COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE OF THE WHOLE - - - Room 400, City Hall Philadelphia, Pennsylvania Wednesday, April 7, 2010 10:50 a.m. - - - PRESENT: COUNCIL PRESIDENT ANNA C. VERNA COUNCILWOMAN JANNIE BLACKWELL COUNCILMAN FRANK DiCICCO COUNCILMAN W. WILSON GOODE, JR. COUNCILMAN BILL GREEN COUNCILMAN WILLIAM GREENLEE COUNCILMAN CURTIS JONES, JR. COUNCILMAN JACK KELLY COUNCILMAN JAMES F. KENNEY COUNCILWOMAN MARIA QUINONES-SANCHEZ COUNCILWOMAN DONNA REED MILLER COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILWOMAN MARIAN B. TASCO BILLS 100115, 100116, 100117, 100118, 100131 and RESOLUTION 100141 - - - 2
I'm sorry for the delay. This is a continued public hearing of the Committee of the Whole. The first department to testify this morning will be Supportive Housing. (Witness approached witness table.)
Welcome. Kindly identify yourself for the record and proceed with your testimony.
Good morning, Council President Verna and distinguished members of City Council. My name is Dainette Mintz and I am the Director of the Office of Supportive Housing. The mission of OSH is to assist individuals and families move toward independent living and self-sufficiency. We plan and coordinate Philadelphia's response to 3 4/7/10 - WHOLE - BILL 100115, etc. homelessness and operate Riverview Home, which serves the elderly and persons with disabilities. Through the hard work of staff and providers, last year we were able to decrease the City's street population to 395. I am pleased to offer this testimony outlining the OSH budget request for Fiscal Year 2011, which totals $98,989,699; 38,473,558 is General Fund at 39 percent and 60,516,141 are Grant Funds at 61 percent of our budget. The Fiscal Year 2011 OSH budget supports a total of 188 positions, including 132 General Fund positions. Of that number, 65 are Riverview Home staff and 67 are OSH specific. This is one less employee than in Fiscal Year '10. There are 56 State and federal grant-funded positions. In addition, the budget supports 127 annual OSH contracts, which provide 6,300 emergency, transitional and permanent supportive housing beds for homeless men, women and 4 4/7/10 - WHOLE - BILL 100115, etc. children in Philadelphia. This is one less contract and a reduction in funding for one Transitional Housing Program, reducing capacity by units. 6 Minority business participation 7 rate: Historically, the expertise of 8 providing homeless housing and services 9 lies in the non-profit provider 10 community. OSH contracts out most of its 11 day-to-day work, and in this respect, OSH 12 continues its longstanding practice of 13 contracting with minority and women-led 14 agencies and businesses, both for-profit 15 and non-profit. Seventy-two percent of 16 OSH's contracts are with organizations 17 that provide housing to homeless 18 individuals and the remaining 28 percent 19 of the contracts are awarded to agencies 20 to provide supportive services, including 21 case management, food services, 22 employment training, et cetera. Funding 23 for 95 percent of the agency's contract dollars goes to non-profit providers, which are not officially classified by 5 4/7/10 - WHOLE - BILL 100115, etc. the Office of Economic Opportunity as to status. 2 percent. For the for-profit group of contracts, six out of eight providers, or 75 percent of the total, are minority, women-owned businesses. OSH's for-profit contracting, therefore, greatly exceeds the Administration's goal of percent 12 minority, women and disabled-owned 13 business participation in City 14 contracting. percent of the Boards are 16 classified as minority, women, disabled. 2 percent. 21 OSH's Fiscal Year '11 budget 22 summary: The proposed Fiscal Year '11 23 budget reflects level funding from Fiscal 24 Year '10 in the General Fund. In Fiscal 25 Year '10, OSH's State funding was reduced 6 4/7/10 - WHOLE - BILL 100115, etc. by one million. OSH implemented efficiencies in order to preserve the department's core function of providing emergency, transitional and permanent housing for homeless individuals and families in the face of this reduction and the continuing economic downturn. 3 percent, consolidated emergency response and relocation service functions under a single administrator instead of two, created an electronic invoice submission process to take the place of paper submissions, and increased electronic fiscal and contract communication with providers. Accomplishments: Despite the impact of the economy on the City and on its citizens, OSH is pleased to share the following achievements through the Mayor's Homeless Housing Initiative. The progress we made advances our achievement of goals articulated in Philadelphia's 7 4/7/10 - WHOLE - BILL 100115, etc. Ten Year Plan to End Homelessness, 2005 through 2015, which was the result of broad-based stakeholder participation.
Number one, close the front door to homelessness and prevent homelessness. With the signing of the American Recovery and Reinvestment Act, Philadelphia's opportunities to prevent individuals and families from ever becoming homeless were multiplied. S. Department of Housing and Urban Development provided over $21 million to Philadelphia through the three-year Homelessness Prevention and Rapid Rehousing Program, HPRP. Using a competitive process, OSH identified five non-profit homeless prevention contractors who have assisted 1,263 households since October 1st of 2009. 7 million in financial assistance to help struggling Philadelphians pay back rent and overdue utilities, thereby remaining housed. This additional HUD funding to 8 4/7/10 - WHOLE - BILL 100115, etc. help renters allows us to target local Housing Trust Fund prevention funds to assist homeowners to keep their homes. In Fiscal Year '10 through February, OSH assisted 159 households with avoiding foreclosure. HPRP funding is also used at the front door of the emergency housing system in Philadelphia's shelter intake sites. Single men, women and families are screened to determine if they can be rapidly diverted and rehoused to prevent their entry into shelter or reduce their length of stay. Since the start of the program in October, 162 households have been diverted from shelter. Number two, end the need for anyone to sleep on the streets of our City. , a renowned non-profit agency, the City conducts a quarterly count of men and women living on the streets. The November 2009 street count showed 25 percent fewer individuals living on the 9 4/7/10 - WHOLE - BILL 100115, etc. street citywide, 395 in November 2009 compared to 532 in November 2008, and 4 percent fewer individuals living on the 5 streets in Center City, 329 in November 6 2009 compared to 377 in November 2008. 7 These achievements suggest that 8 Philadelphia is making progress toward a 9 third major goal, which is to open the 10 back door out of homelessness, create 11 permanent and subsidized housing. In 12 2008, Mayor Nutter announced a 13 comprehensive plan to reduce homelessness, which has resulted in 1,200 new units of housing being made available for homeless men, women and children in Fiscal Year '09 and '10. Two hundred of these opportunities were designed to provide housing and treatment to individuals living on the streets of Philadelphia. Through a partnership with the Philadelphia Housing Authority, individuals who are ready for discharge from behavioral health residential and treatment programs can transition from 10 4/7/10 - WHOLE - BILL 100115, etc. these programs to independent living with service supports and families can move from transitional housing to permanent homes. Philadelphia has increased its inventory of permanent supportive housing for individuals by 35 percent since 2008 and for families by 122 percent since 2008. S. Conference of Mayors report, Philadelphia reported far more family members entering permanent supportive housing than any other city, with 1,081 family members ending homelessness. The HPRP Recovery funding also contributes to our achievement in this area, with 137 households that moved from shelter or transitional housing into housing in the community under the Rapid Rehousing Program component, with another 300 families in the pipeline. HPRP provides financial assistance to help pay utility or rental arrearages that are a 11 4/7/10 - WHOLE - BILL 100115, etc. barrier to being housed and security deposits or rent for a finite period. Housing stabilization specialists help program participants remain stably housed. Although the HPRP program began only six months ago, hundreds of Philadelphians have been helped and 40 individuals have either gained or retained employment as HPRP staff. We look forward to continued success with this important funding source. I appreciate the opportunity to testify before you today. I would be happy to answer any questions you may have.
I have a couple of questions. I'll take advantage of the Chair to ask my questions. According to Pages 12 to 15 of your budget detail, your office intends 12 4/7/10 - WHOLE - BILL 100115, etc. to spend approximately $25 million for the purchase of services with providers that will be determined. In past years these providers have been identified when your budget testimony was presented to Council. What is the basis for this change?
The contracting process is the -- traditional role is to contract out most of our day-to-day services. So we haven't made any change there. The process is all a request for proposal process, and any opportunities that are available, we make them available to our entire listing. So we haven't changed any formatting or any funding mechanisms from the Fiscal Year '11 proposed budget than this year.
So are you saying that these providers have to go through the process of responding to an RFP?
Yes. We use an RFP process annually, and then if you have an 13 4/7/10 - WHOLE - BILL 100115, etc. existing contract with us, on an annual basis you also have to respond to a request for information in order to update your information with us and also to identify any programmatic changes. So all of that contracting is awarded through a competitive process.
Every year? So you don't have ongoing providers in your --
No. Just let me be clear. We issue an RFP, and if you have responded to an RFP, you also then on the next year have to respond to an RFI. So it's not as extensive a response as an RFP response, but it's still a competitive response that you're responding to.
I guess that's why in the past you had contracts with providers to provide ongoing 14 4/7/10 - WHOLE - BILL 100115, etc. service, that's why they were in the budget book?
And so you will see them listed, because we anticipate that we will continue to fund them, unless there is some egregious issue with their submission.
Okay. Let me ask you another question. On you talk about close the front door to homelessness and the services that you provide to families and/or individuals who may find themself homeless. I guess I want to ask you, what ongoing supportive services do you provide to families? Even though you may pay their arrearage and their rent and their utilities and things of that nature, is there a supportive service program there to give them continuous help for a period of time until they grasp the need to 15 4/7/10 - WHOLE - BILL 100115, etc. develop their own strong program?
There is. Under HPRP, we're able to provide stabilization assistance. So for anyone who has received ongoing assistance, we're required to track them and provide assistance to them every three months, checking in to see how they're doing, if their housing is still stabilized. That process is connecting them to mainstream benefits they may be entitled to. We also have built in supports trying to connect them to health benefits. We have the opportunity to try to connect them to entitlement services. So that's the level of support that's provided to them, and that's ongoing throughout the provision of the HPRP assistance, which is tailored individually.
Okay. Thank you very much. The Chair recognizes Councilman Greenlee. 16 4/7/10 - WHOLE - BILL 100115, etc.
Thank you for all you do. My first question was along the same lines as Councilwoman Tasco's. Yesterday when we had the Prison Superintendent in here, we asked about what educational components they had. In this helping people transition, is there any -- and I know your funds are limited, but any help in trying to get people like, say, GEDs, that kind of thing?
Not that we fund directly, but part of the services that are provided under the Homeless Prevention Program is obviously concentrated on the housing aspect, and then there will be an opportunity, once we know what the individual circumstance of the household is, trying to get them through referral to existing programs 17 4/7/10 - WHOLE - BILL 100115, etc. that the providers are aware of. If you are in our homeless housing system, there is much more detailed case management provided and there are stronger partnerships with education and support service and employment and training opportunities.
Job training, yeah. And that's what these housing stabilization specialists --
I got you. Thank you. One last question. Towards the end of your testimony on 3, you talk about the partnership with Philadelphia Housing Authority.
And the 200 opportunities. To the best of your knowledge, are they filled or are they --
Yes. The 18 4/7/10 - WHOLE - BILL 100115, etc. initiative has a partnership with the Housing Authority in which they're providing us with 500 housing opportunities annually. So we are in our second year of our partnership, so we've had a thousand housing opportunities provided through PHA, and the City created the additional 200 that I specifically reference. So there's been a total of 1,200 units made available over the last two years.
And are they filled? I mean, are people getting into those?
The 200 units that the City created are currently full. The 500 units that was made available in the first year are full, and we're about halfway through the second year.
Okay. All right. Thank you. 19 4/7/10 - WHOLE - BILL 100115, etc.
Thank you, Madam Chair. It's always good every year to see you every year, and I appreciate and this body appreciates the good works that you do.
A couple of questions, though. And if I understood my colleague's question, that we are at capacity within our shelter system and that we from time to time have to turn people away?
We have encountered being at capacity. What the new Homeless Prevention Program provides us is an 20 4/7/10 - WHOLE - BILL 100115, etc. opportunity to more rapidly move folks out of our shelter system so that we can have some space available for folks who may not have any other option but shelter. So with the initiation of that program in October, it has given us some cushion, because we've been able to divert those 162 households that I talked about from coming into shelter, which has made it available for us to be able to offer it. Part of it is doing an assessment to determine whether or not people have any other options at all and if they can be diverted, because our goal is trying to prevent folks from coming into shelter in the first place, because there is a stigma attached to it. There's also a tendency for folks to become very dependent on the system for directing their self-sufficiency, and so we try to avoid that.
So you don't turn people away at this point? 21 4/7/10 - WHOLE - BILL 100115, etc.
Secondly, with the stimulus dollars that have come down, I'd like to get a sense of how they've helped out.
Two, last year you were talking about new contracts possibly with shelter providers and get an update on where we are with that. Have we changed any of that, if you could?
Under the stimulus HPRP program, we are currently about five months in, and we have been able to utilize the program to provide homeless prevention, rapid rehousing and diversion assistance. We provided assistance to over about 1,200 folks in homeless prevention. We have expended about $1.7 22 4/7/10 - WHOLE - BILL 100115, etc. million in funding, and that's just in the first five and a half months of the program, which has been a great benefit because these are folks who otherwise would be trying to enter our shelter system if they were evicted from the apartments for delinquency or had utilities turned off. So the program has been a great success. We've also diverted families from coming into the system. That's an additional 162 folks. And we also have been able to rapidly rehouse folks who are currently living in transitional housing programs into permanent housing in the community under the rapid rehousing component, and we've been able to move families out of housing for that. So it has been a wonderful asset to our mission and our objective. We were not anticipating having new shelter providers this year. Our strategy really was because we knew we had this program, that it would be an 23 4/7/10 - WHOLE - BILL 100115, etc. opportunity for us to begin to look at diverting folks away from shelter, and, therefore, we were trying to just be able to manage our current shelter capacity to be able to meet the demand. And so this is a program that's allowing us to meet the demand by being able to divert and house folks before coming in.
Let me delve into that a little further. So the same shelter providers that were from the prior contract still have the contract?
All right. To what percentage is renter homelessness versus homeowner homelessness? There are a lot of things that attribute to the cause of homelessness. One of them this body identified as foreclosures. But I want to know a little bit, have you looked into what utility shut-offs, in light of the fact that we're deregulating electric and there have been rate increases from the Gas Works, to what 24 4/7/10 - WHOLE - BILL 100115, etc. degree is utility shut-offs and what percentage are renters among the homeless population?
The majority of the funding is being provided for rental delinquency, and then second would be utility shut-offs. We have been limited in our ability to provide utility assistance by changes that HUD has made to the program regulations in which they have stipulated that we cannot assist anyone until they have made every opportunity to avail themselves of existing utility assistance programs. So what we have then decided to do was to try to reserve our funding for those folks who had larger arrearages that the existing programs could not provide them a hundred percent of funding and so that we could be able to address their needs.
Actually, that makes sense, to exhaust those funds before you have to go into your own.
But I guess what I'm trying to get to is, what percentage of renters are the homeless?
Of the homeless population, what percentage come from a renter environment versus homeowner that lost their house?
I would say that easily over 85 percent of them are from the renter population. This year, because we had the Recovery program, we took the dollars that we have been working with for the last couple years under the Housing Trust Fund and used those exclusively for mortgage foreclosure assistance, because it's the only program that provides financial assistance to people who are in foreclosure. And so with that program, we've been able to assist -- and, again, the fiscal year started in July -- we've been able to assist about 159 people. 4/7/10 - WHOLE - BILL 100115, etc.
My last point on my follow-up is, then what percentage of that population is a result of utility shut-offs?
That's an important step. With deregulation coming, there may be another flood created because of people living in dark houses and places that can't be heated.
I'll save my next questions for my next round. Thank you, Madam Chair.
Okay. Thank you. The Chair recognizes Councilman Green.
Each 27 4/7/10 - WHOLE - BILL 100115, etc. department that's come in I've asked them to go through their open positions and explain any newly created positions or vacant positions and the need to fill them. I note in your proposed, I guess it was, seven and a half percent cut that the Administration provided to City Council, there were eight positions listed with a total savings of $475,461 that tie in with the vacant positions that we have here. So the Clerk Typist II position, can you explain to me how those duties have been performed while it's vacant?
We have eliminated that activity in our Fiscal Unit and so that activity has been absorbed by the existing staff.
And has the sky fallen since the staff has absorbed that?
No. It's just made things a little bit more challenging. 28 4/7/10 - WHOLE - BILL 100115, etc.
Okay. The Data Services Support Clerk position, same question. Who has been performing these duties?
Again, the activities have been absorbed. The impact here is that it is a service in which we're also not only assisting internal staff, but we also provide assistance to providers who use the automated tracking system, so if they have technical difficulties, that was a staff person who typically could go out in the field and try to help them work through that. So it just means that folks might have to wait a little bit longer for us to be able to resolve some of those issues.
Okay. The Administrative Specialist II position, who is performing these duties now?
Currently, the duties are being, again, absorbed, and this one is more of a challenge. 29 4/7/10 - WHOLE - BILL 100115, etc. Existing staff is having to address new grants that come into us, and as I've testified, 61 percent of our budget are State and federal grants. So it means folks are having to do more, trying to find the time to be more efficient in what they're doing, and so in some cases, folks are feeling a little overwhelmed.
These are positions at the Riverview Boarding Home, and this has resulted in increased overtime and risk of being in non-compliance with State personal care regulations. And so we usually have to maintain a particular 30 4/7/10 - WHOLE - BILL 100115, etc. ratio of staff.
We have a need to be able to do laundry of linens and be able to --
Rather than get into a discussion about it, if you could please provide whatever State regulation requires you to have a certain number of laundry workers for us to look at, I would appreciate it. Healthcare Aide.
Yes. We have five vacancies in Healthcare Aides, and these are aides who assist the elderly and the disabled with daily activities, bathing, dressing, things of that nature.
Let's see. Just could you confirm that none of the reductions listed in the seven and a half percent budget reduction scenarios have been taken?
Okay. During last year's budget process, I submitted a question in writing about OSH's Homeless Management Information System that I don't believe was responded to before the budget process ended. I'd like to go back to the question. You received funding from the U.S. Department of Commerce to create an online information infrastructure designed to facilitate information sharing and resources creation that will assist in ending homelessness. You've also received funds from HUD to maintain a Homeless Management Information System 32 4/7/10 - WHOLE - BILL 100115, etc. in order to assess the effectiveness of homeless programs. What is the status of these initiatives? What findings have you made from the data collected?
The status is that the Homeless Management Information System is operating. It has been for several years. Those are grants that go back a number of years, and every year we get a renewal grant to continue operations. We utilize the HMIS for two primary purposes. It provides us with an opportunity to get a daily census. Providers utilize the HMIS on a daily basis to tell us the number of homeless people who are occupying beds or units. So on a daily basis, we're able to know what our census is. And on an annual basis, it also provides us an opportunity to be able to track an individual's history within the system. So we can go into HMIS and pull up a record of when a person entered the system, how many times 33 4/7/10 - WHOLE - BILL 100115, etc. they entered in a year, what facilities they were placed at and various notes that tells us about their history and their activity while they were in the system.
So is that the system that tells us where we get the figures of a percent decrease in 10 Center City homelessness or -- 11
No. The HMIS is 12 the system that allows us to know the 13 number of units we have occupied, how 14 many vacancies we have so that on a 15 day-to-day basis as folks come into our 16 intake, we're able to go into the HMIS 17 and know where we have a vacancy for a 18 particular family composition. It also 19 gives us the ability to generate reports 20 on the number -- the demographics of 21 folks who are in our system, the number 22 of -- 23
But those 24 are people who are in housing already, not people on the street? 34 4/7/10 - WHOLE - BILL 100115, etc.
People who come into our intake for placement, which is a different population than the people who are on the street. And so the folks who are being engaged on the street, that information is not being inputted into the HMIS.
It is -- right now it is a process that is meant to be able to document the number of people who are placed in housing. The system for outreach is being -- the numbers are being counted by DBH, which operates the outreach function. They're maintaining a database on the number of contacts they're making on the street. Once the contacts on the street results in a placement in our system, then the HMIS can validate and confirm that that placement occurred.
The 35 4/7/10 - WHOLE - BILL 100115, etc. Chair recognizes Councilwoman Blackwell.
Thank you, Madam President. Sorry I missed the beginning of your testimony. And, Madam President, let me say that we've come a long way. We have a long way to go, but we've come a long way in terms of dealing with homelessness in the City from the days when Lucien Blackwell started the program under Frank Rizzo a hundred years ago. But I certainly want to thank OSH, Dainette Mintz and the whole team, and certainly say that we also are so proud of President Obama and the American Recovery and Reinvestment Act, because not only has it made a major difference in homelessness, but it has done in foreclosure and unemployment extension and in job training and so many areas, but it's made a significant difference, because this is the first time we have been able to -- I'm sure Ms. Mintz 36 4/7/10 - WHOLE - BILL 100115, etc. already said it, but this is the first time we've been able to pay for services that are not narrowly homeless, to try to pay for utilities if you've applied and in other areas that certainly keep a person indoors and in their home. So I want to commend them and certainly give a shout-out to continue our cafes. We have one in West Philadelphia. I dare not mention it, then somebody will fight me on that, but we believe in our cafes. And I've learned through dealing with prisoners, homelessness and everything else we do that not one broom does sweeps clean. So we've got to have different approaches for different people, and certainly we support cafes and hope that at some point we can reopen others in different places, because they are really good to help at night. I mean, people want folks to come in and make use of Center City, Madam President, and all that it brings 37 4/7/10 - WHOLE - BILL 100115, etc. and people don't want to see homeless people on the streets, so that means we have to have some place for them to be and those who don't want to go and then that sort of thing. So we certainly want to commend this department, thank them, thank our President, thank PHA for what it's doing, and certainly hope that we can continue these cafes. It seems to me that obviously one of the biggest problems we have is when it's code blue or code red, and that's still an issue when we have people in numbers who still go in the subway and who are still out. So that's always an issue, and we do what we have to do to make sure people are in, but certainly that still becomes an issue. So I'll end my comments by saying our party this year will be July 16th, God willing. I haven't asked the City yet, but out here at Dilworth Plaza. So we'll invite everybody again. And, again, I thank you and the whole team, 38 4/7/10 - WHOLE - BILL 100115, etc. Letty and everybody, all of your folks, who do an excellent job. And, again, I say we've come a long way, baby. Thank you.
Thank you. Thank you, Madam President. I'd first like to just start off by also thanking Dainette, her staff and all the agencies that work with homelessness here in the City and provide those services. I think you do a good job.
And when you read the testimony, it's very clear that you just can't work alone, that you have to have -- and you have the partnership with CBH and DHS and PHA and all those departments, and that's what 39 4/7/10 - WHOLE - BILL 100115, etc. helps make this change. I certainly have seen the change. I've been here 4 years. I've seen the change in Center 5 City and I've certainly seen the change 6 out in neighborhoods. 7 We have some very good 8 providers too up in the 8th Council 9 District, and I do see some of them 10 sitting here today. 11 But I do have a couple of 12 questions, Dainette. We're still working 13 hard to keep the services open over at 14 the Y. 15
We're 17 working to see what we can do, and the help with the heating situation there has really helped keep those men with a home over the winter, such an extreme winter. But how do you actually really keep up with the count of homeless men or homeless people on the street? How difficult is it to take a count when you say that there's been a reduction and 40 4/7/10 - WHOLE - BILL 100115, etc. there's only 395 people living on the streets?
Through the Homeless Coordination Center that's funded by the City's Department of Behavioral Health, we have outreach teams whose job it is to go out on the street, both Center City as well as into various neighborhoods of the City, to engage homeless persons. There is a 24-hour, seven-day-a-week hotline where folks can call to report someone who they see on the street who they feel are in need of assistance. So they're out every day, every night trying to engage folks to be placed in appropriate housing and treatment. On a quarterly basis, the outreach teams and volunteers go out on one night a quarter to just count the number of people who are visibly homeless. Some of them are persons who they know because they've been working trying to engage them. Some of them may 41 4/7/10 - WHOLE - BILL 100115, etc. be new folks that they don't know. And so they're just strictly counting the number of people who they see. And they go to Center City, they go to the bus terminals, they go to 30th Street Station, they go underground in the concourse and other areas where we know homeless people may populate, as well as covering areas in West Philadelphia and Kensington and other parts of the City where we know that there's sizable population. What has been difficult for us is to be able to validate and count the number of people who might be living in abandoned buildings, because there's a safety issue with going into those buildings and trying to count people. And typically the street count happens after midnight so that we can strictly be counting the people who are on the street. So we use that as a barometer to determine that if that number of people appear to be homeless and living on the 42 4/7/10 - WHOLE - BILL 100115, etc. street, then they are homeless. So we utilize that quarterly count to be able to compare it to the previous year's count. We do it seasonally to determine whether there is more or less people on the street. The testimony refers to the fact that when we went out this past fall and did our count on that particular night compared to the night a year ago, there were fewer people.
Thank you. One of the problems has been providing utility assistance to people that don't meet the low-income requirement of LIHEAP and Crisis. So under this, what is it, H --
-- HPRP, are there income restrictions when someone is applying for utility assistance?
Actually, it's a little bit higher, so we can serve the very low income and we can serve all the way up to 50 percent of the median income, which is different from typical low-income programs, which limits it. And it was because the Recovery program was also trying to be of assistance to people who may have been impacted by the economy, who may not have had an issue but were laid off because of closure of their companies and were in need of assistance for the first time ever, and so they were trying to provide a range of incomes for us to be able to also assist those folks.
Well, that's really good, because those were the ones that were caught with no one being able to help them.
Exactly. They sort of fall in between. Typically they 44 4/7/10 - WHOLE - BILL 100115, etc. haven't been low income enough and so they have not been eligible for assistance.
Okay. All right. Thank you. Thank you, Madam President.
You're welcome. The Chair recognizes Councilwoman Brown.
I have a number of category of questions here. Let me first go to an issue Councilman Greenlee is actively involved with, and that is the issue of domestic abuse. I was trying to verify what the fact is with the State. The State has decreased its dollars for domestic abuse programs. What is your office relationship, if any, with domestic abuse programs in the City? 45 4/7/10 - WHOLE - BILL 100115, etc.
We have an annual contract with Women Against Abuse where we operate -- they operate through contract with us a domestic violence emergency housing facility.
It has 100 beds. It is also a facility that has the particular expertise to deal with domestic violence victims.
We also support Women Against Abuse in their operation of a transitional housing program, and we also have been the agency that has been the applicant and the recipient of the federal Domestic Violence Prevention Grant, which provides funding to ensure that our community as a whole, Police, Probation, et cetera, are educated to the issues of domestic violence, are responding in a manner in which it is taken into consideration the concerns and the rights of the victims and ensuring 46 4/7/10 - WHOLE - BILL 100115, etc. that they're having ample opportunity to get the legal representation, police representation that they need to be able to be out of harm's way.
So we have been the recipient of that grant for the last four years.
And on the initial -- you say there's an annual contract with Women Against Abuse. What is the status of that? Is it stable?
All right, then. What is your interface with the Office of Equal Opportunity around MBE and WBE subcontracting?
We work with them closely. We obviously receive our percentage for meeting the minority business opportunities. We also provide them with information about the number of funding opportunities we have. So, for example, every year when we issue request 47 4/7/10 - WHOLE - BILL 100115, etc. for proposals, we provide a copy to them in order for them to be able to provide us the range for minority and business participation. We also have them participate in the review to ensure that we're in compliance with that, and work very hard to provide them with information in regards to the number of non-profits that we contract with.
Now, your agency ultimately makes the decisions about MBE, WBE subcontracts?
How many contracts does the department have with PHMC and what type of services are provided under those contracts at PHMC?
We have one contract with PHMC. It's providing case management to a number of our emergency housing facilities where the provider may not have the capacity to provide the case management, they're just housing the families. And so we have the contract 48 4/7/10 - WHOLE - BILL 100115, etc. with PHMC where they're providing the case management.
I would probably have to get back to you with the amount of that.
Can one of your staff help you with that, only because time is never on our side.
Do you know or could a member of your team also tell us how many of those contracts does PHMC subcontract to other entities and the total -- no. First I need to know the amount. I need to know the total monetary value of the contract with PHMC first and is there --
The contract is $1,880,769. 49 4/7/10 - WHOLE - BILL 100115, etc.
Is there a, what one might call, a standard operating procedure wherein OESS requires, requests that subcontracting agencies do business with MBEs, WBEs?
We identify in our contract that if there are any subcontracting opportunities, that they should be providing an opportunity for minority, women and disabled businesses to participate.
And then what monitoring, what oversight exists to ensure that that stipulation is obtained?
They're required to identify for us any subcontracting and to whom, and then we also require documentation of whether or not they're minority or business, et cetera.
Documentation such as? 50 4/7/10 - WHOLE - BILL 100115, etc.
Such as a copy of the Board certification and makeup and composition.
Board of Directors makeup and composition, as well as whether or not the business is identifying whether or not it's a certified business. Oftentimes non-profits aren't on the City's registry list, so we oftentimes have to ask the providers to identify whether or not they are minority or disabled.
Final follow-up on this, and I'll have to come back because I have several more questions. What has been the experience of PHMC or others like that honoring MBE, WBE participation?
It hasn't been an issue for us, primarily because we have -- there's very limited subcontracting activities with our 51 4/7/10 - WHOLE - BILL 100115, etc. contracts. Most of our providers are providing the direct service themselves and so they really aren't subcontracting out very much of it, but when they have, they've been very compliant with responding to our request. Again, part of the limitation for us, as we've indicated, is that many of our funding requirements dictate that we can only contract with a non-profit to provide the assistance. So in some cases, that has been an awareness that if we could count those organizations within our OEO, we would be in a position to more than exceed what the quota may be. We also have had very good results in being able to identify when we do have subcontracting that folks have gone out of their way to try to identify minority and female-owned and disabled businesses, and in many cases they've been successful. So we have quite a number of minority participation, and as the testimony indicated, we've exceeded 52 4/7/10 - WHOLE - BILL 100115, etc. our quotas.
Thank you, Madam President. I'll continue on the next round.
Thank you. The Chair recognizes Councilman Jones.
Thank you again, Madam President. Where we left off was a couple of specialty groups that constituents that you deal with that I'd like to address a couple of answers to. The percentage of young people in shelters between the ages of 18 and 24, is that a growing demographic, shrinking demographic?
It is a growing demographic. However, for entry into our emergency housing program, all youth have to be emancipated, and we typically have had, I would say, probably a number of 53 4/7/10 - WHOLE - BILL 100115, etc. folks that we have been able to accommodate, but we are accommodating them in our facilities that are also housing adults and others.
What is the phenomena that you can attribute to the increase in this demographic?
I think it's a variety of things. We are aware that there is an increased number of youth who are aging out of the foster care system. We are aware that there are a number of youth who are having parental issues at home and so they run away from home. There are youth who are having issues with their sexual identity and may not feel comfortable, and so they are also leaving home. And so those are groups of folks who are seeking other housing opportunities, and oftentimes we are either aware of them or they may be made known to us, but they typically are being housed in our partnerships with some of our other providers in other areas. 54 4/7/10 - WHOLE - BILL 100115, etc.
The second demographic I'd like you to draw a little light on is the male or people over 50. Is that an increasing or decreasing demographic?
It's an increasing. First, the homeless population as a whole is aging and so we have a larger proportion of homeless people who are over the age of 45. Certainly for males, because they are the larger number of single persons in our system, there is certainly an increase in older homeless males.
In terms of comparison between male and female, we have more males in our system than females.
Finally, I couldn't help but see the sign back there, victims of domestic violence. What is that demographic? Going up, 55 4/7/10 - WHOLE - BILL 100115, etc. going down? And are they often refused shelter? I got that directly off the sign.
The percentage of folks are increasing, and the issue is always one of capacity. And so while we have not decreased our funding to Women Against Abuse, there's also the issue of being able to address the demand, and the demand exceeds the current capacity.
My colleague Councilman Greenlee has been a champion in this regard, so whatever resources that we might be able to aid you with, we're for. He has been all on top of this issue, and if there is a particular reason why they cannot get emergency housing, we'd like you to address that.
You're welcome. The Chair recognizes 56 4/7/10 - WHOLE - BILL 100115, etc. Councilwoman Miller.
Thank you. Thank you, Madam President. I just have a couple of questions. How many family shelters -- do we have a count of all the shelters and the categories, family, children -- I mean, family, male and female, single male, single female?
And while you're looking, what are we doing with prevention? For example, I've been hearing a lot that there's a lot of services going to be directed to veterans because of their particular issues, and also over the years we've always heard that children coming out of foster care, many of them become homeless. So is there something going on? Not that your agency has to do in particular, but in coordination with someone else in terms of prevention, particularly with foster 57 4/7/10 - WHOLE - BILL 100115, etc. children?
In regards to veterans, there certainly is an increase in the number of homeless veterans, and we've been benefited by the additional assistance that the VA Administration and HUD has made available through the vouchers, which is providing opportunities for permanent housing, with the VA providing the supportive services and the case management. There's been an increase of single female-headed households who are veterans who are in need of assistance. We currently work with one of the premier veteran organizations in the City who works with both single and families, and they have reported an increase in the number of female head of households.
The Veterans Multi-Service Center. In regards to the number of 58 4/7/10 - WHOLE - BILL 100115, etc. facilities we have, we have family facilities and 13 single facilities, emergency housing facilities. And in terms of beds, we have 1,669 beds for families and 1,185 beds for singles.
So if 8 you're not going to do any new beds -- I 9 thought I heard you say that earlier. 10
We are not seeking 14 to increase the number of existing 15 shelter beds because we believe we can utilize the Homeless Prevention funding to be able to divert people from homelessness. The issue is, folks come to intake asking for placement, because they don't believe there are any other options. We're providing them with alternative options, and many folks would rather be housed back into the community rather than coming into shelter in the first place. 59 4/7/10 - WHOLE - BILL 100115, etc.
So with this rapid rehousing that you're doing -- and I think that's what you were just talking about.
-- how are you managing that? Are people going to live with relatives? Are those relatives being paid to house those folks? I mean, what actually happens?
No. Actually, what we're looking at are folks who are in our emergency and transitional housing programs and have not been able to move out because they may have arrearages that they owe to utility companies and until they pay their arrearages, they can't get a new place and have utilities turned on, or they may have credit issues that precludes that. What the Rapid Rehousing program allows us to do is to work with the utility company to address a repayment plan of the arrearages so that the person could find housing, private 60 4/7/10 - WHOLE - BILL 100115, etc. housing, in the community and be able to have utilities turned on, if that's the case. So the Rapid Rehousing program is identifying, through the providers that we contract with, one, identifying what the person would need to be able to live independently. The program can provide them with a security deposit, first month's rent. The provider helps identify a unit for them. They make a selection, they move in, and then depending upon their individual circumstance, the program might also be able to provide them with a limited monthly subsidy to help cover the cost of the rent until they can get on their feet and be able to absorb a hundred percent of the costs.
Okay. In our budget book, do you have a list of where those shelters are located?
They're in the book already? I don't have my 61 4/7/10 - WHOLE - BILL 100115, etc. book with me. That's why I'm asking.
Okay. I think that that is it, Council President. Thank you, Madam President.
You're welcome. The Chair recognizes Councilman Greenlee.
I just wanted to follow up a little bit more on the issue that Councilwoman Brown and Councilman Jones raised on the domestic violence.
Just so I'm clear here, because I just want to make sure I got my information right. So you're saying there's not less beds 62 4/7/10 - WHOLE - BILL 100115, etc. provided, but the percent of need has increased. Is that basically the way to say it?
And this contract with Women Against Abuse, is there federal money involved here, too?
In the emergency housing contract, there are no federal dollars.
So it's an annual contract with OSH with General Fund dollars provided, and we've been providing that funding for a number of years. We assisted Women Against Abuse to move to a larger facility a couple of years ago, and as a result of the larger facility, we also increased the contract to accommodate the larger number of staff that was needed because of an increase in beds. We also have a relationship 63 4/7/10 - WHOLE - BILL 100115, etc. with Women Against Abuse for a transitional housing program that has received federal funding, and they have to go through OSH annually in order to get ongoing renewal funding for that program as well, and so we also have that relationship there. And then we have the domestic violence grant, and we contract with Women Against Abuse for the administration of some of those functions, and we jointly work with the domestic violence community, other providers providing services, as well as with the City offices, Police, Probation, et cetera.
I was going to ask the relationship with the Police, too, but just so I'm clear, where the domestic violence victims go, it's not in the general shelter system, it's a separate place?
It depends. If someone comes into our central intake site and they identify themselves as 64 4/7/10 - WHOLE - BILL 100115, etc. being a domestic violence victim, typically we would look to place them with Women Against Abuse if they have any vacancies. If they are at full capacity, then we place them elsewhere within our system where we have vacancies. Certainly we recognize that Women Against Abuse have a particular expertise dealing with this population, but it doesn't mean that our other facilities don't house persons who have a domestic violence issue.
I see. Because the reason I ask that, and obviously I'm sure you know this, but the key is for the abuser not to be able to find the victim.
And we don't want them in places where they're -- I would think that maybe the abuser may look in one of the more, what we call, traditional places to try to find -- 65 4/7/10 - WHOLE - BILL 100115, etc.
They typically could. I mean, I think the benefit for us is that we have a number of family facilities scattered throughout Philadelphia. We have facilities, and 7 I don't necessarily know that the abuser 8 would have information about where our 9 facilities are in order to track someone 10 down. 11
Although, 12 unfortunately, these folks can be 13 resourceful. Because I understand that 14 the homicides, even though the citywide 15 homicides have gone down, thankfully, the domestic violence homicides have increased.
Which may go back to what you were saying. I don't know what that is, but we probably still need to do something to try to increase help for these folks. Again, I'm not putting it on you. 66 4/7/10 - WHOLE - BILL 100115, etc.
I'm just saying that just generally I think there's something else we need to do, and I think we ought to sit down and figure that out. Okay. Thank you, Ms. Mintz. Thank you, Madam President.
You're welcome. The Chair recognizes Councilwoman Brown.
Thank you, Madam President. A continuation of the questioning regarding compliance with OEO expectations of the Administration. I understood you to say that currently your department has met whatever stipulated goals --
-- the Administration has set. Is that by contract or is that across the board? 67 4/7/10 - WHOLE - BILL 100115, etc. For example, I see here an information technology contract for $160,000, rounding it off. In that particular contract, there are OEO goals or are you looking at the total number of contracts across the agency that give you your --
Okay. So there could be examples here where there are no MBE, WBE participation, and that might not matter because of the fact that the agency as a whole has met the goals, correct?
So that I believe is a problem, because what that suggests to me is in contracts where you have large -- it doesn't matter. What I think I hear you saying is there are instances where there's no MBE, WBE participation. Is that fair to say?
What I'm saying is not everyone that we contract with is a 68 4/7/10 - WHOLE - BILL 100115, etc. minority or a woman or disabled organization.
So when we compare and look at the number of contracts we have, we identify that of the number of contracts we have, we have eight that are for-profit, which are the organizations that get certified, and of those eight, six are minority, women and business organizations.
If we add onto that and look at the organizations that aren't certified but we also contract with --
That are not because they're non-profits. If we looked at that number, we also have a large percentage of folks, and we exceed -- more than exceed our goal. What I tried to point out in my 69 4/7/10 - WHOLE - BILL 100115, etc. testimony is that in some respects, we are limited, because 61 percent of our budget are State and federal grants that dictate that we have to contract with a non-profit, so my opportunity to contract with a for-profit is limited.
Okay. I get that, and I also recall Dr. Schwarz saying that the department or the Administration is currently in discussions to figure out -- and let me not misrepresent him -- whether or not we can have that expectations on non-profits.
Yes. Part of what we were doing is trying to identify for -- just using the homeless community for example, because the majority of the providers are folks who have a particular expertise in providing homeless services -- identifying them and looking at their composition. Many of those organizations are minority, women or disabled businesses, and if they could be 70 4/7/10 - WHOLE - BILL 100115, etc. certified, that would provide a broader array of folks for us to be able to document to you that we have met the full spirit of the OEO because those are certified organizations.
My limitation is that they are not currently certified, but they certainly do --
Thank you, Madam Chair. Ms. Mintz, the non-profit organizations that you contract with, do they procure goods and services to fulfill their contract terms?
Do they do business with for-profit? 71 4/7/10 - WHOLE - BILL 100115, etc.
The majority of them do not. The majority of them are organizations that we provide funding to, and then they are either operating a facility --
If they are operating a facility, they procure goods and services to operate their facility, don't they?
Well, can you quantify what procurement opportunities are available in terms of subcontracts?
There are very few for the folks that we contract with. I don't have the exact number here of how many.
You used the term "limited" and you used the term "few," but within your contract terms, if you know that you have to contract with non-profits and you know that those non-profits have for-profit 72 4/7/10 - WHOLE - BILL 100115, etc. subcontracting opportunities, isn't there a responsibility to make sure that they do business in a diverse way?
So do you set goals for non-profits in terms of their subcontracting opportunities?
Yes. We identify the goals that we're trying to meet in order to be in compliance. We also identify for any of our contracted entities that identify that they would be seeking to subcontract out an activity, that there's a goal that has to be met as well. And so we basically provide them and identify the goal that we're trying to reach in order for them to be trying to reach that goal as well.
Just lastly, because I can't imagine any situation in terms of the services that you are procuring where there would be zero percent opportunity for minority and women-owned businesses. 73 4/7/10 - WHOLE - BILL 100115, etc.
I don't believe there are. I think the issue that I'm trying to address is that very few of our non-profit contractors sub out any of the work. They're providing the direct service themself, because they're either operating in a facility that the City owns and so they have staff that we're providing funding for them to cover staff to work with clients, et cetera. If they identify that they are subcontracting out for some -- let's say that they want to have a GED training program or something on site and they want to sub out for that. Then we identify what the quota is that we have always been trying to maintain, which is what is given to us by OEO, for them to be able to try to identify whether they can recruit and identify a minority or a female or a disabled business. What we have seen is that that has not been an issue for us because the majority of them end up contracting with 74 4/7/10 - WHOLE - BILL 100115, etc. another non-profit organization, if they have any subcontracting at all, and it has been such a limited experience for us that anyone subs anything out, that I don't have numbers to give you today in terms of whether we had five or two subs.
The issue is not just subcontracts per se, but whether they procure goods and services. In other words, linen, whatever else is necessary to provide --
And I will revisit this with other departments today, but clearly, if we are providing dollars to organizations that are non-profits and they are receiving City dollars, they have a responsibility of business diversity, particularly if we set that as a goal for the City.
Thank you, Madam Chair. 75 4/7/10 - WHOLE - BILL 100115, etc.
Madam Chair, in a friendly way, that was on my point of information. I still have time. So Councilman Goode has adequately articulated what my concern is, and what I'm going to ask, to take this a step further, knowing that the experience is limited, I'm curious to know exactly what that experience is.
So if you could provide to Madam President details about any contract over a million dollars on what the business diversity experience is with any of those contracts, non-profit or for-profit, where the grant is a million dollars plus.
I heard you say in earlier testimony as well that one of your requirements is for those who have contracts with your agency to provide a copy of the Board of Directors?
Again, looking for diversity in the makeup of the Board of the organizations that we're contracting with.
Okay. Let's go now to -- let me say this: I need to thank you for the continued cooperation and partnership with your office and let me say the reliability of the professionals in your office with our annual Warmth in Winter effort. We could not do that without OESS, and we need to put that on the record.
We say thank you for that. One of my colleagues may have asked this already, but the legal services for SSI, where are you in the process of selecting an organization to handle the application assistance?
We currently have a 77 4/7/10 - WHOLE - BILL 100115, etc. contract with the Homeless Assistance Program, and they work exclusively to train case managers of our contracted providers to do SSI applications for persons who we believe are eligible. The intent is to try to minimize the extensive wait time that typically accompanies someone submitting an SSI application, as well as having the legal representation that -- oftentimes folks are denied multiple times and then told they need to have a lawyer in order to appeal. So by utilizing and having the expertise there, we have been able to do SSI applications that are being approved the first time submitted, provide training to other case managers who can do the applications as well, and be able to just really have an increase in the number of people that we're able to connect to income.
And that goes to the relationship with the federal government. In years past, there's been 78 4/7/10 - WHOLE - BILL 100115, etc. expressed concern regarding the relationship with the School District and keeping, to the extent that it's possible, homeless children whole as they figure out the whole academic school process. So update us on the nature of the relationship with the School District as it relates to getting homeless children where they need to be so that the academic lapse is not long.
We have several partnerships with the School District. They are the recipient of McKinney Homeless Assistance Act federal dollars for homeless children, and so they collaborate with us, one, to identify the number of family facilities, the number of children we are identifying, where we're identifying. We know children to be in school, the various schools. And through that partnership and through the creation of a new children's work group that we've created, all of our family providers, along with representatives 79 4/7/10 - WHOLE - BILL 100115, etc. from the School District, are working to identify what are the issues and needs of homeless children, identifying where we have several schools where we have very good relationships with principals, who have really been able to do some incredible things, trying to learn what they've done, developed sort of like a best practice that we can then share with principals in other schools, also trying to identify a process to ensure that our children are being able to take advantage of the opportunities for assistance for school tokens, transportation, the uniforms. The school starts needing to have the uniforms by a certain day, go to a certain designated place. So doing all those kinds of collaborations, as well as being able to identify what some of the educational issues are where we have kids who might need to be in after-school programs to help them, where we might have truancy. So we have established a work 80 4/7/10 - WHOLE - BILL 100115, etc. group who are specifically looking at those issues and all issues related to homeless children in the School District.
And so has there been an opportunity for a report of findings to come up with recommendations or strategies for that all --
We have some preliminary reports. I did actually a presentation to the conference in January of the Institute for Children and Poverty and sort of talked about a variety of collaborations and also the School District, so we could share that with you.
So if it's two years old and there are 259 buildings in the School District, briefly just dissect what does that partnership look like between the School District and your 81 4/7/10 - WHOLE - BILL 100115, etc. agency when you have 259 buildings in the school system.
We have an identified resource person who works with us on homeless issues exclusively for the School Board.
We have a relationship with the School Board where they provide us with funding to create an alternative school in our intake centers so that when families come in to be placed and they have kids with them, the kids can be in the alternative school and get school credit for that day while the mom is trying to be placed. We have two staff people who manage that, and that's for grade school through high school, and that's run on a daily basis. And then we also have the School District who identifies and works with us through the identification of our Celebrate Education Initiative where we provide to homeless children in our 82 4/7/10 - WHOLE - BILL 100115, etc. system an opportunity to receive a gift card if they can have perfect attendance for a month at school.
Yes. And the School District works with us to provide data runs on what the attendance have been as we are identifying kids who are in our facilities so that we can be able to identify that we had X number of kids who were enrolled at high school ABC and they had perfect attendance for the month of November and they can get, through private funding that we receive, they can receive a $25 gift card, just as an incentive to try to retain good attendance at school. And then we also have the collaboration with the School District around tokens and transportation, because unfortunately when some families are placed in our system, they're not in the same school district and the kid may have 83 4/7/10 - WHOLE - BILL 100115, etc. to travel to get to school if they don't want to transfer to a school close. So, again, it's trying to ensure that we've provided opportunities and assistance for the kids to be able to get to school, identifying what kind of impact that's having on truancy and lateness. And then we also work with them around identifying issues where we might have problems with kids in school who are either not wanting to acknowledge they're homeless because of the stigma attached to it, may be embarrassed in terms of acknowledging that, or they're having other issues and just the whole dynamics of kids in school. So working with them around where we may know of issues, how we're addressing that within the school, within the classroom, with the teacher, et cetera.
Okay. Well, I thank you for your testimony, and when the School District comes, I'll be asking the same question, because I think 84 4/7/10 - WHOLE - BILL 100115, etc. the goal is to always look to see how we can further tighten the connector in serving those children.
You're welcome. Are there any other questions from members of the Committee? (No response.)
Thank you. MR. McPHERSON: Next is the Office of Behavioral Health. (Witness approached witness table.)
Those leaving, I'd suggest you do so quietly. 85 4/7/10 - WHOLE - BILL 100115, etc. We're still trying to conduct business. Good morning, Doctor. Thank you very much. You've been extremely patient. Please identify yourself for the record and proceed with your testimony.
Good morning, President Verna and members of Council. My name is Dr. Arthur C. Evans, Director of the Department of Behavioral Health and Mental Retardation Services, and I am here to present testimony on our FY2011 budget. 9 million in the Grants Revenue Fund, 885 million in the HealthChoices Behavioral Health Fund. The DBH/MRS FY2011 budget will support 296 positions, the General Fund and 22 272 in the Grants Revenue Fund. 1 86 4/7/10 - WHOLE - BILL 100115, etc. billion is for behavioral health services. The mission of DBH/MRS is to promote recovery and resilience for people with mental health and substance use disorders through the promotion of prevention, wellness and the attainment of personal goals leading to improved quality of life. Similarly, it is to promote self-determination and quality of life for individuals with intellectual disabilities or mental retardation. We work with consumers or clients, families, providers and other stakeholders, such as the Philadelphia School District and the criminal justice system and clergy, to ensure that services are accessible, effective, appropriate and of high quality. The Behavioral Health component of the department coordinates the City's behavioral health treatment system for 100,000 adults and children annually. Mental Retardation Services is the component of the department responsible 87 4/7/10 - WHOLE - BILL 100115, etc. for the development, coordination and monitoring of services for 12,000 infant, toddlers, children and adults with intellectual disabilities. In FY11, DBH/MRS will continue its efforts to address the behavioral health and mental retardation needs of Philadelphia citizens. Key activities supporting these efforts include the enhancement of community-based recovery and resiliency supports, including the hiring of certified peer specialists, engagement of the faith-based community and the engagement of indigenous community helpers. Secondly, sustaining supports to vulnerable underserved populations, including the recent expansion of services to individuals who are homeless, the Southeast Asian community and the LGBT community and individuals leaving prison. The enhancement of services to individuals with intellectual 88 4/7/10 - WHOLE - BILL 100115, etc. disabilities, including the development of supports for approximately 200 individuals in the last fiscal year on the waiting list, and affording individuals and families an array of in-home vocational and employment supports. Waiting list numbers continue to remain high as turnover in residential services is generally lifelong. Access to services is controlled by capacity that is determined by the State Office of Developmental Programs. The present waiting list includes 987 individuals in emergency status, meaning some service is needed immediately. Efforts to promote trauma-informed services and to create trauma-informed communities to support gains made in treatment by Philadelphians receiving services and efforts to increase behavioral health disparities -- or decrease behavioral healthcare disparities by improving access to the quality of care as well as supports that 89 4/7/10 - WHOLE - BILL 100115, etc. improve long-term recovery outcomes. A variety of advisory boards and task forces have been established to guide the department's efforts in these areas. Examples include the African Caribbean Task Force, the Faith-Based Task Force and the LGBTQ Task Force. Examples of efforts of DBH/MRS efforts include the following: One, the reduction of out-of-state and out-of-county placements. The residential reduction initiative involves bringing back youth to their communities from out-of-state placement, as well as distant out-of-county placements.
During the past year, DBH/MRS, in partnership with the Department of Human Services, the State's Office of Mental Health and Substance Abuse Services and the State's Office of Children, Youth and Families, has reduced the number of out-of-state placements from 165 to 55 children. Number two, the hiring of peer 90 4/7/10 - WHOLE - BILL 100115, etc. specialists. DBH has trained and certified 100 people with serious mental illness who are in recovery from those illnesses to become certified peer specialists, an employment position created through the State Medicaid waiver that allows people who are in recovery to work with others who have behavioral health disorders. Number three, early intervention. The Infant/Toddler Early Intervention Program provides supports to children ages zero to three with developmental delays. In collaboration with Elwyn, DHS, Public Health and the School District of Philadelphia, MRS served approximately 200 children in 2009 -- 200 more children in 2009 than in the previous year. The average active caseload is 2,677, an increase of 164 from last year, with an average of 418 referrals per month, an increase of 23 referrals per month. Staff of early intervention providers and service 91 4/7/10 - WHOLE - BILL 100115, etc. coordinators is assigned to conduct outreach, screening at shelters, health clinics and most recently a regional early childhood center opened by the School District. Number four, day program transformation. DBH/MRS restructured a component of the City's mental health system with the establishment of holistic recovery centers throughout the City. These centers offer a dramatically improved, effective and cost-efficient approach to assisting citizens with serious mental illness to recover and to transition to productive lives in society. Some outcomes identified in 2009 include the following: Number one, the recruiting, hiring and retaining of a new workforce of 66 individuals who are in recovery from serious mental illness as staff. This new employee pool demonstrates more clearly than any other intervention the high levels of recovery that are possible 92 4/7/10 - WHOLE - BILL 100115, etc. for many individuals. Secondly, a nine percent increase in the people employed and a 5 percent increase in individuals attending 6 school. 7 And, finally, a 38 percent 8 decrease in costly admissions to crisis 9 response centers. 10 Enhancing minority 11 participation: The DBH/MRS is committed 12 to supporting the Administration's goal 13 of 25 percent minority, women and 14 disabled-owned businesses participating 15 in City contracting. While the DBH/MRS 16 participation information presented by 17 the Office of Economic Opportunity has been identified at just over one percent, it should be noted that most DBH/MRS contracts are with not-for-profits and, therefore, not officially classified by OEO as to minority, women or disabled ownership. However, DBH has a strong commitment to the issue of minority participation in the delivery of 93 4/7/10 - WHOLE - BILL 100115, etc. behavioral health and mental retardation services. Minority participation is a key component of our efforts to reduce known behavioral health disparities and to improve the overall effectiveness of our treatment system. To date, we have made significant strides. When the determination and designation of minority, women or disabled status for non-profits is based on executive leadership, the contract percentage for these categories is over percent. For example, 38 percent, or 15 81 providers of our CBH provider network, 16 has executive leadership that is either 17 minority, female or disabled. In 18 addition, 56 of the minority, women or 19 disabled community behavioral health 20 providers experienced revenue increases 21 with the overall amount being paid 22 increasing from 166 million in Calendar 23 Year 2007 to over 191 million during 24 Calendar Year 2009.
It is our intention to continue the department's effort to 94 4/7/10 - WHOLE - BILL 100115, etc. increase minority participation through the remainder of FY10 and through FY11. In addition, we have recently incorporated into our annual budget and invoice instructions a schedule detailing minority participation for subcontractors to our providers. It is our hope that this information will allow us to further quantify participation rates throughout our entire network. The development of provider profiles: An example of the department's emphasis on accountability is the creation of provider profiles. During 2009, DBH/MRS introduced a new provider report series that will measure change at the provider and system level. Provider profiles allow the department to make empirical comparisons of provider performance and base contracting decisions on these comparisons. Additionally, these profiles will support the Pennsylvania Department of Public Welfare's plans for implementing "pay for 95 4/7/10 - WHOLE - BILL 100115, etc. performance" for HealthChoices contractors. To date, the department has issued two report series, one on providers of inpatient psychiatric services and the other on residential treatment facilities. These reports have been shared and reviewed with providers. In the coming months, the department plans to issue reports on remaining levels of care, including drug and alcohol rehabilitation services. Finally, the current economic situation has created challenges at the state, federal and local level in supporting individuals who are uninsured or underinsured. As job losses continue to mount, the number of uninsured individuals seeking physical and behavioral health care will continue to challenge healthcare providers. Since the bulk of the resources supporting DBH/MRS are State and federal dollars, we have sustained reductions in State and 96 4/7/10 - WHOLE - BILL 100115, etc. federal funding in each of the past two years. We are appreciative of Council's historical efforts in advocating for increased funding and are willing to partner with you on these ongoing efforts. We look forward to working with Council and other stakeholders to advocate for resources to support the most vulnerable citizens, and we thank you for your attention this morning.
Thank you, Doctor. The Chair recognizes Councilman Goode.
What is your goal for contracting with disadvantaged businesses for Fiscal Year '11?
What is your 97 4/7/10 - WHOLE - BILL 100115, etc. goal for contracting with disadvantaged businesses for Fiscal Year '11?
If you're talking about our goal with non-profit providers, our goal is percent. 7
I'm not 8 talking about non-profit providers. I'm 9 talking about for-profit -- 10
For-profit 11 providers, what MBEC has identified for 12 us is one percent. 13
We purchase very 23 little for-profit services. So, for 24 example, in the City General Fund, our 25 City General Fund amounts to about $14 98 4/7/10 - WHOLE - BILL 100115, etc. million. One point five million of that is for personnel. The rest of that is 12.5, whatever the math is, is contracts with private not-for-profit entities. Out of the City General Fund, we spend perhaps $120,000 on for-profit entities. So the maximum that we would ever be able to get as a goal out of that is about that one percent that we do.
That's because we purchase mental health and substance abuse and MR services from for-profit -- or from non-profit providers.
That still doesn't necessarily explain why you can only do one percent, but let me move on. You put out an RFP for leadership development?
Leadership 99 4/7/10 - WHOLE - BILL 100115, etc. development.
One of the things that we are doing is radically changing how we deliver healthcare services, and part of that training or part of that initiative is to work with our providers around how they have to change practices. We also have to do a similar kind of process internally. And so we've been working with a group to help our staff develop the skill that they need in order to manage in this new --
In the RFP 100 4/7/10 - WHOLE - BILL 100115, etc. in Section F, it says the required participation ranges will be posted with the original contract opportunity. Detailed notices on the e-contract Philly website is an addendum to this contract. For more information, please contact Candace Hitchcock of the Office of Economic Opportunity. I actually pulled this off of the site. I did not see an addendum with goals. What were the goals for this contract?
Well, this particular contract was awarded to a minority provider.
The question was, what were the goals for the contract?
I'm not quite following you. It is a single contract. I'm not quite understanding the question.
It says the required participation ranges will be posted. What were those participation 101 4/7/10 - WHOLE - BILL 100115, etc. ranges?
Why would they set participation ranges when you are the professional in the field?
Yet they set a goal for your department of one percent?
They set a goal of one percent. They put out an RFP with no participation ranges. It turned out to be 100 percent participation. 102 4/7/10 - WHOLE - BILL 100115, etc. Clearly, it's very possible if they are not in the health and human services field that they don't know what the field looks like in terms of capacity of disadvantaged businesses. I would say, one, they should not be setting your goals; you should be setting your goals. Two, if you are an African American male leading a department and you're trying to develop leadership within that department, clearly there has to be service providers out there, as demonstrated by the fact that you chose a --
-- disadvantaged firm. There's no reason whatsoever that there shouldn't have been participation ranges within the contract and no reason whatsoever that OEO should have been setting goals for that contract. It just doesn't make any sense. 103 4/7/10 - WHOLE - BILL 100115, etc.
You're welcome. The Chair recognizes Councilman Greenlee.
Thank you, Madam President. Good afternoon, Doctor. Just a question on the certified peer specialist. That certainly sounds like a great concept. Not only does it provide jobs, but certainly these people have been there and they certainly know the field. But what type of counseling do they provide? Can you go into that a little bit, like what they do?
They don't provide counseling. What they do is -- these are people who are in recovery themselves and what they do is provide peer support to individuals. There's a growing body of research that shows that one of the 104 4/7/10 - WHOLE - BILL 100115, etc. things that helps people tremendously in their recovery process is to have people who have gone through what they've gone through sort of helping them through that process. And so the State a couple of years ago included peer specialists in the Medicaid plan and has allowed us to implement peer specialists within our service system.
Okay. That sounds certainly like a good concept. I assume a lot or at least some of the individuals that come to you for assistance are uninsured. How is payments -- do they have to pay anything? What is the --
Are you talking about peer specialists or are you talking about in general?
The department gets grants from the State, State and federal 105 4/7/10 - WHOLE - BILL 100115, etc. dollars, to provide services for the uninsured. One of the stretches that we have experienced over the last several years is that because those dollars tend to be 100 percent State dollars, given the State's budget crisis, we've seen a continuing reduction of those resources. So at a time when we've seen more people needing services who are uninsured or underinsured, we've seen a reduction in the amount of resources. But the City does have resources for those individuals who don't have health insurance. It's just, unfortunately, a diminishing pool right now.
I understand. One other question. I'm just going to read this as it was given to me, because it was Councilman Rizzo's question and he unfortunately can't be here. What is the status of the Crisis Intervention Training program for the Philadelphia Police Department?
Sure. One of the 106 4/7/10 - WHOLE - BILL 100115, etc. things that we've been doing over the last several years is training police officers to interact with individuals who they may encounter on the streets who have a serious mental illness. Those tend to be very dangerous situations, both for the police officers and for the individuals, and we've gotten -- we have a tremendous partnership with the Police Department. Commissioner Ramsey is very supportive of the training that these officers go through. We've trained about 600 officers to date. They go through a one-week, very intensive training. They learn about mental illness. For example, there's an exercise called "hearing voices," where the officers actually experience what it's like to hear voices and how difficult it is to process the command they might be giving. And so it's a way of ensuring, number one, that the officers know how to handle those situations. It improves the safety for officers and for the individuals, and it 107 4/7/10 - WHOLE - BILL 100115, etc. helps us to, as a city, make sure that people who really need to be in a treatment setting are in a treatment setting as opposed to being incarcerated.
Yeah. One of the things that we've been really pleased with is that Commissioner Ramsey is a major supporter of this program. In fact, he and I do most of the graduations. He's in fact at every graduation himself. He shakes each officer's hand who goes through this training, and his position is, he'd like to see every officer in the City get the training.
You're welcome. The Chair recognizes 108 4/7/10 - WHOLE - BILL 100115, etc. Councilwoman Brown.
Thank you, Madam President. Last month the Office of National Drug Control Policy had a reception with the nation's drug czar, who coordinates all aspects of federal drug control programs and implementation. What were the intended goals or outcomes of that reception?
The White House Office of National Drug Control Policy is responsible for coordinating the country's drug policy across all federal agencies, and one of the things that they've been very interested in with the Obama Administration is the change in the field to what's called a recovery management orientation, and basically what that means is the kinds of changes that we are trying to do here in Philadelphia in terms of making sure that when we treat people who have an addiction, that we don't just treat the 109 4/7/10 - WHOLE - BILL 100115, etc. acute illness, but we really try to support people for the long term, help people get jobs, help people to be more self-sufficient. That change that's happening in the country is something that the City of Philadelphia has really been a leader in around the country, and so the ONDCP was here sort of as an acknowledgment of that. This was an event that was held at Temple, who hosted the event, and it was just an opportunity for them to acknowledge that work. One of the nice things that happened as a result of that is that a video was being made of a panel that we participated on, they participated on, the Temple professors participated on, and the intent is to use that video around the country to highlight how systems might make the same kind of changes that we've been able to make here in Philadelphia.
Thank you very much for your response to the letter 110 4/7/10 - WHOLE - BILL 100115, etc. I sent asking you to detail for me staff composition as it was and the, I believe, improvements or progress that's been made to have that department look a bit more like Philadelphia. So briefly give us an update on where that is.
Well, one of the things that I think is really important is that we have a staff that reflects the population.
The constituency served. And one of the things that we've been able to do over the last several years is really to increase the number of diversity of staff at all levels of the organization. So, for example, probably -- I haven't done the math, but probably 40 or 50 percent of my executive team are people of color, minority 111 4/7/10 - WHOLE - BILL 100115, etc. status. The leadership training that Councilman Goode was just talking about is something that we've been doing for the last three years, and it's been a way for us to identify people within the organization who are emerging leaders, help them develop the skills and really position them to be able to go into higher leadership positions. So we've done a variety of things to try to both identify people who are talented, but also to help support people in getting the skills that they need to function at those higher levels.
Thank you. So let's drop that down one level to agencies throughout the Philadelphia community that receive funding from CBH. And, again, I have to put this in the context of what Dr. Schwarz made very clear to us, and, that is, that there are ongoing discussions to figure out or determine what constitutes a non-profit. 112 4/7/10 - WHOLE - BILL 100115, etc. I don't quite know what that means. We're just going to have to wait to see what that rolls out as. So the question is, of the agencies that receive funding from CBH, how well do they look like Philadelphia? Let's reduce it to that.
All right. So let me talk about it. And this was, I think, one of the frustrations for departments like mine who contract primarily with private non-profits.
Yes. We contract primarily with private non-profits. So actually about four years ago, four, five years ago, we decided -- because we kept running into this issue of our participation numbers looking very low, when we knew that in fact we were contracting with a number of providers that were minority led, their Boards were minority, they were in minority communities, they were serving primarily 113 4/7/10 - WHOLE - BILL 100115, etc. minorities. So from every conceivable criteria, these were clearly minority organizations, but the department did not receive, quote, credit for that. So a few years ago, what we did was to survey our providers, and we looked at a couple of things. We looked at the executive leadership and who the organization had historically served. We also looked at Board composition, and we came up with the providers and determined who we thought the minority providers were in our system and just looked at -- and we sort of tracked that over time. Most recently what we've done is to look at executive leadership and minority status, women status, disabled status and, again, categorize them. So out of 214 providers that we contract with through CBH, 81 of those are, or 38 percent of those, are minority, women or disabled. Forty-eight of those are minority providers. And what we have seen over the last several years is that 114 4/7/10 - WHOLE - BILL 100115, etc. we've had an increase in revenues for three-quarters of those providers, and, in fact, we've seen a greater increase in revenue to those providers who are categorized as minority than we've seen in the system overall. Additionally, over the last four, five years, we've added minority 10 providers in our service system. Those 11 providers are averaging over, as a group, over a million dollars a year in terms of revenue, and we've seen their revenue increase as well. In fact, we have nine providers where we've seen greater than 50 percent increase in revenue over the last two years and we have six providers who have had revenue increases of over a hundred percent over the last three or four years. So I think what we've been able to demonstrate is, number one, is that we can be effective at recruiting people, identifying minority participation, retaining them in our system and then 115 4/7/10 - WHOLE - BILL 100115, etc. helping to see those organizations stabilize and grow as viable organizations.
Indeed. The clock has struck -- stricken -- struck. The bell has rung, but I am going to circle back, because I'd be curious to know the technical assistance provided. Too often in the past we heard explanations like agencies or providers don't have the skill-set, if you will, to deliver services in a way that meet the expectations of the department. So I'd be curious to know what technical assistance is provided, and that exactly what you just said is the same information we're going to be looking for from DHS.
So I thank you for those survey findings, and I commend you on the progress. Thank you very much.
You're welcome. The Chair recognizes Councilman Green.
Thank you, Madam Chair. I guess we're at afternoon. Good afternoon.
Good to see you. We received a bunch of budget reduction scenarios for every department that was a seven and a half percent cut and we did not get one for DBH, and I assume that's because the General Fund dollars that are appropriated are required match grant funding?
That's correct. Everything in the General Fund for our department is matched or ineligible for State funding. 117 4/7/10 - WHOLE - BILL 100115, etc.
So I just want to commend you. I think you and your staff are doing tremendous work, innovating in the delivery of services. You testified about DBH's establishment of holistic recovery centers, which offer a significantly improved and cost-effective approach to serving citizens' mental illnesses. Among the other great results, you noted that in 2009 the centers resulted in a decrease of 38 percent in costly crisis admissions. A wonderful result. Does the City realize any dollar savings from the drop in crisis admissions?
We don't realize direct savings, but we -- there are two ways that I think it impacts on the City General Fund. Number one is that only one -- first of all, to put this in context, only one percent of the department's budget is City General Fund. So out of a billion dollars, only 14 million. 118 4/7/10 - WHOLE - BILL 100115, etc. The impact that a decrease in crisis admissions has is, number one, it reduces admissions to inpatient hospitalization. Those savings occur on our grant and HealthChoices side, number one. And then, number two, but what that does then, it does allow us to serve more people for similar amount of -- having the same amount of resources. The other way I think it helps is that when we decrease crisis admissions, it also impacts in other City departments. So, for example, numbers of people who are street homeless, it impacts on police who are involved with people who are being 302'd, it impacts on fire and rescue who are having to make those calls. So I think indirectly those kinds of efficiencies also help other City departments, which in turn help the City General Fund.
But you wouldn't have an idea of what the General Fund impact in other departments is of 119 4/7/10 - WHOLE - BILL 100115, etc. that?
Okay. We've talked in past budget hearings about DBH's Crisis Response Center target recidivism rate and trying to bring it down to the national Medicaid standard of ten percent or even lower. It sounds like holistic recovery centers would be a big help in this effort. What was the final recidivism rate for Calendar Year 2009 and how does that compare to 2008?
Sure. The target is five percent for children, ten percent for adults. We have been able to meet the child standard over the last couple of years. We've not met it for adults. It was 15 percent last year. It's 15 percent this year. We've done some fairly sophisticated, with the leadership of Dr. Kathy Bolton, who is a psychologist on our staff, some fairly sophisticated statistical modeling to 120 4/7/10 - WHOLE - BILL 100115, etc. look at what variables were related to reduced recidivism, and it turns out -- this analysis is done towards the end of last year. It turns out that a number of the things that we historically believe related to reduced recidivism in fact were not, and what we found was that what drove a lot of the recidivism in our system had to do with a co-occurring addiction, meaning that what's happening is that what we're seeing are a number of people who are going to crisis centers, being admitted to inpatient hospitalization for a psychiatric condition, when the real issue is that they have an addiction. And so what we're doing are a number of things with our providers and other stakeholders to increase our ability to divert people out of crisis services into an appropriate rehabilitation service. So, for example, when providers call for an authorization for an admission to inpatient, one of the 121 4/7/10 - WHOLE - BILL 100115, etc. questions that they will be asked and actually required to give us is the results of a drug screen, which, one, will tell us whether or not that they are actually looking at that issue. Number two, we've met with a number of our rehabilitation providers to identify providers who can receive people directly out of those crisis situations into a more appropriate drug treatment program. We've had a series of meetings with our providers around this particular issue. We've also met with our providers around the issue of ensuring that when a person who is in a mental health program, maybe going to an outpatient program, is admitted to an inpatient hospital, we want to make sure that those providers are up on the units, are making contact with those hospitals and making sure that those individuals are connected as quickly post discharge as possible. So those are just a few examples of the kinds of things that 122 4/7/10 - WHOLE - BILL 100115, etc. we've begun to put in place and we believe will lead to the kind of reduction that we want to see and --
The same goal for next year. The hope is to go below ten percent. I think the point is that in the absence of the data, I think we would have continued to go down the path of trying things that the literature says work, but were not really appropriate for this particular system.
With respect to sort of diverting people away from inpatient and other things, you gave a presentation on the 30th to CJAB where you talked about diverting people after arrest, pre-incarceration into some mental health treatment, and I know you've been closely involved in several efforts to provide treatment services to inmates and do diversion of people into treatment. 123 4/7/10 - WHOLE - BILL 100115, etc. You talked about seeking grant funding for a new intercept model, which would identify and triage people post arrest and pre-incarceration. Could you describe the timeframe for putting this new model in place?
Well, we're applying for a grant for this particular model. If we get the model, we will be in a planning and development phase for six months to a year. That will be determined, in part, once we get the grant. But we would anticipate that if we're successful, within a year we'd be able to bring up that particular service.
And how many people -- is there an estimate today I guess for the grant of how many people you think end up in prison who would be eligible for this diversion?
We don't have an exact number and, in fact, the way the grant is written, the first year is to develop the plan with the Police 124 4/7/10 - WHOLE - BILL 100115, etc. Department around what the program would look like, the numbers and so forth. So at this point, we don't have an exact number.
Well, or even a ball park number. I think it will be a relatively small number initially. It will grow over time.
Bigger than a bread box, smaller than a refrigerator, I think.
I think over the course of a year, I think a hundred people is probably a reasonable number for the first year, given start-up issues.
And then hopefully there'll be several hundred 125 4/7/10 - WHOLE - BILL 100115, etc. after that?
I would hope that. I think the issue for us is -- and one of the things is, we're just getting a handle on the volume of people that are in -- that end up in detention who potentially would have a mental health problem. And so we're just at the point of sort of quantifying that.
So you might know the answer to the flip side of the question then, which is how many people of the currently incarcerated population are eligible for release into treatment programs?
It depends. Right now we -- if we're talking about addiction or mental health, because individuals who have --
Either, okay. So for addiction, for example, we have run a program called the Forensic Intensive Recovery Program. That program last year 126 4/7/10 - WHOLE - BILL 100115, etc. served 2,967 individuals in that program. And so those are individuals who have been identified in the Prison System who clearly have an addiction, have a history of addiction, meet the criteria from a criminal justice system in terms of their charges and so forth that we've been able to divert out of the City Prison System. On the mental health --
With respect to that, before you get to mental health, do you see the potential for growth of that program or are you sort of taking care of all the people you need to?
We're taking care of the numbers that we currently can handle given the resources and funding that we have.
Well, there is grant funding, but that grant funding hasn't expanded. So we're somewhat limited in terms of the number. 127 4/7/10 - WHOLE - BILL 100115, etc.
How much do you spend a day on people like that? In other words, if more people were eligible and we could divert them, obviously there would be resources in the Prison budget that would be available for that purpose.
Well, the number, if we're talking about -- most of these individuals are going to go into residential care once they are released. Residential care will cost somewhere between $75 and $200 a day. So for most people, initially it's going to cost more to our system than it would to incarcerate them. The savings really come more in the long term, because obviously these individuals don't stay in residential treatment forever.
With mental health, we're actually doing some really exciting work with the First Judicial District and developing Mental Health Court, and 128 4/7/10 - WHOLE - BILL 100115, etc. unlike most mental health courts in the country, which tend to be diversion mental health court, this is a mental health court that is really a reentry mental health court, meaning we're identifying people who are already incarcerated, who have already been adjudicated and looking -- and who clearly have a serious mental illness and have a certain type of charge, non-violent, so forth, that the prosecutor and the public defender, we all agree that these are individuals that would be better suited and better treated in a treatment setting than continue to be incarcerated, and we are working with them to divert individuals out of the Prison System. So that program has been up for the last year or so. We're increasing the numbers of individuals, and our hope is that over the next year, we'll have a steady increase of somewhere between 60 -- or a steady cohort of about 60 or a 129 4/7/10 - WHOLE - BILL 100115, etc. hundred people that we're serving at any given time.
Right now I think we have about 30 individuals that are in the Mental Health Court.
So this would be another up to 70 people that we're taking out of the Prison System on a sort of annual run rate basis?
At a given time. I would say cumulatively over a year, that would be somewhere between a hundred and 200. One of the limiting factors right now is that we use something called and it's sort of community treatment team, which is an evidence-based practice that we use to wrap services around individuals, and so that's sort of the limiting factor right now. 130 4/7/10 - WHOLE - BILL 100115, etc.
Have you found any difference in dealing with some of the stakeholders in getting these programs sort of utilized more with a new DA or maybe --
Are you having more cooperation with stakeholders in terms of getting people into these diversion programs?
Absolutely. I think the level of cooperation now between the criminal justice system and the behavioral health system is as good as I think it's probably ever been in the City. I think the District Attorney's Office, Public Defender's Office, the courts, Judge Woods-Skipper, who is leading Mental Health Court, I think everyone is, I think, solidly committed to this notion that people who need to be in jail need to be in jail and people who don't need to be in jail, we need to 131 4/7/10 - WHOLE - BILL 100115, etc. figure out a way to get them in an appropriate treatment center.
One final question. Are you involved at all in the Veterans Court program where there are mental health issues?
We've been invited to some of the early meetings. I know that there's some continued planning that's going on, and we anticipate that we'll be a part of that process when it's done.
Councilman Green, if you have more questions, we'll have to have a second go-around.
Yes, Madam Chair. I have no more questions. I just want to thank Dr. Evans for the great work of he and his team.
Thank you. 132 4/7/10 - WHOLE - BILL 100115, etc.
I just want to make sure that the two clocks are on the -- that's the Bill Green clock and then everyone else's clock, because it seems to always stall. When we hear the bell, we promptly adhere to the Chair.
I just want to know if we're on standard time or Bill 15 Green time. My point of information also had to do with the concepts of community courts, concepts of alternate courts and ask whether you have been in contact with Judge Frazier on her concept of connectivity court, and have you had any --
There seems to be a disconnect. There are a lot of 133 4/7/10 - WHOLE - BILL 100115, etc. people doing a lot of worthwhile things, and then you have CJAB and then you have those people who are actually in the courtrooms, practitioners that have done a lot of work, and I've reviewed a lot of their proposals, and I would think that there should be a connect to that, because I think we're coming to a point where all of these good ideas could be put in a matrix and us come up with a concept that does a couple of worthwhile things. One, reduces our budget obligation to criminal justice and to mental health, which combined represents close to the majority of the dollars spent. So if we threw in DHS, we throw in police, prisons, incarceration efforts, judicial efforts, we're talking about serious money, as Obama would say. But if we could all get together on this concept, and particularly where my point of information was, the criteria by which you assess risk, the criteria by which we can come together with a uniformed 134 4/7/10 - WHOLE - BILL 100115, etc. understanding of this person is a good risk, this person is a risk that is a little higher and therefore should or should not be eligible. Those concepts are at the building block of any successful diversionary court effort. So if we could all get together around a roundtable, irrespective of those who have official membership on CJAB versus those people who actually do it for a living or are impacted by it in their respective districts, could get together and maybe spend a half a day, lock the door, throw away the key and cell phones and figure this out, I think we could save the citizens of Philadelphia some serious money, come up with a product that actually stops recidivism, helps out some of the people who are doing it. Like the probation people have great ideas. The probation people know these folks better than you or I and can help in that process, but all of us are speaking different 135 4/7/10 - WHOLE - BILL 100115, etc. languages saying the same thing. So if we could kind of get that together, and I'll charge my colleague Bill Green, who is on CJAB, who is on CJAB, who made a commitment to being on CJAB, that he would look into that, that he shepherd that with you and other stakeholders, because right now we're moving at a good pace, but we need some coordination and leadership on this issue. Thank you for your kind clock and my point of information.
Councilwoman Brown, your light is on. Did you want to be recognized?
Thank you. Thank you very, very much. I wanted to follow up on the question around technical assistance 136 4/7/10 - WHOLE - BILL 100115, etc. that -- well, we know what that is. So internally how do you assist agencies who want to move to fit the criteria so that they can deliver services and become a provider?
Well, I think most of the providers who come to us for -- to be a part of the network come with the skills to deliver the service. They're trained as psychiatrists or psychologists. And so the issue really isn't the clinical skills to deliver the services. The issue tends to be more the administrative infrastructure that people need in order to operate their business in a managed care environment, which is a very different environment. So a lot of our technical assistance tends to be around helping people to put in place those systems that they need to function, and we've done a variety of things, from very formal things to more informal things. I've personally been involved in connecting providers with other providers 137 4/7/10 - WHOLE - BILL 100115, etc. who have established systems and infrastructure. We have staff at CBH in our Provider Relations that also provides feedback to providers on areas that they need to -- areas where they can improve their infrastructure. And obviously that's not limited to the administrative parts of their business. It is also -- we also do that relative to their service delivery too, to the extent that that's an issue.
Okay. Let's flip to the other end of that continuum where you may have providers who, based on your own internal monitoring, are no longer meeting criteria. What is your process or procedure for moving to discontinue that relationship, discontinue that contract?
That's a great question. The issue for me is that if we make those kind of decisions, they have to be transparent, they have to be fair, they have to be based on some empirical 138 4/7/10 - WHOLE - BILL 100115, etc. data, and, frankly, we have not had the level of data that I think is necessary to make those determinations that this provider should be a part of the network versus this provider shouldn't, unless someone is clearly providing really poor, egregious services, but beyond that kind of more extreme situation, I think it's more difficult. But this is an issue that we think is enormously important, and the reason that we've developed provider report cards, because it gives us an empirical, objective way to evaluate providers. As I mention in my testimony, we've now done that for two levels of care. We are rolling out this year probably another three or four, and what it allows us to do is a number of things. One is that we identify, again, in very empirical terms, areas where we evaluate providers; for example, on recidivism. We also look at things like complaints that they may have gotten. We look at a number of issues, and we 139 4/7/10 - WHOLE - BILL 100115, etc. provide a summary for each provider as to how they're doing. We not only do that, we give providers feedback in terms of where they are on a particular dimension relative to their others. And so, for example, take recidivism. You would receive back from us a report that would show, here is where you're at and here is where you're at in the continuum of other providers. So it gives people both objective information about how they're doing, but it also gives them information about how they're doing relative to their peers. Our plan and our intent is to then begin to use this data to make decisions about who we contract with, who we don't contract with, to the extent we're able to give some kind of incentive, those kinds of things.
I would suggest also that leads to some level of uniformity across the board when it comes to judgments about whether or not 140 4/7/10 - WHOLE - BILL 100115, etc. providers should be regranted the opportunity next time around or not. Would you agree?
So is that to suggest there's a monitoring unit at CBH that is in the business of reviewing provider contracts, looking to see if what's happening in real life is consistent with what is down on paper?
Yes. In fact, one of the problems that we have is I think we have too much monitoring right now. We have two or three units from CBH that do monitoring. We have units from the City side that do monitoring. And so one of the things that we've been doing for the last year or so is looking at how we integrate and come up with one standard way that we monitor providers. One, it's more efficient for us, it will save us resources, but it will also make it clearer to providers so that they're not 141 4/7/10 - WHOLE - BILL 100115, etc. getting mixed messages. So the short answer to your question is, yes, we have a fairly elaborate process of credentialing providers and then monitoring them through CBH. We have additional providers, but we're really trying to integrate that and make that a much more efficient process.
So if that is operating as you've just defined, when judgments are reached that a provider is no longer worthy of the granting opportunity with CBH, does it become a committee decision or is it a unilateral management decision?
A lot of people are involved in that kind of a decision, including if we take making decisions about who is going to be incentivized or not. I have a finance committee that, first of all, makes decisions about any issue that relates to a financial impact to the department. There are clinical 142 4/7/10 - WHOLE - BILL 100115, etc. staff that will do the monitoring who are supervised by other clinicians, and they will generate reports. And there are those of us in the senior management of the organization if we were to make a decision about eliminating a provider from the network that would also weigh in. So there are a lot of checks and balances throughout the system. There are no unilateral management decisions to have someone not be a part of the network.
I have additional questions, but the bell has rung, so I'll re-circle back when my time comes. Thank you, Madam President.
You're welcome. The Chair recognizes Councilwoman Sanchez.
Thank you, Madam President. 143 4/7/10 - WHOLE - BILL 100115, etc. Good afternoon.
I want to talk a little bit so that I better understand the financial structure of your department, because it's very unique because of its relationship with CBH. I notice that about half of your General Fund budget is for match related to your grant funding. Can you explain that structure for me?
Yes. You have $7.5 million in your General Fund that goes to the match, and according to your description, it's a grant-funded match required for residential services, emergency crisis intervention, day treatment and case management. So I want to understand that match.
Yeah. It's actually the entire 14 million. I think what you're looking at is a subset of the 144 4/7/10 - WHOLE - BILL 100115, etc. match.
Right. So of the City General Fund, 98 percent, say, are matched dollars. So what you're seeing is seven million of that million 9 that's matched, but the other 10 approximately seven million is also match 11 for other areas within the department. I 12 think you're looking specifically at 13 mental health. 14
Yeah. So the department receives State and federal grant dollars. Many of those funding streams require a certain amount of match from the department. For most of our dollars, it is a one-to-nine match. So for every dollar that we spend in the City General Fund, for those revenue streams we're able to draw down $9 to the City. 145 4/7/10 - WHOLE - BILL 100115, etc.
So why is the match from our General Fund and we don't require that as a match to our recipients of these grants?
We're granting this money out to some of these providers. I want to know at what point did we make the decision that the match was going to be a General Fund match versus an agency match for the dollars that we were giving them?
No. We pay the agencies to provide particular services. So we as a payer in turn purchase services from our providers with the dollars that we're able to generate.
I guess I'm trying to understand the formula. 146 4/7/10 - WHOLE - BILL 100115, etc. Because is that based on the fact that we've moved to fee for services versus --
No. Those are historical requirements for various State funding streams. So the State basically says, We will give you a certain amount of grant, but in return, you have to put some resources into the system.
That's for the county. And, fortunately, the county match is only one to nine. Some other funding streams have one to one.
I just wanted to understand that ratio, because then I want to be able to compare it to DHS and others as it relates to our matching kind of --
The matching works a little differently between DHS and Behavioral Health.
So we have a nine to one -- 147 4/7/10 - WHOLE - BILL 100115, etc.
-- as it relates to that. As you know, one of the areas -- and your office has tried to be extremely helpful with this -- has been, again, the need to provide multiple types of venues and support services for people in recovery. And, again, I'm all for the issue of recovery, but as the need grows through Mental Health Court, through community courts and all those issues and our wanting to move these types of services into the neighborhood, we create some other unintended consequences. So I want to get to those, which is the upsurge in recovery houses, many which are not funded or licensed by the City, and so, as you know, that has become an issue in the 34 and the zip code, some 23 of which I represent and some of which 24 Councilman DiCicco represents. If all of these other programs 148 4/7/10 - WHOLE - BILL 100115, etc. are successful, which we want them to be, how are we going to place some of these services throughout the City in a way that is more proactive than what has happened?
Absolutely. I mean, it's a complicated issue because, as you point out, most of the recovery houses in the City are not funded by us, are not controlled by us, we don't license them, we don't regulate them in my way, and people have the ability to do that because there isn't a license for a recovery house. Out of 160 recovery houses that we know about and have actually inspected, only 20 of those are those kind of providers. So I think from our standpoint, especially the attention that you've paid to this issue, I think what I would say to that is that from our 149 4/7/10 - WHOLE - BILL 100115, etc. standpoint, we're very cognizant of the issue and your concern about the community that you represent, and from our standpoint -- first of all, we don't have the dollars to expand, so it's kind of a moot issue, but to the extent that we would, those are the kind of conversations that we'd want to have with yourself and other stakeholders and representatives, to the extent that we were able to get those resources.
Can I get one more? And I'll circle back around, because I think -- I'm going to use the Bill Green clock. I think one of the issues becomes when there is opportunities where we can impact the placement, I think we need to figure out what other tools. I mean, obviously you know we've been trying to figure out whether there should be a recovery house, some sort of licensure and does the State preempt us and all those other things, but we need 150 4/7/10 - WHOLE - BILL 100115, etc. to get ahead of this, because we want those other systems to work and because this has become such a problem in certain parts of the City, and on the legislative side, we in Council need to know what tools we're going to give you so that this becomes a productive discussion and not the one that we have. Because now we're against the tide, because there's this anti-sentiment all over the place. So I think it's important that if we're not going to get something from the State, which it looks like they're not willing to do, what is it that we're going to be able to do at the City level to help you so that there's an understanding? Because I think the part that's the hardest for people to understand and for us to explain to constituents is, we can't -- we haven't regulated this and there's a need for it. I mean, if we shut down -- you're saying 161. The number is closer to 300. We probably know that. If we'd put four or 151 4/7/10 - WHOLE - BILL 100115, etc. five thousand people on the street, we'd have chaos. So we need to figure out what we're going to do, because Mental Health Court and Community Court are going to generate more.
Certainly. But I guess in terms of the things that we're already doing, the 160 that I mentioned are recovery houses that we've actually gone to, we've looked at, we've inspected. We actually rated them. What we've tried to do is because we don't have any regulatory authority over those entities, we've tried to be clear about what our standard is, because we have real clear standards for those that we fund around how they can operate and so forth. And I think they operate very well in the community. So what we've tried to do is, number one, encourage those who are not funded by us to adopt the standards and adhere to those standards. Number two, we've made 152 4/7/10 - WHOLE - BILL 100115, etc. available our training that we provide for our funded providers. We've opened that up to the other providers. And, number three, we've done technical assistance, particularly when we get a complaint about a provider that's not funded by us. We've used our resources to go out and work with those providers. So I think at this point, what we've tried to do is by influence get these providers to incorporate those standards, and I think we can continue to do that. My concern is the department not being put in a position where it's asked to do something that it's not resourced to do. So I think if we have a discussion about increased monitoring of those kinds of things, I think we also have to figure out how do we make sure that we're able to do that given the other demands that we have on our system.
And I 153 4/7/10 - WHOLE - BILL 100115, etc. guess the concern becomes other than L&I, the housing code piece, you know I'm going to have to legislate this somehow. I got to figure it out, because it's a problem. And I'm trying to figure out what's the best way that we do this on a local level where it is not an unfunded mandate. The State does it all the time to us, and we don't want to be irresponsible, but at the same time, we need to figure out whether it's a health code issue. And even your department, in terms of those clients, those people in the recovery houses are clients and somehow come through the CBH system as a fee for service.
Most of them do. I mean, there is a direct connection between a recovery house and your funded service providers.
Excuse me. The stenographer is just asking for a three-minute break, so if 154 4/7/10 - WHOLE - BILL 100115, etc. you don't mind. We'll break for five minutes. Thank you. (Short recess.)
Councilman Goode may have asked this question, but I have two questions, so short answers.
When CBH was organized, the purpose, I guess, was to provide services, but also keep the captured savings so that you could provide additional services. How well are you doing with that? And also has the State budget had any impact on the reserves you may have for that effort?
Sure. Yes. So the way CBH operates -- well, first of all, 155 4/7/10 - WHOLE - BILL 100115, etc. the contract is between the City of Philadelphia and the State of Pennsylvania. That's the contract. The City holds the financial risk. And so what CBH does is, it provides an administrative service for us, claims payment, utilization management, credentialing providers and so forth, but the City is at financial risk. So what happens is, on any given year, we're responsible for the entire behavioral health services for the entire Medicaid population in Philadelphia. It's about 428,000 people right now, probably go up to 450,000 by the end of the year. We get a set amount based on each person who is in Medicaid, and we're responsible for all of their behavioral healthcare. If at the end of the year we're able to manage our resources so that we have some savings, we then reinvest that back into our service system. If in any given year we're not able to manage all of those services within the amount that we get, 156 4/7/10 - WHOLE - BILL 100115, etc. we have a deficit and we would have to go into our reserve amount. So that's sort of the basic structure. So over the years since the program has been established, since the City has had the program, the City has had about five percent, what you might call, surplus or profit in managing the program. Half of that five percent has gone -- about half of that five percent has gone into reserves, the other half approximately into reinvestment. And there are reserves that we have to have by contract. So what we've been able to do with the amount that has gone into reinvestment is a variety of things. Number one, if you were here when Dainette Mintz was talking about the Mayor's initiative around reducing street homelessness, a big part of that strategy is making sure that there are behavioral health services for those individuals. We fund that. Because we didn't get any additional money. We took the surplus 157 4/7/10 - WHOLE - BILL 100115, etc. and used that to fund those services. So there are a variety of services with people in the criminal justice system and the homeless system, other kinds of community-based services that we use those dollars to fund and to supplement areas where we don't get adequate funding. For example, one of the areas that we spend $12 million a year on is the BHSI program for people who are uninsured who have an addiction. So that's typically the way we use it. And your second question had to do with how has the State's deficit or financial problems impacted us. Because we have to have a certain amount by contract in reserves -- it was previously defined as 45 to 75 claims days in reserve, part of our reserve. What the State did last year when there was -- when it was having its financial crisis was to reduce the contractual amount that we needed to have in reserve and then 158 4/7/10 - WHOLE - BILL 100115, etc. took back from programs a certain amount. The amount that we gave back to the State last year was $15 million.
Well, one of the impacts that it had is, as I mentioned, we use any surplus that we have in the program to supplement things that we think are underfunded or do programs that meet these kind of needs, like for the homeless. So essentially what that did was, it limited our ability to fund some of those programs.
But you were still able to provide your basic services to your clients?
The other 159 4/7/10 - WHOLE - BILL 100115, etc. one is, in your testimony you stated that 38 percent of CBH's non-profit providers have minority, female or disabled executive leadership and that 56 of the minority, women or disabled CBH providers experienced revenue increases of approximately million last year. How 9 did your office achieve these results? 10
Well, I think -- it 11 kind of goes back to kind of where we 12 spend the bulk of our resources. The 13 bulk of our resources are spent with 14 private non-profits, and we made a 15 commitment four years ago, five years ago 16 that, number one, we were going to 17 increase minority participation in our 18 provider network, retain those 19 individuals that came in and really tried 20 to ensure that they were viable, and a 21 couple of things that we've done. Number 22 one is, we've created a level playing 23 field, a very transparent process around 24 how one gets into the network. Now, 25 right now we're not accepting new people 160 4/7/10 - WHOLE - BILL 100115, etc. in the network for a variety of financial reasons, but for the first three or four years, we had a process that was much more transparent. People understood how to get into the network. The other thing we did was to procure most of our services through RFPs, which had not been done historically until we made that decision. I think providers appreciated it. All providers across the board, whether they were minority or not, appreciated the fact that the way we were identifying providers was through an open, competitive process. That started before the current contracting legislation that we were implementing. So I think that and the fact that we've been very intentional about having conversations with minority providers. We've met with -- in fact, my entire executive team has met with minority providers on several occasions. We have a task force; for example, an 161 4/7/10 - WHOLE - BILL 100115, etc. African Caribbean Task Force, that has identified issues unique to that immigrant community of color. So we've done a variety of things to both provide the support, but also keep the lines of communication open so that we understood some of the issues that people were dealing with.
Thank you very much, and you're doing a good job. We appreciate what you do.
I want to say that to Dainette. She's still with us. Thank you.
You're welcome. The Chair recognizes Councilwoman Sanchez.
Okay. I'm not going to be short. Dr. Evans and I have been working on this for a long time. It's important that we talk about 162 4/7/10 - WHOLE - BILL 100115, etc. this publicly and put it on the record. I guess where I'm trying to get to is, I want to get us to a place where we can close some of the loopholes that allow some of the bad recovery houses that really spoil it for everybody else so that we can cut down on some of them. So one of the issues is, we want communities to embrace this better, but we need to make sure if Neds (ph) or Wedge or anyone has a relationship with a recovery house, what I'm trying to get to is, is there a way that we can get our service providers to be more proactive around where they're getting their clients and where their clients live? Because I would think that our service providers understand the impact of where someone lives with their treatment program. And is there a way we can close that loop and make that one of the requirements?
I think that is an excellent suggestion and one, frankly, we 163 4/7/10 - WHOLE - BILL 100115, etc. had not considered in any formal way. I think it's a great suggestion. I think the way we've tried to do this up to now, as I mentioned, is to try to encourage people to adopt, but I think working with our provider network to say, Here are sort of the approved providers or recovery houses who have adopted these principles, strategies, whatever we agree to, I think is a good way to put pressure on those providers who are not providing a good service. So I think it's a great idea.
And I'd like to go even further and say to folks, for the providers, If you're getting five or six people or seven people, at one point there's a pattern of guys in one address. Can we require them to say, Okay, as part of this service, we're going to go out and do a site visit? I mean, I think part of it, we got to get our folks on the ground to help us.
We do that. I 164 4/7/10 - WHOLE - BILL 100115, etc. mean, the issue for us is again --
I think that they need to be part of the solution, and I think -- I don't want to give you more work that you're not funded for, but I think that if our providers are on the ground, I think we need to require that part of the service that they do once they get four or five people at one address, they should conduct a site visit. It should be part of their treatment plan. Can we do that? Is there any limitations?
Certainly we could put some things into place to try to help providers put in systems to do that. Again, I think it's a reasonable thing. I mean, one of the things that we've been saying to our providers very strongly is that you can -- and not all providers 165 4/7/10 - WHOLE - BILL 100115, etc. fall into this category, but you can no 3 longer have a program in the middle of a community and not have relationships with people in the community. You ought to be developing relationships with both informal and formal kind of supports. So I think in the context of that emphasis that we've had, I think, again, I think that's a very good solution.
If we can put that in next year's kind of requirements, that will go a long way of me being able to show some of these communities that we're looking to use whatever tools we have to get further cooperation. So I'd strongly like to encourage you to add that there. And then the other notion is -- and while this was in Councilman Clarke's area, it created even further problems in my district, when providers can kind of skirt some of the residential zoning requirements. So I need to put that on 166 4/7/10 - WHOLE - BILL 100115, etc. the record, only because, again, you take a good provider like Volunteers of America that does good work, but because of their rental structure, sets up a house in a deed-restricted area, and so they're now going to be able to place three people in this neighborhood, and you got the neighborhood in an uproar. I think if we want to ask neighborhoods to absorb some of this, we got to make sure that our providers don't use loopholes like that to move into neighborhoods. Because there's no way I'm going to be able to get anybody in Northwood to even entertain this, because they look at it as a provider skirting the system, and because we're subsidizing that provider, then we become party to the problem.
I think -- let me choose my words carefully here -- I think this is a real issue. I think there's a philosophical issue here. The issue is people with mental illness have a right to live in the community. 167 4/7/10 - WHOLE - BILL 100115, etc.
And I feel very strongly about that. One of the things that happens is if three college students or three guys who work construction decided that they wanted to move into a house, the community wouldn't oppose that. And the issue for me is that people and communities should not be able to keep people out of a community simply because they have an addiction, simply because they have a mental illness, because they decide to live together. I think that it's gotten to the point --
But if we want that level of cooperation, we can't have a corporate structure go around a loophole. If we want that community to embrace it --
I agree, to the extent that there's a loophole, but I think if three unrelated individuals who work construction can move into a house 168 4/7/10 - WHOLE - BILL 100115, etc. and rent the house, why can't three unrelated individuals who have a mental illness? I think that's issue that I have. To the extent that providers are doing something that is beyond what they are able to do, if there is a real deed restriction or if there is -- if now you're talking about four or ten people, I think that's a very different issue, and I think providers have to provide services in a way that's consistent with the law and regulation. But to the extent that people are operating legally, I have a real issue with denying people the opportunity to live in a community.
I totally agree with you, but when you set it up in a way that gets around -- it sets a bad taste for everything else. So here you have a community that otherwise might be willing to look at some of this, because I think people get it, but when you have that type of structure -- I think we need to tell our providers -- 169 4/7/10 - WHOLE - BILL 100115, etc. because, again, there's going to be a greater need in the community -- if you want to be a partner in the community, part of it is not using those types of loopholes, it sets up a bad taste, because now you have a situation where when we do need services and there is an opportunity, you're going to have an uproar. So we don't need to go there. I think we could do this -- because I think ultimately they're going to provide good services. People are not even going to know these people are there, but the tension that it caused going there now has unintended consequences that are going to go on for a long time.
I completely agree with that, and, in fact, we have been very clear and I think we've taken a very strong position that providers have to be not only in the community, but a part of the community and that -- in fact, we've created more problems for ourself, 170 4/7/10 - WHOLE - BILL 100115, etc. because one of the things that we require our providers to do when we do an RFP is to go out and get letters of support. We've had instances where providers have been in the community, successful, people loved them, they've gone out and gotten letters of support and because of reaching out, they then get opposition, when prior to that people were okay with them being there. So I think we have a very strong record on this issue of exactly what you're saying. Providers have to work collaboratively with the community, be as transparent as possible, but I also think -- and, frankly, I'm frustrated that there is no part of this city that a provider can put up any kind of program without some kind of community opposition. We have literally opposition to programs for deaf children. I mean, it's that bad at this point. And at some point, as has happened in other communities, what providers have done and 171 4/7/10 - WHOLE - BILL 100115, etc. what systems have done is say, We're going to take a stand under the Americans for Disability Act, and in every instance that I know, they've won. We've not done that here, and providers haven't done that because they don't want to leave a bad taste in people's mouth. But it's really gotten to the point where every single -- it doesn't matter what it is, it doesn't matter how benign it is, there's community opposition. And I think no one wants to see a person falling down drunk in the community. At the same time, those individuals need to be treated some place and at some point they need to recover and they need to be a part of a community and move on with their lives. And our ability to provide that service is getting increasingly difficult. And so I don't disagree with you. I think we have a track record of saying that this is important, but I think we need, as a city and as a city 172 4/7/10 - WHOLE - BILL 100115, etc. department, some help from our elected officials in saying and be willing to sit with us with community folks and say, There has to be a reasonable compromise here so that people who are part of this community can live in the community and the needs and concerns of the community are met.
No, I agree. That, again, under your administration has been a little bit different, but historically that has not been the relationship, and so we're fighting kind of this tidal wave of people feeling like they haven't had an input. And I know how difficult that is, clearly. And so, again, one of the things that I've said to the Administration is, we really got to map out where all these providers are, and so that when we make a hard choice that we are going to go against the community for a particular institution, that we have the data to back it up. But there are 173 4/7/10 - WHOLE - BILL 100115, etc. clearly areas of the City that have more than others, and that's easy for me to say because I don't need to absorb any more, I got more than my fair share, and I know how difficult that's going to be for my Council colleagues to absorb, but I think if there's a more proactive way and this is where departments have to break down their silos, where DHS and Office of Behavioral Health and OES, we start mapping this out in a more proactive way, we can start talking about this around certain neighborhoods and creating a more welcoming environment for some of this stuff, because these are their kids, too.
And it's very disheartening for me when I go to a meeting and people talk about these folks as if they're not our folks. And I take political heat because I said I'm not against recovery, this is a need. There's a correlation between the 174 4/7/10 - WHOLE - BILL 100115, etc. abundance and the need and why they're located where they're located, but if -- and that's why for me when people kind of work around rules, it becomes very difficult for me, because that is an area where we can say, Hey, if we're going to do this, we're going to do this above board versus working around it, because then it creates this bad feeling in the community that's more difficult. So I guess I'll end with, at least you're going to look at contractually how we can, again when a provider has more than six or seven people from one address, how that gets built into their contract, so at least we can say we've accomplished something and we're going to kind of move this. Another controversial issue, and it will be my last one, is around Prevention Point. It has been successful. I want to be more supportive of where we put them, but there has to be a commitment for additional resources for 175 4/7/10 - WHOLE - BILL 100115, etc. us to do that. I mean, I've tried to talk to Temple and some other locations. They've clearly outgrown that site, and they're not going to be able to get a bigger site unless they get more money. And if you want me to continue to take the heat for it, I need it properly funded so that we can move it somewhere where it's more appropriate.
Because I get those calls all the time. As the weather gets warmer, it becomes more visible. I think they're doing good work. I'll continue to defend them and support them, but they need to be appropriately funded so we can place them somewhere permanently.
Thank you. But you didn't commit to the additional resources. 176 4/7/10 - WHOLE - BILL 100115, etc.
I can't do that until I look at my budget. That would be irresponsible and I wouldn't want to do that.
You're welcome. Any other questions from members of the Committee? (No response.)
You've been very patient. The Committee will stand in recess until 2:30. Thank you. (Luncheon recess.)
Sorry for the wait. We are now expecting the Health Department to come up. Dr. Schwarz, please. 177 4/7/10 - WHOLE - BILL 100115, etc. (Witnesses approached the witness table.)
Councilwoman Tasco, members of City Council, I am Donald Schwarz, Health Commissioner for the City of Philadelphia. I am joined by Carmen Lemmo, the Deputy Commissioner for Finance for the Department of Public Health, and I want to thank you for this opportunity to present the Department of Public Health's Operating Budget request for Fiscal Year 2011, and I want to particularly say to City Council that this is National Public Health Week and hope that you and your staffs and colleagues will all feel welcomed tomorrow at a major event by the Department of Public Health and partners at the Reading Terminal Market open to 178 4/7/10 - WHOLE - BILL 100115, etc. the public between 11:00 a.m. and 2:00 p.m. looking at particular ways to use food to be healthy.
The Department's Fiscal Year 2011 budget request totals $361,467,455. 2 million in the Acute Care Hospital Tax Assessment Fund. Of the total budget, $43 million comes from City tax-supported funds. The Fiscal Year '11 General Fund budget represents a decrease of $3 million from the Fiscal Year '10 estimated obligations for the Health Department. The Fiscal Year '11 budget will support 1,027 full-time positions - 742 in the General Fund, 278 in the Grants Fund and seven in the Acute Care Hospital Assessment Fund. Of note beginning in Fiscal 179 4/7/10 - WHOLE - BILL 100115, etc. Year '11, the Employee Medical Evaluation Unit, or the MEU, will be moved to the Office of Human Resources for the City where it will be a better fit because of its integral role in employee hiring, employee leave and determination of fitness for duty, all processes which are managed by the Office of Human Resources. The Fiscal Year '11 budget will continue to support services basic to the Department of Public Health's ability to carry out its core mission to protect and promote the health of all Philadelphians and to provide a safety net for those most at risk. Some highlights from the past year. The Department received two competitive American Recovery and Reinvestment Act awards from the United States Centers for Disease Control and Prevention called Communities Putting Prevention to Work, one for obesity, nutrition and physical activity of $15 million and one for tobacco control and 180 4/7/10 - WHOLE - BILL 100115, etc. 4 million. Of note, of the large cities in the country, we are receiving the greatest amount per capita than any of those cities. The ARRA funds were awarded nationally to just 44 communities out of more than 200 that applied. The "tobacco control" dollars will allow us to work with employers and individuals to improve resources for smoking cessation and to explore regulatory and legislative interventions to reduce the very high rates of cigarette smoking in our city. The "obesity" dollars will help create the infrastructure that I spoke to this Council about just a few weeks ago. We will begin to develop new ways to bring healthier food choices to communities throughout the City, to work with the School District on improving food options for children, and with retailers and employers on reducing unhealthy food choices while promoting active, healthy living. I should note that both grants 181 4/7/10 - WHOLE - BILL 100115, etc. must be spent within two years and we plan to use money raised by the sugary drinks fee to continue the very important and necessary anti-obesity efforts. The Department's Division of Disease Control was awarded three new ARRA grants to enhance surveillance and prevention of selected communicable diseases. The Childhood Lead Poisoning Prevention Program is in the second and third years for two ARRA-funded grants that provide job training, evaluation and remediation of environmental health hazards in foster homes and in daycare centers. com, a website designed to raise awareness about the environmental, economic and health impacts of idling vehicles and to assist in the enforcement of Pennsylvania's new five-minute idling limit for diesel 182 4/7/10 - WHOLE - BILL 100115, etc. vehicles. Currently, Philadelphia does not meet national standards for ozone and fine particulate matter, in large part due to emissions from motor vehicles with vehicle idling a significant source of pollutants. Diesel exhaust contributes to increased cancer and asthma risk and can negatively affect reproductive, developmental, immune and nervous systems. The City's eight health centers provided almost 350,000 patient visits in Fiscal Year 2009. Thus far in Fiscal Year '10, we continue to see an increase in need for our services, with 15,000 additional visits compared to the first half of last fiscal year.
The health centers provide comprehensive primary care, prenatal care, dental care, family planning, podiatry and specialty care to nearly 90,000 patients per year, including nearly one-quarter of the City's uninsured population. The Department expanded dental 183 4/7/10 - WHOLE - BILL 100115, etc. services for children in its health centers by expanding "Kids Only" dental clinic sessions from two to four per week, increasing access to same-day appointments and making reminder phone calls to pediatric patients. The result was a percent increase in child dental 9 visits and a 12 percent increase in adult 10 dental visits. 11 When pandemic influenza A 12 (H1N1) vaccine became available in the 13 fall of 2009, the Philadelphia Department 14 of Public Health launched a comprehensive 15 program to distribute vaccine across the 16 City. S. Centers for Disease Control and 22 Prevention. The vaccine was distributed 23 through hospitals, healthcare providers, 24 schools, walk-in clinics, residential 25 facilities and other selected venues. Of 184 4/7/10 - WHOLE - BILL 100115, etc. particular note, more than 45,000 doses of vaccine were given in Philadelphia schools - public, private, parochial and charter. For the first time we have immunized children through schools in more than 30 years. There were more than 500 sites offering H1N1 flu vaccine in Philadelphia. Approximately 450,000 persons were immunized through the Department of Public Health's H1N1 vaccine program. Of note, vaccine is still available, so please tell all your constituents to come in and get immunized against H1N1. We are not over the H1N1 flu. The Department achieved a score of 99 out of 100 on the Centers for Disease Control and Prevention's assessment as part of its Cities Readiness Initiative. This is a CDC pilot project to help cities increase their capacity to deliver medicines and medical supplies during a large-scale public health emergency. Philadelphia's 185 4/7/10 - WHOLE - BILL 100115, etc. City Readiness Plan consists of detailed information on how we would conduct disease surveillance, environmental monitoring, forensic epidemiology, event response, public information and communication, dispensing, medical treatment and addressing special needs populations. All death reviews in the City have been centralized in the Office of the Medical Examiner. The Medical Examiner's Office, in collaboration with the Department of Behavioral Health and the Office of Supportive Housing, created the nation's first comprehensive Homeless Death Review process to identify opportunities for prevention of future deaths of homeless individuals. The review process includes both a weekly conference call designed to identify and close service gaps and a quarterly retrospective review of all homeless deaths. I am proud to tell you that we 186 4/7/10 - WHOLE - BILL 100115, etc. just received data from the first three months of this year, which shows a substantial decline in the number of homeless individuals who died in Philadelphia despite the severity of our winter. In 2009, the Department worked with Philadelphia chain restaurants to help them prepare for Philadelphia's new menu labeling law, which went into effect in its first phase in January 2010 and in its second phase on April 1st. The Department met with establishment owners and their staff to work on satisfying the requirements of the ordinance. Philadelphia's nutrition labeling ordinance is the most comprehensive ordinance of its kind in the nation. The law will help customers make informed nutritional choices when eating, promote greater awareness of nutrition, and encourage healthier eating in any chain venue. Minority contracting 187 4/7/10 - WHOLE - BILL 100115, etc. information was requested by Council, and the Department of Public Health continues its longstanding practice of contracting with minority and women-led agencies and businesses, both for-profit and particularly non-profit.
The Department is committed to contracting with these businesses and supporting the Administration's goal of percent 11 minority, women and disabled-owned 12 businesses participating in City 13 contracting. The Department of Public 14 Health's 2001 participation goal is 25 15 percent. 16 For Fiscal Year '10, the 17 Department has implemented several cost 18 savings measures and revenue increases. 19 I want to emphasize that these measures 20 were publicly vetted and are geared 21 toward preserving high-quality services. 22 Most significantly, in mid January 2010, 23 the Department began charging for 24 services in our eight health centers. 25 The initial cost to uninsured patients is 188 4/7/10 - WHOLE - BILL 100115, etc. $5. By the end of this fiscal year, there will be a sliding scale in place so that those with the least means to pay will be charged the least. To date, this has resulted in over $40,000 in revenue collected. It's about $49,000 as of yesterday, with no patient complaints received or any drop-off in the number of patients seeking services. Electronic health records have been shown to reduce medical errors and improve the quality of care, while maximizing financial and clinical efficiencies. Given these benefits, the federal incentives being offered, not to mention the threat of federal payment penalties for organizations without electronic health records by 2014, we decided two years ago to implement an electronic health record system and released a request for proposals in 2009. The implementation is scheduled to start this summer and continue for four years. Although we have not finalized the 189 4/7/10 - WHOLE - BILL 100115, etc. contract, the cost for full implementation will be about $22 million. I believe with the revenue-generation measure and cost-reduction steps we initiated in Fiscal Year '10, the Department of Public Health will retain our ability to provide the level of services needed to carry out our public health mission. Thank you for the opportunity to present testimony today. I will be happy to answer questions.
Thank you. Thank you for your testimony. I have a couple of questions and then I'll open to recognize other Councilmembers. Thank you for the good job you're doing. We appreciate it. Considering the recent passage of federal healthcare reform legislation, what impact will this new federal law have in Philadelphia and what steps are being taken to make the necessary adjustments? 190 4/7/10 - WHOLE - BILL 100115, etc.
Perhaps the greatest impact, which won't occur fully until after 2014, will be that the majority of people who are currently uninsured in Philadelphia will be insured. That will make a difference not just to the one-quarter of the uninsured who we see in our health centers, but to the three-quarters of people who are uninsured in the City who have, we believe, not great access to care at the moment and many people go to emergency rooms. I expect it may in fact increase visit rates in primary care, which is what we would like, preventive care, and reduce visits for hospitalization and emergency care. Immediately, right now, children are eligible up till age to 22 be covered under their parents' health 23 insurance. That will have an impact on 24 the City and the City workforce on every 25 part of the workforce, not just in the 191 4/7/10 - WHOLE - BILL 100115, etc. City but in private employers and others throughout the City, and hopefully it will have a measurable impact on the health of people between and 26, who 6 aren't currently mandated to be able to 7 have insurance under their parents' 8 policies, but that went into effect 9 immediately. 10 By the fall, there is a retiree 11 piece that goes into effect early that 12 says that for a health plan like the 13 City's, if a retiree has a very large 14 health claim, part of that health claim 15 will now be eligible to be paid directly 16 by the federal government. We will be 17 reimbursed. That is potentially a good 18 thing for Philadelphia, for large employers as well. The problem is, the total amount in that fund is capped at $5 billion for the nation. So there will be an application process. The regulations are not yet out from Health and Human Services. And it exemplifies for me what's going to happen between now and 192 4/7/10 - WHOLE - BILL 100115, etc. 2014 when we have full implementation. There are many steps in the 900-page Act, and many of those steps are regulatory steps. The Department of Health and Human Services' Secretary Sebelius has the authority and responsibility to develop that regulation. So we know by 2014, a lot more people will be insured. We know that benefit plans will be more standard. We know that it will have an impact on the cost of healthcare based on what's built into the Act. We don't know all the bells and whistles and how things will be done, so for us, the major part of Philadelphia's activity is to make sure that our legislators in Washington are educated about what can be done regulatorily, and we are actively speaking with people in Washington in regulatory offices, and I'm hopeful that we will have Philadelphians on committees that are put together to do some of regulation writing so that we're well 193 4/7/10 - WHOLE - BILL 100115, etc. represented and that the nation gets the best minds, because I think we have many really smart people when it comes to healthcare in Philadelphia who should have an active part in helping with the regulation.
The ability to carry a child on your insurance policy until 26, plus or minus a negative impact on the City?
It will increase our costs as a city, which is why I mention also the piece about retiree benefits. So that analysis is not complete yet, and the problem with the retiree benefit portion is, it's capped. So we don't know how many of those dollars we'll be eligible for, how quickly they'll go. But it will cost us more to insure the dependents of City workers through age if they wish to be 24 insured. It's not -- the first 25 estimates, as I understand it -- there 194 4/7/10 - WHOLE - BILL 100115, etc. may be people from Fiscal who know a lot more than I do, but my understanding is it's not a huge amount of money.
It's not? We can't afford any. That's a good thing. You have both sides to every issue, right?
Yeah. I hope for those children, dependents, who are living at home, it may mean less time away for their parents from the workplace as well. That's also a good thing.
Let me ask you a couple of questions. You talk about the increase in the -- 15 additional visits to the health centers, and certainly I guess the increase in the number of young people and adults to the dental clinic contributes to that. Are there any other factors that might contribute to the increase? 195 4/7/10 - WHOLE - BILL 100115, etc.
The demand for our services has gone up with the recession. It went up in 2008, it went up in 2009, and it's continuing to go up in 2010.
I think probably. There's a mix actually still of people who are both insured and uninsured coming as new patients. But clearly demand is on the way up. Remember, we've also seen some hospital closure in the City in the last year, and there's no indication that opening new primary care practices is very likely given the capital resources have been harmed in hospitals around the City. So I expect this trend will continue for a period of time.
On you talk about revenue-generating initiatives. How is the success in 196 4/7/10 - WHOLE - BILL 100115, etc. billing the State for those Medicare clients who use the facilities of the health centers?
We're doing great. We, remember, are a federally qualified look-alike, which means that we can, in a sense, bill twice. We receive dollars for capitation from Medicaid HMOs and Medicare HMOs, and then we're permitted to bill at our cost for service those same visits, Medicare and Medicaid, and receive a higher rate of reimbursement, minus the amount we received in capitation. And we have a, I think, very efficient billing operation in the Health Department. As you know, I worked before this at Children's Hospital and did billing for a very large physician practice there, and our folks I think do a terrific job. They've been looked at by outside agencies. I think they're doing quite well, and our reimbursement rates are favorable. The problem is, we have a lot of people who 197 4/7/10 - WHOLE - BILL 100115, etc. aren't insured, as well as those folks who are.
Do you have the ability to help an uninsured person apply for insurance?
We certainly do. Every health center has an office of people who help people get insurance if they're eligible. The problem is, it's multi-step, so you can't just come in and get insurance. You have to come in, bring documentation, fill an application, and we track that with people.
Your goal for Fiscal Year '11 in terms of DBE participation is percent. 25
Well, the goal before the Department revised it for '11 was ten percent. So the goal for the current year was less than ten percent, somewhere around eight percent, I believe.
No. I'm 18 actually talking about for the 19 Department. 20
The City 199 4/7/10 - WHOLE - BILL 100115, etc. only achieved 18 percent. A lot of that is due, however you want to view it, to the large fact that the Department of Health and Human Services did over a hundred million dollars in contracting, but less than four percent went to disadvantaged businesses, and that was done in a time when there was a citywide goal of 30 percent and there was a departmental goal of percent. 12 Why are we going to be able to 13 reach that goal next year versus not 14 having reached that goal in Fiscal Year 15 2008? 16
That's a great 17 and important question. Let me answer it 18 in two parts. First is why we haven't 19 reached it to date. As you may or may 20 not be aware, the Health Department -- 21 I'll answer for Health, and if you want, 22 I can also help with Human Services. 23 The Health Department has a 24 number of large contracts for specific 25 health-related activities, like 200 4/7/10 - WHOLE - BILL 100115, etc. laboratory tests. We have a lab in the City, but there are a number of laboratory tests that it just is not efficient for the City to process. We don't do enough of them. So we contract that out. There are limited number of vendors locally and nationally that are certified to collect insurance or bill 11 insurance companies for their service. They have to meet a standard. They have to have enough volume. They have to contract. So that limits with whom we can contract. Those are big vendors for us, large amounts of the vendor group. And so neither of the two big ones that we can contract with is either a minority, woman or disabled person-owned business.
I guess the question I'm really asking, Doctor, is, is there more capacity in terms of disadvantaged businesses? Is there more capacity to participate in Fiscal Year 201 4/7/10 - WHOLE - BILL 100115, etc. '11 than there was in Fiscal Year 2008?
That is part two, and yes. What I'm happy about is, we have two particularly large opportunities for contracting with for-profits, and in one case, we -- both contracts have now been officially posted. One for over $3 million, which is the largest, I think, single contract that the Health Department has, will go to a minority enterprise, and for the second one there's a guarantee of percent 14 participation by the vendor who received 15 the goal for minority and another 55 16 percent for women. 17
Okay. I 18 guess one of the last questions I'll ask 19 is, who set the goals for Fiscal Year 20 2008 and who set the goals for Fiscal 21 Year 2011? 22
I know that 2011 23 was a partnership between the Health 24 Department and the Office of Economic 25 Opportunity. And I don't know, because 202 4/7/10 - WHOLE - BILL 100115, etc. the goals for 2008 were set before I came.
Okay. I made this comment to every department. At the end of the day, the Office of Economic Opportunity does not do any contracting itself for the most part. They're not responsible for contracting. It's the procurement officials in the Procurement Department and/or procurement officials within each department. So at the end of the day, you know what goods and services you want to procure. You should be held responsible for finding out whether that capacity exists, and to some extent, you should set your own goal, and you should be held responsible for achieving your own goal. At the end of the day, when there are that amount of money going toward Health and Human Services and the constituency receiving those services in many cases are minorities and women, it does not make sense that Health and Human Services 203 4/7/10 - WHOLE - BILL 100115, etc. would do a hundred million dollars in contracting and that essentially 96 percent of that will go to businesses owned by white men. That's just wrong. Just one last example of where we're at or where we're not. You put out an RFP for electronic medical records?
The goals within the RFP? I can ask. I don't know off the top of my head.
Ten to 15 percent MBE, five or ten percent WBE. Who set those goals for that RFP?
One hundred 204 4/7/10 - WHOLE - BILL 100115, etc. percent minority participation.
That's a good question. This is a national RFP. This was to buy a software product and the installation. So it's one big award. There's opportunity within it for some subcontracting, depending on the size of the vendor, but in general, what we needed in order to ultimately be compliant with what are now federal regulations that we'll have to comply with meant that we had to use a national firm, and with that, I think the Department was concerned about who would bid, because we didn't know in advance. And we did a lot of work to go out and make sure that we had a well-represented applicant pool. There are really excellent minority contractors possible in that field, as can be seen, but I think we probably have the best -- I believe we have the best in the field, 205 4/7/10 - WHOLE - BILL 100115, etc. highest quality, wonderful vendor.
I guess my simple point is that there's no reason why the range couldn't have been to a 6 hundred percent, particularly if you do 7 the due diligence and find out what 8 capacity exists out there, and if there's 9 capacity to do a hundred percent, you 10 don't necessarily have to wait to see who 11 bids to find out. 12
And that 14 sends the message that, one, you 15 acknowledge the capacity exists out there 16 and, two, that people should not assume 17 that the person is not going to be a 18 prime contractor, but that a minority 19 firm is going to be a subcontractor. 20
Thank you, 23 Dr. Schwarz. 24 Thank you, Madam Chair. 25
On that 206 4/7/10 - WHOLE - BILL 100115, etc. note, how is your department doing with increased number of W/DBE and minority and women providers? We've had this discussion many --
So when I was in Council a couple of weeks ago during the budget hearings, I was specifically asked what do we know about the non-profit provider community, and we had a conversation about how we would define for today a minority non-profit. The issue there, just to remind everyone, is ownership. So the reason everyone is concerned about for-profit in particular contracts is, that improves the equity position of minority, women and disabled business owners. Since there's no equity ownership for non-profits, it's harder to figure out what the goal means, other than employment, for instance, leadership 207 4/7/10 - WHOLE - BILL 100115, etc. in the community and building capacity ultimately for people to be equity owners in business. So we agreed here that what people wanted us to do was to look at Board composition, which we did for the Health Department. So in Fiscal Year '10 to date, we have -- I thought I had it in front of me. I don't. Wait a minute. We have in contracts about $96 million with 74 non-profits, and we reviewed their Boards. And if we look at non-profit Boards, we have 35 of those Boards with majority control by either minorities or women. That accounts for $58.9 million of contracts from the Health Department, and that means that somewhere around 61 percent of the non-profit contracts from the Health Department are with agencies that have majority, minority or women Boards. I hope that answered the question everyone wanted.
It answers 208 4/7/10 - WHOLE - BILL 100115, etc. part of the question, because the other -- and I think that's good. I mean, I'm glad you did that. Thank you. But in years past, a number of community-based organizations, non-profits, had difficulty acquiring access to the Health Department and some of the programmatic activities that the Department provided, and those -- some of them are small neighborhood organizations working in the neighborhood with women or with children or whatever, just providing the on-the-ground health services, whether it's health information -- basically health information, that kind of thing. Those are the non-profits that we are too interested in having access. We talked to Dr. Evans, and he talked about how they have increased their provider base. And that has been a concern raised to us by many community organizations. And so we know we deal with the big non-profits, but there are smaller non-profits that provide that 209 4/7/10 - WHOLE - BILL 100115, etc. kind of service to the community that we want to see increased also. So I hope that you will, since you oversee CBH, kind of follow that pattern or that model and informing people what programs are coming up, what they might bid for, and if there are programs that can be broken down, unbundled, and to allow more opportunity in the community, because people say, Well, I want to run this program, but I don't have funding. So where do we send them for funding or could they contract with the City? But they're not a large profit or large non-profit. So I appreciate looking at the Boards. I think that's very important, but I think we also should look at too how we increase the smaller non-profits.
We can certainly look at it, and it is a priority for the Department.
The Chair recognizes Councilman Greenlee. 210 4/7/10 - WHOLE - BILL 100115, etc.
Dr. Schwarz, on the question I asked, I guess, the other years I've been here too on the health centers and you talk about the increase in need, I've asked before about the waiting times. Have they changed at all? Have they gotten worse because of --
So overall they got better. The average number of days for all eight health centers, I could sit here and just tell you it looks better. However, that's not really the answer to the question, and the reason is that the busiest health center for us is Health Center 10, and Health Center 10's waiting times continue to go up. And we've tried a bunch of things. What we haven't done is expanded service at 10, and we need to do that, and part of the reason for that 211 4/7/10 - WHOLE - BILL 100115, etc. has been the general fiscal condition of the City and the Health Department's contribution to that. But going forward in the next fiscal year, you'll see in our budget that we are investing dollars and expanding services, and a substantial proportion of that will be to expand services at Health Center 10. How much difference that will make is an open question, because the demand is so great. So of parts of the City, Health Center 10 represents a part of the City where there are not very many opportunities for uninsured people to receive care. And I believe that we can even expand services, and I don't know if we'll make a dent on the number of days people wait for a new patient visit. What we're trying to do is help people go to other health centers where we have shorter waiting times.
No. I understand. And I know Health Center 10 is a particular challenge because of the 212 4/7/10 - WHOLE - BILL 100115, etc. geographic area and that kind of thing. I just want to bring up one other issue, and I see Councilman Kelly came in. I know he's been the leader on this issue of animal control. And I say this with all due respect, and I know how hard you've worked on many issues here and I'm not trying to rank issues. Some people might say, Well, there goes Greenlee and Kelly again talking about dogs and cats with all the other stuff going on, but it is an issue that's important to a lot of people. And would you agree that things as far as animal control in the City are not going in the right direction? Well, let me say why I ask that question. At the City shelter, you have a situation, and I think I'm pronouncing this right, Strep zoo disease, which I understand is extremely rare, and it's happened twice in the City shelters. And I understand the kill rate, which has not been good in Philadelphia to start with, 213 4/7/10 - WHOLE - BILL 100115, etc. is going in the wrong direction. So that's why I asked that question.
I'm going to answer both parts of your question. The kill rate is getting better. So our euthanasia rate is improving. We're at 75 percent live release as of now. The bigger issue is the Strep zoo. That is a germ that lives in inanimate objects, and there are a lot of inanimate objects at the shelter. The good news is that if we treat animals with antibiotics, because it's a bacterium, we can protect them. So we don't have large numbers of animals at this point who are being euthanized because of Strep zoo. We have controlled that. But the bigger issue is, we had an outbreak. We have another outbreak. Remember, we take animals from all over the City, and the shelter itself had an outbreak. So what is going on now -- and it was highlighted in the newspaper -- is 214 4/7/10 - WHOLE - BILL 100115, etc. the PSPCA has taken a very unusual step, which is to say we are emptying the shelter of animals and we're cleaning the shelter from top to bottom. Now, that is a calculated gamble, because I think there is many people who would say, who know veterinary medicine, that the germ could have been brought in from the animals that we take in or it could exist on some inanimate surface in the shelter. So we hope this will make animals safer and we will reduce and ultimately control the infection. I think it remains to be seen. If there is, for instance, a part of the City where that organism is embedded and animals go there, they will bring that germ to the shelter and we will likely have another epidemic. I am hopeful that the expense we're going through and the difficulty we're going through will ultimately finish this epidemic, but I can't promise you that. It's the nature of the --
It is a 215 4/7/10 - WHOLE - BILL 100115, etc. rare disease; is it not?
Isn't it a rare disease to have it twice in one place in that short a period of time? At least that's what I've been told.
It would indicate from a public health point of view is there's somewhere the germ exists on a surface or an area that animals are contacting. It may be in the shelter. It may be out of the shelter. We don't have a good way to know that other than to do what we're doing, and I'm hopeful that this will take care of it.
Just one last question just generally, and I hope I'm not stealing Councilman Kelly's question, because he asked it of the Managing Director. But do you think with all the other things going on in the Health Department -- and, again, I'm not trying to rank them, and I know the passion you have for some of these 216 4/7/10 - WHOLE - BILL 100115, etc. things -- is animal control -- should it be in the Health Department or maybe should we all work together to try to find another place to try to do that?
So I will say officially that from a public health point of view, I think the Health Department has tried to be a good home for animal control. It makes a difference on the human side. So if we took animal control out of the Health Department, we would still have human issues, I hope, and rabies is a substantial issue, and rabies control is animal control. So the two are linked in some way. In addition, the Health Department has spent a very large number of hours over the last two years, and particularly in the last year, trying to think carefully about how do we develop, in partnership with the many agencies that care about animals in Philadelphia, a comprehensive plan for animal welfare. 217 4/7/10 - WHOLE - BILL 100115, etc. We've had great participation. We've recently reconstituted that group under the Charter and Councilman Kelly is actually a participant in the group, which is about to have its first official-official meeting. But I'm hopeful that we will be able to create a comprehensive plan for animal control. The issue with animal control at the moment is in part a fiscal one, and having additional millions of dollars in the City budget for animal control would help us get quicker to what is needed, particularly around spay/neuter goals for the City. I'm hopeful that we can find partners, private partners, who will help us achieve that goal.
Okay. I won't belabor the point. Thank you. Thank you, Dr. Schwarz. Thank you, Madam Chair.
Thank you. The Chair recognizes 218 4/7/10 - WHOLE - BILL 100115, etc. Councilwoman Sanchez.
First I want to go on record and thank you so much for all the help that your office has provided as it relates to Aria Hospital and Frankford and your personal attention to the situation in light of all these closures and how important Frankford Hospital is. I know for many folks, when you came over from CHOP, they were probably a little concerned about whether you were going to take care of hospitals, but my hospitals are very happy, so I'm very happy. So I want to thank you, because I think they feel you get it, and that's important in light of what we're going through with healthcare. So I want to go on record and just say I appreciate that. I met with St. Chris the other day and Bernadette also had 219 4/7/10 - WHOLE - BILL 100115, etc. great things to say about you. I wanted to check on our relationship with our federally certified and funded health centers. I know we've talked about it. In some of your PhillyStat discussions, there was discussion about it, and how are we using them in areas, particularly underserved areas, to help us with our overflow at our health centers? Have we strengthened that and how -- can you give me an update?
That's a great, important issue. Everyone who provides safety-net services in Philadelphia has seen an increase in demand, and I would say that most of us, we're part of the official network of all of those health centers. We meet with them on a regular basis. I think we have good relationships with them. I think everyone is strained at the moment, and we have been fortunate we have great leadership in ambulatory 220 4/7/10 - WHOLE - BILL 100115, etc. health here. That leadership and the staff in our ambulatory health centers has bumped up efficiency fairly dramatically, because their budget hasn't gone up, and they've improved service delivery. Some of the other health center sites have had much more difficulty fiscally than we have in that way. So they've had a problem increasing service to the uninsured. And we're committed to being the safety net, so we work with them, we partner with them, we refer to them, they refer to us. We make sure that the hospitals in town who frequently see the uninsured in emergency rooms know not only of the City health centers, but all the other health centers as well. And I am supportive. I cannot even count how many letters and other things of support I've sent in for applications that they've put in to the federal government and to private sources, because if they go down or any of them goes down, just like hospitals in 221 4/7/10 - WHOLE - BILL 100115, etc. Philadelphia, we're in a bad way, and not only from a public health point of view, but from an employment point of view. So we've been very supportive. I hope they would say that.
I want to make sure that, again, for areas that are underfunded, I mean, my district could not get served without some of these providers and they're so important. And I'm aware that Esperanza Health just got a grant through the stimulus and will be setting up shop in Hunting Park, and I want to make sure that we provide them the supports, because, again, they're going to be picking up a lot of our backlog and it's so important.
I wanted to talk a little bit around what Councilwoman Tasco was talking about, our contracting as it relates to small organizations. There's been some cuts in your tobacco funding and I wanted you to 222 4/7/10 - WHOLE - BILL 100115, etc. kind of explain what have been those cuts. And I'm a little concerned about our move from doing some of the youth reduction work that we were doing, particularly the hard-to-serve and hard-to-reach communities, like the Latino community and the gay and lesbian, transgender and bisexual community.
I know what you mean. So we were very concerned when the State budget was finalized this year. You know there was a long period when agencies hung on without cash flow. And when the State budget came out, there was a substantial reduction toward tobacco control, and a large piece of that was taken out of Philadelphia, and it came late. What that meant was, we had been told by the State in the early part of the current fiscal year that we should continue delivering services. Then they didn't fund us. So we had paid agencies for a period of time to continue to deliver services, particularly around 223 4/7/10 - WHOLE - BILL 100115, etc. enforcement, and we didn't have enough money. So we had to suspend some of those services. They, as the agencies all know, will be re-implemented in the current month, actually. So we're going back to that. In addition, in this budget we've been able to identify supports. So we're going to continue doing it, and, in fact, one of the things that is wonderful about the CDC award for tobacco is, we'll actually be able to surround that with all kinds of educational supports that we didn't have before. So, one, for your providers, they should be reassured, and hopefully they are, and, two, I hope they'll feel supported, because in many cases -- and the bodegas and small businesses will feel supported, because one of the other things we're going to do is try to work with them on education in partnership, because a lot of the businesses don't know what a sustainable business model 224 4/7/10 - WHOLE - BILL 100115, etc. would be without selling to youth. We have to help them with that, and we will.
Okay. Just so we've restored -- so what's the difference now between our youth dollars and our adult dollars? Has there been a shift?
Most of the dollars toward youth for inspecting and then enforcement, and we will continue and we'll actually beef up the enforcement side. A number of the agencies from the Latino community in particular have been frustrated that we've not had a strong enforcement piece. We haven't had the money for it. And we've found some money to be able to do that enforcement piece. So I think they'll actually be happier and I believe public health will get better.
Okay. Well, I'm pleased to hear that. I know a lot of that had to do with the State fund, and I just wanted to make sure that 225 4/7/10 - WHOLE - BILL 100115, etc. we were still as committed, particularly around the prevention for young people --
-- since it's such a big issue. I wanted to ask you a little bit as it relates to your provider network in comparison going back to what Tasco was asking. So I just want to be clear on the philosophy, because it's an issue for me. We've moved away to less providers and bigger providers. And I share the concern around some of these harder-to-reach communities where these locally based providers really have their foot in the ground as opposed to the bigger ones, and there's always this debate around administrative costs and it costs us too many to manage. So are you saying that you've moved to more providers or less providers?
I'm embarrassed 226 4/7/10 - WHOLE - BILL 100115, etc. to say I don't know the number. I can tell you -- I'm trying to think where in your neighborhood we've cut back on a provider in the last year. I don't know if there's a particular provider --
No. 12 Obviously from DHS and Health, but a lot of it had to do with the State budget. I just want to make sure that as we move into the next year, we're going back to those funding levels and that folks are reassured.
DHS is different on this one. So I can speak to Health and I can put on a different hat and talk about DHS, but we can wait for the Commissioner.
We'll 227 4/7/10 - WHOLE - BILL 100115, etc. wait for them.
For Health I will say the State budget does not restore funds. So what we've had to do is to piece together, where we can, funds. Where that is a serious issue is around HIV and --
Well, I don't want to make a guarantee there, and the problem is the size of the cut. The size of the reduction in the State budget was huge. We were able to piece together dollars in partnership with the federal government for the end of this year. So we keep everything whole through July. And we're now working with the HIV provider community very actively to figure out how we can fill that in continuing forward, but it is particularly around testing and youth. And I think for the City it is very worrisome the loss of those dollars. We 228 4/7/10 - WHOLE - BILL 100115, etc. don't have good ways to make those up, and it's a substantial -- it's $2 million. It's a lot of money. So we're looking actively. We're happy that CDC dollars for the coming year are more than they were in the last year, so the federal government is helping us, but particularly around testing and minority youth, we have a problem and we need to figure out where to go to get dollars to help, because the State is not going to provide those, at least in full. We're still working, and I'm hopeful that they will come through in some way, but it will need to be a partnership with a lot of partners.
I just want to make sure that when we're making some of those cuts, that we take into consideration when we're making this decision -- and, again, you should never want to choose between young people and adults, but there has to be some sort of commitment that we're going to try to 229 4/7/10 - WHOLE - BILL 100115, etc. keep those youth-directed programs or hard-to-reach communities, because, again, as it relates to HIV, which was going to be my next question, women of color, who are one of the largest growing numbers, that when we're looking at where we take the funding, the big guys can afford a hit. These smaller guys that work at that level cannot.
We completely agree on this. I also think that the populations affected by HIV are often hard to find and it is the small agencies that may be trusted by them. So the sad part and the difficult part about this is, much of the funding around HIV is highly categorical, so it goes to treatment services for X population or testing for this population. We don't have a lot of flexibility to move dollars. The AACO, 230 4/7/10 - WHOLE - BILL 100115, etc. the AIDS Activities Coordinating Office, I think did a magnificent job talking to our funders, helping them be flexible with us so that we could fill in as best we can. We don't have that flexibility at the moment past July 1st. So you're concerned. I'm concerned. We will do our best. I can't guarantee that there won't be cuts, because at the moment based on the budget, there will need to be, but we're going to try our best to figure out a way to minimize those, particularly for communities that are otherwise ones where people are disproportionately affected by HIV and don't have great access to services necessarily.
Thank you, Madam Chair. 231 4/7/10 - WHOLE - BILL 100115, etc. Dr. Schwarz and I spoke beforehand and I spoke with President Verna about the Health Department budget. There are 83 unfilled or newly created positions in the Department of Health, and what I have been doing in each department is going through all of the vacant or unfilled positions. What I would propose to do for the Health Department is sit down with Dr. Schwarz and his team, go through each of those positions, and if I feel the need to put any of that on the record, we will call them back sometime before the end of the budget process. And Dr. Schwarz has graciously agreed to that, and I just wanted to put all of that on the record. Thank you, Madam Chair.
We thank you for your kind consideration. I'm sure Dr. Schwarz does, too. The Chair recognizes Councilwoman Blackwell. (No response.) 232 4/7/10 - WHOLE - BILL 100115, etc.
Thank you, Madam Chair. That means I get Councilman Green's extra minutes. He's yielded them to me.
Thank you. I want to be brief. I will not raise the point that the 4th District does not have a public -- I will not do that this year.
And I will not. But I will cite the fact that last year we talked about the fact that the federal government has clinics in my district and to inform you that one of them has moved from my district to Councilwoman Blackwell's district. So we have now one. And I'm concerned, I'm growing concerned, that the 4th District only has one emergency room in it, and 233 4/7/10 - WHOLE - BILL 100115, etc. that's in Roxborough section of town, and that those kinds of concerns more and more lead me to a solution that I asked you about last year, which is telemedicine. Now, through the insistence of improvements in technology that have proven and borne fruit in other departments, such as the Prisons have utilized technology, teleconferencing and cameras to reduce some of their administrative burden, that it seems to me that technology is a theme that might be applied to your department. Telemedicine and that kind of concept has been used successfully in the private sector. Visiting nurses who moved their headquarters into my district use that on a regular basis to see more senior citizens through teleconferencing than they can ever do with actual visits. So it is something that is not just cute, it is effective. It's proven to reduce costs in other departments. 234 4/7/10 - WHOLE - BILL 100115, etc. I'm asking you again on the Mayor's theme of using technology but also multi-modal buildings. So not just recreation centers, not just libraries, but schools as interchangeable buildings, using them at different times of day for different functions. A mobile teleconferencing unit can come into, let's say, public housing at Abbotsford where there's an open room all the time that could be set up within a matter of hours and more people get access to services. I want to know if we've made any improvement from last year on that concept.
So the district health centers have invested over the last four or five years in a number of telemedicine applications. Probably the largest has to do with radiology. So you may know that we've made a substantial investment and partnership with Council around, for instance, mammography, and our health centers offer mammograms to 235 4/7/10 - WHOLE - BILL 100115, etc. folks. If they can't afford it, they're free. And we would not be able to do that without telemedicine, because we don't hire radiologists, and we beam our mammography images and we beam our x-ray images to a radiology provider who reads them distantly.
Is there a sense of cost reduction if we had to hire that person versus --
It is less expensive for us to do it this way than it would be if we had to hire radiologists at each of our centers. Absolutely.
So following that logic, that there are people who are travel challenged, I'll say, don't like leaving their homes, don't like leaving their immediate communities, that we can get to, deal with some of the problems that Councilwoman Blondell Reynolds Brown has brought up over and over again by getting to them the kind of healthcare, 236 4/7/10 - WHOLE - BILL 100115, etc. and if we just looked at the application of the technology and replicating it in the example that you had, that we could realize those savings over a period of time.
So we look I think with longing at what's possible. There are two issues for us. One is reimbursement. So there's often an initial investment and some recouping. It's unclear based on the current regulations for billing that we could recoup very much around telemedicine. In other parts of the country; for instance, rural areas, there's often a better break-even for telemedicine, because people live sort of clustered in an area, they all use the same provider because there's only one provider for --
It is my understanding, and correct me if I'm wrong -- and I'm sorry for interrupting, but that clock is ticking.
I'm not on the Bill Green time zone. But my understanding is that the federal government has made allowances for telemedicine and those types of visits that allow them to be reimbursable.
It depends on where you are and what kind of visit, unfortunately. So urban telemedicine isn't -- so I'm going to answer the question and maybe I can finish it for you. Urban telemedicine is not quite so lucky as, for instance, rural telemedicine in that way. One of the things that does happen, which you correctly point out, is visiting nurses do a fair amount for heart failure patients, who are often homebound, using telemedicine, and the reason that works is, there are clear measures that have been worked out and there are clear protocols. What we don't want to do is 238 4/7/10 - WHOLE - BILL 100115, etc. what I would call lower-quality care through telemedicine. So what we do with radiology is every bit as good as if we had a radiologist on site.
Dr. Schwarz, my time is up, but I will say this: I agree with you, but some attention is better than no attention.
So as we start to explore this, I want to challenge you with this, that we've gotten significant support for an aging in the new age conference dealing with the issue of aging, dealing with the use of technology to improve that quality of life. Therefore, I want you to be a part of that, along with the visiting nurses, along with some experts nationally that are looking at this issue.
So that next year -- you've made progress, and I'm appreciative of that, but we can make 239 4/7/10 - WHOLE - BILL 100115, etc. substantial leaps of progress if we can codify where we can get those federal reimbursements, and then find a way to minimize your capital outlay to do it. And I'll work with you on that.
Thank you. Dr. Schwarz, according to a recent briefing by Bebashi, Philadelphia's HIV infection is at epidemic proportions. What are the steps being taken to address this issue?
Well, I'd like to say that -- and I think it's true -- that we have one of the finest partnerships between the Health Department and a very rich network of community agencies that address HIV. I don't know that there are any innovations that we're not putting in place. We are a poor city. We have a lot of very poor neighborhoods. That 240 4/7/10 - WHOLE - BILL 100115, etc. means, unfortunately for the HIV epidemic, that we have a lot of people who are at risk for HIV, and in particular, our rates of unidentified infection are very high. As a result, we have invested substantially. We have gone after lots of funds. We have taken State dollars that have come to Philadelphia through the wonderful advocacy of State Senator Vincent Hughes to focus on testing people, going out, identifying and educating and then testing people. And we have made some progress. The problem is, it's those funds which were cut by the State. So I think to date we have done good work. I am very worried about what the work will be like in the future if we are compromised by that funding. So I think we have an epidemic like many urban communities. We have really good partners. We have really good technology. We are using everything from alternative media texting and 241 4/7/10 - WHOLE - BILL 100115, etc. messaging and you name it, things that in my generation I'm afraid were new and different, in order to reach young people and get them to regularly be tested. Once tested, if we can identify them, we have services. That is not the issue. We don't have every service any human being could imagine, but I'm not as worried about the service network as I am about the outreach and testing piece. And particularly for Philadelphia and people's issues around access to care, we need to do better. We're doing testing in the prisons. We're doing testing in emergency rooms. We're doing it in homeless centers. We're doing it on street corners. We're doing it everywhere we can. We need to do more. And I'm afraid in the next year we'll only be able to do less because we won't have the resources. So I'm worried about it. Something that I already mentioned and will mention. I think Bebashi is right 242 4/7/10 - WHOLE - BILL 100115, etc. to raise the issue. I think it is a big concern, what's going to happen if we don't have adequate numbers of dollars for testing.
We can't use any of the Recovery money or any of the money we got from the CDC to --
As you are well aware, the lack of maternity care has been a growing problem in Philadelphia with more and more facilities reducing or closing down maternity operations. What can we do, the City and the Health Department, to address this problem?
We are trying to be innovative. So telemedicine actually comes up in this. We have looked to put together what would be what's called a prenatal care registry. So it's an electronic solution whereby prenatal care providers put information into a 243 4/7/10 - WHOLE - BILL 100115, etc. web-based database, and it allows information about prenatal care to be available wherever a woman goes thereafter for her care, either other prenatal care if she can't get to the same place or, better yet, delivery. Because at the moment, for many women, they go for prenatal care in the community and at the time of delivery, when you most want prenatal information, it's not available because it's a paper record. We have the technology to create this tool. We have the six delivery providers in Philadelphia and several of the delivery providers outside the City willing to participate. We have a lot of the prenatal care providers willing to participate. So I think within the next year, we'll make substantial strides in creating this prenatal care registry. That will help. Two, we have contracts with the large providers, the six hospitals, to 244 4/7/10 - WHOLE - BILL 100115, etc. provide prenatal care services in our health centers. So women can come to our health centers, get prenatal care. And we put out on the street, through many of the partners who are here, information about the availability of that prenatal care. But for some areas of the City, and most notably the Northeast, there's no delivery service in the Northeast and there is no large primary care provider beside our own Health Center 10 that provides prenatal care. So I've been talking to a lot of providers, big providers in the City and some of the small ones, about what are some models we could use to try to create another center or more. And we don't have answers yet, but we're making some progress on that. When we have healthcare reform, this may get a bit easier, but the real issue is capital and liability. Philadelphia has the highest liability costs in the State of Pennsylvania and 245 4/7/10 - WHOLE - BILL 100115, etc. actually some of the highest in the country for malpractice, and that puts a major limit on the viability of new sites, particularly for delivery. So a birthing center, for instance, is something that you and I have talked about in the past. There are huge fiscal constraints because of liability coverage for birthing centers. We're trying to figure out if there's any way to leverage federal protections for that. The City can do something to try to reduce the cost for liability so that it becomes a feasible model for development of a new birthing center.
I think this will be my final question and I'll do it so we can move on. In addition, the lack of maternity care has led to a deficit in care in communities of color. 246 4/7/10 - WHOLE - BILL 100115, etc. Particularly, there are increased rates of infant mortality in minority communities. Again, what are you doing to confront this issue? Are there federal or State or private grant funds that are available to address this issue? If so, how are these funds being used and are these funds being used to track performance and measure outcomes related to the Department's ability to address this issue?
Okay. That's a long question. So let me start with infant mortality rates in Philadelphia, I think I can say, have gone up for some groups and not others. So among the Latino population, for instance, a greater proportion of births in Philadelphia are to Latinos, and infant mortality rates among Latinos have been low. Asians have low infant mortality rates. There has been an increase -- there had been an increase in infant mortality rates in both African Americans 247 4/7/10 - WHOLE - BILL 100115, etc. and Caucasians in Philadelphia. The most recent complete data we have had is for 2007, and we're just about to put out the 2007 vital statistics reports, which summarizes that. It's a new format this year and it will highlight infant mortality changes. Preliminary data for 2008 look like it may be getting a little better, but you still have too high an infant mortality rate in Philadelphia, particularly among African Americans and among Caucasians. And we will be having a conference convened on infant mortality in June, but we get dollars, substantial dollars, from the federal government around infant mortality prevention focused on care, the prenatal care piece, and we do well with that. I think the issues nationally people would say relate to women's health, because the nine months of pregnancy are very important, but it's very difficult to change pregnancy outcomes in those nine months if a woman comes into pregnancy 248 4/7/10 - WHOLE - BILL 100115, etc. unhealthy. It may also be that one of the great risk factors for increased prenatal care -- increased infant mortality in Philadelphia is morbid obesity in women. Yesterday I met with one of the directors of one of the large obstetric units in Philadelphia, who told me that they are replacing all of their gynecology operating room beds because the capacity on those beds is 350 pounds and a substantial proportion of the women who they deliver are over that weight and they are needing to change all of the beds because of that weight. In addition, obese is marked by a body mass index greater than 30, which is a ratio of height and weight. He says that now more than a quarter of his deliveries, pregnant women, have a body mass index greater than 50, twice the body mass index for obese. That is a risk for infant mortality. That is a risk for maternal mortality. What you 249 4/7/10 - WHOLE - BILL 100115, etc. didn't ask me about but particularly worries me is that with the obesity epidemic, obese women are having C sections at incredibly high rates, and maternal mortality is also affected by that. So we need to address obesity. I've said it a lot of times. I'll say it again. This one in particular floored me just to hear his experience. We need to do something about obesity in this city. I actually believe that will have an impact on infant mortality and maternal mortality. And we will be talking as a community in June about what we can do particularly around lifecycle issues for women, so what are ways that we can have healthier women, who then have healthier pregnancies and have healthier children. We're doing a lot around care. We need to do something around life-style and other things I think at this point.
I guess I was going to ask you if there are any 250 4/7/10 - WHOLE - BILL 100115, etc. federal or State funds to help us.
So we already get federal funds for care. There are not large amounts of federal dollars for prevention at this point. I'm hoping there will be, and one of the things that I hope will happen with the June meeting is, we'll begin to get ready for those, so we'll have a plan. We will think about partnerships, so we have lots of other agencies who are ready in partnership, so if they want to apply. There are a bunch of things that government can't apply for, but small agencies can. I want to support them in those applications, particularly for outreach for women's health and so forth. So, yeah. I think there are opportunities. I don't know of six if you asked me right now, but I'm hoping in the future there will be more.
Thank you very much. The Chair recognizes Councilman 251 4/7/10 - WHOLE - BILL 100115, etc. Kelly.
Thank you, Madam Chair. Good afternoon, Doctor, Commissioner Lemmo.
As Councilman Greenlee mentioned, I do have a concern about animal care. Now, I know that there's probably a lot of people in this Chamber, there's probably -- in fact, even a few members of this Council may not think that this is an important issue, that why get involved with animals when you have a lot of other things on your plate. I understand that. I understand the priority that you have. The highest priority you have, of course, is to deliver health service and to make this a healthier city than what it is. That I understand, and I agree with you, as it should be. But on the other hand, I do think there should be somewhere around 252 4/7/10 - WHOLE - BILL 100115, etc. that range some concern about animal care, because if we take care of our animals, we'll take care of our people. And I believe in that intensely. And there's -- I think this is -- I'm passionate about this because I think it's a quality of life issue, and a large segment of our city agrees with me. I know they do. I hear from them all the time. Now, what I would like to do is ask you certain questions that are going to come up, and I'm sure -- I'm hoping that you have the right answers for it. For instance, do you -- well, first of all, going back a couple years ago, I disagreed with you in your selection of a contractor to provide animal care service for Philadelphia. That's water over the dam. I'm not interested in that. Now we're in a different year. But what I would like to know, did you receive any commitment to renew the contract under the current provider, which would be the 253 4/7/10 - WHOLE - BILL 100115, etc. SPCA?
The current -- the RFP that went out and we bid and you've discussed includes renewal, which is what we're negotiating at the moment.
Well, did they send you a letter stating that they are requesting $900,000 additional to continue the service?
We've worked with them both to reduce that number substantially and we're looking for outside supports that can help them with their particular deficit so that we can make it work for them. 254 4/7/10 - WHOLE - BILL 100115, etc.
You gave them a number? Was it more than what's budgeted now?
No. We're working within our budget. As you know, I don't have additional dollars.
Exactly. As what you were mentioning to Councilwoman Tasco, that you can't provide a lot of the services you would like to provide.
I understand that. And I'm looking at that budget and it's the same amount as it was last year.
And it's my understanding that they're not too happy continuing this service with that same level of support. And what happens -- I would like to know if you have a Plan B. 255 4/7/10 - WHOLE - BILL 100115, etc. In other words, if you remember, a few years ago the SPCA did have this contract and they walked out at the last minute, which left us high and dry as far as providing the service and created PACA at the time. In fact, the Board consisted of, I believe, about seven members of the Health Department.
That is correct, and I hope we don't have to go there again, but we're prepared if we need to.
And I agree with you. But I just want to know if there is a Plan B, because that's a very, very good possibility at this point.
Plan B is to do what happened in the past. I don't have another way given the budgetary constraints that the City is under to do anything else.
Well, Plan B is for the City to take over and to run the 256 4/7/10 - WHOLE - BILL 100115, etc. shelter.
The Health Department would take it over again, going back into what it was probably eight, nine years ago?
In other words, it would be another -- you create another organization to take it over or it would be under the City now? It wouldn't be contracted out. It would be under the City. They would be City employees?
I don't know that they would be City employees, but the City would be in charge of the management.
But there isn't any organization ready to take it, as far as I know. You created PACA going 257 4/7/10 - WHOLE - BILL 100115, etc. back nine years ago.
Would you do the same thing again? That's what I'm asking. Could you?
So we -- the City provides a large number of services without creating a non-profit organization. So we don't need to initially -- wouldn't need to initially create a new non-profit. We could provide those services in place fairly quickly if we had to.
What level would you provide these services? In other words, I have a problem with your save rate. You mention somewhere that you have a save rate of 75 percent. How do you come to that save rate?
Is this because an animal is moved out of the Huntingdon Park facility going into SPCA?
We actually 258 4/7/10 - WHOLE - BILL 100115, etc. published on our website and have worked with other members of the animal care community about what the standard should be for a save number, and on the website we show what the save numbers are by month, and as you know, we had a bad summer. So in the summer the save rate went down. That was largely because when PACA left, the facility for spay/neuter at the Hunting Park site went away, and the SPCA installed a new spay/neuter facility there, which is open seven days a week, and since that facility opened, the save rate has gone up consistently. So we were at, for instance, 55 percent in November. We were at 75 percent in February.
Well, let me ask you something. With the animals that were killed in 2009 and 2008, why would there be 3,400 more animals killed in 2009 than 2008 if there was a save rate?
So I absolutely admit that in the first part of 2009, 259 4/7/10 - WHOLE - BILL 100115, etc. one, we had what I would call an epidemic of cats. So the number of cats that were taken into the shelter was at an all-time high, and I can't tell you based on biology why there were so many cats brought in, but I can say there were a very high number of cats brought in. With that, the save rate went down because we didn't have an active spay/neuter facility. We do now, and with that, the save rate has gone up consistently every month since then. And it was a priority for us to get a spray/neuter facility, and the SPCA I think was a good partner in making sure that facility opened and was staffed, and it's now open seven days a week.
Well, I'm glad to see that, and there has been steps taken in that area, which I'm very appreciative over. Councilman Greenlee mentioned something about that Strep zoo outbreak.
Now, who recommended taking that action of closing up the facility, removing all the animals?
Who did they consult? Did they consult anyone other than themselves?
I actually don't know the answer to that. I can ask the person who runs that particular contract, if that would help you. If that's an important piece, I can get you that information.
Yeah. Okay. That's what I would appreciate. I just have questions about the whole attitude of -- and I think Councilman Greenlee brought this up too -- about having the Health Department -- and this is what scares me, that you're going to have the Health Department take over this facility if the SPCA walks away, and I remember years ago 261 4/7/10 - WHOLE - BILL 100115, etc. that's when we had all the problems, and I just don't feel comfortable going through that again. I think we're going to end up with a 90 percent kill rate in the City, and there's no doubt about it if we go into that direction. And I can see in your testimony today you didn't add one line about animal care in this testimony, not one. So I don't think -- I know it's not a high priority, but at least I thought it would be a little priority somewhere along the line. I don't think there's the concern about -- and maybe there shouldn't be in your department, but I think that there has to be some other way that we can do this, and as a member of the advisory board -- which I told you before I'm delighted to be working with you on and I'm looking forward to working with you to get things in the right direction, and I don't think having the Health Department take over the responsibility of this is in the right 262 4/7/10 - WHOLE - BILL 100115, etc. direction. I want to put that on the record right now. So I think what we should be doing is looking at other areas or other organizations, other institutions or whatever that can take over this concern. I really do. And I'm, again, willing to work with you and your department.
You're welcome. The Chair recognizes Councilman Greenlee.
Thank you, Madam President. I just said I would ask these questions when Councilwoman Blackwell had to step out, and there were a couple follow-ups to what I had asked about the health centers. I don't think you specifically answered this. If you did, 263 4/7/10 - WHOLE - BILL 100115, etc. I apologize. How much -- I know you said it has gone up, the wait time has gone up?
So the overall wait time -- as I said to you, it's the waiting time for a new visit or another visit. So the average appointment availability in days in March 2009 was 63 days on average wait for a new patient appointment for an adult and six days for pediatrics. In March of 2010, it was 56 days for an adult and three days for a child, and for a return visit was 13 days in March of 2009 and six days for an adult in 2010 and was two days for a child in 2009 and two days in '10. But as I said, I could give you that, but I don't think it tells the whole picture, 264 4/7/10 - WHOLE - BILL 100115, etc. particularly for Health Center 10, and you and I have talked in these hearings about it, so I want to give you full data. So for 2010, now, as of -- we picked sort of an average month. It's about 266 days. So three-quarters of a year.
And I don't think that's acceptable and you don't think that's acceptable for a new patient visit at Health Center 10. The other health centers are okay. Health Center 10 is the issue.
It is terrible, I agree with you. So what that represents is an increase in the number of patient visits particularly there. So the demand has gone up. No matter how much more 265 4/7/10 - WHOLE - BILL 100115, etc. efficient we are at 10, the demand is huge at Health Center 10, because as Councilwoman Sanchez mentioned, in neighborhoods where there are alternatives, we can work with partners. The Northeast doesn't have alternatives. And so we will be targeting with dollars that are in the budget for '11 Health Center 10 to do our best to improve availability. My fear -- and I will be honest about it -- is that we may never keep up with the demand. The demand in the Northeast because of new people moving in in particular who are uninsured makes it very difficult to keep up with demand.
I mean, that sounds -- I mean, we all agree, 266 days is ridiculous.
That doesn't mean that an acute visit doesn't come in. It doesn't mean that people can't get follow-up care, but what it does do is, it discourages people who are new 266 4/7/10 - WHOLE - BILL 100115, etc. patients from coming to 10, and because of the difficulty right now with space and staffing and everything else, discouraging people from going to and 6 trying to encourage them to go to either 7 other City health centers or other health 8 centers is the best strategy we have. 9
Okay. 10 And the other question she had again as a follow-up was emergency care, if somebody has a real emergency and they go to a health center, can they be seen or is it basically -- are they directed to an emergency room?
It depends on the issue. We have what's called walk-in. So anyone can show up on a given -- people can show up on a given day if they're somebody who is known at least to the health center and receive care. That isn't really emergency care. That's urgent care.
How about a dental issue? 267 4/7/10 - WHOLE - BILL 100115, etc.
So if somebody has been to the health center and they have a dental issue, they can come, yeah. We handle them. We make appointments for them. We get them in if it's something that can be handled there. In many cases they need to go somewhere that has surgical capacity or other things.
You're welcome. The Chair recognizes Councilwoman Brown.
Thank you, Madam President. Good afternoon, gentlemen.
Councilman Goode has already spoken to our continued interest in OEO goals, so I won't use time devoted to that topic, but know that a number of us continue to pay close 268 4/7/10 - WHOLE - BILL 100115, etc. attention to that important issue.
Secondly, let me say what a pleasure it has been to work with your department and you and Kevin and others on the menu labeling. It was heavy lifting for two years, but persistence does have its rewards. So the next heavy lifting issue will be lead poisoning, and you do give some discussion of that in your testimony, but the dollars that you received were principally for childcare centers and foster homes.
So what are the Department's plans to -- are there any plans or opportunities to sustain that particular program after the Recovery Act dollars have been exhausted?
As you know, that is a general problem with Recovery dollars. So they last two years or three years in this case and they go away. 269 4/7/10 - WHOLE - BILL 100115, etc. Dollars for lead work are very hard to come by.
Remember that there are only a selected number of places in the country where lead continues to be a major problem. So that it's not easy to get dollars for lead prevention, and I fear that as state budgets are cut back and ultimately after Recovery goes away and the federal government has to deal with its deficit, we're going to be in a situation where dollars are even going to be harder to come by. At the moment, if a child is lead poisoned, their home is taken care of.
And that is a very important standard for us to maintain, and it is a high priority for this department. I hope never to have the situation where we don't have from some source enough dollars to deal with 270 4/7/10 - WHOLE - BILL 100115, etc. the lead issues in those cases, but that is the floor for lead care. We want to be able to do a broader base of inspection and care, so daycare centers, foster homes and so forth. That's true prevention. And those are the dollars that are hard to come by. So we can address and we will find ways to continue to address children who are poisoned. That's not prevention. That's the issue.
It is the primary prevention which I think should be the state of the art that we can't afford at the moment. And we need to make the case in Harrisburg and we need to make the case in Washington that waiting until a child is poisoned and then doing something about the environment is not the world's greatest investment, but it is far less expensive than trying to impact all of the homes with all children whether the children are poisoned or not. 271 4/7/10 - WHOLE - BILL 100115, etc. So from a limited-dollar perspective, we at least want to make sure that children who have high levels of lead have those levels come down promptly, and the good news is that that number of children continues to decline in Philadelphia.
We'll be working with your department on really continuing the work that Councilwoman Tasco started on this issue years ago, but what I've learned in the short term is that on April 22nd, I believe the federal government -- a new lead bill or new lead law goes into effect April 22nd at the federal level, and the question is, have you thought about professionals in your office looking at the federal law to see how and which there is an overlay for existing efforts within the Department?
We have. I can have our Director of lead come up, if you want or we can -- 272 4/7/10 - WHOLE - BILL 100115, etc.
No. We can wait until the hearing. That will be important, and it will really be a guidepost on how and if we proceed with the bill we've introduced.
Let's move now to a total separate issue, not covered in your testimony, but I'm curious to know. Being a physician, would you -- I want to ask an open-ended question. What would be your perspective on bullying as a public health issue?
So I believe bullying impacts children, and it affects self-esteem. It affects stress levels. It can in some cases for older kids, adolescents, impact the risk of suicide, for instance. So from that point of view, from the outcomes related, it's a public health issue. I believe that the interventions around bullying generally occur in schools, and as such, I think of 273 4/7/10 - WHOLE - BILL 100115, etc. it as an issue that has public health impact, but it's not an issue that's under the portfolio in the Public Health Department. It's under the portfolio in the schools.
That's very helpful in terms of what we're thinking about in my office. To follow up on Councilwoman Tasco's questions around Bebashi and other organizations in the business of attacking that issue, you did mention partnerships. Are there any partnerships with academia; for example, the University of Pennsylvania with John and Dr. Loretta Sweet Jemmott, who have distinguished themselves around prevention and actually outreach in some ways, have they not? Let me say this: They've distinguished themselves in that community. I don't know if it's intervention --
-- or 274 4/7/10 - WHOLE - BILL 100115, etc. outreach or testing. So when you look at the prognosis for next year when it comes to funding for HIV-related programs, are there opportunities there, using the University of Pennsylvania with Dr. Loretta Sweet Jemmott as examples?
So the Jemmotts have developed interventions that can be done to impact on reproductive health by changing behavior. They are interventions that the Centers for Disease Control and a lot of other agencies are looking at as best practices, and I'm hopeful that they will in fact come through and fund us to do some replication with those.
There's a recent publication particularly around abstinence education and there's a long history of work that they've done around general reproductive health education, 275 4/7/10 - WHOLE - BILL 100115, etc. also around violence prevent education, that has been shown to work. And at times, the Centers for Disease Control have highlighted their program and others and given communities an opportunity to choose and put in an application to get funded to do something with those. So I wait to see what that can look like. They're not inexpensive, and for us --
The interventions. So for us to do them and to gear up to do them would take substantial resources. In Philadelphia, we do a fair amount of prevention and information dissemination. One of the biggest pieces of prevention is testing.
And that is the area where, as I highlighted with Councilwoman Tasco, I'm worried.
There's a 276 4/7/10 - WHOLE - BILL 100115, etc. gap.
Excuse me a moment, please. We're going to request a five-minute break for the stenographer.
We're now back in session. The Chair recognizes Councilwoman Brown.
Thank you, Madam President. So on the lead piece, we'll wait to see what the federal government ruling is on April 22nd and then let that be a guidepost going forward with the hearings.
Can you simply give us an update on the dollars recently received from the obesity, tobacco -- help me out.
Yes. Thank you 277 4/7/10 - WHOLE - BILL 100115, etc. for asking. So these are, as I hope everyone realizes, exciting dollars.
This is a national initiative. This is a signature initiative of the President and the First Lady, and this is money that was put aside from the Recovery Act for cities and counties to begin to change the way they're structured and do business to prevent because of infrastructure change tobacco use and obesity by both promoting good foods, discouraging unhealthy food consumption and improving physical activity. So in order to apply for this, they gave us a list of acceptable interventions that were evidence based. We were allowed to pick and choose from that list based on competency and ability we had here in Philadelphia. The good news was of the various interventions on the list, almost a third came from Philadelphia. We are beautifully positioned to do this. 278 4/7/10 - WHOLE - BILL 100115, etc. When we put in our application, we had a strong sense that it was a good application. So we began planning to be in the field immediately when we were awarded, because the CDC specified since it's Recovery dollars, that you have 30 days from the day of funding to be ready to go, and for the City of Philadelphia to be ready to go in 30 days was not realistic. So we started the day the application went in, and we're up and running.
We're not a hundred percent, but we will be by the deadline. And we are working with all of the parts of government. So each one of the Deputy Mayor's areas is participating, particularly around obesity, and we will, I think, have the best crack of anybody in the country at making these dollars do what's needed to begin to address both obesity and smoking, particularly among youth. 279 4/7/10 - WHOLE - BILL 100115, etc.
Final question on this topic. So the entire City will have an opportunity to be impacted by those dollars or is it based on where the greatest needs are on the obesity level? The backdrop on that is, back story, two of my colleagues ultimately supported menu labeling because when I showed them where the incidents of diabetes were, which heavily impacted their districts, they were more prepared, if you will, to support the bill.
So the Centers for Disease Control specified that these had to be at scale citywide.
However, we are permitted to have interventions that are expected to have a different impact. So, for instance, one of the things we're doing is bringing farmers' markets into underserved communities. That's a 280 4/7/10 - WHOLE - BILL 100115, etc. citywide intervention, but not every community in the City is underserved. So we will, in effect, disproportionately work with communities that are poor and communities that don't have good opportunities to have access to fresh fruits and vegetables.
Now, will that have OEO application to ensure that farmers' markets --
We won't pay farmers for the markets. What we'll do is work with folks who can, like the folks who help facilitate finding the people, who can come in and do the selling. We won't -- this is sustainable in that what's required is to figure out who the partners will be and find the place, and we'll facilitate that, and then the farmers' markets should sustain itself.
Okay. Any connection or relationship with the School District as it relates to the U.S. 281 4/7/10 - WHOLE - BILL 100115, etc. Centers for Disease Control for prevention dollars?
Huge cooperation, and I have to say we have been so pleased with the great partnership from the School District around school lunch programs, around physical activity, around health education and nutrition education. So a good example, something that will be important to you in particular, is school children will be educated about menu labeling so that they can interpret the information for their families about menu labeling, and the School District was already thinking of it. We are going to help and encourage that. The partnership I think couldn't have come at a better time.
Lastly, just update us on the website, the IdleFreePhilly.com.
So we are out of compliance with federal air quality standards for two components of air quality. One is particulate matter, particularly very fine or small particulate matter, and the second is ozone. Both of those are produced in this area particularly by motorized vehicles. And when a vehicle isn't moving but sits there idling, we are unnecessarily generating both particulate matter and the precursors of ozone, and as a result, this is an initiative to help both educate people about ordinance 19 and to help people with strategizing around how to reduce the time that vehicles are idling without being in use. So turn off your truck or whatever vehicle it is rather than having it sit in place for long periods of time. Now, part of this is how do we 283 4/7/10 - WHOLE - BILL 100115, etc. get traffic patterns so that where there are particularly large vehicles, diesel engine vehicles, we have good flow. So working with Transportation and Utilities for the City, we can work on that issue. So this is a major effort. It's not a small one, and it goes across a lot of parts of government and a lot of partners to figure out how we can actually decrease the amount of time when vehicles idle, which should make a difference to both particulate and ozone.
Very well. Is the School District or the Health Department developing the curriculum for menu labeling?
Okay. Thank you very much. Thank you, Madam President.
You're welcome. Is Councilman Jones in the 284 4/7/10 - WHOLE - BILL 100115, etc. room? (No response.)
Thank you, Madam President. I just want to ask a question here, and I apologize if you already answered this question, but I'm just curious to know. People who use the health centers, are any of them insured?
Depends on the health center, but you can figure it's about 50 percent.
Fifty percent? I was just wondering what impact President Obama's healthcare reform bill would have on these centers.
Great. I don't know the answer, because it depends if people -- 285 4/7/10 - WHOLE - BILL 100115, etc.
It's also people may choose to go elsewhere or people may stay with us.
Well, that's my point. My point is, if they have their own healthcare, they would probably go to their own doctors, make appointments with their own doctors or perhaps go to the hospital instead of our health centers, and I was just wondering if this would along the line alleviate some of the congestion or whatnot in the health centers.
It may. If the -- remember, 50 percent of the folks who come to us are insured. They like it. We give great care. And I have to say, I came from outside City government. When I came into City government, one of the first things I looked at was the quality of care of the providers.
And I agree 286 4/7/10 - WHOLE - BILL 100115, etc. with you, because I'm familiar with the Northeast there.
Great providers. Great there. So a lot of people like their providers and they are their doctors in their care. So my hope is that folks who are uninsured who have been coming to us when they get insured will stay with the health centers, and what that will do is relieve the General Fund around some of its obligation.
Because it would generate some revenue which we don't have today.
Which I'd love it if you cranked back into the health centers so we have better and better care, but I know from the budget there 287 4/7/10 - WHOLE - BILL 100115, etc. are an awful lot of needs in Philadelphia.
Okay. Thank you, Dr. Schwarz. Thank you, Madam President.
You're welcome. Do we have any other questions from members of the Committee? (No response.)
Thank you for your great service. We will now hear from the Department of Human Services. We were to have public hearings this afternoon for the First Judicial District. However, because of the lateness in time, we are going to reschedule them for April the 13th at 10:00 a.m. (Witnesses approached witness 288 4/7/10 - WHOLE - BILL 100115, etc. table.)
Good afternoon. Thank you for your patience. Please identify yourself for the record and proceed with your testimony. COMMISSIONER AMBROSE: Anne Marie Ambrose, Commissioner, Department of Human Services.
Nice seeing you. COMMISSIONER AMBROSE: Good afternoon, President Verna and members of City Council. I am Anne Marie Ambrose, Commissioner for the Department of Human Services. Today, I will present to you the Department's FY11 Operating Budget request and report on how our expenditures align with our organizational goals to improve outcomes for children and youth, improve the perception of DHS and increase our community presence, and improve operational efficiency. These goals serve as the Department's blueprint for 289 4/7/10 - WHOLE - BILL 100115, etc. meeting the City's charge to invest in youth and protect the City's most vulnerable. The General Fund budget request is for $576,365,473. This is 12,860,000 above the FY10 estimated obligation level of $563,505,473. The total budget request including Grants Revenue funds is $598,859,638. " We 16 currently have 231 providers under 17 contract. Fifteen percent of them are for-profit providers. The Department of Human Services is committed to supporting the Administration's goal of percent 21 minority, woman and disabled-owned 22 business participation in City 23 contracting. The Department of Human 24 Services' FY11 participation goal is five 25 percent. 290 4/7/10 - WHOLE - BILL 100115, etc. Since the tragic death of Danieal Kelly on August 4th of 2006, the Department has undertaken significant reforms under the watchful and helpful eyes of the review teams created by former Mayor Street and reestablished by Mayor Nutter. Our efforts have focused on increased accountability, improved processes to ensure child safety, the creation of a vast continuum of in-home services to meet the diverse needs of children and families, and enhanced community connections. Several of these initiatives were recommended by the review teams and continue to be monitored by them. In November 2006, the Child Welfare Review Panel was created to examine DHS' practices in order to outline ways to enhance child safety. To date, DHS has successfully completed or continues to implement most of the recommendations. Our progress and implementation of the panel's 291 4/7/10 - WHOLE - BILL 100115, etc. recommendations is being monitored by the DHS Community Oversight Board, an independent multi-disciplinary panel of experts convened by the Mayor. In their February of 2010 progress report to Mayor Nutter, the COB concluded that it's pleased with our progress and that we are implementing our reforms in a manner that should lead to long-term sustainability. I attribute our ability to sustained growth in change to having a passionate leadership team that is committed to organizational development and performance management. I cordially extend an invitation to anyone in Council who would like to learn more about what DHS does and how we operate to meet with me and my leadership team. We recently hosted an extremely productive visit with Councilman Kenney. Next, I must recognize how vital our partnership with Family Court is to our growth as an agency. DHS' partnership with Family Court is 292 4/7/10 - WHOLE - BILL 100115, etc. unprecedented. Under the leadership of Administrative Judge Kevin Dougherty, we are working together every day to improve the lives of children and families. Together, we have decreased placements by percent this year and increased 8 adoptions and permanent legal 9 custodianships by 25 percent. 10 DHS is working diligently to 11 continue to improve the outcomes of 12 Philadelphia's most vulnerable children 13 and youth by enhancing internal and external accountability and strengthening our programs and services offered to children and families. Last year I reported to you that DHS enhanced its performance management and provider oversight capacity through the development of the Division of Performance Management and Accountability. PMA uses data-driven and evidence-based methods to track the efficiency and effectiveness of services.
In the year since its inception, we have 293 4/7/10 - WHOLE - BILL 100115, etc. seen significant advancements in evaluating and managing our own performance and our providers. One example of this work has been PMA's development of a provider report card for general foster care placements. I am pleased to report that all of the providers performed well and demonstrated that children are receiving appropriate services while in their care. We intend to continue to develop provider report cards across our various levels of care to measure and examine provider performance. DHS also continues to monitor agency-wide performance through continuous quality improvement methods, including ChildStat, monthly quality improvement case reviews and our newly implemented quality service reviews. With most of our reform efforts to date focused primarily on safety, we are now looking more strategically at our older youth population and wellbeing 294 4/7/10 - WHOLE - BILL 100115, etc. issues, such as education and physical health. Forty-four percent of our youth in placement are years and older, so 5 it is critical that DHS develop a plan to 6 support this population effectively. 7 A third of the City's dropout 8 population has been in DHS' care. As a 9 result, DHS established the Education 10 Support Center to improve educational 11 outcomes for children in our care by 12 taking a more coordinated, effective and 13 targeted approach to remove educational 14 barriers for children and youth in DHS care. We have also expanded our Center for Child and Family Wellbeing to include a part-time medical director who will work with DHS on managing physical health issues of clients and consulting with staff during investigations on detecting child abuse. Our Juvenile Justice Division continues to look forward to the move to our permanent youth detention facility in West Philadelphia. 295 4/7/10 - WHOLE - BILL 100115, etc. DHS is committed to enhancing its community connections. The leadership of DHS values and appreciates the extremely hard work and stress that our staff endures. We hope that by standardizing case assignments, aligning providers geographically and collaborating with system partners, we can better communicate, deliver services and change community perceptions of DHS. For the past two years, DHS Children and Youth Division staff have been organized geographically. Just recently through our collaboration with the School District of Philadelphia we aligned our CYD staff with regional superintendents in an effort to improve educational planning and coordination. Our in-home service providers are also similarly geographically aligned. Through geographic assignment, we aim to foster greater outreach and collaboration between public and private agencies, including social service providers, 296 4/7/10 - WHOLE - BILL 100115, etc. police captains and schools. These new relationships extend up to the highest level of meetings taking place with the School District leadership, as well as with Commissioner Ramsey and District Attorney Williams and their leadership teams. These types of cross system collaborations are vital to ensuring child safety, because as the COB noted in its February 2010 progress report to Mayor Nutter, ensuring child safety is not solely the purview of one agency. Child welfare is a community responsibility. We also continue to improve operational efficiency through organizational restructuring, program development and cost management. Last year, DHS restructured its Administration and Management Division into two distinct divisional support functions - Finance, and Administration and Management. The Finance Division was created in order to 297 4/7/10 - WHOLE - BILL 100115, etc. manage better the complex operations within the department and to focus on budgeting, revenue maximization and integration of financial functions.
Administration and Management will focus on human resources and administrative, technical and logistical support for the agency. DHS has also streamlined its Community-Based Prevention Services Division to more effectively target and provide services. This reorganization has led to an alignment of services, improved access to resources and enriched our engagement with the community and stakeholders. Next, DHS is committed to utilizing technology to improve operational efficiency. Examples of our efforts include merging multiple databases throughout the agency, developing an electronic case management system, piloting an on-board employee vehicle-sharing and tracking program, 298 4/7/10 - WHOLE - BILL 100115, etc. which will enable our workers to conveniently reserve vehicles over the Internet, safely transport children and help better manage our fleet, and working with the Department of Technology to provide, on a pilot basis, hand-held 8 devices that will allow our emergency 9 units to create photo validation of their 10 visits and to record case notes in 11 realtime. 12 Finally, DHS continues to 13 better manage our personnel costs, 14 reducing overtime, eliminating staff 15 vacancies and reducing placement costs. 16 Our projected overtime costs for FY10 is 17 20 percent less than last year. 05 savings in personnel costs. 20 DHS is also committed to 21 obtaining better outcomes for children by 22 reducing placements by ten percent 23 annually through the management of 24 admissions and shortening the length of 25 placement. Over the last three years, 299 4/7/10 - WHOLE - BILL 100115, etc. our dependent child welfare placement population has steadily declined. We now have less than 5,000 children in placement. Equally important are our efforts to minimize the utilization of more costly and family disruptive out-of-state placements for both dependent and delinquent youth. Comparing FY08 to FY09, DHS, in collaboration with Family Court and CBH, decreased out-of-state placements for dependents by 46 percent and delinquents by 27 percent. DHS will continue to look for ways to be cost effective and maximize our operating efficiency. Commencing in FY11, each divisional deputy must develop strategies to meet this goal. The division of PMA will develop divisional score cards to monitor each division's performance and implemented improvements. At this time, I'm happy to entertain any questions you have and 300 4/7/10 - WHOLE - BILL 100115, etc. again extend an invitation to meet with any Councilmember or their staff following the hearing.
Thank you. Ms. Ambrose, you state that your General Fund budget is being increased by $12.8 million in Fiscal 2011. When I look at the revenue estimates from other governments, your state aid is being reduced by $37.4 million in Fiscal 2011. Am I correct in assuming that the City is increasing its cost of DHS by $50.2 million? Kindly identify yourself for the record. DEPUTY COMMISSIONER AHMAD: Good afternoon. My name is Rumana Ahmad. I'm a Deputy Commissioner for Finance here at the Department of Human Services. Our budget, our Operating Budget breakout is, it's a mixture between City share, State share and federal share, and the projected increase 301 4/7/10 - WHOLE - BILL 100115, etc. in City share is not -- let me pull out the actual number that it is, but it's not 50 million. The increase in City share between FY10 and FY11 would be about $4 million.
How is that when -- DEPUTY COMMISSIONER AHMAD: Our target budget for FY10 is $58 million and our target operating budget for FY11 is $62 million. Our State share -- so the Act 148 money that we will be receiving is about $355 million for FY11. So our total operating budget is going to be $576 million, based upon our State, our federal and our local monies. So we're talking about a cash flow issue rather than specifically an operating budget issue. So there have been delays in receiving particularly our IV-E money, which is going back to FY09. So this would be an issue I think that requires a little bit more background. So one of our biggest revenue 302 4/7/10 - WHOLE - BILL 100115, etc. sources out of our approximately -- we'll just say approximately $600 million operating budget for the last couple of years, about a hundred million has been -- a little over a hundred million has been from Title IV-E and a large --
I'm sorry. What was your last statement? DEPUTY COMMISSIONER AHMAD: The funding source, about a hundred million of our revenue comes from Title IV-E funds, which are federal funds, and there are quite a few requirements that are attached to complying to draw down these funds, and the State actually is -- the Office of Children, Youth and Family under the Department of Public Welfare is responsible for interpreting the policy for those funds and forcing or encouraging or requiring counties to comply with those policies. There were quite a few changes that came at a statewide level beginning July 1st, 2008, which would be the start of Fiscal Year 303 4/7/10 - WHOLE - BILL 100115, etc. '09. So there's been a delay in actually drawing down those funds both in FY09 and in FY10 as a result of the various changes that have occurred statewide. In the last several months, we have drawn down -- we've actually invoiced for -- as far as our FY09 funds are concerned, we're about -- 90 percent of our maintenance funds have been drawn down. The rest of our funds, with the balance of -- we have one with our fourth quarter administrative costs, our fourth quarter adoption costs have not been invoiced, but other than that, we have invoiced for the other portions of our IV-E money. There is -- because of the negotiation between the State and the federal government, there is a hold on a subsection of our IV-E money. So about $20 million for FY09 is being held during this deferral period. So we will -- we're expecting to see some resolution 25 between the State and the feds on that in 304 4/7/10 - WHOLE - BILL 100115, etc. the coming weeks, so that money should be released and should come into the City in about 30 to 45 days after that release has occurred.
We are led to believe that the State is reducing its funding for DHS in Fiscal 2011. Can you tell us what options do we have in finding replacement funding from a source other than the City? DEPUTY COMMISSIONER AHMAD: The State -- our budget itself is also reduced from the operating budget from '10, which was at 500 -- I'm sorry. That would have been $590 million, was our operating budget for '10, but our target budget is actually $560 million. So we've reduced our target projection for FY10.
Can you tell us what is the total amount of City-generated funds that go to DHS and the cost of employee benefits, and building maintenance should also be 305 4/7/10 - WHOLE - BILL 100115, etc. factored in at the least. DEPUTY COMMISSIONER AHMAD: So for our FY11 operating budget, the City share is 62.9 million. And let me pull up our actual -- our other City costs. So our other City costs for FY11 projects are projected to be $120 million. Within that, our total personnel costs for FY11 are $95 million. And those fall into our operating budget rather than our other City costs, if that makes sense.
Thank you, Madam President. Good afternoon, Commissioner. COMMISSIONER AMBROSE: Good afternoon.
You state in your written testimony that you currently have 231 providers, 15 percent of them are for-profit providers. What percentage of those are disadvantaged 306 4/7/10 - WHOLE - BILL 100115, etc. businesses? COMMISSIONER AMBROSE: The total percentage is actually, I think, 3.4 percent.
Of the for-profit providers? COMMISSIONER AMBROSE: Correct.
Why is that? COMMISSIONER AMBROSE: Part of it is that most of that funding -- and the total funding that we're talking about is actually about $60 million. About 52 million of that is actually for placement costs, and two of the providers for placement costs that are included in the for-profit are VisionQuest and Cornell, which are -- there's not a lot of discretion around some of the placement issues. We work with the court. And even when you do some research on what for-profits out there are minority or women-owned or disabled, 307 4/7/10 - WHOLE - BILL 100115, etc. there aren't a lot of options.
And what services do they provide? COMMISSIONER AMBROSE: Placement for mostly delinquent youth, some dependent youth. In the discretionary area where we have about $4.9 million, we do much better. We have about a 42 percent participation rate for those services.
You said VisionQuest provides what services? Placement? COMMISSIONER AMBROSE: Placement services.
And there are no subcontracting or procurement opportunities associated with that? COMMISSIONER AMBROSE: Yeah. One of the things that we need to work with those providers on is their subcontracting and how they can do more minority participation with the subcontracting that they do for food 308 4/7/10 - WHOLE - BILL 100115, etc. service and various things that they provide to the children.
One of the things you need to work on? COMMISSIONER AMBROSE: Absolutely.
What does that mean? COMMISSIONER AMBROSE: One of the things that we need to talk to those providers about.
So should your goal be higher? COMMISSIONER AMBROSE: Yes. Absolutely.
So why is your goal what it is? COMMISSIONER AMBROSE: Our goal is what it is because we're trying to get to a higher number.
That doesn't make any sense. Do you or do you not know what procurement or subcontracting opportunities might exist? 309 4/7/10 - WHOLE - BILL 100115, etc. COMMISSIONER AMBROSE: We do know, and we actually work with OEO on all of the RFPs that we put out and try to --
Let me jump back to that. You put out an RFP for daycare services? COMMISSIONER AMBROSE: Correct.
And what's that for? COMMISSIONER AMBROSE: It's for providing daycare for children that are DHS involved.
And what were your goals in that RFP? COMMISSIONER AMBROSE: Just give me one second.
Do you want me to tell you? COMMISSIONER AMBROSE: Actually, yeah, if you can find them before I can.
It actually said "best efforts." That's disgusting. 310 4/7/10 - WHOLE - BILL 100115, etc. For daycare services. If you were providing daycare services and you put out an RFP and that is an opportunity and in the past you've spent $80 million in contracting and only done about three, four percent with disadvantaged businesses, you set a goal now of only five percent. If I ask you about your for-profit providers and what subcontracting opportunities exist, going through all of that line of questioning and then I ask you about a daycare RFP and you say you've been working with OEO and you set a goal of best efforts, that's unacceptable. Do you have any response to that? COMMISSIONER AMBROSE: All I can say is that we know that we're not meeting the goal, that we want to work more closely with OEO.
That means nothing to me. Can you explain how you can't even achieve meaningful participation on a daycare contract, a 311 4/7/10 - WHOLE - BILL 100115, etc. contract to provide daycare services? COMMISSIONER AMBROSE: I think --
To me it means you just think you don't have to do it. COMMISSIONER AMBROSE: I don't think that that's the reason. I mean, one of the issues that we have is that we have to meet State mandates and so some of the requirements that were put out recently in a bulletin by the State require a two star rating.
And so the RFP had to say "best efforts"? COMMISSIONER AMBROSE: No, and we can reexamine that language.
It's closed already. And after it says "best efforts," it goes on to say, "These ranges are based upon an analysis of factors such as the size and scope of the contract and the availability of MBEs, WBEs and DSBEs to perform various 312 4/7/10 - WHOLE - BILL 100115, etc. elements of the contract." These are daycare services. I mean, how long has DHS been providing daycare services? COMMISSIONER AMBROSE: We've been providing daycare services for a long time. We --
So you don't know what capacity exists out there in terms of disadvantaged businesses? COMMISSIONER AMBROSE: One of the issues that we have is in order to get reimbursed by the State, we have to follow certain mandates that they lay out.
I understand all that. Based upon your experience, based upon the fact you've been doing daycare services for years, based upon what you should be doing, which is identifying disadvantaged businesses that are qualified, you should know what's out there in terms of qualified DBE firms, and when you put out an RFP for daycare 313 4/7/10 - WHOLE - BILL 100115, etc. services, it should not say "best efforts." That's ridiculous. COMMISSIONER AMBROSE: I agree with you.
So who set the goals? COMMISSIONER AMBROSE: We worked with OEO on all of our --
How do you work with OEO to say best efforts? I can see if you actually came up with a number that you can say you worked with OEO. In other words, OEO told you you could just put best efforts or don't worry about it? COMMISSIONER AMBROSE: I'm not sure exactly. I mean, if we want to get an answer, maybe -- (Person speaking from the audience.)
You must come up to the witness table. COMMISSIONER AMBROSE: Joe, why don't you come up. (Witness approached witness 314 4/7/10 - WHOLE - BILL 100115, etc. table.)
Good afternoon. Kindly identify yourself for the record.
Joe Cronauer, Assistant Commissioner, DHS. The way that we work with OEO -- and I think that we do need to work more closely with them -- is that we'll share with them what the RFP says, we'll share with them the language, what the goal is, and OEO will return to us what the ranges are that they establish.
That's completely unacceptable. I've said department by department, you're the professionals, you know what goods and services you want to procure. You've been in business of providing daycare services for a very long time. You should know what exists out there in terms of capacity. You should set the goal. You should meet the goal. I don't want to hear that OEO set the goal. 315 4/7/10 - WHOLE - BILL 100115, etc. That's ridiculous. I'm not going to accept that. I mean, if you can't tell me what amount of contract dollars should be going to disadvantaged firms for daycare services, you're not serious about this. You're not. No other response? COMMISSIONER AMBROSE: Councilman, I'm not disagreeing with you. This is --
When OEO came back and said based on good-faith efforts, best-faith efforts, you just said okay?
Thank you. The Chair recognizes Councilwoman Tasco.
Good afternoon. Thank you. COMMISSIONER AMBROSE: Good 316 4/7/10 - WHOLE - BILL 100115, etc. afternoon.
I think that we went through this, I think, last year and maybe the year before. You've been here -- COMMISSIONER AMBROSE: I wasn't here the year before, but we --
Last year, and certainly the Councilmembers raised that issue before, because we've told you, as we've told the Health Department and other departments, that there has been a lack of effort in broadening your base of provider contracts, and that's been a concern of ours, because we get telephone calls from providers who are not being considered. We don't know who is being considered, and it's very disappointing to have the departments come back and not have made any effort to increase minority participation. And I'm looking at one of the questions I have. You have -- there are a number of cultural-based organizations that you 317 4/7/10 - WHOLE - BILL 100115, etc. have that are missing from your increase of $13 million in the General Fund for the purchase of services for the DHS budget. There are organizations that have traditionally been part of your program, APM, Congreso, SCAN and Intercultural Family Services, and they are not listed as providers for Fiscal Year '11, and these organizations have certainly through the years been providers of services for DHS, and if they are not included, I'd like to know why and how you evaluated them for them not to be included. COMMISSIONER AMBROSE: All that you have mentioned are actually current providers and provide a variety of different services at DHS, with the exception of SCAN.
So what happened to SCAN? COMMISSIONER AMBROSE: There were a series of concerns that we had regarding individual cases, and once we 318 4/7/10 - WHOLE - BILL 100115, etc. looked more closely at some of those cases and met with the provider over a series of months, we made the decision that it was in the best interest of the children that we serve to terminate those contracts. I spent considerable time with Derek Green from your staff going over many of those issues and concerns.
And we certainly don't want any problems to happen to children, because that's our first concern, but we want and trust that in your evaluation, and hopefully so, that the performance evaluation will be fair. COMMISSIONER AMBROSE: Yeah. So let me speak to that, because I actually think some of the providers in our performance evaluation process have actually done very well. APM, for instance, was one of the highest scores on our new provider report card for family foster care. Concilio also did well, Women's Christian Alliance. So 319 4/7/10 - WHOLE - BILL 100115, etc. some of the providers that we traditionally value have done well. I think some of the outreach efforts that we've engaged in is, we've met with GPUAC. We believe that they have an infrastructure that can help provide the administrative oversight that some of our smaller community-based providers lack. So we've engaged them in writing out a proposal perhaps that could help. They call it GPUAC University. So we're looking at that and working with Kevin Dow to explore that to help some of our providers. Also, Deputy Commissioner Figueroa is on a task force with the United Way that has public and private providers talking about this issue. Kevin Dow has recently joined that group. Because we do think that there's a problem with what we're doing at DHS and we want to support -- we talk a lot about being more community based. In order to do that, we need to have partnerships, 320 4/7/10 - WHOLE - BILL 100115, etc. and the stakeholders that provide the community services need to be part of that. The other thing that we're working on is, Washington, DC has currently -- has recently created service collaboratives at the community-based level. They're going to be coming up and talking to us about how they've done that, sort of creating the community umbrella that provides the administrative infrastructure that's necessary for providers, to make sure that they're meeting all of the legal mandates that we at DHS have with the federal government and the State government.
And I appreciate that and appreciate your efforts to really address the issue. This morning we had Dr. Arthur Evans talk about their increased minority participation to 38 percent, because that was one department we were on constantly about their lack of outreach to the 321 4/7/10 - WHOLE - BILL 100115, etc. broader community and the involvement of a diverse pool of providers, and so they have -- and you might want to talk to him about how they've done it, because he laid out the whole program, how they have through their office increased the number of people who know about the contracts, how to bid on the contracts, what's involved and all of that. So it's just knowing what they are. And as Councilman Goode said on daycare -- I'm really kind of embarrassed for us, because I'm on your Advisory Board -- that there are daycares -- I mean, we're in zoning every week about daycare, and so there are providers all over this city that are capable and licensed, and certainly Councilwoman Brown's very deeply involved in the daycare issue. And so your pool should be far more expansive than it is. COMMISSIONER AMBROSE: Yeah. We recently requested a new position from the State for childcare, because this is 322 4/7/10 - WHOLE - BILL 100115, etc. of concern to us, and the new requirements by the State are really going to limit the ability of our families to access available daycare in their neighborhoods. And so --
It's going to what? COMMISSIONER AMBROSE: It's going to limit the availability of access. There's a new requirement for the daycares that we use to have two stars under the new State bulletin, and so we do have that position that's going to be housed under Deputy Commissioner Figueroa, and we're really going to work on this. I think, you know, there's an unfortunate choice of words that were used here. We do value community participation, and we need to do a better job.
Next year when you come back and sit in that chair, you're going to have a better report, 323 4/7/10 - WHOLE - BILL 100115, etc. right? COMMISSIONER AMBROSE: Yes. Yes, I will.
Much better report, right? COMMISSIONER AMBROSE: Yes.
Good afternoon. COMMISSIONER AMBROSE: Good afternoon.
I wanted to go back to the discussion that President Verna was asking about, the funding. The $20 million being held by the State right now, was that part of our grants revenue or was that part of -- I'm assuming if it's from the State, it's grant revenue, the 20 million that's being on hold? DEPUTY COMMISSIONER AHMAD: Yeah. It's actually -- it's 324 4/7/10 - WHOLE - BILL 100115, etc. reimbursement. It's IV-E reimbursement, yes.
Why is that money being held? DEPUTY COMMISSIONER AHMAD: It's being held statewide, actually. So it's not just Philadelphia that's suffering. So the State is actually -- there are a variety of issues that the feds had taken with the Title IV-E program in the State of Pennsylvania.
I wanted to clarify that, whether it was grants or general. DEPUTY COMMISSIONER AHMAD: Yeah. It flows through the General Fund, but it is -- it's a reimbursement program. So we do outlay the funds and services continue to be provided. This money supports specifically children who are -- specific children within our foster care pool. So it's a reimbursement for that type of service. So we have to obviously 325 4/7/10 - WHOLE - BILL 100115, etc. continue to pay for it. But the money that's on hold right now, it is due to the State compliance with federal requirements. So what they're doing is, they've been -- there are a couple of things that they've done statewide to improve the process. One is create a statewide collection system. So all of the invoices, where they would historically go in by paper and then be reviewed manually and then get sent off to the feds, they've actually been loaded -- they're now loaded individually into a State collection system, and they're quality controlled. So they're actually reviewed and if you have any issues. And another thing they've done is reviewed the actual reimbursement rates by provider service, and those are some things they've done. Now, the feds are actually working with them to make sure that they meet the standards that the feds have set. So it's been kind of an iterative 326 4/7/10 - WHOLE - BILL 100115, etc. process. There was a piece that's actually on hold in the fall and they released that, and now it's just down to this one subcomponent that I'm told by the State they're very, very close to closing the deal on that, so it should be soon.
So are we going to be able to recoup dollar for dollar? Because I know in our budget discussions with the Mayor's executive team, there's been a concern that we may have to eat some of that, up to $10 million, and, in fact, part of the discussion with them has been we need to budget for that if that's the case, because it's a big number. COMMISSIONER AMBROSE: We actually haven't anticipated that. We've asked that -- and this is a statewide plea from all the counties -- that the counties be held harmless, because this was something that was actually orchestrated by the State, and the 327 4/7/10 - WHOLE - BILL 100115, etc. discussions have always been between the Administration of Children and Families and the Department of Public Welfare. So we have not anticipated that. Oh, here's our Budget Director. (Witness approached witness table.)
Good afternoon. Steve Agostini, Budget Director. As you know, Councilmember and others, we have had concerns that changes either at the federal level or the State level in terms of the reimbursement could put us at risk. I think kudos need to be given to the Commissioner's team and especially to Rumana in trying to get the billings done in a very aggressive and compressed timeframe. If I recall correctly, I think they've thrown as many as ten additional people at the entire claims process in recent weeks, months in an effort to be sure that we are 328 4/7/10 - WHOLE - BILL 100115, etc. receiving those reimbursements in a timely basis and being reimbursed for as much as possible. Nevertheless, it is possible that depending on how that gets worked out -- and Rumana made mention of the deal being worked out with the State and the feds -- that we could be at risk, and that was one of the issues that we raised. Hopefully now all this turns into simply a timing issue in terms of when the dollars are received. Perhaps they're not going to be received in the next couple of months, which means they may not necessarily be received in this fiscal year, but we would receive them in the subsequent fiscal year. If it turns into a timing issue, then our concerns are greatly diminished, but if at some point it actually turns into a material issue where we don't get reimbursed, then I think we'll come back to you and give you some information about that. 329 4/7/10 - WHOLE - BILL 100115, etc.
That will be important, because I know you guys are building a cushion. I just want to make sure that if this becomes a cushion, that we have that information hopefully before we approve the budget, because a $10 million item is a huge item for us.
Okay. So thank you. I notice that in your budget you're still carrying most of your technology to the point of $3.1 million. There's been a streamlining with DOT, so I wanted to know why DHS' technology is not with our other office. COMMISSIONER AMBROSE: I don't -- go ahead, Steve.
So one of the concerns that we had with grant-funded positions like the multitude that exist in DHS is that if we were to remove those positions, put them under the Office of 330 4/7/10 - WHOLE - BILL 100115, etc. Technology, that we would then run into difficulties in getting reimbursed, because they were not directly in the line of command, if you will, providing service. And so what has been agreed to is a service-level agreement and an understanding about how those individuals will report, what the workflow is and what the work needs to be done in order to support the grant-funded activities. We just didn't want to run the risk of pulling those folks out and then not being able to get reimbursed, because the dollars are very sizable.
That's an important point. I just want to make sure that as we're looking around how we manage data, that we are ensuring that there's some connection back since we want to make sure the data interfaces. So that's a good point to bring out. When we look about the amount of money that we've spent for the care for individuals, there's about $109 331 4/7/10 - WHOLE - BILL 100115, etc. million, 72 million of that being with eight organizations. You made reference to how you guys have increased the accountability. What other things have we -- what are the things that we're doing to ensure that in this case there's like eight providers that provide the bulk of the work are meeting the highest standards? COMMISSIONER AMBROSE: I think there's a variety of different things. Most of the children that you're speaking about are court ordered. So we work in collaboration with Family Court on most of those cases. Many of those big providers that we use have many different levels of care and specialized services within that. What we've tried to do is look at each of the levels of care and look at a compliance tool that we're developing. It's going to streamline what we used to have. So the State does their licensing piece. We wanted to focus a little bit more on quality of 332 4/7/10 - WHOLE - BILL 100115, etc. service delivery. So those are the things that we're working, and the tool will be complete on July 1st.
I notice that you moved away from your family preservation, so there's a lot of items that show unfunded. Where are those services now being picked up? COMMISSIONER AMBROSE: We actually eliminated family preservation in the last budget cycle based on some poor outcomes, and now we've created a new service called "family stabilization service," and we've increased our alternative response services.
So are we still servicing the same amount of clients? COMMISSIONER AMBROSE: Yes.
And what's that number? COMMISSIONER AMBROSE: I think it's -- hold on one second. I think it's 3.65, but someone can look it up for me 333 4/7/10 - WHOLE - BILL 100115, etc. while --
Okay. In a lot of your budget, especially as it relates to Class 200 funding, you have many things that say "vendor to be determined." Some of these items were previously funded in 2010, so I wanted to know vendor to be determined, is that because we're changing vendors? And those are mostly on where you have a few million dollars in vendors to be determined, but they were budgeted last year. Is that because we're changing vendors, we haven't selected vendors? COMMISSIONER AMBROSE: Yeah. We're getting ready to issue an RFP mostly around delinquency prevention and mentoring for older youth. That was actually some money that was set aside. The court used to have about $1.6 million in their Prevention Services Unit. We've convinced them that some of the services they were providing were duplicative of 334 4/7/10 - WHOLE - BILL 100115, etc. what DHS was already providing, and we determined that we needed to do a little bit more around older youth. So there used to be an intensive delinquency prevention program that was actually a really good service. We want to look at that. And we've also met with former Mayor Goode about his take on mentoring for older youth. He had some really terrific ideas around site mentoring and the research around site mentoring for pre-delinquent youth, and so --
So we'll have an increase in services, so when we look at the court's budget, are they going to be decreasing that support? COMMISSIONER AMBROSE: No. 19 That was actually a Memorandum of Understanding that was established between Administrative Judge Field and I believe it was Commissioner Martinez. So it dates back that long. It would just be money coming back to DHS that we would issue an RFP in partnership with the 335 4/7/10 - WHOLE - BILL 100115, etc. court. Some of those cases would be around kids coming into the delinquent system, where they think that family services or just some community-based service would prevent that child from entering deeper into the juvenile justice system, so a diversion from juvenile justice.
Okay. In your statement you talk about the breakdown of your staff, and I notice that four percent of your staff is Latino. What is the percentage of Latinos served through your department? COMMISSIONER AMBROSE: That's a good question and I'm not sure I have it for you, but something I can get back to you on.
But I think we'll agree that four percent in a city that's ten percent Latino is not sufficient, right? COMMISSIONER AMBROSE: Absolutely. I can tell you that even 336 4/7/10 - WHOLE - BILL 100115, etc. given our population, it's much higher than even ten percent.
Going back to Wilson Goode, what goals are we establishing to ensure that as opportunities arise, we recruit, without taking all the best from the agencies in the community? COMMISSIONER AMBROSE: Well, I think based in some part on your advocacy efforts, we've developed, I think, a very robust dialogue with the Latino providers. We meet with them frequently. We've included them on both our Prevention Realignment Committee that's determining which way prevention dollars flow and what kinds of services are best there, and also we have two members of the Latino provider community sitting on my DHS Provider Leadership group that meets every other month for a couple of hours talking through issues. So they're well aware of the issues. We've also spent some time meeting with Concilio 337 4/7/10 - WHOLE - BILL 100115, etc. over the last couple of months to make sure that we're supportive of the new leadership at Concilio. They provide great services for us and we want to make sure that we're helpful throughout the transition.
In terms of the new services, your services in the home, what is it you call it now? COMMISSIONER AMBROSE: In-home protective services, and we actually have a continuum now. We used to just have services to children in their own homes. We now have a continuum of services depending on the needs of the children and families presented to us.
One of the concerns that I've heard from the providers is that, one -- and I know DHS' goal is overall to have a reduction of placement, but I think that one of the concerns is around how the referrals come and the providers' ability to maintain staff if their referrals are up and down. 338 4/7/10 - WHOLE - BILL 100115, etc. Are we getting better at that? This was a huge problem last year. COMMISSIONER AMBROSE: That was a huge problem last year and coupled with all the budgetary concerns and the providers not getting paid, they lost a lot of staff. I think most of that has stabilized. Those services have been in place for some time. I think the providers have stabilized, because the money is finally coming in, and I haven't heard any of those concerns recently.
How are we doing with contracts? One of the issues that we really experienced last year when the State delayed their funding and their budgets was also we have providers that provide services and don't get a contract until September, October, November. Where are we? Are we able to turn around contracts in 90 days? Are we getting better at that? It's a huge problem for smaller -- COMMISSIONER AMBROSE: It's a 339 4/7/10 - WHOLE - BILL 100115, etc. huge problem. We're getting better, but there's still a lot of work to be done. I mean, one of the things that we've talked about is bundling contracts, so that under Health and Opportunity, we share many of the same providers. If we could just have one bundled contract for that provider and work it through that way. We're trying to work with Law on that as well. It's a really cumbersome process not only for the agency, but for the providers, it's not a good process.
So what's our goal for this year? I don't want to be calling you guys again in September saying, Where are contracts? COMMISSIONER AMBROSE: I don't know if Joe has set a goal, but --
You got to come back up. I got to get you on the record, someone I call.
Hi. Our goal is to have all of our contracts conformed and ready to go by the time our providers 340 4/7/10 - WHOLE - BILL 100115, etc. are able to invoice for the first time, which will be August 10th, depending on --
Yeah. And it really is possible. It can be complicated, particularly if there are delays in like the State budgeting process or whatever, which could preclude us from beginning the process, but we've been working well and we'll have a full meeting to talk with our providers about exactly what pieces of information we'll need them to have ready for us so that when we get the green light to begin our contracting process, we'll be able to get that information and move it through the process.
And I want to reiterate Councilman Goode's concern around when we contract with some of these private providers, especially for the ones that are not necessarily 341 4/7/10 - WHOLE - BILL 100115, etc. Philadelphia-based providers, the issue of minority contracting, because they do do an array and do purchase services. They can have a tremendous impact in the communities in which they're currently located if they bought locally and so forth. So I can't even tell you how important that is. The one thing that I will add as it relates to our non-profits, because I know Dr. Schwarz spoke earlier around analyzing Board composition, but it would be very important for me to look at staff composition, because they're some of your larger providers who -- and I've seen it. It will have one Latino doing ten million things, and they get a bigger contract than some of the folks that are on the ground, and I think if we started asking for those numbers even on the employment side, I think you start seeing a shift in even their employment. Because ultimately the goal of Wilson and Blondell, who have worked at this for 342 4/7/10 - WHOLE - BILL 100115, etc. many years, is providing contract opportunities, but also employment opportunities. And if organizations are not asked the questions, there's no 6 reason for them to try to recruit a more diverse staff that reflects the population that they're serving. So we're the purchaser of these goods, and if we enforce it, it will happen.
Yeah. And our current plans are not only to ask about what your staff composition is, but to distinguish between senior staff and all staff, so that not only are we having a diverse representation if you look at the overall staff composition, but that includes what your executive staff looks like as well.
And also where they buy. Where they buy, their Board composition, what they buy, where 343 4/7/10 - WHOLE - BILL 100115, etc. they buy and their staffing. I think if we started all saying that and singing that song, I think we'd see a shift in that. And I think ultimately the community would be better served and Philadelphians will be better served. So thank you, Madam Chair.
You're welcome. The Chair recognizes Councilwoman Brown.
Thank you, Madam President. Good afternoon. COMMISSIONER AMBROSE: Good afternoon.
Councilman Goode used the word "unacceptable," but Councilwoman Tasco used the word "disappointing." When you consider the Mayor's Executive Order that we were led to believe he made exceedingly clear wherein he expected the leader professionals in his Administration to 344 4/7/10 - WHOLE - BILL 100115, etc. step up and honor up, I would really use the word "egregious" and some might argue insubordination. When there's an $80 million budget and three, less than four percent goes towards the world that the Mayor stipulated clearly in a formal press conference, he wants Philadelphia to do better. So I cannot let that go by, because I've been here for ten years, and I sent a letter to Mayor Nutter last year making it clear and making it plain that with every single department, we, Councilman Goode, myself and others, would be asking real questions, wanting the hard data about MBE, WBE participation. And so when we get this number ten years later, it's awful. It's awful. Further, when you say that X number of the contracts are for non-profits, 15 percent, and you mention VisionQuest and Cornell, are they local? COMMISSIONER AMBROSE: They're 345 4/7/10 - WHOLE - BILL 100115, etc. for-profit. That's -- 3
Are they 4 local? 5 COMMISSIONER AMBROSE: Some of 6 them -- they're Pennsylvania-based 7 companies. 8
Okay. 9 COMMISSIONER AMBROSE: One of 10 the goals here is also about keeping kids 11 closer to Philadelphia. 12
Exactly, 13 as has been raised and advocated for in 14 this Chamber. 15 COMMISSIONER AMBROSE: That's correct. And so they're Pennsylvania companies. When we've done some exploration with the State on additional providers that we could use, there really aren't very many choices that are local providers.
I understand that, and having worked in the world of placing children in certified, reliable, safe environments, I completely 346 4/7/10 - WHOLE - BILL 100115, etc. understand that. That was my job at Family Court. When it comes to procurement services that these agencies provide, talking to them is not going to move the needle. If there's not a hammer to help them understand that we at DHS have a requirement to meet the Mayor's Executive Order, nothing happens. So talking with them doesn't get you there. Is there a hammer in place for agencies like this, as few as they are, to help them understand, we have a requirement with MBE, WBE, DBE expectations, is there a hammer to help move them to help you honor the Mayor's Executive Order? COMMISSIONER AMBROSE: I think we could put that in the program -- the performance standards of the contract and set percentages for them on each of the things that they subcontract for.
So from that, I should understand that there are 347 4/7/10 - WHOLE - BILL 100115, etc. professionals within DHS that write those contracts? COMMISSIONER AMBROSE: We work with the Law Department to write those contracts, that's right.
But ultimately the sign-off on the language of those contracts rests with? COMMISSIONER AMBROSE: With me as the Commissioner at DHS.
So when we hear the word "best effort," we know that in many words that's a four-letter word. In 2010 with the Mayor's Executive Order, best effort does not get us there. It simply does not get us there. And so when I hear that that is the case on a childcare -- and it's not daycare, because we're not taking care of the day, we're taking care of children -- childcare contracts, that's further disturbing for me, because no one can tell me that we don't have five-star Keystone Star childcare centers in the 348 4/7/10 - WHOLE - BILL 100115, etc. City, because I know that they exist, because I've visited them since I've been here. We can go with the Caring Center in West Philly or Adrienne McKinney right there at the Bourse. So to suggest that we have a contract and we're going to use our best efforts to find childcare centers who provide services to children, most of whom look like me, it doesn't mix, it doesn't connect at all. COMMISSIONER AMBROSE: Understood.
Okay. Who grants the Brightside contracts? Is that a State contract or is that a DHS contract? COMMISSIONER AMBROSE: I believe that's the State contract through Optel, but... (Witness approached witness table.) DEPUTY COMMISSIONER FIGUEROA: I just wanted to -- Cynthia Figueroa, Deputy Commissioner, Department of Human 349 4/7/10 - WHOLE - BILL 100115, etc. Services. I just want to comment, Councilwoman, about the childcare. That particular RFP had been posted, I believe, approximately seven months ago, and now in preparation for the State bulletin that has a requirement that not only is it that you're licensed, a licensed facility will not be sufficient in order for the State to allow us to pay for the subsidy. The daycare provider will have to meet the two Keystone Star qualification. So we're actually working right now to try to figure out what is going to be the best contracting process. So we didn't yield, I think, the responses that we wanted with that posting that happened seven months ago and we're still --
Excuse me. The Chair recognizes Councilman Goode for a point of order. 350 4/7/10 - WHOLE - BILL 100115, etc.
Very simple question. Does that mean that the childcare facility has to be owned by a white male? DEPUTY COMMISSIONER FIGUEROA: No. It means that they have to reach that two Keystone stars, and so we're actually looking at --
Does it have to be owned by a white male? DEPUTY COMMISSIONER FIGUEROA: My response to the question is no. 14
Could you have a hundred percent participation from minority and women-owned businesses? DEPUTY COMMISSIONER FIGUEROA: If they met the requirement.
You should know whether they meet the requirement. You should know whether the capacity is out there. DEPUTY COMMISSIONER FIGUEROA: That meet the --
If you're 351 4/7/10 - WHOLE - BILL 100115, etc. actually evaluating a childcare RFP and it's your field and the Department has been doing this for years, you should know what minority and woman-owned childcare facilities are out there and how they rank and whether it's possible there could be a hundred percent participation. So what you're saying is completely ridiculous. Thank you, Madam President.
You're welcome. The Chair recognizes Councilwoman Brown.
What procedures do you have in-house -- let me go back to what Dr. Evans did, which for me was very instructive, wherein he was able to stipulate X number of -- he conducted a survey. He actually conducted a survey wherein he indicated there were 214 providers, 81, or 38 percent, were minority-owned, women-owned or DBE. And he had as a part of that 352 4/7/10 - WHOLE - BILL 100115, etc. process technical assistance available for those prospective, potential providers who could, if given help, move to possible consideration for CBH. So help me understand how and if DHS has done that recently or has that in the pipeline, because it appears to me that that's the only way you're going to change this number of less than four percent. COMMISSIONER AMBROSE: So on the non-profit side, we actually have recently done a survey. The results are incomplete, but I can tell you that our rates look much better. Of the approximately 300 providers, we actually had 107 responses. Of those, 13.3 percent were minority providers, 24.5 percent were women-owned and one percent was disabled.
So that means only 33 percent responded? Did I hear that correctly? DEPUTY COMMISSIONER AHMAD: I 353 4/7/10 - WHOLE - BILL 100115, etc. apologize. The number she has the denominator on, there's actually -- it's not updated. The number --
You're going to have to talk into the microphone. DEPUTY COMMISSIONER AHMAD: Okay. I apologize. So the -- we also did a very similar survey, and there were about 191 not-for-profit providers that we sent the surveys to. COUNCILWOMAN Brown: Of that, how many responded? DEPUTY COMMISSIONER AHMAD: One hundred and seven.
Stop right there. So these are agencies and providers that are receiving dollars from the City of Philadelphia and you're asking them for information to help you do your job better and only close to 50 354 4/7/10 - WHOLE - BILL 100115, etc. percent of them responded or a little over 50 percent? DEPUTY COMMISSIONER AHMAD: This survey was done -- this is something, I agree, we should have been doing on an ongoing basis, keeping track of this for our not-for-profit providers on an ongoing basis, but this survey was done fairly recently, so that would be the response that we got during the last -- during the survey that we did that took us about over the last month or so.
All right. So you're telling me then that you're reaching out to those who didn't respond so that you can try to get -- DEPUTY COMMISSIONER AHMAD: Yes, we are.
-- the full picture, correct? DEPUTY COMMISSIONER AHMAD: We are, actually. COMMISSIONER AMBROSE: Correct. 355 4/7/10 - WHOLE - BILL 100115, etc. And we did it last year. We had full results. We wanted to update the numbers, and we didn't do it in enough time to actually get a full response, and so we can give you the responses that hadn't come in at the time that we got this. And actually Rumana has more information than I even had.
That would be helpful. Let me go back to the for-profits. For the for-profits, the expectation of Councilmembers is that if you're receiving dollars from the City of Philadelphia and you are a for-profit, we expect for your picture profile to show that you're doing business with MBEs, WBEs, DBEs, period, period, and to the extent that you're not doing that, then you need to know we have to reconsider whether or not we're going to continue to give you taxpayers' dollars. It's 2010, and the Mayor has made it clear in his Executive Order. So then when we come into these Chambers, we 356 4/7/10 - WHOLE - BILL 100115, etc. really want to hear department heads who have embraced it. And we listen to what you say, but ultimately we're looking at what you do based on these numbers. And so as Majority Leader has said, months 7 from now, because I actually had this 8 conversation 12 months ago, but 12 months 9 from now, we really want these numbers to 10 be better. We cannot defend anything 11 less than that, not anymore. The Mayor 12 has made it clear in his Executive Order. And what we're learning or what I've learned since I've been here, for too long department heads were putting it on OEO. Well, OEO is not doing this and OEO is not doing that. And then in conversation with my colleague, I discover no, it's the department heads who ultimately have to be held accountable for honoring these goals and what the Mayor has stipulated, and so ultimately it starts with leadership. COMMISSIONER AMBROSE: Yeah, and I did think that we made an 357 4/7/10 - WHOLE - BILL 100115, etc. improvement at least in the ones that we had more discretion around, so the minority participation rate for those are 42 percent for the for-profits.
Those are non-profits? COMMISSIONER AMBROSE: Those are the for-profits. For the for-profits, for the contracts that we have more discretion with, the minority participation, women rate is 42 percent. For those placement kinds of cases, the majority of the for-profits that we have, we have to do a lot more work on putting some performance standards into our contracts and encouraging them to do subcontracting.
And I would submit that encouraging doesn't get us there. Doesn't get us there. If there's not a hammer and a stipulation, if you don't do A, then XYZ will not happen, they have no reason to move the needle, because they're not committed to 358 4/7/10 - WHOLE - BILL 100115, etc. this the way they should be receiving taxpayers' dollars. So I guess the ask is, come up with -- work with the Law Department to come up with stronger language so that they understand that this is the Mayor's and City Council's expectation. (Witness approached witness table.)
Don Schwarz, Deputy Mayor for Health and Opportunity. I don't want to interrupt the conversation. I just want to point out -- because Behavioral Health was cited, they report to me, DHS reports to me and so forth -- a difference here that I want to make clear.
And something that we all have to be conscious of. So for DHS, unlike DBH, the majority of the provider agencies that are for-profit here for the largest contracts are agencies that have a choice to do 359 4/7/10 - WHOLE - BILL 100115, etc. business with the City and take our kids or not. And we have a lot of difficulty. I've actually been in press since I've been in my role reviewing cases with DHS the number of agencies that don't take Philadelphia kids. Even though they're contracted with us, they don't take kids, and they cite a thousand reasons. So I agree with you --
Can I just do a footnote to that question? So they're being granted a DHS contract and they're opting not to take Philly children? Is that what I'm hearing?
In some cases, that is correct. Part of the answer to your question of can we put this in our contracts is absolutely. Can we hold providers to their behavior? We can. The delicate balance here is at some point if a contractor says to us we're just not going to do business with the City of Philadelphia, that becomes a 360 4/7/10 - WHOLE - BILL 100115, etc. problem because of the number of children who at times are placed particularly by the court, and we lack discretion in those cases. We don't have a lot we can do about that. And if a provider says, Well, you have that in your contract, I'm not going to do business with you, DHS is caught in the middle and doesn't really have a lot it can do. So I understand. I think we will do it. We've actually talked to OEO about can we jointly come up with the right language, particularly for non-profit, for-profit subcontractors.
The Chair recognizes Councilman Goode for a point of information.
Because I want to follow up with -- I get that and understand that. Then there's a role here for Judge Kevin Dougherty or his designee to help these agencies understand we will not refer if we have -- presuming we have options and other alternative like placements, then they have -- "they," the court, Judge Kevin Dougherty or his designee -- have to help us with the hammer. COMMISSIONER AMBROSE: And Judge Dougherty and I had a conversation about this as I was preparing for the testimony. He understands it. I think he agrees and he'll be a partner in this. So I expect his support.
-- remember that many of these entities are licensed by the State and they take kids from all 362 4/7/10 - WHOLE - BILL 100115, etc. over the State of Pennsylvania, as well as in many cases other places. So can they do business without Philadelphia? (Councilwoman Tasco talking without microphone.)
Well, for some providers, that's true. We have the -- it's a complex question because of the kid who is special from Philadelphia, and those kids frequently don't have a lot of options.
Are they the greatest proportion of kids in the particular entities that you do special care? They're not. And those are the agencies where I'm concerned we'll have a problem. Can we do it with the agencies where 75 percent of the kids come from Philadelphia? We absolutely can. Can we do it with the agencies where not 75 percent? We have to figure that out. What I want is a standard in all of our 363 4/7/10 - WHOLE - BILL 100115, etc. contracts.
In all of our contracts. The Councilman has been and you have been clear that in our non-profit contracts, non-profit subcontracts with for-profits should be held accountable.
You've also been clear -- we hear you -- that in our for-profit contracting, if there are for-profit subcontracts, we have to be clear. So the language in the contracts that we use needs work. We are going to in this year and actually very quickly work with OEO on can we agree -- and I think we can easily agree -- on language. We'll get that into our contracts for July. We have to talk to all of our contractors so they understand and we figure out how we can hold them accountable. One of them is reporting, 364 4/7/10 - WHOLE - BILL 100115, etc. which you heard from Mr. Cronauer. We will do that. And a year from now I am hoping, one, we have more data than we do and, two, we have different participation rates so that it does change behavior. Where we are going to have an issue is the issue for DHS when there isn't much discretion, and I want to be clear for the record about that.
And by "discretion," you mean options of like placements. I truly get that, having worked in that area.
For -- good. (Councilwoman Tasco talking without microphone.)
Thank you, 365 4/7/10 - WHOLE - BILL 100115, etc. Madam President. Two comments. One, Dr. Schwarz, you said that if you were to pursue this matter as we suggest, that you would end up stuck in the middle.
Before you answer that question, let me make my second point. We're actually stuck in the middle.
As I came to this Council, 95 percent of City contract dollars were going to businesses owned by white men.
For the last few years, 82 percent of City contract dollars are going to businesses owned by white men. The Mayor's goal in reverse is to have 75 percent of contract dollars go to businesses owned by white men. You're not stuck in the middle. We're stuck in the middle. That's unacceptable. A lot of what you do, whether it's good work or not in terms of health and human services, is tied to poverty, is tied to economic starvation, is tied to a number of things that in part will be solved by people being stuck in the middle and doing the right thing. So do you want to be stuck in the middle or not?
You're welcome. 367 4/7/10 - WHOLE - BILL 100115, etc. Councilwoman Brown, your light is on.
Yes. I have many more questions, but my opening question and comment was around this grid that we keep here on what department goals are.
Okay. Thank you, Madam President. Discuss with us or share with us what is the RFP process for the 231 providers. Just stipulate what happens. You release an RFP -- no. You got to do the homework first and the crafting of the language, the text, and then what? COMMISSIONER AMBROSE: Correct. What we try to do is research what the need is, look at what the best practice standards are, what the evidence shows us works, put all of those requirements in the RFP. We use the e-contracting process. We then select a group of sort 368 4/7/10 - WHOLE - BILL 100115, etc. of experts within the agency that don't have any conflict with who might be selected. We usually try to make those teams not know who is reading the RFPs so that there's a level of confidentiality involved in the selection process. We consider performance. So we look at how the agency, if they've previously done business with DHS, how they've performed on our --
Their track record? COMMISSIONER AMBROSE: Correct. And we evaluate them fairly. We usually ask them -- a new step that we put in the process last year is, we ask them to come in and do a presentation for us, because sometimes what you write in a response to an RFP doesn't necessarily translate into good services. You can hire somebody to write a response.
Exactly right. COMMISSIONER AMBROSE: And so 369 4/7/10 - WHOLE - BILL 100115, etc. we want to hear from them what they believe is the best service delivery system that they can provide to kids and families that are serviced by DHS. That has been a really great addition to our process. In some instances we pull in additional folks. So when we did the Achieving Independence Center RFP, we brought in a young person who received services from the Center to help with the selection process.
And then you make your determination of the awardees, do the release letter, they receive the grant. What happens on the back end? It's a year later, time for renewal possibly. What happens then? COMMISSIONER AMBROSE: Then we look at performance. In the interim, there may be issues that come to our attention through our Provider Relations and Evaluation of Programs Unit. If we get complaints from social workers, if we 370 4/7/10 - WHOLE - BILL 100115, etc. get complaints from families about service delivery, all of those complaints are investigated. The court sometimes is part of the selection process based on what they see, and then we either reissue the RFP or renew it depending on what the guidelines are.
I've worked for the Youth Services Coordinating Office. I was actually in the evaluation unit where I had to go into the trenches and look at programs and take the proposal and look to see if they were in compliance, for lack of a better word. So is that function still real or possible where professionals from DHS hit the trench? COMMISSIONER AMBROSE: Yes. That's the unit we talked about, the program -- the PREP Unit. We have program analysts who go out and every six months they go through a tool that we have that looks at program standards, compliance with State regulations, 371 4/7/10 - WHOLE - BILL 100115, etc. documentation of service delivery, interviews with children and families receiving services, and all of those things are evaluated in their performance and they get a report. We go over the report with them. Sometimes there are areas of concerns. Sometimes they have to write a plan of correction based on our findings. But that's something that we've spent a lot of time working on since the death of Danieal Kelly, since obviously there were many concerns about how we monitored our programs.
Can one assume then that that process you just described is one of the reforms that came out of the Child Welfare Review Panel? COMMISSIONER AMBROSE: That's correct.
In FY11 there were several decreases projected for Lutheran Children and Family Services, Presbyterian Children's Village, Turning Point for Children and 372 4/7/10 - WHOLE - BILL 100115, etc. Youth Services. Might there be a particular reason for the decrease in those, separate from program operations or program delivery of service not being up to -- COMMISSIONER AMBROSE: Yeah. Actually, that's a good thing for kids, because fewer children are going into placement, and that's where those reductions are coming from.
That's a good signal. Okay. New Education Support Center that will track the educational progress of students in DHS care. Again to put this in context, another one of Mayor Nutter's pledges, if you will, coming into office was to look to see how we could deal with the dropout rate. And we know that by sixth grade, if they aren't reading, chances are we're going 373 4/7/10 - WHOLE - BILL 100115, etc. to lose them. Truancy signals start to go up. So speak to the relationship with the School District, what's in place to tighten the connectors there, because the two are linked. COMMISSIONER AMBROSE: Hugely linked. I mean, this has been one of the most exciting things I think that we've done at DHS. We recognize -- and Cynthia Figueroa, Deputy Commissioner for Prevention Services, Lisa Rodriguez, who is our Director of the Education Support Center, are both here, but what we realized early on is that we finally had I think a Superintendent who cares about our kids in the way that we've been waiting for someone to care about our kids for a long time. And so we had an opportunity and we've spent the last 18 months working very closely with her leadership team around these issues, with the assistance of Lori Shorr from the Mayor's Office of Education. We've recently, actually two 374 4/7/10 - WHOLE - BILL 100115, etc. weeks ago, we had a meeting where we pulled together the leadership of DHS and the leadership of the School District and we sat for about three hours putting them in their geographic regions, having real conversations about how are we all going to be partners here. So many things have resulted. We have a Memorandum of Understanding around data sharing, so we're now able to talk about kids in a real way and --
Bravo. That took about ten years. That's a good thing. COMMISSIONER AMBROSE: Well, Dr. Schwarz was --
At least the needle has been moved now. COMMISSIONER AMBROSE: That's right. And so the Education Support Center is a real understanding of DHS, is that the place that we're really going to make a difference for kids is where they're all supposed to be, which is 375 4/7/10 - WHOLE - BILL 100115, etc. school. And if we have better partners with our educators, we're going to make a huge difference in preventing them from coming deeper into the system. And so Lisa -- we're starting with a pilot program. Lisa is working with one of our ongoing service regions, and we're just working with a Regional Superintendent. The cooperation from the School District has been terrific. This meeting that we had with the two leadership teams coming together was a really amazing experience. They want to talk to each other. They want to talk about these kids. They're both frustrated by the lack of communication and collaboration. And so we're very excited about what this might bring for outcomes for kids.
You should be. I know it did take hard work, because I remember three or four years ago grappling with the issues of confidentiality and the different types of information those two worlds have to 376 4/7/10 - WHOLE - BILL 100115, etc. keep. So to have overcome that hurdle is huge. So I commend you for that. I think, Madam President -- this is a small item. I notice the change in the title of Social Worker Trainee positions open at DHS to Social Worker Trainee -- no; Social Services Trainee? COMMISSIONER AMBROSE: This is a source of frustration for us at DHS. There was actually a legislative change that we weren't part of and didn't know about, and it impacted Philadelphia only, because in other counties the civil service system calls their workers case workers. In Philadelphia our workers are proud to be called social workers. I did engage in a bit of a battle with the assistance of Rita Urwitz from District Council 47, but ultimately we had to comply with the law. And so we came up with a title that we thought worked best, and we're trying to make the best of it.
Okay. All 377 4/7/10 - WHOLE - BILL 100115, etc. right, then. Well, thank you all for your testimony. Thank you for the progress. COMMISSIONER AMBROSE: Thank you.
You're welcome. Any other questions? (No response.)
Seeing none, thank you very much. Thank you. The Committee will stand in recess until Monday, April the 12th at 10 o'clock. Thank you. (Committee of the Whole recessed at 6:00 p.m.) 378 CERTIFICATE I HEREBY CERTIFY that the proceedings, evidence and objections are contained fully and accurately in the stenographic notes taken by me upon the foregoing matter on April 7, 2010, and that this is a true and correct transcript of same. ______________________________ MICHELE L. MURPHY RPR-Notary Public (The foregoing certification of this transcript does not apply to any reproduction of the same by any means, unless under the direct control and/or supervision of the certifying reporter.)