That's a really good question. That is, I think, at the heart of the work that we're doing in the City in terms of trying to transform our system. Historically, behavioral 00191 health systems tended to be very institutionally-based. We created treatment, we discharge people back to the community, and we assume that people are going to sustain their recovery going back to the community. We're putting much more emphasis on the kinds of supports that I talked about earlier. The recovery center doing more family work in particular with children, making sure that we're not only doing the family work prior to children leaving residential treatment, but also making sure that there are community-based supports in the community that allow -- that sustain the children in terms of the progress that they've made in residential treatment. So it's a large emphasis on that. And we're doing that across populations, whether it's children, adults, addiction or mental health.
Some of them are. There is a percentage of people that we work with who are forensically involved, and we're work with the courts with those populations.
Thank you, Madam President. (Councilwoman Tasco takes over as chair of the committee.)
I'm going to take advantage of serving as the Chair to ask my questions.
If I can find them here. On , a $56 million increase is identified for mental health and mental retardation services. What services does this increase represent?
This would basically -- the primary dollars that we would anticipate expansion for would 00193 be on the MR side. The State has undertaken a major waiting list initiative over the course of the last couple of years so that individuals who have been living at home have had the opportunity to move into either day services or, in some cases, community residential services. What we generally try and build with the budget is enough appropriation to accommodate the potential for the waiting list initiative. The balance of those increases would be an anticipation of if the Governor's budget ends up with a cost of living or some other targeted initiatives there.
On of your PowerPoint presentation, you show a 20 percent MBEC participation. What steps are being made to increase that participation?
Well, we've been 00194 very aggressive at bringing in minority providers into our network. Over the past three years, we've brought in a number of new providers. We've increased the revenue of minority providers by 29 million over the last three to four years. And one of the ways we do it is to use targeted investments to -- particularly for providers who want to work in high-risk areas or with specialized populations. So, for example, we've had providers who are doing special outreach to the Southeast Asian community or providers who are working in some of the most challenged communities within the City. And so what we've done is to provide seed money for those providers to start services in those areas that are underserved.
Are the services pretty much spread around 00195 across the City, or are you -- is there a -- an unintended effort to -- not effort. Unintended, I guess, impact on neighborhoods? Maybe two or three neighborhoods rather than providing services across the City? Did you look at that?
It depends on what the services are. I think if you looked at all of the services, you would see that they're pretty much spread out across the City. We tend to concentrate in those areas where we have a high percentage of Medicaid or unentitled individuals, because those are the individuals who are receiving those services, particularly outpatient services, but the distribution tends to be pretty even. There are some areas of the City that have more of the residential, particularly the small two- to three-person residential facilities than others, and that has 00196 more to do more with the type of housing that are in those areas than anything else.
Sometimes you will get a provider who will go into a neighborhood, purchase a large home, and then proceed to convert the home into a facility. Are you mindful of that project, contracting with that person to see if they first converted legally and then went before the Zoning Board?
'Cause we get a few complaints about that, particular in the East Oak Lane area.
Yeah. We do would with our providers around that. Sometimes providers are ahead of us, and they will do those things unilaterally. The providers who have been around for a while know that our 00197 expectation is that there will be outreach to the Councilperson in particular and that there will be community work in general if that's needed. There are a couple of providers now that are working with members of Council and community groups in trying to work that out. And so, for the most part, I think that we do a pretty good job of closing that loop and making sure that the appropriate people in the community know, but there are times when providers may move ahead of us and we are, you know, brought in on the back end of those.
Well, when we know about it, then we -- you know, our protocol is, you have to involve the Councilperson, and sometimes you have to -- and many times, you have to also involve community groups. 00198
Are there any more questions for Dr. Evans? (No further questions.)
Thank you. MR. McPHERSON: The next department is the Department of Human Services. (Witnesses come forward.)
Before you go, and since you're going to remain at the table, I just need to ask you a question. I think we've had this discussion before, and I -- you don't have to answer it, but just know that it has -- the issue has come before us a number of times about people who live in a community and the person may have a mental health problem and they're causing a lot of problems and distress to their neighbors. But because of the law, it's difficult to do anything about it. We 00199 may call, and they may get 302ed, but they become a constant concern of the neighbors 'cause they feel helpless; they can't do anything, they're not members of the family. And so, you know, you've done the blueprint, but I think that's an area that you all might want to look at to see if there are -- there may be legislation that needs to be introduced. I have one constituent who's just constantly -- I mean, just constantly causing my neighbors a problem, and it's very difficult to deal with that. So that's an issue I'm going to ask you about.
Yeah. If those situations come up, please let us know. And I know your office and other offices let us know. I think, you know, there is a threshold, a legal threshold, that has 00200 to be met before a person can be involuntarily committed. Short of that, what we try to do is engage people and try to get them into and connected with some kind of treatment, but sometimes that is a process; it's not the kind of thing that happens automatically. And so, to the degree that you have those kind of issues, let us know and we'll work with you. There's a case now that I'm aware of where we're working with a Councilperson that's kind of in a similar situation. And because of my sort of dual role now, the family is -- both DHS involved and Behavioral Health involved, and we're bringing together staff and providers from both systems tow work with that family. So I think we have a lot of options, and I would just say don't give up if those kind of situations present themselves. 00201
Well, there's one guy who's running for president. He was on Channel 6. (Laughter.)
It works (referring to microphone). Good afternoon. I am Dr. Arthur C. , Acting Commissioner for the Department of Human Services. Today I will present to you the department's FY '09 operating budget request and report on how DHS is addressing the core areas outlined in the City's Five-Year Plan. 3 million, which represents a carry-forward budget allocation, with no significant budget increase over the current year's level. The allegation of this request by class is: Class 100, 98 million. Professional services, 148 million. Professional services for the care of individuals, 367 million. 6 million. 8 million. 5 million. 2 million. 7 million. 00203 Children and youth, 360 million. And community-based prevention, 110 million. Over the last year, DHS has undertaken a major reform effort. This effort is a multifaceted strategy, which is changing the entire culture of the department as well as the way it addresses service delivery, accountability, communications, and infrastructure. As part of this effort, the department has developed a new mission and core values statement that serves as a foundation for its policy and practice. It states that DHS's mission is to provide and promote safety and permanency for children and youth at risk of abuse, neglect, and delinquency. Our goal is to strength and preserve families while empowering them to make choices that lead to 00204 safety, stability, and well-being. We partner with communities, providers, advocates and each other to develop and deliver preventative and culturally-appropriate services that are consistent with the needs of Philadelphia's diverse communities. This mission is well aligned with the core areas outlined in the City's Five-Year Plan. In terms of public safety, the core area of public safety is at the heart of DHS's mission and its reform effort. One of the department's major accomplishments in this area has been the completion of face-to-face visits with every child in the Children and Youth Division who is either in placement or receiving in-home services to ensure their safety and well-being. We have also adopted standardized evidence-based tools to improve the way we assess the safety 00205 of children in our care, and are currently in the process of training staff to use those tools. Additionally, in line with the City's plan to improve emergency response time, DHS has taken several steps to improve its own response to potential emergencies. The department now ensures that children five and under for whom a report of abuse or neglect has been made are visited within two hours of the time a report is accepted for investigation. In addition, a rapid-service response initiative is also in place to provide services during the investigation period to children with reports of abuse or neglect. DHS is also striving to eliminate preventable deaths of children due to fire or co-sleeping. We've teamed up with the Fire Department to provide working smoke alarms and education to families 00206 involved with DHS. We've also partnered with the Health Department and the Maternity Care Coalition to raise awareness of the dangers of unsafe sleeping and provide cribs to families. The department is also improving public safety by aggressively working to reduce juvenile crime. Through the Adolescent Violence Reduction Partnership, outreach is conducted in community settings to youth at high risk of delinquency or violence. Program participants receive regular and intensive supervision and are linked to a continuum of supports. In addition, the police, under Commissioner Ramsey, are using the curfew centers more to reduce the number of young people on the streets during the hours when crime is most prevalent. Finally, we are making strides 00207 in reducing recidivism among those who are involved in the juvenile justice system.
The Philadelphia Reintegration Initiative provides young offenders with the necessary supports and resources to help them make a process transition into their community and to avoid first time contact with the criminal justice system. Education is another key component of our mission. DHS is actively involved in the effort to ensure our city's youth consistently attend and graduate if school. The department's truancy prevention programs provide case management and support to address the underlying factors that lead to truancy for youth involved in the City's regional truancy court process. To help youth who have already dropped out of school complete their education and prepare for employment, 00208 the department supports specialized community-based programs called "E3 Centers," which provide intensive career preparation, educational support, life-skills training, subsidized employment opportunities, and job-placement support particularly for youth who have been involved JJS. All of the youth in placement receive instruction and mentoring to help develop the life skills they need to live independently through a variety of programs at the Achieving Independence Center. In the coming year, the department will also collaborate on an education and physical-health support center to provide consultation and technical assistance regarding the education and health-related services that DHS-involved children and families needs. Healthy and sustainable communities are also central to our 00209 mission. DHS funds a comprehensive network of community-based prevention services that help at-risk families address the underlying problems that often lead to abuse and neglect in an effort to reduce their involvement with formal child protective services. In addition, our Teen Placement Diversion Program has been effective in helping families address issues that might otherwise result in the placement of an older youth. For children already in the department's care, DHS has been extremely successful in attaining permanent homes in a timely manner through initiatives such as performance-based contracting as well as a pioneering Achieving Reunification Center, which provides a host of services under a single roof to help parents with children in placement reunite with their families. In situations where 00210 reunification with a child's family of origin is not an option, we employ innovative measures to find loving adoptive families such as the Heart Gallery, Wednesday's Child, Philly Kids Connection, and Faith and Families in permanent legal custodianship. DHS is also better meeting the physical and mental health needs of children in our care. Nurses are onsite to assist social workers on cases involving medically-fragile children, and Behavioral Health staff provide consultation to the social workers for children with behavioral health issues. In the past year, DHS has also diligently strived to improve the quality of our services as well as way we communicate with families. We have established the Commissioner's Action Response Office to address concerns and complaints, and have contracted 00211 with the Consumer Satisfaction Team, incorporated, which conducts consumer satisfaction interviews with youth in group homes. In addition, DHS is working hard to communicate more effectively with its clients, stakeholders, and the general public. Widely distributed newsletters and reform updates as well as a regularly updated website provide information about our reform efforts and other important issues. We also continue to hold town meetings in locations throughout the City to provide information about the reform, answer questions, and address concerns. Moreover we meet regularly with the Community Oversight Board that was established by the Mayor, the Child Welfare Advisory Board, and other stakeholders. We are also taking steps to ensure that clients receive highest- 00212 quality services.
We have implemented enhanced standards for targeted providers, and we are holding them accountable. Every week, contract administration and program evaluation staff call a random sample of families to validate that our providers are visiting regularly and providing the services and supports families need. Furthermore, the department is undertaking several efficiencies to reduce cost and adhere to its budget, including reducing overtime while ensuring effective delivery of client services and thoroughly examining ways to reduce paperwork requirements so social workers can devote more of their time to direct client care. Additionally, as noted, the department is making numerous service improvements through its reform effort. DHS is fervently dedicated to becoming the best child welfare agency in the country. In doing so, I 00213 believe this agency will significantly advance the goals outlined in the City's Five-Year Plan. Thank you for this opportunity to present on behalf of the Department of Human Services. I will be happy to answer any questions that you may have.
Thank you, Doctor. Dr. Evans, is DHS's proposed FY '09 budget consistent with the proposed State budget?
It is consistent with what we have been told our allocation will be from the State for FY '09.
Can you tell us, when will you be vacating the current Juvenile Justice Center?
We are planning to move out this summer. We don't have a date certain on that yet, but we are anticipating that we'll be out by this 00214 summer.
And can you tell us when you expect the new center to be completed?
When is the interim temporary not-to-exceed-three- years-and-a-day center going to be completed?
As I mentioned, we anticipate moving in the summer, probably the late summer. 00215
Dr. Evans, on -5 of your detail, it reflects a $4 million reduction in prevention programs. Will you explain this reduction, please.
This represents a transfer of $4 million within DHS from Safe and Sound programming to other programming in Children and Youth.
Any particular programs, or can you tell us for the record?
There are both programs that currently are pass- through programs and programs which were divided in the last administration 00216 between Safe and Sound and DHS prevention programs. So this represents rationalization, if you will, of those programs, so moving dollars back so that we have a rational expenditure within DHS for programming as opposed to pass-through's.
Dr. Evans, on -76, would you please explain for the record why you're requesting over $46,000 for Fund for Philadelphia? And also for the record, can you tell us what Fund for Philadelphia does?
The $46,000 is for family-preservation programs. Those are families where we're trying to keep the family together.
00217 Please explain for the record precisely what the fund -- what is the Fund of Philadelphia and what does it do?
The fund, as I understand -- and I discovered the fund probably halfway into my tenure -- is a mechanism that the department has used historically to fund a variety of activities: In particular, what we just talked about, the family preservation, but also things like the facility rental. The department does not have adequate space in our building at 1515, and so we rent a considerable amount of space from Temple University. Communication. You probably are aware of a public relations or a public education campaign that we recently did on safe sleeping. Those activities are funded out of the Fund for Philadelphia.
All right. On -76, you're requesting a little more than $46,000. 00218 Again, on -82, you're requesting over $879,000 for Fund for Philadelphia. Can you please explain?
In the $879,000 portion of that, that would be our public outreach efforts. As I mentioned, in -- I didn't mention the numbers in my testimony, but in Philadelphia, for example, we have between 40 and 50 children who die each year as a result of unsafe sleeping conditions. Back in October, we started a public education campaign to educate the community about that. That comes out of our communications budget, which is operated out of the fund. In addition, the facility rental that I talked about, there are some Web-based activities that are also a part of that.
Dr. Evans, let me ask you, does Fund for Philadelphia actually follow 00219 bidding requirements?
I don't believe that the way the fund operates today is consistent with the new contracting requirements. And, in fact, when I discovered the fund, one of the things that we did was a review of the fund. We looked at what was in the fund and we made the decision that those things that needed to fall in line with those contracting requirements would be procured that way in the next fiscal year, starting July 1.
They would be procured that way, beginning July 1 of this year.
And how long are these contracts for, just a year?
If a 00220 contract is signed, how long is the contract for?
So are we just doing it for a year so Council doesn't have to approve?
Are we just doing one-year contracts so that they don't have to come to City Council to approve the contract for more than one year?
Well, why are they doing just a one-year contract?
I'm not sure I'm following the question. When you say "they," who are you referring to? Are you talking about the Fund for Philadelphia?
Okay. Dr. Evans, on -- we'll come 00222 back to the bidding process. On -122, you're requesting more than $109,000 for the 1st Judicial District for the REAPP Program. What does REAPP stand for?
Ellen Walker, Divisional Director for Community- Based Prevention Services. We apologize for the acronyms, 00223 but REAP, which stands for reasonable efforts at assessment and planning, is a program facilitated by the First Judicial Court system for children that are brought to that system for incorrigible (indiscernible), et cetera.
Can you tell us how these funds are budgeted for in the courts?
They are budgeted in collaboration with Judge Dougherty. This year, they were budgeted in line with the utilization by program. Some programs were reduced. Next year, we are looking at whether to continue the current structure or whether we do want to RFP it out.
Can you give us an example of the program, what it does, please.
Case-management services to the older youth that -- for 00224 example, a mother feels their child is incorrigible, they're not appropriate for child welfare services, they want to bring 'em to court to evoke what actions the court can bring to the table, so to speak. And the court, as a diversion method, uses the REAPP programs to provide intensive case-management services to those older youths while the case is opening or pending opening with the family courts.
You know, Dr. Evans, we want a little update on Safe and Sound. Would you give us an update? I'll repeat my question.
'Cause there are some, you know, providers 00225 that are still concerned about their funding and what's going to happen in '09, so if you could give us a little update, I would appreciate that.
As we discussed at the time of the hearings here in City Council, we have been throughout the last month working with Safe and Sound on their budget revisions for the current fiscal year.
We, I believe, have come up with a final agreement. In addition, we've been meeting, as you directed, with providers on a weekly basis to assure that providers have agreements in place, that they're clear on their allocation and that they're clear on the expectations for them in terms of serving children between now and the end of this fiscal year. 00226 We have told providers that the summer program, particularly the after-school summer program and Beacons, will receive word from the administration through Safe and Sound this week about our intentions. We're in the final stages of that discussion.
The chief set of issues is that we want to both assure that the program is in keeping with the Mayor's agenda and that we don't leave children without something to do in the summer. And we are trying to figure out the balance between existing providers and existing areas of the City and the nine high-crime areas that the Mayor has targeted.
So that is the current discussion. We also are developing a 00227 timeline for looking at each of the programs that's within the Safe and Sound Program for opening rebidding, as we promised Council we would over the course of the spring. We hope to have those requests for proposals out within the next 60 days certainly and back by the beginning of June so that by the --
Okay, mm-hmm, okay. I'm still on, right? Thank you. Over the past several years, Council has heard from DHS providers that they have not received consistent cost-of-living increases or rate adjustments to compensate them for additional contractual and regulatory requirements such as obtaining FBI 00228 clearances for staff and foster parents and increased home visits. This year, some services did receive a 2 percent increase, but this did not cover the skyrocketing expenses like gas, health insurance, and utilities. Some programs such as diversion case-management and counseling and educational services have not received increases since their inception. As a result of chronic underfunding, providers cannot offer competitive salaries to attract and retain staff. Will a COLA be given to the providers in 2009?
Well, right now, Councilperson, our tentative allocation from the State does not include a COLA for providers. I have been consistently an advocate for not only COLAs for providers but paying providers a fair and adequate rate. 00229 And, in fact, we put that into our needs-based budget request consistently since I've been at the department. We will continue to advocate with the State around that issue. I know that the statewide provider organization is lobbying hard for that. We would be very supportive of that. The problem for us right now is that we get our allocation from the State. At this point, our allocation does not include that. But we feel -- and I feel personally very strongly -- that we should make sure that providers are paid an adequate rate. What happens when they are not paid an adequate rate is that we get poor quality of services, they have high turnover, and ultimately, the people that we're trying to serve aren't served adequately.
Okay, thank you. 00230 As DHS moves ahead with reform efforts, how does it plan to adequately fund client services delivered through the private sector?
(Referring to aide.) Let me ask him; he wrote this question. (Laughter.)
Again, let me -- while he's trying to figure that out for me, would you talk to me about your minority participation? It seems that you have percent. Tell me how 17 you plan to increase it. And also let me know if there are enough providers in the broader community that maybe contracted before in the past, haven't contracted in a while, maybe they went out of business or maybe they did something else. And are they coming back, or just what is going on with that? 00231
Well, I think there are a few answers to that question. The first is that the department has to put an emphasis on what is often called "cultural competency," the degree to which a provider understands the community that they're serving, has members of the communities that their serving, hopefully are a part of the community that they're serving. I think increasingly what we are trying to do, at least certainly under my tenure and I'm sure in my predecessor's tenure, is to write into RFPs that as a requirement, that that's not an add-on but that's really central to how service delivery happens. And so by doing that, we increase the odds that we will have in the pool of people that are selected providers from the minority community. Secondly, I think -- and this is an area that we frankly have not 00232 worked on in the last year primarily because our attention has been diverted on the reforms, but I think we have to do a better job of providing technical assistance to providers. My experience, both in Behavioral Health and in Child Welfare, is that often you will have providers that are very good at engaging the community, can be very good at service delivery, but may not have the administrative infrastructure, may not have the administrative systems to really run a business in a way that -- that's needed. And I think that by providing more support around those kinds of technical administrative capacities, I think we're going to do a much better job of making sure that we have a broad and diverse group of providers. I can talk more about it if 00233 you'd like. I think it's an important issue, but I think it's not something that happens simply because you want it to happen; I think you have to make an effort, you have to be willing to put resources into it. I think that the department overall has done a good job. I mean, one of the difficulties in the private and nonprofit world is that, how do you define "a minority provider"? Is it where they're located? is it who the CEO is? if the CEO changes, does that mean it's no longer a minority provider? is it the board of directors? What we did on the Behavioral Health side a couple of years ago to try to get a handle on that was, we actually surveyed our providers and asked them, you know, tell us the racial, ethnic composition of your board of directors, tell us the CEO, who it is that you serve primarily. 00234 And even with all of that information, it was kind of difficult to, you know, where do you draw the line in terms of defining? In the private world, it's a lot easier; it's my ownership, and you don't have the same kind of ownership in private nonprofits. That being said, though, there are some providers who historically have been considered minority providers, and those are the ones that we try to reach out to.
Okay. Do you feel that the children are now in the last, say, year or so, the children are -- our children are safe under the care of DHS or safer (inaudible) --
I would say that children are absolutely safer today than they were a year ago in the department, and that's, I think, due to a lot of hard work of a lot of different individuals. And I can give 00235 you a number of examples. One of the recommendations from the Mayor's expert panel, national panel, was that we respond to reports of abuse or neglect within two hours. We call that our "expedited response," and so now, if you call into the department and the child is 0 to 5 years of age, and we accept that as a report, we're out there within two hours. The last data that I looked at showed that we were meeting that standard over 90 percent of the time. We are -- we have much better oversight of our contractors. I mentioned in my testimony that we do random calling. You may recall one of the really horrific cases that was publicized prior to my coming to the department. It was very clear that a provider was supposed to be visiting a child, had not seen the child. Because we didn't have systems in 00236 place, the department missed it. We now randomly call families to find out whether or not a provider has shown up. It's been very helpful in both verifying that the service has been delivered, but we've also found other issues that we've been able to intervene on. We're working much closer with the Behavioral Health System to share information. What happens sometimes is that information about a provider might be discovered in Behavioral Health System, but we have not been very good at making sure that the DHS knew about it or vice-versa. We're now sending joint teams out across the country to residential providers and making sure that we are sharing that kind of information. There are at least a dozen examples of things that we're doing today that we weren't doing a year ago that have a direct bearing on the 00237 safety of children in the system, and we're just beginning. I think one of the major changes that we're making is changing and moving to an evidenced-based way of assessing safety, which is -- probably will have the biggest impact on the department's ability to keep kids safe. Prior to now, when an assessment was done on a child, it was not standardized. It was -- clearly, people had some guidelines, but you may do it a little different than the way that I did it. We are eliminating that kind of variability by moving toward a more evidence-based tool and being very clear about what are the things people ought to be looking at and basing their decision on. By -- in two weeks, we will be moving to a structured decision-making process in the hotline, something 00238 called "guided decision-making." Again, standardizing how those calls are received, what information is asked for on the phone, and then how that information is analyzed, and then a disposition made. That will be starting in two weeks. We are training all of the hotline staff on that practice. So, again, I can easily talk about at least a dozen things that we've implemented just really over the last ten months, and there are another does practices, changes that we'll be making that we think will significantly improve the safety of children.
Thank you. Well, we enjoy having Dr. Evans over there. We want to have him back at CBH (inaudible; off-mic).
It was fascinating to hear your testimony on how you're making improvements on information systems. I had a brief question to ask. How does that information -- how will that information be used in 3-1-1? And to what degree do you share information with other relevant departments; meaning, does the guidance counselor at the school know about the health -- the mental-health problem of the student, and is there unified treatment of that individual when we run into problems?
Very good question. I think really at the heart of a lot of reforms that we're making is, how do we share information. And I think your question alludes to the fact that a lot 00240 of the children -- probably the majority of the children that we work with also touch other systems, whether it's Behavioral Health System, educational system, a lot of those systems. And often, the work with that family is not coordinated information, is not shared. And often, I think too often, systems work at odds with each other. So there are a couple of things we're doing. One of them is creating something called "an educational support center." We've gotten approval or agreement with the School District of Philadelphia to station -- to outsource a person that will be in the department and will be a resource to our staff. Because a number of the children in the child welfare system have very significant educational needs, which cannot be adequately -- excuse me, adequately be addressed by people who are not 00241 educational professionals. And so that's one concrete way that we're doing that. I know that the City is looking at how to incorporate on a wider scale something that had been called "DSS Cares" and is now called "Philly Cares," and I know Dr. Schwarz is working very hard on that issue, which allows us to pull information from various databases from Behavioral Health, from Child Welfare, from other systems, and essentially create a dashboard where you can see all of the systems that a child is -- or a family is involved in. That will be a huge improvement. Of course, that has to be done with the proper -- the proper releases, but that will be a huge improvement, because right now, you could have someone in the child welfare system who is also maybe in the shelter system or maybe in the 00242 Behavioral Health System, and that information is not known. And so those are concrete things that are underway that will greatly improve that ability to coordinate care for individuals that we serve.
Data, when processed, becomes useful information. And I'm wondering, are there bells and whistles that you guys look for when you notice a problem, whether it is abuse, whether it is neglect by way of nutrition? I mean, what are the bells and whistles, signals that can be incorporated into this data-gathering to give a social worker a heads-up that they need to make a visit?
Again, I think that's a good question. I don't think we at this point -- well, there are some things that will be built into the new data system that will greatly 00243 enhance a social worker's ability to stay on top of the case, but I think that there are even more opportunities. For example, when we did a study of the parents of -- the parents who had essentially killed their children, and we looked at those parents, over half hour of those parents had also had a history of being abused or neglected themselves. So that tells us that if we're working with a family where the parent had been in the child welfare system, that is a high-risk case just by definition. And so what we've done in the interim is to send out an alert to our staff, sort of educating people that this is a high-risk factor, this information that went out to all of our social workers. I think what you're suggesting -- I think what you're suggesting is that we ought to also 00244 look at opportunities to create a flag within our system so that as we're taking history, that information goes in, that that becomes a flag for the social worker. And I think that kind of -- using technology makes a lot of sense and, I think, is the next iteration of this.
I know you have all kinds of legal issues by way of confidentiality. I know that you have to respect the client-patient privilege, I understand all of that. But if we can prevent a death by these bells and whistles being in place, I'm willing to lose a little bit of that confidentiality to save a life, and I'm encouraging you and your departments to look at those things so that we can -- now, there are no 23 absolutes. One bell, one whistle doesn't equal one train wreck always.
But if we can prevent it a percentage of the time, I think that will be good. Now, my understand part of that question is: How does the 3-1-1 system integrate with what you're doing?
Well, Dr. Schwarz might want to talk more about that. My understanding of the 3-1-1 system, as it is evolving, is that it's really an information and a referral system. We would either provide staff there locally or we would be connected to 3-1-1 electronically for those cases where someone called in needed information and it really was a DHS issue. We have the infrastructure within DHS to handle those calls. I think the issue is, how do we then connect that infrastructure to the broader 3-1-1 infrastructure? And that's the kind of thing that I know 00246 people are looking at right now.
Just thank you. And the reason why with ask so many questions is not just to get on your nerves, but it is --
Here's why: When we go out in the public, in town meetings, town hall meetings, we are you; meaning, they see the City as one entity. They don't know this department from that department. So in many cases, we have to be your ombudsman, your translator, your ambassador, if you would. So the more we know, the better we are able to address at least the questions that we get from the public. So I thank you, Dr. Evans.
Thank you, 00247 Madam Chair. Good afternoon, Dr. Evans.
You mentioned a new data system, and I walked in late, so I apologize if you mentioned DHS Cares before I got in here. But can you describe what you mean by "new data system versus? the DHS Cares?
Two different things. And I'll let Dr. Schwarz talk about the DSS Cares or Philly Cares, as we're calling it now. The department has right now a legacy system called "FACTS," which is a sort of an old, awkward system. It really requires a lot for our social workers to use that. We are updating that system to what we're calling "FACTS II," which is more of a Windows-based system, more a point-and-click kind of 00248 interface and an interface that allows us to do more of the kind of programming that I was just talking to Councilperson Jones about. So we are very close to being able to launch that. We have identified all of the business practices, we have done the programming, and we are going to be launching that within the next month or two.
When you say you identified the business practices, did you look at current business practices and program around those?
Well, it's a combination of looking at what we were currently doing, but then also looking at opportunities moving forward, because what we didn't want to do is just simply take outdated practices and then automate them; we really wanted to capitalize on the technology. And so we really tried to look forward and do 00249 that. I'll give you an example. One of the reasons that the system isn't up now -- I mentioned a little while ago that we are moving to something called "guided decision-making," which is a structured way of taking information in and making decisions. And so, three months ago, I was asked whether or not I would delay the implementation of the new system so that we could program that into the system. Now, my view was that it was a great opportunity. We've changed the practice for the social workers at the front end. If we can automate that and delay the implementation by three months, it made a lot of sense. And that's the kind of thing that we tried to take advantage of groups.
So earlier, Dr. Schwarz and I were having a conversation about EMR and an effort to 00250 go paperless within the medical practice in the Department of Health. So what extent does FACTS II move us towards the elimination of paper to the extent legal and practicable within your department?
Another good question. There are two parallel processes that are going on in the department. FAX II predated me coming to the department, and people have been working on that, I think, probably two or three years. And so that was pretty close to being ready to be launched not long after I came into the department. As I mentioned, we delayed the implementation. So that process has been going on. When I came to the department and looked at the efficiencies, or inefficiencies, one of the things that was very clear to me was that we spend 00251 a lot of time -- our social workers spend a lot of time filling out paper, and they literally have boxes and boxes of paper. And my view is that there's no 7 way that can be useful. A person can't digest that information and still do all of the work that they need to do. And so, we brought in national consultants to come in, look at all of the paperwork we were doing, our processes, and make recommendations. And of 269 forms that were being used by our child protection -- as I said, 269 forms that were being used in some way by our staff, we have a recommendation to eliminate 103 of those. And so, we will be eliminating -- drastically eliminating some forms, consolidating some other forms, and then that work will then feed into this new system. 00252 So we sort of have these parallel processes going on just because of historical issues, but those will merge.
Well, for now, we are. My view is that we need to get the efficiencies and realize the efficiencies quickly. And so what we will do is eliminate some forms, continue the other forms in some kind of paper fashion, but as I mentioned, the goal would be to try to get as many of those forms into an electronic format so that people aren't filling out the same name and numbers over and over again. And so we're going to get, I think, some huge efficiencies just by eliminating those forms, but ultimately, I would like to see the 00253 department move to a more electronic format.
Yeah. If your intake system is electronic and you put all of the information in at the front end, then even if you need to print out a form. Nobody has to reenter the data as long as there's an account number for that client. The forms can be automatically populated; and if they can be automatically populated, they can also be automatically transmitted electronically --
-- even if there are other agencies that require forms. So there's really no need at all, once you have all of the data in the system, to be filling out a form.
I absolutely agree with that. And the people -- the IT people within the department, I think, have done a wonderful, wonderful job of getting those kinds of efficiencies. My only point is that if you look at the totality of everything that a social worker has to do, not everything will be -- you'll be able to do that with the first iteration of this. There will be a lot of that kind of efficiency in the first iteration, but I think we still have some room to go in terms of making it completely electronic.
Okay. I would -- Terry Phyllis and MOIS have done a great job in going paperless. They do have OCR-scanning technology available, for example, in the pension system and the Pension Board. So I just -- they say it is cut -- and this is without having totally electronic forms. This is 00255 just the first time a paper form comes into the system, it's scanned, which has OCR capability, and then it becomes a part of the file or permanent record electronically.
They say that has cut down their processing time by 50 percent per case because all of the data is available even on a screen in front of somebody, rather than having paper files going back and forth, and then future information, once it's there, is done electronically. So I would ask you to talk to them about -- or bring them into the process if they have not been in the process.
So how is FACTS II different from DHS Cares and Philly Cares? And why are we having two separate systems -- actually, let 00256 me ask that question a second back, something you said. Many of the agencies and nonprofits and other people that do business with DHS, one of the biggest complaints that I have from them is that -- the people that I've spoken to is that when they send information into you, or data or a bill or whatever it is, that they do it by fax generally or they have to send it in; they can't remit it electronically. They all have said that they would pay to go electronic on their end if you would go electronic, because it would save them so much time and money. But one of the biggest complaints is that they're asked for the same information three or four or five times from DHS. What are you doing to try to eliminate that, you know, burden on the people who are having to spend their money on that 00257 instead of the provision of the services that you're contracting them for?
It is burdensome and I think that -- I'm very sensitive to that, having been a provider myself. I'll tell you what we did on the Behavioral Health side. Two years ago, we made a requirement that all information coming into the department had to be electronic. And there were some providers that we helped to get there because some of them couldn't do that. If I were going to stay in the department, one of the things I would do -- this will be an issue for the next commissioner -- is that I would require that providers move to a completely electronic system. To me, it doesn't make sense in this day and age to have a paper system. There's Web-based technology, where people can just sign onto a Web 00258 site, enter the information. They've entered it once; we don't have to reenter the information into our systems. There are a lot of advantages and efficiencies that can be realized by moving to a completely electronic system. I probably won't be in the department long enough to effectuate that, but that would be one of my strong recommendations to my successor.
Thank you. Just for the record, do you know how much time a social worker spends on paperwork versus the provision of delivery of services?
We didn't do a time study; that was one of the questions I asked the consultant who looked at the paperwork. We didn't do a time study, so we don't know that. What I can tell you is that I think it is much, much too much of 00259 their time is spent in just completing forms. And literally, it is not unusual to have a box of forms for an individual case. And that's not a good use of anyone's time because that information is never really used. And so, we want to eliminate that.
Also, I think I noticed -- or someone told me that DHS spends $700,000 a year on SEPTA tokens?
I don't know what the number is, but I wouldn't be surprised. Yeah, Transpasses and tokens.
And that's for people to get to and from -- that's for people to get to and from sites, not to and from work.
Yes. And although I'm a big proponent of public 00260 transportation and I think it's terrific for people to use, in terms of the time of the social worker and the time they have to get to and from places, and when you take a look at the entire DHS fleet in terms of what's available to social workers, I would ask you to please -- I'd ask you to please take a look at Philly Car Share and see if participating in the car-sharing service and eliminating your fleet for people who don't need a car in the evening might actually increase the ability for people to get to and from locations quickly. I know Philly Car Share or Zip Car or someone else would be very interested in providing the vehicles to you for the week and then having them available to citizens for the weekend. The more that we use them and citizens use them, the more we're going to get cars off our streets in 00261 the City of Philadelphia and replace the second car with a Philly Car Share car or a Zip Car or whatever. So I think it might provide efficiencies for your department in terms of time, getting to and from cases and also, you know, be good for the City and the environment, et cetera.
Okay. Back to my previous question, which was FACTS II, DHS Cares. Why are we having more than one system where people have to input data?
Well, I think Dr. Schwarz is chomping at the bit here, so let me give you at least the DHS part of that. The way DSS Cares was conceptualized was that you have different departments and systems that have their own database, for 00262 legitimate reasons. For example, within CBH, we have to pay claims, and so we have to have a specific database to pay those claims. Within DHS, we have to have a different kind of system, so we're collecting different information. And so when the concept of DSS Cares, Philly Cares now, was created, you know, I think that the initial -- again, this predated me coming to Philadelphia, but my understanding was that what people tried to do is to take all of that information, put it into one single system, and combine it, and that didn't work well for a lot of reasons. And so the idea was to leave the databases intact. And, really, what you want to know are some key indicators and -- or key variables in each database. So pull those into a common interface and then be able to look at, Here's a history from 00263 Behavioral Health, here's a history from Child Welfare, here's a history from Homeless Services, which essentially gives you a dashboard of information for each system. And so, the reason that there are those separations is historically that's why each -- that would be why.
Right. Philly Cares was programmed using existing work processes in each department and did not look for efficiencies in its implementation. In other words, people had to do their regular department computer programming or paper forms and take the additional step of then putting the information in what we're calling "Philly Cares" right now.
Rather than 00264 re-engineering work-flow processes so the information is entered once and the data can then go into automatically a Philly Cares system, we've done that. Also, I understand, part of the problem is that it was programmed in a way that everybody -- that you had to have permission from through each permission to share the information among the departments because of privacy and privilege concerns, et cetera; when, if the system, when it was originally architectured, had allowed all of the data to go into a system but only allowed those departments that had permission to look at it, then we'd be collecting all of this data over the years while we try to get permission. And then, when finally you get someone's signature, it would all be available. So I'd ask you to look -- work with MOIS or work with somebody to try 00265 to either scrap that system and just find a way to integrate the databases and then go seek permission based on that, or change the system so that we can have all the information going into these databases so that when you get permission, the whole history is available.
And it's already been input 'cause it's been in each system's computer. That would create far more efficiencies than requiring an additional step in a social worker or other person's process. So I just wonder if you could talk about that and whether or not that's a part of the plan.
Part of the issue is that Philly Cares was not designed with a front end, so it wasn't designed 00266 as a primary input system; it was designed as the back end, taking the information from a series of systems and putting it into a warehouse, which is both searchable and able to then push information back out to each individual system. The reason that that's needed is that we don't have a unique identifier in the City of Philadelphia for every client. So that if you think about it, the information that's collected in any one system, because I think it grew from legislative mandates, that information is different across systems. And when someone enters the DHS system, while their name may be John Jones yesterday, they may be George Jones today, for any one reason. Even birth dates are not always accurate. Social Security numbers aren't collected by every system. 00267 So the expenditure and the heavy lifting, if you will, for DHS Cares, as I understand it, was for the technology to identify clients based on the likelihood that two records are -- relate to the same person, since we don't have a unique identifier, and that's the advantage that it provides to the system. The problem was that all of that information was only searchable through a web portal that didn't interface back into primary systems. So that if a social work in DHS put information in, it was then uploaded to DHS Cares, combined with everything else, so if there's a matching record from the justice system, the mental health system, or wherever else, things would be combined, and then sent back to being a separate portal. What we're currently doing is working with the people who designed 00268 the FACTS II system so that in a way that's seamless, a social worker will put information into FACTS II and then get a little notification that there may be other information in City systems about an individual, can then be prompted to get the individual's consent, and then have that information available within the same application that the Department of Human Services work is using rather than have them access several systems at a time. Where we're currently thinking at the moment is that the front-end investments that exist, we won't shut them down but, rather, we'll use this behind the scenes to communicate across systems since the expense apparently for trying to move all of these systems to single identifiers is enormous.
It's enormous to do it with past records. 00269 Can we try to do it going forward?
You've anticipated my great interest. We are already exploring for several of the departments in health and opportunity. If there's a way to do that, the carrot, if you will, is that several systems have identification cards; like, for instance, libraries, schools recreation, centers. And the technology for reading those cards has had a major investment, for instance, by the libraries. We can take that technology and share it with other departments, which we should do, so that we minimize the cost to the City for trying to figure this out. And at the same time, when we do that, we could invest in a single number that all of those people who use that card begin with, and then spread that to other systems. But we're going to have to do 00270 some major work to, as you can imagine, map every individual to that unique identifier and spread that out, which won't happen overnight, but I think it's an important contribution of this administration to the City going forward.
Great. I probably misdescribed Philly Cares. What I'd heard from many providers was that it created an additional step, and you're saying that's not the case.
The additional step has been because no one interfaced that that information back into the primary input systems so that there were parallel systems that one had to access.
What we're doing for relatively minor costs compared to the architectural expense is, we're building a Web-based interface back into the primary system, so that no 00271 worker will have to try to access a separate system. And the information in Philly Cares will be available to them in the front-end system that they're already using.
Is there any thought or effort to integrate these -- this information or these systems into a platform or a system similar to the one New York City has, which identifies, then, based on all of the information in these kind of programs, what federal, state, et cetera, funds or benefits are available to these people that are not currently being taken advantage of by them so that we can, as the City, make sure we get as much of that to our residents as possible.
I think it's a great idea, and it's something in a needs to happen. The design of Philly Cares as of two months ago wasn't geared toward 00272 allowing that to happen, but it certainly can be in the future. And the question then becomes, whose responsibility is it and how do we make it the responsibility of the appropriate people who interact with clients for case management and so forth to assure that they have accessed each of those entitlements?
Okay. If you're pursuing that or looking at that, if you could provide the Chair with that information or my office.
There's a lot of work to do at the moment just to get the system to be useful to workers without having to go into a separate system, but I'm happy to work on it over the course of this year and get back to you next year.
Great. 00273 One finally question for you, Dr. Schwarz, and that is -- I'll give the Budget Director some warning 'cause he distracted me before when he got up. Are you satisfied with the capital expenditures in the Department of Health? Is 1.3 million enough for this year, or would your druthers be more?
We would need to spend that money, and part of the issue is how quickly we can spend money to do things that are needed. And what we can find, as we do those things, may be done more efficiently. So I think every responsible manager would say we should work toward efficiency. And I believe the capital expenditure that has been allocated, while it won't fix all of the capital needs, I think for this year, it will take us some distance. And I believe that the administration is working 00274 hard to figure out how to meet the large capital needs for all of the --
And if you look at the six-year capital plan, is that satisfactory?