Right. We're looking at this division summary for one of the divisions, the Children and Youth Division of the Department of Human Services. And that increase falls into the 200 classification, as you can tell. And the vast majority of that money goes into what we call "290 contracts," which are per diem services. They are out-of-home placement services and in-home SCOH services.
And we, of course, could give you a detailed breakdown on how that $35 million is allocated over a variety of contracts.
I guess the question I have is not the detailed breakdown or it's how it's allocated, but what the policy is on what seems to be a substantial increase over last year's allocation, both -- I mean -- again, as I 912 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 go down this increase and decrease column, the stuff that pops out is either a major decrease in something or what seems to be a reasonably major increase in something, and that's a $35 million, almost a $36 million increase in services on 42-57. On the same line -- I guess it's the same type of services -- there's an increase of $30.2 million. And then on 42-64, there is a professional service line, Line 250, which indicates an $18.5 million increase. And, again, I'm not looking for a breakdown of what's spent or what's attached; I just want to know what the policy shift is that we're increasing substantially in those three areas.
We have our Fiscal Officer John Zanier, but the $36 million is cumulative, and John can --
Some of the numbers you mentioned are subcategories of that 36 million.
Hi. I'm John Zanier of 913 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 DHS Fiscal --
Before you start, I'm sorry, I don't mean to interrupt you, but am I misreading the fact that there's an increase of that amount?
Yes. I'm John Zanier, Fiscal Officer. The $35 million that you're seeing on -55 includes the $30 million increase on . The 55 pages are -- increases all funds.
Okay, fine. How about the 18 million in the "Professional Services" line on 42-64? What professional services are being increased to that level?
Is that the -- 914 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
Most of the -- there's two categories that are increased in that column. One is an artificial increase of the Children and Families Cabinet that's being included in the Children and Youth Division now.
In the Children and Families Cabinet. You'll see that further in the budget, under the Children and Families Cabinet.
Yes. There's the actual increase that John mentioned. And, of 915 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 course, there are some regular rate increases that are a result of rate studies that caused that number to go up as well.
Okay. So some of it has to do with just the increase in the services that are being charged. People are charging for those services, having general increases in the industry.
And those increases are things that we determine based on rate studies.
All right. And going back now to 42-55 and 57, so that I understand the explanation, it is not a cumulative $65 million increase, it a -- probably a -- could you tell me what the increase is? I mean, you can imagine how difficult this is for us. This is my ninth budget, and I still have a little difficulty understanding it, so I mean, the average person who gets this on line is totally lost. It would seem to me to be a $65 million increase that obviously isn't, so how much of an increase is it?
The total in all funds is 916 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 35 million.
It's made up of a combination of what we said earlier. There's the shift from the Children and Families Cabinet to the Children and Youth Division, and that's around million. There's an increase in adoption 9 services in our Class 250. 10
There's an increase in adoption subsidies. There's a 2 percent COLA increase, there's an increase in our service to children in their own homes, and there is some dollars in there for targeted rate increases for services.
Okay. On 42-67 and 42-68, there is a two-page list of organizations and contracts that amount to about $39.5 million that deal with various types of services. Some of them are clear in what it is that they're doing. I mean, second -- on 42-67, Line 2, is $286,000 for outpatient evaluation and treatment of sexually abused victims. I mean, to me, that's a pretty clear 917 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 explanation of what it is those services are that are being provided. But there are others, for example, that for -- like the $510,000 down at the bottom, there's an "Outcomes Project." And underneath that, I'll have a "Transition Housing for Youths," $514,000. On the next page, we'll have an item for a half a million dollars for "Youth Violence Reduction," and then another half million dollars for "School Readiness," a $900,000 item for "School Performance Improvement." Now, they all sound great, but what are they, who determines the level that they're funded? What are the criteria that we judge them on annually, how do we judge this particular program spending almost a million dollars, whether it's accomplishing what it is we're intending them to accomplish? And how do we judge their performance. Because, again, my concern is that we're spending, 39, almost $40 million in various contracts that the average person, and even the average Councilperson, would have a difficult time understanding their purpose, which, I'm sure, is 918 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 well intentioned and what it is they're accomplishing.
This is Estelle Richman, Director of Social Services. The primary reason to integrate both budget and policy for social services is to answer that specific question is, are we getting money's worth, are the programs doing what we need to do, and are we getting the outcomes that we thought we were going to get when we went into these programs? Under Social Services, we will have someone dedicated to both quality management and quality improvement that will go across budgets and across departments, because I'm not sure I could answer today that, one, we're getting our money's worth -- in other words, we know what the outcomes are -- and is the money working for us, and if any of that is being duplicated by any other department. So one of the things that will be very clearly delineated as we move forward is the quality piece of this, the outcomes piece, and the integration piece across the seven departments 919 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 that are now falling within Social Services. So we should be able, hopefully, by next year, when you ask that question, to be able to tell you, yes, we increased that budget because we were getting the outcomes that we needed and it's different than it has been before, and we aren't engaged in what I always call "historical funding," where we do it just because we've done it before.
I moved -- I moved -- I mean, when I first came here, when I looked at numbers like this, I would kind of just rub my eyes and shake my head and say, God, we're just overwhelmed with the amount of money it costs for Social Services, Children and Youth.
And one of the concerns I have is the amount of money -- and I'm not doubting that we have a responsibility to deal with these problems 'cause if we don't deal with them in one way, we're going to deal with them in another, and I recognize that. But at the same time, what I have to do is translate to those taxpayers who are 920 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 increasingly leaving the City at a rate that's far above what any of us want, is that what is it that they're getting out of their tax dollars?
This Social Services portion of our budget is a huge portion of our budget, and I mean everything. Juvenile Justice, the Courts, Children and Youth, the Health Department, it's just a large Titanic of the section of our budget.
And I'm always trying to understand what we're trying to accomplish and whether or not we're exactly getting our money's worth. COMMISSIONER MARTINEZ: Well, in terms of the fundamental question of what results we're getting for our investment, that's a very basic business question that sometimes government asks itself, but our systems are not set up in order to hold, you know, ourselves accountable once we find out the answer. So that is one issue that I think we're all going to struggle with. That being said, however, that's a 921 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 fundamental issue and is central to systems reform. I did want to give briefly an opportunity for the deputy commissioners to speak about work that is actually happening in the Department right now, which is quite cutting-edge. It's not the entire answer, but just so that Council is assured that this is not a new question for DHS. And I'd like to --
I'd just like to make a -- before the deputy commissioners begin, I'd just like to make a request. At least on these two particular pages 42-67 and 68, at sometime in the future -- not next week or -- at sometime in the reasonable future, if I could get just kind of like a short paragraph explanation of what "School Readiness" means, what their mission is, who does it, where the money goes, just so that at this time next year, when we have this same conversation, I'll have something at least that I'll know what I'm talking about when it comes to those services.
Councilman, we will be able to do that. That is clearly part of where we're going. 922 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
They had previously been a part of the Cabinet, and integrating them as we reorganize at this point. So we will be able to answer and give you the update on that.
As you may be aware or not, ProDES, Program Development and Evaluation System, has been a big investment from Juvenile Justice Services over the last five years. And the intention was to look at several sets of scales that would measure what was happening in programs for Philadelphia children -- which programs worked best for them, what kinds of services existed in some programs that were effective with kids and may have been absent in other programs that were not yielding as effective outcomes. ProDES was recognized by Harvard's Kennedy School of Government as one of the 22 innovative programs in government this year. It 23 did not make the top-ten finalists, but what it 24 tells us is whether or not our programs are 25 working. What it provides for our providers and 923 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 our monitors of services is information for fine-tuning their operations. In some cases, it has resulted in the closing of programs because folks are not meeting the outcomes that they clearly said they could deliver if we awarded them contracts for certain kinds of services. Children and Youth is going to that model in their performance-based contract. It's expensive to evaluate programs, but it is critical if we want to achieve outcomes that keep kids from penetrating the systems further.
Could I just move to one other issue, and I know I'll have to come around again, 'cause I have a few more questions. It seems that -- and this may be saying it simply -- a lot of the problems that we deal with as the result of juvenile delinquency and truancy and family dysfunction and sexual abuse and all the things that come about from that is the fact that people are having children when they're not capable of having or raising them or they're too young and are having children, and we're dealing right now probably with the second 924 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 generation of children having children, and we're moving towards the third generation of children having children. What do we do overall, in all of our programs, as it relates to family planning, birth control, abstinence, or other types of issues that would reduce the numbers of teenage pregnancies, the number of single-mother pregnancies? I mean, do we have a -- do we have a comprehensive to try to reduce the number of children coming into our city, into the world that have parents that aren't prepared?
Abstinence and pregnancy prevention, fathering skills, parenting skills are a part of every program in the Juvenile Justice contracted services program and in the Youth Study Center that we run ourselves, and I would think that Maxine Tucker would respond for the CYD Program.
And I know it's a very sensitive issue from a social, religious, other types. I mean, I have two children primarily because I can't afford three, and that's a part of what my discussion process is within our 925 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 family when it comes to how many kids you're going to have, what you're going to do, how you pay for education. And that's in a stable family with skills. How do we -- how do we translate that into the reduction of the number of kids that are coming here that aren't with parents that aren't prepared?
Maxine Tucker, Deputy Commissioner. One of the ways on the Children and Youth side is, we have a program called "the Adolescent Initiative Independent Living Program," and we subcontract with Family Planning to also do some counseling to young people, both male and female, with regard to that. We also, through our private agencies, there are counseling services going on through our purchase of service arrangement in terms of trying to work with young people in terms of our preventing planned or unplanned pregnancies.
But you believe that this is a continuous thread that goes through all of our programs and all of our approach? 926 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 Because it seems to be the crux of the problem in many ways -- in addition to the drug-abuse issues and unemployment and poverty. But that thread of children unwanted, wanted, not capable, all that seems to be the common denominator. COMMISSIONER MARTINEZ: Well, I mean, I think that, obviously, it's an issue that is critical to the future of this city and to the future of the people that live here and are committed to staying in this city. And I will say that the City of Philadelphia, from my experience even as a provider and prior to that, as a legal services lawyer, has been addressing this issue, but I can't say that we should be satisfied with what we're getting. And so I think that it goes back to the discussion of results. You know, are we getting what we paid for, who is in charge? I believe that, you know, by having Estelle Richman being Director of Social Services, it means that this city is going to be better organized to deliver a unified message. And I think that it is critical people must have information to make informed decisions about, you know, when they want to have 927 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 kids and if they want to have kids, and the message has to be effective, because we have multiple audiences that we need to reach. This is very complex work. So I will say that I believe that we are doing things, and it's an issue that's recognized. I am not satisfied with the results we're getting, and I don't think any of us should be.
Thank you, Madam Chair. I'll come around again. I'm sorry.
I just wanted to add to what my colleagues have already said, and it sort of touches on your previous question as well. We have a sophisticated contracting process in the Department of Human Services, which includes a set of performance standards. So all of our services have expectations -- explicit -- which are monitored against in terms of the very issues you just mentioned, not just the special programs we've talked about, but all of our services address the various issues you just talked about, Councilperson, and we'd be happy to talk to you more. 928 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
Yeah. I just think part of the problem is from an individual who's responsible for voting on the budget and for citizens who may be interested in understanding what's going on, that type of explanation -- granted, the space constraints -- really just doesn't tell you anything. And, again, it doesn't tell you whether or not the program's effective. COMMISSIONER MARTINEZ: Mm-hmm.
So I'll be looking forward to talking to you guys next year on what's going on. Thank you. I'd like to come around again when you're done, Madam President.
Thank you. The Chair recognizes Councilman Rizzo.
Thank you, Madam Chair. I'd like to get back to the discussion that I had early about meals and food. With Mayor Street's initiative in trying to have a better lifestyle, better nutrition for the residents of Philadelphia, what does DHS do in that area? Do we have some quality control, a dietary program 929 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 that when you feed people with DHS funds, that it's a good quality, that it's of the right nutrition for the children and adults? And now that the Mayor is really focussing on a better diet for Philadelphians, are you going to coordinate your programs with that office to assure that we in government are doing what the Mayor wants the residents of the City to do? COMMISSIONER MARTINEZ: Well, I will answer your last question first, which is, we will definitely coordinate, and we are the healthiest agency in the whole city already, for the record. But we will be healthier. Anyway, I would like Peggy Holtzman the Superintendent of Riverview, to answer the question about our standards in relation to our services to the elderly, to begin there.
Good morning. My name is Margaret Holtzman. I'm Superintendent at Riverview. We recently revised the menu under which we serve our residents. It was done by a registered dietitian whose experience is in 930 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 designing menus for nursing homes all up and down the East Coast. We're required, under State regulations, to meet U.S. nutritional guidelines for residents, and I must say that our food is really delicious. Every staff member at Riverview eats at Riverview every day also, which is a pretty good sign if people who can choose to eat elsewhere choose to eat there. It's a pretty good sign that the menu is what it's intended to be. We also, sometimes when very elderly residents are declining and deteriorating to the point where -- it's fairly predictable as people decline toward a natural passing, if they are still at Riverview rather having been transferred to a nursing home at that point, they begin to lose their appetite. And so what we do is learn what their preferences are so that if it is something -- for example, an unusual kind of food that isn't normally on our menu, we will just go to the Superfresh and buy it for them, for example.
So what you're telling me is that a certain culture would require a certain diet that you, on occasion, can 931 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 accommodate that request?
Now, what about -- I'll guess we'll leave Riverview now, and I'm glad to hear that. But what about children, what about the kids? The Frosted Flakes and all that, are --
At the Youth Study Center, a registered dietitian also reviews our cycle menus, and those cycle menus are based on the guidelines for adolescent population. There are special menus for those youngsters who have medical needs -- diabetes, those few who have hypertension, or other medical conditions that require special diets. The Medical Unit reviews them for every child coming into the Youth Study Center and updates that in their chart and works with Dietary to make sure that those needs are met.
It's good to hear and it sounds as though there will be even more coordination in an effort to have the elderly and our young people eat healthier, more -- do they get fruit and vegetables, like bananas and apples? 932 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
Just a couple of questions. Councilwoman Miller asked about family preservation and permanent placement. Are we finding more and more families not being able to maintain the family preservation atmosphere? Are you finding that more and more children have to go into placement?
Maxine Tucker, Deputy Commissioner. Actually, our placements, our overall placements, are substantially down, probably at minus 1.9 percent. Family preservation, I might add, which I think is a good thing and has produced great results, is a part of a continuum of services. For example, after that 12-13-week of 933 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 very intensive services, as opposed to just turning families loose, saying, "Okay, we've done this emergency shot and you can go on your way," we step them down into a less intensive SCOH services, and we do that until we are able to either step them out of the system through levels of services, or if they are not working in the circumstances which brought them to our attention and are not ameliorated, then we may have to remove them. But the continuum of services really gives families an opportunity to be weaned away from us, as opposed to just suddenly we leave them.
Thank you very much. You know I care a lot about family preservation.
And we talk a lot about that here in Council, and I'm really concerned that we try and keep families together, and I appreciate the services that you all do provide. My other interest is the Kinship Care. 934 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
And the Grand Central Program that's working to support families who are taking care of other's children. Are the numbers increasing where you find family members taking care of children that are not their children?
Yes. Maxine Tucker, Deputy Commissioner. We are seeing a slow rise in terms of the number of children who are in Kinship Care families. I think we're probably about at 1300 children at this particular point. It is still a viable alternative to removing children from their family system. So if I looked at what I would do with those children if they were not with Kinship Care, they would be in out-of-home placement because they absolutely cannot remain with parent and remain safely. So we are seeing some slow growth. It's not a phenomenal growth but it is some slow growth.
Just for the record, would you let me know how some of the 935 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 problems we discussed earlier about Kinship Care families having problems with the schools, physicians, and services that we found early on, how are they improving access to service?
We are improving them in two ways. One, some of the support services, like Grand Central, Kids in (unintelligible), we are looking at in terms of not only continuing to support those kinds of services, but even looking at where the expansion needs to be as a part of our assessment of what services we need to buy and at what level for the coming Fiscal Year. We are also looking at the population of Kinship families and the services in the right neighborhoods together. So what we're looking at is where our children are coming from and are there services that need to support them at a level that can sufficiently do that. So we definitely believe that we need to, and will, expand those support services.
One of the areas cited in this monitoring report was the absence of -- and, again, this is subject to discussion, I 936 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 understand that -- the lack of medical services once a child is initially given a medical exam, ongoing medical services for these children.
Maxine Tucker, Deputy Commissioner. There are some areas in which the report that has been put out in which we dispute some of the findings, and we are in the process of trying to look at where those differences are and what have you. Basically, children are getting the medical services that they need. Children are covered under HealthChoices. There are times that there may be a delay in a service, child-specific, not life-threatening, or affect their health. When a child moves from one health-care provider to another, in other words, where he lived prior to going with his grandmother, for example, may have been with another primary-care physician in another health maintenance organization. What we're trying to do, through work with our managed care unit as well as with the administration and management's medical eligibility unit, is as quickly as possible try to 937 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 make sure that, at a minimum, if a child needs an evaluation, to be able to get that evaluation and let the payment and the transfer to a more appropriate HMO catch up with them. So sometimes, there is a delay in getting perhaps a routine evaluation, but I want to stress that no child is ever at risk of a health problem or an existing health problem is not treated because there has been a change in HMO or a primary-care physician. COMMISSIONER MARTINEZ: And I want to emphasize on behalf of the Department that the children that are under our supervision and in our care should get the best health care that's available to them, both in terms of life- threatening situations, as well as preventive health care, and to the extent that we can find new ways and better ways to make sure that they get what they need, and we're going to have to work very closely with the agencies we contract with as well, because there are limits to what the Department staff can do when a lot of the services that are provided to these children are provided by other, you know, other entities. 938 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 And so we're talking about what, 300 agencies? I mean, we -- there's a lot to coordinate here. But I guess I just want to speak to the principle of the issue that you're raising, which is, it's definitely a priority, and we will continue to make sure that, you know, we move to the ultimate goal of everybody getting what they need.
Thank you, Councilwoman. The Chair recognizes Councilman Rizzo.
Yes, thank you. I have a follow-up to Councilman Kenney's inquiries, one with regards to the tremendous increase in adoptions, which is encouraging -- putting young people in a permanent home versus tossing them around in foster care. Why that significant jump? What are the 939 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 contributing factors? In terms of the detail, it's on -69, but it's also spoken in the narrative, , top paragraph.
Maxine Tucker, Deputy Commissioner. Certainly the significant increase in the number of children who have been adopted as a permanent plan, and I want to stress that adoption is just one permanent plan.
That by and large, other permanent plans, like children going back to their parents, children going with relatives.
But in relation to your question about adoption, I think a number of things have occurred. One, in terms of staffing at a level that has been sufficient, I believe just the funding of the program by the State, and certainly there's been a reorganization at the State level and in the Department. The reorganization at the State level is that they developed a statewide adoption network system, which, by and large, allowed agencies to purchase 940 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 out but purchase through the State contract and manage by the State contract, as opposed to the Department and the agency trying to do adoptions directly themselves, and did not have the ability to do recruitment, home studies, post-adoption services. It was kind of like they were trying to do everything.
As opposed to how they're doing now. So I think some organizational changes, some staffing increases, certainly some sufficient dollars to bear, have all resulted in the adoptions. As a matter of fact, we anticipate this fiscal year that we're in now completing 700, and 750 in the 2001. We're right on target for this year -- we are at 310 adoptions so far this year, and we expect by June 30th to hit the 700 mark.
That's wonderful. Another follow-up to Councilman Kenney's inquiries with regard to teenage pregnancy. Commissioner, you indicated that we're never pleased or satisfied, and we shouldn't be. Has there been a decrease as a result of the 941 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 programs that you have in place that specifically address that?
Jean Hunt, Mayor's Children and Families Cabinet. There's been a national decrease in teen pregnancy, which has been mirrored by a local decrease in the City of Philadelphia, but I think it would be a mistake to be able to say that we could directly attribute our efforts to that decrease. There are a number of factors that are involved, probably one of which is a strong economy.
It's a very good thing, but in the presence of a weaker economy, I don't know that we could guarantee you that our efforts could stem the tide. And I think that Alba's commitment and Estelle Richman's commitment to measuring outcomes of programs is really going to be required. Teen pregnancy is a very knotty problem and an extremely difficult problem. It has many, many, many causes. It is not a single-bullet 942 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 theory. And the effort to change the behavior of young women is extremely complex -- and young men.
And because it is a knotty problem, is there a layering of the message? meaning, is there a coordination with the School District, activity in the rec. centers, so that young people here are not just one entity, in addition to hopefully getting the message at home, but in the various worlds that they travel, a layering of the message, 'cause we know young people got to hear it over and over and over again before it's --
The message to young people is to "have hope for your future and to go for your goals." That's the message that makes the most difference. Young women, for instance, who are engaged in athletics postpone pregnancy and sexual activity at a much higher rate than young women that are not. So that it's a very complex piece, it has lots of parts to it.
Estelle Richman, Director of Social Services. This is another good example where it's more than one department. The Health Department 943 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 also has major initiatives for teenage pregnancy through the Office of Early Childhood and the activities that have been in place for many years in maternal and child health. So the School District has to be resolved, the recreation center has to be involved.
Again, this is some of the reasoning behind the Mayor's creation of the position of Director of Social Services, so that we can get all of these initiatives working together. It can't lie in one place. They all have to -- the policy has to apply across the board. So we will be working -- I will be working with the Department of Human Services, the Department of Health, Recreation -- and including homelessness services 'cause we have many teenage girls within those programs -- all to be able to focus on what we want as our outcome and to be able to do it together.
Thank you very much. Thank you, Madam Chair. 944 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
You're welcome. Councilman Cohen? You have no 5 questions?
No. They've been answered in the process of other Councilmembers' questions.
I just have a couple other questions. It's good to read, and we're all talking about outcomes and performances that the family initiative is working so well, as you state on the second page, at the bottom of your testimony. I used to be a member of one of the first family-to-family initiative groups up in 945 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 Germantown, and the base of information that I can remember, that program was put together because there was a very high incidence of children going into foster care in zip code 19144. So it's really refreshing to read that five years later, it's working, in terms of foster care, decreasing the number of homes that children have to go into foster care. So when you assign your social workers geographically, I guess what I'd really like to know, because it really feels good for me to read the results of something that's been happening and something good that's been happening. Could you give us data -- not today, but in the future, give us data on, for example, foster care -- extra foster care was needed in 19144, what else is needed, according to the sections of the City or by zip code? 'Cause sometimes that can help us. When I go out and when I was a part of family-to-family, everywhere I went, I tied to recruit people to become those mentors in those neighborhoods. If we have that information and we know that there's the problem and we're out all 946 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 the time all over, we could actually be a part of trying to help with the success. COMMISSIONER MARTINEZ: Mm-hmm.
And one other question I have. When you described the young person that needed someone to be with them, I guess, during their working hours, is that the wrap-around service? Is that what it's called? 'Cause the School District says they have something called "wrap-around," and I was wondering if that was the same thing.
No. I described youngsters in the Youth Study Center who need one-on-one services hours a day. But 16 wrap-around services are services that extend into 17 the community to support a youngster's needs, 18 whatever they are, once he or she returns home and 19 is living at home but may still have needs that 20 were being met by a residential placement or an 21 institutional setting. But it doesn't stop the 22 services. They are often at a lesser degree but 23 they are available all of the time with that 24 youngster. It's based on need. COMMISSIONER MARTINEZ: I would say 947 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 that -- and correct me if I'm wrong -- that the one-on-one that we're talking about is more of a security measure and to prevent, you know, harm to themselves or others, and wrap-around is about treatment and rehabilitation.
Okay. COMMISSIONER MARTINEZ: So, I mean, that's just the harsh reality of what we do at the Youth Study Center.
Thank you very much. Are there any further questions from DHS from members of the Council?
To the new commissioner, I just think this field is such an important field that it needs thorough new examinations from time to time just to review things. The Department seems to be much more stabilized than it has been over many years. 948 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 We heard stories of impossible caseloads. That does not seem to be a problem at this time? COMMISSIONER MARTINEZ: We will continue to work on that issue. It's better, but we have more work to do.
Yes, they are. Maxine Tucker, Deputy Commissioner the caseloads are lower. The caseloads are large. In intake, they are probably around per social worker, as 15 a maximum. In the ongoing services calls, the family service regents, they are around 26. And we are requesting dollars in our needs-based budget as well to further reduce those caseloads. But they are, considering how we have sat here a couple of years ago, they are quite different.
All right thank you very much. We hope the progress continues -- in fact, intensifies. Thank you. Thank you, Madam Chair. 949 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
Certainly. In fact, they were double that, if I'm not mistaken, if my memory serves me right.
And then that didn't necessarily mean in individual, it could be -- you have to treat the family, so that number could be multiplied many, many times over, which is part of the issue. And it makes it very, very difficult to deal with maybe a family of six, and that's one case, and that still exists. Is that still a part of it?
Maxine Tucker, Deputy Commissioner. Absolutely. When we talk about a caseload, we talk about two things. When you look at workload, you look at the actual number of families, so that that I identified, for 20 example, is the number of families. Conceivably, 21 the number of children in that particular caseload 22 for that social worker could be anywhere from 45 23 to 60 children. And each of the children's 24 service needs have to be addressed as a child in 25 the context of a family. 950 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
Yes, and I wanted our colleagues to be aware of that. That's still quite a big caseload. And even though it's 100 percent better than it was, it's still a tremendous caseload to deal with. And, certainly, we look forward to the days when we won't have to hear horror stories because there are not enough people to really deal with the preventive and supportive services that our children need. Are there any other questions? (No further questions.)
Thank you very much. COMMISSIONER MARTINEZ: Thank you for your time. Thank you.
And, again, congratulations to our new commissioner. And thank you, all the others, for all of that you've done over the years. Thank you. We're now going to ask the Health Department, if you will come forward. 951 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
We're only an hour behind. We just ask that you be quiet as you leave in the back for us, please. (Health Department witnesses come forward.)
Thank you very much. We certainly greet you. We want to say good morning, Commissioner Domzalski, and let me personally thank you for all that you have done -- not only with the School District issues that we've worked on in the past from McMichael School and up, but on any issue where we've called, you've been very, very supportive, and we thank you.
Certainly. All right, now we'll ask you to identify yourself for the record and proceed with your testimony.
Good morning, Chairwoman Blackwell and Members of Council. I am John Domzalski, acting Commissioner for the 952 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 Department of Public Health, and I'm pleased to be here this morning to present the Department of Public Health's Fiscal Year 2001 Operating Budget. With me is Ellen Steiker, the Deputy Commissioner for Finance and Administration. The full text of my testimony has been provided, and I will summarize that testimony.
The Fiscal Year 2001 Budget contains a total request of $995.2 million, of which 6 percent, or 58.5 million, comes from City-tax supported funds. To accomplish its mission, the Department administers a range of programs and services. These include: Disease (unintelligible) system, which enables us to identify and respond to the occurrence of communicable diseases in the city; The provision of personal and public health services in our health centers; Services directed to combatting HIV and AIDS; And services targeted to the special needs of women and children. Environmental regulatory and direct 953 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 services are also provided within the Department. In addition, the Department operates the Medical Examiner's Office, maintains oversight of the Philadelphia Nursing Home, monitors health services at the Riverview Home for the Aged, and performs quality oversight of the health services provided within the Philadelphia prison system, the Youth Study Center, and the Main Offender Processing Unit at the Police Administration Building. The investments in our public health programs have borne measurable results. For example, there has been a continued decline in AIDS-related deaths and in the prevalence of elevated blood lead in children.
Could I ask you to please speak more directly into the microphone.
Very good. Thank you. 954 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
Thank you, Councilman. And the prevalence of elevated blood lead in children has also declined. There's been an increase in number of the women receiving prenatal care and in the number of children who are immunized. And our capacity to provide regulatory and direct environmental services has improved. Mayor Street has declared this "The Year of the Child," with a goal of coordinating and more effectively directing resources and attention to the needs of Philadelphia's most promising and vulnerable asset -- its children. We know from a number of studies that many of the factors that interfere with a child's ability to succeed in school are health-related. In furtherance of the Mayor's goal and to promote school-readiness, the Department has created an Office of Early Childhood. The intent of this action is to bring health-related programs and services for children together, under one organizational umbrella. Lead poisoning causes brain damage and is the most preventable environmental risk to 955 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 children. As a result of aggressive screening, education, and prevention activities, we expect the number of children with confirmed elevated blood lead levels to be fewer than 1,000 in Fiscal Year 2001. Now, this is 1,000 too many, but it's a significant improvement over numbers as high as 3,000 a few years ago. With regard to childhood immunizations, Philadelphia was found to be one of only nine cities nationwide with immunization rates over 80 percent. Our rate now is 82 percent, a significant improvement over the 68 percent level reported in Fiscal Year '96. In recent years, there have also been improvements in our infant mortality rate and in the number of women receiving prenatal care, and the number of women who do not smoke during pregnancy. We must work to make additional improvements in these important indicators. With regard to HIV AIDS programs, Philadelphia continues to experience a decline in AIDS-related deaths, and the number of newly reported AIDS cases dropped by 11 percent between Fiscal Year 1997 and Fiscal Year 1999. To support 956 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 these efforts, Philadelphia continues to successfully compete for AIDS funding. 2 million for Fiscal Year 2001. Because this epidemic impacts minority communities most severely, the Department will continue to target more resources for service provision in the minority communities. The City Health Care Centers continue to make a major contribution to the Department's capacity to deliver public health services throughout the city. In Fiscal Year 1999, the health centers provided care to more than 86,000 individuals, who made over 320,000 visits. Sixty-three percent of those visits were made by individuals who are uninsured. In Fiscal Year 2000, the centers expect total visits to remain unchanged, and a percentage of those visits, which are unreimbursed by health insurance to increase slightly, to 64 percent. This percentage of unreimbursed visits is up from 49 percent in 1996. 957 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 We face the challenge of a growing fiscal imbalance resulting from the increase in number of uninsured patient visits. Compounding the pressure on our health center budget is the steady increase in pharmacy costs, an increase of percent per year since 1996, while the number 8 of prescriptions filled at the centers has 9 increased by 30 percent during the same period. 10 These increases have driven up City funding of the 11 pharmacy program for the past three years. 4 million in Fiscal Year 2001. The Department of Public Health also provides a number of services that have a direct impact on the quality of life of those who reside in, work in, or visit our city. These consist of regulatory and directly provided services, which range from monitoring the safety of food sold at local establishments to monitoring businesses and 958 OPERATING BUDGET CONT'D.
- BILL 05 - 2/16/00 industries that release pollutants into the air. Our objective in carrying out these wide-ranging responsibilities is to ensure that the public health purpose of the applicable laws and regulations is achieved, while conducting these activities in a way that is clear, understandable, and as business-friendly as possible. The creation in 1997 of an integrated mechanism for the management of all publicly funded substance-abuse prevention and treatment and mental-health treatment programs in Philadelphia has brought about significant improvement in the accessibility, responsiveness, accountability, and cost-effectiveness of those programs and services. In addition, the significant amount of medical assistance funds for behavioral-health services, which previously went into profit for the private sector, are now available for reinvestment in related public-health services. 2 million. The improved coordination and integration achieved through the creation of a unified behavioral- 959 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 health system has enabled the Department to work with other City agencies and with the private sector to better address previously unmet needs, such as enhanced behavioral-health services for children in the City's public schools and expanded outreach and residential services for homeless persons who also have mental illness and/or substance addictions. In concluding the summary, it's appropriate to recognize that the new organizational structure put in place by Mayor Street offers exciting opportunity for improved coordination, integration, and efficiency among City health and social services. Within this new structure, the Department of Public Health will be a major contributor to a more responsive social service delivery system. Eliminating neighborhood blight, improving the lives of Philadelphia's children, helping to make our regulatory environment more business-friendly all are initiatives to which the Department can make a considerable contribution. The people who make this department work are optimistic and committed to work aggressively to meet the challenges that 960 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 lie ahead. I thank you for the opportunity to present this testimony, and I will be pleased to respond to your questions now.
Thank you very much. Before we do, let us pause to recognize the student council 4th and 5th graders from Daroff School and certainly my friend and a teacher when I was in elementary school. Thank you. Welcome. (Applause.)
All right. Mr. Commissioner, as always, there are always concerns about the health centers. For a while, we had to focus on lowering the wait time, and then we heard there were issues of individuals with toothaches, for example, who had to wait four or five weeks to get treated, and that sort of thing. Where are we with that? And are we focusing on that? Given the explosion and the need, where are we with that? And is that a focus of yours? 961 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
That continues to be a focus of concern for us in terms of ensuring that our health center services are delivered as efficiently and effectively as possible. We do continually look at waiting times and attempt to find areas where there are inefficiencies in that and try to remove those barriers. One of the things that has helped us somewhat in that area has been the ability to provide some child-care services in the centers, which has helped make the visit to the health center a better experience for the parents who are trying to concentrate either on their own care or on the care of siblings that are brought to health centers.
Do you know what the average length of time is now?
I think I can help with that. I invite Mike Lucas, our Assistant Commissioner for Ambulatory Health Services, to maybe help with us that information.
Certainly. Good morning. I'm Mike Lucas, Assistant Health Commissioner in the Department of Public Health. 962 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
The waiting time varies by program, if you look at adult care versus pediatrics versus family planning, prenatal and dental. Generally speaking, about 70 percent of all patients can get an appointment within a three-week period. But as I said, it does vary by program.
What if you have an emergency toothache, what happens then?
If it's any type of urgent type of situation, you can walk into the health center and access care that day. You'll be triaged by a professional staff member, who will make the determination as to whether or not you need to be seen that day by a health center person, go to a hospital, or be seen the next day or at a later time.
Okay. Councilman Cohen, do you want to follow up before I continue?
I'm missing the tail-end of all of your statements. Your voice lowers, drops.
All right. Well, that's a good answer. If emergency care can be accessed immediately, that's a good answer. In terms of lead paint, do we have a handle on the groups that complain? I see Mr. Vernard Johnson -- that's always his issue and I know that's why he's here, one of them, lead paint. Do we have a handle on focussing on the need for a program in communities where you get complaints and where you see the need to do that level of investigation, and in schools?
Yes, Councilwoman. We can also share with you some maps that we've made about where lead poisoning is occurring most frequently across the City. Essentially, the hot spots for lead continue to be North and West 964 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 Philadelphia, with some extension into South Philadelphia. We think that the efforts around education, educating parents and families about how to live in a lead environment have paid dividends in terms of being able to get our lead levels, the prevalence of children with elevated lead levels down in Philadelphia. As you know, Philadelphia has a very old housing stock, and it's those houses that are occupied that were built prior to 1978, when lead paint was prohibited from being used after that date, that are most at risk. So those community education programs, particularly the programs that we were able to get assistance from community- based organization with, are extraordinarily important.
Absolutely. Where are we with immunizations as you see it in terms of these new young mothers making sure when children start school that they're fully immunized?
Well, there are a couple pieces with that, Councilwoman Blackwell. 965 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 I think one of the things that is the main factor that has helped us the immunization rates that we have in Philadelphia, 82 percent, being only one of only cities that has a rate of over 80 6 percent, is our immunization database, where we 7 can track the immunization status of children. 8 And we focus on children 19 to 35 months, and that 9 is a continuing issue with educating new mothers. One of the things, in terms of coordination of services across the board, as we look at service coordination, we look not only at our immunization program but also at some of the outreach services that are being done through the Office of Early Childhood and the wisdom of brining immunization into that office, is to be able to capitalize on programs such as the one we do have in maternal and child health of "Welcome New Baby," where every new mother in Philadelphia will be getting a packet of information about care for the newborn, including the all-important immunization piece.
Very good. And finally, my last question. Virginia Brown always been excellent in working 966 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 with our community out there in West Philadelphia. In terms of infant mortality, you know, Mantua in my area, has always broken records. And do we continue to focus programs? You know, I know some funding programs start and stop, and then we've got to come at it another way. Do we continue to focus on programs in that area to deal with those terrible records?
Yes, we do, Councilwoman Blackwell. And the infant mortality rate does vary across the city. And while we've noted our progress of being able to go from 13.4 per 1,000 live births to 12.2 in Fiscal Year 2001, that's still far too high. And it just focuses on the need to redouble our efforts about improving the health care of women, improving the health care and services that are available to women who are pregnant. I think one of the most astounding figures that I saw was in a recent survey in one of our health centers that the Office of Early Childhood conducted, which identified that a whopping 80 percent of the women in that center in that survey were smokers -- either were smoking or 967 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 were in a household or in an environment in which they were taking on board environmental smoke, which is one of the most serious matters affecting women. But it's a constellation of services, ranging from community-based organization support to services that occur in our health centers. So we've got to continue to focus on that. And while 12.2 is an improvement, it is nowhere near where we need to be.
Absolutely. Thank you. The Chair recognizes Councilwoman Brown.
Councilwoman, would you begin again. Your mike wasn't on.
Good morning. 968 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
Okay, I'd like to follow up on Councilwoman Blackwell's inquiry around lead in the schools, a few specifics, if we could. First of all, are all children getting screening for lead?
Our recommendation is that every child in Philadelphia be screened for lead. There is no acceptable level for lead, so that is the standard of care across the community, that every child get screened for lead. And we focus on not only the screening that the Health Department does but the screening that can take place in organized systems of care delivery from our EPSDT system to the health centers to the private practitioner.
Okay, well, you answered the follow-up question then. Procedurally what does that mean? So at whatever point young people are being touched, that becomes a part of the itinerary of services that focus should be given.
Absolutely. 969 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00
Okay. You say in your testimony that there will be fewer than 1,000 children confirmed for this fiscal year, correct?
What kind of treatment is done once that happens, once you identify a young person or a child who how has that? Procedurally, in terms of the system, what happens?
What I'd like to do, first of all, as I'm answering the piece of this, I'll ask Dick Tobin, our Director of Lead Poisoning, to come up and join us. But just in general, the level of intervention, it escalates from, say, 0 to 9. The way it's measured is in micrograms of lead per deciliter of blood. And the action level in Philadelphia at this point is -- we're using the 15 microgram-per-deciliter level. But even at the or microgram-per-deciliter of blood, our recommendation is that there be anticipatory guidance being provided by either the nurse or the 970 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 pediatrician in relation to the kinds and the sources of lead that may be in the household and in the community for people to look at. As the level increases, there is more significant medical intervention that's sometimes required.
You mentioned West Philadelphia and North Philadelphia as hot areas, if you will?
Should we assume from that that the other areas of the City are pretty much covered, rescued?
No. Some of it has to do with the age of the housing there and the sources of lead.
Okay, let's move on. Again, a follow-up to Councilwoman Blackwell's question regarding the immunization.
And hats off to the dramatic improvement that you have experienced there. On of your testimony about health centers being what we would like to think 971 OPERATING BUDGET CONT'D. - BILL 05 - 2/16/00 as customer-friendly?