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2005 Testimony

Testimony Before the House Appropriations

Human Resources Subcommittee
Representative Delzer, Chairman

Regarding House Bill 1012 - DHS Budget - Human Service Center Overview

January 28, 2005

Chairman Delzer and members of the Human Resources Subcommittee, I am Yvonne Smith, Deputy Director of the Department of Human Services. Today you will receive testimony from each of the regional human service center directors in regard to the regional demographics and trends that affect service delivery, and the changes in their regional budgets in response to those factors.

Over the past several years, human service centers have taken on the role of “safety net” for individuals whose mental illness, addiction, or disability place them at risk for harming themselves or others, as well as children and adults whose conditions cause them to be at risk of out-of-home or institutional placement. In this capacity, human service centers deliver a wide array of community based services, including the following:

  • Evaluation, treatment, and care coordination services for people who have serious mental illnesses, developmental disabilities, and substance abuse issues.
  • Evaluation and treatment services for children who are abused or neglected, attending to the needs of not only the children but also their families.
  • Assessment and intervention services for elderly people whose well-being is endangered by abuse, neglect, or exploitation.
  • In addition to the direct service responsibilities, the human service centers are responsible for program supervision and regulatory oversight of the child welfare services provided by county social services and oversight of the Aging Services programs in their regions.

One focus of our management team during the past two biennia has been to create greater alignment of services among the regions. To this end, core services have been established and continue to be examined and refined among the regions. (See Attachment A)

During State Fiscal Year 2004, human service centers served a total of 22,738 people, including 17,528 adults and 5,171 children. (39 people did not have birth dates recorded in our system.) This compares with a total of 23,086 clients served in SFY 2003 including 17,800 adults and 5,280 children. (6 people did not have birth dates recorded in our system.)

  • Individuals received a total of nearly 773,000 hours of direct service.
    • Because of the variation in client service needs, actual direct “billable” service hours per client range from a low of less than one hour to a high of 59 hours during the year.
    • 9% (2,046) of the clients served were seen only one time in the year.
  • Client fees are paid by third party insurance including Medicaid, or by the client subject to a sliding fee scale.
    • 43% of the clients seen have no third party payer at all.
    • 26% have Medicaid coverage only.
    • 17% have Medicaid coverage plus another third party payer.
    • 14% have no Medicaid coverage, but have another third party payer.

During the same time period, 6,815 individuals received services at the human service centers through Vocational Rehabilitation. Of these, approximately 30% also received another service through the human service center.

The charts on Attachment B show the percentage of the state’s population living in each region, and the percentage of the total human service center clients served by each region. You will note that there is considerable consistency between these two sets of data.

Statewide there are general trends that affect the demands placed upon the human service centers:

  • Centers face increasing referrals from the courts, law enforcement, and the corrections system, particularly in regard to the need for addiction evaluations and parental capacity evaluations. While we attempt to meet the expectations and timelines imposed, we are not always successful, particularly when we have staff vacancies.
  • Centers face increasing referrals of young children with developmental delays. This appears to be related to earlier identification by hospitals and clinics, the survival of more at-risk infants, and the federal requirements for screening/assessment of young children who are victims of abuse or neglect.
  • The treatment needs of methamphetamine users have affected the centers, creating a need for longer treatment programs, increased residential capacity, and increased medical detoxification services. Data indicates that overall the number of human service center clients involved with methamphetamine has doubled in the past year and a half. Alcohol addiction, however, is still by far the most common.
  • The complexity of the problems presented by clients continues to increase. Most individuals exhibit more than one presenting problem. Many clients are diagnosed with both an addiction and a mental illness. The design of the human service centers as multi-disciplinary teams is critical in comprehensively addressing the complex needs of the clients we serve.
  • Human service centers are falling behind in our ability to compete in the marketplace for salaries for professionals. Because the demand for the skills of certain professionals exceeds the supply, there is considerable competition for licensed addiction counselors, clinical psychologists, psychiatrists, and experienced social workers.

PERFORMANCE INDICATORS

  • Since the human service centers are the direct service arm of the Department of Human Services, the performance outcomes of the human service centers are tied to the client services measures of the following divisions: Mental Health and Substance Abuse; Disability Services; Children and Family Services; and Aging Services.
  • In addition, the following performance goals have been established:
    • 100% of the individuals requesting service will be given an initial appointment within 10 working days.
    • 100% of emergencies will be responded to through all human service centers 24 hours a day, seven days a week.
    • Human service center administrative costs will be under 10%.
    • 80% of clients surveyed will report overall satisfaction with the services received at the human service centers.

MAJOR BUDGET HIGHLIGHTS

  • Human service centers receive a lump sum budget, in order to allow the needed flexibility in managing resources to meet the client needs. This flexibility has allowed centers to adjust their resources by choosing between purchasing and providing services, based on cost-efficiency, service demand and availability within the regions, and staff recruitment factors.
  • The total budget request for the human service centers is $116,856,144, of which $54,970,793 are general funds. When compared to the overall budget of the Department of Human Services, the human service center budgets comprise just under 7% of the total budget request. This request compares with a 2003-2005 budget of $109,240,856, of which $51,941,128 are general funds.
    • The Governor’s salary and health insurance package accounts for $5,037,225 of the total increase, and $3,029,076 of the general fund increase.
    • Prior to adding in the Governor’s salary and health insurance package, along with a slight increase in bond payment ($783), the human service center budgets had increased by only $2,577,280 in total including $589 in general fund, an increase of 2.4 % total, or one one-thousandth of one percent in general funds.
    • Federal funding enhancements were received by the centers from the Substance Abuse Prevention and Treatment Block Grant ($2.3 million), and Vocational Rehabilitation ($200,000). Each of these funding sources is tied to specific service requirements, and cannot be used to supplant other funding.
This concludes our statewide overview. Unless you have questions, the human service center directors and business managers will proceed with the region-specific overviews and the budget details.

Thank you.

 

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