Social Work News

Tuesday, October 18

Recent Testimony by NASW Illinois Chapter Members

Joel L. Rubin, MSW, CAE
NASW Illinois Chapter Executive Director

This past week, the following NASW Illinois Chapter members provided testimony on two pressing state issues:

  • Joe Harper, LCSW, to the Commission on Government Forecasting and Accountability (COGFA) on the proposed closing of Chester Mental Health Center.
  • Marge Berglind, president and CEO of Child Care Association, to the state’s Budgeting for Results Commission.

Their testimony reflects the importance of members of the association using their knowledge and expertise to shed light on important social work professional issues.
 

Joseph J. Harper, LCSW

DHS has submitted a recommendation to the Commission for the closure of Chester Mental Health Center. This is in conjunction with closure requests for other state operated psychiatric hospitals and the virtual elimination of acute care civil psychiatric beds in the state hospital system. The plan submitted by DHS is inadequate and will deal a death blow to the system of mental health care in Illinois.

Chester Mental Health Center is the mental health “emergency room” for the state. Chronically mentally ill patients (both civil and forensic) who are unable to be treated elsewhere due toviolent and aggressive behaviorsin community and state operated psychiatric hospitals or the correctional systemare sent to Chester for treatment and stabilization. CMHC and its predecessor organizations were created over 100 years ago and proudly serve this function. The facility was created by state statute and is permitted to function with special provisions for maintaining the safety of staff and patients. The DHS closure recommendation letter indicates that Alton MHC will be designated as the new maximum security facility for the state simply by installing $550,000 of security perimeter fencing. ; this is undoubtedly underreporting as it does not reflect costs associated with other physical plant modifications, provisions for additional staff, staff training etc.

The mental health system in Illinois is currently in crisis and is unable to provide adequate psychiatric services for the community. The current state of affairs is outlined in a position statement issued by the Illinois Hospital Association in May of 2011:

  1. Illinois state operated hospitals had approximately 35,000 beds in the 1950-1960’s. By 2009 only 1,400 beds remained in the IL state hospital system.The number of licensed psychiatric beds throughout the state decreased from 5,350 in 1991 to 3, 869 in 2010—a 28% decrease.
  2. In 2009, Illinois hospital ED’s treated 750,000 people with a behavioral health condition. Of those, more than 190,000 had a primary diagnosis of mental health or substance abuse.
  3. There are 53 IL counties that do not have any form of inpatient psychiatric care.

Community mental health center s and private hospitals do not have the resources to deal with additional patients. Many have already had significant budget reductions. The DHS closure recommendation asserts that DHS will provide “minimal funding to serve patients in the community setting.” Those costs are not enumerated in the closure recommendation. In addition, DHS indicates that it will assist community hospitals with “building capacity” to serve 2,800 annual admissions. Again the specifics of the associated costs are not outlined.

The State of Illinois should not make the same mistake that the State of Missouri did last year in eliminating most of their state hospital civil beds. Missouri unceremoniously “dumped” the responsibility for some 4,000 individuals previously served by the state system on the community. This resulted in an influx of untreated chronically mentally ill consumers in the Emergency Rooms of private hospitals. The wait time for all patients to be seen in the emergency rooms increased, the wait time for availablepsychiatricbeds has increased, and the level of violence in the emergency rooms has increased. Psychiatric patients often find it difficult to deal with the chaotic environment of the typical emergency room and staff are often not equipped to deal with this population. The transition has been so problematic that the state has had to assist with reopening the St. Louis Metropolitan Psychiatric Center.

From personal experience and the clinical literature, I can assure you that the movement of the untreated chronically mentally ill from the state hospital systems to the correctional system –a process termed trans-institutionalization—is a stark reality. The correctional system in Illinois is already overburdened and being scrutinized for their inability to effectively treat these individuals in that system. Dismantling the state hospital system will undoubtedly lead to increased incarceration rates for the chronically mentally ill and increased problems for the correctional system.

Numerous professionals on the front line are opposed to this proposed change in the operation of the state hospital system. My own professional organization, the National Association of Social Workers Illinois Chapter, representing approximately 7,000 professional voting Illinois social workers, has voiced their opposition to this plan in writing to Governor Quinn. I applaud the organization and my colleagues for standing up for those without a voice in our society. I am requesting that the Commission summarily reject the DHS recommendation for the closure of Chester Mental Health Center.
 

Margaret M. Berglind

We thank the Committee for the opportunity to provide comments on the important task of Budgeting for Results.

The Child Care Association of Illinois (CCAI) represents 65 child welfare agencies that provide services for Illinois children in such areas as residential treatment, foster care, child mental health, juvenile justice, youth services and special education. The services provided by our agencies benefit Illinois children and families, and many of the services directly benefit vulnerable children and fragile families, and are provided upon referral by state agencies as part of state contracts.

The CCAI supports the concepts included in the Budgeting for Results initiative. However, we are concerned about major components of the process for the human service related priorities:

  • How state agencies seek input and agreement from the private contract agencies in the Budgeting for Results processes, budget requests and suggestions for efficiency; and how the state agency’s ideas for efficiency in state government might impact their private providers
  • How state agencies monitor their private providers
  • How state agencies can quickly adopt greater efficiencies in monitoring their private contractors.

SEEKING PRIVATE PROVIDER INVESTMENT IN BUDGETING FOR RESULTS

The human services system in Illinois relies heavily on private agencies to provide the direct care and programs for our citizens. Any initiative for state human agencies to Budget for Results translates into private contract agencies providing such results. In the Department of Children and Family Services, for example, private agencies provide nearly 95% of the direct care of state wards—either in foster care or residential treatment. In the Department of Human Services, 100% of the youth services work in communities is provided by private agencies.

It is imperative that Illinois adopt a process that mandates that state agencies seek consultation from their private sector partners as they pursue funding requests, develop performance measures and monitor those measures. Such consultation has to be more than the occasional meeting at which information is given out to providers, or the alert that new contract expectations are posted on a state agency web site. The process must include shared analysis of need, open discussion on areas of system or performance improvement and discussion of cost.

The Department of Children and Family Services uses a Child Welfare Advisory Committee (CWAC) process to work with its providers in many areas of child welfare system improvement. This process is mutually chaired by the public agency executives and private providers. Private providers have helped design our performance contracting models and metrics. CCAI has long advocated for a structure similar to CWAC in the Department of Human Services. We still await formation of a public/private provider oriented group that can help DHS grapple with its many service, program and budgetary challenges. As the Department of Juvenile Justice moves to a system of more community based services for its young people, we strongly suggest they develop a provider group now. We ask the commission as part of its recommendations to:

  • Insist that the same CWAC process be used by DCFS as that agency enters into a Budgeting for Results process.
  • Insist that Department of Human Services adopt a Provider Advisory Group process as that agency enters in a Budgeting for Results process.
  • Insist the Department of Juvenile Justice develop a Provider Advisory group as soon as possible.

MONITORING PRIVATE PROVIDERS

CCAI agencies understand and agree that when vital state functions are contracted to private providers, the state must provide proper oversight. However, as part of Budgeting for Results, the state agency must be required to detail why the monitoring funds they request are truly necessary, and how such monitoring is actually making services better. They should be asked to stretch to determine if they can be more efficient and effective in their monitoring as a state function.

State agencies must be required to develop “Monitoring That Matters.” In partnership with provider agencies, state agencies should examine the types of data, material and information that truly reflect good practice, competent care and the ability to mutually improve outcomes for clients. Current private agency monitoring is often developed only by state agency staff, frequently in a checklist format, with information based on single incidents/anecdotes. Such monitoring does not really improve the quality of care for Illinois children and families and expends valuable state funds that could be put to better use.

We ask the commission, as part of its recommendations to

  • Insist state agencies implement “Monitoring That Matters” for any contracted human services.

STATE AGENCIES TO ADOPT GREATER EFFICIENCIES IN MONITORING THEIR PRIVATE CONTRACTORS.

We also recommend the commission strongly encourage state agencies to seek efficiencies in the ways they contract with and monitor private human service providers. A report from the HB 5124 steering committee was provided to the General Assembly almost a year ago. Few of the suggestions for implementation of HB 5124, which mandated streamlined auditing, accountability and monitoring have yet been implemented, and many more are waiting for discussion or some action by the state agencies. State agencies have not made those recommendations a priority. Two items could be immediately addressed for greater efficiencies: an electronic document vault and deemed status for accredited agencies.

Electronic Document Vault

CCAI agencies have long expressed frustration about the many duplicate requests for hard copies of identical information made by multiple state agencies and from various divisions. We estimate that 36% of the materials requested from various state entities were requested by another division or another state agency during the same year. These include materials such as the agency’s annual independent audit and bylaws. Responding to such duplicate requests diverts precious provider time and resources away from our primary responsibility: caring for abused and neglected children.

Creation of an electronic document vault accessible by any state agency should be a top priority to gain efficiency. If the state cannot create it quickly, it should allow private agencies to develop their own vault as an allowable expense. Other states, including Florida and North Carolina already have such systems.

We ask the commission, as part of its recommendations to

  • Insist state agencies work with private providers to fully implement the electronic document vault within 6 months.

Deemed Status

Human service agencies frequently seek accreditation from a nation entity that demonstrates the provider’s good governance, stability and compliance with best practice standards. Many of the materials generated or standards required are identical to state agency licensing, approval or contract requirements. An accredited agency should not be required to submit additional and duplicate materials for state bureaucratic requirements, since the materials submitted to show compliance with accreditation standards far exceed state standards. Some of our state human service agencies have rule provisions already to allow deemed status, but have not been able to operationalize them.

We ask the commission as part of its recommendations to:

  • Insist state human service agencies immediately convene a work group with provider agencies to develop an action plan to IMPLEMENT DEEMED STATUS within the next 6 months. Insist that any state human service agency without a deemed status provision immediately convene a work group with its private providers to develop a deemed status process within the next year.

Certainly, an operational electronic vault system as we detail would help with

The Child Care Association agencies and staff are more than willing to work diligently with our state agency partners to implement any recommendations and to grapple with the hard questions of how Budgeting for Results in human service agencies that rely greatly on the private sector for their results, can be implemented.

Respectfully Submitted,

Margaret M. Berglind
President/CEO   
Child Care Association of Illinois 

Posted on 10/18/11 at 02:47 PM

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