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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.
-
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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