCMK provides the only adult day treatment and drop-in services for the chronically mentally ill in the
county, GCMK is the only provider of long-term, residential, substance abuse treatment in the county with KTR
in Marathon. GCMK is the only provider of day/night treatment in the county with Safeport in Key West.
GCMK stations two Life Skills Counselors in Marathon schools, enabling interventions in a familiar setting to
school-aged children. Funding for these positions is shared with the Monroe County School District and office
space is provided by the two schools.
GCMK provides a Prevention Coordinator to implement a science-based, substance abuse, prevention curriculum
(Project Alert) in the middle schools from Key West to Key Largo. Prevention programs are also offered at Stanley
Switlik elementary school (Keep a Clear Mind and SMART Team), in Key West (Strengthening Families
7
Program/SFP), and at GCMK headquarters in Marathon (SFP), and in Key Largo (SFP). GCMK was awarded the only
Prevention Partnership grant (3/02-6/04) by DCF to provide prevention programs throughout the Keys, GCMK
collaborates with Wesley House Family Services that receives funding the MCSO to extend the SFP program to
throughout the Keys, _.
Keys to Recovery (KTR) and outpatient substance abuse services work closely with local law enforcement and the
judiciary to provide an appropriate mix of supervision and treatment to persons whose substance abuse has led to
legal problems,
GCMK worked closely with the Care Center for Mental Health to transfer funding from GCMK to Care Center to
provide psychiatric and forensic case management services with the Monroe County Detention Center. This step
was initiated by GCMK to streamline mental health and substance abuse services provided with the Stock Island
facility,
GCMK partners with KWHA to offer long-term substance abuse treatment in Key West at Safeport, GCMK rents
treatment space from KWHA for a dollar per year,
GCMK is state-designated Community Transportation Coordinator for the transportation disadvantaged of Monroe
County and for Medicaid Transportation Coordinator, GCMK is the only provider of Baker/Marchman Act transportation
services in the county,
GCMK partnered with Catholic Charities and Rural Health Network and received a federal award from HRSA to provide
psychiatric services, primary healthcare, prescription assistance, and case management at St, Francis Community
Services Center in Key West. Additionally, Catholic Charities provides space for our HIV intervention specialists to
conduct outreach/intervention directed toward the homeless who use or are at risk of abusing substances.
GCMK is on the Board of Directors of SHAL, a Monroe County community coalition dedicated to serving the
needs of the homeless, as well as several other planning and health-related organizations.
12. Is your agency monitored (for example, by Dept, of Children and Families, a parent organization, or a state or
federal agency)? If yes, by whom and how often? ..If not, how does your agency document and measure its service
performance and success rates?
The State of Florida Board of Professional Regulation or the Florida Certification Board licenses or certifies individual
clinicians by professional discipline. The CSU and the two-bed residential facility are licensed by AHCA and
monitored each year, Substance abuse detoxification, residential, outpatient, intervention, aftercare, and prevention
programs are monitored and licensed annually by the DCF, GCMK is a DCF designated Baker Act Receiving Facility
and is recertified every 3 years. DOC monitors KTR semiannually.
" "',>.,<
FINANCIAL INFORMAl"9~ '."...'
13, Is your agency receiving any cash or in-kind services e.g, free rent, utilities, maintenance, etc. from the
County or any other source? If so, briefly explain below and be sure to include the fair value in Attachments E
and G,
KWHA provides a lease to GCMK treatment space at Safeport for one dollar per year, The building is a
converted 4-unit apartment building. It is estimated that the public housing units would rent for approximately
$16,800/ year ($350/month x 12months x 4 units). GCMK pays for all utilities and other associated fees.
Office space at Stanley Switlik and Marathon Middle/High Schools for Life Skills Counselors has an estimated
value of $4,000/year.
14, Please specify the percentage of total agency revenue that goes to the following:
Fundraising Expenses 0 % Administrative Expenses 10,1 %
., "',,
DETAILS OF SPECIFIC PRp(3RAM FORWHICH FUNDING IS REQUESTED
15, Please give a paragraph description of each program for which you are requesting funding,
8
Baker Act services include mental health crisis stabilization in a DCF designated Baker Act Receiving Facility and
transportation. A solid description of both services was provided in Narrative Overview, Section 2, above. Crisis
stabilization services are provided on an 11-bed, inpatient unit licensed by the AHCA for persons in acute psychiatric
distress, A multidisciplinary team of psychiatrists, nurses, counselors, mental health technicians, and a discharRe planner
provide services on the unit. Pharmacotherapy and milieu-based approaches are used to achieve rapid psychiatric
stabilization. GCMK provides the only publicly funded crisis stabilization in the county, (Average crisis stay = 8-10 days)
Baker/Marchman Act transportation services provide a conduit for accessing crisis stabilization services, Baker Act is
legislation that provides criteria for involuntary mental health care, while the Marchman Act is legislation that provides
criteria for involuntarv substance abuse care, See Narrative Overview, Section 2, for details,
16. What need or problem in this community does each program address? Include your target population,
Needs Addressed:
According to the Center for Mental Health Services (CMHSl, Substance Abuse and Mental Health Administration
(SAMHSAl, in 1997 there were a total of 12,2 million people in the US who have a serious mental illness (SMI), The
prevalence of SMI in Monroe County is estimated as 5,1 percent of the adult population, or approximately 3,365
adults, [Note: Based on the 2000 US Census, 65,984 of the 79,589 people in Monroe County are?: 18 years,]
Adults with a SMI are defined as persons ages 18 and over who had a diagnosable mental, behavioral, or emotional
disorder that met DSM-IV criteria and "that has resulted in functional impairment which substantially interferes with or
limits one or more major life activities" (SAMHSA, 1993). The definition also elaborated the terms "life activities" by
noting that these include "basic daily living skills (e,g" eating, bathing, dressing); instrumental living skills (e,g"
maintaining a household, managing money, getting around the community, taking prescribed medication); and
functioning in social, family, and vocational/education contexts."
The National Alliance for tb,e Mentally III (NAMI) reports the following "Facts and Figures about Mental Illness:"
· Despite media focus on the exceptions, individuals receiving treatment for schizophrenia are no more prone to
violence than the general public. Unfortunately, almost one-third of all US jails incarcerate people with SMI who
have no charges against them, but are merely waiting for psychiatric evaluation or the availability of a psychiatric
hospital bed. Today roughly 150,000 people with SMI are incarcerated in jails and prisons, mostly for crimes they
committed because they were not being treated for their illness.
· On any given day, approximately 150,000 people with SMI are homeless, living on the streets or in public shelters,
[Note: The Southernmost Homeless Assistance League, Inc. (SHALl. estimates that 621 people with SMI are
homeless and living on the streets in Monroe County.]
· Roughly 80 to 90 percent of people with SMI are unemployed. [2,692-3.029 of the 3,365 adults with SMI in
Monroe County.]
· Approximately 9-13 percent of children ages 9-17 have a serious emotional disturbance with functional impairment
(approximately 342-494 Monroe County children), and 5-9 percent have a serious emotional disturbance with
extreme functional impairment and a mental illness (approximately 190-342 Monroe County children).
· Not all mental disorders identified in childhood and adolescence persist into adulthood even though the prevalence
of mental disorders is almost the same percentage, A substantial number of children and adolescents recover from
mental illness.
· Four of the ten leading causes of disability in the US and other developed countries are mental disorders, which
include major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder,
· The treatment success rate for a first episode of schizophrenia is 60 percent, 65-70 percent for major depression,
and 80 percent for bipolar disorder,
· Of the total 1998 hospital admissions in the US, 26 percent were psychiatric admissions,
NAMl's legal affairs director, Ron Honberg, states that only about 70,000 people now live in public mental hospitals.
but more than 200,000 people in jails and prisons have SMI.
The Justice Department's Bureau of Justice Statistics released a report on 7/11/99 stating that an estimated 283,800
mentally ill offenders were held in the nation's state and federal prisons and local jails at midyear 1998. An additional
547,800 mentally ill people were on probation in community. [Note: These figures are higher than those reported by
NAMI as these include 8MI and other mental disorders.]
· The highest rate of mental illness was among white females in state prisons - 29 percent,
· Almost 40 percent of white female state prisoners age 24 or younger were identified as mentally ill,
· 20 percent of the black females and 22 percent of the Hispanic females in state prison were mentally ill,
9
.
Nearly 1 in 5 violent offenders in prison or jailor on probation were identified as mentally ill.
41 percent of the local jail inmates said they had received treatment for a mental condition in the form of
counseling, medication, or other mental health services,
56 percent of mentally ill probationers had received treatment since beginning their sentences.
.
.
The Florida Commission on Mental Health and Substance Abuse published its Final Report in January 2001, The
Executive Summary of this report states the following (pages i-ii):
· The state of the science in both mental health and substance abuse has improved dramatically during the last 20
years, We now have proven techniques to successfully treat most mental and addictive disorders, With
appropriate care, most people - even with the most sever disorders - can recover and become productive
members of their community.
· We have compelling reasons to better address these issues, Mental and addictive disorders are signifCant public
health problems, Accprding to the US Surgeon general, mental illness is the second leading cause of disability
and premature deal in the United States, following only cardiovascular disease,
· Due to the failures in emergency care, local law enforcement systems are experiencing significant problems with
persons with mental illnesses being arrested and jailed for minor offenses, The majority of persons in juvenile
justice and corrections facilities have mental or addictive disorders, Our jails and prisons are now our largest
mental hospitals,
· Financial and bureaucratic barriers, as well as continuing problems with stigma, all contribute to persons not
receiving the care they need in order to avoid poor outcomes. Our communities suffer substantial expense and
losses in human capital because of the shortcomings in our system,
GCMK has 11 licensed mental health crisis stabilization slots in its Baker Act Receiving Facility at this point in time,
DCF funding provides 3,760 days of crisis treatment, which funds 10.3 crisis beds for 12 months, In FY02, GCMK
proved 2,940 days of CSU care. It is expected that 3,029 will be provided in FY03, It is clear that need outstrips
funding for crisis services, Additionally, GCMK provided 362 Baker/Marchman Act trips in FY02 and expects to
provide 398 trips in F03.
Tarqet Population: GCMK Baker Act Receiving Facility receives a person with a valid Baker Act regardless of age, If
a child (::;;17 years) is received at GCMK with a valid Baker Act, our staff makes arrangements for the child to be
admitted to a receiving facility in Miami-Dade that is age appropriate, GCMK provides Baker Act transportation to
ensure the child is safely admitted to the facility on the mainland, If an adult (:2:18 years) is received at GCMK with
a valid Baker Act and a bed is available, our staff admits the client to our crisis stabilization unit CSU, A broad
description of the CSU-eligible client male or female that is :2:18 years and a danger to himself or others as a result
of a mental health disorder(s), The client will be in acute mental distress and likely need pharmacotherapy and milieu-
based treatment approaches to achieve rapid psychiatric stabilization,
See Attachment C for a profile of the clients and services for which GCMK is requesting funding,
17, What data support these needs? Attach copies of any relevant documents,
See citations in #16 above.
18, Where and when are these programs being offered? List all sites and hours of operation,
GCMK services discussed herein are offered at its headquarters - 3000 41 Street-Ocean, Marathon, FL. Baker Act
crisis stabilization and Baker/Marchman Act transportation services are available 24 hours/day, 365 day/year, Services
are available to residents throughout Monroe County
19, What measurable goals do you plan to accomplish in this next funding year?
Overall: GCMK continues its efforts to achieve accreditation and HIPAA compliance and continue to move forward in
the process. Full HIPAA compliance was a major push in FY 03 with accreditation a FY04 goal. GCMK has in place an
integrated performance measurement system, which allows for quarterly adjustments in procedures when found
appropriate and necessary,
Program Specific: DCF establishes goals for service provision within each yearly contract. These goals relate to the
number and type of services provided. Each year GCMK exceeds DCF requirements, GCMK maintains on file at
headquarters copies of all performance measurement reports performed internally or externally,
10
PROGR
20, Define program unit of service (i.e, 1 unit = 1 hour counseling; 1 unit = -1 night shelterl1 meal, etc)
or state why this does not apply to your operation,
See page 11 A,
a. Indicate the full cost of the unit of service, This cost should include administration, etc, The unit cost
should be the same for all funding sources of the program. Explain how you developed the cost per unit
(e,g. total cost of program divided by total units; total cost of program divided by total clients, etc,).
See page 11 A,
b. 3 Year Unit Comparison: Provide the "cost per unit of service" for the past, current and proposed fiscal
years. Provide the numbers of units of service for the past, current and the proposed fiscal years,
See page 11 A,
, UNIT TYPE
PROPOSED~YEAR,
.'ENDfNG9/30/04
" PROJECTED - CURRENT
YEARENDING _,_,_
ACTUAL - PRIOR YEAR
ENDING _1_1_
Please note: the following attachments are available in a Microsoft Excel workbook file, If you
use the Excel workbook file, you do not have to enter any information into the fol/owing sheets,
nor do you need to print them.
11
BOARD OF COUNTY COMMISSIONERS
Agency Name: Guidance Clinic of the Middle Keys, Inc,
Application for FY 2004
UNIT TYPE PROPOSED - YEAR PROJECTED-CURRENT ACTUAL - PRIOR YEAR
ENDING 09130104 YEAR ENDING 09130103 ENDING 09130102
TOTAL COSTS $1,522,219 $1,522,527 $1,446,112
COST PER UNIT CSU Days (a) 497,62 502,65 491,87
TOTAL # OF UNITS 3,059 3,029 2,940
(a) Costs based on utilization of Inpatient unit. Proposed CSU units based on 84% occupancy of a 11 bed unit
TOTAL COSTS $94,307 $95,696 $77,597
COST PER UNIT Round trips (b) 234,59 240,32 214,36
TOTAL # OF UNITS 402 398 362
(b) Costs based on round trip expenses
Page " A