COUNCIL OF THE CITY OF PHILADELPHIA2 COMMITTEE OF THE WHOLE - - - Room 400, City Hall4 Philadelphia, Pennsylvania Wednesday, April 20, 2011, 10:27 a.m.5 - - - RES. 110161 - Five-Year Plan7 BILL 110135 - Capital Program 2012 through 20178 BILL 110136 - FY 2012 Capital Budget9 BILL 110137 - FY 2012 Operating Budget10 BILL 110138 - Wage Tax Bill11 12 COMMITTEE MEMBERS PRESENT: 13 Anna C. Verna, Chair Marian B. Tasco, Co-Chair14 Jannie C. Blackwell Blondell Reynolds-Brown15 W. Wilson Goode, Jr. Bill Green16 James F. Kenney Frank Rizzo17 Maria Quiñones-Sanchez 18 - - - 19 20 21 22 23 24 25 2 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Good2 morning. This is a continued public3 hearing of the Committee of the Whole.4 I would ask Mr. McPherson to5 please read the titles of the resolution6 and the bills.7 MR. McPHERSON: This is a8 continuation of the hearing for:9 Resolution 110161, the City's10 Five-Year Plan;11 Bill No. 110135, the Capital12 Program for 2012 through 2017;13 Bill No. 110136, the Capital14 Budget for 2012;15 Bill No. 110137, the Operating16 Budget for Fiscal 2012;17 And Bill No. 110138, the wage18 tax.19 Today we're continuing20 testimony on Bill No. 110137, the21 Operating Budget for Fiscal 2012.22 And the first department is23 Behavioral Health.24 (Witness comes forward.)25 3 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Good2 morning. Please identify yourself for3 the record and proceed with your4 testimony.5
Okay. Good6 morning. I'm Dr. Arthur C. Evans, Jr.,7 Commissioner for the Philadelphia8 Department of Behavioral and Intellectual9 Disability Services.10 COUNCIL PRESIDENT VERNA:11 Please proceed.12
Sure. Good13 morning, Council President Verna and14 members of Council. My name is15 Dr. Arthur C. 11 COMM. 11 COMM. S. Senator Barbara6 Mikulski introduced legislation that7 would bar the use of the word in8 government offices. 17 We work with consumers,18 families, and providers to ensure that19 services are accessible, effective,20 appropriate, and of high quality. 11 COMM. OF THE WHOLE - BILL 1101371 disparities. 18 In FY '11, DBH/IDS has19 continued its efforts to address20 behavioral health and intellectual21 disability needs of Philadelphia22 citizens. Key activities supporting23 these efforts include:24 1. 11 COMM. 6 2. 12 3. In the fall of 2010, IDS13 convened a strategic planning process to14 enhance its commitment to the employment15 of individuals with intellectual16 disabilities. 20 4. 11 COMM. OF THE WHOLE - BILL 1101371 communities. 4 And 5. The continuation of5 crisis intervention training to assist6 police officers in interacting with7 people impacted by serious behavioral8 health challenges. 18 Examples of our efforts include the19 following:20 1. The reduction of21 out-of-state placements. The residential22 reduction initiative involves bringing23 youth back to their communities from24 out-of-state placements. 11 COMM. OF THE WHOLE - BILL 1101371 DBH/IDS has worked to reduce the number2 of out-of-state placements from 1513 children to 28 children; that is a 814 percent decrease. 17 Secondly, securing federal18 grants. Over the course of the last19 year, DBH/IDS has secured a number of20 state and federal grants that will become21 fully operational during FY '12. 11 COMM. 13 The Veterans Jail Diversion14 Project is a four-year, $576,000 grant15 from the Commonwealth, which will16 integrate veterans' issues into the17 crisis intervention training I mentioned18 earlier. 11 COMM. 7 3. Early intervention. 11 COMM. 4. 11 COMM. 3 And 5. Evidence-based4 practice. The use of evidence-based and5 promising practices is being expanded to6 maximize the effectiveness of the7 behavioral health and intellectual8 disabilities services. Examples include9 the following:10 Cognitive therapy. Cognitive11 therapy has voluminous empirical support12 as a highly effective treatment. 17 Philadelphia's employment of18 cognitive therapy is expected to19 constitute one of the first large-scale20 implementations of an evidence-based21 psychotherapy in a public mental health22 system. 11 COMM. OF THE WHOLE - BILL 1101371 Wellness recovery action plans2 is another evidence-based tool developed3 by Mary Ellen Copeland, which has proven4 to be highly effective in promoting5 personal recovery. These are self-6 directed and self-implemented tools that7 enable people to proactively manage their8 mental illness. 12 Trauma training is being13 initiated in response to research that14 shows that over 90 percent of people with15 mental health and/or addiction challenges16 have experienced at least one traumatic17 event in their lifetime. 11 COMM. 5 And 6. Enhancing minority-,6 women-, and disabled-owned business7 participation. DBH/IDS continues to be8 committed to serving the Administration's9 goal of minority-, woman-, and10 disabled-owned businesses. It should be11 noted that the majority of the DBH/IDS12 are with not-for-profit providers and,13 therefore, cannot be officially14 classified as minority-, women-, or15 disabled-owned. DBH's efforts to date16 include the following:17 First, continuing support of18 the Office of Economic Opportunity's19 efforts to build supplier diversity20 programs within the not-for-profit21 sector. 11 COMM. OF THE WHOLE - BILL 1101371 policies. 4 Secondly, the department has5 surveyed the board composition of all of6 our nonprofit providers. Based on the7 most current information, 25 percent of8 all DBH/IDS nonprofit providers had more9 than 50 percent of their board consisting10 of minorities and/or females.
13 And then, thirdly, continued14 support of our minority, women, and15 disabled providers through community16 behavioral health. CBH contract17 providers with minority and female18 executive leadership account for 73 of19 our 208 contract providers. 11 COMM. 3 And, finally, the current4 economic conditions at the state and5 federal levels continue to challenge6 efforts to provide essential services to7 individuals who are uninsured or8 underinsured. 19 We appreciate Council's20 historical efforts to advocate for21 sustaining funding and are willing to22 partner with you in these ongoing23 efforts. 11 COMM. 4
Thank5 you very much.6 Dr. Evans, you are requesting7 $919 million in FY 2012 for Health8 Choices Behavioral Health Program. Will9 you explain for the record, please, the10 funding source for these funds and the11 various per-month type of service fees12 that you receive.13
I got the first14 part of the question; I didn't get quite15 the last part. You said something about16 fees? I'm not quite -- could you repeat17 that part? I'm sorry.18 COUNCIL PRESIDENT VERNA:19 Certainly. Will you explain for the20 record the funding source for these funds21 and the various per-month, per-member --22
Per-member,23 per-month.24 COUNCIL PRESIDENT VERNA:25 19 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Per-member, per month --2
Sure. The Health7 Choices Program is a contract that the8 City has with the State of Pennsylvania9 to provide all of the behavioral10 health-care services for individuals who11 have medical assistance who live in the12 City.13 That -- the latest numbers are14 about 440,000 people in Philadelphia have15 medical assistance. The City is16 capitated for that entire population.17 And so, we get paid a per-member,18 per-month fee for each person who is19 Medicaid-eligible.20 That -- the actual rates vary21 from a low of anywhere of $31 per member22 per month to as high as over $500,23 depending on the category of aid that the24 person is in. And so, people who are25 20 4.20.11 COMM. OF THE WHOLE - BILL 1101371 more disabled, we get paid a higher rate2 for.3 So the revenue that we generate4 and we're projecting to generate is based5 on the number of people that we have in6 each category of aid and the rate for7 that category.8 And so, when we look at the9 projections of where we think Medicaid10 enrollment will be, what our per-member,11 per-month fee is, we're able to then12 determine what our revenue will be for13 the year.14
For FY -- the20 Health Choices Program is on a calendar21 year, not a fiscal year.22 And in the current fiscal year,23 which began January 1, the fees have been24 set through the end of December of this25 21 4.20.11 COMM. OF THE WHOLE - BILL 1101371 year.2
Do3 you estimate that your reserves will4 increase in 2012?5
In 2012, they will6 most likely increase.7 We have two types of8 contractual reserves. One is an equity9 reserve, which is 5 percent of our10 capitated revenue. And so, this year,11 that will be around $850 million we12 anticipate in terms of capitated revenue.13 And so, we will be required to have in14 reserve about 5 percent of that amount.15 The other reserve account that16 we have to have, per the contract, is a17 risk and contingency reserve, and that's18 based on medical expenses for the year.19 And it's a range of between 45 and 6020 days of medical expenses; a day is about21 $1.8 million. And so, our revenue would22 be between 45 to 60 days of 1.8.23
In24 the event that the federal and state25 22 4.20.11 COMM. OF THE WHOLE - BILL 1101371 governments reduce its funding support to2 the level that you are no longer covering3 your costs, what happens?4
Well, at that5 point, the City can always get out of the6 Health Choices contract. We have a7 120-day clause, and if we ever felt that8 we were in a position where we didn't9 have the -- have adequate funding, the10 City could always choose to get out of11 the contract.12 However, the reason that the13 contract requires us to have reserves is14 in the event that in any given year, if15 we were to go over the revenue that we16 had, we would have reserves to cover17 that.18 And so, our revenues again19 right now are $140 million? Or $16020 million? So it would have to be a pretty21 catastrophic problem for us not to be22 able to cover any given year's medical23 expenses.24
Thank25 23 4.20.11 COMM. OF THE WHOLE - BILL 1101371 you, Doctor.2 The Chair recognizes Councilman3 Goode.4
Oh,7 I'm sorry. We have a number of8 Councilmembers that want to be9 recognized. So for the first go-around10 today, each Councilmember will be given11 five minutes.12
Thank you,13 Madam President.14 Good morning, Dr. Evans.15
What's the18 largest contract that you will award in19 Fiscal '12?20
Since the beginning7 of the contract with the Commonwealth.8 If you are interested in the9 provider, you know, CBH is a City-created10 entity. If we are looking at for-profit11 providers, the largest contract would be12 with an organization --13
Or nonprofit. It19 would be -- if it's a City contract, it20 would be Resources for Human Development.21
A little over24 $6 million.25 25 4.20.11 COMM. OF THE WHOLE - BILL 1101371
It's a contract4 that includes a variety of different5 services. And over the years, they've6 done a variety of different service,7 residential service, other kinds of8 behavioral health services. So it's not9 one -- sort of one contract, per se.10
That contract -- or17 those services have -- most of the18 services, I should say, that they have19 provided are not services that we bid out20 because they've been for-profit, not-for21 profit residential services --22
So they will23 be required to submit a supplier24 diversity plan?25 26 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Okay. Are3 they currently compliant with the City's4 living-wage-and-benefits standard?5
Okay.13 That's all I have.14 Thank you, Madam President.15
Thank16 you.17 The Chair recognizes Councilman18 Green.19
First of24 all, I want to say really I want to25 27 4.20.11 COMM. OF THE WHOLE - BILL 1101371 commend you and your department and your2 staff on tremendous testimony on the way3 you run your department.4 The detail that is available5 with respect to specific outcomes in all6 of what you do, or almost all of what you7 do, it is, I think, a model that every8 single department should follow. There9 are metrics by which people can judge how10 successful they've been compared to11 goals. And you've been doing that for12 years.13 And, you know, I think you are14 the model for outcome and program-based15 budgeting that we need to spread to the16 rest of city government.17 So I just want to commend you18 on, you know, the work that you19 continue -- the good work that you and20 your staff continue to do in that regard.21
You24 testified about the department's25 28 4.20.11 COMM. OF THE WHOLE - BILL 1101371 data-driven approach, the commitment of2 you and your team to using data to access3 performance and strive for continuous4 improvement. It's impressive.5 I understand that DBH has a6 series of system metrics, both7 programmatic and financial, that it uses8 to assess the department's performance.9 What process did you use to develop these10 metrics?11
Okay, thank you.12 The process has evolved over13 several years. It's led by Dr. Kathy14 Bolton, who is in the audience, but we15 have a team of whom who work with her.16 The primary purpose -- the17 primary way that we figure out what we18 want to look at is based on our system19 goals. You know, I talked a lot about20 recovery in my testimony. Our goal is to21 help as many people as possible get into22 long-term recovery, and that includes23 individuals who have serious mental24 illness or people who have addictions.25 29 4.20.11 COMM. OF THE WHOLE - BILL 1101371 And so, the measures that we2 look at are derived from what we believe3 are good indicators of people making4 those kinds of gains.5 We look at at least three6 levels, what we call three levels of7 analysis. We try to look at systems8 indicators that show our people at -- if9 we look at the system as a whole, our10 people moving towards recovery, are they11 sustaining the gains that they make in12 acute treatment, are they doing better.13 The second level that we look14 at is at the program or provider level,15 and we do a variety of things at that16 level, including provider profiling so17 that we can determine who are the18 providers who are doing a good job and19 who are the providers who are not doing a20 good job in those areas.21 And then we try to look at the22 individual level, at specific cohorts,23 and how they're doing. And so, we look24 at, for example, how are individuals who25 30 4.20.11 COMM. OF THE WHOLE - BILL 1101371 are homeless in our system doing; or how2 are kids in residential treatment doing.3 And so we try to look at all4 three of those levels to determine both5 how we're doing as a system in managing6 the system, but how are providers doing7 in terms of meeting those goals.8
And within9 that, how do you choose the performance10 metric to determine whether or not a11 child is being successful or a provider12 is being successful -- or is it -- you've13 looked at data and outcomes over years in14 terms of what has worked, and then you're15 driving providers towards using that16 practice, and then, you know, measuring17 the outcome of, you know --18
That's10 both empirically determined and11 theoretically determined.12 So we -- for example, to get13 concrete, one of the things that we think14 is really important -- when we look at15 the literature and when we look at our16 own data, one of the things that we know17 that happens in the system is that people18 tend to use the most acute parts of the19 system, and there are a cohort of people20 that use those systems over and over.21 So if you look at our22 recidivism rate, our recidivism rate and23 inpatient psychiatric hospitalizations is24 about 15 percent. We think that that25 32 4.20.11 COMM. OF THE WHOLE - BILL 1101371 number should be at around 10 percent.2 And despite a lot of things that we've3 done, we've not been able to drive that4 number down appreciably.5 So one of the things we start6 to look at are things that we think are7 correlates of performance that would get8 that number down.9 So one of the things that we10 know is that providers who make sure that11 individuals are connected to the next12 level of care tend to have lower13 recidivism rates. And so, that's one of14 the things we now track.15 (Timer bell rings.)16
We also know that17 providers who make sure that they do a18 good job of discharge planning are also19 going to have lower recidivism rates.20 And so, once we've identified21 sort of the problem area in our22 department or in the system, we then try23 to go back and look at what are the24 things we think or correlates of that and25 33 4.20.11 COMM. OF THE WHOLE - BILL 1101371 begin to measure those and then to tie2 performance to those indicators that we3 think are related to the outcome that4 we're trying to get.5
Thank you,6 Doctor. I have more questions but my7 time is up.8
The11 Chair recognizes Councilwoman Blackwell.12
Thank13 you, Madam President.14 We have so many issues. I15 won't ask any now. I will say thank you16 to Mr. Evans. If I have any questions17 about anything in the City, I call him;18 he always comes up with a answer.19 But we thank you for your20 commitment to our city and for all you21 do, and thank you for personally for22 answering all of my questions about23 government.24 (Laughter.)25 34 4.20.11 COMM. OF THE WHOLE - BILL 1101371
You're certainly2 welcome, although I don't know how good a3 job I do, but I appreciate the sentiment.4
Thank5 you.6 Thank you, Madam President7 Madam President.8 COUNCIL PRESIDENT VERNA:9 You're welcome.10 The Chair recognizes11 Councilwoman Sanchez.12
Good13 morning. Thank you.14 Thank you, Dr. Evans.15
This is17 going to sound like a parade of18 everybody's congratulating Dr. Evans.19 But in my case, I do want to echo -- I20 inherited some challenging situations in21 my district, and I want to thank you and22 your department for always being there to23 work through the challenges of how --24 what do we do with folks in recovery and25 35 4.20.11 COMM. OF THE WHOLE - BILL 1101371 how do we make sure they get integrated2 back into their own neighborhoods and3 that they get service. So I greatly want4 to say that I appreciate your willingness5 to work with me through all of those,6 from prevention point to our recovery7 house situation.8 Last year, when we talked, we9 talked about figuring out ways in how we10 get our stakeholders, our providers to11 work better with us and their clients in12 the neighborhoods, and one of the things13 that I had requested from the department14 was, could we get our providers to be15 more engaged in providing house visits or16 home visits, particularly in places that17 we understand recovery houses and18 recovery support is provided in19 neighborhoods.20 Can you update me on that?21
Sure. The issue22 that you brought up was that there are a23 number of recovery houses around the City24 that don't necessarily do a good job, and25 36 4.20.11 COMM. OF THE WHOLE - BILL 1101371 the thing that we pointed out last year2 was that of the 200 -- we estimate there3 are over 200 recovery houses in the4 City -- about 20 of those are funded by5 the department and we have direct control6 over and oversight.7 For those 20 that we do provide8 direct oversight over, you know, we don't9 get complaints; they are viewed as good10 neighbors and so forth.11 The issue you raise are the12 others that we don't have under our13 control and how do we get those providers14 to really adhere to the standards that we15 have for the other providers. And one of16 the things you suggested was whether our17 providers who provide service and have18 clients who live in those recovery houses19 could do more to try to encourage those20 not-so-good recovery houses to do better21 the.22 I got the issue, right?23
So there've been a25 37 4.20.11 COMM. OF THE WHOLE - BILL 1101371 number of things that we have tried to do2 to increase our footprint within the3 recovery house world. So one of the4 things -- and I think we mentioned this5 last year -- is that even though there6 are providers who we have really no7 control over, we've asked them to8 voluntarily adhere to our standards.9 And so, we've had -- initially10 we got 35 providers to do that. And so,11 those providers are adhering to the same12 standards as the providers that we13 directly fund.14 In terms of providers doing15 site visits, we didn't go to the point of16 requiring them to do that, but we have17 encouraged providers to do that. And I18 think that that has helped because I19 think more providers have voluntarily20 stepped up to adopt our standards because21 of that.22 The thing that has happened in23 the last year that I think has been --24 that will really make a big impact is25 38 4.20.11 COMM. OF THE WHOLE - BILL 1101371 that we received a federal grant that2 allows us to fund additional recovery3 houses. We won't be able to give them a4 grant, but if a person needs a recovery5 house, we can give them a voucher and6 they can attend the recovery house.7 Obviously, all of those providers now8 have to, if they want to have that source9 of income, will have to adhere to our10 standards.11 So I think that it is, you12 know, realistic that we will easily, in13 the next year, again, increase our14 footprint in terms of the number of15 providers who are adhering to those16 standards. Already we have at least five17 or six that have taken on our standards18 because of that. And we're just19 starting; we're only a couple of months20 into the grant.21
What's22 value of the voucher? What is -- how is23 that going to work?24
It's $31 a day.25 39 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Okay.5 So someone will be able to pay...6 In addition to this oversight,7 because now you have a voucher and people8 get involved, or hopefully will get more9 involved, is there anything else that you10 think we need to be doing in terms of how11 we communicate with our community, that12 we should be doing?13
Well, I think if --14 and I do appreciate your work and15 willingness to work with us around some16 of these issues. I would say two things.17 One is if there are providers18 who are problematic, for whatever reason,19 to call our office. And, again, even20 though we don't have the authority to21 make providers do things, we do have some22 influence.23 (Timer bell rings.)24
And so, we have no25 40 4.20.11 COMM. OF THE WHOLE - BILL 1101371 problem in stepping into those2 situations.3 The other thing is that on a4 national level, there is a move to create5 national standards for recovery houses6 and create actually a network of recovery7 houses so that there will be some peer8 review of what people are doing. We are9 encouraging, and, in fact, there's some10 organizing in Philadelphia to do that.11 We think that that will help12 because it will create essentially a peer13 group of people who are really trying to14 do the right thing and to be neighbors.15 And so, if there are recovery houses in16 your community that you think could17 benefit from that, we could certainly18 connect them to that group.19
Yeah. I20 mean, one of the results of all the21 attention that has been paid is that the22 good guys have stepped up, and at least,23 in Frankford and West Kensington, they24 have started a coalition that's being25 41 4.20.11 COMM. OF THE WHOLE - BILL 1101371 more aggressive on the ground in terms of2 cleanups and showing and demonstrating to3 the community that they're better4 members. So we've seen that immediately.5
And7 that's good and that's a result of our8 town halls, our annual town halls, and I9 look forward to next year having even10 more progress.11
You16 know, and when we call them, they're17 there, and they're really helping us with18 our parks --19
-- and21 just showing neighbors in the22 neighborhood that they want to be there.23
So I25 42 4.20.11 COMM. OF THE WHOLE - BILL 1101371 want to thank you for that. Thank you.2
Thank6 you.7 The Chair recognizes8 Councilwoman Tasco.9
And thank13 you for the good job that you all are14 doing there.15 Under -- and this question may16 have been asked; I've been distracted.17
Under19 Governor Corbett's budget, significant20 cuts have been proposed, the State21 education funding. If cuts are shifted22 from State education funding and State23 behavioral health funding, what areas are24 mostly likely to be impacted by25 43 4.20.11 COMM. OF THE WHOLE - BILL 1101371 reductions?2
I do a lot of3 thinking about that every night,4 Councilwoman.5 I think that it is most likely6 that the State will cut where they have7 cut before, and that is the State-only8 dollars. The Medicaid dollars and the9 Medicaid program is a cost-sharing10 program. So for every dollar that the --11 roughly every dollar the State puts in,12 they get a dollar back from the federal13 government.14
So it doesn't make16 a lot of sense to make deep cuts into the17 funding of Medicaid because of the18 leverage that the State uses to bring in19 additional federal dollars.20 So that means that the most21 likely place are the grants that we give22 to providers to cover the uninsured and23 in what we call the BHSI, Behavioral24 Health Special Initiative, program, which25 44 4.20.11 COMM. OF THE WHOLE - BILL 1101371 has received consistent cuts over the2 last several years. That is a program3 that is a hundred percent State-funded.4 It is for the uninsured.5 It is the -- the irony is that6 as the economy gets worse, that's where7 we have the greatest need, because more8 people lose their jobs, they don't have9 health insurance. And we depend on that10 funding to serve those individuals.11 So it's most likely to be in12 the area of BHSI or community grants that13 we pay our providers to cover the14 uninsured in our community mental health15 centers.16
You talked17 about the providers, not all of them18 being a part of the organization. If19 someone decides to become a provider of20 services, where do they get their funding21 from; is it through Medicaid?22
It is through23 Medicaid. So the primary way that new24 providers come into our system is through25 45 4.20.11 COMM. OF THE WHOLE - BILL 1101371 the CBH network.2
And so, if a4 provider meets the criteria, we5 credential the provider; they would be6 then be paid on a fee-for-services basis7 for the services that they provide.8
But9 otherwise, they're dealing directly with10 what department with the State?11
They would be12 dealing with either other private13 providers if they are seeking public14 funds. And if they are in Philadelphia,15 they would receive those through my16 department, through one of the funding17 streams that we manage and control.18
We talked19 about the reserves, and when we started20 CBH years ago and we knew that we had to21 set up the reserve account, has there22 ever been any effort to remove those23 reserves from you to --24
No. One of the4 things that the State has done is to5 change the reserve requirements.6 So when I took this job, the7 reserve requirements were between 60 and8 90 days of paid claims, and I mentioned9 earlier that our paid claims were about10 $1.8 million a day.11
So,13 you know, do the math. Roughly 1.8 times14 90 would have been the maximum amount15 that we could have had in reserve.16 Over the years, the State has17 sort of played with that as a way of18 getting dollars back into the State19 coffers. And so, they've pushed that20 number down. And so, today our reserve21 requirements are between 45 and 60 days22 of paid claims.23
And so, but they25 47 4.20.11 COMM. OF THE WHOLE - BILL 1101371 wouldn't -- the reason that they wouldn't2 the reserve requirements is that if for3 whatever reason the City decided to get4 out of the business, we would need5 reserves to pay for claims and to pay for6 services that may have been provided as7 we were trying to bring the program down.8
Let me18 underscore the accolades expressed by my19 colleagues. I agree 2,000 percent.20
You've22 mentioned a number of constituencies.23 I'm particularly interested in the24 infant, toddler early-intervention25 48 4.20.11 COMM. OF THE WHOLE - BILL 1101371 program. What type of intervention2 strategies or services are delivered to3 children with developmental delays?4
Sure. So the5 early-intervention program is a program6 that tries to identify developmental7 delays in kids early on and tries to8 intervene.9 And so, depending on what the10 delay is, there are therapies, there are11 interventions that are made. So12 sometimes kids may have speech problems13 or are not developing their speech or14 maybe have hearing difficulties or maybe15 it's a visual difficulty.16 So what happens is, after the17 kids are assessed, screened and assessed,18 a plan is put together. And then, based19 on the kinds of developmental problems20 that they have, there will be either21 speech pathologists or some other22 professional that will work with the23 child to try to ameliorate those24 problems.25 49 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Any2 special focus or emphasis on children3 with developmental delays as a result of4 lead poisoning?5
Not lead poisoning6 per se, but I would imagine that if a7 child has a delay as a result of lead8 performing, they would be picked up in9 that screening process; and, again, they10 would get the same kinds of interventions11 as other kids would whose delays may be12 caused for some other reason.13
Mm-hmm.14 Is there any categorizing of the reasons15 why young people may have a developmental16 delay? Like do you put in a box all of17 those children who have a developmental18 delay because of lead poisoning, and they19 get a certain type of treatment problem?20
I don't think so,21 but the person who would know that agrees22 with me, no. No, no, there's not.23 I think at that age, what24 we're -- you know, whether it's a25 50 4.20.11 COMM. OF THE WHOLE - BILL 1101371 congenital problem or genetic or2 whatever, the issue is, you know, what is3 the delay, and then how do we then4 intervene and treat that.5
But we don't then7 go back and try to find out the etiology8 of the delay and that kind of thing9 necessarily.10
Okay, all11 right. I'll have a separate sidebar12 around this whole lead opining issue.13
'Cause15 we're going to look at that very, very16 closely soon.17 Are diagnosis of developmental18 delays among African-American children19 equal to their proportion of the20 population?21
That, I don't know22 that number. I do know the number and I23 don't know if --24 (Addressing colleague.) Kathy,25 51 4.20.11 COMM. OF THE WHOLE - BILL 1101371 do you know the number? Do you know if2 the proportion diagnostically is equal3 across racial groups?4 (Kathy's response is off-mic5 and, therefore, inaudible to6 stenographer.)7
Okay. So she said8 that she believes there are more male9 children.10 I think that socioeconomic11 status does affect delays. And so, to12 the extent that you have disproportionate13 numbers of people with color in the lower14 socioeconomic status, you would expect15 them to find greater delays in some of16 those populations.17
A lot of24 concern was raised last year around25 52 4.20.11 COMM. OF THE WHOLE - BILL 1101371 out-of-state placements.2
And we see4 here that that's dropped significantly5 from 151 to 28 children last year.6 So under what circumstances now7 are children placed in facilities outside8 the state?9
Yeah. Well, we're10 very proud of the fact that we are11 serving children in Philadelphia in the12 community, and it is only the rare13 instance now that we will have to use a14 facility out-of-state.15 The only time that that happens16 is -- right now is if there is a service17 that is not provided within Pennsylvania18 or the five-county area, that -- where we19 can send a child.20 So it tends to be, for example,21 residential programs for children who22 might be -- who might have a core23 occurring intellectual disability and24 mental health problem.25 53 4.20.11 COMM. OF THE WHOLE - BILL 1101371
So it's those kind3 of really specialized programs that we4 may not have a program for in the City --5
So what8 systemic changes did you make to make it9 clear that in-state placements are the10 priority?11
Okay. So a couple12 of things. One is, as you know, the Blue13 Ribbon Commission that you were a14 co-chair of, one of the things that was15 identified was that we serve too many16 children in residential settings outside17 of the State, which makes it very18 difficult to do family work, it makes the19 transition back to the community very20 difficult.21 We had kids who were doing22 quite well in Texas for two or three23 years and would come back to the City and24 not do so well.25 54 4.20.11 COMM. OF THE WHOLE - BILL 1101371 (Timer bell rings.)2
And so, there were3 several things, starting with the Blue4 Ribbon Commission.5 Secondly, when Commissioner6 Ambrose came on, one of things we agreed7 to, because most of those kids are8 involved in the DHS system, we agreed9 that we would begin shutting off10 residential programs that were out-of-11 state and forcing people to do -- to find12 alternatives.13 And then, thirdly, and I think,14 very importantly, I think Nancy Lucas,15 Kenny Selonka (sp?) at CBH, I think, did16 a really fantastic job of looking at17 alternatives, 'cause this doesn't work18 unless you have community-based19 alternatives.20
And so, there are a22 couple of things that happened. One is23 that we expanded the use of things like24 family functional therapy, evidence-based25 55 4.20.11 COMM. OF THE WHOLE - BILL 1101371 practices that kids could access within2 the City.3 And then the other thing that I4 think has made a huge difference is that5 we created an assertive outreach team, an6 assertive after-care team so that as kids7 were coming out of residential or being8 diverted out of residential, we had9 basically case managers that made sure10 that those kids got connected to local11 services and that those services were12 working.13 So we didn't just refer kids to14 local community services; we made sure15 that those services were working for kids16 and that they were having access.17
Okay.21 Thank you. I'll circle back my next22 chance.23 Thank you, Madam President.24
Thank25 56 4.20.11 COMM. OF THE WHOLE - BILL 1101371 you.2 The Chair recognizes Councilman3 Green.4
Thank you,5 Madam Chair.6 The Five-Year Plan highlighted,7 and you had testified about, DHS's new8 pay-for-performance, approach which is9 designed to enhance service delivery and10 client outcomes. And you and your team11 were kind enough to brief my office on12 this initiative.13 And I wondered if you could,14 for the record, describe how DBH's15 provider profile and pay-for-performance16 model works. The current model uses17 incentive payments to reward high-18 performing providers.19 How does the department plan to20 address low-performing providers either21 in terms of helping them to improve22 services or end their contracts?23
And before25 57 4.20.11 COMM. OF THE WHOLE - BILL 1101371 you answer that question, if you could2 just describe to us how you came up with3 this plan and, you know, how it's worked4 for you so far.5
Sure. So as we9 were discussing a little while earlier,10 one of our major concerns is the -- what11 we think is the excessive recidivism rate12 for people leaving acute in-patient13 hospitalization.14 And so, we identified that as15 one of our primary goals is to reduce16 that because we think it's better care17 for people, and it's certainly more18 efficient and effective care to make sure19 that people are sustaining the gains that20 they make in in-inpatient post-discharge.21 So for our -- for the paid-22 for-performance, I think it was a23 combination of two things that happened.24 One, at the State level, the State was25 58 4.20.11 COMM. OF THE WHOLE - BILL 1101371 encouraging counties to move to pay-for-2 performance. And then, secondly, we had3 these issues where we wanted to make an4 impact, and for as much as we have spent5 a tremendous amount of time and energy6 and training and all those kinds of7 things, we know that the most powerful8 incentive that we can use is money.9 And so, we really wanted to tie10 resources to increased performance to11 shape provider behavior.12 So that's sort of the13 background as to how we got there.14
Did you do15 any kind of return-on-investment analysis16 in determining what the appropriate17 amount of pay-per-performance is, because18 if they achieve that, it was going to19 save even more than you were giving as20 the incentive?21
Sure, yes. It's a22 great question. And the answer to that23 is -- I'll give you an example of the24 benefit.25 59 4.20.11 COMM. OF THE WHOLE - BILL 1101371 So we spent for the entire2 pay-for-performance project last year3 about $3 million. And if you look at the4 levels of care that we use that on,5 that's about 3 percent of what we spent6 on those levels of care. So $3 million7 pay-for-performance.8 We did another analysis that9 looked at recidivism over a three-and-a-10 half year period, and we stratified the11 population in different groups. And so,12 there was one group that had four to nine13 readmissions over a three-and-a-half year14 period.15 We calculated that if we were16 to reduce the number of episodes in the17 people that had four to nine by just one18 episode, it would save the system about19 $18 million.20 So if you look at the impact,21 the potential impact, that this can have,22 it's more than -- do the math -- six23 times potentially just for that one24 cohort. So the cost benefit is pretty25 60 4.20.11 COMM. OF THE WHOLE - BILL 1101371 large.2
Are there3 additional service areas where you think4 you might be able to expand this model,5 and are you looking at that?6
Yes, we are.7 Our goal is to have a8 pay-for-performance strategy for each9 type of service in our system. Last10 year, we did three: We did inpatient11 hospitalization, we did residential drug12 treatment, and we did residential13 children's services.14 This year, we're doing BHRS,15 we're doing targeted case-management.16 We're also going to be doing some17 incentives for outpatient providers.18 Our goal is that by 2013, our19 entire system will have some kind of20 pay-for-performance. Next year I think21 if you added -- did it by revenue, we22 would probably be up to about 75 percent23 of our service system.24
Thank you.25 61 4.20.11 COMM. OF THE WHOLE - BILL 1101371 You testified about some of2 your diversionary -- working with the3 courts on -- mental health courts and4 providing the resources for treatment5 instead of prison, and I know that6 program has just begun.7 But are you or anybody else in8 the system going to measure outcomes in9 terms of recidivism for, you know, on the10 criminal side in addition to outcomes11 sort of on your treatment area of mental12 health?13
Mm-hmm. Yeah,14 we're early on right now, so it's kind of15 hard to do that now.16 (Timer bell rings.)17
For any of these18 kinds of programs that we do, we will do19 some kind of analysis.20 And so we do one of two things:21 Either we do it by ongoing data22 collection and looking at the numbers, as23 I mentioned earlier; or we'll do a small24 study to look at that. So we've done25 62 4.20.11 COMM. OF THE WHOLE - BILL 1101371 that with a variety of services, and2 we'll be doing that with this one.3
Thank you.4 My time's up. I just have a few more5 questions, so I'll come back one more6 time.7
Thank8 you.9 The Chair recognizes10 Councilwoman Brown.11
Persons12 with disabilities, how has the business13 community responded to the work you're14 doing in that area?15
Well, I think -- I16 think two things. One is that when we17 talk about people with severe mental18 illness, for example, we've put a lot of19 emphasis on recovery, on normalizing,20 helping people to have a more normal kind21 of life. A lot of emphasis on what in22 the field is called "community23 inclusion," and I'll just give you an24 example.25 63 4.20.11 COMM. OF THE WHOLE - BILL 1101371 When the State hospitals were2 closed -- and I think this happened3 really around the country -- people were4 deinstitutionalized, they were taken out5 of large state hospitals and brought back6 to communities, but the reality is that7 people were what we call8 "institutionalized within the community."9 They're not really a part of the10 community; they live in segregated living11 situations, they're not really12 interacting.13 And, frankly, the way we had14 structured our treatment system, we15 really contributed to that to some16 extent.17 Over the last several years,18 we've made a concerted effort to look at19 how do we help people become a part of20 the community and not just live in the21 community.22
And so, we've --24 with one program in particular, where25 64 4.20.11 COMM. OF THE WHOLE - BILL 1101371 people were going to those programs2 literally for years, day after day,3 brought to the program by a -- by medical4 transportation, taken home at the end of5 the day, sort of in that pattern for6 literally ten, fifteen years, we7 radically changed those programs so that8 those programs were focused on recovery,9 they were focused on people obtaining10 jobs, getting an education, we taught11 people how to use public transportation.12 And the -- sort of the short13 story here is that not only did we14 improve outcomes, for example, we -- for15 people who went through those programs,16 we saw a 33 percent decrease in crisis17 visits, and we saw -- half of those18 visits would have converted to inpatient19 hospitalization.20 So we know from a system21 standpoint that it's been very effective22 in both saving resources but also in23 improving people's clinical care.24
But the real, I2 think, important part is that it really3 has improved people's quality of life. A4 number of people have gotten jobs,5 they've gone back to school. I think6 we've tried to model the importance of7 hiring people who are in recovery who8 have disabilities.9 And so, we have a number of10 people within our department who are11 people who have had psychiatric12 disabilities or who are in recovery from13 drug addiction.14
And so, I think16 we're getting there, but we have a long17 way to go to really get the larger18 business community to really embrace19 that.20
Mm-hmm.21 So have you had a chance, then, to22 explore strategically how you penetrate23 that community in a real strategic way?24
I heard a really25 66 4.20.11 COMM. OF THE WHOLE - BILL 1101371 interesting presentation a few weeks ago2 in Washington of a group that has done3 just that, and it was led by people who4 are in recovery themselves, who were5 business people themselves, and they had6 done some really interesting things in7 terms of engaging the business community.8 So I think there's some lessons9 learned out there that we want to tap10 into.11
But, you know,14 getting -- you know, breaking through the15 stigma around having behavioral health16 problems is a big challenge. So if you17 can help us with that, we'd appreciate18 it.19
Will23 Philadelphia have a face with the24 national effort to standardize best25 67 4.20.11 COMM. OF THE WHOLE - BILL 1101371 practices for recovery agencies?2
Yes. We are3 actively involved in that. And, in fact,4 Philadelphia and Pennsylvania was one of5 the first actually --6 (Addressing colleague.) Was it7 Philadelphia or was it Pennsylvania that8 first started trying to organize the9 recovery houses?10 UNIDENTIFIED SPEAKER: Well,11 Pennsylvania (inaudible.)12
Pennsylvania?13 Okay. So it was at the state level. So14 there were providing from around the15 State that were trying to do that, and16 our staff are going to be actively17 involved in that effort.18
Okay.19 It's a -- national best practices or20 standards is long overdue.21
My last23 question. Last year, you discussed the24 process of monitoring providers for those25 68 4.20.11 COMM. OF THE WHOLE - BILL 1101371 who were deemed inefficient, mostly2 resulting from duplicative inspectors and3 overlap of duties.4 What steps has the department5 taken to create efficiencies in that way?6
I am pleased to7 report that we've, I think, come a long8 way from last year. We now have what9 we're calling "an integrated monitoring10 team." The issue has been historically,11 because of the categorical nature of12 funding --13 (Timer bell rings.)14
-- each category of15 funding had a different monitoring16 process.17 So if it was Medicaid dollars,18 we had one group of funding; if it was19 State Block Grant dollars, it was another20 group of people.21
And so, a provider23 literally would have five, six different24 people coming out, all from my25 69 4.20.11 COMM. OF THE WHOLE - BILL 1101371 department, sometimes saying different2 things.3
And so, what we've5 moved to do is to put all of those people6 on one team.7
We have started9 that process; we started that process10 back in February as one team. And we're11 working to reduce the amount of time and12 the effort at doing this. And so,13 it's -- you know, it's rough.14
It's -- well, I17 think it's -- I mean, we're in the early18 stages, and I think it's very difficult19 when you have so many different views.20 But I have to give the staff a21 lot of credit. I think people understand22 why it's really important.23
And I think25 70 4.20.11 COMM. OF THE WHOLE - BILL 1101371 providers really appreciate it. They get2 one visit; it's a big visit.3
Just one7 quick story I'll close with.8 Decades ago, I worked for the9 Youth Services Coordinating Office during10 Mayor Rizzo's administrating in the11 Evaluation Unit, evaluating programs12 receiving City dollars, providing13 services to kids, and that was an issue14 then.15
Then, that's right.16 We've been dealing with issue for a long17 time in the field so we're --18
Okay, thank you.25 71 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Thank you2 Madam President.3 COUNCIL PRESIDENT VERNA:4 You're welcome.5 The Chair recognizes Councilman6 Green.7
Thank you,8 Madam Chair.9 Dr. Evans, you testified a10 little bit about crisis intervention11 teams and CIT training, first responders.12 Does that relate to the intercept program13 at all --14
Sure. So the21 intercept model basically is a model that22 was developed by Dr. Patty Griffith, who23 actually works with us, and another24 psychologist.25 72 4.20.11 COMM. OF THE WHOLE - BILL 1101371 And basically what they did2 was, because of the high overlap of3 people who have mental illness who find4 themselves in the criminal justice5 system, they wanted to create a framework6 that would guide how people could7 intervene.8 And so, basically, the9 intercept model is, you try to intercept10 people at various points in the criminal11 justice, starting with police officers12 who come into contact with people, the13 initial hearings that people have through14 people being incarcerated, all the way15 through reentry. And at each one of16 those points, there are a set of17 interventions that you try to implement.18 So what we've done, I think the19 City, over a number of years, I think,20 has quite successfully created21 interventions at each one of those steps.22 One of the last, frankly, that we needed23 to do was sort of the first two24 intercepts, which was law enforcement and25 73 4.20.11 COMM. OF THE WHOLE - BILL 1101371 the initial arraignment portion.2 But that program has been3 enormously successful, we think.4 Commissioner Ramsey and I -- Commissioner5 Ramsey supports the program; in fact, he6 personally comes to the graduation of7 those officers who have gone through the8 training. So he and I do that graduation9 ceremony together, which, I think,10 reflects his commitment to this issue.11 And he believes -- I'm not12 putting words in his mouth -- but he has13 said that he thinks it's really important14 for officers to be able to spot and15 understand when someone's having a mental16 health problem versus someone who's just17 being belligerent or non-cooperative and18 be able to intervene effectively.19
Is that20 program going to move into the Police21 Academy as part of the initial training22 of officers?23
No, the -- we24 already do some mental health training25 74 4.20.11 COMM. OF THE WHOLE - BILL 1101371 for officers within the Police Academy.2 What this is, is a much more extensive --3 it's a one-week long process.4 We have a variety of people5 that come in during that week. And it's6 geared for officers who've already had7 enough of an experience that they can8 actually integrate the training into what9 they do.10
Is the11 intercept model something that is applied12 to juveniles also or in the juvenile13 justice system?14
It is. It's -- we15 primarily thought about it more in terms16 of the adult criminal justice system17 here.18 With juveniles, we work a19 little differently in thinking about20 Family Court and the Youth Study Center21 and those kind of things. So we don't22 quite have the same kind of process that23 we have for adults.24
We've25 75 4.20.11 COMM. OF THE WHOLE - BILL 1101371 developed and we're developing and I2 think we're going to develop broader3 diversionary programs not just related to4 mental health but, you know, substance5 abuse and other things, sentencing people6 to almost community service and other7 things that are -- you know, trying to8 prevent people from going to jail,9 diverting them into useful things, get10 your GED within this, your records11 expunged, et cetera.12 I wonder if there's a model13 that you're aware of from around the14 country that we can -- an intercept-type15 model that we can apply in schools or in16 other places to help people identify17 problems that would allow social services18 to be applied when necessary before19 things get out of control and children20 end up in the juvenile justice system.21 I don't know if you know of22 anything, but you have a great staff, and23 if they see something like that, I'd be24 very interested in it.25 76 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Sure. We can look2 at it.3 I mean, I've actually spent a4 little time looking at that literature5 because of the school-violence issues6 that have come up.7 And there are a number of8 interventions that people have developed:9 school climate kinds of interventions;10 family interventions; interventions11 directed at individuals, whether those12 are individuals who are at risk or more13 universal kinds of applications.14 So there are a number of things15 that are out there that we can -- and, in16 fact, some of those things we're already17 using in the system.18
If your19 staff would be kind enough to forward20 what you think is relevant, I'd21 appreciate it.22
Thank you.24 Thank you, Madam Chair.25 77 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COUNCIL PRESIDENT VERNA:2 You're welcome.3 Are there any other questions4 from members of the committee?5 (No further questions.)6 COUNCIL PRESIDENT VERNA:7 Seeing none, Doctor, thank you very much.8
Thank15 you so much.16 Our next department...17 MR. McPHERSON: Is the Health18 Department.19 (Witnesses come forward.)20
And25 78 4.20.11 COMM. OF THE WHOLE - BILL 1101371 thank you for all the wonderful work that2 you do.3 Please identify yourself for4 the record and proceed with your5 testimony.6
Yes, ma'am. Good7 morning, Council President Verna and8 members of Council. 11 COMM. 2 Of the total Fiscal Year '123 Budget request, about $110 million is in4 the General Fund, a little over a hundred5 million is in the Grants Fund, and6 $145 million is in the Acute Care7 Hospital Assessment Fund. 10 The Fiscal Year '12 General11 Fund Budget represents a decrease of12 $3. 3 million from Fiscal Year '1113 estimated obligations. 11 COMM. 15 The City's eight health centers16 provided about 350,000 patient visits in17 Fiscal Year 2010, including18 comprehensive, primary care, prenatal19 care, dental care, family planning,20 podiatry, and specialty care to a little21 over 90,000 patients. 11 COMM. 13 For pediatric patients, the waiting times14 have gone down, though, from 3 days from15 an initial visit in March of 2010 to one16 day in March 2011. 18 We continue to provide care19 several evenings each week. At our20 busiest centers, we provide Saturday21 hours. 11 COMM. OF THE WHOLE - BILL 1101371 waiting time. 9 First-party collection of a10 modest fee was implemented in all eight11 health centers in the third quarter of12 Fiscal Year '10. In Fiscal Year '10,13 $150,000 was collected. 11 COMM. 2 The health centers continue to3 work diligently to provide excellent care4 for all those who present, including the5 uninsured, into improved health insurance6 coverage where possible. A few7 achievements:8 Approximately 70 percent of all9 pediatric visits are now made by insured10 patients. 17 We expanded the indigent fee18 drug program, utilizing 16 Americore19 workers to complete applications. 11 COMM. 4 And the AZ & Me Prescription5 Savings Program from AstraZenica provided6 3700 free prescriptions to more 13267 patients. I should point out that for8 each of these patients, we have to9 complete an application, including income10 verification, so the work for our staff11 is considerable. 15 Through pursuing every16 opportunity to improve our collection17 from insurance companies while utilizing18 all programs to cover expenses for the19 uninsured, our unreimbursed obligations20 for ambulatory health services for Fiscal21 Year '12 are estimated at just22 $14 million. 11 COMM. OF THE WHOLE - BILL 1101371 $17 million in 2010, and more than2 $19 million in 2009. 16 Through Get Healthy Philly,17 we're changing the environment to make it18 easier for people to engage in health19 behaviors. 11 COMM. OF THE WHOLE - BILL 1101371 thousands of low-income children. The2 Supper program offers healthy, age-3 appropriate meals, including fruit and4 vegetables, dairy products, and lean5 meats. 11 Through these activities, school wellness12 councils have been created that will13 incorporate physical activity into the14 school day and eliminate junk foods from15 classrooms, fundraisers, and school16 stores. 20 We've worked directly with the21 School District to deliver free breakfast22 to children's classrooms in schools23 eligible to participate in the federal24 school lunch programs. 11 COMM. OF THE WHOLE - BILL 1101371 breakfast carts were purchased and are2 now being used to bring food to3 classrooms in 60 schools. With this4 change, 18 percent more children are now5 eating breakfast in our schools. 9 We've launched multi-media10 campaigns to decrease consumption of11 sugar-sweetened beverages, and increase12 the proportion of those who smoke, who13 try to quit, with assistance. 15 We've launched the first-ever16 nicotine patch giveaway in Philadelphia,17 in partnership with the State of18 Pennsylvania Free Quit Line, 1-800-quit-19 now. Five thousand Philadelphians called20 for free counseling and free one-month21 supplies of nicotine patches. Usually22 only two to three Philadelphians call the23 quit line. 11 COMM. OF THE WHOLE - BILL 1101371 We've mapped so-called "food2 deserts" in Philadelphia for the first3 time ever. These are areas where people4 have poor access to fresh produce.
From5 these maps, we have recruited nearly 5006 corner stores into our new Healthy Corner7 Store Initiative. 13 We've sponsored the first four14 of ten new farmers markets and helped15 farmers markets get equipped to be able16 to accept SNAP, or food stamp benefits,17 in areas with poor access. 11 COMM. 7 This increased the farmers market voucher8 benefit from $20 to $80 for WIC9 participants. 12 With unanimous City Council13 support, fines for merchants that sell14 tobacco products illegally to our youth15 were increased. 11 COMM. OF THE WHOLE - BILL 1101371 have noticed in City Hall and today on2 this floor -- there are about 250 overall3 in the City -- are now giving healthier4 drink choices. 8 The Environmental Health Services9 Division implemented a performance10 management system for food service11 inspections to reduce the time interval12 between inspections. 11 COMM. OF THE WHOLE - BILL 1101371 and the AIDS Activities Coordinating2 Office. As I hope all of you have heard,3 rates of sexually-transmitted infection4 among our youth are too high. 14 We got there first. 17 Our campaign is modeled after18 successful efforts in Washington and New19 York. Through this campaign, we hope to20 encourage our young people to delay the21 onset of their sexual activities, while22 promoting safer sexual practices among23 those who are sexually experienced. 11 COMM. 11 COMM. 6 Electronic health records. The7 department, in concert with the8 Philadelphia Prison System, is9 establishing an innovative electronic10 health record that will support the11 integration of health services. 11 COMM. 11 COMM. OF THE WHOLE - BILL 1101371 received a 96 percent overall rating for2 its health and safety program, as3 evaluated by the Office of Risk4 Management. 22 We are happy to report that the23 Department of Public Health has surpassed24 that goal for Fiscal Year '11. 11 COMM. 12 percent minority participation for our3 for-profit contracts. 313 percent, which still exceeds our goal,14 but we believe that it's a more accurate15 reflection of all City dollars used in16 for-profit contracting. 11 COMM. 4 General Health Care Resources primarily5 provides staffing for pharmaceutical6 services at our health centers and7 nursing services at Riverview. The staff8 working under this contract is 90 percent9 minority and all female. 11 Caremark, LLC, or Procare/CVS,12 is used for pharmaceutical and drug13 services people with HIV. 1 million. 18 Our three largest nonprofit19 contractors are Fairmount Long-Term Care,20 the Public health Management Corporation,21 and the Health Federation of22 Philadelphia. 11 COMM. OF THE WHOLE - BILL 1101371 Home. The Fairmount Long-Term Care board2 is 80 percent minority and 20 percent3 women. 6 million. 7 percent minority and15 three-quarters female. Health Federation16 has a board that's 55 percent minority17 and 64 percent female. Approximately 9018 percent of Health Federation contract19 dollars go to staff. 21 We are proud of the work we22 have done this year to improve public23 health in Philadelphia. 11 COMM. OF THE WHOLE - BILL 1101371 areas. 14 Thank you for the opportunity15 to present testimony today. 17
Thank18 you, Doctor.19 As of December, we're told that20 you had 72 vacancies in your department.21
That is the22 number that is recorded in the budget,23 yes.24
Yes.25 100 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Were you able to fill any of those2 vacancies?3
And5 can you give us a little more information6 --7
-- A,9 on the vacancies, what types of positions10 they were, who you've been able to hire.11
So first, let me16 clarify. As you know from City budgets,17 the number of positions listed is not18 necessarily the number of positions19 funded. That gives departments20 flexibility in times of change.21 So a good example of that, I22 think, is pharmacists. The Department of23 Public Health has eight pharmacists24 listed in our budget, and eight25 101 4.20.11 COMM. OF THE WHOLE - BILL 1101371 pharmacists is the number that we needed2 before we took away over-the-counter3 medications as part of our budget4 reductions during the recession and5 before we brought in all of the new6 vendor -- opportunities for free7 medications that I mentioned in my8 testimony.9 With that, we no longer need10 eight pharmacists at all of our health11 centers, but we have eight in the budget.12 And the reason is that should any of13 those programs go away and demand14 increase during the year, we have the15 flexibility to hire pharmacists.16 At the moment, there are 2017 pharmacists on the City's list, so we18 believe that we could hire pharmacists if19 we need to, and we're working on that20 issue actively.21 But that speaks to the issue of22 what is the number of funded versus23 unfunded positions for the department.24 So we have 72 positions in the budget.25 102 4.20.11 COMM. OF THE WHOLE - BILL 1101371 We had 659 in the increment run that you2 saw people hired.3 If we look at funded positions,4 the actual number of funded positions for5 the Health Department is not the 731 in6 the budget but, rather, 710 based on7 average salaries for workers and the8 average salaries of vacant classes. That9 means that we have 21 unfunded positions10 in the department, or actually 5111 vacancies.12 Fifty-one real vacancies13 translates to about 7.2 percent of our14 workforce. I should point out that in15 the health-care sector in the City of16 Philadelphia, the average for hospital HR17 folks is about 5 percent. Given the18 Civil Service system in Philadelphia and19 the difficulty of hiring, we believe that20 the extra 2.2 percent is reasonable.21 So I actually believe norming22 our HR services, based on performance23 management, that we are actually on24 target for a system that provides health25 103 4.20.11 COMM. OF THE WHOLE - BILL 1101371 care services in Philadelphia.2 But you asked specifically3 about vacancies, and I'm happy to go4 through that in detail with you.5 So, I don't know how it would6 be easiest for you to hear it. I can7 present you with the information. There8 are a lot of vacancies, and I have9 information on each one, and I believe10 that Council received a report on our11 vacancies, or I can go through specific12 ones of interest.13 What would be best?14
I15 don't recall seeing that.16 Do any of the Councilmembers17 have that list?18 Can you just give us the title19 of the positions that are vacant, please?20
Okay. We have:21 One administrative services22 supervisor position.23 One clerical supervisor II24 position.25 104 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Seven clerk typist I positions.2 Five community health3 registered nurses.4 Two community care5 coordinators.6 One health services analyst7 director.8 One social work services9 trainee, which we're using to replace, as10 in the budget, a social worker II.11 Three medical assistants.12 One medical clerk.13 Would you like me to continue?14
Three17 pharmaceutical technicians.18 Six pharmacists at the time of19 the increment run, but I've talked about20 pharmacists.21 One pharmacy manager; that22 position is currently filled.23 Public health administration24 analyst, which replaces a health services25 105 4.20.11 COMM. OF THE WHOLE - BILL 1101371 administrator II.2 One vacant position for a3 physician.4 One vacant position for a5 public health dental hygienist.6 One vacant position for a7 radiographer.8 Two positions for a medical9 technologist.10 That's in our health centers.11 I move on to the Division of12 Maternal, Child and Family Health.13 We have one position that's14 vacant for the director of Maternal,15 Child and Family Health.16 One for a semiskilled laborer,17 with lead as a specialty.18 One for an abatement worker.19 One for a sanitarian.20 One for a budget analyst II,21 which replaces a field investigator.22 One for a laborer.23 In the Public Health Nursing24 Home, we have one position for a25 106 4.20.11 COMM. OF THE WHOLE - BILL 1101371 registered nurse supervisor.2 In Environmental Protection3 Services, we have one electronic4 technician. We have one graduate5 environmental engineer, one clerk typist6 I, one semiskilled laborer, and one7 sanitarian.8 In the area of Administration9 and Support Services: One public10 administration analyst, one secretary,11 one public relations officer, one account12 clerk, one industrial hygienist, one13 automotive driver, two custodial workers,14 one HVAC mechanic I, one HVAC mechanic15 II.16 In the Medical Examiner's17 Office, one deputy medical examiner18 position is open, one forensic19 investigator I, one forensic investigator20 supervisor, and one municipal guard.21 In the Division of Disease22 Control: Three management trainees; one23 public administration analyst; one24 physician; two clerk-typists I's, which25 107 4.20.11 COMM. OF THE WHOLE - BILL 1101371 replace clerk-typists IIs; and one2 licensed practical nurse.3
You're welcome.6 COUNCIL PRESIDENT VERNA:7 Doctor, how many physicians do we have8 for the clinics?9
And11 are they all part-time? Are some of them12 full-time? Have we hired any recently?13 Have those doctors been given waivers?14 I'd just like to...15
Okay. I'm sorry19 to have to go through papers. But as you20 know, there's a lot of detail.21
Thank you.24 So we have a total of three in25 108 4.20.11 COMM. OF THE WHOLE - BILL 1101371 the -- should I do it by division or2 overall for the department? Do you want3 it just in the health centers?4
Just in the7 health centers, yes, ma'am.8 We have 3 full-time and 919 part-time physicians. Of those, 48 are10 in civil service, and 40 are on contract.11 And six of them are both.12
-- part-time,19 correct. And 48 of them are in civil20 service, 40 of them are on contract.21
They are -- uh,24 no. Of the 48, three of them are25 109 4.20.11 COMM. OF THE WHOLE - BILL 1101371 full-time.2
Okay.3 Is that the full-time complement that we4 need?5
We need more6 physicians. We recruit constantly for7 physicians.8 In general, the competition in9 Philadelphia for hiring physicians is10 pretty fierce. So, for instance,11 Miss Scott mentioned in her testimony12 that one of the incentives we should use13 is loan repayment.14 We currently have about --15
Loan repayment.18 So the federal government19 provides the opportunity for physicians,20 nurses, and other personnel who work in21 areas with poor access to care.22 Particularly in federally qualified23 health centers, the government offers24 repayment of student loans because the25 110 4.20.11 COMM. OF THE WHOLE - BILL 1101371 loan burden for health care professionals2 is often quite large.3 COUNCIL PRESIDENT VERNA:4 That's wonderful.5
It is wonderful.6 We have about six people, I7 believe, now who are taking advantage of8 that program, but we have 90 positions9 that have been approved by the federal10 government to offer loan repayment.11 We advertise widely, we12 advertise on the federal website, and so13 forth.14 The problem is, we compete with15 the other federally qualified health16 centers in town and other centers that17 are based in low-income, high-need areas.18 So the competition is large. And we're19 competing nationally with anyone who20 wants to go anywhere for loan repayment21 in practice a low-income community.22 So I think our efforts are23 substantial. We're looking for people24 who will be successful with us, who will25 111 4.20.11 COMM. OF THE WHOLE - BILL 1101371 come, like the job, and stay. It's2 difficult to find physicians who would3 like to work under the conditions we4 have, which are very high-volume5 practice. We have a lot of scrutiny on6 quality. We work very hard to keep7 people out of the emergency room; and as8 a result, we have a large number of9 people who walk into our centers because,10 on a given day, they're sick and they11 want care, and you've seen other waiting12 times.13 That's not the most desirable14 set of conditions. And as a result, the15 people who succeed in our health centers16 generally are fairly mission-driven.17 They really want to serve people who need18 care and don't have other sources for19 care.20 So I'm proud of the workforce21 we have, but it is a struggle to maintain22 that workforce.23
Madam24 President?25 112 4.20.11 COMM. OF THE WHOLE - BILL 1101371
The2 Chair recognizes Councilman Rizzo for a3 point of information.4
Doctor, I'm5 trying to keep track of this, but could6 you just get right to the number? How7 many doctors work without any benefits at8 all?9
The majority of10 our doctors work on the -- of the11 physicians who are contract physicians,12 the majority do not get benefits through13 their work with the City. Most of them14 are part-time, many of them work in other15 places, and many of them rely on their16 spouses.17 And of the physicians who work18 in the City, being hourly employees, they19 receive pension benefits; they don't20 receive other benefits.21
So why would22 some doctors work for 40 hours a week and23 not get benefits?24
They generally25 113 4.20.11 COMM. OF THE WHOLE - BILL 1101371 don't work for 40 hours a week.2
They are4 part-time folks. Many of them5 historically have had other practice6 areas, and we've been able to get their7 time to come and work in the City part-8 time.9
So there's10 no doctors who work 40 hours, like a full11 schedule.12
They do, but17 their salary, their actual take-home pay18 on a weekly basis, is substantially less19 in order to cover the benefit costs.20
And generally22 folks, particularly if they have a spouse23 or someone else who can provide health24 insurance, would prefer to get higher25 114 4.20.11 COMM. OF THE WHOLE - BILL 1101371 take-home pay from the City.2 And we do that by doing3 essentially a dollar-for dollar match.4 If you don't get benefits, we build it5 into your cost.6
I'll wait7 for my turn to come back around.8 Thanks, Madam Chair.9
Thank10 you.11 Doctor, you mention in your12 testimony that the average waiting time13 for an initial visit is 66 days.14
That is correct,15 on average.16 COUNCIL PRESIDENT VERNA:17 However, however, the waiting time in18 District 10 Health Center is, we're told,19 244 days.20
You22 know, I think we went through this last23 year too.24
Can2 you give us an explanation as to why that3 is and what could possibly be done to4 reduce the waiting time?5
Yes, ma'am.6 So waiting time -- I should7 point out that waiting time is for8 adults, not for children. It's not the9 waiting time for family planning10 services, dental services, which are much11 shorter. So it is an outlier, it is for12 adults.13 We know that the Northeast,14 particularly the lower Northeast, has15 been growing quickly, particularly with16 folks who are new immigrants to17 Philadelphia and are uninsured. And we18 know that that area of the City was19 particularly hit hard during the20 recession.21 So demand for our services has22 gone up disproportionately in that area,23 but it's always been high. When I first24 got here, as you know, demand for our25 116 4.20.11 COMM. OF THE WHOLE - BILL 1101371 services there was high and our waiting2 times were long.3 So we have, with various4 budgets, tried over time to increase the5 number of folks who are working in the6 health centers. And each time, we7 diligently put it in, the recession, and8 we've cut back no less than the number9 that we've had, but we've had an issue.10 What we've done in this year is11 tried very hard to at least fill the12 complement of staff at Health Center 10,13 so they have all the people that they14 can. But, again, remember, Health Center15 10, because it's got such a long waiting16 time, it's very hard working conditions;17 people work very hard at Health Center18 10.19 They work hard at all of our20 health centers, 'cause we have waiting21 times at all of them, but they22 particularly very hard at Health Center23 10. The volume is overwhelming.24 So it's not easy to hire people25 117 4.20.11 COMM. OF THE WHOLE - BILL 1101371 to do it. We don't have huge amounts of2 space. The health centers were built3 generally in the '50s and '60s, as you4 know, and we've expanded too the space5 that we have. We've opened on Saturdays,6 we've opened in the evening.7 So coming up with the best8 solution, as Council has heard, I9 believe, is another health center. I10 think we need another health center in11 the lower Northeast.12 The challenge is finding the13 capital and the property to build that14 health center. The first step in this15 was to create a mechanism that was the16 Health Center Authority for the City --17 and I appreciate Council's support on18 that -- to allow us, at least for one19 health center, to try to identify a20 property and the support needed. And21 we're working actively on that.22 But I think with a waiting time23 like this, the answer is not going to be,24 given the constraints on the space, that25 118 4.20.11 COMM. OF THE WHOLE - BILL 1101371 we're going to staff up and fix this. I2 think the answer is that the demand is3 increasing, that it's going to continue4 to increase, we're not able to keep up;5 we need another health center in the6 Northeast.7
Thank8 you.9 Doctor, you also mention on10 of your testimony the initiatives11 that have been undertaken to reduce the12 City's unreimbursed obligations for13 ambulatory health services and have14 reduced this cost by over $5 million from15 your Fiscal 2009 level.16 The revenue estimates for17 payments for patient care in the18 Five-Year Plan are a consistent19 $7.4 million for Fiscal 2011 through20 2016. Why are the revenue estimates not21 increasing each year?22
The issue here is23 one that relates to how we are reimbursed24 as federally qualified, look-alike health25 119 4.20.11 COMM. OF THE WHOLE - BILL 1101371 centers; and that is, we get an enhanced2 rate for Medicaid payment. And the3 timing issues with how we're paid4 determines ultimately how much money5 comes in.6 So I've talked about as best I7 can actual and compared it to the8 budgeted amount to give you a sense9 that -- and the comparison was done to10 give Council a sense that the revenue11 estimates are conservative. Based on12 reality and what we've achieved in the13 past, we have been able, through14 appropriate and adequate billing, to15 reduce the dependence on the General Fund16 slightly.17
Oh,18 my. Everybody wants to ask questions. I19 just want one more minute.20 In your testimony that we21 received from District Council 47,22 Catherine Scott indicated that the23 district health centers would be more24 efficient and more cost-effective with25 120 4.20.11 COMM. OF THE WHOLE - BILL 1101371 the use of additional certified2 registered nurse practitioners and3 physician assistants to aid physicians in4 providing health services.5 What is your position on that6 issue?7
Well,9 now that she agrees and you agree, where10 do we go from here?11
Okay. So three12 years ago, we were far behind the market13 in the salaries for nurse practitioners,14 physicians, and physician assistants.15 The department's solution on16 physicians has been to contract physician17 positions. It gives us flexibility. It18 also is the case that many physicians19 actually don't want to work for the City,20 be that as it may.21 For nurse practicers, we were22 way behind market rates. So we worked23 very diligently with the Civil Service24 Commission and the Office of Human25 121 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Resources for the City to increase the2 salary for nurse practitioners, and we've3 increased the hiring of nurse4 practitioners. We hope to continue to do5 that.6 The problem is that in this7 health care market, as quickly as we8 increase salaries, the market readjusts,9 and it's very hard through civil service10 to keep up with market rates.11 So it is our intention to hire12 more nurse practicers. At the moment,13 the chief, most attractive criterion for14 a nurse practitioner to come to the City15 is the other nurse practitioners working16 with us. So nurse practitioners working17 in an environment like ours, which has18 primarily had physicians as leaders and19 practitioners, they're a little leery20 about coming in to our workforce. So we21 have to convince them to do, which we're22 trying actively to do.23 On physician assistants, we24 have not yet been able to do the work we25 122 4.20.11 COMM. OF THE WHOLE - BILL 1101371 need to while doing everything else to2 hire folks to increase the salaries for3 physician assistants.4 But that is on our list for5 this year, and we will increase the6 salary -- we will go back with the Office7 of Human Relations to the Civil Service8 Commission and attempt to increase9 salaries for physician assistants so that10 we can get again begin to hire them into11 the City.12 Miss Scott mentioned a number13 of about 60-some thousand dollars for a14 salary in the City for a physician15 assistant. And based on that, she thinks16 it's a real bargain. It is a real17 bargain at that rate.18 Unfortunately, the market rate19 for a physician assistant in Philadelphia20 is about $94,000, so...21
Okay.22 And what is it for the nurse23 practitioner?24
Very similar.25 123 4.20.11 COMM. OF THE WHOLE - BILL 1101371
That's not market6 rate; we've still below market, but we're7 at least in a competitive range.8
I'm9 sorry. Was that civil service or under10 contract?11
And our civil16 service rates, if they're hourly rates,17 not annual salary, but hourly rates for18 part-time people, our civil service rates19 and our contract rates are the same.20 We've done a lot of work to keep them the21 same.22
We do. For nurse25 124 4.20.11 COMM. OF THE WHOLE - BILL 1101371 practitioners, we do.2
No, we are --5 there are four people on the list. We've6 been hiring off the list.7
Very8 well.9 I'm sorry to my colleagues. I10 know that you've all been waiting.11 Councilman Goode.12
Thank you,13 Madam President.14 Good afternoon, Dr. Schwarz.15
My first few18 questions are related to your capacity as19 Deputy Mayor.20
Will all22 Fiscal Year '12 contracts under your23 control as Deputy Mayor contain24 provisions related to the living-wage-25 125 4.20.11 COMM. OF THE WHOLE - BILL 1101371 and- benefits standard?2
I don't know the3 answer to that because that depends on4 people who are above me in the hierarchy.5 I'm not the decision-maker.6
I'm not the9 decision-maker on the terms in the10 contracts related to that. They're a11 part of the general provisions for12 contracts. So it's its the Law13 Department who makes that decision.14
Would you15 like all of the contracts under your16 control to contain provisions related to17 living-wage-and-benefits standard?18
So the more19 difficult answer to the question is, I20 believe in a living wage. The challenge21 is the amount that it will cost the City22 and what that will do to the budget over23 time.24 So what we've tried to do is to25 126 4.20.11 COMM. OF THE WHOLE - BILL 1101371 increase as best we can over time the2 proportion of contracted workforces who3 are earning a living wage. And I believe4 we need to continue to push in that5 direction.6 The challenge is the budget7 constraints, particularly the constraints8 we've had over the last few years and the9 ones that I anticipate with --10
Have any11 firms requested waivers for Fiscal Year12 '12 or Fiscal Year '11?13
If it's in the25 127 4.20.11 COMM. OF THE WHOLE - BILL 1101371 general provisions, that would be2 correct.3
Okay. What4 is the largest contract that you will5 award in Fiscal Year '12, for-profit and6 nonprofit?7
In Fiscal Year8 '12. Yes, sir.9 The largest contract awarded10 for '12 is the contract that --11
-- will be14 awarded is the contract for Fairmount15 Long-Term Care.16
For '12, it's25 128 4.20.11 COMM. OF THE WHOLE - BILL 1101371 $39,010,860.2
And when's9 the last time you bid the contract or an10 RFP?11
It's a nonprofit,12 so it actually hasn't been bid in a13 while, since the beginning.14
Okay. Is15 that firm in compliance with the City's16 living-wage-and-benefits standard?17
Okay. Will19 that firm be required to have a supplier20 diversity plan and do they have it?21
They already have22 one, and we've worked with them on that.23 As is in my testimony, they've done24 pretty well. I can also give you a25 129 4.20.11 COMM. OF THE WHOLE - BILL 1101371 summary of that for them for at least2 Fiscal Year '11.3
And the9 other contract, the other largest10 contract?11
Yes, sir. The15 largest for-profit contract is for CVS16 Caremark. It is for $1.121840 million in17 '12.18
And are they25 130 4.20.11 COMM. OF THE WHOLE - BILL 1101371 in compliance with the City's living-2 wage-and-benefits standard?3
We believe7 that since -- there aren't very many8 opportunities for them with us to do so,9 but we are in active conversation with10 them about that.11
For Fiscal15 Year '11, your participation rate is 4916 percent.17
I want to be sure18 you heard. I corrected it in my19 testimony not because the number's wrong.20 Based on -- as you know and we've talked21 about over time, how you calculate that22 number matters. And the question of the,23 do we count all of the contracts which go24 through Procurement but use health25 131 4.20.11 COMM. OF THE WHOLE - BILL 1101371 dollars.2 Having listened to you last3 year, you were very clear that you wanted4 all contract dollars for the department.5 So that number, using all contract6 dollars, is 33.3 percent.7
Okay. And8 you have a contract with eClinical Works,9 LLC?10
It's a new11 contract, a capital contract that we just12 signed, yes.13 (Timer bell rings.)14
And the15 question is: When was that contract16 awarded? And what was your participation17 rate without that contract?18
And then,24 what was the participation rate without25 132 4.20.11 COMM. OF THE WHOLE - BILL 1101371 that contract?2
Okay. It was3 awarded the last week in March, and it4 was awarded, I believe, with best5 efforts. And the reason for that was6 that at the time that that RFP went out7 --8
The question9 is: If you subtract that contact from10 the other contracts, what would be your11 participation rate without that one12 contract?13
Understood. Much14 lower. It's, I think, probably somewhere15 around 1 percent.16
Okay. So20 it's about 1 percent without that21 contract.22
Okay. Thank24 you, Madam Chair.25 133 4.20.11 COMM. OF THE WHOLE - BILL 1101371 (Councilwoman Tasco now2 chairing this hearing.)3
Thank you,6 Madam Chair.7 Good afternoon, Dr. Schwarz.8
I have said11 this to you in the past and I'm also --12 and I said it to Dr. Evans. I'm very13 impressed with your staff and your team14 in the various meetings and briefings15 we've had over the past year.16 I do have a few questions for17 you, most of which I'm going to have to18 submit in writing, and I apologize for19 that, because I'm late for a meeting I20 had at 12 o'clock.21 But just the general question I22 have for your department is: We just saw23 what I think is extraordinarily24 impressive testimony from DBH and the25 134 4.20.11 COMM. OF THE WHOLE - BILL 1101371 attendant PowerPoint, which has specific2 performance metrics basically related to3 everything they do.4 Do you think it is possible for5 you to present a budget like that to us6 next year?7
The answer is yes8 and no, and I apologize for equivocating.9 So we are fortunate that the10 Centers for Disease Control, using11 dollars from health reform, has funded in12 large health departments in the country13 performance-management specialists. So14 we have hired a performance-management15 specialist, and it is our intention for16 all of our infrastructure areas -- Human17 Resources, fiscal IT and so forth -- to18 do that.19 We believe it's going to take20 probably another year to get all of the21 rest of the areas of the Health22 Department onboard.23 But what we did for this year's24 budget -- because I read your article in25 135 4.20.11 COMM. OF THE WHOLE - BILL 1101371 the Inquirer -- is that we have output2 measures and cost-per-output. And where3 we have benchmarks, we have benchmarks4 for every division. So we believe that's5 a first step.6
And we need to9 work from there.10 The difference between11 Behavioral Health and Health is the12 diversity of the departments. Remember13 that Behavioral Health principally a14 series of insurance companies, and things15 are paid either for a program or for a16 service that's defined by a federal code.17 So the numerator and denominator can be18 defined easily because it's not so easy19 in Public Health to define a unit of20 service, unfortunately. So we're working21 on it.22
One of the23 things I'd be really interested in, if24 you could take a look at it as a25 136 4.20.11 COMM. OF THE WHOLE - BILL 1101371 department, is -- and maybe you've done2 this -- how much would you estimate the3 existence of our eight health centers4 saves the hospitals and emergency room5 walk-ins and things like that?6 And -- well, do you know the7 answer to that question?8
I mean, you11 cited a statistic that basically said, We12 know that the people who come to see us13 don't go to emergency rooms --14
--22 economically and in neighborhoods.23 And I think it would be very24 useful for us to have a study of the25 137 4.20.11 COMM. OF THE WHOLE - BILL 1101371 value we are giving the hospitals and2 medical community themselves.3 As you say, you are having4 trouble getting physicians. That may be5 something to present people who pay no6 taxes for their real estate and other7 things to the City of Philadelphia to8 maybe cause them to want to provide the9 physicians that we need to reduce waiting10 times and other things that would have a11 further benefit on them.12 That's just one small idea I13 have out of your testimony. I have a lot14 of questions for you.15
And I'm20 assuming I'll be satisfied. If not, we21 can do a callback.22
Thank you24 very much.25 138 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Thank you,7 Madam President.8 Good morning, afternoon?9
And thank13 you for your testimony.14 Of course, I pay close15 attention also to the line of questioning16 of my colleague Councilman Goode, and I17 wanted to thank you for the detail on18 , which for sure is a great19 improvement from last year in terms of20 preparation, and we appreciate that.21 What I would ask to dig even22 deeper, looking at next year, for those23 large -- for those organizations or24 agencies, nonprofit or profit, will you25 139 4.20.11 COMM. OF THE WHOLE - BILL 1101371 stipulate the composition of staff,2 specifically minority and women.3
My ask is5 that you dig even deeper.6 And the next question will, be7 for example, with PHMC, 60 percent are8 minority, 75 percent are female. The9 next question, to dig deeper, a step10 lower is: Of that, what percent are in11 positions of leadership and12 responsibility, and what percent are line13 staff?14
Yes,17 uh-huh.18 And I appreciate the19 information regarding the board 'cause20 I've been trying to get that for years.21
But we now23 need to dig even deeper for that type of24 information for City agencies getting --25 140 4.20.11 COMM. OF THE WHOLE - BILL 1101371 receiving City support, period.2 Of all those that you've3 mentioned, there was no indication as to4 whether they are all local. Are they?5
Oh, okay,10 'cause that's helpful to us as well.11 We're interested in keeping12 Philadelphians working.13
With18 regards to the schools and the details19 you gave around schools that are20 participating in ensuring that our young21 people are having healthy lunches --22
That24 number seems to be growing. What are the25 141 4.20.11 COMM. OF THE WHOLE - BILL 1101371 continuing hurdles or impediments for2 schools to just sign on and just get it3 done?4
I don't think5 there's been an impediment in will; I6 think it's a question of size.7
One of the things12 that we've worked with the district on is13 ideas. So for schools that are in14 communities that might not be used to15 eating the average American diet, as we16 might call it --17
-- or the new19 American diet that we want them to20 have --21
-- what are23 culturally appropriate foods, and how can24 they be prepared or contracted, and what25 142 4.20.11 COMM. OF THE WHOLE - BILL 1101371 do kids wants to eat.2 For the program we've done in3 rec centers --4
We were fortunate6 to be able to ask to ask the kids for the7 Supper program what they'd like to eat.8
We gave them what11 they like, and they're eating it, which12 has actually, despite the fact that we're13 feeding more children, the amount of14 wastage has gone down.15
The amount of21 stuff that's thrown out, unopened has22 gone down dramatically. So we're feeding23 many more kids, we're feeding them more,24 and the amount they're leaving behind is25 143 4.20.11 COMM. OF THE WHOLE - BILL 1101371 down because they're getting what they2 want to eat.3 So it's been clear with the4 School District that that's an important5 piece of this, within their budget6 constraint.7
And that doesn't9 happen for the whole district overnight.10 So you can't just say everybody has to do11 it this way.12 The school Wellness Councils13 have helped us so.14
So there are16 parents and staff and others in the17 school, on the ground who are helping18 make those decisions, and we're excited19 to have them. There are 200 who have20 signed up. A hundred are in full-fledged21 action so far.22
So we're -- we24 think we're well on the way.25 144 4.20.11 COMM. OF THE WHOLE - BILL 1101371
I agree2 2,000 percent. I'm very excited about3 all of you're doing in that way, and I'd4 be remiss not to say thank you for the5 huge partnership we've enjoyed --6
So that11 there was one task that your office12 delivered on in terms of mapping high13 blood pressure and diabetes, and now14 you're mapping food deserts.15
Have you17 broken that down by Councilmatic18 Districts because that becomes very19 informative for District20 Councilmembers --21
-- who23 then may look to look for economic24 development opportunities where there may25 145 4.20.11 COMM. OF THE WHOLE - BILL 1101371 be a growing -- you know, continuing2 needs for supermarkets.3
Okay.6 Could you forward that to the Chair,7 please.8
Thank15 you.16 The Chair recognizes17 Councilwoman Tasco.18
I'll be19 brief.20 Good morning -- well, good21 afternoon.22
Good day,24 Dr. Schwarz and staff. Good to have you25 146 4.20.11 COMM. OF THE WHOLE - BILL 1101371 here. And thank you so much for all f2 the work that you're doing, good work.3 According to recent studies and4 an April 15th story in the Philadelphia5 Tribune, most new HIV infections are6 clustered in areas of the City with7 limited access to HIV-prevention8 services, including Germantown, North9 Philadelphia, Southwest Philadelphia.10 President Obama national AIDES11 strategy calls for allocating resources12 to the area of the country and city most13 affected by HIV/AIDS.14 How does the City plan to15 address the geographic clustering of16 infections, and will new resources be17 dedicated to the most highly affected18 areas of Philadelphia?19
I appreciate the20 question. I'm actually going to call up21 the head of the AIDS Activity22 Coordinating Office from the Health23 Department to give you more detail on24 that.25 147 4.20.11 COMM. OF THE WHOLE - BILL 1101371
I'm Jane Baker.10 I'm the Director of the AIDS Activity11 Coordinating Office.12 And in response to your13 question, we currently have a new ECHIP14 Grant that was put out through the City15 --16
An ECHIP Grant, for19 enhanced comprehensive HIV program20 planning. So we're looking at those21 things for areas that are underserved.22 And we're doing geo special23 mapping to look at these areas so that we24 can target, you know, those communities25 148 4.20.11 COMM. OF THE WHOLE - BILL 1101371 and put services there.2
Would you3 -- are you -- do you know if you have4 resources or programs or offices in those5 areas where they could -- where the HIV6 patients could go to provide those7 services? Do you have providers in those8 areas? I guess --9
Yes, mm-hmm. But13 for some services, we will redirect14 providers to those areas that are15 underserved.16
Okay.17 Would the providers be from that area, or18 would they be in other areas but to19 provide services in those areas?20
Okay, all23 right. Don't go away.24 The Tribune story also25 149 4.20.11 COMM. OF THE WHOLE - BILL 1101371 highlighted the issue of wait lists for2 houses where people are living with3 HIV/AIDS. How does the City plan to deal4 with this housing crisis, given that we5 know that housing is a part of HIV6 prevention and treatment?7 And how does Philadelphia's8 HIV/AIDS housing program and wait list9 compare to cities of comparable size?10
I guess I would11 start by saying there's always more12 demand than there is resources available13 to serve that, but we do actively look at14 that, and we do keep a waiting list at15 ACO for our services.16
So I will help17 only because Ms. Baker needs reading18 glasses, and I don't have them for her,19 and she got up quickly. So I apologize20 let me fill in, and she'll add as we go,21 but I'd like to answer your question22 today, okay?23 Okay. So we currently have --24 as of March 2011, there were 165 people25 150 4.20.11 COMM. OF THE WHOLE - BILL 1101371 on the waiting list for what's called2 "HOPWA," which is Housing Opportunities3 for People with HIV/AIDS.4
And that's down6 from 197 the year, before so we're making7 progress on that list.8 Of those people, none of the9 people, the 165 people, on the current10 list consider themselves, or considered11 themselves homeless. So they're living12 somewhere, they need different housing.13 We try to work down the waiting list with14 housing opportunities.15 We receive money from the16 federal government to provide that, and a17 little bit money from the State.18 Concerning to us is that19 federal dollars for this support and20 State dollars for this support look like21 they're being reduced.22 (Timer bell rings.)23
So we're worried25 151 4.20.11 COMM. OF THE WHOLE - BILL 1101371 about being able to keep up even as we2 are at the moment.3 We agree that housing4 opportunities would be important. We5 also know, with my other hat on, that6 there are very long waiting lists for7 housing in general in Philadelphia,8 including for people with disabilities9 and people with serious illness.10
So we prioritize12 those folks who are in shelter and13 homeless or those folks who have a14 medical need that can't be met otherwise15 urgently and/or homeless and in shelter.16
We get17 your message. Thank you very much.18 We'll come back.19
The22 Chair recognizes Councilwoman Blackwell.23
Thank24 you, Madam President.25 152 4.20.11 COMM. OF THE WHOLE - BILL 1101371 I am glad that Councilwoman2 Tasco brought up those issues. We had3 been asked about AIDS and obviously asked4 about people, homeless people during this5 budget crisis and what happens.6 I want to likewise say, Madam7 President, this is the day we have all8 good departments who work hard and do a9 good job for us, and we likewise want to10 say that to Dr. Schwarz and his11 department and certainly say that albeit12 we ask a lot of questions, and I continue13 to contact him, even before this meeting,14 on various issues, so we look forward to15 continuing to work with him, and we thank16 him for the work that he and his17 department does.18
A point of22 information.23 We don't wait until budget time24 to ask questions of these departments; we25 153 4.20.11 COMM. OF THE WHOLE - BILL 1101371 stay in contact with these departments2 all the time. So, you know, the3 questions are just a matter of formality4 for the record, but they provide us with5 information.6
Responsive9 and through hearings we've had an various10 issues. So it's not that we lack11 interest; it's just that they've been so12 helpful.13
I18 don't believe Councilman Rizzo is here19 but his light had been on.20 Do you have any further21 questions, Councilwoman?22
Yeah, I23 just had a couple.24 Based on the current State25 154 4.20.11 COMM. OF THE WHOLE - BILL 1101371 cuts, 72,000 will be cut from consumer2 education for ACO for AIDS education3 programs. How will this cut the City's4 ability to implement a local initiative5 that is consistent with President Obama's6 national AIDS strategy?7
I appreciate you8 asking that question. We obviously are9 worried as well about State cuts.10
The 72,000, I12 will say -- and let me be transparent.13 That's a small cut compared to the larger14 cut that was included in the Human15 Services Development Fund.16
So there's about18 a million dollars in cuts to ACO that19 happened through the State cut of the20 Human Services Development Fund.21
We are looking23 now to see what we can do with federal24 dollars. And if -- while the federal25 155 4.20.11 COMM. OF THE WHOLE - BILL 1101371 government is changing some of its policy2 on housing, they seem to be, through the3 President's initiative, increasing4 funding opportunities particularly for5 prevention.6 So we're hopeful that we will7 actually be able to move some of our work8 among programs. And as you heard from9 Ms. Baker, we're also reassessing in10 terms of our service network where we're11 providing service.12
All right.16 So I'm sure we'll be working together and17 you'll be talking about what you plan to18 do.19
Let me21 just ask this final question about the22 Governor's budget and the cuts that have23 been proposed for education. If they24 shift it from education to health, how do25 156 4.20.11 COMM. OF THE WHOLE - BILL 1101371 you think it's going to impact on you?2
Well, one, we're3 hopeful that it won't shift to health. I4 think the biggest concern for us is5 around Medicaid.6
And where that is8 particularly pertinent is that we have9 been protected to date in the State10 budget process because when health care11 reform was passed, it included a12 provision which said that states had to13 maintain their effort for Medicaid, which14 meant that they could not cut the15 eligibility of people on Medicaid.16 We are very worried that,17 through compromises that will happen18 because of the debt ceiling discussion,19 there will be a relaxation on that issue.20 If that happens and states are21 permitted to cut eligibility, then our22 Medicaid reimbursement will likely go23 down. That is a big issue for the health24 centers.25 157 4.20.11 COMM. OF THE WHOLE - BILL 1101371 And it is -- I can answer a2 little bit about Behavioral Health, if3 that would help as well, but I can tell4 with this, my Health Department had to5 say that whatever the impact is on the6 health centers, Medicaid cuts would be7 very bad for the health of people in8 Philadelphia, not just the health of our9 health centers.10
Demand for our12 services, I think, would go up, and our13 resources would be less. But the bigger14 issue is, there are probably a lot of15 people who will be cut off Medicaid if16 eligibility can be cut have, who will17 have nowhere to go, or will go nowhere.18 We know that the largest line19 items in the State budget relate to20 education, but the second largest relate21 to Medicaid. It's almost one in five22 State dollars go to pay for Medicaid.23
So if the federal25 158 4.20.11 COMM. OF THE WHOLE - BILL 1101371 government allows the State to cut2 Medicaid, I'm very worried about what3 will happen in Philadelphia.4
I have one5 other question to ask you. You talked6 about the increase in the serviced of the7 health centers for I guess maternal care?8
Is that10 because we've lost so many -- so many11 hospitals have closed, providing those --12
Well, we've also13 provided prenatal care and postpartum14 care, and we have maintained that. We15 actually do that in partnership with the16 hospitals, the existing hospitals, so17 that we can facilitate entry to those18 hospitals for delivery and people have19 prenatal records that are available at20 the time of delivery.21
No, no.25 159 4.20.11 COMM. OF THE WHOLE - BILL 1101371 I'm saying, have you -- you've increased2 it --3
Increased6 it because some of the hospitals have7 closed?8
A little bit, a9 little bit.10 What has happened is, much of11 the change has been absorbed by other12 hospitals. And what we're seeing13 actually is, women are going outside the14 county.15 So the total number of births16 within the county appear, from17 preliminary information from a number of18 the hospitals, to be going down compared19 to what they were immediately on the20 closure of Northeastern and Chestnut Hill21 for delivery.22
And it looks like24 women are shifting to choose where they25 160 4.20.11 COMM. OF THE WHOLE - BILL 1101371 can to go outside the county in larger2 numbers for care.3 So it means that there are a4 larger network of hospitals that we have5 to worry about in terms of Philadelphia6 births, but at least it means that women7 are getting good delivery care.8 (Timer bell rings.)9
Thank you10 very much.11 Thank you, Madam President.12 COUNCIL PRESIDENT VERNA:13 You're welcome.14 The Chair recognizes15 Councilwoman Brown.16
Thank you,17 Madam President.18 Okay, I asked Dr -- help me19 out. I'm having a memory lapse.20
Dr. Evans22 about lead-related matters. We do know23 that there are new federal regulations.24 How will that impact what the department25 161 4.20.11 COMM. OF THE WHOLE - BILL 1101371 is already doing with its lead-related2 work?3
We're really4 worried about lead. We're really worried5 about lead because we have cuts in the6 State budget, which likely will impact7 the amount of money we have for lead8 abatement. And at the same time, it9 looks as though there will be cuts at the10 federal level.11
And you12 know that already, that there will be13 cuts in the State budget around that?14
Thus far. It15 depends on what happens with the final16 State budget, obviously.17
And those cuts19 are not huge compared to what we20 anticipate from the federal government.21
We already have,23 as you know, a waiting list for24 abatement. It's not as bad as it's been25 162 4.20.11 COMM. OF THE WHOLE - BILL 1101371 in past years, but there is a waiting2 list. And we're very worried about the3 proportionate cut that we could receive4 for abatement services.5 So I would like to have better6 news on that. We're thinking very hard7 about what super-cleaning. Do you know8 about super-cleaning and how super-9 cleaning has been used in many homes,10 where there are paint chips and things11 like that, to clean up or to seal --12
-- without14 removing lead, which is the most15 expensive thing.16
We've done that18 in the past; we're looking to see if we19 can do more of that. But I am very20 worried about what's going to happen in21 terms of lead-abatement availability.22
Do you23 have any idea how long that wait list is24 for families?25 163 4.20.11 COMM. OF THE WHOLE - BILL 1101371
I know the2 numbers on it. And waiting depends a3 little bit on where you live and who you4 are and how your lead level is and so5 forth.6
I can give you11 the numbers of cases that we're waiting12 on if you'd like.13
Okay.14 Well, that's well taken.15 As I shared with Dr. Evans16 offline, we're going to go to look at17 that very closely --18
-- and see20 what alternative actions or strategies we21 need to look at, given the new budget22 constraints we're confronted with.23
It would be24 exciting to do this in concert with other25 164 4.20.11 COMM. OF THE WHOLE - BILL 1101371 northeastern and midwestern cities that2 are going to have the same issues with3 lead, because the federal cuts will not4 just affect us; it will affect us5 disproportionately because of the number6 of homes that we have with lead, but7 there will be other cities impacted as8 well.9
Oh, okay.10 All right, then. so we'll have subsequent11 discussions around that.12
In your14 testimony, you talked about how an15 appointment for an adult patient16 increased from five, six days to 6-617 days. What are the wait times at your18 busiest health centers?19
Okay. So the20 busiest health center is Health Center 1021 in the lower Northeast, and the waiting22 time at Health Center 10 is 238 days.23 And that's for adult care only. And in24 fact, the particularly long waiting times25 165 4.20.11 COMM. OF THE WHOLE - BILL 1101371 are in general for adult care.2 The next longest is at Health3 Center 6, which is at Third and Girard.4 And the waiting time there is 70 days for5 adult care, for an initial visit, not for6 a return visit.7
And given8 the earlier discussion around vacancies,9 do those vacancies in any way impact10 these realities you've just stated?11
Vacancies will12 always impact it a bit. We have -- and I13 have Carla Hill here because of the14 exemplary work she's done this year with15 the department, trying to come up with16 both a plan and move on how do we fill17 vacancies more quickly.18 We have meeting weekly with19 Ambulatory Health Services to go through20 every vacancy that they have and have a21 plan on every vacancy so we can fill it22 for Ambulatory Health.23 We have made remarkable24 progress on nurses. So a year ago, we25 166 4.20.11 COMM. OF THE WHOLE - BILL 1101371 had a shortage of nurses. I've been to2 each of the health centers throughout the3 year, and the cries I heard last year4 were, "We don't have enough nurses." This5 year, it's much better on nurses.6 The challenge for us is, we7 have a lot of job class, and filling them8 all is a big deal. But it's clear that9 the nurse and the nursing hierarchy --10 supervisors, health care coordinators --11 are very high priority.12 We also have a very high13 turnover rate.14
Nurses who come16 to work us see, in more cases than we'd17 like, come, see how hard they have to18 work, and decide they could earn the same19 money elsewhere.20
We have a very25 167 4.20.11 COMM. OF THE WHOLE - BILL 1101371 dedicated staff. They delivery really2 wonderful care, but they work very hard.3 And as a result, it's hard to retain4 nurses.5
Sure.6 That raises a real interesting7 opportunity if anyone had, you know,8 another staff person to oversee it.9 We have Teach for America,10 where teachers have to sign up for11 X-period of time. And so, linkages with12 Temple School of Nursing or Penn School13 of Nursing for young men and women who14 are coming out, any relationship at all15 with those schools?16
We've had17 relationships to help with recruitment in18 the past. It's difficult in the City19 system, in part, because we have a lot of20 hurdles, and it's a long process.21
And generally, if23 you're a new grad, you want to get24 licensed and go to work.25 168 4.20.11 COMM. OF THE WHOLE - BILL 1101371
This past year,3 we did better than we have in getting4 people onboard. We're hoping that this5 continue year, we'll continue to do6 better, but it's challenging -- it's been7 a challenge in the civil service system8 to be able to respond in the current9 health-care market fast enough --10
So given14 that reality, do you think -- would you15 say that you've made progress, looking at16 where you were?17
And we have a21 plan. We've actually increased the22 number of people who were hired in the23 Health Department this year. We think24 that we'll actually potentially make a25 169 4.20.11 COMM. OF THE WHOLE - BILL 1101371 real visible dent by the increment report2 next year, in December.3
So I hope we can5 prove to you what we've been able to do,6 and that is part of our performance-7 management work.8
Okay. A9 follow-up question regarding the campaign10 around condoms. Are the schools linked11 in any way, shape, or form to that12 campaign?13
There are centers17 in the schools currently which make18 condoms available, and the nurses refer19 kids to outside providers in their20 neighborhood, who have condoms available21 at the moment.22 We are working with the School23 District to figure out how we might do24 more. The issue is that any condom25 170 4.20.11 COMM. OF THE WHOLE - BILL 1101371 availability has to go through the SRC.2 And, remember, the SRC is controlled by3 the State.4 So we believe we'll probably5 get one chance to make a request, and we6 want to make sure that it's right and7 it's exactly what we need. So we've8 taken a little bit of time to make sure9 we get everything right.10
Oh, okay.11 I think I have one more here.12 Last year... The question is13 around this notion of telemedicine; I14 think that was Councilman Jones who had a15 real interest in that.16
You18 testified before Council last year about19 this new methodology, I guess you call20 it. You indicated uncertainty regarding21 how your agency would be reimbursed for22 services rendered.23 Have you gotten any clarity on24 this whole reimbursement issue?25 171 4.20.11 COMM. OF THE WHOLE - BILL 1101371
We're in2 Philadelphia because the distances aren't3 great, and we don't do specialty services4 primarily; we do primary-care services.5 It's not going to work very well.6 Where we may have an7 improvement is for patients where a8 photograph -- like a photograph of the9 skin with a rash could go to a10 dermatologist. We're waiting to see if11 dermatologists can be paid for that and12 paid adequately.13
And if that's the15 case, then with our electronic health16 record, we actually will have very easy17 and seamless connections with patient18 approval and consent to do that kind of19 work.20
Now,21 talking about records across systems. Is22 the Eagles mobile eye --23
-- service25 172 4.20.11 COMM. OF THE WHOLE - BILL 1101371 linked into the Philadelphia Health2 Department?3
-- so that5 when they take exams of young people at6 schools in their mobile vehicle, it gets7 to that child's record?8
There isn't at12 the moment. Remember, we don't have an13 electronic record yet.14
Oh, okay.15 All right, then. That's fine.16 Well, again, to underscore the17 good work you've done that's been stated18 by my colleagues, it comes clear in the19 testimony, and I can't speak for Wilson;20 he can speak for himself.21 But I really do appreciate the22 detail given now around MBE/WBE23 participation.24
And the2 progress that's been made compared to3 last year.4
Thank you7 very much.8 Thanks, Madam President.9 COUNCIL PRESIDENT VERNA:10 You're welcome.11 Any other questions from12 members of the Committee?13 (No further questions.)14 COUNCIL PRESIDENT VERNA:15 Seeing no one, this committee will stand16 in recess until 2:15.17 Thank you again.18 Thanks, Doctor.19 (Lunch break taken.)20 (Proceedings resume.)21 * * *22 23 (Councilwoman Tasco now24 chairing this hearing.)25 174 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Our next2 department is the Department of Human3 Services.4 (Witnesses come forward.)5
Good6 afternoon. Would you state your name for7 the record and begin your testimony.8 PANEL MEMBERS: Good afternoon.9 Anne Marie Ambrose, Commissioner of the10 Department of Human Services.11
How are12 you doing?13 COMMISSIONER AMBROSE: Good.14 How are you?15
18 COMMISSIONER AMBROSE: Good19 afternoon. 11 COMM. 18 This is not additional funding19 but is required as part of the transition20 of DHS's Operating Budget from the21 General Fund to the Grants Revenue22 Department. 11 COMM. 7 DHS continues to make8 significant improvements in providing9 safety, permanency, and well-being for10 children at risk of abuse, neglect, and11 delinquency. 11 COMM. OF THE WHOLE - BILL 1101371 2011 noted that DHS reforms over the last2 three years has led to increased3 childhood safety and to improve fairness4 in the decision-making process for5 families. DHS is now working with the6 COB to create new recommendations7 regarding family well-being. 11 COMM. 11 COMM. 7 DHS has vital partnership with8 all of its stakeholders, especially9 Family Court. 13 DHS has reduced placement by 2414 percent from January of '08 to July of15 '10. 11 COMM. OF THE WHOLE - BILL 1101371 December 31st of 2010. 4 Since 2003, DHS has used5 performance-based contracting to improve6 outcomes for children. 11 COMM. OF THE WHOLE - BILL 1101371 Over the course of 2010 and,2 2011, PBC has been expanded to treatment3 foster care. 7 DHS has made substantial8 efforts to work closely with families9 themselves to increase permanency for10 children and youth. 11 COMM. 3 In order to ensure that the4 complex medical needs of children served5 by DHS are being addressed, we have6 expanded the staff of the Center for7 Child and Family Well-Being. Dr. 18 Under Community-Based19 Prevention Services, DHS is also working20 diligently to improve the educational21 outcomes for children in our care. 11 COMM. 7 The Educational Support Center8 received a total of 619 child-specific9 consultations from November of 200910 through December of 2010. 20 In our efforts to improve the21 likelihood of achieving permanency and22 better outcomes for older youth, DHS and23 the Family Court have started a24 Permanency Action Teaming. 11 COMM. OF THE WHOLE - BILL 1101371 consists of external and internal2 child-welfare experts who meet to3 determine what, if anything, changes can4 be made to a youth's plan to improve the5 youth's likelihood of achieving6 permanency. 19 Under the Juvenile Justice20 Services, DHS is also focusing on21 ensuring that the needs and well-being of22 youth involved in the delinquent system23 are met in an effective matter. 11 COMM. 11 COMM. OF THE WHOLE - BILL 1101371 Philadelphia Working Group on2 Disproportionate Minority Contact. This3 represents the first time forums of this4 nature have even been held within a5 secure detention facility. This unique6 program was designed to improve relations7 between minority youth and law8 enforcement. 13 Finally, the new Youth Study14 Center is under construction, with plans15 to move by the fall of 2012. 11 COMM. 11 COMM. 11 COMM. OF THE WHOLE - BILL 1101371 quality visitation reviews starting at2 the end of November 2010. 8 DHS is committed to utilizing9 technology to improve operational10 efficiency. 16 DHS plans to extend the use of17 this technology throughout DHS's Intake18 and Investigation Units. 11 COMM. 10 Because of our successful11 efforts at reducing the number of12 children in the former child welfare13 system, our caseloads have been14 significantly reduced. 11 COMM. OF THE WHOLE - BILL 1101371 business participation in City2 contracting. 8 Our nonprofit providers are not9 OEO-certified. Based on our survey, 3510 percent of the 208 nonprofit providers11 have boards that are primarily minority,12 women, or disabled status. 11 COMM. 2
Yes, you3 are. Thank you very much.4 Commissioner, the5 Administration is proposing to move all6 of your State and federal funding to the7 Grants Revenue Fund for Fiscal Year 2012.8 Can you explain why the General Fund9 revenue estimates for DHS show 22.7 and10 43.1 million in Fiscal 2012 and 2013,11 respectively?12 COMMISSIONER AMBROSE: I'm13 going to ask either Rebecca or Romana to14 introduce themselves and answer that15 question.16 ROMANA: I'm Romana17 (indiscernible) the Deputy Commissioner18 for (indiscernible).19 STENOGRAPHER: I didn't hear20 that.21
You have22 to speak into the microphone.23 ROMANA: Sorry.24 (Romana does not repeat her25 193 4.20.11 COMM. OF THE WHOLE - BILL 1101371 introduction.)2
Rebecca3 Rhynhart, Budget Director. Good4 afternoon.5 The question regarded the6 22 million in federal monies that show in7 Fiscal '12; is that correct?8
The reason for15 these payments being budgeted in '12 and16 '13 to -- into the General Fund are,17 they're late payments, so that those are18 reimbursements from the State and the19 feds that we are not anticipating getting20 in Fiscal '11.21
Yes. They will24 be billed for. And Romana could give25 194 4.20.11 COMM. OF THE WHOLE - BILL 1101371 more information on the types of2 payments, but the four reimbursement gets3 delayed, and so, it's not going to be4 received by the City in Fiscal '11, and5 that's something that we've already -- in6 our last quarterly report, the Fiscal '117 fund balance of $13.5 million already8 took that into consideration, but that9 comes in later than the end of the fiscal10 year.11 And then the Act 148 State12 payment, there's actually a significant13 lag in that payment. The Fiscal '0914 payment was received at the very15 beginning of Fiscal '11, so that's why we16 haven't received the Fiscal '10 payment.17 So that's why we budgeted that we would18 receive that in Fiscal '13.19
When do20 you typically receive your federal and21 State grant awards?22 ROMANA: So we receive the23 final allocation after the State budget24 has passed. So we get a tentative25 195 4.20.11 COMM. OF THE WHOLE - BILL 1101371 allocation after the Governor's address.2 So this year, it was March 3rd, so we get3 a tentative allocation the following4 week, but we don't get a final allocation5 until the State budget passes.6 So it's -- last year, the State7 budget passed, I think, sometime in8 mid-July. So we got a final allocation9 the end of July.10
Okay.11 What is the operational impact on your12 department if the State budget is not13 passed by June 30th?14 ROMANA: If the State budget's15 not the passed by June 30th, the impact16 is -- it does affect some of our 25017 contracted providers, our ability to kind18 of finalize what our allocation is for19 some of the services.20 So we have to kind of -- for21 the 290 place -- for all the placements22 providers, we're confident that we can23 get those contracts and move funding24 forward. But for the 250 providers, for25 196 4.20.11 COMM. OF THE WHOLE - BILL 1101371 some of our services, where we have to2 assess what our actual funding for those3 programs is, that is where we're -- where4 we struggle.5 COMMISSIONER AMBROSE: Yeah.6 And I just want to add, when the State7 budget wasn't passed on time two years8 ago, it was a disasters for our private9 providers. And so, we've really been10 trying to advocate for a budget that's11 passed on time, because then we're12 delayed in our contracting.13 And, thankfully, the Finance14 Department set up an emergency payment15 process, but private providers were very16 severely impacted by that delay.17
The issue18 is, if you move it to the Grants Revenue19 Fund and the State doesn't pass the20 budget, you can't spend the money from21 the Grants Revenue Fund. If you leave it22 in the General Fund, then you could honor23 your contracts.24
Well, as you25 197 4.20.11 COMM. OF THE WHOLE - BILL 1101371 know, we manage our cash on a2 consolidated basis. So the Grants Fund3 and the General Fund are together, in one4 pot of cash, in the consolidated cash5 account.6 So even when the -- when DHS7 was in the General Fund, and it still is8 currently, it still creates -- it9 actually creates a very big problem for10 us cash-wise when the payments are late11 or when the State budget is late, because12 we're, in essence, fronting money from13 the General Fund to pay for the DHS14 providers.15 So moving it to the Grants Fund16 will not impact our cash position, or it17 will still be the same amount of cash18 basis, because we commingled the cash.19 That's how we manage our cash; we20 commingle it.21 But it's still -- either way,22 it will be an issue for us if the State23 doesn't pass its budget on time.24
Okay,25 198 4.20.11 COMM. OF THE WHOLE - BILL 1101371 thank you.2 The Chair recognizes Councilman3 Goode.4
Thank you,5 Madam Chair.6 Good afternoon, Commissioner.7 COMMISSIONER AMBROSE: Good8 afternoon.9
Can you tell10 me what's the largest for-profit11 contracts you will award in Fiscal '12?12 COMMISSIONER AMBROSE: The13 largest for-profit for Fiscal '12 was14 VisionQuest.15
I said,16 what's the largest contract that you will17 award in Fiscal Year '12?18 COMMISSIONER AMBROSE: That is,19 yes.20 Oh, the largest -- that's the21 largest for-profit. Our largest22 nonprofit is PHMC.23
So the24 largest for-profit in the next fiscal25 199 4.20.11 COMM. OF THE WHOLE - BILL 1101371 year.2 COMMISSIONER AMBROSE: Correct.3
Okay, is4 VisionQuest.5 COMMISSIONER AMBROSE: Correct.6
And that's7 for how much?8 COMMISSIONER AMBROSE: For9 $19,427,051.10
And that's a11 renewable contract?12 COMMISSIONER AMBROSE: Correct.13
And how long14 has the firm held that contract?15 COMMISSIONER AMBROSE: It was16 contracted in '08 for '09.17
Okay. And18 is that firm a certified disadvantaged19 business?20 COMMISSIONER AMBROSE: No, sir.21
Does the22 firm subcontract with disadvantaged23 businesses?24 COMMISSIONER AMBROSE: Yes.25 200 4.20.11 COMM. OF THE WHOLE - BILL 1101371
What was the2 D/B/E participation goal in the RFP?3 COMMISSIONER AMBROSE: I don't4 know if it was addressed in the RFP of5 this contract. I don't have...6 (Desirée Thomas comes forward.)7
Desirée Thomas,8 Deputy Commissioner for Community-Based9 Prevention Services.10 When we did the RFPs in 2008,11 at that time, we were using the best-12 efforts standard that was established by13 OEO.14
That was the --17 during that time, our practice was to18 follow the lead of at -- that time, it19 was MBEC.20
No, that was last23 year, and we did not -- I guess in terms24 of us --25 201 4.20.11 COMM. OF THE WHOLE - BILL 1101371
You were5 procuring the service.6 COMMISSIONER AMBROSE: I agree.7 I acknowledge the responsibility last8 year. This was a contract; we didn't9 have an opportunity to re-contract this10 out. Next year --11
So the12 answer to the question is, you didn't13 identify the subcontracting opportunity,14 so you didn't put a goal if in the RFP.15 COMMISSIONER AMBROSE: Correct.16
Okay. Thank17 you.18 What was the goal in the19 contract?20 COMMISSIONER AMBROSE: Best21 efforts.22
The goal in23 the contract was best efforts?24 COMMISSIONER AMBROSE: In the25 202 4.20.11 COMM. OF THE WHOLE - BILL 1101371 original RFP, it was best efforts.2
Best3 efforts. What was the goal in the4 contract?5 COMMISSIONER AMBROSE: The same6 as was in the RFPs.7
The goal was8 best efforts.9 COMMISSIONER AMBROSE: Correct.10
And what has11 been achieved?12 COMMISSIONER AMBROSE: Their13 achievements have not been good on the14 subcontracting portion.15
I wonder16 why.17 COMMISSIONER AMBROSE: But at18 our request, they've actually done a lot19 of movement back to Philadelphia. So at20 our request, they moved their community-21 based detention shelter that was based in22 Chester County to Philadelphia, and they23 now have a hundred new staff working in24 that shelter.25 203 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Okay. You2 know what my questions are, right?3 COMMISSIONER AMBROSE: Yes.4
Okay. I'm5 asking about subcontracting6 opportunities. You didn't take the time7 to identify them for the RFP, so there8 was no goal in the RFP. You didn't take9 the time to identify them for the10 contract.11 The issue is: What has been12 done since then to identify13 subcontracting opportunities?14 COMMISSIONER AMBROSE: So they15 have two new subcontracting16 opportunities. For minority businesses,17 it's a total of $78,464. For women, it's18 a total $12,754. For con --19
So they have20 two new opportunities.21 COMMISSIONER AMBROSE: Correct.22
Is that the23 extent of the opportunities that exist24 within the contract?25 204 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COMMISSIONER AMBROSE: No.2 They have also -- for the new3 construction and build costs for the4 shelter that they relocated in5 Philadelphia, there's $250,000, and6 they're currently -- there's a potential7 spend with a letter of intent for8 $500,000 with United Bank to relocate9 some group homes in Philadelphia.10
Okay. What11 does that represent in terms of12 percentage of the total contract?13 COMMISSIONER AMBROSE: I'll ask14 somebody to do some quick calculations,15 but it's not the 25 percent goal that we16 have. It's not meeting our goal.17
I'll wait.18 ROMANA: So if it's about a19 million dollars out of a $20 million,20 would be 0.5 percent.21
It's 0.522 percent.23 ROMANA: I mean -- yeah, that's24 about a million dollars' worth of --25 205 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Okay. So5 what do you think is achievable under the6 contract in terms of subcontracting7 opportunities?8 COMMISSIONER AMBROSE: In9 discussions with VisionQuest, they have10 met with us on a number of occasions.11 They have also attended OEO's sessions on12 increasing their participation rates.13
My question14 is: What's achievable in terms of15 percentages of contract dollars in terms16 of subcontracting opportunities? I mean,17 clearly 0.5 percent is ridiculous.18 COMMISSIONER AMBROSE: Right.19 So most of their budget. Actually goes20 to paying staff salaries, and their21 staffing is primarily minority and women22 staff, and about --23
What24 percentage goes to staff salaries?25 206 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COMMISSIONER AMBROSE: I can2 tell you that. Hold on one second.3 Seventy percent. Their annual4 payroll is $11,700,000, and approximately5 $8,190,000 of that amount is paid to6 minorities and women.7
So 308 percent of the contract is not dedicated9 to staff salaries.10 COMMISSIONER AMBROSE: Yes.11
It's about12 $6 million?13 COMMISSIONER AMBROSE: Correct.14
And so, what15 portion of $6 million is available for16 subcontracting opportunities for17 businesses owned by minorities and women?18 COMMISSIONER AMBROSE: So those19 are the discussions that we continue to20 engage in with VisionQuest. And they've21 also hired somebody who's a minority who22 lives in Philadelphia to help them work23 on those efforts.24
In other25 207 4.20.11 COMM. OF THE WHOLE - BILL 1101371 words, you still don't know.2 COMMISSIONER AMBROSE: Correct.3
Okay. Is4 the firm in compliance with the City's5 living-wage-and-benefits standard?6 COMMISSIONER AMBROSE: They7 are.8
What's the9 largest nonprofit contract that you will10 award?11 COMMISSIONER AMBROSE: It's12 PHMC.13
Okay. And14 how long have they had their contact?15 COMMISSIONER AMBROSE: The16 same. The contract was issued in '08 for17 '09.18
And is the19 firm a certified disadvantaged business?20 COMMISSIONER AMBROSE: No.21
Is there a22 supplier diversity plan?23 COMMISSIONER AMBROSE: Yes.24
And what25 208 4.20.11 COMM. OF THE WHOLE - BILL 1101371 have they achieved?2 COMMISSIONER AMBROSE: They3 haven't achieved much in the areas of4 what they do, but their subcontracting is5 actually very good.6 So, for instance, their7 diversity plan wasn't something that was8 particularly helpful, so we --9
I have their10 numbers right here. It says 6.3411 percent.12 ROMANA: I'm sorry. Could you13 please clarify that?14
I have their15 numbers right here. It says 6.3416 percent.17 I guess you're wondering where18 I got it from. The Health Commissioner.19 ROMANA: Okay.20
So you21 didn't know it was 6.34 percent.22 COMMISSIONER AMBROSE: I23 actually think it's lower for DHS. I24 think that might be its numbers for the25 209 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Health number.2
But you just3 said you thought their numbers were4 pretty good.5 COMMISSIONER AMBROSE: Well,6 their numbers for subcontracting with7 minority firms are good.8
And what's9 the number?10 COMMISSIONER AMBROSE: So for11 our out-of-school time, the composition12 of executive director -- 53 percent are13 minority, the board is 43 percent14 minority --15
That's not16 what I'm talking about; I'm talking about17 subcontracting opportunities. You18 clearly still don't get it.19 Could Miss Dowd-Burton come to20 the table.21 (Ms. Dowd-Burton comes22 forward.)23
Good24 afternoon.25 210 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Good2 afternoon, Councilman. My name is Angela3 Dowd-Burton, Executive Director of the4 Office of Economic Opportunity.5
Has OEO6 looked at -- going back to VisionQuest,7 has OEO looked at subcontracting8 opportunities for the VisionQuest9 contract?10
We have11 looked at some opportunities but really12 have not done an in-depth --13
So does OEO14 know what the subcontracting15 opportunities should be, and out of the16 $20 million, what percentage of contract17 dollars should be going to businesses18 owned by minorities and women?19
So it's a25 211 4.20.11 COMM. OF THE WHOLE - BILL 1101371 $20 million contract, the RFP was put out2 with just best efforts, the contract was3 put out with just best efforts. The4 accomplishment so far has been one half5 of 1 percent, and we still don't know6 what opportunities exist within the7 contract.8
The contract9 went into place in 2008, and we will be10 working with, and have over the past year11 been working with, the Department of12 Human Services to analyze all of their13 contracts and to get their contract14 providers engaged in supplier diversity15 programs.16
Okay. Thank17 you.18 Madam President, I'd like to19 bring DHS back too. Thank you.20 COUNCIL PRESIDENT VERNA:21 Councilman, yes?22
I'm done.23 I'd like to bring them back when they24 have more information about that25 212 4.20.11 COMM. OF THE WHOLE - BILL 1101371 particular contract and what2 opportunities exist within that contract,3 and I'm not prepared to vote on the4 budget particularly funding them until5 they get a bit better with what they need6 to do in terms of diversity.7
Thank11 you very much, Madam President.12 We were concerned about three13 issues. One certainly is the whole issue14 of truancy with students, and I15 understand that's at about the same16 levels as last year.17 Would you give us some feedback18 on how you're handling that?19 COMMISSIONER AMBROSE: Sure.20 I'll also invite Desirée Thomas up, who's21 sort of leading these efforts for the22 Department of Human Services.23
Okay.24 COMMISSIONER AMBROSE: There's25 213 4.20.11 COMM. OF THE WHOLE - BILL 1101371 actually been a good collaboration2 between Family Court, the School District3 of Philadelphia, and DHS in the last4 couple of years. We've created a new5 planning process that's led by Erica6 Washington from the School District,7 who's really been terrific on trying to8 get the schools to be a little bit more9 proactive on the truancy issues.10 They've created a checklist of11 things that the school needs to do before12 they refer the case to Family Court. So13 the letters to the family have to be14 verified; the phone calls to the family15 have to be verified; the outreach to the16 family, including home visits, have to be17 verified before that case can even go18 Family Court.19 And we think that's a more20 effective, preventive way of getting both21 children and families engaged in22 education before it goes the truancy23 route and Family Court. And so, those24 efforts have actually been quite25 214 4.20.11 COMM. OF THE WHOLE - BILL 1101371 successful.2 The numbers have decreased a3 little because that process just started4 in January, but we feel very good about5 the partnership that we've built with the6 School District at this point.7 I don't know if Desirée has8 anything to add to that, but she's been9 leading that.10
Yes. For the16 fiscal year last year, 11,013 youth,17 grades 1 through 12, were served through18 Regional and Family Court. And at that19 time, we took just one approach to20 managing truancy and intervention.21 So all kids that the school22 deemed eligible for court went to court.23 So that was the 11,113 kids.24 This year, we took a age-25 215 4.20.11 COMM. OF THE WHOLE - BILL 1101371 differentiated approach to intervention,2 where kids in kindergarten to 3rd grade3 are diverted from court, and they receive4 Diversion Case- Management Services in5 the community.6 The assumption is that there7 are family issues that create the chronic8 absenteeism, and we want to deal with9 that. And so, kids again that are in10 kindergarten to 3rd grade are diverted11 from court.12 To date, we started receiving13 deferrals for that age group in December.14 And from December to April, there are 24115 youth that meet that criteria that are16 currently being served through our17 Diversion Case- Management Services.18 For grades 4 through 12, there19 are 6,793 youth that are currently20 receiving truancy case-management21 services and being supervised by Truancy22 Court.23 So the numbers are lower. But24 just as a caveat, during this time of the25 216 4.20.11 COMM. OF THE WHOLE - BILL 1101371 year, the numbers also spike. So we2 can't tell yet if it's a result of our3 intervention and the School District's4 screening so far that it's kept the5 numbers down or whether the numbers are6 actually going to spike up and we'll be7 around the same numbers that we were last8 year.9
Do you10 know how this new system, this new11 technological system, that the Police12 Department is engaged in with the13 schools, if that affects you?14
They20 do it for kids who are supposed to be on21 probation, so that they don't have to22 leave school. A lot of those kids would23 be truant as well.24 COMMISSIONER AMBROSE: I think25 217 4.20.11 COMM. OF THE WHOLE - BILL 1101371 you're referring to the in-school2 suspension protocol that they've3 developed.4
I5 don't think so.6 COMMISSIONER AMBROSE: Okay.7 Then we aren't a part of that.8 We do have a new information-9 sharing protocol with the School District10 of Philadelphia so we find an MOU with11 the Superintendent so that we can share12 information about children who are common13 to DHS and the School District, and14 that's part of our Education Support15 Center efforts.16 So we're able to share17 information that normally we wouldn't be18 able to share, so that if the school is19 concerned about a child who's DHS-20 involved, we sit down and meet with the21 counselors and the teachers and whoever22 is necessary to try to solve those23 problems.24 So that's been a huge25 218 4.20.11 COMM. OF THE WHOLE - BILL 1101371 advancement, and we signed that in2 December of '09.3
And4 how does this work with traditional5 public schools and charter schools; is6 the program the same?7 COMMISSIONER AMBROSE: We're8 working on an MOU with the charter9 schools but we're not there yet. And10 also the Archdiocesan schools.11
All12 right. Although their attendance is13 always up anyway. That's one of their14 successes.15 I understand that there's some16 concern about the intake system, and17 folks are concerned about the proposed18 cuts that the State makes and that if19 they give more money back to the schools,20 that they're going to hurt DHS, and that21 part of what you do is take -- if22 students -- if children needs meds, et23 cetera, you do that kind of taxi service.24 You take them there and make sure they25 219 4.20.11 COMM. OF THE WHOLE - BILL 1101371 get where they need to be.2 My question is: Do you expect3 to have the finances to continue this?4 If not, how will you maintain the5 service? If not, how do you propose that6 this will operate, given the needs of7 youngsters who still will need the meds8 as before?9 COMMISSIONER AMBROSE: Yeah.10 I'm actually not sure what service you're11 referring to, but we believe, based on12 the Governor's budget cuts that we won't13 have any kind of service impact at all.14 So that service should continue15 if it's something that we currently do.16 You might be referring to the17 old consultation and education service18 that DHS provided, but the School19 District has taken over that program, so20 I'm not really sure.21 The good news for DHS is that22 we expect to be able to cut -- cover the23 initial budget cuts from the Governor's24 office through staff positions and25 220 4.20.11 COMM. OF THE WHOLE - BILL 1101371 underutilization in one of our services.2 Now, we are concerned if the3 legislature decides to do something4 different, that there could be some5 impacts on DHS funding.6
And my7 final question is -- and maybe you8 responded to it. And that is about9 hiring and vacancies, what vacancies you10 have and how that affects the service you11 provide.12 COMMISSIONER AMBROSE: Sure.13 We actually have a lot of vacancies right14 now. I think we have 142 vacancies at15 this point.16 Part of the reason for our17 vacancies is that the system has shrunk.18 As we've continued to move children out19 of placement and increase permanencies,20 we have about 4,000 fewer children in the21 former child welfare system than we had22 three years ago.23 So our caseloads sizes have24 gone 19, when I first came, to about 1225 221 4.20.11 COMM. OF THE WHOLE - BILL 1101371 or 13 right now. And so, we haven't had2 the need to fill those positions. I3 think some of my staff might argue with4 me about that.5 We've -- at the same time6 caseload sizes have been diminished, I7 think we've created additional quality8 measures, including monthly visits by DHS9 staff. So right now, we're in the10 process of trying to readjust caseload11 sizes and move staff from non-carrying12 caseload to carrying caseloads.13 And so, that's a process that14 we're engaged in. We're working with our15 union leadership on making some of those16 adjustments, but we don't think at this17 point it's necessary to fill some of18 those vacancies in the social work19 practice areas.20 The areas that we're21 particularly concentrated are on the22 front end. So Intake, which is the23 Investigations Unit at DHS, which is24 really critically important to keep25 222 4.20.11 COMM. OF THE WHOLE - BILL 1101371 staffed up, and also hotline.2 Traditionally, the department has used a3 lot of overtime on the hot line, and we4 don't believe that's best practice. And5 so, we really want to change the way we6 staff those two sections. And that will7 the area of focused concentration to us.8
We9 would like to know how you want to change10 that. And also caseloads -- if a case is11 a child, does it not include that family?12 COMMISSIONER AMBROSE: So the13 cases are actually families.14
I15 thought so.16 COMMISSIONER AMBROSE: And each17 of our families has approximately 2.318 children. So some of our case workers19 have way more children than that should20 have if they have a big sibling group.21 But we now measure caseload22 size not by just the number of families23 but the number of children in that family24 so that we can understand the impact that25 223 4.20.11 COMM. OF THE WHOLE - BILL 1101371 it has on that worker's workload.2
So3 you're saying, then, that a worker's4 caseload is considered 2.3 children in5 the family?6 COMMISSIONER AMBROSE: Well,7 the caseload is families, and the average8 family size for each is 2.3 children.9 That's just an average, so you may have10 --11
So12 what if there are six children; then13 what?14 COMMISSIONER AMBROSE: Then we15 try to do some adjustments, but we aren't16 always able to do that. We don't have17 the sophisticated way of assigning cases,18 but we are looking at a weighing system;19 we're trying to develop a weighing system20 that would take into conversation not21 just the number of children in the22 family, but the complexity of those23 issues.24 So, for instance, some of our25 224 4.20.11 COMM. OF THE WHOLE - BILL 1101371 sex abuse cases can be far more2 complicated than a truancy case -- just3 kind of making this up. And so, if we4 create a waiting system, we might be able5 to more equitably distribute cases so6 workers aren't overwhelmed.7
Well,8 how can you have 142 vacancies and not9 have such a system and say you don't need10 the employees then?11 COMMISSIONER AMBROSE: Well,12 we're in the process of trying to develop13 that system.14
But we15 -- let me ask you to get this information16 back to the Chair, because 142 vacancies17 is a lot of vacancies, and for kids to be18 out there in large families, when we hear19 about people passing away and tragedies20 that happen, it generally involves some21 instance where somebody wasn't there or22 wasn't looking, for all kinds of reasons.23 You know, we've all heard for many, many24 years about people with these caseloads.25 225 4.20.11 COMM. OF THE WHOLE - BILL 1101371 We do not want people and2 children to be hurt because of the fact3 that they didn't have a case worker who4 could follow up because they have so many5 cases, and they're so -- I mean, it's6 common. We've heard it as long as I can7 remember, we've heard about these large8 cases.9 So we would like to -- all of10 the programs you mentioned that you're11 interested in starting, we would like12 specific information to be sent to the13 President, especially with regard to14 these vacancies.15 Thank you, Madam President.16 COUNCIL PRESIDENT VERNA:17 You're welcome.18 The Chair recognizes19 Councilwoman Brown.20
Thank you,21 Madam President.22 Good afternoon, ladies.23 PANEL MEMBERS: Good afternoon.24
A few25 226 4.20.11 COMM. OF THE WHOLE - BILL 1101371 follow-ups to Councilman Goode's line of2 questioning.3 With regards to VisionQuest, is4 there any other entity in the region that5 provides the type of services VisionQuest6 provides?7 COMMISSIONER AMBROSE: No. The8 closest area in the region that provides9 the type of service is Cornell, which10 runs a facility in New Morgan, which is a11 juvenile justice facility.12
Mm-hmm.13 COMMISSIONER AMBROSE: But they14 also have several other placements15 further away from Philadelphia.16 And so, one of the goals that17 we've had is moving children closer to18 Philadelphia, so we've been able to do19 that with our out-of-state population.20 VisionQuest has been the provider who's21 been most responsive to that.22 So as I was saying earlier,23 they moved their 120-bed shelter into24 Philadelphia, creating additional jobs25 227 4.20.11 COMM. OF THE WHOLE - BILL 1101371 for our residents and being closer to the2 families where our kids are from.3 They've also moved about 2004 beds closer to Philadelphia from5 Franklin, Pennsylvania, which is way6 close to the Ohio border and South7 Mountain.8
Mm-hmm.9 COMMISSIONER AMBROSE: And10 they've created additional beds closer to11 here by a new program called Lighthouse,12 and they've also created some community-13 based services at our request, functional14 family therapy being the biggest one.15 So we're trying to move the16 children closer to Philadelphia.17
I see.18 COMMISSIONER AMBROSE: And this19 is a provider who's actually complied20 with our request and been creative in21 thinking through on how we could do that.22
Okay. So23 your last statement is a summary of where24 I was headed to. They get it now, that25 228 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Philadelphia cares about keeping our kids2 as close to home as possible.3 COMMISSIONER AMBROSE: That's4 right.5
And6 they've made the appropriate internal7 systemic changes if they want to continue8 to be considered for funding; is that9 fair to say?10 COMMISSIONER AMBROSE: That's11 fair to say.12
Okay.13 COMMISSIONER AMBROSE: And14 we've met with them on many occasions15 about this.16
Okay, all17 right. So they get it with regards to18 there being really a policy change for us19 to move our kids closer.20 And then speak to how you've21 tried to help them understand the policy22 concern we have around MBE/WBE23 participation.24 COMMISSIONER AMBROSE: So since25 229 4.20.11 COMM. OF THE WHOLE - BILL 1101371 we've started meeting with them after2 hearings of last year, they have hired3 some additional staff. They're saying4 that some of their contracts -- so, for5 instance, we tried to work with them on6 the food-service contract at the new7 facility in Philadelphia.8 Unfortunately, that's with9 another company that -- the facility10 doesn't just service VisionQuest, and the11 food service is provided by a bigger12 entity that serves multiple agencies in13 that location.14
Okay, in15 the region?16 COMMISSIONER AMBROSE: Right.17
Okay.18 COMMISSIONER AMBROSE: And so,19 that's something we intend on exploring20 with Angela.21 The other areas that we talked22 about were food for some of their other23 facilities 'cause they just don't have24 children in Philadelphia. Clothing and25 230 4.20.11 COMM. OF THE WHOLE - BILL 1101371 additional subcontractors that they --2 COUNCIL PRESIDENT VERNA:3 Excuse me.4 Councilman Goode, you have a5 point of information?6
You said you7 tried to work with them on what?8 COMMISSIONER AMBROSE: We sat9 down with them and asked them -- told10 them we're very serious about this goal11 and that their numbers are not where they12 need to be and tried to explore with them13 and their consultant about ways that they14 can increase those goals.15 So we had a meeting as -- last16 week as well.17
And you18 suggested what to them?19 COMMISSIONER AMBROSE: That20 they should look at who they contract21 with for things like clothing for the22 children --23
And you24 mentioned food service specifically.25 231 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COMMISSIONER AMBROSE: Yes.2
Tell me3 about that conversation.4 COMMISSIONER AMBROSE: So we5 asked them why they couldn't contract out6 food service in their new shelter. And7 there are multiple tenants in the8 building that they're in, and there was9 an existing food contract, so they're10 going to continue to explore how they11 might maybe take out whatever food12 service they provide from their lease13 agreement and contract that out.14 So those are some of the15 conversations that we've had.16
And that17 food-service contract is part of a larger18 contract?19 COMMISSIONER AMBROSE: Correct.20
And who's21 that between?22 COMMISSIONER AMBROSE: I don't23 have the name of the company, but I can24 try to find out.25 232 4.20.11 COMM. OF THE WHOLE - BILL 1101371
So I can2 tell you specifically, when I questioned3 the Recreation Commissioner, she4 specifically talked about food-service5 contracts and how she pushed on that and6 was able to push specifically on a7 food-service contract participation that8 was in the single digits to 15, 20, 259 percent.10 So she's done it.11 COMMISSIONER AMBROSE: Okay.12
So maybe you13 need to talk to her.14 COMMISSIONER AMBROSE: I15 definitely will.16
So food19 service, clothing. What other type of --20 COMMISSIONER AMBROSE: Various21 services that children need, like22 sometimes they need to be seen by23 doctors.24 We explored education, but the25 233 4.20.11 COMM. OF THE WHOLE - BILL 1101371 education -- they're in the process of2 working with the Philadelphia School3 District on the educational portion of4 the services that they provide. So that5 isn't something that we were able to move6 forward on.7 If they have psychiatrists that8 come in to do med management, there are9 those kinds of opportunities.10 The bulk of their payments,11 though, are to their employees for12 salaries.13
Okay.14 When you attend those meetings, does an15 officer from OEO join you in those16 meetings with VisionQuest?17 COMMISSIONER AMBROSE:18 VisionQuest has attended two of the19 forums that OEO sponsored. In these20 meetings just between us and VisionQuest,21 I have not included them, but that might22 be a good idea for me to include Angela23 or her staff as we move forward.24
I would25 234 4.20.11 COMM. OF THE WHOLE - BILL 1101371 think so, just to help them understand2 that there are people in government who3 are not playing about this. And either4 they need to get it or they need to be5 prepared to reckon with the consequence6 of not getting it.7 COMMISSIONER AMBROSE: Okay.8
Okay?9 PHMC, they have a contract with you, with10 the Health Department, and they also have11 a contract with DHS.12 COMMISSIONER AMBROSE: Correct,13 they do have a contract with DHS.14
What15 services do they provide?16 COMMISSIONER AMBROSE: So the17 bulk of the services that they provide18 for DHS is our out-of-school-time19 contract, which is $32.822,133.20
Okay.21 COMMISSIONER AMBROSE: And our22 Parenting Collaborative, which is23 approximately $6 million.24
Okay. So25 235 4.20.11 COMM. OF THE WHOLE - BILL 1101371 help me understand. PHMC is a direct-2 service agency?3 COMMISSIONER AMBROSE: No.4 They're actually an administrative arm5 that helps support the administrative6 functions of smaller, more grassroots7 kinds of provider agencies.8
Okay. I9 thought that to be the case; I just10 needed to double-check my own thinking11 about that.12 Okay, I guess it's been two or13 three years that the very sad14 circumstance regarding the young -- the15 child Daneale -- help me remember her16 name.17 COMMISSIONER AMBROSE: Daneale18 Kelly.19
Right.20 Triggered an overall and a re-look-see at21 how DHS operates. And I know that each22 year, you've been about the business of23 rolling out and honoring recommendations24 that were in that final report.25 236 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COMMISSIONER AMBROSE: That is2 correct.3
What was4 the total of recommendations; do you5 recall?6 COMMISSIONER AMBROSE: Yeah.7 The total number of recommendations was8 37.9
And how10 far are you along in the implementation11 of those?12 COMMISSIONER AMBROSE: So we're13 in various stages of implementing all of14 the recommendations. There's really15 three that need additional attention.16 One is the clarification of17 roles and responsibilities between DHS18 staff and the provider staff, and that's19 our Improving Outcomes for Children20 Initiative that we're working on with the21 private providers, which is creating the22 single-case management model of service23 delivery.24
Right.25 237 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COMMISSIONER AMBROSE: And then2 really redefining the role of DHS staff3 to be more of practice specialists,4 monitors, technical assistance.5
Versus...?6 COMMISSIONER AMBROSE: Versus7 this lack of clarity about who does what.8
Okay.9 COMMISSIONER AMBROSE: And so,10 that's really a lesson learned from the11 Daneale Kelly case and something that12 we're actively engaged in planning on.13 The other two were establishing14 a local office. And we have determined15 that based on the Improving Outcomes for16 Children Initiative, we should wait on17 that, because, ideally, we'll be working18 with community groups in the areas where19 our kids are most likely to live and then20 creating a local office based on that21 work that we're doing with the community.22
Okay.23 COMMISSIONER AMBROSE: And then24 the third is collocation. And I'm happy25 238 4.20.11 COMM. OF THE WHOLE - BILL 1101371 to announce that we have identified a2 collocation site; it's actually going to3 be in Councilman Jones' district. And4 we'll hopefully be moved in there before5 July of '11.6
I see.7 COMMISSIONER AMBROSE: So this8 is one of the things that was important9 to the Mayor, and we're really pleased10 that we're moving forward on that. And11 that's the collocation of Philadelphia12 Children's Alliance, the Police13 Department, and DHS to collaborate on14 investigation so kids aren't15 retraumatized by multiple re-interviews?16
Yes, yes.17 Congratulations on that achievement.18 I too had additional questions19 around truancy and shared some of those20 concerns as Councilwoman Blackwell.21 So you gave the numbers of 24122 for little people, K through 3, correct?23
And then25 239 4.20.11 COMM. OF THE WHOLE - BILL 1101371 7,000-plus for young people, 4th through2 12th grade.3
Thank you.8 So now, how does the stat9 compare to last year? I mean, where are10 we in this continuum of the strategy for11 executing around truancies. Is it better12 than last year or what?13
I can tell you in14 terms of the numbers, again, last year,15 for the whole year, we really can't tell,16 but we serviced 11,000 kids total last17 year.18 Our strategy this year was to19 take a age-differentiated approach to20 truancy overall. And so, in terms of21 outcomes and whether or not the22 attendance has improved yet, I can say23 for the 241 youth that are currently24 getting services, because the services25 240 4.20.11 COMM. OF THE WHOLE - BILL 1101371 they give is a 90-day service, those2 families are engaged in the services, and3 the attendance is improving in terms of4 the 241.5
With the 6,793,10 truancy is a practice area for the Policy11 Analysis Center, where we are to develop12 an evaluation plan of both our process13 and our outcomes. And so, we presented a14 plan for that, to look at how we can15 evaluate our process, to see if it's16 effective; you know, how we did it last17 year and looking at how we're doing it18 this year.19
As well as21 looking at the outcomes for it, so we22 really don't know yet.23
Okay.24 It's premature to speculate.25 241 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Okay. I'm3 curious about one thing, typically the4 adolescents, young people between the5 ages of 4th and 8th are broken out,6 because, you know, their challenges are7 so different than 9th and 12th graders.8
And when10 you look at when the dropout grade11 actually begins to happen, it's typically12 after 9th grade. So, you know, they come13 in 9th grade and 48 months later, you14 know, we can't find them.15
So is17 there any particular reason why you've18 grouped together 4th through 12th-19 graders? I'm just curious.20
'Cause it22 would seem to me the treatment for a 4th-23 through a 8th-grader would be different24 than the treatment you would offer to a25 242 4.20.11 COMM. OF THE WHOLE - BILL 1101371 high school student.2
It's the -- the3 case-management services in terms of the4 4th to 12th grades are developmentally5 appropriate.6
And so, they have8 in-home case-management services as well.9 A case manager goes in the home and deals10 with the family as a whole.11
And so, they're13 aware of, you know, developmental issues14 and how to engage and stuff like that.15
And so, we23 determined that 4th through 12th grade24 cases needed court attention, so it's25 243 4.20.11 COMM. OF THE WHOLE - BILL 1101371 about court. The intervention components2 are similar.3
So the n,7 how do you define success when it comes8 to truancy? Does this mean that kids are9 going back to school and flourishing?10
It's a tough11 question. And in terms of defining the12 role, collaboratively, we're looking at13 improved school attendance.14
So if school16 attendance has improved, that's a17 measurement of our success.18
Of course, we want20 academic improvement --21 COUNCILWOMAN BROWN:22 Achievement.23 (Indiscernible; parties talking24 over each other.)25 244 4.20.11 COMM. OF THE WHOLE - BILL 1101371
-- achievement as2 well. But in terms of the scope of our3 initial intervention and the refinement4 of our process, we're looking at5 improving school attendance and6 alleviating crime and absenteeism, with7 the goal that once a child is in school,8 you know, on a continual basis and is9 engaged, that school achievement will10 occur.11
Okay. We12 could have a lot more conversation about13 truancy, but I'll move on, and I'm going14 to revisit this with Councilwoman15 Blackwell and then sit down with you all16 because we need to, I think, tackle that17 separate from all of the other work that18 you do, okay?19
Okay. You21 talked about the reduction in caseloads,22 and that too is a direct outcome or23 result of the recommendations you talked24 about, correct?25 245 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COMMISSIONER AMBROSE: That's2 right.3
Okay. I'm4 trying to get through this, 'cause I know5 Councilman Kenney has questions.6 Madam Chair, why don't we allow7 --8
And I'll11 come back.12 COUNCIL PRESIDENT VERNA:13 Yielding to Councilman Kenney.14
I16 appreciate that, and I also have truancy17 questions, so I guess it's better that I18 get mine in before you start to --19
Thank you.22 Does your truancy intervention23 stop at the end of the school year?24
I mean,2 when May or June rolls around and kids3 aren't in school, does the contact stop?4
It depends on if5 the family is still actively involved.in6 the service. And so --7
But of the8 241 families with the youngsters, is9 there any contact at all during the10 summer months?11
The service for12 the K through 3rd grade is a 90-day13 service.14
The providers, if16 they feel that there are issues that need17 continual monitoring or supervision and18 support in terms of the family, they can19 make a request to extend that service.20
But for the21 241 and even the rest of the cohort of22 kids --23
-- would it25 247 4.20.11 COMM. OF THE WHOLE - BILL 1101371 make more sense to start ramping up the2 contact intervention from mid-July, say,3 on through early September or so?4 COMMISSIONER AMBROSE: Yeah.5 And I actually --6
And let me7 flesh it out a little bit more. I mean,8 there's got to be some partnerships I9 guess we could develop with the school10 itself with organizations that are11 nonprofits that care about this stuff.12 COMMISSIONER AMBROSE: Mm-hmm.13
I mean, it14 could be an issue of not having money for15 clothes, it could be an issue -- I mean,16 you know the process when you're getting17 your kids ready to get back to school;18 it's a pretty long and drawn out and19 sometimes expensive process.20 And my thought is we identify21 the 241 in the last school year that are22 having difficulty in that area --23 COMMISSIONER AMBROSE: Mm-hmm.24
Would it25 248 4.20.11 COMM. OF THE WHOLE - BILL 1101371 not be better to start with them again in2 July or so, after the 4th, say, and start3 reminding schools coming, "Let's get4 rolling," you know, and send out notices,5 "School's going to start," and maybe have6 some contact from some other folks or7 maybe do something innovative in the way8 of children's clothing purchases, sales9 that these folks can get a voucher or a10 percentage sale thing where they can go11 to a Boystown or a Girlstown and get12 ready?13 It's more of a like -- as14 opposed to trying to treat the disease or15 the illness, if we can, like, encourage16 people and moms and dads and grandparents17 and everybody else, like, to kind of get18 this "we're getting back to school"19 thing --20 COMMISSIONER AMBROSE: Mm-hmm.21
-- as22 opposed to waiting till they don't show23 up for two weeks, and then we have to go24 do it on the back end.25 249 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COMMISSIONER AMBROSE: Yeah, I2 think those are great ideas.3 I think the other thing is that4 we do target some of those kids for the5 summer programs that we have. So there6 is a pretty good partnership with the7 Philadelphia Youth Network and the School8 District on the summer programs, and9 those kids would be priorities to make10 sure they have those programs.11 I think with the younger kids,12 the issues are far more complicated --13
Right.14 COMMISSIONER AMBROSE: -- which15 is why DHS is directly involved in case16 management, 'cause it's -- if you're in17 2nd grade and you're not going to school,18 it's not your fault.19
Correct.20 COMMISSIONER AMBROSE: There's21 something wrong in the home.22
But if23 you're not -- if you have situations24 where the only issue is the truancy or25 250 4.20.11 COMM. OF THE WHOLE - BILL 1101371 it's none of -- or where these2 youngsters, a 2nd grader, and they're not3 going to school, is the only issue the4 truancy, or are there other --5 COMMISSIONER AMBROSE: Usually6 --7
'Cause I8 know there are other issues in the home;9 are you dealing with any other issues?10
Yeah, we're11 dealing with the family as a whole. And12 I guess what you're talking about, one of13 the things that was missing from the14 planning for developing the truancy15 intervention was understanding why16 families were truant.17
And so, what we19 initiated was focus groups with20 stakeholders to get their reasons why so21 the school, the providers to find out why22 they believe kids are truant from school.23 And we're also developing a24 survey for both families and students25 251 4.20.11 COMM. OF THE WHOLE - BILL 1101371 that we're involved in now to gather that2 information to be able to look at data.3
But, for4 example, do your folks interface in any5 way with the elementary school principal?6
No, I'm15 talking about in the summer months, as16 we're just starting to --17 (Indiscernible; parties talking18 over each other.)19
Okay.25 252 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Well, I would like to talk to you at some2 point in time, maybe during the summer or3 right after school gets out, to start4 trying to figure out how to meet -- you5 see on TV at -- towards the end of July,6 you start seeing the back-to-school7 commercials and the Staples and the8 clothing and the stuff. I mean, it's9 just getting people's heads around that10 school's coming back.11 And I think if we wait until12 school starts up and the kids don't show13 up, then we're in a different --14 COMMISSIONER AMBROSE: Yeah, I15 mean, we actually do that.16
We're in a17 different climate.18 COMMISSIONER AMBROSE: We do19 the Backpack Challenge every year.20
Right,21 right.22 COMMISSIONER AMBROSE: -- for23 our AIC students, but we could certainly24 make that bigger. We actually have a25 253 4.20.11 COMM. OF THE WHOLE - BILL 1101371 very good partnership with the radio2 station that sponsored us last year.3
All right.4 COMMISSIONER AMBROSE: And we5 could make that more of a department-wide6 effort for all kids in the City --7
Okay.8 COMMISSIONER AMBROSE: --9 instead of just the older kids.10 And we really focused on those11 kids that were going to college and12 didn't necessarily have the financial13 resources to buy the kinds of things that14 youth need when they're on their way to15 college --16
Okay.17 COMMISSIONER AMBROSE: -- but18 we could certainly expand that --19
Okay.20 COMMISSIONER AMBROSE: -- and21 would be happy to have conversations with22 you about doing that.23
All right.24 I'll get with you after the election.25 254 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COMMISSIONER AMBROSE: Okay.2 (Laughter.)3
Sometime4 around May 18th, I'll (inaudible).5 COMMISSIONER AMBROSE: Okay.6
Thank you.7 COUNCIL PRESIDENT VERNA:8 You're welcome.9 Councilwoman Brown.10
Thank you,11 Madam President.12 I would like to be a part of13 those discussions too, after the14 election.15 COMMISSIONER AMBROSE: Okay.16
Okay.17 What is the total number of young people18 in the DHS system?19 COMMISSIONER AMBROSE: About20 over a 100,000 if you include out-of-21 school-time kids.22
Okay.23 COMMISSIONER AMBROSE: So the24 services that we provide, there's a huge25 255 4.20.11 COMM. OF THE WHOLE - BILL 1101371 continuum of services right from children2 that are in the Prevention Division, who3 receive services in out-of-school-time-4 programs, to children in secure detention5 on the Juvenile Justice side.6 So the total number is usually7 over a 100,000 kids served a year.8
Okay. So9 let's break that down into the two10 categories you just talked about.11 The young people in the12 out-of-school side, that number is what?13 COMMISSIONER AMBROSE: At any14 one time, it's 10,233 slots that we have15 available.16
Okay. And17 the other 85-plus thousand are in secured18 facilities?19 COMMISSIONER AMBROSE: Oh, no,20 no, no, no.21 So some of those slots rotate.22 So there's not -- at any one time23 throughout the year, those slots can24 rotate.25 256 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Oh, okay.2 COMMISSIONER AMBROSE: And then3 we have a whole continuum of prevention4 services, including the truancy youth and5 children that Desirée talked about,6 children involved in our pre Rs and Rs,7 which is Alternative Response Service8 System.9
Okay.10 COMMISSIONER AMBROSE: Children11 receiving services through Family12 Stabilization Services.13
Okay.14 COMMISSIONER AMBROSE: So15 there's a huge continuum that we have.16 And we look at least intrusive to most17 intrusive, and that's the playing field18 that we have, yeah.19
Okay,20 that's a better picture.21 I clearly remember after the22 report, the discussion around training23 and professional development for24 professionals at DHS.25 257 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COMMISSIONER AMBROSE: Mm-hmm.2
So give us3 a update on where that is, how often it4 happens, when you have training, how5 impacts that staffing, et cetera, et6 cetera.7 COMMISSIONER AMBROSE: So8 according to my staff, it happens far too9 often, and I think that that's true.10 We've had tremendous mandates on our11 staff to change as a result of the12 Daneale Kelly case.13 The biggest area where we've14 really done tremendous amounts of15 training is the Safety Model of Practice.16
Okay.17 COMMISSIONER AMBROSE: So we've18 adopted a Safety Model of Practice. The19 criticisms of the agency were that we20 became too many things to too many21 families in the City and that we really22 needed to focus in the Children and Youth23 Division on those children that were at24 risk for abuse and neglect.25 258 4.20.11 COMM. OF THE WHOLE - BILL 1101371 And so, we've adopted, through2 work with the Community Oversight Board,3 a new way of taking cases, which is the4 hotline guide decision-making tool, which5 is a differential response tool that6 looks at safety as being the reason why7 we would accept a case for service after8 investigation.9
Okay.10 COMMISSIONER AMBROSE: And then11 a very sophisticated assessment tool that12 required tremendous amounts of training13 for our staff in order to be able use14 that tool.15 And so, I think staff are right16 when they are concerned about the number17 of hours they've spent in training. And18 so, that's been a huge area of focus.19 The other area of focus that we20 worked on is supervisory training, so we21 haven't necessarily always given staff at22 DHS the tools that they need when they23 become supervisors. And so, we went24 through a practices process of looking at25 259 4.20.11 COMM. OF THE WHOLE - BILL 1101371 a better -- through a steering committee,2 what would be a better training model for3 them to use. And we went through with4 the support of Casey Family Programs.5 And what we found after the6 initial pilot phase is that we didn't7 include some of the nuts and bolts. So8 we're now working on revising that9 training.10 The other training that we're11 mandated is, every staff person on the12 children youth side is required to do 2013 hours of training every year to be in14 compliance with the State regulations.15
Is that16 right? Was that in place prior to17 Daneale Kelly?18 COMMISSIONER AMBROSE: Yes.19
Okay.20 COMMISSIONER AMBROSE: And so,21 staff do -- we've implemented a bunch of22 new models that are best-practice models.23 So Family Group Decision-Making requires24 training family, finding requires25 260 4.20.11 COMM. OF THE WHOLE - BILL 1101371 training.2
Okay.3 COMMISSIONER AMBROSE: We've4 done training on fatherhood. And the5 real urgency in DHS is doing a better job6 at reaching out to fathers as potential7 resources for kids.8 The other thing that we've9 started doing in the last year is10 planning for something we're calling "DHS11 University." And that's a way of looking12 at training not just as substance but how13 do we give our staff the competencies to14 move up in the agency? How do we give15 them an opportunity to enhance their16 skills in a way that allows them to be17 better workers, better supervisors,18 better administrators and directors?19 So that would be, hopefully,20 something that we're able to do online.21 So you could have staff do it on their22 own time instead of having to come over23 to talk and sit, do it on their own time24 with a pre- and post-test so it's more25 261 4.20.11 COMM. OF THE WHOLE - BILL 1101371 convenient for them.2
And you3 discussed this new model of treating4 young people and families. And when you5 consider the mission of DHS, who is --6 and when you factor in the Daneale Kelly7 case, 'cause that really changed life for8 everybody in a needed way, who's9 ultimately responsible, the service10 provider or DHS?11 COMMISSIONER AMBROSE: DHS.12
Okay.13 Council Lady/Majority Leader Tasco has14 some additional questions.15 Under Governor Corbett's16 budget, significant cuts have been17 proposed for the State education funding.18 If cuts are shifted from State education19 funding to the State human services20 funding, what areas at DHS are most21 likely to be impacted by those22 reductions?23 COMMISSIONER AMBROSE: So we've24 been on a pretty aggressive lobbying25 262 4.20.11 COMM. OF THE WHOLE - BILL 1101371 campaign to make sure that doesn't2 happen. We spent a couple of days up in3 Harrisburg a couple weeks of ago meeting4 with legislators.5 But I think, unfortunately,6 what would be most vulnerable, if the7 legislator decides to make additional8 cuts, would be our prevention services.9 So the safety nets that we've really10 tried to build, that have definitely11 impacted our improved outcomes for kids12 would be at risk.13 So the reason we've been able14 to reduce placements, I think, and15 increase permanencies is because we have16 prevention services available for17 families that are at risk in18 Philadelphia.19 And I think by definition,20 almost every family in Philadelphia who21 lives in certain zip codes is at risk22 because of the poverty levels here, and23 the poverty levels that are here are much24 higher than any other county in the25 263 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Commonwealth.2 And so, that's something that3 we really hope doesn't happen, and would4 appreciate any support from Council that5 we could get to maintain our current6 funding in prevention.7
So let's8 walk that. When you say "we," you're9 going to Harrisburg and actually meeting10 with State officials and elected11 officials there?12 COMMISSIONER AMBROSE: Yes.13
I see.14 COMMISSIONER AMBROSE: So we've15 met with the new Secretary for the16 Department of Public Welfare, we've met17 with several legislators, talking about18 the importance of prevention services,19 talking about the improved outcomes that20 we've been able to achieve.21
Okay.22 COMMISSIONER AMBROSE: Talking23 about how Philadelphia is different, and24 that this is a really important service25 264 4.20.11 COMM. OF THE WHOLE - BILL 1101371 to maintain in order to continue to2 provide better services to kids and3 families.4 And, ultimately, it's more5 fiscally responsible because the high-end6 things that we don't have to do anymore7 are because we don't have the safety net8 for at-risk families.9
Mm-hmm,10 okay. On , you discuss an11 initiative to create -- we've actually12 talked about that -- the single case13 management tool, have we not?14 COMMISSIONER AMBROSE: Correct.15
Okay. And16 you've stipulated that this model will17 have a stronger emphasis on keeping18 children with providers in their home19 communities.20 COMMISSIONER AMBROSE: That's21 right.22
What steps23 will be taken to ensure that all24 providers indeed have the ability to25 265 4.20.11 COMM. OF THE WHOLE - BILL 1101371 sustain that level of service for the2 children?3 COMMISSIONER AMBROSE: I'm not4 sure --5
I guess it6 boils down to accountability and/or7 monitoring of providers.8 COMMISSIONER AMBROSE: So I9 think what we would do is actually work10 with other jurisdictions that have done11 this as created lead agency models, with12 one performance-based contract for that13 lead agency that would include certain14 requirements.15 So easily, we could include the16 OEO requirement of 25 percent, and that17 lead agency would be responsible for18 maintaining that and reporting out on19 that level.20 The lead agency would be able21 to provide the administrative support22 that's necessary to comply with the23 federal and state regulations that DHS24 has.25 266 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Okay.2 With the increased pressure to reduce3 costs due to budget constraints, what is4 the cost-benefit analysis of outsourcing5 staffing; for example, nurses? Do you6 outsource nurses?7 COMMISSIONER AMBROSE: Yes. So8 we have hired nurses at DHS since the9 Daneale Kelly case; that was one of the10 requirements of the Community Oversight11 Board.12
Okay.13 COMMISSIONER AMBROSE: And14 we're continuing to do that based on15 Dr. Christian's assessments of the needs16 of the kids and families that we serve at17 DHS.18
Is that19 indeed more cost-effective?20 COMMISSIONER AMBROSE: Based21 upon our initial analysis, it is more22 cost-effective.23
Wow.24 Okay. I want to make sure I've gotten25 267 4.20.11 COMM. OF THE WHOLE - BILL 1101371 through all of my questions as well.2 I'm going to take a page out of3 Councilman Goode's book and ask Angela4 Dowd-Burton to come back to the table,5 please.6 (Ms. Dowd-Burton returns to7 witness table.)8
Thank you11 very, very much.12 Simply state for me, define13 what is "best efforts." What does that14 mean?15
The16 individual that is responding to a17 request for a proposal or a bid will have18 to take certain actions to demonstrate19 that they have seriously looked for a20 minority- or a female-owned business that21 can support the effort of a particular22 contract.23
So, for25 268 4.20.11 COMM. OF THE WHOLE - BILL 1101371 example, they would go into our registry2 and see if there are companies that have3 the commodity codes that support the4 contract that they're pursuing.5
(Inaudible,9 off-mic.)10 COUNCIL PRESIDENT VERNA:11 Councilman Goode.12 COUNCILMAN GOODE:13 Ms. Dowd-Burton, if that's the case in14 terms of implementing the contract in15 terms of the RFP, why would best efforts16 ever be used as a goal?17
When we have18 identified few or no companies in our19 registry. So the first place they would20 start is the new registry, if there are21 any.22 If there are none there, they23 would altogether look at various industry24 associations to locate companies.25 269 4.20.11 COMM. OF THE WHOLE - BILL 1101371
That's the2 technical answer, but on any number of3 contracts with this department and a4 number of contracts in other departments,5 best efforts was used without actually6 looking at subcontract opportunities.7 That's been proven already.8 So sometimes best faith efforts9 is just giving someone a pass.10
Well, the11 legislation that was passed last year12 strengthened the good and best-faith13 efforts that we include --14
That relates15 to the implementation of the contract;16 that does not relate to what you set as17 goals in the RFP.18 In terms of setting goals in19 the RFP, OEO staff and departmental staff20 should be doing due diligence to actually21 see what opportunity actually exist.22
And so,24 sometimes best-faith efforts is put in as25 270 4.20.11 COMM. OF THE WHOLE - BILL 1101371 a goal because no one actually looked to2 see whether opportunities existed or not,3 so that's just a simple truth.4
You can, but9 I've proven it this year and last year10 that that's the case.11 And in particular, the contract12 related to VisionQuest, best-faith13 efforts was put in the RFP, best-faith14 efforts was put into the contract.15 You've only achieved 0.5 percent, and16 you've said yourself that you don't know17 whether subcontract opportunities exist18 or not.19
Well, what I20 said was, the contract was put in place21 in 2008.22
And since24 that time, we've put additional actions25 271 4.20.11 COMM. OF THE WHOLE - BILL 1101371 and requirements in place --2
-- in terms11 of the actual VisionQuest contract.12 Should best-faith efforts have been put13 in the RFP and the contract, or were14 there more subcontract opportunities that15 should have been identified? And should16 a goal, some goal, even it's single17 digits, possibly double digits if someone18 actually did the work, but single digits,19 single digits has to --20
Councilman, I24 would absolutely say at least single25 272 4.20.11 COMM. OF THE WHOLE - BILL 1101371 digits given the time period for food,2 for clothing, for stationery supplies,3 for maintenance on facilities, yes, those4 are --5
Then it10 should have been best-faith efforts.11 Thank you, Madam President.12
You know,22 we're beginning to sound like a broken23 record.24
And so5 with that, have you or your designee sat6 down with the Law Department to help them7 understand that best-faith efforts in8 RFPs based on the description as outlined9 by my colleague, quite frankly, is10 probably unacceptable, because if you11 look far enough -- if not in the City, in12 the region -- you might -- we might look13 up and find an MBE/WBE that could honor14 some of the particulars of that contract.15
That's17 number one.18 Number two, have you worked19 with the Law Department to craft20 stronger, more explicit language? 'cause21 you were very explicit in the way you22 just described it here.23
But any25 274 4.20.11 COMM. OF THE WHOLE - BILL 1101371 conversations with the Law Department2 towards that end?3
We work very4 closely with the Law Department on the5 language that goes into our requests for6 proposals, our bid language, into our7 economic opportunity plans, absolutely.8 And the definition of "good and9 best-faith efforts" is not a pass. It is10 a clear demonstration that companies have11 taken deliberate steps to pursue the12 identification.13 Now, some companies -- and I'll14 say this really clearly -- in for15 example, the Procurement organization,16 where we have that list of few and no17 companies --18
And the fact21 of the matter is, we rely on a lot of22 companies to look across a broader region23 and across their industry to identify24 minority- and female-owned businesses25 275 4.20.11 COMM. OF THE WHOLE - BILL 1101371 that can support a contract, and that2 there have been more subcontracts this3 year than ever before in certain areas4 that we've never seen subcontracting5 before, because companies are competing6 to ensure that they get participation on7 their contracts in order to achieve the8 goal and to win the bid or the request9 for proposal.10
The staff17 people that are assigned to the OEO18 staff, people that are assigned to the19 Health Department, DHS, and other related20 departments --21
-- have they23 ever put goals in RFPs? Or have they24 always generally put best-faith efforts.25 276 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Okay. Give7 me goals for -- just name any contract8 under Health in the past, under Health9 and Human Services.10
All right.12 Give me the most aggressive goal that you13 know of.14
Okay. The17 truth of the matter is that MBEC always18 gave those departments a pass in terms of19 setting goals in RFPs. It was hands-off.20
Councilman,21 I'll be happy to provide you with22 additional information; I don't have it23 with me.24
Okay, thank25 277 4.20.11 COMM. OF THE WHOLE - BILL 1101371 you.2 COUNCIL PRESIDENT VERNA:3 Anything else, Councilwoman Brown?4
So will5 there be new language regarding minority6 contracts with regard to best-faith7 efforts so that will continue to be the8 phrase that's used?9
We will use10 "good and benefit faith efforts" in11 instances where we cannot definitively12 identify a goal.13 As an example, companies now --14 you know, if we have no goals, it's zero.15 Good and best-faith efforts gives us an16 opportunity to look at those17 opportunities that companies come to us18 with, where they've identified companies19 that can support their contract as20 participants.21
Okay. Let22 me ask you the follow-up question, 'cause23 we've known this to be true.24 Where companies do that, and25 278 4.20.11 COMM. OF THE WHOLE - BILL 1101371 unless we, on our side of the table, do2 the look-see, the investigation to ensure3 that they are who they purport to be,4 then we end up getting surprised on the5 back end to discover that they're not MBE6 and WBEs.7
And I'll8 share with you, when companies are put on9 the solicitation and commitment forms --10 and these are the forms that we actually11 use -- where the minority or female12 actually is identified, or the disabled-13 owned business, the percentage of the14 contract is placed on that form along15 with the commercially acceptable function16 that that company, that minority- or17 female-owned business, is expected to18 provide.19 So there's detail there that20 ultimately goes into the contract when21 that contract is awarded. The companies22 that are identified on that solicitation23 and commitment form go into the prime's24 contract.25 279 4.20.11 COMM. OF THE WHOLE - BILL 1101371
And we hold3 them accountable.4 We also contact the subcontract5 -- the companies that are on that6 solicitation and commitment form prior to7 award to confirm that they, yes, were8 called, they did agree they were going to9 provide that kind of product or service.10
Okay. So17 that's an improvement from years past.18 Commissioner?19
Okay. So the20 Commissioner has just identified a few of21 the contracts from Fiscal Year 2011 where22 we've identified the goals for minority-23 and women-owned businesses.24
That wasn't25 280 4.20.11 COMM. OF THE WHOLE - BILL 1101371 my question. My question was related to2 MBEC, my question was related to pre-OEO3 and what the practice was before.4 And, therefore, unless you've5 hired new staff, they're not used to6 setting goals, they're not used to going7 through contracts, they're not used to8 actually looking at contracts that are9 renewable contracts and say, "Let's go10 back and set goals now."11 That's the problem.12
Okay. So13 we -- I hear that you're talking about14 the previous contracts that are in place15 and whether or not we've ever taken a16 renewable contract and put goals in it.17 That is a focus that is emerging for us;18 we're absolutely going to do that.19 The contracts that we are, in20 fact, placing requests for proposals in21 the marketplace and bids that are going22 into the marketplace have more ranges on23 them and goals than we've ever had before24 so --25 281 4.20.11 COMM. OF THE WHOLE - BILL 1101371
So there6 continues to be a lot of discussion and7 conversation about the business of8 running DHS as well as the programmatic9 piece of DHS. Both matter equally.10
My last12 question is a rewind back in time. Now13 with the benefit of hindsight and the14 Daneale Kelly case again, did we lose15 anything by no longer having SCOH16 services, which is, you know, a place17 where I come from, and the value they18 help to service their children.19 COMMISSIONER AMBROSE: So we --20 in my opinion, I don't believe that we21 lost anything, and let me tell you why.22 We still have services for23 children in their own homes. So,24 remember, SCOH was services to children25 282 4.20.11 COMM. OF THE WHOLE - BILL 1101371 in their own homes.2 We now have a continuum of3 services for children in their own homes4 that depends on the risk level of that5 family.6
Okay.7 COMMISSIONER AMBROSE: So when8 we do a safety assessment, if there's a9 safety risk to that child, we implement10 in-home protective services, which is the11 highest level of service that we can12 provide in-home.13
Okay.14 COMMISSIONER AMBROSE: And that15 service is supposed to mitigate that16 safety threat.17 And for families that don't18 present with intensive need, we try to19 divert them out of the formal child20 welfare system because, usually, the21 families that come to us where there22 aren't safety issues poverty-related.23 And families don't deserve to24 be in the formal child welfare system25 283 4.20.11 COMM. OF THE WHOLE - BILL 1101371 'cause they're poor; they deserve to get2 services that help them keep their3 children and families together in the4 community.5 And so, I believe what we've6 tried to create here is better than SCOH,7 because SCOH was one-size-fits-all, and8 it labeled too many families as being9 part of the abuse and neglect crowd;10 when, in fact, they actually just need11 some supportive services in the12 community.13
I see.14 Okay, well, thank you for that15 explanation.16 So in closing, I want to17 restate how Councilwoman Jannie Blackwell18 and Member Jim Kenney and I are19 interested in this truancy question and20 want to be a part of that conversation21 after the election.22 And on the staffing piece,23 there are X-number of -- you said 14024 vacancies?25 284 4.20.11 COMM. OF THE WHOLE - BILL 1101371 COMMISSIONER AMBROSE: Yeah.2 And not all of those are social-work3 positions.4
Okay, all5 right.6 COMMISSIONER AMBROSE: Some of7 them -- we are a large agency, so we're8 always going to have some vacancies.9 Some of those vacancies haven't been10 filled because we don't believe there's a11 need to.12
Okay.13 COMMISSIONER AMBROSE: Others14 are in various stages of the process to15 get positions filled, particularly in the16 area of Finance and Revenue Enhancement17 activities.18
All right,19 okay.20 COMMISSIONER AMBROSE: We're in21 the process of filling a number of those22 vacancies. And there are also some23 vacancies in the Juvenile Justice section24 for Youth Study Center staff.25 285 4.20.11 COMM. OF THE WHOLE - BILL 1101371
Okay. And2 so, given whatever that number is, when3 do you anticipate the next class of4 professionals to help move and fill those5 vacancies?6 COMMISSIONER AMBROSE: We7 haven't planned a new class for social8 work service managers yet. We have9 students, C well students and C web10 students, coming onboard that we'll be11 hiring.12 And then after we do some of13 the readjustments that we've sat down and14 discussed with our union leadership,15 we'll determine whether we need to hire a16 new class.17
Okay. All18 right, then.19 Well, I do want to -- given20 where we were last year on the program21 side, to commend you for -- because it is22 an enormously big undertaking to save so23 many children. So know that I appreciate24 all of the work that you and your team of25 286 4.20.11 COMM. OF THE WHOLE - BILL 1101371 professionals do.2 COMMISSIONER AMBROSE: Thank3 you.4
Thank you,5 Madam Chair.6 COUNCIL PRESIDENT VERNA:7 You're welcome.8 Councilman Goode.9
Thank you,10 Madam President.11 Commissioner who handles RFPs12 and contracts for your department?13 COMMISSIONER AMBROSE: Joe14 Kronhour (sp?) is actually the Assistant15 Commissioner who handles contracts. And16 since last year, we've assigned Yvonne17 Farrell as our point person on all OEO18 issues.19
And how long20 have they worked in those capacities?21 COMMISSIONER AMBROSE: Joe has22 worked in that capacity since I've been23 the Commissioner.24 And Yvonne has worked in that25 287 4.20.11 COMM. OF THE WHOLE - BILL 1101371 capacity since last year; however, she2 has extensive experience in working with3 contracts at the Department of Human4 Services. And so, we thought she was a5 good fit for the jobs since she knows the6 providers. And she's the one who meets7 with Angela and her staff on a consistent8 basis.9
So her10 history of -- her contract history with11 DHS goes back how far?12 COMMISSIONER AMBROSE: Hold on13 one second.14 Twenty years.15
Is she16 available to come to the table?17 COMMISSIONER AMBROSE: Sure.18 (Yvonne Farrell comes forward.)19
Good21 afternoon. Simple question. What22 percentage of contractors start --23
I'm24 sorry, Councilman.25 288 4.20.11 COMM. OF THE WHOLE - BILL 1101371 Please identify yourself for2 the record.3
Simple6 question. Historically, what percentages7 of contracts under DHS have had8 good-faith effort historically?9
Are18 there any other questions?19 (No response.)20
Are21 there any other questions from members of22 the committee?23 (No further questions.)24
Thank25 289 4.20.11 COMM. OF THE WHOLE - BILL 1101371 you very much.2 COMMISSIONER AMBROSE: Thank3 you.4
Thank5 you, Commissioner.6 MR. McPHERSON: Our next7 department is the Office of Supportive8 Housing.9 COUNCIL PRESIDENT VERNA:10 (Pounds gavel.) We're still trying to11 conduct business. Please leave quietly.12 Good afternoon.13
Good afternoon.14 COUNCIL PRESIDENT VERNA:15 Kindly identify yourself for the record.16
My name is Dainette17 Mintz. I'm the Director of the Office of18 Supportive Housing.19 COUNCIL PRESIDENT VERNA:20 Please proceed.21
Good afternoon,22 President Verna and distinguished members23 of City Council. 11 COMM. 2 The mission of OSH is to assist3 homeless individuals and families in4 moving towards self-sufficiency and the5 operation of Riverview Home, providing6 housing to low-income elderly and persons7 with disabilities. 11 COMM. OF THE WHOLE - BILL 1101371 The Fiscal Year '12 OSH Budget2 supports a total of 167 positions. 6 There are 49 state and federal7 grant-funded positions. 5 percent, are bilingual9 or trilingual, with fluency in languages10 Spanish, French, Yoruba, Igbo, Chinese,11 Mandarin, and to Malayalam. 20 A summary of the OSH Fiscal21 '11. After the submission and adoption22 of our Fiscal Year '11 budget OHS's state23 grant funds were reduced by a million24 dollars. 11 COMM. OF THE WHOLE - BILL 1101371 the first quarter of Fiscal Year '112 included the loss of 80 units of capacity3 for families in both emergency and4 transitional housing. 11 COMM. 11 COMM. 13 A total of 2,300 of the14 households received financial assistance15 to help them stay in their homes through16 the prevention component. 11 COMM. 16 In 2008, Philadelphia extended17 a invitation to Pathways to Housing to18 join our existing housing-first partners,19 Horizon House and 1260 Housing20 Development Corporation, in our efforts21 to end street homelessness. 11 COMM. 4 Pathways to Housing5 Philadelphia is currently serving 135 men6 and women with serious mental illness7 and/or addiction. 13 The OSH Fiscal Year '12 Budget14 summary. 22 At the beginning of Fiscal Year23 '11, we had 5,900 beds. 11 COMM. 4 The outlook for Fiscal Year '125 is extremely challenging. 11 COMM. OF THE WHOLE - BILL 1101371 eliminated, OSH will seek to preserve 172 of the 41 HSDF positions with general3 funds instead by shifting costs from our4 Class 200 to Class 200 budget. 12 The loss of the State Grant13 Funds would reduce availability of social14 workers, and emergency relocation efforts15 would eliminate protective services for16 abused and neglected individuals, 7017 monthly. 11 COMM. 14 Also in Fiscal Year '12, OSH15 will be phasing out the City's largest16 emergency housing site for single men at17 1360 Ridge Avenue, which has the capacity18 to serve up to 340 men. 11 COMM. 8 In addition, the three-year9 $23 million Homeless Prevention and Rapid10 Rehousing Program, funded through the11 American Recovery and Reinvestment Act,12 will end in the first quarter of Fiscal13 Year 13. 11 COMM. 12 Our minority business13 participation rate. Historically, the14 expertise of providing homeless housing15 and supportive services lies in the16 nonprofit provider community. Seventy-17 two percent of these contracts are with18 organizations that provide housing to19 homeless individuals, and the remaining20 28 percent of the contracts are awarded21 to agencies to provide supportive22 services. 11 COMM. OF THE WHOLE - BILL 1101371 agencies contract dollars goes to2 nonprofit providers. 11 OSH also partners with OEO to12 survey the top 100 nonprofit contractors13 of the Health & Opportunity cluster, and14 OSH is the lead agency for nine of those15 top 100 nonprofit contractors. 11 COMM. 2 percent. 9 For Fiscal Year '12, the OEO10 minority, women, and disabled for-profit11 goal for OSH is 25 percent. 11 COMM. 11
Thank12 you.13 The Chair recognizes Councilman14 Blackwell.15
Thank16 you.17 Thank you, Ms. Mintz's staff.18 We appreciate all that you do.19 Your testimony does, in fact,20 frighten me, and I hope that the21 Administration is listening and will22 realize that in 2011 and '12, we do not23 need to go backward and have more people24 on the streets of our city.25 305 4.20.11 COMM. OF THE WHOLE - BILL 1101371 (Applause.)2
It3 took us a while around this city to try4 to have homeless people not in front of5 every Wawa and every shop you'd stop at6 if you wanted to get a cup of coffee.7 And we are really, really frightened with8 that. We're frightened about the closing9 of Ridge shelter.10 (Applause.)11
And we12 are hopeful that the Administration will13 hear how important it is that we do not14 have homeless people on the streets.15 I have only one specific16 question, and that is: Someone asked me17 to ask you before they left about Ridge18 Avenue and -- no, about our senior19 shelter, not Ridge. You know what I'm20 trying --21
Riverview?22 COUNCILWOMAN BLACKWELL:23 Riverview. And their concern was that it24 was closed, and people were let go, labor25 306 4.20.11 COMM. OF THE WHOLE - BILL 1101371 people, union people, and that it opened2 up without union people.3 Could you talk a little bit4 about that for the record?5
Sure. At the6 beginning of Fiscal Year '11, when we7 realized the State reductions, we looked8 at where we could provide and absorb the9 impact.10 And one of the things that we11 did was to reduce the census at12 Riverview. We decided to close one of13 the cottages. And in my testimony, I14 made reference to the fact we partnered15 with DPW to relocate.16 So one cottage has capacity17 reduce the capacity by 48 persons, so we18 were attempting to reduce the capacity by19 48 individuals, single men. And we20 worked with them to make those reductions21 concurrent with the reduction of the22 census and the closing of that cottage.23 We no longer needed to have the same24 number of health care aids because we had25 307 4.20.11 COMM. OF THE WHOLE - BILL 1101371 a reduced census. So we also laid off2 four health-care aides at Riverview.3 And the ability for us to move4 forward was that we also had utilized a5 empty cottage to provide some overflow6 housing for homeless families, and we7 also eliminated that and relocated those8 families with -- using our Homeless9 Prevention Rapid Rehousing component.10 I believe that what folks may11 be concerned about is that when we12 eliminated using that cottage for13 families, we no longer needed to have the14 Riverview staff providing continued15 services. And so, that eliminated some16 overtime, et cetera.17 But we did not hire non-City18 staff because we no longer had the19 activities occurring there.20
But the facility is23 still opening and still operating. It24 currently has a census of about 9925 308 4.20.11 COMM. OF THE WHOLE - BILL 1101371 people, and that's one male and one2 female cottage.3
About 99 are -- we6 want the census to be no more than a7 hundred, and I think we have one vacancy.8
It was closing one11 cottage. There's a number of cottages on12 the campus.13
And we just closed15 one cottage that was housing disabled and16 elderly residents. And then we also17 stopped using one other cottage that we18 were using for extra space for homeless19 families.20
Okay.21 Thank you. That will answer his22 question.23 And I would love to hear from24 the Administration. I saw our...25 309 4.20.11 COMM. OF THE WHOLE - BILL 1101371 (Ms. Rhynhart comes forward.2
Good afternoon.3 Rebecca Rhynhart, Budget Director.4 Councilwoman Blackwell, to your5 point, the Administration definitely6 understands the gravity of the cuts that7 the State -- that the Governor's proposed8 budget is making to homeless services,9 and that's something that we are working10 on right now.11 So we agree with you that this12 is a deep concern, so we're working on13 the possibility of what to do here.14
Well,15 I hope we have some specific plans. We16 knew that this year would come from the17 blueprint that Carl Greene helped18 negotiate with the City, and that was a19 big, big, big help. So we are grateful20 for that and to him for that.21 But we knew this year would22 come, irrespective of the change in23 administrations and that we would need --24 that we would need this help also with25 310 4.20.11 COMM. OF THE WHOLE - BILL 1101371 this plan to cut -- certainly to get rid2 of Ridge Shelter; that's no news, either,3 which is another tragedy for 340 men,4 when we don't have anything.5 I know it's more popular to do6 smaller shelters. But the issue is, you7 know, that people don't disappear. And8 we have to have safe, clean, well-cared-9 for people and facilities that offer the10 best possible kind of care.11 And we really are concerned12 about what happens, and we're asking you13 to ask the Administration to come up with14 plans as to what's going to happen.15 I mean, we have our night16 programs. And often, they don't last in17 the summer. And in the summer, we18 realize that more people, more homeless19 people, prefer to be outside than inside.20 But it still doesn't lend for21 the best situation in our city because22 all of the people who come here, who23 visit here, complain, and then the24 Administration has the other problem.25 311 4.20.11 COMM. OF THE WHOLE - BILL 1101371 So it behooves us all. We have2 to do what we can to have specific3 problems to deal with the population that4 we know exists.5 Madam President, I say it every6 year. We know who our homeless are, we7 know where they are. We know everything8 about them. We have their case history.9 We're not someplace big that10 accepts them like New York. In New York,11 they accept 'em. They have job training,12 they have places just for vets, you know,13 a place as big as the Convention Center14 just for vets.15 We have a couple years where we16 pay for their lodging and job training at17 the same time because they accept that18 there are people who, through fire,19 through domestic problems, through all20 kinds of reasons, who have issues with21 where they stay.22 And I think that our city has23 not yet arrived to the point where we24 accept this as part of life and25 312 4.20.11 COMM. OF THE WHOLE - BILL 1101371 something -- all of those who deal with2 it, you know, certainly, Ms. Mintz and3 all of her crew realize, this but our4 city has to accept the fact that this is5 an issue that we will have to deal with6 and plan for these eventualities and plan7 when we know problems may occur.8 So what I'm asking is that you9 would send to the Chair a plan as to what10 we will do, given cuts, if they are cut,11 and what -- and given the cuts that are12 mentioned here about what this department13 is supposed to do with homeless people on14 the streets of Philadelphia.15 (Applause.)16
We are17 very committed to this issue. The late18 Lucien Blackwell started homelessness as19 an agency being funded during the20 beginning of the Rizzo years. And we21 still believe that in a city as great as22 ours, we should not have people who still23 have to sleep in subways or on the24 streets, on benches and parks. It25 313 4.20.11 COMM. OF THE WHOLE - BILL 1101371 shouldn't be that way.2 (Applause.)3
And I4 continue to hope that one of these days,5 while I am still here, that we will see a6 plan for everybody such that the only7 people in the streets would be a person8 who's had a fire that day or evicted that9 day or had a problem at home that day10 because we have a plan for everybody else11 we see out there.12 (Applause.)13
So we14 are prevailing to you to have a plan15 submitted to the President of Council16 that will address all of these issues so17 that we know what the plans are.18 There always should be some19 areas that are exempt from cuts;20 homelessness should be one. My goodness,21 people have to eat, people have to have22 someplace to stay. This is one of those23 areas that we believe should be exempt.24 Since it is not, then the25 314 4.20.11 COMM. OF THE WHOLE - BILL 1101371 second-best thing is that we have a plan2 to address all cuts. And, again, we3 request that that be submitted to the4 President.5
Sure. We are6 working on that as we speak, so we'd be7 happy to, when we're completed with that,8 submit that to the Chair.9
Thank10 you.11 Thank you, Madam President.12 COUNCIL PRESIDENT VERNA:13 You're welcome.14 Since there is no one else15 to -- I don't think anyone else here has16 any questions beside you and me.17 So thank you. We appreciate18 your testimony. Thank you.19
It's been a20 pleasure working with you. I wish you21 all the best in your retirement.22
Thank23 you. Thank you so much.24 This committee will stand in25 315 4.20.11 COMM. OF THE WHOLE - BILL 1101371 recess until Tuesday, April the 26th, at2 10 o'clock.3 (Proceedings end at 4:18 p.m.)4 * * *5 6 316 C E R T I F I C A T E2 I HEREBY CERTIFY that the4 proceedings of the City of Philadelphia5 Council Committee of the Whole are contained6 fully and accurately in the stenographic notes7 taken by me on Wednesday, April 20, 2011, and8 that this is a true and correct statement of9 same.10 _________________________________ JOSEPHINE CARDILLO Registered Professional Reporter15 (The foregoing certification of21 this transcript does not apply to any22 reproduction of the same by any means, unless23 under the direct control and/or supervision of24 the certifying reporter.)25