Who's running that program? COMMISSIONER DOMZALSKI: It's a variety of organizations. Greater Philadelphia Urban Affairs Coalition has a 143 04/21/04 - WHOLE - BILL 040255 contract with that. Branch Associates is in a contract for tobacco. We contract with Teach do our enforcement. We contract with Philadelphia Safe and Sound to do prevention and cessation activity. And probably a list of maybe some or 30 organizations through 8 which we provide service and I'd be happy to 9 provide you with that list as well, 10 Councilwoman. 11
I'd like that 12 list to, too. 13 You talked earlier about the 14 enforcement by L&I on merchants who are 15 selling cigarettes. How forceful were you 16 with the L&I Department in terms of -- how 17 strong was your advocacy to them that it's 18 important that they enforce that law not to 19 children. Because we get calls all the time 20 and we get calls about the same store doing 21 it. So what is the real force to make them 22 stop? 23 COMMISSIONER DOMZALSKI: L&I is 24 really on board with this. They've been a 25 tremendous partner. I think what got me 144 04/21/04 - WHOLE - BILL 040255 exercised at that meeting was look just how many sales are going to children in communities that are impacted by so many other negative health status indicators, and we clearly need to focus on that. L&I is right on board. In fact, it was L&I that took the unprecedented step of not only putting in a $10,000 fine a year half ago, but actually supporting and causing the court of Common Pleas to have a business close; not taking away its license, they closed the business. So they've been partners in this. We need to keep pushing on our end too to make it all come together and to get this ratcheted back up to where it was a couple of years ago.
One other question. There's so many here. What has the Health Department done to address the OB/GYN crisis? COMMISSIONER DOMZALSKI: We continue to work with every one of the OB providers that are in the City. We get provided OB services by a number of health systems. All 145 04/21/04 - WHOLE - BILL 040255 of them have difficulty around the uninsured and are having very, very great difficulty with supplying services to uninsured individuals. We've worked with them. We've met with several of the systems. Later this month or earlier this month we're going to having all of the OB providers in to talk about where they see our services going and what needs to be done to make sure that they continue to be available in the health centers. We did have one system that wanted to pull out of our health centers. We had advance notice of that, talked to them. That health system did not pull out. They're back in those centers. So it's a matter of serious concern to me. That's very much on my front burner that's going to stay there as long as this remains in crisis.
Well, would these women qualify for medical assistance? COMMISSIONER DOMZALSKI: Yes. There's an issue that's now being addressed by 146 04/21/04 - WHOLE - BILL 040255 the Department of Public Welfare that's not an easy one. For women who are uninsurable who are pregnant -- say, they're immigrant women. There's no coverage for them under the present system. We provide some coverage for that out of some funds that we have called the Maternity Services Program. We're working with the State and others are working to look at a way to look at the CHIP regulation -- and this is controversial -- to see whether or not when a woman becomes pregnant whether or not her prenatal services might be covered in relation to the yet unborn child, covered under the CHIP program. That is being aggressively looked at and considered by the State Department of Welfare. The reason it's controversial is because the issue of declaring the fetus as a person.
That's a whole other issue. On of the budget detail, 200,00 is identified to be determined provider for a new federal grant for postpartum women's health services. 147 04/21/04 - WHOLE - BILL 040255 Who has been selected for these services? If a provider has been selected, what is the timeline and selection process for a provider? COMMISSIONER DOMZALSKI: This is new money that we've gotten for Fiscal Year '05. We haven't selected a vendor yet.
How are you going to select them? COMMISSIONER DOMZALSKI: We'll look at maybe existing providers, we'll look at organizations that we continue to do business with to see whether or not we can get these services that are going to be specified that have not been specified yet. We want to have an open process. We want to have people who are working in the community, working with our programs. We don't want to be aloof in any of our services. So we're going to work very hard to have community-based, culturally competent services.
When you're preparing a proposal for funding, do you list in the proposal the possible organizations who 148 04/21/04 - WHOLE - BILL 040255 could do the work? You have in mind who could perform the service that you're applying for the grant? COMMISSIONER DOMZALSKI: We don't name organizations.
No, but do you have some idea who might be able to provide the service? You don't just apply for the money and say, "Let's get it and then we'll figure out who can do it." COMMISSIONER DOMZALSKI: Well, we know what the services are and we know that there are several ways that we might go about doing that. For postpartum services, we'd probably want some nursing services for home visiting, maybe some lay home visiting serves. The question would be, do we hire those individuals ourselves as City employees and deploy them or does it make more sense to associate with and collaborate with an existing program, whether it's LaSalle or whether it's Maternity Care Coalition or some other provider. 149 04/21/04 - WHOLE - BILL 040255
So the program begins July 1st. When do you put out the RFP or when do you determine who gets the money? COMMISSIONER DOMZALSKI: That will be in process the next couple of weeks.
On the budget detail, $136,656 is allocated to be determined providers for HIV/AIDS prevention and care services. What is the selection process and time line for the selection of these providers? Also, what the ethnic makeup of the City's HIV and AIDS population -- which you don't have the answer; you said that. And which percentage of the City's HIV and AIDS providers are MWBEs? COMMISSIONER DOMZALSKI: What are we looking at, Councilwoman?
Yes. Down at the bottom you have, "To be determined, $136,000 prevention services and care 150 04/21/04 - WHOLE - BILL 040255 services." It's item 250, second from the last. COMMISSIONER DOMZALSKI: Councilwoman, to get you a complete answer on this, I'd like to get back to you on that.
Okay. What are the steps for a healthier US program and how will the million dollars designated to be -- how will you designate the providers? How will you spend the million dollars and who will be providers. COMMISSIONER DOMZALSKI: The Steps program is -- I think you may have some detail on that. There are three pillars, it's obesity, asthma, physical activity. What we did was look at a number -- probably about 50 individuals representing maybe that many organizations participated in this grant process. And the proposals have been an RFP-type of process, came back and a number of individuals having gone through that process and were selected. There's some, I think, additional Procurement going on. Steps -- is Brenda here? 151 04/21/04 - WHOLE - BILL 040255 Brenda Shelton Dunston is our program manager on this. Brenda, state your name for the record.
I'm Brenda Shelton Dunston, I'm the Project Director, Footsteps to a Healthier Philadelphia.
How will the million dollars designated for the program be determined? How will it be spent and who will be the providers?
The one point, for year one -- it is a five-year program. And for year one there was 1.5 million received. And primarily during year one, which is occurring right now, it is a planning year. However, we do have involved on the planning process neighborhood representatives, individuals who represent the neighborhoods that this program will be addressing --
There are 15 intervention areas that include a population 152 04/21/04 - WHOLE - BILL 040255 of just under 500,00 within north, southwest, south and Center City. These are individuals who have a -- we are basically addressing the morbidity and mortality and attempting to reduce morbidity and mortality as it relates impacted by obesity, diabetes, and asthma. And so these intervention areas are -- that's basically how it was determined that this project is funded by Health and Human Services, the Centers for Disease Control. And I mentioned for year one the 1.5, however, it's funded for a five-year period and during that five-year period there will be approximately 9.15. We are looking right now at program years two through five. And there will, in fact, be some programs within those areas that are community-based organizations that links will be established and they will, in fact, receive funds to support and address the reduction of the incidence of diabetes, asthma, and obesity in those communities. But there is a strong neighborhood component and a neighborhood coalition as well as a 153 04/21/04 - WHOLE - BILL 040255 faith-based coalition to ensure that.
What will be the process for selecting the providers?
Let me just -- are you going to do an RFP? Are you going to do professional services? RFP is you put it out and people have to bid on the program, they've got to compete. Or you can just say, "There's a group, North Philadelphia, West Philadelphia, let's give it to them," without any bid into it. How are we going to spend $10 million?
What the group is looking at is really trying to make it an inclusive process, one that makes sure that those individuals in community-based organizations in those areas who have an interest and skills in providing those services are in fact aware of the availability of the funds and that they have an opportunity 154 04/21/04 - WHOLE - BILL 040255 to submit proposals to be involved in those funds. The other piece is that in instances where there is a need for an organization to, I guess, have a stronger foundation for administrative or foundation to ensure that they can in fact operate those services provide those services and it be a community-based organization for that. Technical assistance will be provided to help sure them up so that that can be done. And if necessary -- I've seen other situations. We're going to explore all options so that we can do that, that technical assistance and consulting could possibly be provided to some of those community-based organizations to ensure that they have the infrastructure to operate and sustain the operation of them.
Will the technical assistance come from the Health Department? Are you going to contract with someone to do the technical assistance?
I am not sure. We're 155 04/21/04 - WHOLE - BILL 040255 going to explore all options. Now, this is program year two through five. And I am not sure whether it will actually be provided through the Health Department or an external organization.
Have you talked to the Councilmembers whose districts these programs will operate?
We will be doing that. This is the planning year and we do have plans for sharing that information and getting input from them as well.
Well, since the Councilmembers and maybe even the State Representatives know the community groups in their district, it would be helpful to have them involved in the planning process.
Thank you. COMMISSIONER DOMZALSKI: It's an important point and we need to do that.
I guess you can see where I'm going, Mr. Commissioner, in my line of questioning because I had a very 156 04/21/04 - WHOLE - BILL 040255 frustrating meeting yesterday with some member staff of your Department around an issue in my district. And when I see large organizations that continue to get funded year after year without having to bid, it is very unfair, I think. And when you have community based organizations that struggle along year after year trying to provide services to the community that get into a situation where they have to compete against agencies that are set up new to provide services to meet the criteria of a new program, it gets to be a little much. And then when you have community organizations come to say, "We are not treated fairly," and then when we speak to the Health Department -- you agree and you are concerned, but nothing changes. We want to know what's going to change and how are we going to look at funding these community-based programs? I want them to get some professional service contracts. Because if you give our professional services contracts to solve these community groups, then they don't have to get 157 04/21/04 - WHOLE - BILL 040255 into this competing against each other. All you've got to do is look at the City. If the people who are making the decision about the funding knows the community and they have the information which they base their determination where they have the program, you know, it's all subjective from the Health Department. "Well, we like this group, we'll give to this group over here. And we'll make this group over here bid and we'll make this group over there compete." And that's what's happening in the Health Department. And there's an unrest, not only with me, but other elected officials in this City about how the money is distributed in the community for services to the community. And when you have a City as diverse as Philadelphia and you have very few groups from the minority community with any level of support from the Health Department and you look at these two large groups will millions of dollar and all you do is say, "Let me just pick up the phone and give them a contract." That's just real easy. They just do 158 04/21/04 - WHOLE - BILL 040255 that, and it's all insidious. It's just not fair; it's not fair. So before we pass the budget, we're going to have to figure out what we do about that. We'll have to do something about that. And it can't continue to go on because its continuous over and over again and there is a disparity. I guess maybe that's what City operates disparity, but it's not fair. COMMISSIONER DOMZALSKI: I understand the perception, Councilwoman. I think a first step in that would be to open up the process, come in and talk to you, show you the process that we're going through --
I just want you to give them some of those professional services contracts. If you've got a training contract, don't call the Philadelphia Health. I don't have anything against them. I think they're fine people. But there are a lot of people who do training in this City. They're people I know who do training. They don't get any contracts. It's just like what's been in the paper lately. The same group gets the 159 04/21/04 - WHOLE - BILL 040255 same money. It's not expanded to be inclusive of the rest community. It's same little network who know the people who work in the Health Department and they work them to help them expand their businesses and they get the contracts. It's what it is. It's not a secret in the community how it's done. I could ask a lot more questions. If you want to break, I will. COMMISSIONER DOMZALSKI: We certainly want to clear up that information for you, Councilwoman. I'll be happy to do that.
Thank you. While the Commissioner is here, Councilwoman, since it's just me and thee, do you have any questions regarding CBH?
Commissioner, you do not have to read your testimony. It will be given to the stenographer. It will be transcribed in full. We do have it, and I'm sure the Councilwoman will be asking her questions from your 160 04/21/04 - WHOLE - BILL 040255 testimony. And I have a couple too.
It goes back to the secondhand smoke. What is your outreach and communication strategy for dealing with secondhand smoke in the City? Is that part of your responsibility with the tobacco money. COMMISSIONER DOMZALSKI: Yes. It's part of the education effort that we do. We have regulations that we enforce with regard to separate sections in public eating and drinking establishments. They have to provide a smoke-free area. So we support those efforts. Secondhand smoke is very definitely a problem. There's no smoking in public buildings. The airport will be going smoke-free next week, I think. So these are all important pieces of our educational process.
Do you have any money in this budget for communicating and educating people about secondhand smoke and about the whole issue of tobacco? COMMISSIONER DOMZALSKI: Yes, Councilwoman, we do. 161 04/21/04 - WHOLE - BILL 040255
What is it? COMMISSIONER DOMZALSKI: I don't know the specific dollar figure, but it's a fairly reasonable portion of the 3.4 million that we have. I've been having some conversations about how we're spending that communication money. Some of it is regarding advertising. Some of it is whether or not we can use community groups to get the message out. Some of it has to do whether we can use community newspapers to reach folks.
Have you made that determination yet? COMMISSIONER DOMZALSKI: Not yet. The only determination we've made is what we're now doing is not inclusive enough.
Well, that's the buzz word today. How do you plan to make it inclusive? COMMISSIONER DOMZALSKI: By looking at what we're doing, looking at who else is out there that we can have that kind of a relationship with and to have the contract 162 04/21/04 - WHOLE - BILL 040255 done.
Is it a professional services contract? COMMISSIONER DOMZALSKI: They're all professional services contracts.
So you can make the determination without doing a bid. So who have you got on the list to give this contract to? COMMISSIONER DOMZALSKI: Well, I mean, some of the places where we do this education is through the media such as we'll be doing stuff on public transportation, we'll be doing some targeted advertising in community newspapers, those kinds of things.
Well, I'd like I have a conversation with you about that before you leave. COMMISSIONER DOMZALSKI: I would love to.
Councilwoman, can we go to CBH? I just have a 163 04/21/04 - WHOLE - BILL 040255 couple questions too. COMMISSIONER DOMZALSKI: Is the Health Commissioner dismissed.
As far as I'm concerned. COMMISSIONER DOMZALSKI: Thank you.
Thank you so much, Commissioner. We don't have to read the testimony from CBH. As I said, a copy of it has been given to the stenographer and it will be transcribed in full. (Testimony attached.)
Can you tell me how many members are in the CBH program?
Sure. There are approximately 370,000 Medicaid recipients for a part of the Health Choices program that's operated by Community Behavioral Health.
What are the various category levels of care and the associated per member per month payment?
The categories of 164 04/21/04 - WHOLE - BILL 040255 service, Councilwoman --
Excuse me, sir. Those leaving, do so quietly, please. We're still trying to conduct business. Thank you. Please proceed.
The categories of service include psychiatric inpatient which is hospital-based inpatient care, not hospital, drug and alcohol care, residential rehabilitative services, there are residential treatment facilities for children requiring out-of-home placement, as well as traditional outpatient services both on the mental health and drug and alcohol side and a variety of ancillary supports, including case management services, resource coordination.
How about the associated member per month payment?
I don't have the exact figure with me. I believe it's somewhere in the neighborhood of, on a blended average, $120 per member per month. That varies by 165 04/21/04 - WHOLE - BILL 040255 category of aid. There are approximately six categories of aid, and each one has a different per member per month, and that represents a blended may.
Thank you. I think we're so eager to move forward that I neglected to ask you to identify yourself for the record.
We know who you are, but I don't think the stenographer did. Have the per member per month rates been set for FY '05?
For FY '05, let me just clarify one point. The Health Choices Program operates on a calendar year, so the per member per month have been set for the current year that began January 1st. The negotiations for the next year will occur during the summer.
Do you have any outstanding rate issues with the State? And if so, what are they? 166 04/21/04 - WHOLE - BILL 040255
At this point in time, what we're identifying for the Commonwealth are things that we believe may impact next year. For example, we're undertaking a strategic planning initiative with the group of stakeholders from the behavioral health system. Part of that effort, we believe, identify areas where we will need to expand services in the future. And what we're looking at identifying are those areas where we think that may indeed impact on the rate.
Thank you. The Chair recognizes Councilwoman Tasco. Do you have any questions?
I don't have a lot of questions, just a couple. Would you just explain to me now the new status of CBH in going from an outside agency to -- explain that process.
If I can first clarify that back in October, the Mayor signed an Executive Order creating the Office of Behavioral Health and Mental Retardation Services. So there are three components 167 04/21/04 - WHOLE - BILL 040255 Office of Behavioral Health, and that's the City Office of Mental Health, the City Coordinating Office of Drug and Alcohol and Community Behavioral Health who is our managed care entity for the Health Choices Program. So those three groups which used to be part of -- two of them used to be part of the Health Department, and one a 501C3, as you're aware, CBH are now part of a separate department. CBH is not City Civil Service at this point in time, it's just part of that, as well as our Office of Mental Retardation Services. With this budget represents really the first break from the Health Department. In previous years, we testified in conjunction with Commissioner Domzalski as part of Health.
So the community Behavioral Health will remain a 501C3?
Will the Office of Mental Health come under that, or will it just managed in the Managing Director's Office? 168 04/21/04 - WHOLE - BILL 040255
We're partners in that as part of Behavioral Health. We will remain City offices, the Office of Mental Health, and the Coordinating Office of Drug and Alcohol; both will remain City Civil Service offices.
Yesterday we were talking about the mental retardation side, correct.
Part of the reason mental retardation services was kept is because as the Mental Health Mental Retardation Act was established back in the '60s, it was an Act that had both those 169 04/21/04 - WHOLE - BILL 040255 services together. And basically the infrastructures of the office are supporting both mental health, drug and alcohol, and our mental retardation programs. And when the Mayor was considering the issue of an Executive Order, one of the things we didn't want to do was have to break out and create duplicative administrative structures to separate out mental retardation as a separate department. So our finance offices, our IS offices support both sides.
The Managing Director actually is chairing a search as we speak. And there's a search going on for the director for that office
It's going to be real confusing. Now, here you have a budget of 170 04/21/04 - WHOLE - BILL 040255 $500 million. Now, is that combined budget of Mental Health, CBH, and mental retardation?
That 500 million represents the Health Choices, the CBH of the program. The testimony will give you the breakdown of the various components. About 272 million or percent of that is for 9 mental retardation services and approximately 10 $809 million are for the behavioral health 11 component, which includes CBH, CODAP and the 12 Office of Mental Health. 13
Okay. I'll ask 14 you the same questions I hammered on with the 15 Health Department. 16 How many of the 100,000 17 Philadelphians who you serve in the Office of 18 Behavioral Health are -- what is the ethnic 19 makeup of that population? 20
I actually have that 21 here for you. Approximately 56 percent are 22 African-American, 22 percent Hispanic, 23 percent Asian, and the balance are Caucasian. 24
According to 25 of the budget detail, your office to 171 1 04/21/04 - WHOLE - BILL 040255 provide contracts worth $593 million. What portion of these providers will be MWBEs and what is the dollar amount of the contract these providers will receive of the amount?
Similar to the Health Department, we can update and provide you with that information. I believe last year when that information was requested, it was somewhere in the neighborhood to 11 percent. But we'll give you an update and 12 we'll attempt to provide you with the growth 13 over the last couple years as well. 14
Just for the 19 record, we had an in-depth discussion about 20 this yesterday, we talked about the support 21 coordination systems for individuals with 22 mental retardation. As you know, we really 23 had a serious discussion about the selection 24 process. 25 Would you go on record and tell me 172 04/21/04 - WHOLE - BILL 040255 how that selection process worked? Because we raised some issues about using new organizations versus organizations who had experience in running programs.
And this, as we discussed yesterday, fortunately or unfortunately, was a process that we went through a formal RFP on. We began discussions about reconfiguring the MR service, case management system almost three years ago at this point in time. Spent about a year prior to the issuance of an RFP, meeting with families and consumers and provider of network around the changes that are required as a result of -- some major changes that were going on with our funder at the state and federal governments and the requirements that on the mental retardation side, services had to be provided by providers that were quote/unquote conflict-free. And what was meant by that is that provider could also not be a direct provider of mental retardation services. We issued a RFP on July 1, 2003. We 173 04/21/04 - WHOLE - BILL 040255 had organizations that responded to that RFP in September. The RFP was reviewed and six agencies were selected to go to the second level which was a formal interview process that began in December and continued through February. That interview process consisted of a group of two parents, a consumer, a provider representative, a member of the Mayor's MHMR advisory board and three representatives of the Office of Mental Retardation. In mid-March, the four entities were selected for this particular service and really are using this point in time as a transition point in time. The new services will take effect July 1st, but they're working with the current network of providers to transition records, to transition information.
And the one organization that you know I was very concerned about was Warren E. Smith.
I want Warren E. Smith to be like Philadelphia Health Management Corporation. Why can't they just 174 04/21/04 - WHOLE - BILL 040255 get some --
Warren E. Smith, as I said yesterday, I think has and continues to provide valuable services to the City. Between the various components of the behavioral health system, they receive in excess of $20 million. The vast majority of that comes through Community Behavioral Health, but over the course of the last year, that organization was one the first organizations selected to do one of the new school-based behavioral health programs, was the only organization selected to expand that in the second year of that particular initiative and also as an organization that was, over the course of the last year, identified as one of our targeted case management pilots. There's only four that we have in the City for behavioral health services, and they were selected as one of the four. As I said yesterday, they're an organization who does do good work. This was not meant -- they're not being selected for 175 04/21/04 - WHOLE - BILL 040255 the mental retardation was not meant as a criticism of the organization.
Just to go on record, our concern was, one, the selection process and the internal process for selection. We question that in that there were staff people who made those selections and we had some concerns about that. And in the future, the selection process should be, even from the initial point, should be much more community-based inclusive.
And I think we hear that concern. That's something we'll certainly take in consideration as we do future RFPs. One of the thing I did want to comment on that is the selection process, that two-layer selection process that we discussed yesterday where staff reviewed the first wave and the larger group of stakeholders reviewed the second, was articulated in the RFP. So that was not a surprise to any of the bidders how that was going to be --
Well, that may 176 04/21/04 - WHOLE - BILL 040255 be true, but also we looked at the two organizations who received the services were spinoffs from other organizations that already existed. And we have some concern about how they would gear up the programs in communities that they did not serve and do not serve. How would they serve those communities? I jut want to put on the record. We still have open dialog about what we do with that process. We haven't ended that. I thank you, Madam President, that's all the questions I have.
Thank you. Mr. Covone, you indicated that the Managing Director presently has a search he's conducting for the director this department. Can you tell me what the qualifications are?
I believe they're looking for someone who has broad-based knowledge of both behavioral health and mental retardation reserve who has operated in large systems and in an urban environment over the years, has background both from a programmatic and financial operating end of that. And 177 04/21/04 - WHOLE - BILL 040255 there is a job description that I believe is finalized and available if you would like that.
Is there another organization like CBH in any other City in the country that you know of?
CBH is probably one of a kind. This was an initiative that actually received the Innovations in American Government Award a couple years back because of the approach we took with behavioral health. And really the intent behind the establishment of CBH is that any savings that existed through the initiative, unlike other states and other counties in Pennsylvania is not going to the for-profit managed care entities but is available for reinvestment in the system.
What did you say the qualifications were? The person had to work in an organization like CBH?
They would 178 04/21/04 - WHOLE - BILL 040255 have to have some knowledge of the programs.
Thank you. Thank you very much. Nice seeing you. The Committee will stand in recess for a half hour. Thank you. (Recess.)
The Committee is back in session. The next department that we'll hear from is the Department of Human Services. We do have a copy of your written testimony which has been given to the stenographer. It will be transcribed in whole. I would ask that you please abbreviate your testimony. COMMISSIONER MARTINEZ: Good afternoon, President Verna and Members of City Council. It's an honor to be here once again. My name is Alba Martinez, I am the Commissioner of the Department of Human Services. And this afternoon, I am here to 179 04/21/04 - WHOLE - BILL 040255 present on behalf of our department our Fiscal Year '05 Operating Budget request and also to report briefly to Council the progress we have been achieving on successful outcomes for children. I'm also here prepared to share with you and discuss with you the challenges that remain for us and also to preview some of the plans that I believe will place Philadelphia's Department of Human Services on the cutting edge of service provision. 4 percent over our Department's Fiscal Year '04 estimated obligations. The Department has a budgeted position level in Fiscal Year '04 of 213 employees, of which 1,887 were filled as of December 2003. We are seeking a position level to be filled at 1,964 and the increase of 77 staff is detailed in the testimony, but I would like highlight that 33 of them are to investigate child abuse and neglect cases and 11 are to fill other social work vacancies. 180 04/21/04 - WHOLE - BILL 040255 We have been engaged since the year 2000 in a top to bottom effort to make a department more efficient, effective and accountable. Reform of a child welfare system, as we all know, is an ongoing work in progress. However, I want to highlight briefly some of the accomplishments that we have made, and I have to personally thank Council for its support throughout this reform period. We have increased our social work staff, including experience and master level professionals which has resulted in a reduction in staff case loads. We have created a staff training and development center that counts on the University of Pittsburgh, Temple University, and the University of Pennsylvania as formal partners. We have specialized our sex abuse investigations. We have expanded our investigation division by six unites to respond to a 17 percent increase in reports of abuse and neglect over the last three years. 181 04/21/04 - WHOLE - BILL 040255 We created a midnight to 8:00 in-office shift to respond to abuse and neglect. We redesigned and expanded our treatment foster care system which has resulted in a reduction in the dependence on institutional care for children with behavioral health problems. We've implemented performance-based contracting in foster care which is designed to increase permanency outcomes for children. We had a record number of adoptions last year, 654, and in the first year of performance-based contracting we have seen a 31 percent increase in permanencies over the prior two years. We've implemented permanent legal custody as a third permanency option for children in our care. We've created the Achieving Independence Center for aging out youth. These are just some examples of the many accomplishments that we have been able to achieve with the support of City Council. 182 04/21/04 - WHOLE - BILL 040255 For '05, our goals and initiatives include automating the entry of child abuse and or neglect reports, and this is going to help us document and track reports of abuse and neglect more timely and also assign cases much more quickly, which will, of course, minimize any risk that might be resulting from delays in the assignment of cases. We are eager to establish a parent support center focussed on family unification. There are 2,474 families with at least one child in placement as of December 31, 2003, for whom the Department was seeking reunification with their children.
And while we currently offer these array of services to support the return of children home, we recognize that parents often need additional support. So in collaboration with the Workforce Development System, we are going to develop a one-stop shop for parents to reduce the time that children are in placement, and that one-stop shop is going to include services like a gateway to mental health and drug treatment services, education and 183 04/21/04 - WHOLE - BILL 040255 training programs, benefits counseling, mentoring and peer mentoring for these parents and visitation, life skills, adult basic education and transportation assistance, among other supports. Another important reform the Department plans to fully implement is the transition from the existing way in which we are receiving legal representation to a team approach to legal representation. This means that attorneys will follow cases from beginning to end and there won't be a discontinuity in representation of children. We believe that this will add to the efforts to reduce the length of stay of children in placement. Lastly, we're working very aggressively to seek reimbursement for the Department's costs from, of course, any other source that can assist us in meeting our financial goals, and we are working on some substantial revenue initiatives, increase initiatives and we are tracking and following and advocating for those two specific pieces 184 04/21/04 - WHOLE - BILL 040255 of legislation which we can testify to in more detail. This concludes my truncated testimony, and I look forward to your questions and recommendations for the coming year.
Thank you very much. You mentioned about attorneys following the case from beginning to end. Are the attorneys within your -- are they in-house? COMMISSIONER MARTINEZ: They are attorneys that work within the City Solicitor's Office that are designated to the Department of Human Services.
How many attorneys assigned to your department? COMMISSIONER MARTINEZ: The exact number of attorneys is 34. We added 14 in the last year.
Commissioner, do you have any contracts with the fund for Philadelphia -- 185 04/21/04 - WHOLE - BILL 040255 COMMISSIONER MARTINEZ: Yes, we do.
-- in FY '04? You said yes. Can you tell me what's the amount and what are the funds used for? COMMISSIONER MARTINEZ: Yes. Allow me to look it up in our budget book, and I will also ask our contracts Deputy Commissioner Cheryl Ransom to join me at the table.
Are you also planning to contract with the fund for Philadelphia in FY '05? COMMISSIONER MARTINEZ: Yes.
Can you tell us what the amount in '04 is and what are the funds used for and also what is the amount for '05 and what services will be provided? COMMISSIONER MARTINEZ: Yes.
Cheryl Ransom, Deputy Commissioner for the Department of Human Services.
Good 186 04/21/04 - WHOLE - BILL 040255 afternoon.
Various projects. One is we have a CAPTA Project for special needs children.
We call it a CAPTA Project, C-A-P-T-A. It's support for children with special medical needs and equipment. The next is family preservation services in terms of planning family preservation activities for families. We have our communications campaign for the Department.
Our Communications Director, Ted Quali (ph). COMMISSIONER MARTINEZ: While it's called Communications, we have invested a 187 04/21/04 - WHOLE - BILL 040255 significant amount of time and effort in public education and outreach to the community. And that's really at the core of what we do in communications. In addition to public education and outreach on many different issues, which is partly the reason why we have a 17-person increase in reports of abuse and negative, we have also done tremendously aggressive outreach which has cost us money but has paid off in recruitment of staff for the Youth Study Center and the Department of Human Services social work team. And just to explain why this is needed, because it is a substantial amount of money, since in the last four years we have hired over 450 social workers for a net increase in the Department today of around 118. So the turnover is enormous. And the recruitment -- this is crisis nationally, the recruitment of social workers. So these are examples of the kinds of initiatives that we do through our communications campaign. And we have a Communications Director and we also then use different consultants in carrying out some of 188 04/21/04 - WHOLE - BILL 040255 those functions.
What are you planning to contract with the Fund for Philadelphia in FY '05, how much?
Would you explain your contract with Philadelphia Safe and Sound. COMMISSIONER MARTINEZ: Yes. I'm asking Deputy Managing Director Ellen Steiker to join me at the table for that question. But Safe and Sound is a provider for the department of after school and youth development initiative, and the department contracts with Safe and Sound to manage and oversee those many after school and youth development initiatives. In this current fiscal year, the Department provides them with approximately $25 million for those comprehensive programs throughout the City. And in Fiscal Year '05, 189 04/21/04 - WHOLE - BILL 040255 we are proposing to provide the same amount, and if we are successful in getting our increase, then we would increase that by an additional $10 million.
Let me ask. You also have summer programs that Safe and Sound administers. Are community recreation groups allowed to participate in running or applying or being a part of the programs that are in existence? COMMISSIONER MARTINEZ: Well, I will defer to Deputy Managing Director Syker for detail. I will report to you, President Verna, that I am aware that the Children's Investment Strategy does invest in the Recreation Department and that there are 63 recreation programs, at least that I am aware of, that receive support that comes from the Department through Safe and Sound. And in addition to that, the Mayor has committed and an additional $1.2 million --
I am led to believe -- and I don't mean to be cutting you short, but we are really pressed for time. 190 04/21/04 - WHOLE - BILL 040255 I understand that last year 40 recreational, I guess, different communities filed an application with Safe and Sound to be a part of a summer program or after school program, and not one of them were accepted. Was that portion of the money that would have gone to the community groups given to the Department of Recreation?
This is Ellen Steiker, Deputy Managing Director. As part of that RFP process, indeed, a number of groups, recreation advisory councils, and recreation departments sites applied. A decision was made to actually give the money directly to the Recreation Department where it could be optimized better, so that instead of having one site getting a lot of money and another site getting nothing, we have awarded or Safe and Sound awarded 1.2 million over three years to the Recreation Department, that's 400,000 a year and that started in FY '04. So FY '04, FY '05 and FY '06, and that's being used by the Commissioner to develop and enhance after school programming. 191 04/21/04 - WHOLE - BILL 040255
Would you please send me in writing the breakdown of how the Fund for Philadelphia operates their money and who they contract with and for what amount for both FY '04 and FY '05, please? COMMISSIONER MARTINEZ: Yes.
Thank you. The Chair recognizes Councilwoman Tasco.
Thank you very much. Good afternoon. Could you bring me up to date on the status of the Kinship Care Program? COMMISSIONER MARTINEZ: Well, the Kinship Care Program of the Department of Human Services has two components. One would be in the prevention side, the Kids and Kin Program that we support through Philadelphia Society for Services to children, and that has been growing and it's very successful. And I believe at this point -- and I will David Fair to join me to answer questions pertaining to that, but I believe our funding level with 192 04/21/04 - WHOLE - BILL 040255 them is $350,000 now. And when I became Commissioner, it was around 200,000. So we're investing more in that. In addition, on the foster care side, which is the other part of Kinship Care where relatives or friends actually become certified as foster parents, the number of kinship caregivers in foster care is growing dramatically. I mean, we continue to see a growth in that. And this year, we are seeing a dramatic move of kinship caregivers to permanency. We have close to 200 families that have now achieved permanency and are out of the foster care system, many of whom were kinship care providers. And that means that they will continue to receive a subsidy until the age of 18 of the child. So we're making progress. We prefer children to be with relatives caregivers instead of with strangers in foster care. And second of all, we prefer children to never to come into the system at all if we can avoid it. So we want to support that network of community services for families. 193 04/21/04 - WHOLE - BILL 040255
What's happening to the Grand Central Station site that was opened as a information site.
My name is David Fair, I'm Director of community based and prevention services for DHS. We're actually funding seven programs in addition to the Kids and Kin Program that the Commissioner mentioned targeting kinship caregivers, and Grand Central is one of those. We have continued to fund that. They are talking to us now about moving out of their Center City office building to a neighborhood site in South Philadelphia, and we are supporting the planning for that. That's probably our most essential component of our Kinship Care approach because it's the place where almost everybody starts. They're asking for information, they're asking for advice. Grand Central has helped a whole lot of Kinship caregivers through the Kinship foster care process, which can be very confusing and cumbersome for people. But mostly what they 194 04/21/04 - WHOLE - BILL 040255 do for us is help primarily older Kinship caregivers to connect to the network of social services that are available for them so that they don't need go through the formal foster care process; or if they do want to adopt the children, we help though process. Grand Central in Philadelphia is a society for services to children with the Kids and Kin Program, our largest providers in that area. We also have contracts with the 18th Street Development Corporation for a program called Raising Others Children. With the Center for Intergenerational Learning for a respite program for older caregivers called Family Friends. And that's targeting Kinship caregivers where the children have serious emotional disturbances and the adult needs respite periodically. And that's a peer respite program, so other Kinship caregivers who are in the same situation participate in that. We also have the Grandma's Kids Program which is a program that we've been expanding in the last two years which is a 195 04/21/04 - WHOLE - BILL 040255 tutoring literacy training program targeting the children of Kinship caregivers in what used to be the William Penn Cluster in North Philadelphia. And what we're trying to show there is that if we can target those kinds of supports to the Kinship families, that we can make more progress for those children than we do than just by having them go through the regular School District tutoring programs.
Grandma's Kids is also run by the Center for Intergenerational Learning.
I don't know exactly. I think there are about 70 kids who are in Grandma's Kids. That's one program and it's serving a particular neighborhood in North 196 04/21/04 - WHOLE - BILL 040255 Philadelphia. We started it at the time when the School District was organized by clusters. And that's about the extent of my knowledge.
Now, is Grand Central Station moving from -- they were downstairs, right?
They're currently at 1211 Chestnut Street. They want to move to a site that's actually right next door to Philadelphia Society for Services to Children since that's the primary social service agency that they actually refer families to, there is a certain cost effectiveness as well as just a smoothness of operation by having them together.
They always want more money, but other than that... I should say, we also support an annual local conference through Grand Central 197 04/21/04 - WHOLE - BILL 040255 to highlight Kinship issues and to advocate for the needs of Kinship caregivers. COMMISSIONER MARTINEZ: We are deeply, deeply committed to this issue. There are, the last time I looked at statistics, approximately 23,000 children being raised by relatives and family in the City of Philadelphia. These children do not belong in foster care. Clearly, the foster care system is not big enough to serve them. So the Department's whole reason for creating that community-base service network is to create real networks of support in communities that are there when people need them, not when it's too late or not after the fact. And so we are proud of those efforts and we're deeply committed to it.
And Raising Others Children, they are out of South Philadelphia, aren't they?
Yes, they are part of another organization called the 18th Street Community Development Corporation. There is some question about 18th Street's continuing 198 04/21/04 - WHOLE - BILL 040255 operation after the end of this fiscal year. If they decide to go out of business, then Raising Others Children Program will be transferred to either Grand Central or PSSC or one of the other programs. We've already started discussions with other kinship programs to make sure Raising Others Children doesn't suffer as a result of 18th Street's problems.
One of the things that I asked a lot of questions about to the Health Department and I want to talk to you about is how much of your direct services to children is contracted out and what is your bidding process and how contracts are given out and how many of them are no-bid contracts and what's the diversity in those people who operate those programs who are providers? COMMISSIONER MARTINEZ: Well, I will begin answering the question and, again, will ask Deputy Commissioner Ransom to join me at the table since she's our contracts and program evaluation deputy. The Department is really committed 199 04/21/04 - WHOLE - BILL 040255 to diversifying our provider base because it's the right thing to do, because it's the mandate of the Mayor and Council, and also because it results in a greater ability to deliver quality services, all for the right reasons. We have seen an increase -- I'll just give you one example. We have worked very aggressively to bring in a minority provider who does excellent work in Baltimore and District of Columbia to come and do treatment foster care in the City. And so we gave that provider a start-up grant, and they should be online with us, hopefully, next year. And refresh my memory about their name.
Progressive Life Center. COMMISSIONER MARTINEZ: Progressive Life Center. And in addition to that, the Department has grown in the prevention arena. A lot of the work that have done before that continues to be done, it's foster care and 200 04/21/04 - WHOLE - BILL 040255 institutional placements. And in the prevention arena, we have been very aggressive at diversifying. Unfortunately, the MBEC does not count that because a lot of that money gets the passed through intermediaries. So, for example, if we give a substantial amount of money PHMC then PHMC gets counted as a provider and not the subcontracts which usually the majority of the money goes. However, we are prepared to give you information today about the diversity in our prevention contracts. But first I would ask Cheryl to speak to the difference in accounting and what our numbers tell us.
Before you go to that question, one of the questions I raised earlier is why do you pass the money through PHMC and why don't you contract directly with these groups? COMMISSIONER MARTINEZ: Because the Department is so large, we are right now at close to $600 million and most of that money is in service contracts, $450 million. But 201 04/21/04 - WHOLE - BILL 040255 yet our staff infrastructure has not grown sufficiency. Frankly, Councilwoman, we wouldn't have the capacity to execute all of those contracts individually. So in order to be able to achieve the work and do it efficiently and do it responsibly and have sufficient accountability, we have to do it through an intermediary.
No, we use GPUAC as an intermediary, Greater Philadelphia Urban Affairs Coalition, and we use PMHCC as A intermediary as well.
Do you monitor who they contract with? If they are contracted with these programs, does the Department monitor the diversity of their contracts? COMMISSIONER MARTINEZ: Yes, we do. And in fact, we participate in the selection of providers. The providers are selected by the Department. We also use North City Congress as an intermediary for contracts. 202 04/21/04 - WHOLE - BILL 040255 It's partnership. When we talk about intermediary, we're not giving them the contract and then allowing them to do anything they want with the money. We are actively involved in the selection process, in setting standards, in setting expectations, and assuring that the providers are in the neighborhoods we need them to be, because our services are following the need. We look at data. We know that most of our client base is in lowest income neighborhoods in the City. We know that, so we've made every effort to, while having services equitably distributed according to need because abuse can happen anywhere, we are targeting the highest risk neighborhoods. We have to concentrate our resources, and we're doing it in those neighborhoods. And we know that those neighborhoods are often minority neighborhoods in the City. So, therefore, the logic follows that we need to have great representation. So I will differ to my staff, however, for the details of that which they will give you right now in terms of numbers 203 04/21/04 - WHOLE - BILL 040255 and specifics.
Cheryl Ransom, Deputy Commissioner for the Department of Human Services. The majority of our contracts are with non-profit providers. However, we participate with MBEC, but we're not able anymore to count the minority participation. They used to be able to get an affidavit and we could count their participation. And the requirement was to have over 51 percent minority or women on the board to serve minorities and to serve minorities in their communities. And we would really seek support to be able to go back to that because that's where the majority of our money is spent, with minority providers in minority communities.
I'm not sure about that. MBEC decided that they would no longer allow the affidavit process. You're not 204 04/21/04 - WHOLE - BILL 040255 permitted to certify a non-profit. According to MBEC rules, only for-profits may be certified.
Well, we've got a new director now. Let's see what he says.
Because our numbers were to percent. Now, it's like 2 11 percent because we can't count on non-profits, 12 and that's where a lot of our money is spent. 13
That's why the 14 community groups are very concerned because 15 they're not getting a dollar share as 16 providers anymore. So if there's no 17 monitoring and there's no way to hold these 18 people accountable, then the contracts go to 19 whoever. 20 COMMISSIONER MARTINEZ: Correct. 21 And also the City, both the Administration and 22 Council, not getting the credit for what we're 23 doing because non-profits are businesses. 24 They are organized businesses. DHS is the 25 largest operating department, and we put most 205 04/21/04 - WHOLE - BILL 040255 of our money on the street and services so that $450 million --
It seems to me that you have the contract with these organizations to subcontract out, you can require them to have a number to report to you how many of non-profits who the service providers, how many of them are disadvantaged or minorities. There's nothing to stop you from doing that.
The majority of our new services now, we issue requests for proposals. As part of that process, the MBEC requirements are attached and providers must adhere to them. So that's a standard requirement for all of our requests for proposals.
Well, if you do that now, will you see an increase in the number of minority providers through that process?
If we could count the non-profits because those are ones that are --
Who says you can't count the non-profits? 206 04/21/04 - WHOLE - BILL 040255
But you can do it. COMMISSIONER MARTINEZ: And we do. So our numbers show to of our 8 contractors are minority, overall. That's not 9 counting the intermediaries. The 10 intermediaries is over and above that. Our 11 direct contracts -- 12
Now because MBEC only 15 counts at this point in time for-profits, so 16 our minority participation with for-profits is 17 2 percent. When we were able to count 18 non-profits we were 15 to 20 percent and we've 19 even grown 20 to 25 at this point in time. 20 COMMISSIONER MARTINEZ: Also to 21 explain that, that 20 to 25 percent is our 22 accounting of what we consider minority 23 organizations according to what we know is 24 real, not the MBEC standards, 20 percent. 25 However, in the last four years, the 207 04/21/04 - WHOLE - BILL 040255 Department has grown by $180 million and a lot of that has been in the development of a prevention and community-based services network. Our community-based contracts since that time are 71 percent in minority organizations, and those are the ones that we count through PHMC and North City Congress and others. So 71 percent of those contracts are with minority community-based organizations.
Well, are there a number non-profits who are in the business here, minority non-profit organizations in the City? You said that there are only 2 percent for-profits.
The for-profits that have to have minority participation on their contracts.
How many for-profits do you have? Do you have a large community of for-profits? 208 04/21/04 - WHOLE - BILL 040255
But those who do exists only get 2 percent of the participation?
Are they subcontracted out through these larger organizations? COMMISSIONER MARTINEZ: No, those are contracted --
For example, on our MIS contracts, we required that some of their staff be minority employees. That was a way to get participation.
Yes, we actually had MBEC identify MIS businesses that were certified by minority and had our consultant providers go meet with them to talk about the kind of work we needed and actually received 209 04/21/04 - WHOLE - BILL 040255 resumes from them so that we could interview of those staff, those minority firms that were approved by MBEC. COMMISSIONER MARTINEZ: Councilwoman, just to clarify, the overwhelming majority of our contracts are directly contracted. We use intermediaries in limited purposes. So most of our contracts are direct contracts with providers.
Thank you. The Chair recognizes Councilman Kelly.
Good afternoon. Commissioner, I just want to know what percentage of funds in your budget is matching funds from the state or federal government? COMMISSIONER MARTINEZ: I'm going to ask our finance director to join me at the table to address your financial questions.
Good afternoon. I'm John Zanier, DHS Fiscal Director. Around 93 percent of the money for DHS comes from 210 04/21/04 - WHOLE - BILL 040255 federal and state and other sources.
Is that committed by the federal government? Are they federal grants? Is it state funding?
I just want to know if anything happens with the state or the federal government reducing the level of funding, what would you do to make up the difference, if there's any reduction at all proposed in in '04 or '05 or '06? COMMISSIONER MARTINEZ: First, Councilman, let me say that Philadelphia has the fifth largest child welfare system in the country. And we know nationally that child welfare systems are fragile and that if something goes terrible wrong that it can cost a CITY, a county, a state unspeakable amounts of money, as we're seeing in New Jersey. So our position and my position as Commissioner, and I position of the Mayor is that we must 211 04/21/04 - WHOLE - BILL 040255 receive all the funding that has been certified as due to us. So there is a certified number that the state has certified that relates back to our need, and it is our position that that money has to be provided, the state and federal share in that. In the last few years, our tradition has been, when we are not satisfied with the results of what the state has given, to file 11 an appeal and to proceed with litigation if we need to, and we intend to do that also. To date, I believe 60 counties --
Has that happened recently? COMMISSIONER MARTINEZ: Sixty counties in Pennsylvania have filed appeals against the decision or the recommendations of the Governor to the Legislature, and we are one of those counties. And so I guess what I'm saying is that we are taking the position that we will receive our full funding. So if we have a situation where we absolutely don't have everything we're asking for, then of course we would look first at expansion 212 04/21/04 - WHOLE - BILL 040255 dollars, the things we wanted to do to make our system better that we can't afford to do without. However, we're not conceding that at this point. And, of course, if things went beyond that, then at that point I believe it is the position of the Mayor that he will find the money for child welfare because that is not an area where he believes our City can compromise. Of course we do everything we could to be even more efficient and as efficient as possible. But at this point, we are fighting for our revenue.
The word I was looking for was certified, and you explained that. I just have another question that has to do with the foster care. Do you have any problems in finding qualified foster parents at any time? Do you have a waiting list? What is the procedure for that? COMMISSIONER MARTINEZ: Well, we have over 30 foster care agencies, 27 of them are most active partners, 27 of them are performance-based contracting foster care 213 04/21/04 - WHOLE - BILL 040255 agencies. It is the responsibility of those agencies -- and we fund them. Within their contract there's money for recruitment and outreach, but we also use our own communication dollars to do a lot of outreach for foster parents. In answer to your question, absolutely, there is always a need to be recruiting foster and adoptive parents. And anything that Council can do to help us in that is important because the more qualified, committed, loving foster parents and adoptive parents you have, the safer we keep our city's children. So you always want to have more foster parents than you need. You never want to be just at that moment because it's organizational nature people will cut corners. So, yes, there's always a need. And also, as a City we are moving more to permanency and moving more children to adoption and permanent legal custody. And that means that foster parents in the system will move out of the system and become just regular parents. So there's always a need to replenish that. And what we are doing is we're forging 214 04/21/04 - WHOLE - BILL 040255 partnership. We just formed a partnership with Freddie Mack Foundation to come into the City, and with Channel we're doing a lot of 5 recruitment for adoptive parents, Wednesday's 6 Child. We put a lot of ads in the paper, we 7 work with our providers in that. It's always 8 a need, always a concern and -- 9
I'm sure I have a 10 large screening process also. COMMISSIONER MARTINEZ: It's a regulated process and there are state regulations around who is qualified. And in addition to that each agency is responsible for doing a careful screening process. And lastly, what I wanted to also share with you is that this is an opportunity also, as we grow the foster parent pool, to reduce the number of children in institutions because we have almost a thousand children, perhaps a little more, of children in institutions. And if we can bring them into foster homes, then that would not only be a cost-efficient solution but better for children. 215 04/21/04 - WHOLE - BILL 040255