We had a total of seven providers who were an awarded funds. Out of those seven providers, three are minority controlled, one is woman controlled --
BABASHI, GALAEI and Philadelphia Minority Providers were awarded funds under that process.
You asked me for the names of the organizations? 1530 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: Say it again.
GALAEI is an acronym. COMMISSIONER DOMZALSKI: How do you spell that?
It's GALAEI. It's Gay and Lesbian Aides Education Initiative. It's a project through GPUAC that is serving Latino communities, gay and lesbian in particular. BABASHI received funding out of this process.
If you had a million dollars and you gave $500,000 to one agency, how much did the others get?
I can get the breakdown of the funds between the organizations for you. Some of the money that we awarded out of the street immediately because we were clear from Senator Hughes, the instructions 1531 03/23/05 - FY '06 OPERATING BUDGET were that we needed to provide services and to provide them now. He wanted some services to begin immediately. What we said is it is our normal process to have competitive processes so we can begin some services now and we want to put competitive process on the street to make linkages for the first time in minority youth through the DHS system and the Aids system so that we could begin serving new groups of minority youth with these dollars, and the Senator agreed to that.
Well, what we'd like to see is the breakout of the million dollars, the groups that got the money and the areas that were served. COMMISSIONER DOMZALSKI: We'll get that right away.
Thank you. I would like to follow-up on Councilwoman Tasco's line of questioning. There was exhaustive testimony and questioning 1532 03/23/05 - FY '06 OPERATING BUDGET and inquiry around this issue last year. And let's say for the record now that next year there will be additional discussion, so all back up information related to number of providers and number of that percentage of minority and number and identification percentage of women and number and identification will be asked next year so that we don't have to wait for the information and wait until it gets back to the office when we're into another department. Back to Steps. There's another point I need to make about the whole application process, because this was discussed last year as well. We appreciate and we need the technical advice, the TA that you provide to applicants. That's a part of the step. The goal is top move those minority and female-run providers to a place where they are at capacity to be a qualified applicant to receive dollars from the Department of Health. So the provision of the service is important, but the goal is to move them so that they can be boni fide applicants for dollars with RFPs 1533 03/23/05 - FY '06 OPERATING BUDGET that come through the Health Department. COMMISSIONER DOMZALSKI: We want that to be sustained.
And we know that you've met those kind of challenges before you did it very, very successfully with the lead poisoning program. You put a task force in place, you met for two or three consecutive years, and now lead poisoning has drop dramatically. That's really the kind attract we want to see on this issue as we go forward. COMMISSIONER DOMZALSKI: I think we can certainly commit to that, Councilwoman.
The request will also be made of the centers, the health centers and the wait for mommies or mommies-to-be. You mentioned that you brought together professionals, OB/GYNs together to take a laser beam look at the long wait that's happening in health centers and the why. So what are the next steps for that? Because that's the same type of approach you took with the lead poisoning control and prevention 1534 03/23/05 - FY '06 OPERATING BUDGET program for children, and we see some very demonstrative results. So what is the next step with this task force of professionals that you're pulling together to deal with the issue of long waits for pregnant women? COMMISSIONER DOMZALSKI: I'd like to take a step back and look at what our current estimates are, our current weights are at the various health centers for appointments. This is for a new patient. And this is as of the week much March 21st. At Health Center it was days. At Health Center 3, it was 12 14 days. At Health Center 4, it was 4 days. And 15 Health Center, it was 10. And then the largest wait was at Health Center 9, which was days. And a couple of things there, one is 18 certainly, we rely on people board certified 19 in OB/GYN to deliver this care. We're also 20 reaching out to midwife practices to make sure that we incorporate them in our setting as well. And I think, to the extent to which we could increase our capacity in the centers themselves by doing things more in a group way, not the stuff that would compromise 1535 03/23/05 - FY '06 OPERATING BUDGET patient comfort or confidentiality, but the kinds of educational things that we might now do on a one-on-one basis that we think we can do in a group setting. We think that could increase our capacity to see patients as well. It's not going to be a panacea. The City's health centers are never going to be a panacea for the problem with the availability of obstetrical care in the City of Philadelphia. We just don't have the physical capacity do that.
That's recognized. However, the point I'm trying to make is, when there was a very focussed laser beam strategic kind of thought process, it lead to a more favorable result. And I hear you saying that you have pulled together professionals, OB/GYNS who live and breath the issue every day, so the hope and expectation is that something that tangible in terms of an improvement will come out of those meetings so that next year we have a different lineup of the wait list for pregnant women. That's the ask. 1536 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: You know, with lead, we knew what the end point was. The issue here is more complicated by the fact that the what's driving the system is the reduction in support for care for women who are uninsured. That is the crux. You know, we talked a little bit about some of this. That's where we're going to have to get together as a City on this. We have to sit down and talk about the fact that, look, we've got 20,000 deliveries in the City every year. We take care of 10 percent of those in the City health centers. Where else are these women getting cared for? And if it's a money issue, we're all spending money on it anyway. Because if we're not going to deliver pre-natal care to uninsured women, sure enough we're going to deliver labor and delivery services at the end and perhaps a far more complicated medical situation than would have been if the person got care. So I agree with you. I hear what you're saying, Councilwoman.
And know that I will one, among others, who look forward to 1537 03/23/05 - FY '06 OPERATING BUDGET how far we've moved in resolving this issue of the long wait for pregnant women months 4 from now. 5 On the issue of money, in your 6 testimony, -53N, public health, 7 communicable disease medical services, tobacco 8 control programs, are those grant programs or 9 General Fund. 10 COMMISSIONER DOMZALSKI: Grant 11 programs. 12
Okay. Talk to me about the $609,975 for the Philadelphia Health Management Corporation advertising campaign program and data evaluation. And the reason why that number jumps out at me is that is the second largest grant on this page. Grant from whom? COMMISSIONER DOMZALSKI: This is the tobacco grant.
More than a half million dollars went to Philadelphia Health Management Corp. COMMISSIONER DOMZALSKI: That's for -- our tobacco people have a horrible way of 1538 03/23/05 - FY '06 OPERATING BUDGET describing it. It's for counter-marketing advertising, health education. Essentially what we do with that contract is buy advertising that we think is going to work. I will tell you it's something, I think, that we have to do. We've made some changes in the some of the avenues that we used. I'm not a big fan of billboards and that kind of thing. So that's what that's about.
And I need to clarify the number. That was fir FY 2004. FY '05 it was 442,000, and the obligation level for Fiscal '06 is 305, so we need to make sure the numbers are accurate for the record. So the bell has rung and I'll wait my turn next time around. COMMISSIONER DOMZALSKI: Thank you.
Commissioner, we have had and we've presented a bill in City Council that still hasn't come up for public hearing on the issue of immigration. And I went recently to the Northeast health clinic. I believe it was on Cottman around Bustleton. 1539 03/23/05 - FY '06 OPERATING BUDGET And also the Fourth and Girard Avenue that you and I are very familiar with. And there were a lot of people there that were very limited English proficient. They spoke very little English or no English at all. The health clinic up in the Northeast tells me that around approximately half of the people that go into that clinic are immigrant people from eastern Europe, from Russia, from Spanish-speaking countries, the Caribbean, and also from Arabic countries. And I saw the same thing at Fourth and Girard Avenue. And I know that probably the one at Broad and Lombard and the one around 57th Street in West Philadelphia is probably having the same type of influx of immigrants coming to our public health clinics. Are we keeping any official documentation of how many immigrants are coming to use our clinics? Are we keeping documentation on how many of the immigrants are undocumented? Are we doing any of that at this time? COMMISSIONER DOMZALSKI: Yes. We 1540 03/23/05 - FY '06 OPERATING BUDGET steer away from the documentation stuff. We do have keep records from a language perspective. First of all, it's a wonderful thing. When you just look at the array of language groups that come and use our centers. There are some language groups that we now 8 know use our centers actively. 9 At Health Center 10, 25 percent of 10 the people who use that health center speak a 11 language other than English. And at Health 12 Center 6, 40 percent of the persons who use 13 Health Center 6 speak a language other than 14 English. So a big part of our service 15 delivery structure is to find language 16 communication support to provide for our 17 health centers, both in the form of physical 18 interpretation services as well as in using 19 technology such as the language line. 20
Are you saying 21 that we have statistics that indicate that 25 22 percent of the people that come through Health 23 Clinic No. 10 in the Northeast speak another language besides English? COMMISSIONER DOMZALSKI: Yes, sir. 1541 03/23/05 - FY '06 OPERATING BUDGET
And we have how many people that amounted to, a hundred, a thousand? Do we have those type of numbers? COMMISSIONER DOMZALSKI: We do.
I think that for many reasons for those that are very much in favor of certain reforms in our immigration laws that there are federal issues and then also for the critics of us being too lax on immigration, when I mentioned the word undocumented you said you didn't go there. But do you think we might want to start also keeping count on how many undocumented patients we're getting in our health clinics? COMMISSIONER DOMZALSKI: We're trying to reduce the anxiety in our patients. First of all, we don't want to chill care-seeking behavior on part of our patients by the fear that some information that we may have about their immigration status might be given to John Ashcroft or his successor. Also, a big part of this as well is to encourage people who may not have been born here and may be here under a variety of 1542 03/23/05 - FY '06 OPERATING BUDGET authorizations who have children after their arrival, that those children are citizens of the United States and are eligible for medical insurance. And often times persons such as I've just described will shy away from accessing any government service for fear that their whole issue of how they got here and all the rest of it would come into question. I'm understanding you and saying that we want to and we'll work with you and take any suggestions you have as to how we might use the data that we have in a way that gets the issue out there that shows just how international this wonderful City is and the fact that we have many, many needs among the new Philadelphian population.
I know what you're saying, and I respect your opinion on it. I think it might be, at least in my view, a good idea to see how we can do this. I sent to an e-mail to see if I could get a legal opinion. I haven't gotten it back fast enough. If there's a way that we can, in fact, we do this without creating fear, the 1543 03/23/05 - FY '06 OPERATING BUDGET human element, without also having to have documentation that would indicate, but if I came as an undocumented patient to Health Clinic No. 4 that there would be a way for you and for us to know that X amount of the people that we're treating in our clinics are people that are undocumented. We don't need necessarily to put it on their record. The records in the health clinics are private as well. But if there's a way we can start to compile information to see if, in fact, Philadelphia is becoming a destination for immigrants and within that immigrants there's this percentage of undocumented people that are now also taking advantage of publicly-funded healthcare -- and of course, we all know there's a big national debate on this issue, pros and cons. And I know that our health system here in Philadelphia, our public health system has been very caring for people that are coming to this country looking for a new way of life. I think we should consider the idea of keeping statistics that will indicate that also where they're coming 1544 03/23/05 - FY '06 OPERATING BUDGET from. If we're going to go and do more for immigrants in this City and hoping that they stay in this City for all the positive reasons, then we're probably going to need more documentation. COMMISSIONER DOMZALSKI: We'll be excited to share that, just the list of countries of origin is just so impressive. The Managing Director Phil Goldsmith, his Global Philadelphia actually did a tour, took all the department heads to various neighborhoods in the City. And you think if you lived here you know them and, of course, you don't until at the end of that day to see everything from the burgeoning Mexican community on Washington Avenue to actually my first visit to a Mosque in the Health District 6 region, and to say nothing of the Vietnamese and Cambodian communities that we've gotten to know through the Mayor's initiatives, it's a wonderful thing. You can really, truly go all around the world without leaving the City.
So you and I will work on seeing if there's a way we can start 1545 03/23/05 - FY '06 OPERATING BUDGET documenting where people are coming from, what countries, and also a way that is fair without getting too tangled up in the dispute and the different opinions on undocumented people here. COMMISSIONER DOMZALSKI: Absolutely. We'd be pleased to work with you, Councilman.
Thank you. The Chair recognizes Councilwoman Miller.
Thank you, Madam Chair. A couple quick questions, Commissioner. One, do you have a brochure that describes all the Health Department programs? Because you have some really good programs in the Health Department. COMMISSIONER DOMZALSKI: Thank you. Yes, and we do. We'd be happy to give you a good supply of those.
I don't know that the public knows. The only reason why I 1546 03/23/05 - FY '06 OPERATING BUDGET know it is because of the Five-Year Plan and testimony in the budget information. I also want to thank you for being so available and being just a good resource to my office. I think I've been learning a lot. These meetings that we've been having in my district about the raccoons and opossums and all those terrible things. COMMISSIONER DOMZALSKI: Yes, ma'am. Thank you.
Is there a Healthy Start Program in the Northwest? And has the infant mortality rate in the Northwest started to decline? COMMISSIONER DOMZALSKI: Not fast enough. Northwest is one of the areas that we continue to be concerned about, particularly as you look as a map of Philadelphia and you look straight up from City Hall to where the Y is and just a little bit to left of that and some parts of my neighborhood, 19144, continues to be a concern for us. And I will tell you that without going on to a long discussion, but we're learning something about 1547 03/23/05 - FY '06 OPERATING BUDGET how babies die in this City. And I want to be just very clear that I was not in the forefront of getting my arms around this co-sleeping business. I mean, somebody had to pull my coat on it a couple times, and then I needed I guess every now and then I had to get hit with a 2 by 4. And then I began to focus on this. And right now when we have an infant death, there are several of us get calls from the medical examiner's office no matter what time of night or day it is, and I'm one of them. And what we do is subject every one of those to a multi-disciplinary review, including the Department of Human Services. And what we're finding is just the difficulties that mothers are having, particularly young mothers -- I can tell you what we're learning about probably is no 20 secret to the people over Joanne Fisher and the Maternity Care Coalition, no secret to them at all, but what we're doing is institutionalize this information to be able to develop approaches to this. And one of the reasons we've got these OB people together is 1548 03/23/05 - FY '06 OPERATING BUDGET that we were seeing this issue of co-sleeping where adults are in a bed with an infant. And they're not in that bed with an infant because they've got other choices. What we've been seeing is very difficult situations. An 7 year old mother whose baby died, they were in 8 the bed with five other people. One of the 9 adults rolled over the on the five-week-old 10 infant and smothered the child. When we went 11 in and looked at that, the housing conditions 12 -- first of all, the mother had a lot 13 involvement with the law and various 14 activities. This was her second child. So 15 her first child, she might have been 15 and 16 there were just so many issues in that family 17 that really focus us on the broad need of 18 public service, public health, public welfare issues that need to be brought to bear and why we want to know about high risk infants as we define it and we've communicated to hospitals when we're discharged so we can make an intervention.
So when you do the intervention, since you brought up the 1549 03/23/05 - FY '06 OPERATING BUDGET family, do you do referrals to other social service agencies? COMMISSIONER DOMZALSKI: Yes, yes. As you mentioned, we have a wide variety of programs. Often times we don't organize them in the most effective way, and there are some parts like our families program that could be available to a high-risk mother. The better news on this is, or equally good news is that Healthy Start North has been expanded to the Northwest. So we're going to be able to provide some more services in that important area.
Now Healthy Start North actually comes -- I think I read in the book, Temple? Who's running Healthy Start North? Is it Temple? COMMISSIONER DOMZALSKI: I don't want to misstate this. Kate, you want to talk about this?
I'm Kate Maus, Director of Maternal Child and Family Health. We run the Healthy Start North program. As the Commissioner indicated, we recently received 1550 03/23/05 - FY '06 OPERATING BUDGET an increase in funding so that we're now expanding the program into the northwest area.
AND what are the boundaries? When you say expanding into the Northwest, are you going al the way to the city limits.
We're going all the way to the city limits. One of the areas that we looked at was Cedar Brook and Oak Lane area where our infant mortality and other poor indicators of child health have been getting worse. And that was the justification for our asking for an increase in money and moving the program to include those areas of the City. We contract with Jefferson Hospital to help us employ the staff, but we run the program.
So when you say Cedar Brook and West Oak Lane, those are zip codes 19150, 19138. What about 19144?
Yes, we're definitely in 1551 03/23/05 - FY '06 OPERATING BUDGET 19144. We're in the process of holding community meetings in order to assemble the necessary consortium to help us run that program. Those meetings going on right now.
Councilwoman Tasco and I share that area. We'd like to get some information on exactly what program and services and prevention and educational materials are going to be available so we can also have those in our office when we attend community meetings and help spread the word. I have one more question.
Are these the meetings that you called to ask us to attend at the various sites? There was supposed to have been one Monday.
I think that you're co-hosting one with us to get the word out into the Northwest that Healthy Start is 1552 03/23/05 - FY '06 OPERATING BUDGET expanding and that we're looking to involve community in whatever way we can, as we've done in the central part of the existing part of Healthy Start North. We've got a very strong community consortium that is getting the word out to that part of the community. We now need to -- since we're expanding into the Northwest, we need to do the same community organizing effort in the Northwest. And we'd be happy to provide you with materials describing Healthy Start, describing our Safe Program which is also in your area.
Thank you. Thank you for that. I think you heard once that the Health Department was funding some violence prevention programs. Is that true? Did I hear that right? COMMISSIONER DOMZALSKI: I think we do such a little bit, unfortunately, in that area that it would be inappropriate to say we're funding programs. Under the leadership of Julia Danzy, the Director of Social Services, a work group is convened to begin to 1553 03/23/05 - FY '06 OPERATING BUDGET get the agencies that are non-public-safety agencies circled and focused on the issue of violence. Our task as part of that team in the Health Department will be to provide the support of an epidemiologist to understand just what are the factors that lead a child to get into a situation where she or he is either a victim or shooting someone or inflicting serious injury and what steps along the line could conceivably be taken to intervene in that process. So I think this is the first time we've had a social service focus on this, and I'm very excited about that. But no, we don't fund that.
That's under the Youth Violence Prevention Partnership? COMMISSIONER DOMZALSKI: What I've just described with Ms. Danzy, that would be part of it.
You're welcome. 1554 03/23/05 - FY '06 OPERATING BUDGET The Chair recognizes Councilman Clarke.
Thank you, Madam President. Good afternoon. COMMISSIONER DOMZALSKI: Good afternoon.
Real briefly, I understand that there was a revelation earlier in the testimony about the Philadelphia Nursing Home. COMMISSIONER DOMZALSKI: Yes, sir.
I will not beat you up in public because of the lack of notification. I can't promise you what will happen behind close doors. You have been a good Commissioner, so... COMMISSIONER DOMZALSKI: Understood and well taken.
What we'd like to do, because I'm assuming we'll get a call and we'll set a briefing up first for the District Councilperson and subsequently I'm assuming that you would like -- 1555 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: Councilman, just as soon as you would like to do that, I will do it. In this setting, I'd like to apologize to for not having had an in-person conversation with you on this.
In preparation for that briefing -- were you here when this particular contract was let? COMMISSIONER DOMZALSKI: Yes, sir.
So you have some knowledge of that? COMMISSIONER DOMZALSKI: Yes, sir.
In preparation for the meeting between you and I, can you recreate the process that was in place to determine the selection of that particular provider? COMMISSIONER DOMZALSKI: Sure. Should I give quick describe now?
You can do it here, but I want to have a little more in depth discussion. COMMISSIONER DOMZALSKI: We had a review team that had providers, advocates, 1556 03/23/05 - FY '06 OPERATING BUDGET financial people, regulators, to see what did we need to build in and what were the weak points of these proposals and things that we weren't really aware of that we needed to ask further. So essentially, ranged the proposals based on various aspects of what we were concerned about and did a score and then did an award based on that. I can really lay that out for you when we get together.
I'd be interested in seeing how that process worked. Are we anticipating replicating that process to any degree? COMMISSIONER DOMZALSKI: Yes. It seems just, I think, the field of people who are interested in this is narrower this time than it had been then. There's probably some reasons for that that we can go into in terms of just what's going in the long-term care industry and why people are getting out of the business and some of the strictures that are occurring with regard to the major funding sources such as medical assistance. I think it may not be quite as large a group, but I 1557 03/23/05 - FY '06 OPERATING BUDGET think the people that we need whose view points we need and expertise we need will be included.
Has the patient/clientele changed dramatically from the time in terms of categories from this particular contract being let years ago versus currently? COMMISSIONER DOMZALSKI: Somewhat. But the Philadelphia Nursing Home still distinguishes itself by having a much higher percentage of persons under the age of 60 than any other nursing home in the City and certainly in the industry. So we have that large group of people. We also have a fairly large group of individuals who have behavioral issues that we need to structure some services for. And on the younger patients particularly, it seems like if we were to take another look at this -- unfortunately, places like a nursing home, the Philadelphia Nursing Home and others are looked at as a destination instead of a stop along the way to independence or to a less restrictive 1558 03/23/05 - FY '06 OPERATING BUDGET environment, so to make assess and try to make available more community-based care for these residents is something that I think we all would want to do.
Does that in any way cause an environment where they may be more difficult getting the appropriate or a larger pool of particular providers because of that type of clientele? COMMISSIONER DOMZALSKI: Yes, they do present issues. And as the funding for medical assistance becomes uncertain, you know, the whole press at the state level is to reduce the number of long-term care beds in the state because they've got 70,000 beds that makes up 65 percent of the total medical assistance expenditures. I mean, I'm sensitive to that, but our responsibility here is to make sure that our residents have the care they need. And if the care they need is in the nursing home, then that's where they need to be. If they can served in the community, and increasing numbers can, then we ought to be able to do that as well. I think 1559 03/23/05 - FY '06 OPERATING BUDGET it's both economically and service better.
In this particular state budget that's being formulated or proposed is there an additional cut in resources that will ultimately trickle down to this issue? COMMISSIONER DOMZALSKI: There are all sorts of proposals to reduce medical assistance coverage. The eligibility won't be interfered with. But the limits that we've heard are limits on the number of prescriptions people can get, limits on the number of hospitalizations people can get, limits on the number of doctor visits they can get. So far, we don't see, other than the desire on the part of the Commonwealth to reduce totally the number of beds, we haven't seen specifics about reductions in the reimbursement piece.
In the Commonwealth's desire, do they talk about alternative strategies? COMMISSIONER DOMZALSKI: For nursing home care? 1560 03/23/05 - FY '06 OPERATING BUDGET
Yes. COMMISSIONER DOMZALSKI: There are a whole range of people that can be maintained in the community. The only thing that separates them one from the other is how much community support they need. At the easy part of the continuum, there are individuals who may be connected with family and whose family is on the scene and part of their lives, and all they need would be some physical therapy in the home, some of that kind of care. At the other extreme are individuals who need such heavy care ranging from not only physical therapy but meals and housekeeping and actually to be fed, and so those individuals become more challenging to find an alternative to an institutional setting. Then there's the vast group of people that are in the middle that under the right circumstances and creating resources in the community such as housing, similar to community living arrangements and those kinds of things, if they're supervised and structured well, they can very effective in providing not only 1561 03/23/05 - FY '06 OPERATING BUDGET better care but an improved quality of life for people.
All right. I'll await your call. COMMISSIONER DOMZALSKI: My apologize again, Councilman.
Thank you. The Chair recognizes Councilman Rizzo.
Thanks for your good work and the people that work with you. COMMISSIONER DOMZALSKI: You're welcome, sir.
I just have a curiosity question about the problem that we had about the flu vaccine last year. As you know, we had lots of conversations about that. Was there any deaths as a result that the Health Department's aware of, of people that died because of the lack of flu vaccine at the early stages? COMMISSIONER DOMZALSKI: First of 1562 03/23/05 - FY '06 OPERATING BUDGET all, on death certificates, influenza is very rarely listed as a cause of death. But what we know is that every year there are 36,000 deaths in the country and about 114,000 hospitalizations. We know that we had -- we determine how much flu is in the community by using sentinal hospitals around the City, so we have a sense of that. In terms of deaths, there are two deaths that we know of where flu was a major contributing factor. And in both of those deaths, they were children.
And they wouldn't have gotten -- that was not because they were not able to get the flu vaccine, or is it? COMMISSIONER DOMZALSKI: There would have been vaccines for children.
There was vaccines for children? COMMISSIONER DOMZALSKI: There was.
Since the Feds and I think the State are involved in the process, and we know what happened with a bad lot of vaccine, what have they done to assure that the goal of 80,000 that I think you had 1563 03/23/05 - FY '06 OPERATING BUDGET projected for Fiscal Year 2005, what are you projecting for Fiscal Year 2006 and are you confident that this problem that developed is now going to be dealt with? COMMISSIONER DOMZALSKI: No, I don't think anybody can be confident that the problem is fixed. Throughout this whole mess, and that's what it was, I mentioned earlier that last year we gave 30,000 doses. We got 30,000 shots into people's arms. Despite the mess this year, we were able to get 59,000 doses into people. But it wasn't without a lot of sweat. And as a result of that, because we took people up -- when Tommy Thompson got on television and said, "There's no problem with flu vaccine. If anybody's got a problem with flu vaccine, they ought to get me a call," I called him. They didn't know what to do with the call. So they sent people around the country to explain all this and the rest of it. What came out of all of that is the need to communicate with local health officials because the people at the local level had no idea what was going on. We had 1564 03/23/05 - FY '06 OPERATING BUDGET no idea how decisions were being made. And I've heard from a local administrator here for health and human services that that is a clear focus for this year to improve that communication. It had nothing to do with the supply, though. We had two manufacturers last year. And something's going to have to happen so that we encourage people to get into the vaccine manufacturing business it's only good for one year, and one year is maybe about four months. If you haven't used it all then, you can't sell it to anybody after that. And there needs to be some adjustment in this in order to keep an adequate supply of flu vaccine available for people.
Thank you, Commissioner. I know you'll keep us posted on this process. COMMISSIONER DOMZALSKI: Yes, sir.
I have a question about air management. I don't think I'm talking to the right department, but maybe I can be enlightened about a program. A 1565 03/23/05 - FY '06 OPERATING BUDGET constituent e-mailed me about a program in service stations called vapor recovery. I don't whether your department is involved or it's an L&I issue. COMMISSIONER DOMZALSKI: We are.
Well, I've noticed myself and after I was asked the question, the light bulb went off and I said I notice exactly what this person asked me. Many service stations today in Philadelphia, the pumps that recover the vapor, they've either thrown them away or they've just put the regular old nozzle back on and there's no vapor recovery system. I assume that that's valuable program, vapor recovery? COMMISSIONER DOMZALSKI: It is.
And who monitors the fact that service stations have the proper nozzle on their dispensing pumps to recover vapor? COMMISSIONER DOMZALSKI: I stand to 1566 03/23/05 - FY '06 OPERATING BUDGET be corrected by Morris Fine, but I think we do. In fact, we have done an extensive program to do educational work with the gas station operators. This is called Stage 2 recover, including producing a brochure that talks about the different requirements on different parts of the year.
Is Mr. Fine in the audience? Would he please approach the witness table?
I was noticing that it was just an old dispensing pump. I don't want to make a big deal about a program that's not maybe not effective, but if nobody's monitoring it, that's not good.
I'm Morris Fine, Director for Air Management Services. There are several different kinds of systems that are used for Stage 2 vapor recovery at the gasoline stations. The ones that that work purely on the displacement of the vapor, meaning that when the tank empties 1567 03/23/05 - FY '06 OPERATING BUDGET as the car is being filled that the level going down in the tank results in a suction that brings the vapors back into the tank. Those nozzles require a boot, so you'll see a boot on those nozzles. And if the boot is not there, then that's a violation and we should be called and we should have our number on the pump. If the pump doesn't have our number, then we would need to know about and we'd make sure that they would it put that on. There's another system. It's call the vacuum assist system. That does not have a boot. When the car automobile is being filled, it kicks in a vacuum assist that draws the vapors out. That does not require a boot. So it's not necessarily a violation if the boot is not on, it just means they're using a different system. And our inspectors do monitor that.
So the fact that you're losing people, that's one program that I would think might not be as attentively inspected in the future?
Well, we try to do 1568 03/23/05 - FY '06 OPERATING BUDGET everything.
L&I has their own regulations on underground storage tanks, but the actual Stage 2 vapor recovery, that's done by Air Management Services.
I would just like to make a very brief announcement. I know that people have been waiting from CBH to testify. I am going to suggest that we conclude the testimony from the Health Commissioner with the Councilmembers that want to be recognized now and we'll recess for a half hour. The Chair recognizes Councilwoman Tasco.
Commissioner, since we just got this Executive Order, you probably haven't had an opportunity to read it. COMMISSIONER DOMZALSKI: Yes, ma'am, 1569 03/23/05 - FY '06 OPERATING BUDGET I have.
I just want to point out to you that on Executive Order, there is a provision in there for non-profits. And what I'd like to know is although they are not subject to the procurement program, there are requirements that they have to follow. So I'd like to know who will be your point person on this? When do you plan to meet with MBEC to discuss how you follow through on this, set up the procedures? And when you do that, I would like to, with the permission of the President, ask that Howard Rye of the Council staff who has been working with MBEC and with us to be a back part of that Committee. COMMISSIONER DOMZALSKI: Absolutely. You know, one of the things we have to do -- the new Managing Director pulled us all together yesterday. And the reason I said I read it is because we had it there. The section you refer to is Section H. It's something that we're tasked to do. The Managing Director is dead serious about this. 1570 03/23/05 - FY '06 OPERATING BUDGET So the onus is going to be on us to go out and implement that and not depend on some central agency to tell us what we need to do. And on those requirements that are in there that has to do with reporting, as I recall, report of composition Board of Directors and variety of other things that are required to be reported. So we're just organizing that. In all candor, Councilwoman, I can't tell you who my point person is going to be on that. I'm it right now, but that will change quickly when we talk among my deputies about who's the best to be, and we'll keep you posted.
And we would like Howard Rye who is Council policy person on minority MBEC program. COMMISSIONER DOMZALSKI: I'm sorry. Who?
Howard Rye, R-Y-E, to be part of your discussion. COMMISSIONER DOMZALSKI: Okay.
So that we can be kept in the loop. I think that's the only question I 1571 03/23/05 - FY '06 OPERATING BUDGET have. One other question about the HIV. We know that the increase in HIV/AIDS is rapidly increasing in the minority community, but the education prevention services are not really aggressively located in the community. They're more in the Center City area. How do we reach out and get out into the broader community where there are HIV and AIDS programs, especially around education and prevention? Just how is that done to reach the broader community? Because our broader community is not in Center City. COMMISSIONER DOMZALSKI: I think through wise choice of community-based organizations to do this. I can think of two one is certainly BABASHI and organizations like that that do great education and help us get out there, not only in their offices but across the venue. I was with Gary Bell, we did a program last summer out of a couple of rec centers. In addition to that, we've got Reverend Wells organization called One Day At a Time up on North Broad Street, and we've got 1572 03/23/05 - FY '06 OPERATING BUDGET One Day At a Time South down at Broad and Lombard. These organizations do a tremendous job of getting people in the hard-to-reach communities, communities that are not traditionally connected with the broad range of social service organizations or medical care facilities. So that's where we've got to get to. And the thing that concerns me is a figure that we've talked about in my shop, and that is the age is only the tip of the iceberg. The whole other thing that's floating out there is HIV infection. And we only do about 30,000 HIV tests a year. We've got to tremendously expand that. Our AIDS Activities Coordinating Office under the leadership of John Cella and overseen by Joe Cronauer has some ideas, but we need to press it more. And I will tell you, if there are organizations or if there are venues that Councilpeople see in their districts which sounds like that would be a venue -- one of the areas we do a great job with, I think, is up at 5500 block of Germantown Avenue right across from the Y where we developed a 1573 03/23/05 - FY '06 OPERATING BUDGET storefront where people can come in and get a variety of services, including not only HIV testing, but a connection to care. And those are small things that are effective. We need to do much more.
You told, I think, Councilwoman Brown that the Philadelphia Health Management Corporation do a lot of marketing and outreach. Who do they partner with? Do they partner with local neighborhood newspapers to market and get the information out? Or do they just go to the big boys? COMMISSIONER DOMZALSKI: We buy advertising -- one of the areas the tobacco program advertises is billboards. They do community newspapers. And we've made a change in what we're doing with that. I don't have a problem with some of the just main stream community newspapers, but we ought to get out there where we know people smoke and we've got to get the word out.
What is your direction to them? Do they get the money? Do 1574 03/23/05 - FY '06 OPERATING BUDGET they have to submit a plan how they're do outreach? COMMISSIONER DOMZALSKI: We review the ad plan.
Is the plan sufficient for you? If you say we need to get out there, if it's not sufficient, what do you do about it? COMMISSIONER DOMZALSKI: We have them change it.
Could we get a list of their marketing plan? COMMISSIONER DOMZALSKI: Absolutely.
You're welcome. The Chair recognizes Councilwoman Brown.
Thank you, Madam President. First let me commend you on the enormous success you've had with the STD effort and the difference that's made 1575 03/23/05 - FY '06 OPERATING BUDGET particularly in our schools. That's just another example of how when your department and your leadership focuses on something there's an improvement in the outcome. COMMISSIONER DOMZALSKI: Thank you.
To that end with the Steps Program, could you submit to the Chair the list of schools benefiting from the Steps Program? Because you did mention that it's not City-wide, for reasons we understand. So to know where they are would be useful. COMMISSIONER DOMZALSKI: Absolutely.
When I look at the provider agencies, I see here the 17 College of Physicians which has a $33,000 18 contract estimated for FY '05. Knowing that 19 they are not neighborhood based, speak to me about how this fits into the mission of Step. And when I look at what it's used for, which says here, "promote healthy behavior through Internet site," knowing that many of our communities are neighborhoods where parents don't own computers so that their children can 1576 03/23/05 - FY '06 OPERATING BUDGET access the Internet. So help me; bridge that for me. COMMISSIONER DOMZALSKI: This is an Internet device developed over at the College of Physicians called Philly Health Info. It's the sort of thing -- they would come up and talk to me about this program, and it sounded an awful like Web M.D. to me, but it's more than that. It's the kind of thing where very specific health information can be obtained by accessing this portal. We've connected with libraries. One of the libraries that where this was piloted was connected with Health Center 10, which is the Northeast Regional Library. It's using that to get out the portals into the community for the health information. You know, Councilwoman, I think it would be useful if you would have the time and interest to kind of walk you through that.
I'll take you up on that, in terms of community neighborhood activity. So is Health Center 10 the only one or is it City-wide. 1577 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: The idea is that it would be City-wide and additional portals would be put together. I'm not sure if that 33,000 is in furtherance of that, but we can get you the specific detail of that.
So I mention them because when I look at the providers, I don't consider them neighborhood-based at all, yet they're benefiting from a program designed to hit and touch people directly in their own communities. I do believe that may have been my last question. How long is the wait for citizens who need HIV testing? COMMISSIONER DOMZALSKI: We do it on a walk-in basis in our health centers, Health Center 1, and we have community sites across the City. We just want to do more for that.
And what about for Hepatitis C? COMMISSIONER DOMZALSKI: Hepatitis C we do not do on a walk-in basis. That's in conjunction with a medical appointment, but if 1578 03/23/05 - FY '06 OPERATING BUDGET persons are seen, for example, in our STD clinic at Broad and Lombard, the physician may determine that you really need to get worked up for Hepatitis C as well, and we'll do it in that context.
Again, let me commend you on the enormous success with the lead prevention from where we were three or four years ago when Councilman Cohen and PCCY really raised the roof on that issue and it needed to happen and the progress that we've seen on that issue. COMMISSIONER DOMZALSKI: Thank you.
Thank you for you testimony. Thank you, Madam President.
You're welcome. The Chair recognizes Councilman Cohen.
Thank you, Madam President. About an hour ago, there was testimony that a program was moving from the north part of Philadelphia to the northwest 1579 03/23/05 - FY '06 OPERATING BUDGET part, that there was an increase in funds. Could you tell us where that increase came from, state, federal, grant? COMMISSIONER DOMZALSKI: Yes, sir. It's a grant, a federal grant, that allows us to move our Healthy Start North program to Northwest Philadelphia.
And is that separate from the regular City budget the Health Department gets? COMMISSIONER DOMZALSKI: Yes, sir.
About how much funding does the Health Department get from these kind of state and federal grants that are unrelated to the budget? COMMISSIONER DOMZALSKI: About $185 million is in our General Fund. About $78 million of that is in Grants Fund.
And to what extent are you free to use that fund for reasons important to the Health Department? COMMISSIONER DOMZALSKI: We have some flexibility, but pretty much we need to hue pretty closely to the purposes of the 1580 03/23/05 - FY '06 OPERATING BUDGET grant. But on things that we're talking about here, the health of women and children, we're able to deliver a pretty significant array of services in a flexible way.
How does it get determined at the City level how much should be provided for which need as a City? COMMISSIONER DOMZALSKI: What we've been fortunate enough to do, Councilman, is break our health status indicator data down to the neighborhood level. So we know what neighborhoods of the City have higher incidence of certain diseases or conditions of public health significance. For example, in this case we're looking at infant mortality and the neighborhoods where the Healthy Start Programs are located are those areas that have much higher infant mortality.
What is the responsibility divided between the City and State with respect to inspection of long-term care facilities or restaurants or that kind of thing? Restaurants, I'm not of not publicly but food dispensing places connected with 1581 03/23/05 - FY '06 OPERATING BUDGET long-term care facilities. COMMISSIONER DOMZALSKI: The local government, Philadelphia, would inspects nursing homes for food service sanitation issues and for safety issues. The quality of care in long-term care facilities is regulated and inspected by the State.
And is there any crossing of information? COMMISSIONER DOMZALSKI: Yes. The State frequently accesses our inspection reports of the facility. And one of the things that the State does when they come on site in a long-term care facility is ask for the last Health Department inspection report of the inspection of their kitchen.
What's the difference between a skilled nursing facility and then the other medical term of confinement? COMMISSIONER DOMZALSKI: Well, it's --
Apparently no 25 doctors are available. 1582 03/23/05 - FY '06 OPERATING BUDGET COMMISSIONER DOMZALSKI: It pretty much has to do with the intensity of the nursing services that are medically necessary for the resident or the patient. Persons who require a high level of care and a high number of nursing hours per resident day pretty much are in long-term care facilities. Other conditions can be managed in our personal care boarding homes. And now, thankfully, we're now getting an increased capacity through the willingness of the State to fund community-based supportive care for people where you normally be heretofore confined to nursing homes who can now get services in and home and have that paid for in the same way as the State paid for their institutionalization.
To whom would we recommend the constituent go to arrange for care, say, for a parent? What would be the initial step? COMMISSIONER DOMZALSKI: PCA, call PCA, Philadelphia Corporation on Aging. And I will tell, while we're not expert on this, we don't mind building some calls if somebody 1583 03/23/05 - FY '06 OPERATING BUDGET wanted to know how to get hooked up with that. You can call me and we can work with you on that.
Well, you've done very well in that regard. COMMISSIONER DOMZALSKI: Thank you.
So I join the accolade of praises your department gets. It's a thinking department. We get help; we don't get generality. COMMISSIONER DOMZALSKI: I'm blessed with wonderful colleagues and staff.
You are blessed with those characteristics yourself. COMMISSIONER DOMZALSKI: Thank you.
Thank you. Any other questions or comments from members of the Committee? (No response.)
Commissioner, I am a little upset -- I see Mr. Fine still back there. And I think he does a 1584 03/23/05 - FY '06 OPERATING BUDGET wonderful job, he really does. But I just get very concerned that we do not do a cumulative impact study with many of the issues that are before us. I just don't think it's fair to the community. How do we address that? COMMISSIONER DOMZALSKI: You know, it's probably one of the most difficult issues that there is, and that is the connection between environmental conditions and personal health. There's no question about that. Indeed, of all the issues that come up, the hardest for us to deal with in public health is just that. The most difficult part is these questions never come up unless there's a community or a community member that says, "You know, I think my health is being negatively impacted by that" --
That has been occurring, and we still don't know what the cumulative effect is. I can go through a whole array of facilities that are in my community. Now, maybe independently they may not be a problem, but when you have all of these other facilities surrounding it and the 1585 03/23/05 - FY '06 OPERATING BUDGET community is sandwiched in -- and we talk about smoking? That's a joke. COMMISSIONER DOMZALSKI: President, we'd be happy to sit down with the community and try to see with the resources and technics and capabilities that we have and that which we might be able to get from the state and federal government to how we might be able to address some of those concerns.
Whose responsibility is that? Is that our responsibility, or is it the State's responsibility to come up with some study to be made? COMMISSIONER DOMZALSKI: Well, it's probably a combination. It probably needs to start locally. There are some issues that the State has sole control over, such as some of these smelting and recycling and trash facilities. They permit them. We don't get to do that. But I think that we have seen responsiveness on the part of the State, and I believe that they and the EPA would be happy to work with us. 1586 03/23/05 - FY '06 OPERATING BUDGET
Well, I personally would appreciate your looking into that because, as I said, I am always being approached by my constituents about that; and I don't this have an answer. COMMISSIONER DOMZALSKI: I understand.
Thank you so much. We appreciate your patience. This Committee will stand in recess until 2 o'clock. COMMISSIONER DOMZALSKI: Thank you, President Verna and Members of Council.
Good afternoon this is the continued public hearing of the Committee of the Whole. The next department to testify will be BBH. You've been extremely, extremely patient. Thank you so much. We do have a copy of your testimony. If you would summarize it, we would appreciate 1587 03/23/05 - FY '06 OPERATING BUDGET it and we'll make certain that the stenographer has a copy and will transcribe it in full. Thank you.
Good afternoon, President Verna and Members of Council. I'm Dr. Arthur C. Evans. I am here to present testimony on the Office of Behavioral Health and Mental Retardation Services FY '06 budget. This department is a newly formed department within the Division of Social Services which is a section of the Managing Director's Office, and I began my tenure on November 1st. I do want to explain how the department is organized. There's been some confusion. I'm not the Director of CBH; I am the Director of the entire office which includes CBH, so I want to take a moment to explain that. We have two components of the department which was formed by an Executive Order by the Mayor on last year. The behavioral health component of the department consists of the Office of Mental Health, the Coordinating Office of Drug and Alcohol Abuse Programs, and Community Behavioral Health. 1588 03/23/05 - FY '06 OPERATING BUDGET The mental retardation component is responsible for the coordination, monitoring of services for children and adults with mental retardation. Those are the two components. Given the lateness of the hour, I won't go into my testimony, but summarize a couple of the highlights. The first thing that I'd like to just state is what our budget request is for FY '06. Our budget request totals $1.2 million; 14.6 in the General Fund, 476 million in the Grants Revenue Fund, and 718 million in the Health Choices Behavioral Health Revenue Fund. Of the 1.2 million, 288 million or 17 percent is for mental retardation services, 18 and 921 million or 76 percent is for 19 behavioral health services. 20 The budget will continue our efforts 21 in addressing the behavioral health and mental 22 retardation needs of the citizens of 23 Philadelphia. Over the next year, there are 24 three major goals that we have. One is to improve and increase the 1589 03/23/05 - FY '06 OPERATING BUDGET organizational capacity of both our internal organization and our service system while we ensure that we continue to provide quality services. Secondly, we want to continue to foster integration across other division of social services agencies and other governmental departments. One of the thing I've been very impressed with in Philadelphia is that the City works extremely well together in terms of the departments, and I've been very impressed with the amount of integration that Behavioral Health has had in collaborations with other departments like Prisons and Office of Adult Services, the school system, et cetera. And thirdly, to promote transformation towards a service system that maximizes recovery, resiliency and self-determination. With that, I'm going to stop and give you an opportunity to ask me any questions.
Thank you. 1590 03/23/05 - FY '06 OPERATING BUDGET I simply want to congratulate you and wish you well in your new position. Where are you from?
From Connecticut for the last years. I was previously the Deputy 7 Commissioner for the Connecticut Department of 8 Mental Health and Addiction Services. 9
Wonderful. 10 We welcome you. Congratulations. 11
The Chair 13 recognizes Councilwoman Blackwell. 14
Thank you, 15 Madam President. 16 How does combining OBH and MRS affect our client and improve conditions?
Well, let me take a couple of parts, because part of the rationale for combining the behavioral health component is that traditionally public sector healthcare and public sector behavioral healthcare is very fragmented. It is driven more by the funding stream than by client need. So if you have people who don't have an entitlement, the 1591 03/23/05 - FY '06 OPERATING BUDGET care that they receive, the options that are available to them, the standards that the providers have to meet are different than those people who may be on medical assistance or Medicaid eligible. And so what you end up having is a system where someone may be unentitled today, they may be Medicaid the next day. Based on that, the treatment options are different. Administratively the programs have to build infrastructure that's different. From our standpoint, it is difficult to see how the care of an individual plays out over time because often that information is in different data sets. So really over the last years, the City has 17 been moving towards a system of integration of 18 the service system. It's a move that's 19 happening both nationally. 20 Frankly, I think Philadelphia is probably ahead of every other part of the country and was really one of the reasons why I was very excited about having an opportunity to come here. I think that we are extremely close to creating a unified system that is 1592 03/23/05 - FY '06 OPERATING BUDGET driven by client need as opposed to funding source. So in terms of the behavioral health part, that's the rationale for doing that. In terms of the combination with MRS, Pennsylvania, as I understand it, has a unique law in that mental health and mental retardation services are administered by the same county department. Again, that's fairly unique, although mental health and mental retardation are often combined in mega agencies, social service agencies at the state level, that's sort of unique. So as the integration with mental health, CODAAP, and CBH happened because traditionally mental health and MR had been together, MRS was also part of that.
Thank you. Madam President, I'll only ask one more question in the interest of time. What is the role of the consumer satisfaction team?
The consumer satisfaction team provides an assessment of providers in terms of how user friendly their 1593 03/23/05 - FY '06 OPERATING BUDGET services are. These are people who are consumers themselves. We contract with an organization to essentially go out, talk with consumers, evaluate programs in terms of their consumer friendliness. I can tell you I've been very impressed with the work that they have done here. I thing they do a wonderful job, not only in term of assessing, but the thing that's been very impressive is that we take that feedback, we give that to the providers, and they're responsive to that feedback. So I think it has had the impact of improving the consumer friendliness of services and responsiveness of treatment providers.
Thank you. Madam President, in the interest time, I'll defer other questions so we can move forward.
Thank you very much. The Chair recognizes Councilwoman Tasco.
Hello. I don't 1594 03/23/05 - FY '06 OPERATING BUDGET have a lot of questions for you, just maybe one or two. Welcome to Philadelphia.
We hope that your stay will be pleasant and productive. How will you implement the Mayor's Executive Order as related to your agency?
Yes, and the non-profits. We really are concerned about that.
I think as I have been here, as I came into the City, one of the things a lot of people talked with me about was a perception that minority providers have not had an equal shot in our service system. And I think a lot of the discussion this morning sort of bears that out in terms at least of perception. So since I've been here, I've been very aggressive at going out, meeting with providers. I met with executive directors. I've gone out and I've met with 1595 03/23/05 - FY '06 OPERATING BUDGET providers or done site visits with providers from the minority community and the majority community as well. I've reached out to the Latino community. I've reached out to the Asian community; I have a meeting set up with them. I've already met with members of the Latino community. My view is that the issue is, for me, more than simply meeting a sort of checklist of criteria and certification. The issue really boils down to commitment in terms of serving communities of color, number 1. Number 2, you heard the Commissioner, the Health Commissioner John Domzalski talk about the issue of health disparities. The reality is that we have disparities across healthcare, we have them in physical health and we have them in behavioral health. And one of the things that we know is that when we have providers and people from communities that are being served that the services that provide are much more effective both in terms of engagement of people, keeping people in treatment, and the kinds of outcomes that we 1596 03/23/05 - FY '06 OPERATING BUDGET can see. So from my perspective, this is an issue of the quality of the services that we provide within the City. It's an issue of how do we reduce disparities around the kinds of outcomes we see for people as well as the issue of equity in terms of how resources are distributed within the community. I think in terms of specific things that we've been talking internally about -- there are a couple of things. One, there was discussion this morning about technical assistance. I've been a provider. I've sort of sat on the side that many of the providers sit on, and I know that there's a wide range of ability in terms of the leadership of organizations. You have organizations like west and consortium who has very sophisticated leaders like John White or Dennis Cook. You have others where you have people who are grass roots who have a real strong commitment, may engage in the community, but don't have the infrastructure nor sort of the business background to be successful. So I think for those providers, we really have to step up and 1597 03/23/05 - FY '06 OPERATING BUDGET provide technical assistance around the kind of infrastructure that they need to be successful and to also help in terms of looking at how we can help them network with other maybe larger providers who can provide some of that infrastructure. I think the other thing is that we have to look at the criteria that we use to select providers. One of the things that happens in service systems is that a lot of those skills that those grass root providers bring to the table are often discounted and they're not valued. My experience is that those very elements are some of the things that make them successful. So I think in terms of procurement processes, we have to systematically build those things into our procurement process where we give them weight along with other things that we might want to consider. Thirdly, I think that we need to look at -- one of the things we did in Connecticut quite effectively was to require all of our providers to have a cultural 1598 03/23/05 - FY '06 OPERATING BUDGET competency plan.
A cultural competency plan, which essentially looks at provider's ability to recruit -- their efforts at recruiting, their efforts at ensuring that the services that they're providing are meeting the needs of a diverse group of people, the folks that come through their doors. So I guess that was a long answer, but I think we've given this a lot of thought. We are committed to the issue of equity, both this terms of providers but also in terms of the kinds of outcomes that we have in our treatment system.
Thank you. We will give you a test number 1 next year. That's when you walk the burning sands. (Laughter.)
I have just two more and then I'll be done. In the attachments to your testimony, $4.4 million in various mental health services and 34 million in various 1599 03/23/05 - FY '06 OPERATING BUDGET mental retardation services will be allocated to providers that have yet to be determined. What services will be procured and what is the procurement process and what is the timeline?
I'm sorry, you're going to have to identify yourself for the stenographer.
Michael Covone, Deputy Director with the Office of Behavioral Health and Mental Retardation services. The undetermined are basically those resources that we anticipate coming as expansion resources as part of the Governor's budget in the upcoming year. Primarily on the mental retardation side, because of the timing of this budget process and the state budget process, we have to anticipate what can come down. There are expansion resources within the Department of Public Welfare budget. How much of that will come to Philadelphia really isn't known until the Governor's budget is finalized. So those undetermined resources 1600 03/23/05 - FY '06 OPERATING BUDGET really are around the thousand or so individuals who've been identified in the preliminary Governor's budget as receiving services through the waiting list initiative.
I just have one quick thing about that. One of the things that we're looking at relative to that is how do we want to use those dollars in terms of approaching the waiting list, and there are a couple things we don't have to go into now around that.
I'm not sure what you're looking at, but the FIR program is really a conglomerate of various programs that really are looking at how do we address the behavioral health needs of people who are in the criminal justice system. As I mentioned earlier, that's one of the things I've been very impressed with in Philadelphia, is that people have been working for a long time together around some of these issues. So over the last few years, several years, a series of 1601 03/23/05 - FY '06 OPERATING BUDGET programs that help place people in both residential treatment programs and outpatient treatment programs who are involved in the criminal justice system, those services are provided through the FIR program. There's also some efforts through that program at helping people as they are leaving the prison system to reenter the community, community reintegration.
Are there any other questions or comments from Members of the Committee. (No response.)
Mr. McPherson, who is the next department to be called?
Good 1602 03/23/05 - FY '06 OPERATING BUDGET afternoon.
Please identify yourself for the record and proceed with your testimony. May I suggest, sir, that you summarize your testimony and we will make certain that the stenographer has a copy and it will be transcribed in full.
Thank you, Madam President. We will do just that. My name is Rob Hess. I'm Deputy Managing Director Special Needs Housing. I'm pleased and honored to offer this testimony on the Division of Social Services, Adult Services, Office of Emergency Shelter Services budget request for Fiscal Year 2006. I have to my right Letty Hinton who is the Director of Shelter Services, and to my left, Richard Shaeffer, our Administrative Services Officer and Director. I also have behind me and with me today the various operating unit heads for adult service of OESS, and I'd ask them to be 1603 03/23/05 - FY '06 OPERATING BUDGET rise to be recognized. Thank you, Madam President, for giving me an opportunity to do that. They work extremely hard every day and I think deserve that brief recognition. As presented to Council, the Fiscal Year 2006 budget for the Office of Emergency Shelter and Services is $50,203,107, of which $17,909,150 is in the General Fund and $32,293,957 is in Grants Revenue. The proposed 2006 budget includes two significant changes from the 2005 budget. The budget for Riverview Home was transferred to OESS from DHS. The amount of this General Fund transfer is 5,453,383. The second significant change is the appropriations for Act 148 eligible costs incurred by OESS for family preservation appear in the budget for Department of Human Services. 4 million in Fiscal Year 2005 and 14 million in Fiscal Year 2006. If these amounts are included in the amounts that appear in our budgets each year, there is very little change as the Fiscal Year 1604 03/23/05 - FY '06 OPERATING BUDGET 2005 budget estimated obligations are $64,184,106, and the Fiscal Year 2006 total budget request is $64,203,107. The Fiscal Year 2006 budget request will enable OESS to manage an average of 2500 shelter beds, nearly 2,000 beds in transitional and permanent and supportive housing and will provide emergency relocation services for up to 2,000 individuals. The Fiscal Year 2006 budge request will also support a total 192 positions. This reflects a percent decrease from the number of 14 filled positions in our agency in December 15 2004. In the coming Fiscal Year, adult services is dedicated to supporting the overarching objectives of Division of Social Services, in particular to invest in programs to support family structures, to ensure that adults have the supports and the tool to become and remain self-sufficient, and to ensure that Philadelphians have the earliest possible access to treatment. Now, just to summarize a couple of 1605 03/23/05 - FY '06 OPERATING BUDGET key points of the testimony that I wouldn't want to miss, the demand for shelter has continued to increase. Economic conditions in the City are not significantly brighter for poor people today than they were a year ago. And in fact, we've seen increases on demand for shelter on the family and single side over the last couple years. We think that's largely because the gap between the low wages of entry level jobs and the housing costs in this area continue to have a huge gap. In fact, it's estimated now that one would have to work a minimum wage job for 130 a week in order to afford market rate housing. The results of that gap are often times manifested in ways that people end up at the front door of our shelter system tragically. We are working very closely with OHCD and other City departments to develop additional affordable, safe, decent housing in the City. And I'm pleased to report that given our efforts this past year, we saw a record McKinney award from the federal government of almost $26 million that will allow us to build and lease 160 new 1606 03/23/05 - FY '06 OPERATING BUDGET units of affordable housing to go with the 100 new units that are in the pipeline already, bringing 260 new units over on line over the next year or so. So that is very positive, and we're pleased about that.
However, it's a drop in the bucket when you look at the needs of our City with respect to the needs of poor people for safe, decent, affordable housing. In fact, I think Dennis Culhane has estimated that there is a need of about 33,000 affordable housing units in our City to meet the demand. So we continue to try to create the best possible shelter system with the highest set of dignity and respect as a point of entry to a system but understanding that we are not a housing system and that the answer is more safe, decent, affordable housing in communities around our City to be able to support the needs of our poorest citizens. I think with that, I'll stop and ask for questions.
Thank you. Mr. Hess, you mention on your testimony that adult services reaffirms 1607 03/23/05 - FY '06 OPERATING BUDGET its commitment to making available permanent and transitional housing opportunities so that the households can return to supportive communities. Can you explain for the record how adult services accomplishes that goal?
Yes, Madam Chair. In a couple of ways. First, we now have 540 transitional housing units that we manage ourselves. And so those are units that are available to people that are leaving emergency shelter and are in need of some supportive housing and may not be either ready or able to acquire permanent housing. In addition to that, we have for the last couple years managed the McKinney process, which is a major federal grant application that we're working on. In fact, this time of year each year, submitting to the federal government in June or July, and then we get the award in December.
I don't mean to interrupt you, but with the McKinney, you mentioned that twice, isn't the McKinney Act for surplus federal properties? 1608 03/23/05 - FY '06 OPERATING BUDGET
That is one of the purposes that you can use the McKinney Act for. And you're quite right, the naval yard, for example, was acquired under the McKinney Act. But in addition to that, McKinney Act provides for the majority of federal funding that goes into homeless services across our country. So we are part of a competitive federal application each year to bring money into the City to be able to support people experiencing homelessness in our community.
You're welcome. It's through that Act that we were able to bring in the $26 million this past year, which was a percent increase over the 19 previous year and represented the largest 20 increase any city in America received. Through that application, we will through leasing and bricks and mortar development working with OHCD and the RDA and others create 160 new units of housing through the '04 application, and we are now hard at work 1609 03/23/05 - FY '06 OPERATING BUDGET on the '05 application.
Thank you. The Chair recognizes Councilwoman Blackwell.
Thank you, Madam President. As you may imagine, this is one agency with whom I work regularly. I guess I know everybody who is here. And I will tell you as one who has dealt in this area for our entire political career, this is just about the best department and Rob Hess and his team have done a phenomenal job, better than any of his predecessors. We're so encouraged about programs they have like Bright Spaces where in all the shelters children have little places to play, their own little equipment and little dolls and doll houses and all that. We're so impressed because not only do we -- it's not the old homeless department, but OESS is now a department where we have transitional and permanent housing, job training, so many, many modern and wonderful things. And I will say we have been awarded and commended many times 1610 03/23/05 - FY '06 OPERATING BUDGET nationally for what we do in Philadelphia. So I am just proud of the work and enjoy every moment that I work with this department. And certainly, I want to commend them. I've been asked to ask two questions. I was just handed a sheet of paper. One was about the reunification program with DHS, and the other is about victims of domestic violence being a place in regular shelters as opposed to battered women shelters. Can you respond to those two issues, Mr. Hess? Again, thank you very much.
Thank you, Councilwoman, for your leadership and support. Hardly a day goes by without us having an opportunity to talk and to work on this issue together, and we certainly appreciate your leadership.
With respect to the family unification program, we do work closely DHS to try to reunify families. And there are about 450 family unification program housing subsidies available for that purpose. Over 1611 03/23/05 - FY '06 OPERATING BUDGET and above that, as you might imagine, all too often the shelter system becomes the housing reunification option, and people end up moving on to transitional or permanent housing from there. Because of that, we work very closely with first Alba Martinez and now Cheryl Ransom at DHS, and we have in our housing development pipeline a number of programs that are targeted to youth aging out of foster care or families to be able to reunify and bring those children back out of placement and placed in permanent housing. And so we are making progress on this particular area. But it, like many of our housing issues, the resources are nowhere near as great as the demand for permanent housing services. And so it does remain a challenge for us. With respect to the domestic violence issue, I think we reported last year before this Council that there are 48 domestic violence secure beds in the City, which is really far below any reasonable or rational number we might expect in the fifth largest city in America. So we have budgeted adequate 1612 03/23/05 - FY '06 OPERATING BUDGET funds to double that number of beds, working with Women Against Abuse and Mayor's Task Force on Domestic Violence, we expect in this budget, the Fiscal Year '06 budget, to double the number of beds to a hundred for the coming year and also to bring some domestic resources to the front door of the shelter system, the intake center, so that we can do a better job of identifying victims of domestic violence at our front door and providing them with the services they need. And frankly, in the past we've not done as good a job as we would have liked. And very often, women who have been subjected to domestic violence or sexual abuse had ended up in our shelter system without the support that they may have wanted or needed. So this is a primary focus for us for the coming Fiscal Year.
Thank you. Madam President, it's ironic that you mentioned the McKinney funds being used in the Naval Yard and you didn't know they could be used this way. I didn't know they could be used the way you mentioned, so it's amazing 1613 03/23/05 - FY '06 OPERATING BUDGET how broad it is.
We did address that issue, I think, for both the Navy Yard and the homes on 20th and -- the Naval Hospital site. And I know that the monies that would be generated in the sale of the properties would go to the homeless.
And I might tell you that I think it was just under $5 million that has been transferred to the Homeless Trust. Dainette Mintz and I sit on the Homeless Trust for the City. Sister Mary Scullion and Sharmain Matlock-Turner sit on it for the non-profit community. And Bob Downing is Chair and sits on it for the for-profit community. We're actually reinvesting the proceeds of that sale, the interest earned on the dollars, to provide for housing subsidies, short-term housing subsidies for families that wouldn't otherwise qualify under our normal programs because maybe there's a criminal history or something. And so we're beginning to roll out that program now.
Wonderful. 1614 03/23/05 - FY '06 OPERATING BUDGET
You're welcome. The Chair recognizes Councilwoman Tasco.
I just have a couple of questions for you. What is the status of privatizing social services and case management services of the city shelters?
Good question, Councilwoman. We have, in the last few months, completed the privatization of case management of our city shelter system. Prior to that, over the last several years, we've had a hybrid of combination of city workers in some shelters and private provider, non-profit provider case managements in other facilities. Frankly, over the last couple of years our 1615 03/23/05 - FY '06 OPERATING BUDGET inability to hire City social workers has left us in a bit of a bind. Through attrition and because of the increased demand of the shelter system, what we found is we ended with about a third of our shelter system that wasn't receiving case management because we couldn't hire additional people. So we've moved to a model whereby we can hire non-profit case managers on a ratio of to for families and 30 to 1 for singles at our facilities and see that all the folks that come into our shelter system now have access to the case management. In order to make that happen and in order to minimize the layoffs that we needed to meet our target budget numbers, we ended up transferring, I think it was 10 social workers and 2 supervisors to DHS over the past couple of months and then consolidating the balance of our social workers in our intake centers. That, again, allowed us through the contracts with providers provide case management to all the clients in our shelter system.
Who are some of 1616 03/23/05 - FY '06 OPERATING BUDGET the case managers you contract with?
The providers that we contract with, we can give you the complete list. It would include places like ODAAT, and Self Incorporated, RHD, PHMC, Act Masters.
SO what kind of services do they provide to the clients?
They provide a full range of case management services for the client from developing case plans to following up with clients to ensure that those case plans are being followed, developing of housing applications for the next level of housing support. Again, we kind of view emergency shelter as a point of entry, not a destination. So one of the first things that has to happen is the case manager works with the client to make sure they're getting the service they need, but make sure they're also getting the ID that they need and the other things that they need to move on to the next level of housing.
Are these providers on the sites, or do the clients have 1617 03/23/05 - FY '06 OPERATING BUDGET to go to their facilities?
What is the current status of Riverview Home, and is there a proposal to close it?