Along with its many assets and amenities, Philadelphia is a City with a high poverty rate, low educational attainment among residents and great need for support services and healthy recreational and developmental activities that support children while parents are at work or school. The departments in the Office of Health and Opportunity provide these services and activities, comprising a critical piece of the City’s safety net and offering opportunities for every citizen. Further, the grouping of these agencies allows the Office to enhance public safety and quality of life for all residents of the City.

The Department of Human Services is responsible for mandated child welfare and juvenile justice services for the children of Philadelphia and offers a range of supports to children and families to keep them safe and secure. The Departments of Public and Behavioral Health offer direct health services as well as services that protect citizens from environmental risk and communicable disease. The Office of Supportive Housing provides shelter and housing programs for those who have no home of their own as well as supports to develop self-sufficiency. These services are available to every citizen regardless of ability to pay. As the country’s economic situation worsens, they become even more critical.

Some of the services offered in this cluster are mandated and must be maintained. Others, while not mandated, provide healthy, safe environments for our City’s most vulnerable and so were preserved despite a difficult budget situation for all departments. After-school programs, homeless shelter beds and lead poisoning prevention programs fall into this category. Moving forward, our plan is to increase the focus on population-based approaches at a primary prevention level instead of high-cost interventions after damage is done.

The clinics are often the only dependable providers of basic services like prenatal care, childhood immunizations, asthma treatments, cancer screenings and tests for sexually transmitted diseases. ^viii “Research has repeatedly shown a higher prevalence of ill health…in men and women who are unemployed”. ^ix Furthermore, “… longer-term unemployment causes deterioration in mental health in those who were previously healthy”. ^x

Faced with a declining City budget, and an expectation of increased need, department staff made some critical decisions about services to be preserved.

• The Office of Supportive Housing insured that no shelter beds or housing program slots would be cut. Additionally, funds that support the Mayor’s Homeless Strategy were preserved as this partnership with the Philadelphia Housing Authority provides permanent housing and support to families and chronically homeless individuals.
• The Department of Public Health, which serves a high proportion of those with no health insurance through its eight health centers, balanced the need to provide critical public health services while insuring that primary care remained available to those in need. The Department will maintain its system of health centers; instead of service reductions, the Department will increase fees and improve collections. With an expected increase in the uninsured, the provision of primary care through these centers becomes an even more critical part of the City’s safety net.
• All services for abused and neglected children and for children at risk of entry into the child welfare and juvenile justice systems were preserved. The Department kept service reductions to a minimum by targeting programs that were duplicative of services being provided in other systems. DHS also found savings in administrative efficiencies such as fewer contracts.

Every department in Health and Opportunity held numerous meetings with staff, provider agencies and interested stakeholders to insure that all voices were heard as part of the budget process for FY10.

While the Department of Behavioral Health and Mental Retardation Services (DBH/MRS) did not face City cuts, reductions from the Commonwealth were required during the current fiscal year and additional reductions may be required in FY10. The Director instituted monthly meetings with the directors of contract agencies and provider organizations and other stakeholders. Of primary concern to stakeholders was the desire to avoid across the board reductions. In response, the department enacted only targeted reductions to services, based on performance, as well as administrative savings associated with hiring freezes and other reductions.

Because so many of the services of the Department of Public Health are community - based, the Commissioner and Chief of Staff met with the entire workforce to solicit feedback and ideas about how best to meet growing community need in a time of fiscal austerity. Meetings were held with the members of the Board of Health and the health center community boards, as well as other community stakeholders, to get feedback on proposed budget reductions and revenue enhancements. In response to a request for more health data on the neighborhoods served by each of the health centers, the Department of Public Health developed and published a report entitled, “Health Center Service Areas: Examining Population Health in Philadelphia,” available on its website.

In FY09, the Office of Supportive Housing reduced case management budgets in contracts with non-profit organizations that provide emergency housing to single men and women, as well as to two programs serving homeless families. In considering FY10 budget reductions, stakeholders were strongly opposed to additional reductions in case management funding and OSH agreed to identify alternate reductions.

These collaborations provide options for those most in need that were not available before. Not only are new behavioral health supports offered, but individuals who have spent years living on the streets have embraced the low demand offering, taking the first step to recovery.

• Every department has instituted administrative savings, including unit and position consolidations and overtime reductions. DHS expects to reduce overtime spending by more than $1 million this year through strict adherence to and enforcement of overtime policies and will continue this overtime management next fiscal year.
• The Department of Public Health is integrating services and consolidating three divisions:
  • Maternal, Child, and Family Health;
  • Lead Poisoning Prevention;
  • Chronic Disease Prevention, leading to a net reduction of eight positions.
• This consolidation is being done to address coherently the underlying predictors of poor health outcomes, to think creatively about surveillance, analysis, and policy development to protect and promote health and move towards a Healthy Homes model for which the Department expects to receive federal funding that targets many of the health risks inherent to poor housing.
• In order to increase revenues to support services, the Health Department is instituting fees for some services, including a sliding-scale fee for patients of its eight primary care health centers and a charge for applicant physical examinations at its Medical Evaluation Unit. These two items are expected to bring in over $1 million in revenue in the next fiscal year. New restrictions on dispensing of over-the-counter medications and reinstitution of a utilization review process related to pharmacy and laboratory utilization in Ambulatory Health Services are both expected to reduce department expenditures. By implementing these initiatives, the Health Department is avoiding crippling service cuts.

viii Kevin Sack, “Expansion of Clinics Shapes Bush Legacy”, The New York Times, 26 December 2008

ix Bartley, M. Jane Ferrie, S.M Montgomery, “Living in a High-unemployment Economy: Understanding the Health Consequences”

x Ibid.