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 current economic turmoil only heightens the importance of the services of Health and Opportunity. Increased unemployment means increased need for the services offered across the Health and Opportunity agencies.
Increases in unemployment automatically add to the number of the nation’s uninsured and will undoubtedly increase the need for City health center services.
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.
The Department of Behavioral Health and Mental Retardation Services (DBH/MRS) and the Office of Supportive Housing (OSH) joined forces to advance the Mayor’s Homeless Strategy. Specifically, this initiative involved the expansion of treatment services and the use of reinvestment funding to develop fifty five additional low-demand beds with behavioral health services to help move people living on the street. DBH also increased its investment in behavioral health services provided to residents of emergency shelter, helping to offset some of the reductions OSH was forced to make to balance its budget in FY09.
- 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.
Protection and support of vulnerable populations, enhanced opportunities for youth, healthy communities with opportunities for residents, and improved use of data across service systems to improve client outcomes and determine program effectiveness will continue to be of great importance in FY10. If the City is successful, then one day every Philadelphian will have a home, every resident will have access to health services, children and adults will be able to engage in a wide range of activities and every resident will be safe. In the next fiscal year, each agency in Health and Opportunity will continue on a path to make these hopes a reality.
- The Office of Supportive Housing and the Department of Behavioral Health and Mental Retardation Services will continue efforts to expand housing opportunities. Through a partnership with Philadelphia Housing Authority (PHA), OSH will expand permanent housing for families and singles. DBH/ MRS will implement an initiative to increase rent-subsidized apartments for its clients through a partnership with the Pennsylvania Housing Finance Agency (PHFA), providing long-term, apartment-based rental subsidies for 63 adults with mental health and/or substance abuse issues. Funding to support this project has been provided via Health Choices reinvestment dollars.
- DBH/MRS will continue the reconfiguration and recovery-focused transformation of mental health and substance abuse residential services to focus on increased independence for individuals living in congregate housing. Other programs are moving to a recovery focus that expands the use of community settings and allows participants to achieve individualized goals including education, employment, housing, spirituality, and socialization. A continuation of the specialized Intensive Residential Assessment Initiative will enable persons who have been incarcerated to re-enter the community. This project serves to reduce delays in the release of offenders from incarceration into residential drug and alcohol treatment programs. Initial outcomes have been positive and, as a result, consideration is being given to pursuing expansion.
- The Early Intervention and Children’s Unit in DBH/MRS will ensure the effective delivery and coordination of services to address the needs of children who are at risk for developmental delays. This collaborative connects children age birth to three to early intervention services and provides supports to some of the City’s most vulnerable families.
- The Department of Public Health will continue the maintenance and improvement of core public health services to protect and promote the health of all Philadelphians and provide a safety net for those most at risk. The Department provides over 300,000 primary care visits per year to over 80,000 adults, children, and pregnant women. Over 50% of the patients are uninsured and have few other options for primary care. The Department also provides free vaccines to over 350 medical offices for patients without medical insurance. Focusing on the most vulnerable, DPH will continue its home-based family support programs for over 3,800 high-risk families with young children to reduce infant mortality and connect women and children to needed social services. Monitoring the city for 57 reportable illnesses and infectious diseases to prevent their further spread is a key component of public health services for Philadelphians, along with management of an STD clinic that tests and treats thousands of patients per year, and through multiple partnerships, the work of the AIDS Activity Coordinating Office to coordinate screening, treatment, and social support for Philadelphians living with HIV/AIDS.
- In FY10, DHS will launch full implementation of In-Home Protective Services (IHPS) and Alternative Response Services (ARS). DHS is undertaking a massive restructuring of its in-home services to children at risk of abuse and neglect currently known as SCOH (Services to Children in their Own Homes). IHPS will address the needs of children who are in need of a protective intervention, but who can stay in their homes with the implementation of a comprehensive safety plan. Children who do not need a protective intervention, but who can benefit from other services to build families’ protective capacities and prevent risk of maltreatment, can be diverted to an ARS program where they will receive services of lesser intensity than IHPS. It is expected that 1,800 families will be served by IHPS. Implementation of Family Stabilization Services (FSS) will provide the final step in phasing out Services for Children in their Own Homes. FSS will bridge the two new services by providing in-home services to approximately 600 families in FY10, who are not experiencing active safety threats but who are court ordered to be monitored by the Department.
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”