But you have 230 homes that you do need to clean where families could live? COMMISSIONER PARIS: And that is why we are constantly reinspecting those homes, to make sure that no family move in with a child, because as long as there is no children in the home, we don't consider that a priority, but we want to make sure that nobody goes back in there again.
But considering the fact -- I was just reading Ms. Dainette's testimony from the Office of Services to the Homeless. There is a need for housing for families, and so if we have housing available and 98 4/11/07 - WHOLE - BILL 070114, ETC. these families have children and we have 230 houses that need to be cleaned, that means that 230 families can't utilize those homes. COMMISSIONER PARIS: These 230 homes are not vacant. These homes are occupied by adults, and many of them are owned by the people that live in them.
Well, how did we get to 230? Where do they come in? COMMISSIONER PARIS: This is the original 1,400 backlog where we identified children with lead poison. Since then, since we started this -- and this is back when we started the program, I believe this was 2002. Since then, we have reduced that backlog that started with 1,400 to where we are today, which is exactly 273. But of the 273 that we have left out of the 1,400, there is no 23 child in that home. That doesn't mean that that home isn't occupied and that doesn't mean that that home is available 99 4/11/07 - WHOLE - BILL 070114, ETC. to have families coming in. This means that the children that used to be in those homes are no longer there.
How do you keep track of that? COMMISSIONER PARIS: What we do is we reinspect those homes anywhere between three and six months. Every three to six months we go back out there, we look at those 273 homes to make sure that no child has moved back in.
Now, let's go to the second one where you have the Safe Babies program. COMMISSIONER PARIS: Yes, ma'am.
Where the homes are tested for a newborn. Is there a backlog for that? What's the status of that program? COMMISSIONER PARIS: We have been able to go into the homes and -- the purpose of that program is primary prevention, is to go in and educate the 100 4/11/07 - WHOLE - BILL 070114, ETC. parents about the risk of lead poisoning and what to do to prevent that. So what we do is, we go into the homes and we visit with the parents. We do an assessment of the home. We let them know whether or not there is lead present in the home and we educate the parents on how to prevent child exposure. We do that by showing them and actually teaching them how to clean the homes, and in many instances we provide super cleans, which is we go in there and we thoroughly clean the property for them and we teach them how to do that.
But you don't remove the lead paint? COMMISSIONER PARIS: We do not abate the lead, no, ma'am.
Is there a program for lead abatement for that category? COMMISSIONER PARIS: No. 24
Only for the category for the -- 101 4/11/07 - WHOLE - BILL 070114, ETC. COMMISSIONER PARIS: The ones that have been tested positive.
Okay. A couple other questions, then I think I'm going to be done. I noted on you have appropriated $50,000 for the preparation of Medicare and FQHC report costs. Are our health centers federally qualified health centers or look-alikes? Can you tell us what that is? COMMISSIONER PARIS: Our health centers, all eight of them, are federally qualified look-alike health centers.
And do you get funding from the federal government for those health centers? COMMISSIONER PARIS: In the form of reimbursement for the services that we provide, yes.
The other question I have, and I think I'm done, is the reimbursement. You talk here on you're asking for $50,000 to address 102 4/11/07 - WHOLE - BILL 070114, ETC. the completion of Medicaid forms. What does this cost? Are you assisting clients to complete the application form for reimbursement when clients come to the health centers? Are you billing the state for the services you provide? COMMISSIONER PARIS: Yes, we are. We're billing not only the state but also we have a number of private insurances, and we bill to all of them.
Are you up to date on the billing? COMMISSIONER PARIS: Yes. Yes, we are. We have taken very aggressive approaches to making sure that we continue to bill and that we do it in a timely fashion, because there was a time that our T's were not all crossed and we were billing but were not submitting those claims on time, so that by the time we were submitting them -- and this was a few years ago. By the time we are submitting them, they were no longer effective. So now we make sure that 103 4/11/07 - WHOLE - BILL 070114, ETC. they're submitted in a timely fashion so that we can get reimbursements.
So what does the $50,000 do? How are you going to spend that? Is that for staff? COMMISSIONER PARIS: That is the cost for the preparation for the reports that we need to submit to medical assistance.
It costs $50,000 to do that? COMMISSIONER PARIS: Yes, ma'am. But that then results in us being able to get what is called the wrap-around dollars, which is the dollars that we don't get reimbursed from Medicare and Medicaid.
Thank you. Are there any other questions from members of the Committee? (No response.) 104 4/11/07 - WHOLE - BILL 070114, ETC.
Thank you very much, Commissioner. Thank you. COMMISSIONER PARIS: My pleasure. MR. McPHERSON: The next department is the Department of Behavioral Health.
Good afternoon. Please identify yourself for the record and proceed with your testimony. And I would ask you -- your testimony is rather lengthy -- if you can abbreviate it, we would make certain that the stenographer actually transcribes it in whole. Thank you.
Yes, ma'am. I will do that. I'm Dr. Arthur C. Evans, Director for the Department of Behavioral Health and --
I'm sorry. You're going to have to pull the microphone closer to you.
I'm Dr. Arthur C. Evans, Director for the Department of 105 4/11/07 - WHOLE - BILL 070114, ETC. Behavioral Health and Mental Retardation Services, and accompanying me today is my Deputy Commissioner, Michael Covone. And I will abbreviate my comments. Good morning, President Verna and members of Council. My name is Dr. Arthur C. Evans. I am here to present testimony on the Department's FY08 budget. The Behavioral Health Department has two major divisions. The Behavioral Health component of the Department consists of three major entities that coordinate the City's behavioral health treatment services for approximately 100,000 adults and children annually. These three entities include Community Behavioral Health, or CBH; the Coordinating Office of Drug and Alcohol Programs, or CODAAP; the Office of Mental Health, or OMH. Mental Retardation Services is a component of the Department responsible for the development, coordination and 106 4/11/07 - WHOLE - BILL 070114, ETC. monitoring of services for children and adults with mental retardation. MRS provides services to over 12,000 individuals per year, including case management/supports coordination, in-home and residential services, early intervention for infants and children, family support, day programs and employment services. 2 million in the General Fund, 538 million in the Grants Revenue Fund, 886 million in the Health Choices Behavioral Health Fund. The DBH/MRS FY08 budget will support 293 positions, 34 in the General Fund and 259 in the Grants Revenue Fund. Over the past two years, the Department has continued to foster the concept of recovery-oriented care. The initial phase of this approach was the alignment of concepts associated with recovery. Towards this end, the Department has worked closely with 107 4/11/07 - WHOLE - BILL 070114, ETC. stakeholders to assure that training and educational opportunities were available to create a strong foundation of concepts. The current and upcoming activities highlighted below have and will continue to support the implementation of these concepts and to everyday practice and service delivery. I'll just highlight a few of those. One of those being the implementation of the Blue Ribbon Commission recommendations on children. In February of 2006, the Mayor commissioned a Blue Ribbon Commission consisting of families, consumers, advocates and child service professionals. The BRC was charged with developing a set of recommendations to improve Philadelphia's ability to promote the social and emotional well-being of children -- of all of the City's children. This initiative is addressing the complex needs of children who frequently require support from multiple 108 4/11/07 - WHOLE - BILL 070114, ETC. systems of care, such as behavioral health, child welfare and housing. Another important initiative has been the continued expansion of Early Intervention services for children zero to 3. And Early Intervention is an entitlement program for children with developmental delays between the ages of birth to three and their families. It is a comprehensive, coordinated program where multi-disciplinary teams work to enhance the development of the infant and the toddler to enhance the capacity of the family to meet the needs of their infants and toddlers with disabilities or delays. Early Intervention has the goal of minimizing the need for special education services while enhancing the potential for children with disabilities to participate fully in typical everyday life activities. A few of the other major initiatives that the Department has been engaged in, one is the faith-based 109 4/11/07 - WHOLE - BILL 070114, ETC.
initiative in which we are working with community-based organizations and faith-based organizations to increase the relationship and their ability to refer people into the formal treatment system and for behavioral health professionals to understand better how to integrate a person's faith within their treatment and recovery experience. We are engaging in several activities that are increasing the linkages of the formal provider treatment system to the broader community. One of those is the Coalitions of Care initiative. In this initiative we have identified coalitions from around the City who are working on behavioral health issues and problems and are supporting those through grants that we've made to them for the next two years. We believe that these coalitions will have the potential for strengthening communities and their ability to address and prevent behavioral health conditions. 110 4/11/07 - WHOLE - BILL 070114, ETC. We're also looking at and have been actively involved in expanding our services to diverse cultural groups. In the upcoming year, the Department is continuing its efforts to work with these groups. The Department has engaged in a collaborative process with several cultural groups to gain a better understanding of behavioral health needs within those communities; for example, the Asian community. The Department has supported the Asian Behavioral Health Task Force, which developed a set of recommendations which we're now actively implementing. We're also looking at how to better meet the needs of people who are homeless. In order to better address these needs, we are looking in the process of transforming several residential treatment programs to better address the needs of people who are chronically homeless and looking at how we can use those services to reduce 111 4/11/07 - WHOLE - BILL 070114, ETC. homelessness in the City. In the MR division, based on the Governor's FY08 budget, mental retardation services statewide would see the largest proposed increase in over a decade. Philadelphia MRS expects to have a unique opportunity to address the needs of a large number of people on the waiting list. The Philadelphia waiting list is the largest in the state, with over 800 people currently identified as meeting the criteria of a person in emergency status requesting one or more services. The Governor's budget proposes services for 3,428 persons statewide, with approximately 15 to percent of 19 that being available to Philadelphians on 20 the waiting list. This number represents between 500 and 700 new people who could expect to receive services in the upcoming year. Finally, I would be remiss if I did not point out a number of challenges 112 4/11/07 - WHOLE - BILL 070114, ETC. facing the Department and our sister social services agencies in the upcoming year. The proposed federal reductions in Medicaid will increase the risk to our most vulnerable citizens. Federal and state reductions to Medicaid eligibility or limiting of benefits will place individuals at greater risk for homelessness, hospitalization or out-of-home placements. DBH/MRS will continue to articulate the potential impact of the federal and state reductions and to partner with members of City Council and our stakeholders in the community to advocate for continued state and federal funding for these critical supports. Thank you for the opportunity to provide this overview. I look forward to continuing to work with City Council in the upcoming year.
Thank you very much. Dr. Evans, can you explain how 113 4/11/07 - WHOLE - BILL 070114, ETC. your department works with DHS and other governmental departments?
Very closely. The two Directors have a great relationship, for one. We have a number -- one of the things that has been happening really -- I guess it started with Estelle Richman -- is that the two departments have been working very closely. As you can imagine, there is a lot of overlap between behavioral health issues and child protection issues. And so really starting with Estelle, the two departments have met regularly for several years. We're now looking at how we evolve that work to look at some real critical issues, and I'll give you an example. One of the real challenges that we face really in both systems are the number of children that we have in the City who are placed in residential care and oftentimes that residential care is very far from the City, and so it makes 114 4/11/07 - WHOLE - BILL 070114, ETC. it very difficult for those children to transition back into their families and transition back into the community. So we are working with the Robert Wood Johnson Foundation, who is providing some support for us to look at ways that we can develop new services that allow those children to be served within their community context. That's just one of many examples. We also have staff that are located within the Department, Behavioral Health staff, that are located within the Department of Human Services and are co-located in the courts, and those staff have been very effective in helping to facilitate referrals when DHS staff need to refer children into the behavioral health system. They've been very effective in helping children to do that. So on a number of levels, both at the practical, clinical practice level, we're working. We're also working at the systemic level to look at 115 4/11/07 - WHOLE - BILL 070114, ETC. large-scale systems issues that are barriers for children.
Thank you, Doctor. The Chair recognizes Councilman Greenlee.
Thank you, Madam President. Along the same line, Dr. Evans -- good afternoon.
What communication or what working relationship do you have with the schools, particularly the public schools or schools in general with children and behavioral health issues?
I think we have a very good relationship with the School District. I mentioned in my testimony the Mayor's Blue Ribbon Commission on Behavioral Health. Mr. Vallas, Paul Vallas, was a part of that Commission. He dedicated staff to that Commission. 116 4/11/07 - WHOLE - BILL 070114, ETC. He's a part of the Philadelphia Compact, which is the mechanism that we're using to implement the recommendations coming out of the Blue Ribbon Commission. The Department spends about $50 million annually in the School District. We are at this moment looking at the services that we provide. There's the school-based behavioral health teams that we provide in the School District and looking at how we optimize that. So on a lot of different levels, the School District has been very supportive. They clearly understand that mental health issues, behavioral health issues are very important, and, in fact, they will tell you that it's one of the, if not the number one -- I think it's the number one predictor of whether a child will succeed in school, is whether or not they have a mental health problem. So they see the importance of what we do. They partner with us in lots of ways.
How about 117 4/11/07 - WHOLE - BILL 070114, ETC. the non-public schools? You probably don't have a direct connection, but are there referrals? Do you have contact with them, that kind of thing?
I think we do. We don't have the same type of relationship with those, particularly the private schools. It's an area that we could do better in.
Okay. Thank you, Doctor. Thank you, Madam President.
Thank you. The Chair recognizes Councilwoman Brown.
Thank you, Madam President. Let me first commend you on the seamless transition of leadership there at DHS, when one recognizes how challenging it can be to embrace another huge system and still maintain a level of service and the one you currently led. 118 4/11/07 - WHOLE - BILL 070114, ETC. Give us just a quick update on where we are in the Blue Ribbon recommendations. And the second question is, you say that Robert Wood Johnson Foundation is playing a role in working with your department on how to keep children closer to home, and that role will be what? Is it funding? Is it --
Yeah. What they're doing is, they're actually providing technical assistance to a cross-systems team of people within the Department of Behavioral Health and DHS and the Director of Social Services, Julia Danzy, and they've been providing that technical assistance through consultants, but also in other -- by pairing us with other jurisdictions around the country that are doing similar kind of work. So it's been very helpful to the Department. In terms of the Blue Ribbon Commission, there were several major recommendations. The one that I think is probably the hallmark and really 119 4/11/07 - WHOLE - BILL 070114, ETC. distinguishes this work from other work that's been done nationally is that the Commission that you co-chaired took the position that children's behavioral health, their social and emotional health was the business of everyone, which was a very significant recommendation, because what happens is, children often find themselves in multiple systems. They're in the School District, they're in recreation centers, they're in lots of different places. And to the extent that those other systems understand children's mental health issues, people who can identify and intervene early, children will have much better outcomes. So that recommendation was a huge, I think, milestone for the City. In terms of where we're at, the mechanism that the Commission and all the people that were involved decided to use to implement those recommendations was something called the Philadelphia Compact, and the Compact essentially has 120 4/11/07 - WHOLE - BILL 070114, ETC. three components. One is an Intergovernmental Leadership Council, which, again, is a huge milestone, because for the first time, you have the legislative branch, we have members of Council, the judicial branch and the executive branch all sitting down together looking at how we address the needs, the mental health and substance use needs, of children. There's also a component of community advocates. We had several hundred citizens, stakeholders, participate, parents and youth themselves who participated in the generation of the recommendations. Those individuals will continue to be a part of implementing and making sure that the recommendations are implemented, and they'll do that through a process called the Council of Advocates. And then the third component is a group of experts around a variety of areas that -- content experts that will 121 4/11/07 - WHOLE - BILL 070114, ETC. be used to implement specific recommendations. So I think the important thing at this point is that we have very clear recommendations. We have the infrastructure and I think all of the people in place to implement those. We've actually started already implementing some of the recommendations, and through our website and other mechanisms, we're going to be getting out the story of our successes.
Okay. Is there any interface with the Children's Commission, any interface between the Blue Ribbon Commission execution plan and the Children's Commission?
Well, only through common membership. We haven't made formal connections, but one of the things that we see the Compact doing is forming those relationships. I think one of the things that we noted in the process is that there are lots of other people in 122 4/11/07 - WHOLE - BILL 070114, ETC. the community that really need to be connected to the Philadelphia Compact, and that's really the next phase of the work in terms of making those connections more formal.
My final question is a follow-up to the hearings of a resolution that was co-sponsored by Councilwoman Tasco and myself regarding internal changes that need to take place with regards to professional development of DHS staff and the notion that they work years without having a pause or taking a break for a professional development. Where are you with that?
I can talk about that now or I can talk about it in my DHS testimony. I actually refer to it in my DHS testimony, so if you'd like for me to talk about it now --
Thank you. 123 4/11/07 - WHOLE - BILL 070114, ETC. Thank you, Madam President.
You're welcome. The Chair recognizes Councilwoman Tasco.
First I want to say thank you to you and your staff for your immediate response to the shooting that took place at Simons Recreation Center. You responded immediately to talk to the young women and men who were in that center at that time and provided counseling, and then right on the heels of that, you sponsored one of the Department of Social Service Safe Streets program with Dr. Ella Bowen, and all her wonderful staff came forward and provided a positive picture to the community that Simons is a wonderful recreation center, it's still a safe place to be. And we didn't end up with 124 4/11/07 - WHOLE - BILL 070114, ETC. any negative yelling and screaming about what happened, but a positive reinforcement that the center is a good place to still go. So I want to thank you for that. It was very helpful.
Okay. Since you made that statement, I want to thank Dr. Gail Edlesohn, who is in the audience, who really took the lead on that and has done a tremendous job in leading our efforts around addressing the needs of children.
Thank you. The Chair recognizes Councilwoman Blackwell.
Thank you, Madam President. Good morning, Dr. Evans. 125 4/11/07 - WHOLE - BILL 070114, ETC.
Can you explain to us the role of the ICM, intensive case managers, their role with their clients and families? As you know, given the population, we deal with so much, we get concerns about them.
Michael Covone, Deputy Director with the Department. The Intensive Case Management system has evolved probably over the last 15 years within the Behavioral Health system, and really the intent of that was to provide families and individuals with a level of case management where the case managers were not overburdened with heavy caseloads. So most of our case managers have caseloads between 15 and 18. The other recent evolution with that is, we've gone to much more of a teaming model with the case managers, whereas there will be individuals to back 126 4/11/07 - WHOLE - BILL 070114, ETC. up so that the availability of an individual in crisis at off hours or on weekends, there will be a team available who is familiar with the individual situation, familiar with the family and can help facilitate those linkages that would be necessary.
All right. What we'll do is, I have one of my people who works mainly with people who are on the streets who's having some issues, so I'll contact you in detail about that later.
The other question is on the beacon program, because I know you all administer the beacon program.
No. That's DHS. I know it's confusing. I'm wearing my Behavioral Health hat right now, but I do have people who can answer that if you'd like to address that now or -- 127 4/11/07 - WHOLE - BILL 070114, ETC.
Thank you. As you know, or you may not know, I bring up this issue every year. I always have. I'm concerned about these youngsters who are so designated or labeled having ADD and what happens with them. I've talked to charter school principals and administrators who kind of tell me if kids are on their meds, it's okay. And I'm always concerned about it because as we know, when a child becomes a teenager, if the medication isn't altered, it could have the opposite effect and we do have people who are suicidal if they're not properly diagnosed. I'm really, really concerned about people being diagnosed, this Chadd company, C-H-A-D-D, that is in business to make money from -- this company that's 128 4/11/07 - WHOLE - BILL 070114, ETC. in business to make money on drugs, and I'm really concerned about youngsters who maybe need home life, who maybe need proper food and proper care who may not be ADD. There are some, but I don't know if there are as many as are so designated. And nobody is talking about it lately. But it's been an issue with me for many, many years, and Council had hearings about it. We've had several hearings about it, because we're concerned about these youngsters and about them being properly diagnosed and receiving help they need and maybe not properly being diagnosed.
Right. Let me address that, and I've also asked Dr. Edlesohn, who is a child psychiatrist, to come up and talk about that, particularly the issues around the medication. It is a big concern and I think you are right, and I think we are equally concerned about the number of children 129 4/11/07 - WHOLE - BILL 070114, ETC. who are diagnosed with ADHD and have that label. Clearly, one of the things that I personally believe that we have to do better when it comes to children is do a better diagnostic job and also look at other alternatives. There are a number of cases where children who have been on medication who were told or the families were told that they really needed to be on this medication. When the medication was removed, the child did fine. And given that those medications often have other side-effects, I believe that there needs to be much more flexibility at looking at treatment options. But I'm going to ask Dr. Edlesohn to also comment on this, as she's a psychiatrist that often prescribes --
Thank you, and we will note that we had hearings, because we learned many years ago that medicine was arbitrarily being 130 4/11/07 - WHOLE - BILL 070114, ETC. passed out, and after this Council held hearings, then one person in a school, if the nurse wasn't there, since nurses share two or three or four schools in today's world, the principals had to designate someone specifically to give out meds for little children, those who were taking them. So we've had a big, big, big issue with this. We've had one mother who was threatened to be removed from her welfare -- in those days it wasn't called TANF assistance -- if she didn't agree to let her children take meds, and we fought with her and she took her kids off meds and they were fine. So it's a very big issue. I know it's complicated, but it's very, very important, because it does deal with the health of our youngsters and their future.
Let me just say that if that person were in our system, that's the kind of thing that if you 131 4/11/07 - WHOLE - BILL 070114, ETC. brought it to our attention, we could also intervene. I don't know if you wanted to add anything.
Yes. I'm Dr. Gail Edlesohn. I'm the Associate Medical Director for Children Services in the Department of Behavioral Health and Mental Retardation Services, and thank you for an opportunity to comment. Attention deficit hyperactivity disorder, which is a mouthful, ADHD for short, is a complicated diagnosis, not one to be made lightly, and as Dr. Evans says, it requires a comprehensive evaluation, which means having a good understanding of the child in their home, school and community environment. As far as treatment goes, the treatment is multi-factorial and may include medication but also includes a behavioral component, a social support and for many children there's a high chance that they may also be struggling 132 4/11/07 - WHOLE - BILL 070114, ETC. with some learning problems. Any one of those problems alone can be mistaken for attention deficit disorder, including undiagnosed ear infections. So the diagnosis is extremely important. I did want to say something about medication, because I think there's a lot of misinformation out there, that there has been a multi-site national study done, almost nine years old now, that shows the effectiveness of medication under conditions of proper diagnosis. And it's important that I think people know that although many chemical substances sound like some of the medications, they don't behave differently. And the federal government has done studies to look long term at the consequences of medication and that although they may sound the same, they do not increase of themselves a risk of substance abuse. In fact, there are studies looking at teens who if they are treated and truly have attention deficit, 133 4/11/07 - WHOLE - BILL 070114, ETC. they're treated earlier, it can actually reduce their risk of substance abuse. I don't think this information is well known enough. But by no means is medication the only answer and, as I said, many presentations can be mistaken. So it's not a diagnosis that should be made lightly. And the combination of treatment usually can make a huge difference, especially if the school, home and parents, caretakers and children are all on the same page. It takes a lot of coordination and significant attention to monitoring the progress over time and monitoring the effects of all sorts of treatment. I hope that gives some clarification.
Well, I might say that there are studies too that show that certainly for those children who need it and who need meds, that's one thing, but for those who don't 134 4/11/07 - WHOLE - BILL 070114, ETC. need it, the risk of becoming a victim of substance abuse is just as great if they're misdiagnosed. Then you create drug addicts. They go from these chemicals into those. There's as much study out there. And we've also had hearings where we had grandmothers who came in and who told us that they didn't want to give their grandchildren as caregivers, they didn't want to give their children meds and they believe their children didn't need them, the grandchildren didn't need them, that they were told by the system and the School District, Well, we have no program for you. There are too many children in a class and if you don't give your children this medication, then we don't know what you do. You can do whatever you want to do. You can keep them home. You can home-school them. You can do whatever. But if one child becomes a substance abuser because he or she was misdiagnosed, it's too many. But I've 135 4/11/07 - WHOLE - BILL 070114, ETC. read many studies that say drug addicts are created from this medication, just as you mentioned there are some that say the opposite. But after all my years of dealing with this issue, maybe years 7 now, we've read many horror stories and 8 have experienced some in my office with 9 parents and grandparents who talk about 10 kids. And we've all seen movies about 11 people who become suicidal, as you know, 12 when misdiagnosed. 13 So it's a very important issue, 14 and so I really am concerned about -- 15 obviously anybody who gets proper 16 medication for a proper condition is 17 great, but there is the grave danger that 18 we have youngsters who have other 19 problems, other problems in their family, 20 dysfunctional families, abuse problems, you name it, who get involved in a situation where they're given medication and in today's world, it's worse and worse. I mean, you have grandparents at 40 years old. You have kids that have so 136 4/11/07 - WHOLE - BILL 070114, ETC. many, many issues to deal with, raising other kids, victims of abuse, so many. And so I mention again how important proper diagnosis and that we do everything we can to ensure that we keep a focus on this as an issue. I've tried to deal with it for years. Obviously I've been unsuccessful, but I bring it up every year, and we will continue to do that, because it's so important for young people to have a chance at life and to have a chance at a wholesome life without being drug ridden and without being victims of abuse of this chemical sort that could certainly hurt them as they try to become stable, wholesome, responsible adults.
We agree with you, and if there's anything that we can ever do to support what you're trying to do, just let us know.
Thank you. So I'll be in touch with you on this, because we have some issues in my 137 4/11/07 - WHOLE - BILL 070114, ETC. office with the ICM workers. I'll get in touch with you. I'll get the detail. Thank you. Thank you, Madam President.
You're welcome. Are there any other questions from members of the Committee? (No response.)
Dr. Evans, as long as you're at the witness table, perhaps we could hear testimony at this time from the Department of Human Services.
Doctor, we're ready to proceed. Please identify yourself for the record and proceed with your testimony. 138 4/11/07 - WHOLE - BILL 070114, ETC.
I'm Dr. Arthur C. Evans, Acting Commissioner for the Department of Human Services, and I'm here with my Deputy Commissioner, Dr. Joseph Kuna. Good afternoon, Madam President and members of Council. Today I will present to you the Department's FY08 Operating Budget request. I will also report on our significant progress on reform efforts, outline our plans moving forward, and detail how DHS is responding to the changing needs of Philadelphia's children. DHS's FY08 General Fund budget request is $677 million, which represents an increase of $85 million over the Department's FY07 estimated obligations of 592 million. DHS also receives 20 million in Grants Revenue Funding, placing our grand total of funds at 698 million. These budget figures are based on current assumptions regarding the 139 4/11/07 - WHOLE - BILL 070114, ETC. state budget. We are currently in negotiation with the Department of Public Welfare regarding our FY08 budget. Changes in the final state budget that is passed by the Legislature and signed by the Governor may impact on the proposed request. DHS is acutely aware of the enormity of the responsibility to the children of the City. Since I assumed my position in October of 2006, the Department has focused resolutely on ensuring the safety and well-being of our city's children. To that end, we are actively engaged in an aggressive reform effort aimed at improving the quality and effectiveness of our services and restoring public confidence in the agency. The framework of that effort is called the Children's Safety Net Action Plan, which was designed in consultation with numerous child welfare experts. I want to underscore that we are proceeding with urgency in these 140 4/11/07 - WHOLE - BILL 070114, ETC. reform efforts. Rather than wait for mandates, we are acting immediately on information as it becomes available so that we can improve our responsiveness to the children and families we serve. I am pleased to report that DHS has achieved many of the goals outlined in that plan and I would like to take a moment to update you on our progress and our plans for the upcoming year. One of the most urgent goals set forth in the Action Plan was to conduct face-to-face visits with every child in the system to ensure that they are safe and receiving the most effective and appropriate services. DHS has successfully completed safety visits to all children receiving services in their own homes from the Children and Youth Division. A total of 6,653 children in 2,636 families were visited and assessed by a social worker. Also within the past six months, compliance visits have occurred for children in out-of-home 141 4/11/07 - WHOLE - BILL 070114, ETC. care. To further the Department's ability to assess safety during visits, the Department has developed and will be using a standardized tool going forward. During these visits, social workers used a uniform tool to examine a number of factors affecting the child's safety, including how frequently the child is visited by a social worker, the length of those visits, whether the child has a doctor or whether they have special needs, and whether the child is in imminent risk or danger of abuse or neglect. In addition, a special database was developed to collect, monitor and analyze the information from those visits. Furthermore, we are consistently using that information. For example, when it is noted that a child with special needs or conditions does not have a doctor, the Health Management Unit at DHS is engaged to assist that family in obtaining healthcare. 142 4/11/07 - WHOLE - BILL 070114, ETC. Another priority outlined in the plan was to evaluate the quality and appropriateness of in-home services we provide. One important way to achieve this goal was using a process called the Quality Service Review, in which cases are randomly selected and all the records of those cases are carefully reviewed using a federally vetted standardized instrument.
In addition, a series of interviews are conducted with all individuals involved with the case, including the social worker, supervisor, parents or caregivers, service providers, teachers and others. Through this process, the case is examined on safety, well-being and permanency factors. The QSR also helps to identify systemic factors impacting service delivery. We achieved our goal of completing QSRs on 15 randomly selected cases that received in-home services from the five DHS units where child deaths had occurred between 2003 and 2006. The 143 4/11/07 - WHOLE - BILL 070114, ETC. reviews were conducted by trained internal and external reviewers, including staff from DHS and the Office of Children Youth and Families, providers and Philadelphia Safe and Sound. A report summarizing the findings and recommendations from those reviews was drafted and is being used to guide immediate reform efforts. A third area of concern addressed in the Action Plan was increasing the openness and transparency of the agency. There are a number of things that I won't go into now that we've done, including interviews with the press. We have a website. We are doing internal and external newsletters to keep people apprised of the progress that we're making as a department. We are also better utilizing extensive knowledge and the expertise of our staff and working to be more responsive to their concerns. We're enhancing our suggestion box through 144 4/11/07 - WHOLE - BILL 070114, ETC. which employees, providers and the public are encouraged to propose ideas, raise concerns or make complaints. Additionally, we are establishing a DHS Innovator Award to acknowledge individuals who make suggestions that result in improved services and/or efficiency. Let me just talk about a couple of other initiatives, one of them being the curfew center that we recently established in South Philadelphia. This center opened in July 2006. Youth in violation of the City's curfew laws in the 1st and 17th Police Districts are taken to the center, where they receive an intake assessment and behavioral health assessment and are linked to appropriate services. Through March 18, 2007, 338 youth have been screened and assessed for services at the center. The center has also stimulated community involvement. Since the institution of the curfew enforcement 145 4/11/07 - WHOLE - BILL 070114, ETC. initiative, over 75 residents have volunteered at the curfew center, contributing their time and demonstrating their commitment to combatting violence in their community. 5 percent drop in juvenile shooting victims in that neighborhood -- or in those neighborhoods. Another initiative I just point out for you is the truancy initiative, which we are actively involved in. In September of 2007, the eight regional truancy courts will operate two full weeks per month, which is double the number of days they currently operate. Youth involved in the truancy court process receive case management and support to address the underlying factors that lead to truancy. Approximately 3,500 families will be served by the courts in FY07. By the end of FY08, we 146 4/11/07 - WHOLE - BILL 070114, ETC. expect the courts to serve 10,500 families. In addition, we are working with the School District of Philadelphia to increase the use of parent truant officers to reach out to parents and caregivers about the consequences of truancy. We are also making great strides in reducing recidivism among those involved in the juvenile justice system. Until as recently as FY04, of the 1,500 young offenders placed by the county annually, 34 percent were back in juvenile justice placement within 12 months. The Philadelphia Reintegration Initiative was developed in 2004 by DHS and numerous other stakeholders to provide young offenders with the necessary support and resources to help them make a positive transition into their community and avoid further contact with the juvenile justice system.
Finally, we continue to work hard to prevent families from becoming 147 4/11/07 - WHOLE - BILL 070114, ETC. involved in the formal child welfare system by providing a comprehensive network of supportive services to help them address the underlying problems that often lead to abuse and neglect. These services include diversion case management, parenting support and education, crisis nurseries, supportive services to relatives raising children, enhanced services for compromised caregivers, and truancy and delinquency prevention programs, as well as an array of positive youth development programs. In conclusion, I want to reiterate that DHS is fervently dedicated to becoming the very best child welfare agency in the country. I believe that we can achieve this goal. Since coming on board, I have been consistently impressed with the high standards and level of expertise and professionalism of many of the agency's staff and the high quality of our providers. They are truly passionate about ensuring the safety and 148 4/11/07 - WHOLE - BILL 070114, ETC. well-being of our children. The past six months have been an extremely difficult time for the Department. Yet despite the challenges we have faced, the staff have remained dedicated and focused on the tasks at hand, and I salute them for their hard work and perseverance. This concludes my testimony. Thank you for the opportunity to present it on behalf of the Department. I'll be happy to answer any questions that you might have.
Thank you very much, Doctor. Doctor, what is the amount of additional state aid that you are requesting to be added to the Governor's budget?
Well, we have been in conversations with the Department of 149 4/11/07 - WHOLE - BILL 070114, ETC. Public Welfare. We'll be actively lobbying the Legislature. In fact, a group of us will be going to Harrisburg on Tuesday to meet with our legislative delegation and other key legislators to lobby for what we believe the state should be giving to the Department.
Can you tell us what additional City dollars have been added to your budget to cover the City's share for FY08 Needs-Based budget?
What happens to these dollars if the state does not increase its funding?
Well, we're hopeful that the state will. We're looking at both Act 148 dollars as well as additional drawdown from the federal government. We think that we can draw down additional dollars from -- Title IV-E dollars by changing some processes 150 4/11/07 - WHOLE - BILL 070114, ETC. internally. If we're not successful -- I think we will be successful. I think it's the degree to which we'll be successful -- we're prepared to make changes both in terms of what we are proposing to do and perhaps some reshuffling of dollars to address any of those things that we deem as priorities.
Thank you. On -48 of your detail, you're requesting $2,250,000 for the relocation of the Youth Study Center in FY08. Are these funds for a temporary relocation and, if so, where will the facility be located?
Those are for a temporary relocation. We don't have a site at this point for that temporary location.
Doctor, on -74, you're requesting $46,904 for Fund for Philadelphia to 151 4/11/07 - WHOLE - BILL 070114, ETC. provide housing programs. Can you tell us what services Fund for Philadelphia provides? -74.
Family preservation support, a communications campaign and some support for Temple University.
Okay. What I said was that it's providing family preservation support, some support for a training facility at Temple University and some communications support.
Who provides the communications support and how much is that? 152 4/11/07 - WHOLE - BILL 070114, ETC.
Who provides the communications support and what is the cost of that?
I'm trying to get an answer for you. I'll have to get back to you on the specific individual entities that that supports, but those dollars are used to support our efforts around promoting adoption, foster care and those kinds of services.
See, Doctor, you really have me a little confused here. I know it's not too difficult to confuse me these days, but according to your detail, it indicates -- and, as I said, on , Section 74 -- "provide housing programs." Now we're getting an entirely different version of what Fund for Philadelphia is.
I'm sorry. I gave you the wrong information. Can I get back to you on that? I will look into 153 4/11/07 - WHOLE - BILL 070114, ETC. exactly what that fund is funding and get back to you with an answer.
On -79, you have two requests for the Fund for Philadelphia. The first is for $180,000 and the second is for $798,688. Can you explain why you use the Fund for Philadelphia and what services they will be providing?
I guess that was the confusion. The amounts that I -- the amounts that I talked about before were related to these items. The Fund for Philadelphia, items of communication, were as I mentioned earlier, about promoting adoption and foster care, the faith in families, the fatherhood initiative and those kinds of efforts that the Department is engaged in. I'm sorry. What was the other part of your question? 154 4/11/07 - WHOLE - BILL 070114, ETC.
Can you tell us why you're using Fund for Philadelphia?
Well, my understanding is that it's a mechanism for us to quickly get out brochures, pamphlets, those kinds of things and it's a mechanism, I guess, the Department has historically used to do those kinds of activities.
Hi. I'm John Zanier, DHS Finance Director. 155 4/11/07 - WHOLE - BILL 070114, ETC. Using the Procurement process, usually these projects are quick projects that we need to get out right away on campaigns, like co-sleeping, public outreach, staff recruitment, and we use this fund, the fund that was set up, to provide funds to get these out quickly for these activities.
Well, there's a need to get these brochures and these campaigns and staff recruitment and things out in a fast way. The City Procurement process will be a long and protracted process. We wouldn't be able to do these things in a timely manner.
And I see on that same page, Fund for Philadelphia, $180,000, it's rental fees for meeting spaces and visual and equipment project.
This is for the 156 4/11/07 - WHOLE - BILL 070114, ETC. facility we use at 15th and Market Street, Temple University, for our training, mostly training, and large staff and community and provider meetings. We don't have the space at DHS to have these large meetings.
It varies. There are meetings that we have regularly, monthly meetings, where we bring together all of the senior-level managers within the Department. We have no space within the DHS building to hold a group that large. And then when we have periodic special meetings, again, we don't have a space adequate within the building to do that and so we will use the Temple University site.
On 157 4/11/07 - WHOLE - BILL 070114, ETC. -110, you're requesting $53.7 million for Safe and Sound. Doctor, what services does Safe and Sound perform?
They provide a variety of services, including the after-school programs, beacon programs. They provide some support to the Department around research and evaluation. They do the Report Card. They do AVRP. It's a variety of services.
Does the School District get reimbursed for the expenses it incurs for after-school programs?
Does the School District get reimbursed? I'm not sure if I'm following the question. Does the school system get reimbursed by whom?
I don't know the answer to that question. I think I saw -- the answer is no. The answer is 158 4/11/07 - WHOLE - BILL 070114, ETC. no. 3
Well, I think we would like to know why the School District doesn't get reimbursed.
Thank you. I got a couple of letters and some calls regarding reduction in funding for some of the DHS programs, the EPIC Stakeholders program and some of those programs.
I saw that letter, too. I can tell you that it's erroneous. There is no reduction that is being planned. That letter was inaccurate. There is no reduction that we're planning in our prevention services.
Do they 159 4/11/07 - WHOLE - BILL 070114, ETC. continue at their same level of funding? Do they get an increase?
No. We are looking at how to reconfigure those services, as any department would do. You have a set pot of dollars. You want to use those in the most effective way, and we are looking at are we using those prevention dollars in the best possible way. I'll give you one really important thing that's come out of the crisis that we've had in the child protection part of the Department. As I noted in my testimony, many of the families that we see often don't need child protection services. The child isn't at imminent risk for maltreatment, but the families need support, and one of the things that I think we have universal agreement among our top management is that we have to do a better job of connecting those families to prevention resources, resources that we have in our Prevention Department. 160 4/11/07 - WHOLE - BILL 070114, ETC. So we're looking at two things. One is how do we create an alternative for families so they don't have to go into the child protection system when they don't need to and how do we use those resources to support families even if they are in those systems. Often times the families need services that they could benefit, parenting classes and other kinds of services that we provide in the prevention part of the Department that would greatly benefit those families, and we're looking at how do we make those connections. And some of those connections, frankly, are going to need us to rethink services that we may already be providing in terms of designing them differently to meet those needs.
So as you look at redesigning those services, it could mean that some of the programs that are existing would be reconfigured or no 25 longer exist? 161 4/11/07 - WHOLE - BILL 070114, ETC.
Well, I mean, I think one of the things that we're looking at and, frankly, what we've talked about is how do we ask providers to do something different with the resources that we're giving them. That's primarily the approach that we've taken and the approach that we're looking. So if you're providing parenting classes, for example -- I'm making up an example here, but if you're providing parenting classes, we know that one of the real challenges we have is families or parents who have some kind of cognitive impairment, that they have an intellectual impairment or they might have mental health impairment. The kind of parenting classes that you might do for that parent would look different than a parent who might not have those kinds of challenges. And so we're looking at how do we ask our providers to modify their services so that they are more useful to the kind of populations that 162 4/11/07 - WHOLE - BILL 070114, ETC. we're serving in the child protection part of the Department.
I don't know. Someone who has some history in DHS can answer that. AUDIENCE MEMBERS: Eight years.
I'm sure they feel some sense of -- they have some fear that their programs may be cut.
They're all my ladies. We got good programs and we don't want them -- they provide services needed in the community.
Don't be 163 4/11/07 - WHOLE - BILL 070114, ETC. messing with them. (Applause.)
I just want to know if I can carry them to some of the meetings I go to.
Yeah. Okay. Today our youth and their families are more troubled and seem to need more intensive prevention services. I know there are many children in after-school and beacon programs and there is the Adolescent Violence Prevention Program for the 10- to 15-year-old. What services are available for youth who need more intensive services who are younger than 10 and older than 15?
I'm going to ask Ellen Walker, who is our Prevention Director, to talk about what services we have available.
Good 164 4/11/07 - WHOLE - BILL 070114, ETC. afternoon.
Ellen Walker, Department of Human Services, Director for the Community-Based Prevention Services. We have many programs directed at serving both the child/youth below age and the older youth above age 16. For 10 youth that are exhibiting behaviors which demonstrate they're out of control, we normally use the case management services, Intensive Case Management services, to support those youth. We also use our consultant and education program, commonly known as school-based case management, to support those youth, because they are normally displaying those behaviors in a school environment. We also have targeted programs after school or positive youth development programs for those youth. An example of a program that supports the older youth is the IDAAY program. Unfortunately, I can't do the 165 4/11/07 - WHOLE - BILL 070114, ETC. acronym right now, but -- Institute for the Development of African-American Youth. That program was recently sponsored in the Daily News. We also have our E3 programs that support youth that are transitioning from juvenile justice service facilities back to the community. Those programs also support older youth that have dropped out of the school system or systems in general. Other programs that I can talk about is our youth empowerment services, our Trip programs. So in short, Councilwoman, we do have an array of programs that are designed to support youth that are not active with Adolescent Violence Reduction Program, youth both on the older continuum and on the younger continuum.
Okay. What are the recommended interventions for at-risk youth and their families since most youth don't, particularly at-risk youth, do not attend after-school 166 4/11/07 - WHOLE - BILL 070114, ETC. programs? Are they required to go?
A youth is not required to go to an after-school program. Youth that are age or older 6 that have been identified at risk due to 7 their behaviors, we make direct outreach 8 to them through our Adolescent Violence 9 Reduction Program intake staff in the 10 Department to strongly encourage those 11 families and those parents and caregivers 12 to involve their children in those 13 programs, and those programs have both a 14 quasi-mentoring component and a 15 center-based program component that includes academic support, counseling, training around get real about violence, some Bar support, which is giving back to the communities, for example. Youth that are younger, the outreach is through our community-based services, primarily case management programs. Again, the support is directed to the families in their own home, because, no, they -- 167 4/11/07 - WHOLE - BILL 070114, ETC.
Who manages all of this? Who manages all of these programs? I mean, from your department, if you have a child that is at risk and he's supposed to be or she's supposed to be involved in some of these programs, how do you monitor that?
The programs that are directly affiliated with -- the programs in the Prevention Division that are directly affiliated with the Department and not through a fiduciary agency that has the management or monitoring component is monitored by the Prevention Division. Programs that are through a fiduciary agency are monitored by that agency.
Dr. Evans, will any prevention programs receive 168 4/11/07 - WHOLE - BILL 070114, ETC. funding increases in '08, and what services and how much?
We haven't completed our process of looking at the programs, so I don't know that as we sit here today.
What funding will be utilized to annualize prevention programs in FY08 which are being implemented in FY07?
We have the dollars in the certified numbers that the state has given us to annualize the things that we've started for FY08. We don't have the dollars, as was noted earlier, for those new and expanded programs that we want to do.
I heard you say to the President that you are lobbying the state? 169 4/11/07 - WHOLE - BILL 070114, ETC.
We are lobbying the state. We feel that the state funding level should be higher for the Department, and we're lobbying the state to get those additional funds.
In your testimony you talked about a lot of the changes that you've made in the Department in your programmatic effort. Now, how will that fit in with the report that's due and when is it due?
The report from the Mayor's Child Welfare Panel, which is looking at the Department and what changes we should make in the Department, that report, again, is due in May. I work very closely with the Panel, really through the Co-Chair, Dr. Carol Spigner, who is a Professor at the University of Pennsylvania. The way we've looked at this -- and I noted in my testimony that we're moving forward on changes, that we're not waiting for the Panel to complete its work, but on those things 170 4/11/07 - WHOLE - BILL 070114, ETC. that we think are really important for us to move on, we're doing that. I do that in consultation with Dr. Spigner and members of the Panel. The way we've sort of divided the world is that I'm focusing on operational issues and they're focusing much more on large-scale policy issues. Now, obviously there's overlap between the two of those, but I think we have a good division of what we're focusing on and I think that the kinds of changes that we're making -- and I'm quite confident the kind of changes that we're making are very consistent with what the Mayor's Panel will come out with, again, because we're constantly consulting with them as we make those changes.
So as you look at the changes that you've made, do you think they will have an impact on the number of abused children that come to the Department?
I do, and I do for 171 4/11/07 - WHOLE - BILL 070114, ETC. a number of reasons. One is that we are, in all the work that we're doing, we're looking to and consulting with national experts on this issue. We're looking at and using the collective wisdom of people within the Department who have, I think, correctly identified what some of the areas are that we need to improve. By the way, one of the things that we've done over the last several weeks is to visit other jurisdictions. We spent a day, me and some top managers, in Allegheny County. We also spent a day in New York City, which has gone through a similar process to what we've gone through. And what's been striking about particularly the New York visit -- their crisis happened about 18 months ago -- they developed an action plan and many of the things that they identified in their action plan are almost identical to the same kinds of issues that we identified in our action plan. So it says a couple of things. One is that -- and they've 172 4/11/07 - WHOLE - BILL 070114, ETC. gotten rave reviews for the kind of reform that they've done. It says a couple of things. One is that some of the issues that we struggle with are more universal than might be known, but it also, I think, reinforces that the kinds of things that we are picking up in our own internal review are probably the right things, because they're the same kind of things that other systems are picking up. It's changes that they need to make in the system in order to improve how the Department performs its duties.
You talked about curfew centers. Are you scheduled to open other curfew centers?
The process is that the Mayor and top City officials have gone around to various communities. One of the things that the Mayor has insisted on is that the community not only has to want the curfew center but has to also participate in it. And you heard in my 173 4/11/07 - WHOLE - BILL 070114, ETC. testimony that in South Philadelphia they have 75 volunteers that are manning the curfew center from the hours of --
Staffing, yeah. What did I say, manning? Personing the curfew center to 7 o'clock in the morning. So as we've identified spots around the City, we've made that commitment. I think we are opening 12 over the next year or so. We have three open now. I think we're due to do a couple more this month, and we'll continue to open those up until we get to the number.
Are you doing those by RFP process or are you just identifying --
There is an RFP, but what happens is once a community decides that they want to do it, we do an RFP and make a selection of a provider. So it is a competitive process. 174 4/11/07 - WHOLE - BILL 070114, ETC.
Thank you very much. The Council will likewise note that we passed hearings on school violence years ago, maybe in the early '90s, where we talked about parent patrols, PPO. And now we're happy to have parent truancy officers, but we've been -- and it was the same time that we passed legislation asking for uniforms. So this is a good Council. We're on the case and happy to do that. I suppose now I can ask you about the beacon program.
Yes. I'm going to ask Ellen to come back up and respond to that.
Is the beacon program -- obviously they're in the schools, and I've had people come to me about West Philadelphia High School with our current issues there. I've had 175 4/11/07 - WHOLE - BILL 070114, ETC. two beacon models whose leaders I've spoken with. So my question is, do I assume there are different models for different schools and are they just after school, are they during school, and how are those decisions made? Are they made by you or the School District?
I'm going to let Ellen talk a little more in detail. They are different. I think it's driven by the community in terms of how those look. So there's not a standardized -- I should say an identical model in each place that there are. But, Ellen, you want to speak more into it.
Councilwoman Blackwell, I will attempt to answer the question you have related to the beacons. They are primarily facilitated by our Philadelphia Safe and Sound program, but as our Acting Commissioner stated earlier, beacons are developed to be in tune with the communities in which 176 4/11/07 - WHOLE - BILL 070114, ETC. they are placed. Key stakeholders are involved in the development of what the beacons should look like. They also develop the RFP process for those communities. They do operate during the after-school hours and not primarily during the day. Some beacons do have weekend activities; some do not. Depending on the beacon, they may have activities that may be on site that focuses on enhancing a parent-child relationship, older programs, younger programs, depending on the needs of the community and the beacon itself.
So they're really RFPs to private people who -- or I guess they could be non-profit -- to provide a service for that school and community?
All right. Because all mine work except one, and that's Turner School. That's always 177 4/11/07 - WHOLE - BILL 070114, ETC. been an issue, always been an issue. It was a different program there, different zip codes, but it's been one of those instances where the community said one thing and the school said another. And very seldom in life do you have an issue where you have oranges and apples and in between do not meet and never did. Of course, now the school is pretty much out of control, with all components therein. But we have looked at a couple models for West Philly High and would like to have that discussion. We're trying to work with various programs. We started an expanded Third District Safe Corridors Program after the problems at Sayre and we tried to organize that, and today was the first day out on the streets for a Safe Corridor Program there. So we really want to have a model to help the community in and around West Philadelphia High School. So who do we approach? Do we approach you or do we 178 4/11/07 - WHOLE - BILL 070114, ETC. approach the School District?
Great. That helps a lot. Thank you. Councilman Greenlee.
Thank you, Madam Chair. Commissioner, on the number of social workers, how many do you have for the coming year? Is that an increase, decrease, the same?
I will have to give you that number. I thought I knew that. I'll have someone get that number while you ask another question.
And could you also put in there their caseload as far as, again, increase, decrease, whatever?
The caseloads have been coming down over the last really ten years within the Department. For workers who are in the family service regions, 179 4/11/07 - WHOLE - BILL 070114, ETC. it's about -- I'm sorry; about 20, around in the 20 range. Overall within the Department, it's about 14 to one. And it varies depending on the intensity of the families that the workers are working with.
Is there 9 a target that you'd like to see ideally 10 caseload-wise? 11