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Q&A with Linnea Mirsch, the Northland’s public health director

Linnea Mirsch, director of the St. Louis County Public Health and Human Services offices, stands by her 12-18 month action plan, which she she outlines on the wall of her office with a dry-erase marker. Bob King / rking@duluthnews.com

Linnea Mirsch rose through St. Louis County government as a behind-the-scenes data maven, working several years as its deputy administrator for operations and budget.

Now, she's directing the county's largest agency, Public Health and Human Services, with four locations across the county, including an office building on West Second Street in downtown Duluth.

The News Tribune met her there for a question-and-answer session last week in advance of the department's annual conference — a two-day event which figures to draw upward of 3,000 attendees beginning today at the Duluth Entertainment Convention Center.

A retiring colleague, Mary Bridget Lawson, said of Mirsch: "We're lucky to have her. I can't say enough good things about her breadth of public policy and human service understanding. She has a real good mind and heart."

What follows is a condensed version of a half-hour conversation with Mirsch.

Q: I wanted to start by asking about the conference. It's been going on so long, what's important about it?

A: It brings world-class training to Duluth at a very low cost. Our employees definitely take advantage of it — the variety of classes. There are 106 workshops and then half-day institutes as well as incredible keynote speakers every year.

Q: Is this job a lot different from what you've done historically?

A: There's definitely similarities. What I love about this job and what I love about my last job is getting to work at the systems level. Looking at the challenges from a high level is what drives me — getting to evaluate our programs, getting to check our assumptions, why we're doing what we're doing, how we know if we're being successful, how we're going to measure that, how we're going to be a good steward of taxpayer dollars. That's kind of what drives me, so that's similar. And yet this is really different. I like to be behind the scenes, and here I'm in a much more visible leadership role. We have 670 employees and ultimately I have to provide the leadership that they need to do their jobs. So that's different.

Q: Your predecessor was short-lived and critical about having too few resources. Can you tell me where you're at with resources?

A: The county board stepped up with some tremendous support for our department in the last couple of years, but definitely last year. I think when we spoke last summer the county board had just approved 20 additional workers for child protection. We brought four new supervisors on in the fall followed by 16 social workers county-wide that joined right around the beginning of this year. Child protection was the area where it was absolutely critical to bring on some new staff.

Q: Does that mean you feel better about resources?

A: We've made tremendous progress. In the short term, we are seeing a documented, albeit small, impact in a reduced caseload for our ongoing child protection workers. That is critical for how we want to do child welfare work. We are projecting the expense associated with the number of children in placement and the number of children to be in placement to be flat. (Editor's note: recent averages place the number at around 700.) That doesn't sound like a huge step except it has grown 79 percent over the last nine years and we're not alone. So being able to say we're projecting flat in this context of the opioid epidemic is really important.

Q: Where are you finding foster families? We'd previously reported a shortage.

A: We're starting to see more and more of our children placed with relatives — that is also a key strategy for us and statewide. Right now over 53 percent of kids in placement are with relatives. That's up from the 30s two years ago. That takes a lot more work for our licensors to make that happen.

Q: How so?

A: Time is critical. Having time to do the relative searches. These relatives, they don't know that they're going to get asked to provide foster care.

Q: I have a general question about social workers. Is their job harder than it's ever been?

A: I appreciate that question. We have a tremendous workforce. So, what I understand is the level and complexity of the needs and the interplay of the multiple challenges that we are facing —- all the barriers, the co-occurring disorders — coupled with more and more requirements from the state and federal government, and the increased scrutiny of our work, has definitely made the work more challenging. But more needed than ever.

Q: Co-occurring?

A: The substance use and the mental health.

Q: How does the opioid epidemic impact what you're seeing?

A: The primary reason we remove kids from their homes is due to substance use. Not alcohol — substance use. And we are absolutely at a higher percentage than the rest of the state. That's just one example of how we see it across our entire department. Three women overdosed last month and died. We knew all of those families through our child protection. Not to say we were currently working with all of them, but we had worked with all of those mothers and their children through child protection. We knew them all. It touches all areas. The reality is that opioids or substance use disorder, again, is co-occurring with mental illness. And then you add in poverty, racial disparities, a difference in health outcomes by ZIP code, the prevalence of chronic disease that we have in this county, and there are a number of underlying challenges that we have to work with the community to tackle in strategic ways.

Q: What chronic disease issue are we facing?

A: We have a higher percentage of diabetes.

Q: Why do we have higher percentages of these things — what is it about us?

A: That's the question. Truly. Some of it has to do with the fact that we are kind of a regional hub — and a regional medical hub. It's a piece of it. Higher rate of poverty too. We have significant disparities specifically in the Duluth community by ZIP code — and by race and ethnicity.

Q: Can you point to a success with systems innovation?

A: I can give you some great examples. We have some key partnerships right now. This (one) is specifically in the Duluth area — with the Duluth Police Department, our mobile crisis response team, our hospitals and our adult foster care providers to create this whole person-centered response matrix. So when someone living in corporate adult foster care is in an unsafe place or having some type of episode there are steps to follow so the most appropriate resources are utilized at the right time. That's one example. We have seen that when we can work creatively or partner in different ways we can really get somewhere.

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