Committee Hearing, February 19, 1999

COUNCIL OF THE CITY OF PHILADELPHIA CAPITAL PROGRAM & BUDGET HEARINGS BEFORE THE COMMITTEE OF THE WHOLE - - - Room 400, City Hall Philadelphia, Pennsylvania Friday, February 19, 1999 9:32 a.m. - - - Bill No. 990023 - An ordinance adopting the Operating Budget for the Fiscal Year 2000. PRESENT: COUNCIL PRESIDENT ANNA C. VERNA, Chair COUNCILWOMAN AUGUSTA A. CLARK COUNCILWOMAN JANNIE BLACKWELL COUNCILMAN DAVID COHEN COUNCILMAN JAMES F. KENNEY COUNCILWOMAN DONNA REED MILLER COUNCILMAN MICHAEL A. NUTTER COUNCILMAN ANGEL L. ORTIZ COUNCILMAN FRANK DICICCO COUNCILMAN RICHARD T. MARIANO COUNCILMAN W. THACHER LONGSTRETH COUNCILMAN FRANK RIZZO CHARLES MCPHERSON, Chief Financial Officer - - - VINCENT VARALLO ASSOCIATES, INC. Registered Professional Reporters Eleven Penn Center, Suite 600 Philadelphia, PA 19103 (215) 561-2220 681 2/19/99 WHOLE COMM./Budget/Bill 990023 I N D E X Estelle Richman, Commissioner . . . . . . . . 683 Department of Public Health (DPH) Susan Lieberman, Director . . . . . . . . . . 713 Maternal and Child Health, DPH Mike Lucas, Assistant Health Commissioner . . 717 Department of Public Health Mark Bencivengo . . . . . . . . . . . . . . . 723 Assistant Health Commissioner for CODAAP Michael Nardone Deputy Managing Director. . . 768 Special Needs Housing Sally Fisher, Director. . . . . . . . . . . . 794 Office of Family Shelter and Services Michael DiBerardinis. . . . . . . . . . . . . 843 Recreation Commissioner Jane Golden, Artistic Director. . . . . . . . 864 Department of Recreation's Mural Arts Program Greg Grillone, Stadium Director. . . . . . . 873 Veterans Stadiums William E. Mifflin, Executive Director . . . 891 Fairmount Park Commission. James Donaghy, Operations Director. . . . . . 902 Fairmount Park Commission 682 2/19/99 WHOLE COMM./Budget/Bill 990023 (Index - cont'd.) Nancy Goldenberg, Program Administrator . . . 913 Natural Lands Restoration and Environmental Education Program, Fairmount Park Commission Anne d'Harnoncourt, Director. . . . . . . . . 934 Philadelphia Museum of Art Elliot Shelkrot . . . . . . . . . . . . . . . 953 President and Director of the Free Library Helen Miller, Director of Public Services . . 964 Free Library Dr. Richard Tyler . . . . . . . . . . . . . . 984 Historic Preservation Officer Philadelphia Historical Commission Jeffrey Benoliel, Vice President. . . . . . . 988 Board of Trustees, Atwater Kent Museum Nancy Moses, Executive Director . . . . . . . 992 Atwater Kent 683 2/19/99 WHOLE COMM./Budget/Bill 990023 P R O C E E D I N G S

Good morning, everyone. I'm truly sorry for the delay. I would ask all Councilmembers who are in their offices to please come into the chamber. This is the continued public hearing on Bill No. 990023. The Health Department will be the first to testify. (Commissioner Estelle Richman comes forward.)

Good morning, Commissioner. Please identify yourself for the record and proceed with your testimony. COMMISSIONER RICHMAN: Good morning, President Verna and members of Council. I am Estelle Richman, Commissioner of the Department of Public Health. Thank you for the opportunity to present the Health Department's budget for Fiscal Year 2000. With me is Deputy for Finance and Administration Ellen Steiker; and John Domzalski, Executive Deputy and Chief of Staff. /Budget/Bill 990023 Fiscal Year 2000 Budget maintains service levels comparable to Fiscal Year 1999. 6 million in the Grants Revenue Fund, and 430 million in the HealthChoices Behavioral Health Revenue Fund. 9 million, or 6 percent, comes from City tax-supported funds. The Department's budget will support 1,312 full-time positions -- 926 in the General Fund and 386 in the Grants Rund. In fulfilling its mission, the Department administers a wide range of programs and services that are delivered either directly by Health Department employees or through contracts with providers. The Department of Public Health operates eight neighborhood health care centers that serve City residents regardless of their ability to pay; runs a specialty clinic for the treatment of sexually-transmitted diseases; and administers public health programs to control the spread of communicable diseases such as tuberculosis. /Budget/Bill 990023 The Department of Public Health coordinates funds and monitors: Maternal and Child Health services, including immunizations and infant mortality reduction and prevention; mental retardation programs and behavioral health services, including substance abuse prevention and treatment, and mental health care. It provides infectious-disease control, including the coordination and funding of HIV-AIDS prevention, education, and treatment. In addition, the Health Department monitors and combats environmental pollutants, including air pollution and lead poisoning, and regulates the food service industry medical. The Department also operates the Medical Examiner's Office, and it maintains oversight of the Philadelphia Nursing Home. Further, it monitors health-care services at the Riverview Home for the Aged and performs quality-assurance oversight of health services provided within the Philadelphia Prison System and at the Youth Study Center. /Budget/Bill 990023 progress in infrastructure development and program enhancement. The Heath Department continues to pursue efforts to improve efficiency and service quality at its health care centers in the face of devastating State and federal welfare cuts. As a major step forward, in 1997, the Health Department created the Behavioral Health System and took over management of behavioral health services for the City's approximately 400,000 medical assistance recipients. Philadelphia's experiencing a decline in AIDS deaths; our infant mortality rate, while still high, is also declining. Through aggressive screening and education campaigns, the Health Department has significantly decreased the prevalence of elevated blood lead levels in the city's children and dramatically increased the number of children immunized. These and other achievements are discussed below. /Budget/Bill 990023 financial plan and detail. In addition to increasing reimbursements from the State and federal government, the Department has been able to recover costs of direct service provisions at a level more in line with spending. 4 million. 8 million. 2 million in Fiscal Year '99. 7 million in Fiscal Year 2000 -- due primarily to increased Medicaid reimbursements as a result of changes included in the federal Balanced Budget Act of 1997. These changes require the State from Fiscal Year '99 to Fiscal Year 2003 to make payments to the health centers for the difference between negotiated payments received from HMOs and documented costs incurred by the health centers.

/Budget/Bill 990023 Since 1992, one of the Health Department's highest priorities has been the improvement of service, facilities, staffing, and community relationships of the health care inserts. The centers provide comprehensive health care, dental care, pharmacy, and laboratory services to city residents. Further, the centers are one of the only health providers in the city that can offer seamless service delivery as patients move in and out of health-insurance status and between health-care plans. The health care center network provided services to more than 8 4,000 adults and children in Fiscal Year '98 -- almost 68 percent of whom were uninsured. Over the past three years, the Department has added a new managed-care nurse specialist and additional clerical personnel at each center. The solid performance of the eight centers in this area is particularly remarkable when viewed against the volume of patient visits. /Budget/Bill 990023 2000. The 312,000 visits in Fiscal Year '98 represented a decrease of almost 4 percent, from 324,000 visits in Fiscal Year '97. The decline, in part, was due to the impact of renovations at the four inserts at one time, which temporarily reduced the appointment capacity of the centers. In addition, health care center personnel are increasingly relying on telephone consultations, a growing practice in public providers alike. By giving patients advice over the phone, the staff has helped reduce the need for patients to come to the centers for minor medical problems. This reduces the burden both on the patient and health care. The Department projects 24,000 telephone consultations in Fiscal Year '99. DPH has been working since Fiscal Year '95 to upgrade its centers through the installation of a new heat, ventilation air-conditioning system, security, electrical systems and roofs, as well the redesign of waiting areas and examination rooms. /Budget/Bill 990023 each year through Fiscal Year 2001. In part, as a result of this improvement, the City's 1998 citizens' survey shows an overwhelming 80 percent of the health centers' patients surveyed reported being satisfied with the physical conditions of the centers. For more than 30 years, the Health Department has provided behavioral health care for disenfranchised, impoverished, and uninsured Philadelphia residents through the Office of Mental Health, the Coordinating Office of Drug and Alcohol Abuse Programs. The City successfully competed for the Department of Public Welfare's contract to become the local managed- care organization for behavioral health services in Philadelphia. The Health Department carries out its managed-care behavioral health responsibilities through Community Behavioral Health (CBH), a nonprofit corporation governed by City officials. Since February of 1997, the Behavioral Health System has achieved a number of significant accomplishments that have benefitted its consumers in many ways. /Budget/Bill 990023 66,000 individuals had assessed CBH services, and CBH had received 529 million in capitation payments from the State. Furthermore, CBH has met or exceeded all financial goals, including the State's requirement that it establish a reserve equal to one half of one month's total capitation payment. Creating an integrated Behavioral Health System also fostered new collaboration within the Health Department with other City agencies such as the Department of Human Services, Family Court, and the Philadelphia Prison System, to improve services for at-risk populations, including the children and juvenile justice and foster care systems, adults with co-occuring mental-health and substance-abuse disorders, and adults in the criminal justice system.

The Health Department, in coordination with the First Judicial District and the Philadelphia Prison System, has continued its direction and administration of several criminal justice initiatives, including the Forensic Intensive Recovery Program, Treatment Court, and the Intermediate Punishment Program. /Budget/Bill 990023 programs currently serve more than 860 clients and represent a significant part of the City's effort to control its prison population by offering appropriate treatment alternatives to incarceration for addicted inmates. The Department of Public Health provides community-based services to 550 former residents of the Pennhurst State School and Hospital, which was closed in 1986 as a result of a federal consent decree stemming from a class action lawsuit. Under the consent degree, the City and the Commonwealth agreed to move class members to community placements and provide a specified set of services. S. District Court vacated its 1994 contempt order, and ended its act of supervision over the case as of September 1998. /Budget/Bill 990023 the City's Office of Mental Retardation, which has overall responsibility for the provision of mental retardation services by the City. The Department continues to be an active member of the Mayor's Children and Families Cabinet and a sponsor of many cabinet activities. In Fiscal Year 2000, the Department will continue its support of initiatives such as the Family Centers and Safe and Sound in Philadelphia, a project funded by the Robert Wood Johnson Foundation to reduce incidence of pregnancy, substance abuse, and violence among teens. The Health Department has put great effort into its own Violence Prevention Program for the Philadelphia Interdisciplinary Youth Fatality Review Team and other interdisciplinary programming aimed at reducing youth violence. The Health Department also directs a substantial portion of its programs to the health needs of children. As recommended by the Mayor's Children and Families Cabinet and based on the Philadelphia School Readiness Report, the Health Department plans in this year to establish the Office of Early Childhood. /Budget/Bill 990023 combine services to young children and their families in one place to finding the local responsibilities for their health and well-being. We know from the school Readiness Report that many of the risk factors that interfere with children's ability to succeed in school are health-related. The consolidation of the Department's immunization, early intervention, children's mental health, childhood lead poisoning prevention, and Maternal and Child Health programs in this office will allows us to utilize resources more efficiently and provide a more integrated system of care. Philadelphia is one of only seven urban areas nationwide of 28 surveyed with preschool immunization rates of at least 80 percent -- up from 68 percent only two years before and approximately 50 percent before Fiscal Year '96. The Health Department projects that the immunization rate will remain at 80 percent for Fiscal Year '99 and Fiscal Year 2000. /Budget/Bill 990023 years old were fully immunized in Fiscal Year '98, with projected increases to 89 percent and 92 percent respectively in Fiscal Year '99. In Fiscal Year '97, the Health Department and the Robert Wood Johnson Foundation completed a database that facilities outreach in under-immunized areas by automatically reporting overdue and missed immunizations. This software has been installed in all City health care centers as well as in other federally qualified health centers, and private medical-care providers are being encouraged to participate in the program to ensure its continued success. Seven community-based social service agencies and health clinics also use the data to provide outreach to immunization-delayed preschool children throughout the City.

In recent years, Maternal and Child Health expanded its lay home visiting efforts as a result of HealthChoices, which requires that participating HMOs provide prenatal care, including outreach activities. /Budget/Bill 990023 Health Department to shift its focus to home-based services. As part of Maternal and Child Health's lay home visiting services, nonmedical personnel, who are supervised by nurse professionals, make home visits to families often in the communities in which these personnel reside. These home visitors identify the needs of at-risk families through comprehensive assessments, provide family focus health counseling and health education, and link families with appropriate service-providers. In Fiscal Year '98, Maternal Child Health and the Department of Human Services created the Health Intervention Program for Families (HIP). HIP is a preventive intervention for families with special needs who have not yet, but without the service might have, required child protective services from DHS. The Health Department expects to serve 1,000 families during Fiscal Year '99 and 1100 families during Fiscal Year 2000. The Maternal and Child Health Division will conduct an outcome evaluation of HIP during Fiscal Year 2000. /Budget/Bill 990023 is experiencing a decrease in AIDS-related deaths, primarily due to wider availability of new medication regimes and increased access to health care and support services for persons living with HIV and AIDS. Because the decrease in deaths is less pronounced for minority populations, through the remainder of Fiscal Year '99 and Fiscal Year 2000, AACO will continue to target minority communities to enhance their ability to take advantage of new medications and other critically needed services. In addition to providing direct primary care and support, AACO funds prevention and education services. In part, as a result of AACO's prevention services, the number of newly reported AIDS cases in Philadelphia dropped by 16 percent in Fiscal Year '97 to 1,074 in Fiscal Year '98, with an 18 percent decrease in the number of new cases among Caucasians, a 34 percent decrease in new cases among Hispanics, and a 13 percent decrease among African-Americans. /Budget/Bill 990023 decreases in newly reported cases, those communities still have a much higher incidence of AIDS and AIDS-related deaths relative to their population sizes. For this reason, in Fiscal Year '99, AACO implemented the Philadelphia HIV Prevention Continuum, a new model for the delivery of HIV prevention services in the city that resulted from intensive planning by the community-based Prevention Community Planning Group of the local HIV Planning Commission. As part of the new program, $5 million in City, State, and federal funds was awarded to 45 community-based agencies, largely minority providers serving the populations at the highest risk for HIV infection for prevention services in Fiscal Year '99. This funding represents an increase of approximately $200,000 over previous years, primarily due to an increase in federal grant funds. /Budget/Bill 990023 populations based on an intensive community planning process, attempts to quantify the level of prevention services provided to targeted communities in meaningful ways, and integrates all funding for prevention services citywide into one unified system. This reorganization has already resulted in a significant reallocation of funds to minority providers serving high-risk populations and has enabled the local HIV service community to target prevention services to the changing needs of city residents. A primary objective for the Department of Public Health is to continue provision of quality health care in the face of burgeoning and uncompensated demand caused by eroding federal and State financial support of America's poorest citizens.

That financial viability of the city's health care system has depended on the Health Department's ability to balance services to the uninsured with services to the insured. /Budget/Bill 990023 the same level of service. 3 million for Fiscal Year 2000. 2 million for pharmacy and physician costs over the last years, and will maintain this increase throughout the five-year financial plan. 3 million in Fiscal Year '98. The increased revenue in Fiscal Year '99 and Fiscal Year 2000 is primarily due to a Medicaid cost settlement with the Commonwealth under the terms of the Balanced Budget Act of 1997. /Budget/Bill 990023 in costs. In addition to previous cuts in general assistance as well as federal funding cuts, the City currently projects as many as 32,000 families to lose welfare benefits between March and June 1999 due to federal welfare reform provisions. While the termination of cash benefits does not mean that the families are no longer eligible for Medicaid, the State requires families in some circumstances to initiate re-enrollment in the Medicaid program on their own. The Health Department is working with the State Department of Public Welfare, service providers, and advocacy groups to identify ways to maximize the level of retention and re-enrollment among affected households. The Department, nonetheless, expects that not all families will re-enroll -- at least not right away. As a result, the health centers could be adversely impacted by yet another increase in the number of uninsured visits. To address this, three health insurance counselors have been hired to enroll eligible Medicaid recipients at our health care centers. /Budget/Bill 990023 These counselors will meet with health center clients, discuss insurance options with them, and assist them through the Medicaid enrollment process. By keeping eligible individuals enrolled, we will ensure their ability to continue assessing Medicaid funding health-care services. 8 million in Fiscal Year 2000 as a result of a couple of factors. An increase in the number of pharmacists at the health centers and a reduction in private community pharmacies have contributed to a percent increase in the number of 15 prescriptions filled at the health centers. 16 Additionally, increased availability of 17 important but expensive HIV treatment drugs, along 18 with increases in pharmaceutical costs overall is 19 a major contributing factor to an increase in the average cost of prescriptions at the health centers. /Budget/Bill 990023 with the additional investment contained in our Fiscal Year 2000 Budget request and continued advocacy for policy and practical changes in welfare reform, we can continue to protect our most vulnerable citizens. I want to again thank you for the opportunity to give testimony today, and I will now take questions.

Thank you, Commissioner. In your testimony, you indicate that the district health centers are projecting patient visits to reach 320,000 in FY '99 and FY 2000. What do you expect the impact of welfare reform to be on the district health centers in terms of patient visits, appointment availability, and third-party reimbursements? COMMISSIONER RICHMAN: The health care centers at this point in time last year, we were at 312; so that 320,000 number gives us some growth room. If we don't go over that, the appointment availability should stay about where it is now, which is about 75 percent within a 704 2/19/99 WHOLE COMM./Budget/Bill 990023 three-week period. If we go over that figure of 320,000, then my expectation would be is that appointment availability could be affected somewhat slightly but could have an impact, which means that we could go to 75 percent within four weeks, and that's beginning to push the limit. The average out there at this point in time among the other health-care providers, private providers, group providers is probably four weeks, and we've always tried to better that, and we would continue to try to do that by how we shape our staff, what time the hours were open. Part of what has affected our ability at this point in time to improve on that 75 percent is that we still have renovations going on in the centers. And while we've tried to focus some of those for after-hours, most of those require that we are not open as much in after-hours, and it does affect some of our appointment availability.

Commissioner, it's my understanding that approximately $430 million is appropriated for CBH. Where in the budget detail does the CBH appear? 705 2/19/99 WHOLE COMM./Budget/Bill 990023 I would like to know how many employees does CBH have, and is there a listing of their positions in detail? COMMISSIONER RICHMAN: CBH has 242 employees.

Is it in the budget detail? Because I haven't been able to find it. COMMISSIONER RICHMAN: The positions are not in the budget detail, but we can provide that information for you.

If you don't mind, would you provide us with a detailed breakdown and make sure that you include it in the next year's budget because I don't think we had it in last year's budget either. But I would like to have a breakdown as to the listing of these positions in detail and what the salaries are. COMMISSIONER RICHMAN: Okay. That is not a problem; we will get it to you.

Thank you. I understand that you are either in the process of or have concluded negotiations with the 706 2/19/99 WHOLE COMM./Budget/Bill 990023 State on setting revised per-member per-month rates for behavioral health services. Could you please bring us up to date on where you are with regards to these negotiations and rates. COMMISSIONER RICHMAN: We have completed with the State the negotiations for the rate effective for calendar year 1999. However, the contract has not been signed as of yet in that we still are looking at some of the language within the contract. And we had specifically wanted some of that language changed because it was including things in our rate that we did not think we had fully been compensated for. But for the things that are currently in the new contract, the negotiation of that rate has been determined, and the new rate. . . We're going to give you the blended rate. The way the rate is actually negotiated is, we negotiate seven different rates with the State and seven different Medicaid categories. The blended rate is about $77 per member per month.

Thank you. Commissioner, will you please summarize for us the Justice Department's investigation and 707 2/19/99 WHOLE COMM./Budget/Bill 990023 the settlement agreement with regards to the operation of the nursing home. COMMISSIONER RICHMAN: I will start this and probably have John Domzalski pick up on anything that I may have left out. We did reach an agreement with the Justice Department on oversight and monitoring of the nursing home in August of 1998. The agreement stipulated that we will have a monitor in the nursing home for one year. And during that period of time, the monitor will provide some oversight in looking at a variety of different areas and protocols within the nursing home. We also agreed that there would be an investment into the nursing home at the discretion of the monitor in certain areas of about $15,000. At this point, none of that money has been allocated as the monitor has not given us anything specifically in recommendations and where she would like to see it spent. The monitor's in the center approximately ones or twice a month to look at services within the nursing home, at which point there is a meeting between all of the relevant 708 2/19/99 WHOLE COMM./Budget/Bill 990023 parties to look at what she's recommending and provide any correctional plans or other activities that need to be looked at.

What is the census of the nursing home? COMMISSIONER RICHMAN: The census is -- it's 425. At this point --

Was that one wing ever opened? COMMISSIONER RICHMAN: They are in the process of opening it now. They have been given permission to proceed. They are proceeding to staff up and we do recommend that the nursing home will reach capacity before the end of this calendar year.

What is the status of the City's contract with Episcopal Long Term Care? And can you tell us, what is the City's operating subsidy to Episcopal for the nursing home in FY '99 and FY 2000? COMMISSIONER RICHMAN: At this, the City has a contract with Episcopal under the long-term agreement with ELTC, which is their arm that operates the nursing home. This contract 709 2/19/99 WHOLE COMM./Budget/Bill 990023 runs through June 30th, and at this point in time, we have not given them any notice and would proceed to renew the contract for an additional year as of July 1, 1999 through Fiscal Year 2000. The budget for this year and projected for Fiscal Year 2000 is 3.3 million in the subsidy, which it has been.

It's a lot better than what we were paying several years back, isn't it? If my memory service me. What is our deficit for running the nursing home at this point in time? There for a while, it was really a huge amount. COMMISSIONER RICHMAN: I'm not sure there's a deficit now at all. They expect --

Oh, really? COMMISSIONER RICHMAN: Yeah. In fact, I think even Episcopal now is breaking a little better than even. But before we privatized the nursing home, there was an $8 million deficit.

I recall that very clearly. COMMISSIONER RICHMAN: So things have significantly improved with the privatizing and 710 2/19/99 WHOLE COMM./Budget/Bill 990023 the continuing improvement of maintaining the license.

The Chair recognizes Councilman Mariano. I believe his light was on. Is he in the room? (Councilman Mariano not present at this time).

The Chair recognizes Councilwoman Blackwell.

Thank you, Madame President. I have several questions before I ask about the sidewalk ordinance. You mentioned, on , the BHSI funding. We talked about this, I don't know, maybe a year, a year and a half ago. And at that point, it was testified that the State was giving us the money that we needed, and we asked you to report back to us if there was a problem. Obviously, I've heard outside of this room from organizations that we did not get the money that was required when we specifically wanted to fight for you. We've had this conversation before. I don't understand when we ask you to 711 2/19/99 WHOLE COMM./Budget/Bill 990023 help us help you, why you don't keep us informed and also what you intend to do. Here you're talking about reducing your scope of services available to this population. So what happens now? And I don't understand why you don't ask us to fight with you to help you help our folks in the city. But what do we do now? COMMISSIONER RICHMAN: We are not anticipating decreasing services in this population. Last year, when we were working with the State, we had reached an agreement to use dollars coming out of the Reinvestment Fund, and all of the funding -- that brought us up to the level of funding that we needed to complete all services for last year. This year we have a total budget. There should be no cutback in services, and everyone who's providing those services should be able to provide them to clients coming. It is not an entitlement program, however, so we do watch how funded and whether there's going to be a deficit in it at any level. But at this year, we are anticipating no deficit in, we are anticipating that we will provide 712 2/19/99 WHOLE COMM./Budget/Bill 990023 services to anyone who needs those services, and that we have worked with the State to make sure everybody who provided those services last year were being funded. And much of that cost was able to be carried over through the CBH reinvestment dollars.

Well, what does the sentence mean next to the last paragraph. I quote: "In order to remain within these budgeted levels in Fiscal Year '99, DPH has had to restrict the scope of services available to the BHSI-eligible population and the number of people served, and it will continue these restrictions in Fiscal Year 2000." COMMISSIONER RICHMAN: I think at the point that this particular document was written, we hadn't had a written confirmation from the State that the dollars would be there for Fiscal Year '99 or for Fiscal Year 2000. And at that point, that was probably an accurate statement. At this point, with those dollars having come in, unfortunately, the State does not give their information as timely as we want, and we always want to be careful not to misrepresent where we 713 2/19/99 WHOLE COMM./Budget/Bill 990023 are, particularly if we don't have it in writing.

That's good news, that's fine. On , you mention Healthy Start funds and that these federal funds were exhausted that for that purpose in West and in Southwest Philadelphia. Where are we now in terms of this? And people like Virginia Brown and Vernard Johnson and those people who have worked so well in this field, are they included in some new programming and funding stream? COMMISSIONER RICHMAN: I will have my Maternal and Child Health Director come up and answer these questions. (Susan Lieberman comes forward.)

Good morning. I'm Susan Lieberman, the Director of Maternal and Child Health. Yes, we've received word that there will be another round of Healthy Start applications, which will -- the maximum at this point, which we just received an indication, will be 2.5 million for the Healthy Start area. That's 714 2/19/99 WHOLE COMM./Budget/Bill 990023 what we've gotten in this past year. We will apply again. It is a competitive application. We have always received the maximum when we've done competitive applications, so we hope to receive that. Virginia Brown is a member of MCH, and she works very hard with the entire community. Vernard has been very involved with the consortium and has made significant contributions. We look forward to working with him and his agency around some other programs, too.

Thank you, thank you. Commissioner, we're getting complaints. For the most part, we were kind of in front of the -- and you focussed on it earlier in your term here on the health center lines. Now we're hearing that we're getting long lines again. And part B of that question is, we're really, really getting a lot of complaints. I've talked to Penn about -- the University of Pennsylvania about doing something in this area, and they've agreed to -- children with dental problems, that's become a major issue in our world 715 2/19/99 WHOLE COMM./Budget/Bill 990023 today, as I'm sure you realize it. How does that fit into the whole health center in terms of people getting visits? And is it true, as we've heard, that the lines are long again? COMMISSIONER RICHMAN: For dental service specifically? Dental is an area that I think going to present a challenge for us also. You may have noticed in The Inquirer yesterday that two of the HMOs are no longer going to be providing dental services as a benefit at all to their members, which means that many of those people, particularly children, will start coming to the health care centers. At this point, we have not increased the availability of the dental services that we provide, but certainly in light of the changes, we may need to reconsider how we meet some of that need. I think all of us are fully aware that dental pain can be significant and can alter lots of different kinds of behavior if there's not relief of the cause of that pain with dental services. I think that we're going to probably 716 2/19/99 WHOLE COMM./Budget/Bill 990023 have is have to look at that planning effort and where we fall in it, but I'm not sure I have an answer for you today on all the issues that are going to be related if we try to come back in and try to provide a more comprehensive dental plan for adults and children.

Yes. And especially, as you know, given the nature of it, appointments are needed pretty quickly. COMMISSIONER RICHMAN: Right, right.

And I think all of us know little babies and preschoolers who are even having problems, dental problems today. That's a big issue. And that also, as Councilwoman Clark says, is a preventive program. So we would like to know if you would get back to us on that. COMMISSIONER RICHMAN: Let me see. Mike, do you have any comments on that program? (Michael Lucas comes forward.) COMMISSIONER RICHMAN: Let me have Mike explain a little bit of what's going on now in the dental program. 717 2/19/99 WHOLE COMM./Budget/Bill 990023

Thank you.

My name is Mike Lucas, and I'm the Assistant Health Commissioner. As of right now, 85 percent of all individuals who try to get a dental appointment within three weeks can get an appointment. That's relatively similar to what is spent for the past year or two years. What is happening in the communities is, there appears to be less and less providers who do provide dental care. And we in the health centers end up being more of a choice than we used to be. We're not sure what the impact of welfare reform will have on dental care. At this point, as Commissioner Richman said, there has been an impact with the HMOs, but we fully anticipate that we will continue to meet the need as we're meeting it right now.

Three weeks may be okay for general appointments, but I don't think if a four-year-old has a toothache that three weeks is a realistic goal and that it means that we as a city are on top of the situation. If 718 2/19/99 WHOLE COMM./Budget/Bill 990023 a person has toothache, they pretty much need some immediate relief.

Yes. The appointment availability figure I quoted was for somebody who would get routine dental care as opposed to somebody who had an immediate problem. Somebody who has an immediate problem can always walk in to one of our health centers and get any type of care -- both primary or public health services.

All right.

So if you are hearing that there is a problem with some of your constituents, we would like to hear so that we can take whatever action is necessary.

All right. And we're also asking, as Councilwoman Clark just mentioned, for some kind of preventive program, especially with regard to dental care. That's really become a major, major issue. And Commissioner, overall, have you heard that, I guess, after March 3rd, only God knows what will happen, but we've heard even now that are lines are longer again. And, as I said, 719 2/19/99 WHOLE COMM./Budget/Bill 990023 I know when you first came here, you focused on that. We made the neighborhood health centers a serious issue, and we were able to reduce the times, but I'm hearing about these lines and waitings that are stretching out to longer periods again. COMMISSIONER RICHMAN: We try to stay on top of that, and I know periodically those have gotten -- I've heard also that some of those lines have gotten longer. When that happens, we try to look at that particular center and try to figure out what else is going on and what we can do to reduce it again. We're really trying to keep the first appointment -- not immediate appointments and emergency appointments -- within that three-week period. And different things do happen. When a center is -- if it's a center that is having renovations going on, we know we've got longer lines because the renovations are affecting appointment availability. If it's happening in a center where there's not renovations going on, then we want to take a firm look at what else is going on. Is it 720 2/19/99 WHOLE COMM./Budget/Bill 990023 vacations, are we down a doctor, are there things that make it temporary rather than ongoing? And where we're having ongoing problems, we're trying to take some immediate action not to have those lines continue to be long. That continues to be very much of a focus of this Administration. And if you are hearing that, then it's a time for us to look very closely again at which centers that's happening at and then come up with some type of remedy.

With regard to the Philadelphia Child Guidance Center, I know they've been in the last two years kind of organizing. Some services have been absorbed by CHOP -- especially more heavy, more severe cases CHOP has absorbed. And I don't really know what Child Guidance Center since they've reorganized, changed leadership, and all of that. I don't even know really where they are and what they're doing today. What do you know about them and their services to women and children? Are they in the same general location? COMMISSIONER RICHMAN: Well, there's a 721 2/19/99 WHOLE COMM./Budget/Bill 990023 lot of change going on.

Yes. COMMISSIONER RICHMAN: As you know, CHOP has bought, or has now taken over, Child Guidance, and they're also taken over Children's Seashore House. And they're merging both of them into the internal organizational structure of CHOP. The reorganization is still underway, and I think there's still a lot of fragmentation and confusion in the process. We have been very much involved with that, and I've met both with Ed Notabar (ph.) on several occasions and his staff that he's had leading this organization. Some of their activities are taking place at the Kirkbride Center, which used to be the Institute. Some of their activities are taking place at other locations in West Philadelphia. They're estimating that this total transition of bringing both Children's Seashore House and Child Guidance Center under one frame work is probably going to last about another year. My hope is that if we work closely with them, they'll meet that deadline and we'll have a 722 2/19/99 WHOLE COMM./Budget/Bill 990023 better-organized children's service in West Philadelphia. Overall, they have not been a lot involved in Maternal and Child Health. That may be something new that comes out. They've been much more involved in children's mental health and ongoing support for families with children who have behavioral problems. So at this point, we'll see what comes out of the next years.

There's a figure FY '99 and FY '98 of 302,000 but nothing for '99 and 2000 under "Outpatient Treatment Services." Do you know why? COMMISSIONER RICHMAN: No. Mark? It shows a reduction? Is it drug and alcohol? It's at the top.

Yes.

It is under --

"Drug and Alcohol."

Yes, Drug and Alcohol. The Council President and I both share the -- 723 2/19/99 WHOLE COMM./Budget/Bill 990023 COMMISSIONER RICHMAN: I'm not sure there's any change. That's why I -- (Mark Bencivengo comes forward.)

I'm Mark Bencivengo, Assistant Health Commissioner for CODAAP. Because of the existence of CBH and HealthChoices and because of the existence of BHSI, which you spoke about earlier, that has changed the whole array of services and the way that services get counted because anyone enrolled in HealthChoices, their treatment services -- both mental health and drug and alcohol -- are covered by the HealthChoices contract, so CODAAP doesn't count those services. And on the Behavioral Health Special Initiative side, that's another funding stream coming to the City from the Department of Welfare, which is further complicated the way that CODAAP counts services. It's specifically identified in the contract that the City has with the State Department of Health that the dollars that we receive, the City receives from the State Department of Health, cannot be used to supply the 724 2/19/99 WHOLE COMM./Budget/Bill 990023 same services that are supplied by the HealthChoices contract. So our provider system and the Health Department are accommodating to the implementation of HealthChoices. So we're funding those kinds of things which are not fundable by HealthChoices or BHSI. And, generally, they're ancillary services which don't appear as, like, residential days or outpatient hours and those kinds of units. The total array of services that people are able to get is probably greater now than it was prior to the implementation of HealthChoices and BHSI; it's just different funding streams and some different ways of counting.

Does that mean the same people do them but it's listed a different way?

The same people are providing the -- the same providers are providing the services who had been under contract to the State Department of Health -- to the City Department of Health. CODAAP, as are part of CBH network and the BHSI provider network, the providers are the same. They are providers who 725 2/19/99 WHOLE COMM./Budget/Bill 990023 are licensed by the State Department of Health to provide drug and alcohol services.

With regard to the sidewalk ordinance, many of us here have concerns about the status of it, what's going on, how it's happening. And I notice here in the funding detail that you have -- that you have money funded for this year for various organizations. I'd like to ask you, what have you done so far? And my understanding is that the focus has thus far been in Center City. But given the fact that these organizations are funded for this year and next year, I'd like to ask you the status of what you've done and where you are with it. COMMISSIONER RICHMAN: Obviously, we've been very active in trying to get the sidewalk ordinance up and continuing to follow through on the services. At this point in time, all of the activities related to outreach are there. The outreach teams are activated through the OCC, the Outreach Coordinating Center. And they can be and have been sent to places outside of Center City. 726 2/19/99 WHOLE COMM./Budget/Bill 990023 So that if a call comes in and someone in an area outside of Center City says there are people who need these services, we do have the ability to move a team to a different area where the people are -- partly because we also know that its folks have been more vigilant in Center City. Folks have moved outside of the city, outside of Center City to do encampment or to be on the sidewalks, and the ordinance affects all parts of city. At this point in time, almost everything that we had put into the plan is at some point being operationalized. There are a couple of residential programs that we're still working on to get some zoning and get the purchase of the residence on, but everything else is at some place in being within the operational frame work. All the money has been allocated to the agencies, and they're working to either complete their full staffing, or they're working to complete identifying a residential program and to take charge of that property. The funding -- incidently, we have now approval for funding, and we've included the funding for the next year and a half or a total of 727 2/19/99 WHOLE COMM./Budget/Bill 990023 probably two and a half years within the Behavioral Health System Reinvestment Fund.

Now, you said that people in other areas call that these services are available, the sidewalk ordinance 7 services are available to them and that some of these homeless people have gone into other areas. Do you have detail with regard to where they are? COMMISSIONER RICHMAN: No. We're trying to collect that detail now. That came up at our last orientation meeting that there may be a need to -- as look at the tracking system, be able to see where else in the city people may be as opposed to on the streets of Center City.

Well, as you know, we have various organizations in other sections of the city too, so you're not going to necessarily have the same problems in every neighborhood. COMMISSIONER RICHMAN: Right.

It depends on what services are in those neighbors. I'm concerned about that 'cause that has been a part 728 2/19/99 WHOLE COMM./Budget/Bill 990023 of my disagreement with this bill. It all depends, you know, on the community and their needs as to how those issues evolve. COMMISSIONER RICHMAN: The services, the actual residential services and support services are not located in Center City. The outreach efforts have been focused in Center City. But where the residential programs are, the support programs and the other activities have not traditionally been in the Center City area. What we now need to look at is how do we provide outreach and how do we provide responsiveness to businesses and requests outside of Center City, as on a timely basis everywhere else, but the programs themselves, the residential programs, the support programs are not in Center City. Those are in the neighborhoods.

Does not Project Home, does not Ridge Avenue, does not -- you know, we have many, many shelters in Center City. And, for example, Ridge Avenue does treat people with problems. I don't understand that statement. COMMISSIONER RICHMAN: Well, Ridge 729 2/19/99 WHOLE COMM./Budget/Bill 990023 Avenue's in Center City, but many of our other residential programs are not in Center City.

But many of them are. COMMISSIONER RICHMAN: Yeah.

We have a city where we have services in some areas, but Center City has the main focus of all kinds of services; that's why the homeless people come here in the beginning, because we have all these homes and we have all these services. That's why they're here. I don't think that's the truth. COMMISSIONER RICHMAN: Okay. Well --

Within -- within ten blocks of this very building, you have approximately ten shelters. I mean, we have a lot of treatment opportunities available and shelters available right near City Hall. COMMISSIONER RICHMAN: We do. Let us get you a breakdown of where all of the residential programs, particularly for behavioral health are, and maybe I'm thinking too specifically. Ridge Avenue is not a behavioral health 730 2/19/99 WHOLE COMM./Budget/Bill 990023 site; it is a site run by OESS.

Right. But it is a site that offers treatment, so I'm saying we have -- all shelters aren't narrowly homeless. COMMISSIONER RICHMAN: Right.

Some focus for veterans, but it could be veterans with drug problems or others. COMMISSIONER RICHMAN: Right.

So we do have many, many places in and around Center City, which is the reason -- part of the reason for the focus on Center City in addition to all the other, you know, the Convention and Avenue of the Arts and all those other things, and this being our main business point and commercial point in the city. COMMISSIONER RICHMAN: Right.

But this is also the main place where we have shelters. COMMISSIONER RICHMAN: You're absolutely right. There are many shelters in Center City. Many of those shelters, though, do not provide services for people with behavioral health problems. 731 2/19/99 WHOLE COMM./Budget/Bill 990023

Right, although many do. We have many shelters that do provide that. COMMISSIONER RICHMAN: Right.

That do allow people in. On any given night, they take them to a shelter irregardless of what their problems are. Sometimes they may take them to Kirkbride, sometimes they may take them to Ridge, so I don't want the record to reflect that -- that we don't have all of these shelters and that we don't have these -- this focus here in Center City. Otherwise, it changes the whole nature of why we have the sidewalk ordinance in the first place. Madame President, I know others have questions so I'll relinquish the rest of my time.

Thank you. The Chair recognizes Councilman Mariano.

Thank you, Madame Chairman. My question is -- what I want to start out is about CODAAP, so could -- COMMISSIONER RICHMAN: Mark. 732 2/19/99 WHOLE COMM./Budget/Bill 990023

Mark? I'm not going to ask you about Komar (ph.), so relax. COMMISSIONER RICHMAN: Thank you.

The recovery houses in CODAAP. On the bottom part of my district -- Kensington, Juniata, Frankford -- and a little bit of Councilman DiCicco's district, Tioga, there's a lot of recovery houses. And what I'm finding out is that it's usually males between the age of 35 and 55 with mainly drug, but a lot of alcohol addiction problems. And they're white, Puerto Rican, African-American, Asian, so it crosses all barriers. But these recovery houses, a lot of these guys in these houses -- it's mostly males for some reason, so that's one of my questions, what happens with -- we'll get to that, how come there's not a lot of females in them houses 'cause I'm sure -- maybe they're just males houses, the ones that I got to. But it seems to me that they're really involved in community service and they're on the right track. But I understand there's 61 units in 733 2/19/99 WHOLE COMM./Budget/Bill 990023 the City of Philadelphia, but there's only one funded by CODAAP in my district. Is there any truth to that? My district's from Girard to Grant.

Girard to Grant. In the Kensington-Frankford section, I'm exactly sure that would fall in your district.

That's mine, yeah.

CODAAP funds two of the Fresh Start Incorporated Houses.

Fresh Start.

CODAAP has a program called the "CODAAP Housing Initiative," CHI. There are 15 recovery houses that are under contract to the Department as part of the CODAAP Housing Initiative. There are many more facilities operating in Philadelphia that are part of the CHI. There are 4 of the 15 CODAAP Housing Initiative Houses which are for women or women with children. One of them out in West Philadelphia, the Parkside area, is the one that has women with children. There are many recovery houses that are 734 2/19/99 WHOLE COMM./Budget/Bill 990023 seeking to become part of the CODAAP Housing Initiative -- many more than the Department has dollars to support. We started out with 7, we are now up to 15. We do it on a competitive basis through a request for proposals. I would also say, because I know it's of interest to Council, that CODAAP and the Department sat down with the Recovery House managers and developed what we call the "CODAAP Recovery House Standards."

Would the people that were at this meeting be the recovery houses that already have contracts with you, or would it be people that are seeking contracts?

They were both -- those that have contracts with us and those that are seeking contracts.

Would you have barred anyone, especially constituents in my district, maybe Tioga House or places like that, from possibly being at these meetings?

Not at the meetings where we developed the Recovery House Standards. The particular program you're talking about did 735 2/19/99 WHOLE COMM./Budget/Bill 990023 come to a meeting of the Forensic Intensive Recovery Program. It is not part of the Forensic Intensive Recovery Program, and so they were really not supposed to --

Is it that they're seeking to be part of Forensic --

They're seeking to be part of -- as many programs are, they are seeking to be a part of the CODAAP Housing Initiative, and I believe that particular facility -- in fact, I know it's submitted a proposal to us in response to our last request for proposals, as many programs did. And at that time, we brought on seven more. That particular facility that you're talking about was not one that was awarded a contract.

Is there a certain criteria where contracts are awarded and not awarded, I mean?

Yes. It's in response to a competitive request-for-proposal process, which is reviewed, and then awards are made based upon the proposal that's sent in. 736 2/19/99 WHOLE COMM./Budget/Bill 990023 (Councilwoman Clark assumes the Chair.)

Now, most of the ones that are awarded -- and you say you have 15?

15.

And you started with 7. Would a lot of them -- is there any groups that have a great number of them? Is there one group with 3, 4, or 5?

Two of the current providers operate -- or three of the current providers operate two houses.

Okay.

Fresh Start operates two, the Art House Group operates two, and a New Way of Life operates two. They are a bit different in the sense that Art House, for example, has a house for men and then it has a house for men who are on methadone maintenance programs.

Where is that one, Art House?

That one is in West Philadelphia, I think, on West Girard.

Could we possibly 737 2/19/99 WHOLE COMM./Budget/Bill 990023 get a breakdown through the Chair to the District Councilpeople and to the At-Large Councilpeople, if they so desire, of where these houses are located?

By Councilmatic district?

Yeah. That's easier for us.

Yes.

I mean, that makes it better 'cause I -- you know, in the middle there, DiCicco and I -- one side of the street's his, one side's mine, so maybe you want to -- I know the one on Womrath Street's mine, and there's one on Sedgeley Avenue that's mine. And these guys are always out there, voter registration drives. If I call and say, "I need guys to clean a lot," they're there. And, 20 you know, and then when I go meet with 'em, they say, "Councilman, here's one of my problems. We can't seem to get our fair share of the pie." I mean, these are guys that look just like me, that have the same problems I had, and somewhere in life, they took a road to heroin or 738 2/19/99 WHOLE COMM./Budget/Bill 990023 cocaine -- and, fortunately, I didn't, but I could see myself sitting there. I mean, they're guys that are my age, in their early 40s that have really wasted most of their life and they're on the road to recovery and need to feel that there's a, you know, they have their spot in this society, especially in the city. And they certainly do. I mean, we can't afford to throw any one away. I know my colleague Councilwoman Blackwell concentrates on a lot of the homeless issues. I just think that this group of people -- and I realize that there's a little bit of funding, you would like to have more funding, and if the State and the feds cut out the funding that used to trickle down to us slowly, you know, it's become a full-time issue. I actually have someone on my staff that has some families that were involved in this. I want him to be assigned to this. Can he attend meetings as my representative?

Surely.

So I'm up on this?

Yes. And we will make 739 2/19/99 WHOLE COMM./Budget/Bill 990023 a listing of the CODAAP Housing Initiative Houses by Councilmatic district available to the President of Council.

Okay. Thank you very much. And my next question, Madame Chairwoman, is -- I don't think you'd be involved with this -- is the Prevention Point, the needle exchange program. Oh, you got that too? Good, all right. Now, we all know that it's a very controversial issue. And until we find cure for AIDS, nobody wants to give needles away -- mostly me, three months before an election, all right? Let's make it simple. But we give them in certain neighborhoods. Now, I will pick the 19th Ward, which is lower Kensington, which is heavily Latino and, you know, a little bit African-American, and I'm sure there's some Caucasians involved there. But it's on its upswing. You know, there's some things happening there that haven't happened there for 30 years, and I'm excited about it. But when the leaders in that community 740 2/19/99 WHOLE COMM./Budget/Bill 990023 come to me and say, Councilman, we understand the AIDS epidemic and we understand the needle exchange. We don't really like it but we understand the need for it and we understand that there's heroin addicts here and things are going on, and we're afraid maybe a 52-year-old Latino man who may have been addicted to heroin for 30 years doesn't want to go to South Philadelphia to get his needles. So we could debate that issue for a long time. And Councilman Ortiz and I have talked about that, and he's looking at me, and, you know, we feel the same about that, we need to do something with that. But I've been in contact with Prevention Point because the community leaders don't want it on their corner because it just makes it looks like everything's being thrown there. So we want to try to do something at the health center. And I understand there was a problem opening health centers on Saturday to give out these needles. And before you say anything, the second part of this problem, which is probably the 741 2/19/99 WHOLE COMM./Budget/Bill 990023 first part is, there's a lot of people -- anytime you think of anything good, like the road to hell is paved with good intentions, Councilwoman Clark always tells me. So these are all good intentions, but there's somebody out there collecting needles. If I can think of it, 30 people have thought of it before me. Now, there's probably some 18-year-old guy out there that may not be a heroin addict that's collecting needles, old needles, and he's taking 'em back and he's turning in 100 and he's selling 'em for $1 apiece, which is pretty good -- he's making $100 on a Saturday afternoon or on a Saturday turning in needles. We need to have a point where -- and I don't know where that point is, but we need to let these people that are getting free needles sit through something -- maybe sit through a movie or some kind of lecture or something so that it's not that easy to come in, gimme my 100 needles and I take off. How 'bout, you got to sit here and be a little bit, you know, inconvenienced for 20 minutes or 30 minutes. Now, we will find out right away who 742 2/19/99 WHOLE COMM./Budget/Bill 990023 the hard-core drug addicts are. And I don't want to plug this on anybody. I'm just looking at making sure them scammers aren't scamming the system because what it's doing is, it's costing money, taxpayers' money for needles, and it's giving a good program with good intention a bad view in the eyes of the people that live there. Can you imagine looking outside your door on Saturday morning and seeing 120 people or even 30 people lined up getting needles? I mean, it's not a good thing to say to a young mother and a father who are in an economic status where they're struggling and working every day and explaining to your children, three or four children why these people are addicted to heroin and why the City gives them free needles. I mean, it's an issue nobody wants to deal with it, but we have to.

And I'll respond to the one part of your question about the particular site which was causing considerable concern in the 19th Ward. We have moved that site. We've moved that site to a drop-in center not terribly far 743 2/19/99 WHOLE COMM./Budget/Bill 990023 from there, working with the ward leader of the 19th Ward. And he and other folks out there are going to work with us to find a permanent storefront for that particular site, which was located on an area which, I understand, is undergoing a lot of economic development or is contemplated for economic development. And I -- the people at Prevention Point and myself and the people out in the neighborhood have worked very closely to move that site to a storefront that we currently fund for Prevention Point.

Where is the storefront?

Around Third and Girard.

Third and Girard?

Yes.

But it's not in the health center, right?

No, it's not.

But it's around there.

It is not in a health 744 2/19/99 WHOLE COMM./Budget/Bill 990023 center; it is around the health center. The coordinating office funds the site at Third and Girard. For a number of reasons, I would prefer to operate it out of that store front rather than out of the health center. But we do want to ultimately have a storefront. That particular site, like the other ones, operates on a very limited time fame: it's two hours once a week on Saturday morning. And we're probably going to, in all likelihood, move it again in several weeks when we're working with the ward leader to find us a permanent place.

Now, you know that Congreso de Latinos Unidos, what Alva Martinez runs, I acquired a site for them at American and Sommerset that was a part of the City's spray-paint deal or the Anti-Graffiti Network. And they're going to have that. Now, Congreso is probably -- I mean, not probably; it's definitely a first-rate organization. And once they get feet their on the ground from their old site to here, that might be a place where -- and Congreso would probably love to be involved in that. 745 2/19/99 WHOLE COMM./Budget/Bill 990023

We are certainly looking at that one and have had some conversations around that. It will be some time before they get that one up, but we are certainly looking at that and having discussions with Miss Martinez.

Is there any other sites that we're using at all up in that area? I know we have some in South Philadelphia, and that's interesting to the At-Large Councilpeople or Councilwoman Verna or DiCicco, but is there anything else in Kensington or Frankford that I need to know about?

Across the railroad tracks from A and Gurney on a stretch up there.

Behind the abandoned factory?

Yes.

They're still going out there?

Well, no. It's on the other side of the tracks. It was next to the abandoned factory. It's no longer next to the abandoned factory; it's in front of the empty lot, 746 2/19/99 WHOLE COMM./Budget/Bill 990023 between two railroad bridges. That one is going on up there. It has been going on for some time, but we had moved that also in response to --

A number of times.

-- meetings that the Commissioner and I had with representatives from EPOP (ph.). We moved that. I, quite frankly, haven't heard any problems regarding that site for some considerable period of time.

I just don't like to be surprised. And the last thing say, and I've had this discussion with the Commissioner before. Any issues that affect my district -- and I'm sure the other District Councilpeople will speak up -- tip us off, save us like a mountain of work. Most things can be avoided if you'd just let us know what's happening we can be the ones to go to the community and say, Look, this may happen here, and this may be a problem. Is it going to be a problem? If it is, let us know now before they're talking about it on the radio or before it's in the newspaper or before EPOP's even involved, okay?. 747 2/19/99 WHOLE COMM./Budget/Bill 990023 COMMISSIONER RICHMAN: I have, after our last meeting, have tried to reinforce very strongly with the staff that I don't want any Councilmember blind-sided by their community on any issue that we know of in advance.

'Cause if I lose my election 'cause of Komar, I'm working for you, at as much money as you make. And that's in the record, so you can't deny it. Thank you. Thank you, Madame Chair.

Thank you. Mr. Ortiz?

Thank you, Madame Chair. Commissioner, during the last few years, and I don't know if you had it in part of your statement, the increase in terms of uninsured individuals coming to the health centers, what has been the increase in the last two years? And what is the projected increase that you see happening after welfare reform takes hold? COMMISSIONER RICHMAN: I believe, and I'm not sure I have it in this budget testimony, but I think last year, we said that in 1996, the 748 2/19/99 WHOLE COMM./Budget/Bill 990023 percentage was around 45 percent. We are predicting for Fiscal Year 2000 that it would be 62 percent. So, obviously, we've had a significant change in the number of uninsured, the percentage of uninsured that are now coming to the health care centers. We've also tried to do some study to find out if these are people who have been previously insured -- in other words, who are coming off welfare rolls, or whether these are people who've always been uninsured, who are beginning to find their way more frequently to our doorstep because other people who would have treated them are either no longer doing it or no 16 longer doing it in the same volume.

Yeah, I'd like to find out whether that's a direct result of Act 35 and its impact. COMMISSIONER RICHMAN: Right.

And one of the economic issues involved in that in terms of monies and expenditures and who pays for it and do we get any reimbursement from somewhere to take some of the economic impact off. 749 2/19/99 WHOLE COMM./Budget/Bill 990023 COMMISSIONER RICHMAN: No one pays us to be able to treat the uninsured; that falls on the City. But one of the issues that we have tried to work with is that many of the people who are showing up at our door, who come in uninsured, actually are insured and didn't know it or couldn't get through the process or didn't know how to get through the process. And one of the reasons that we've added insurance counselors to the health centers -- and we have three now and will be adding a fourth one -- is to be able to help people get back on their insurance. Technically, welfare reform should not affect their Medicaid eligible. But most people do not know that. They're assuming that if they're losing cash assistance, they're also losing their medical-assistance benefit. We also know that if they don't show up for appointments around their cash assistance, that in some cases -- many cases perhaps -- they're losing their medical-assistance benefits. We also have families who are eligible for the CHIP Program who don't understand they're 750 2/19/99 WHOLE COMM./Budget/Bill 990023 eligibility or how to get it. So part of our effort in trying to figure out more about this number increase to 62 percent is how many of that 62 percent really are insured and have eligibility and don't know it, how to get them through the paperwork (which is horrendous), how to make sure they're applying for the right thing at the right time, and to literally help them through the process. At a study we did this summer, 50 percent of the people who came in uninsured had eligibility and didn't know it. And that's the group we're going after.

And I imagine that this is an increase in terms of the amount of people that you see and how you are assimilating in terms of staffing, that increase in terms of people that are coming into the health centers. COMMISSIONER RICHMAN: Okay. We are staffed to be able to provide treatment for a population for 320,000 visits. Last year, we had 312,000, so we've left ourselves a little of that room to grow in. And as I commented to President Verna, 751 2/19/99 WHOLE COMM./Budget/Bill 990023 if we go over the 320,000 visits, we will now then need to look very seriously at what impact that will have on our waiting time and our accessibility time. At this point, for this year, we will probably not hit 320,000. And we will be watching that very closing and very carefully. Our statistics have stayed very fairly constant over the last two years.

In terms of the sidewalk behavior bill, do you have any data as to that you can maybe provide us? I know that it's too soon perhaps. But in terms of people, visits, contacts by your outreach teams and so on that, you know, how often are they occurring, you know, when are they called and so on and so on, and the results of those contacts down the line and what happens. COMMISSIONER RICHMAN: We are collecting that data. We're actually involved in -- and there will be full data-tracking system that will be up and running probably, I believe, May 1st. In the meantime, we are collecting it 752 2/19/99 WHOLE COMM./Budget/Bill 990023 by hand, and we would be able to summarize that data for you. I do have some of it here, and we'll be able to put it in a little clearer format. It's a little bit complicated in terms as it goes through. We know how many clients we've seen, the events, we know how many we looked for and didn't find, how many refused services when we found them. So we're collecting a fairly sophisticated amount of data that we will be able to share with you.

Thank you, Madame Chair.

Okay. I'd like to follow up on Mr. Ortiz's question. Would you please describe any programs that you have designed and implemented in order to be responsive to the new requirements of the sidewalk behavior bill. What have you done internally in your organization to get yourselves ready for the new waves of service that will be required as a result of sidewalk behavior bill? COMMISSIONER RICHMAN: Okay. We've done a variety of things. The first thing is, 753 2/19/99 WHOLE COMM./Budget/Bill 990023 beginning to look at how we provide outreach services. And in the past, outreach services have been provided by a team of people who go out, provide the service, deliver a person they find to a shelter, and then they go out and find someone else. One of the things we're doing different this year is beginning to look at combining outreach with case management. In other words, when you find a person, you stick with them.

Until it's resolved? COMMISSIONER RICHMAN: You stay with them until you think they are fairly well stabilized. In other words, even if you have them involved in a residence, people may stay for a week and disappear again, and then another team finds them. We want a team to be assigned a group of people and they stick with that person. They know where they are during the day, they try to make sure that they're assessing treatment. They try to stay with them long enough to know they are in a stable environment, not just a shelter. 754 2/19/99 WHOLE COMM./Budget/Bill 990023 So by being able to put some continuity of care in there, our expectation is that we will cut down on the times we find the same person over and over and over again, because that was one of issues that we heard from the outreach teams in the past. We're also trying to be much more aware of people with co-occurring disorders, which means that many people who are homeless not only may have a drug and alcohol problem but have a co-occurring mental illness. Or people that have a mental illness also have a co-occuring drug and alcohol problem, and seeking and supporting providers that can treat both at the same time, not one after the other, and bringing providers along that understand the concept of co-occurring and how to work with both together.

Is this a major change in the way you used to do it? COMMISSIONER RICHMAN: Yes, it is. In fact, we're making that change over the entire system. Because in part, more than anything else, the way the system both has been funded in the past and how the allocations have come from the 755 2/19/99 WHOLE COMM./Budget/Bill 990023 State and federal government, it comes very categorical, and the government wants that drug and alcohol money to treat drug and alcohol problems, and mental health money to treat mental illness -- with the failure to understand that many people have both at the same time and you can't treat one and then the other.

They can't bifurcate it without being arbitrary and sometimes foolish. COMMISSIONER RICHMAN: Exactly. And what we've tried to do is much more focus now on what we are calling "people with co-occurring disorders," and you have to treat both at the same time. We are, in fact, next week having a major meeting with the State to see if we can bring them into this line of thinking. We have written a white paper, we're doing some major training of our staff, but we're running into some of the same problems with the State being in a little different place and trying to say that the way their fundings work is not helpful for Philadelphia, it's not helpful for us being able 756 2/19/99 WHOLE COMM./Budget/Bill 990023 to work with the citizens of Philadelphia, and that we need -- we need them to work with us, as opposed to being a barrier.

In the previous treatment regimen, you had one person on two case loads; now you have one person with two problems. COMMISSIONER RICHMAN: Right.

That makes better sense to me that you would treat the person with whatever his or her problems are. Let's make government fit the person rather than make the person fit the government and follow the dollars. COMMISSIONER RICHMAN: Would you like to come to the meeting with the State? (Laughter.)

You know, that was my next question. How can we help you make people who are more like us than they are like you understand your problem? I don't think we have yet used our coordinated strengths. Now, you can talk to your subject matter; I don't even try to pretend to understand it to the degree that you, but I do, after about 20 years, understand how legislators think. And 757 2/19/99 WHOLE COMM./Budget/Bill 990023 maybe we ought to have a coordinated local approach to attack it at the various other governmental levels. COMMISSIONER RICHMAN: We are, at this point, doing the first-level meeting with people within the Department of Public Welfare, not even at the top level of Public Welfare now. We're working with their licensing people and some of their program people. If we can get those people who are at the front line to begin to change their behavior, then obviously, we have solved the problem. Our concern is --

But before you get them to understand it enough to change their behavior, they're going to talk to people like us, and we can't carry your message because we haven't understood it because you haven't taught it to us yet. And that's the point I'm trying to make without belaboring it unnecessarily that we need to have some internal in-the-family discussions so that we understand you and share with you what we know about how legislators and bureaucrats think. 758 2/19/99 WHOLE COMM./Budget/Bill 990023 Now, you know how bureaucrats think, but we know how legislators think. COMMISSIONER RICHMAN: We would be very glad to educate you one some of the issues and where we see some of the legislative problems or some of the more resistant problems as we try to create, first, a behavioral system; and within that system, the concept of co-occurring disorders.

Thank you. I cut across you; you were about to tell me something else. COMMISSIONER RICHMAN: (Shakes head.)

Okay. The next person on our list -- and I won't interpose myself here because Mr. Rizzo is next on the list to speak. Mr. Rizzo, you are called upon now.

Thank you, Madame Chair. Commissioner, I had a constituent call very, very upset and concerned because there was just a lack of service. And I know we can't deal with every issue, but I'd like to try to describe this concern. 759 2/19/99 WHOLE COMM./Budget/Bill 990023 Yesterday, on my voice mail, a woman called distressed, terribly in tears, and described her situation. She lives -- she presently lives with her boyfriend. She has a 13-year-old son. She's paying the rent cash to the boyfriend; they split the rent. The boyfriend wants to end the relationship. He has put the mother -- the woman and her 13-year-old son out. She said she's called from the White House to the State Capitol to my Council office, not able to find anyone that would give them any assistance. She said she tried to get into a shelter and she was rejected because of the 13-year-old son. Is there anything that you can think of? And I'm sure that there are situations like this. It kind of concerns me that there's at least at this moment nothing available to help this woman and her 13-year-old son, and I'm hoping to there that there may be. COMMISSIONER RICHMAN: Let me try to answer it in two ways. If the woman or her 13-year-old son have any kind of behavioral health issue, I'd probably have some resources that I can 760 2/19/99 WHOLE COMM./Budget/Bill 990023 bring to bear to help resolve it. If none of the issues that they have are health-related, then what I would do is probably try to work very closely with OESS, the Office of Emergency Shelter, to see what together we could come up to support it. There have been occasions in the past where we have seen families -- particularly sometimes families with many children, up to five, where we have literally put them up temporarily in a hotel or a motel until adequate housing could be found to get them that level of protection. So usually we take those on as special projects, we try to make sure that both the mother and child are in safe conditions as quickly as we can, working through the resource of both OESS and the Health Department.

In fairness, I believe she was offered separate -- separating them, and I can imagine a mother not wanting to be separated from her child, and I can understand the problem of not allowing a mother and 13-year-old boy to come into a shelter, but -- COMMISSIONER RICHMAN: There are 761 2/19/99 WHOLE COMM./Budget/Bill 990023 shelters for mothers and their children. They aren't run by the Health Department. Again, they are run by OESS. But I'm sure that we would not like to see them separated. The cost to the City of placing a child in a foster home versus having the mother and child together is much higher, so we would try to keep the family dyad together and find adequate places for them to work.

What concerned me and why I took the opportunity to discuss this publicly with you is that her final words were that she would live on the street before she would be separated from her child. And that concerned me. COMMISSIONER RICHMAN: And that would concern me too. And, obviously, one of us want to see her with the only alternative of living on the street or in an unsafe environment with a person who may be potentially abusive to her or the child. So if you could let us have that information, I will certainly follow up with Mike Nardone. And we will solve this problem. 762 2/19/99 WHOLE COMM./Budget/Bill 990023

Thank you, Commissioner. I knew there had to be something out there, but she was so down to the point where I was concerned. And I was concerned also that this might be something -- there might be similar situations out there like this, and I'm pleased to hear that there is the potential of some help for her. COMMISSIONER RICHMAN: There have been occasions like this, and when someone does call us on it, we try to get those resolved and actually not just give the person another phone number to call, but to make sure it gets resolved.

Thank you. Thank you very much, Commissioner. Thank you, Madame Chair.

Thank you. Are there any other questions of the Commissioner?

Right here.

Councilwoman Miller.

Good morning.

Good morning. 763 2/19/99 WHOLE COMM./Budget/Bill 990023

I just had one question regarding the new equipment that --

I can't hear you.

Regarding the new equipment that I think you're purchasing. I'd just like to know if a mammogram machine or device is going to be put in Health District No. 9. It's my understanding that's the only health center without a mammogram machine.

This is Mike Lucas again. In the past, Medical College of Pennsylvania provided mammography services directly at Health Center No. 9. All of the other health centers were serviced by our own mobile mammography unit. So there were mammography services available at all health seniors, including Health Center No. 9, except it was done by MCP rather than the City. As of right now, Tenet is no longer providing that service, and we're looking at ways in which we can provide that service at Health Center No. 9. The physical facility at 9 does not lend itself to that right now, and we have our 764 2/19/99 WHOLE COMM./Budget/Bill 990023 facility management people looking at ways to restructure things and change things so we can move our mobile mammography unit in once a month a Health Center No. 9 just like it is at every health center.

Okay. So you're saying that Tenet is not going to do the mammograms.

That is correct.

Okay. 'Cause I had spoke to the Advisory Council President, and she was under the impression that Tenet was going to do the mammograms. So it's good to have clarity on that issue. Okay, thank you. That's my only question.

Thank you. Will after-work and weekend hours be extended at all?

I'm sorry, I didn't hear the question.

Will after-work and weekend hours be extended at all of the health care centers? 765 2/19/99 WHOLE COMM./Budget/Bill 990023

Each of the centers is open one evening a week at this point. One center is open one evening a week and also on Saturday mornings.

And you don't envision one evening and one weekend for all of the centers; this is the present level of after-work and weekend hours that you anticipate?

You're right, that is the current level. We are looking at ways to expand it. As our facilities have undergone renovations over the past few years, we've had to change the hours of the health centers, and some of the health centers have been open 7:30 to 4 o'clock, and the earlier hours also appear to be very appealing to the patients who use the health centers. So we are exploring other possibilities, perhaps even going to a 12-o'clock-to-8-o'clock shift one day a week.

That's where my question goes to, some non-traditional work day to permit people to come either before or after.

Well, we're certainly supportive of that, and I can say unequivocally 766 2/19/99 WHOLE COMM./Budget/Bill 990023 that the current evening hours and Saturday hours have been very successful, and we would like to expand it.

Are you having difficulty attracting and retaining qualified professional staff at the centers?

Several years ago we had difficulty not necessarily recruiting but retaining physicians. We developed a physician retention program which included such items as a salary increase, further training and education, as well as paying for malpractice insurance for contract physicians. Since that point, we've been very lucky in the sense that there's been very, very little turnover of our physician staff over the past, I'd say, two years, maybe three years. COMMISSIONER RICHMAN: Actually, Mike knows that I have many people who come in who actually want to work in the centers and that at that point in time, we may not have vacancies. And it's the ability the offer the malpractice insurance to our contract workers that seems to be able to make the major amount of difference in 767 2/19/99 WHOLE COMM./Budget/Bill 990023 people not only coming in to the jobs but then staying once they got there. So that what we saw in the beginning of this administration, we haven't seen now in the last two or three years.

Okay, so it's working. COMMISSIONER RICHMAN: Yes.

You found a solution to your problems. COMMISSIONER RICHMAN: Yes.

Okay. COMMISSIONER RICHMAN: And the doctors told us what it was; we just had to find out a way to work it.

To pay for it. COMMISSIONER RICHMAN: That's right.

All right. Okay, well, I thank you very much. There are no more lights showing; if I were you, I'd leave. (Laughter.) COMMISSIONER RICHMAN: Thank you.

The next group to be heard is OESS. Please join us at the table. 768 2/19/99 WHOLE COMM./Budget/Bill 990023 (OESS panel comes forward.)

OESS, let's go. Good afternoon, how are you?

Okay. (Proceedings disrupted by din of audience conversations.)

Ladies and gentlemen, we're going to ask you to do your meetings outside and let us proceed with this hearing. Good morning, sir. Please introduce yourself to the record, spell your name for the benefit of stenographer.

Okay.

And proceed with your testimony, but just a minute. (Councilwoman Clark taps gavel.)

Good morning, Councilwoman, members of City Council. My name is Michael Nardone. That's N-A-R-D-O-N-E. And I am Deputy Managing Director for Special Needs Housing. /Budget/Bill 990023 Services; Kevin Breazeale, Deputy Director of OESS; and Richard Shaeffer, Administrative Services Director for OESS. I am pleased to offer this testimony on the Office of Emergency Shelter and Services Budget Request for FY 2000 and the significant challenges that lie ahead for the homeless services system. 9 represents Grant Revenue Funds. 5 million increase over projected General Fund expenditures in FY '99. The increase allows for a $2 rate increase for shelter providers, annualized lease costs for a new family shelter, annualized costs related to implementation of the sidewalk ordinance, and an additional staff person to help monitor a new federal grant for employment and training. /Budget/Bill 990023 levels. As you and other members of Council know, there is perhaps no other social problem as complex and challenging as homelessness. It is a national scourge, and it -- is because of the multiplicity of factors, it is also a policy dilemma that does not yield to any easy solutions. Despite the complexity of the problem and the many challenges faced by the homeless services system this past year, I would like to report on some significant progress we have made in the development of the City's continual services for homeless individuals and families. 2 million in State funds that had been eliminated in two prior-year State budgets. These dollars, as well as an additional $800,000 in federal McKinney Emergency Shelter Grant funds allowed the City to avoid the shelter restrictions imposed the past two summers and better equipped us to address demand for emergency shelter. /Budget/Bill 990023 continuation of the progress made this year, as well as new initiatives proposed for next. You already heard much discussion about the sidewalk behavior ordinance, so I will not discuss in great detail the second major area where we've enhanced services, which is in outreach and behavioral health resources available to chronically homeless individuals. As you heard from the Commissioner, we have significantly expanded the number of outreach staff as well as we are in the process of developing additional residential resources with a behavioral health focus for chronically homeless individuals. The sidewalk implementation plan also includes resources to improve behavioral health services available to individuals residing in the OESS system. That includes the behavioral health assessment and treatment team that was instituted at Ridge Avenue and which is available at Gateway and Eliza Shirley, as well as additional behavioral health staff that have been added to support 30 beds within the OESS system targeted to chronically homeless individuals with mental health or substance-abuse problems. /Budget/Bill 990023 might have been able that Councilwoman Blackwell was referring to earlier. These enhanced behavioral health services are in addition to other OESS initiatives, including additional intake and case management staff and establishment of a day program at the Ridge Avenue Center. In addition to these enhancements, over the past year, we have also launched initiatives to increase employment- and training-related services for individuals and families in emergency shelter and transitional housing. Utilizing a combination of C General Funds as well as Private Industry Council resources, between April '98 and March'99, the City will invest close to 1 million to fund training programs targeted at people ineligible for temporary assistance for needy families. This is primarily single men and women residing in the emergency shelter or transitional housing. Through January -- and these programs are ongoing -- we've enrolled almost 450 non-TANF individuals in these programs; and today, have placed over 180 in full-time or part-time employment.

3 million over the next three years to support this employment and training initiative for homeless individuals. The grant awarded in December as part of the competitive McKinney funding round will provide a stable funding stream for employment and training efforts and will allow us to build on the programs established for non-TANF initiative. The OESS/PIC initiative for non-TANF individuals was designed to complement services developed with federal welfare-to-work dollars for TANF families. Parents within the shelter and transitional housing system will have access to a full range of service available through Greater Philadelphia Works. However, we have also added -- we have also -- there have also been earmarked $2 million for specialized services for up to 1,000 homeless families in the emergency shelter and transitional housing system. /Budget/Bill 990023 skill classes for up to 1,000 families within the shelter and transitional housing system. We have also begun to develop computer labs in several OESS shelters to provide literacy training as part of the GPW initiative. Obviously as you know, these initiatives will not fully counter the impact that welfare reform will have on the City homeless services system. The Mayor has said on countless occasions that the welfare-to-work dollars fall far short of the resources necessary. Moreover, the workforce strategy embodied in the welfare-to-work legislation is not the best fit for the hardest to serve clients such as many of those in the homeless services system. However, despite this stark reality, it has certainly been the Administration's priority to support a employment and training infrastructure that assists individuals and families within the homeless services system achieve economic independence and self-sufficiency. And these efforts that we've described are a part of this effort. 9 million McKinney Competitive Homeless Assistance Award to public and nonprofit agencies in the City. 1 million in grant funds compared to last year's level and reflects the City's continued success in attracting federal funds to support homeless initiatives. These additional McKinney funds as well as additional resources devoted to shelter beds, behavioral health services, and employment and training represent significant steps to enhance the continuum of services for homeless individuals and families. However, despite the progress made on these fronts, the past year also presented serious challenges to the homeless services system as well as trends that are a harbinger of things to come. For much of this year, demand for emergency shelter has exceeded prior-year levels. Now, much of this can be explained by the fact that unlike the previous two years, shelter restrictions were not imposed during the summer months. /Budget/Bill 990023 been particularly acute for families. Developing shelter capacity of reasonable quality continues to be an ongoing challenge for OESS. So far OESS has met demands for family beds by expanding within existing facilities operating family facilities at full winter capacity for much of the year. However, this obviously is not a satisfactory solution over the longer term, and welfare reform will only further exacerbate this situation. I would also say that the impact of welfare reform is beginning to be felt in other parts of the system, and perhaps that's best seen in the increase that we've seen at soup kitchens and food cupboards that are funded in part by the Office of Emergency Shelter. increase, over projected spending in FY '99. million in new General Fund dollars to respond to several critical challenges faced by the homeless services system. 3 million in FY 2000. 5 million in new initiatives represents a significant increase. But in light of the serious pressure faced by the shelter system, the Administration is proposing additional investment in several key areas. They include rate increases for emergency shelter providers.

The Administration has been working to ensure adequate payment rates for its shelter provider. In FY '98, the Administration proposed and Council approved a $1 increase in the per-diem rate. The Administration is now proposing an additional $2 increase for FY 2000, raising the reimbursement rate from $12 to $14 a day. As mentioned above, perhaps the most serious problem currently facing OESS is maintaining its present shelter infrastructure and ensuring a level of quality service. It is clear that the $12 per-diem rate is seriously stretching our current providers. As a result, we have had difficulty retaining current providers as well as attracting new quality programs to the OESS system. /Budget/Bill 990023 The $2 increase requested for FY 2000 will bring the rate that OESS pays its providers more in line with other per-diem rates. It also will contribute to the quality of existing programs, putting providers in a better position to meet basic program costs, including building maintenance and facility improvements. 8 million in Fiscal Year 2000. Second, we included in the budget the Administration's request for 450,000 in FY 2000 General Funds to cover annualized lease costs of an additional shelter facility housing up to 200 family members. One of the major challenges facing OESS continues to be inadequate family bed capacity. Even if demand were to remain constant additional beds would be needed to relieve overcrowding in existing facilities and upgrading the quality of service. Welfare reform will only obviously exacerbate this situation. /Budget/Bill 990023 overall level of quality in the shelter system. I'll briefly mention two other initiatives. One is the annualized cost of the sidewalk ordinance. The FY 2000 Budget contains full-year funding for a behavioral health assessment team as well as the Ridge Avenue Center, which were -- the day program for the Ridge Avenue Center, which were initiated in November of this past fiscal year. And in order to properly monitor the employment and training program as part of the match for the HUD McKinney program, we agreed to fund the program analyst with specific responsibilities for overseeing the employment and training program. Right now, that duty is split with a -- is done by a person who is in quality assurance, and this will add an additional position. We talked -- in addition to these proposed initiatives, the FY 2000 OESS will continue to support the core services at the heart of the OESS mission. The OESS Budget includes funding for an average of 2,476 beds. /Budget/Bill 990023 Human Services as well as additional entry-level capacity funded as part of the sidewalk ordinance 4 legislation. In addition to emergency shelter, the Administration plans to maintain its commitment to other important components of the homeless continuum of services. The FY 2000 Budget will continue support for homeless prevention at the $2 million level provided this fiscal year. These dollars, which are administered by OHCD, fund two organizations to provide comprehensive services, including cash assistance for delinquent rent and utility payments, case management, and employment assistance to households at risk of becoming homeless. OHCD is in the process of doing a full-scale evaluation of the success of this program to date so that we can make decisions moving forward about this program. We also recognize that transitional and permanent housing options are, if not the critical linchpin if we are to break the cycle of homelessness. /Budget/Bill 990023 projected number of households who can be served by this program at any one time up to about 600. You may hear more about this from John Kromer when he testifies, I believe, on Monday. This is above and beyond the 245 units of transitional housing funded through OESS.

Likewise, in planning for the future McKinney rounds, the City has decided and the RFP process is currently unfolding to make development of permanent and transitional housing the top City priority when seeking -- during this round of McKinney and the special needs housing needs development funds. This is in addition to the roughly 450 units of special-needs housing for homeless individuals and families now in the development pipeline. As outlined above, we have a firm commitment and long-standing commitment to the development of continuous services for homeless individuals and families designed to help people move from the streets to self-sufficiency. The budget before you today builds on the progress of the last seven years and contains a number of key initiatives intended to move us forward. /Budget/Bill 990023 However, as you are well aware, welfare reform looms on the near horizon, threatening to undo much of the good work that this Administration and Council, in concert with providers, advocates, churches, and community leaders have done. We are making use of available funding opportunities such as Community Behavioral Health reinvestment dollars, HUD McKinney grants, federal welfare-to-work funds, to mitigate -- as well as additional General Funds to mitigate the serious human consequences welfare reform may entail. However, in the end, the City cannot go alone. The federal and State governments will have to continue to step up to the plate and do their fair share if we are to continue make progress to combatting homelessness. Unfortunately, recent news from Harrisburg does not give a great deal of cause for optimism. 2 million restored this fiscal year to support the City's homeless services program. /Budget/Bill 990023 assistance development grant program, which will provide more than 1 million this fiscal year to strengthen the City's anti-hunger efforts. As the City prepares to face the welfare reform challenge, we will obviously need to work with the legislature and Governor to ensure that the State maintains its commitment in vital areas such as these. Thank you very much for giving me this opportunity to testify before you today, and I would be happy to answer any questions you may have.

Thank you, sir. You spoke of the need to help people successfully transition from the sidewalks to self-sufficiency. Would you speak to the success of our efforts so far. Do you have any success stories to tell?

Well, I think we have quite a few success stories. I didn't bring specific -- I didn't bring specific cases with me today. But if you look at the number of people, for instance, that we placed from emergency shelter into transitional housing, for instance, in this fiscal year, I believe, and it's on the 784 2/19/99 WHOLE COMM./Budget/Bill 990023 back of the testimony, we are looking at placements into the transitional housing as well as other housing options in the neighborhood of 800 to 900 families. And what we have found in looking at the transitional housing program is that actually very few of those families -- I mean, there are some that come back into the shelter system, but the large share of those families who move from emergency shelter and then into transitional housing, basically our records are not showing them coming back into the system. So I think that's a good example of, I think, where we are developing the continuum of care, and people are moving along in terms of services to independent living. And we're trying to enhance that with some of the employment and training efforts that we're doing.

Has the traditional housing program been operating long enough for you to say that it is working and that people are work moving from that into independent living, without any need for further supervision or assistance of and by your system? 785 2/19/99 WHOLE COMM./Budget/Bill 990023

Well, I mean, that is an issue, when people move from transitional to, say, publicly -- if they move to public housing or in the private market. I would say, though, that the best evidence that we have is looking at those cases that have gone through the transitional housing system to see how many of them have returned back into the system. And, I guess, in terms of that indicator, I can report to you that we are not seeing a large number of those people who are going into transitional housing then returning after they've completed that program.

Okay. Now, that gives me an overall feeling that things are going well.

Right.

But I need something harder than that. So I wish you would look at your data.

Okay.

And display it in ways that we can say objectively that people are getting helped to function independently. 786 2/19/99 WHOLE COMM./Budget/Bill 990023

Right.

And the next level that you need to study is, do they move from your transitional housing into independence.

Right, I agree with you. And one of the things that we've been trying to work on is a management -- I mean, we do not have frequently the information that would be very helpful in assisting us to do that. And we are in the process now of upgrading our management information systems to really allow us to track people through the homeless system, because that's really critical.

If you don't, then I have to go by your hunch, your overall feeling that things are better.

Right. Councilwoman, I am doing everything in my power to get -- we hope that by -- now, I've been told July so I guess we have to give it a few months of time when maybe it won't be up, but I hope that by the summer of this year, we'll have a system in place that will help us to begin to answer many of those questions.

Well, I have no 787 2/19/99 WHOLE COMM./Budget/Bill 990023 doubt that there will be a system, sir. What I'm trying to do is help you develop the system that gives us the kind of information that's useful to us. And while I'm glad that you feel good about it, I will feel better about it if there is some hard data on which to bottom these feelings, and I don't know how you justify not going all the way to self-sufficiency if you just count the people who don't come back into your system and call that success.

Right.

It is, no doubt, a level, but it drops dramatically below the level that we who have the responsibility for making and assessing policy would need.

I agree with you, Councilwoman. It's something we need to work on.

All right. Thank you. (Council President Verna resumes Chair.)

The Chair recognizes Councilman Nutter.

Thank you, Madame 788 2/19/99 WHOLE COMM./Budget/Bill 990023 Chair. Good morning, Mr. Nardone.

Good morning, Councilman.

I'd like to talk to you a little bit about of your testimony, the section that talks about the rate increase for emergency shelter providers.

Yes.

Do I understand from your testimony that in FY '98, there was a rate increase of $1?

Yes, sir.

And that the present rate is now $12 a day?