Faced with dwindling participation, King County will seek to revamp how it delivers maternity support and nutrition services to low-income women and infants throughout the region, county Executive Dow Constantine said in his State of the County speech Thursday.

The programs, which are administered through county public-health centers, have seen participation decline by more than 35 percent in recent years and need to cut 50 to 55 positions — about 20 percent of their workforce, said Keith Seinfeld, a spokesman for Public Health – Seattle and King County.

In response, Constantine is proposing to make the programs only part-time at five of the 12 public-health centers where they’re currently available, while also creating four new “mobile teams” that would provide the services at food banks, shelters, human-services agencies and community centers throughout the county.

The programs, known as First Steps and Women, Infants and Children nutrition services, are not prenatal or OB-GYN care, rather they are “wraparound services” providing things like counseling, support services and nutritional help. Funded by both state and federal dollars, they have a combined budget of $33 million for 2019.

“For decades, these programs have benefited mothers with low incomes and their children by providing extra support for healthy pregnancies, births and early childhood development,” Constantine said. Now, he said, the county would “re-examine our clients’ needs and refocus our priorities to provide the greatest access to quality health care to the most people.”

The job cuts, which will fall on nurses, nutritionists and administrators, will be implemented at the end of the year, Seinfeld said.


Public-health officials think that participation has been falling in the programs for two main reasons: One is that some Medicaid-eligible women are being better connected with other aspects of the primary care system and their needs are being met elsewhere. Constantine touted the county’s success in implementing the federal Affordable Care Act, cutting the county’s uninsured rate in half over five years.

But public-health officials also cite regionwide issues that are keeping some women from accessing services available to them: gentrification and mobility, homelessness, substance-abuse and mental-health issues, and the reluctance of immigrants to engage with government services.

“Public Health’s role going forward will prioritize being more responsive to the needs of women and families facing these additional challenges, who often struggle to access our services in our current service model,” Seinfeld said.

The cuts and changes come when, as Constantine said, “our region is experiencing unprecedented prosperity.”

“Today, our region is providing more transit to people than ever before,” Constantine said. “We are providing more housing to people than ever before.”

Constantine’s speech, at Preston Community Center in unincorporated eastern King County, comes 18 months into his third term as county executive and with him eyeing a potential run for governor.


He spent a chunk of his speech praising the county’s relationship with labor unions, and the Master Labor Agreement that the county recently signed with 62 separate local bargaining units. He touted the county’s response to the snowstorms that pounded the region in February, the increases in homeless shelter beds and the county’s efforts to reduce youth incarceration.

Last year, Constantine abruptly canceled his State of the County speech, after demonstrators who wanted to stop the building of a new youth jail showed up, threatening to disrupt the annual event. Protesters have repeatedly disrupted Constantine’s speeches and public appearances over the last several years, in opposition to the youth jail.

This year, with construction on the new juvenile facility well under way, Constantine said the county has reduce the average daily population at the juvenile detention facility from 110 in 2009 to 41 this week.

“We set a goal of zero youth detention because we want to be diligent about making sure young people avoid the legal system, because we know that detention is a lost opportunity to do something positive, something that can change the trajectory of a young person’s life,” Constantine said.