Changes coming to public health

Decorated with major state awards and beloved for his leadership both in-house and across the public health sector, Dave Lee conducted his final all-staff meeting on Jan. 9.

The roughly 150 employees in Carlton County Public Health and Human Services left him with a standing ovation. The 66-year-old director is retiring at the end of the month after 25 years with the county, with the last 20 in the department's top spot.

"I have been director for 20 years," he said. "I feel like I have had my time to make progress in areas that are important to me and it is time to transition to new leadership."

His successor, Annie Napoli, spent eight years as deputy director, calling it on-the-job training.

"Dave leaving is a huge deal," Napoli said, describing the staff meeting. "It was pretty emotional."

The response from staff illustrated what was most important to Lee: relationships. "For us to succeed," Lee said, "you're only as good as your relationships."

His first assignment to Napoli when she took the deputy job was to collaborate with the community and other departments. His reasoning was that neither the government nor private sector could accomplish big things alone.

"We're so interdependent," he said last week.

"That's something I will carry on," Napoli added.

The praise for Lee came in from corners near and far.

"I have always appreciated his professionalism and commitment to serve both the county and the Tribes," said Fond du Lac Band of Lake Superior Chippewa tribal councilor Wally

Dupuis said.

Lee invited the Band into the county child protection screenings at the start of this century, an unheard of move at the time. It led to an operational agreement between the county and Band that remains in place today.

Sue Abderholden, executive director for the National Alliance on Mental Illness, called Lee, a licensed psychologist who attended the University of St. Thomas, a leader in building a mental health system in the state.

"He has always listened to the voices of people with lived experiences," she said in the news release. "Thanks to his leadership and commitment, he has helped countless people."

County board chairman Marv Bodie said Lee will be greatly missed, calling his leadership "transformative."

"His willingness to think outside the box and work with other leaders to create innovative solutions to ever changing problems has helped our citizens immensely," Bodie said in the news release.

To learn more about Lee's impact and what Napoli expects to encounter, the Pine Knot News met with both of them last week at the Community Services Building in Cloquet.

The $10 million, 45,000-square-foot building downtown opened in August 2011, replacing a department that had been scattered across Cloquet and Carlton, taking up residence in places such as a converted warehouse.

"It was horrible," Lee said. "It used to be a bulk oil storage facility."

The county was sending its oftentimes distressed consumers hither and yon, often with no means of transportation as they endured low points in their lives.

"We just made problems worse for people," he said. He came on as director and made the point, "I'm not going to shut up until we get a new building that brings services together."

Because units in public health and human services had been separated for years, there were conflicts. Lee updated the culture by asking employees to commit to a set of six core values.

Napoli rattled them off: "Wellness, compassion, diversity, respect, integrity and accountability."

"You had to commit to the core values if you were going to work here," Lee added. "For the most part, we have a much more positive, supportive group of people."

An effective department

Public Health and Human Services is often portrayed as an unruly governmental bureaucracy responsible for unchecked welfare rolls and soaring taxes. The characterization doesn't seem to bristle Lee as one might expect. Instead, he arms himself with facts and figures to support its effectiveness and efficiency.

"There's a lot of misperceptions - that there's all of these unworthy people using the system," he said.

The department is responsible for out-of-home placements for vulnerable children and seniors, and people with disabilities and mental illness. Most of those placements are paid for using roughly more than $7 million in levy funds - which is only one-third of the $24 million departmental budget. Over the past eight years, the department has increased its annual levy by 0.7 percent annually - one of the slowest growing facets of the county budget - from $7.4 million in 2016 to $7.8 million in 2024.

"We haven't had an increase in four years," he said of taxable income aimed at the department. "We've had salary increases and [staff] health insurance increases. We've added four staff this year because we needed them and documented it. Even with all of that, we have found other ways to draw down revenue to be able to offset those costs."

The department under Lee has been aggressive and organized about billing and drawing revenue from outside sources to offset the levy. Two-thirds of the budget comes from the state and federal governments and grant dollars. A leader in suicide prevention with the TXT4Life Suicide Prevention Program, beginning in 2010, and now its Crisis Text Line, the county receives state money for overseeing the deployment of that program across 30 northern Minnesota counties.

"It's a substantial grant," Lee said. "And we are also the liaison for the seven northern Tribal nations for suicide prevention within the state."

The county's Assertive Community Treatment team monitors placements for people with serious mental illness - folks who are visited multiple times a week in their community settings by case workers and who otherwise would be living in far costlier hospitalizations or institutions. It's an important program and one Lee points to when illustrating the effectiveness of the department.

"So that's where the money is going," he said after a lengthy recital of the work. "You tell me which of those groups you don't want to have in out-of-home placement. Do you want the sex offenders out? You want to release kids that are not protected? You tell me. Dead silence. Those are short conversations."

Napoli nodded along, saying she "totally agreed," with Lee. A lot of the work the department does is "invisible," they say.

"People don't know what we're doing unless you have a need," she said.

And that's where another component of the department comes into play. As public health purveyor for the county, the department visits families who are pregnant to ensure they have what they need and set up the families and their newborns for future success.

When the 2012 flood devastated parts of Carlton, Scanlon, Barnum and Moose Lake, public health set up a command center at the Cloquet Armory and worked 16-hour days for weeks. Later those same incident command strategies drew the attention of national media, when Carlton County was deploying drive-through Covid-19 testing and mass vaccinations.

"Because of what we learned in 2012, we were positioned in 2020," Napoli said. "We were asked to do joint vaccination clinics with the Fond du Lac Tribe, and that was an honor."

When the pandemic struck in 2020, the department was among the only ones in the state to never close, having pioneered work-from-home strategies and Telepresence, a remote video meeting technology, as far back as 2005.

Napoli was among the first county workers to work remotely. Given the rigors of social work, working from home was used to help provide better work and life balance, she said.

Among its latest innovations, the county is developing a special form for use in the event evacuations become necessary. Residents will be able to log any extra support or special needs the county can aid in, in case there's ever an evacuation required.

"That project is under way," Napoli said. "I could go on and on about our incident command work. It's a big deal. We do a lot of that."

Looking back, forward

Lee recalled the first meeting he ever took part in with Carlton County. The seeds of its innovation were there and he noticed it right from the start. He'd been working big jobs with long titles for Lutheran Social Services for more than a decade. He was intimately familiar with how big players like Hennepin, Dakota and Ramsey counties conducted business. A longtime Duluth resident, Lee walked into his first Carlton County child protection meeting featuring representatives from multiple law enforcement agencies, the county attorney's office, the local shelter, domestic violence advocates, a school superintendent, and more.

"All of these people around the table, talking about, 'How do we work with this family?'" he said. "It wasn't like, 'What are you guys going to do to fix this?' It was amazing, and I thought, 'This is different. This is a different culture. This is community - its ownership of the problem.' It was, 'These are our kids and families.'"

He embraced the move to Carlton County and would even return after a brief dalliance as director in St. Louis County, where he found its public health and human services to be woefully understaffed and struggling as a result. When he later learned the county leaders listened to his advice and added a wave of 20 staffers, he'd already returned to the welcoming arms of Carlton County, thinking "too late."

"I got to the point where, 'I cannot do the job if you're not giving me the resources,'" he said.

Lee is departing Carlton County at a time when a second Trump administration atop the federal government is talking openly about defunding large swaths of the government.

Whatever funding comes will be Napoli's concern.

"Annie underestimates herself," Lee said. "She could have been the director of so many counties for so many years."

As she ascends into leadership of the department, she's concerned about what types of funding cuts are headed her way.

"I don't think we are far enough removed," she said of machinations at the federal level. "We're going to have to be vigilant on all the changes at the federal level, working with the state and our board."

The county's income maintenance and financial assistance unit has seen 51 bulletins announcing updates to their jobs in the past three years, she said. It's a staff that's nimble and capable of adjusting.

And the work they do is important. The division's financial workers are responsible for approving Medicaid expenditures to the tune of $300,000 per day and $100 million per year. Roughly 5,000 households - including seniors in long-term care and people with disabilities - are reliant on the funding.

"It will be interesting if they try to cut Medicaid," Lee said. "It'd be a very hard sell, and it's not going to be a quiet battle."

Napoli agreed, but noted the department will be able to pivot in the event of federal upheaval.

"We have a continuity of operations plan," she said. "We have things in place if there are major cuts to keep things running smoothly and make sure the most vulnerable are being taken care of."

As Napoli takes over the department, Lee will head into retirement with a plan to continue to put to work his psychologist license, as well as to slow down and breathe easier.

"There comes a time when you want to leave when things are going really well," he said. "It's a huge relief to have Annie be the director and to have a strong administration and staff. We have really strong people and we have a good board."

With that, the director and his successor returned to the business of the day. Forever operating with six core values in mind, salving the wounds and catering to the needs of a county and its people.