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.