November 1995

Summary

The recommendations of the Human Services Commission represent the product of an intensive and inclusive, citizen-led effort to develop a consensus on the future direction of human services in Arlington County. Staff has worked closely with the Commission and strongly supports the direction recommended by the Commission.

In summary, the Commission's advice falls into three categories: "Guiding Principles", "Strategies for Implementing the Guiding Principles"; and "Implementation Measures Related to Independence and Self-Sufficiency". Staff's recommendations on how to deal with each category are discussed below.

Staff recommends that the "Guiding Principles" proposed by the Commission be adopted by the County Board as official County policy. This would provide focus and a conceptual framework within which the County can assess the many competing demands for services and from which the County can prioritize efforts during an era of shrinking State and federal resources. This policy also provides a vision to guide the County as it seeks to influence the State and federal debate and provides a guide as Arlington develops its local initiatives and exercises local discretion.

Staff recommends that the County Board endorse the Commission's "Strategies for Implementing the Guiding Principles" as policy goals for the County, with minor exceptions as noted in the above recommendations. By adopting the strategies as policy goals, the County Board would establish a commitment to move in the direction recommended by the Commission, subject to available resources and as appropriate in a changing environment.

Staff recommends that the more specific recommendations contained in the "Implementation Measures Related to Independence and Self-Sufficiency" be considered separately on their own merits or be considered during the County Board's policy and program reviews conducted as part of the annual budget process. While the conceptual framework proposed by the Commission has received broad support, it can be expected that there will be more debate around the specifics of implementation.

The policy approach emerging from the Commission's recommendations contains the following elements: a defined purpose for human services (prevention and independence/self-sufficiency); a range of services to achieve those objectives (continuum of care); and coordination of care among the different services, including access to services. It is proposed that the County accept responsibility for the development and maintenance of this system through collaborative work with the community. This means that Department of Human Services (DHS) is not just responsible for providing services efficiently and effectively -- which is the bureaucratic norm from which most organizations operate. Instead, in this framework, DHS is responsible for coordination of the overall human services system and leadership in its development. The County's efforts should be based on community needs, providing services directly only when they cannot be provided efficiently and effectively by the private sector and when such services are necessary to achieve the community's objectives. While these ideas may appear abstract, they represent a major shift in approach.

To move in this direction, the DHS leadership team will organize its implementation efforts into five policy centers during the next year:

• Children and Families
• Aging and Physical Disabilities
• Mental Health and Developmental Disabilities
• Employment and Income Support
• Public Health

These policy areas overlap with the current organizational structure, which is based largely on the way human services are organized at the State level, and through which flow the various intergovernmental funding streams. Over the next year, staff will use this policy framework to develop on-going mechanisms for monitoring and assessing community needs, developing community benchmarks in human services, and promoting integrated systems of care involving public and private providers consistent with recommendations of the Human Services Commission.

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Background

The Human Services Commission was appointed by the County Board in late 1993, and began its work in January 1994. The charge to the Commission from the County Board outlined broad areas of study and set a period of 18 months for completion of its work. The Commission organized seven Program Area Committees, membership on which was open to any stakeholder in Arlington County. The Program Area Committees examined specific program areas, supported by seven parallel staff teams. The Committees' reports were submitted to the Commission in the spring of 1995, and the Commission then examined what it considered to be the critical cross-cutting issues affecting the overall human services system. In addition to the Committee reports, the Commission considered results from three public hearings, site visits, focus groups, and numerous special reports and presentations to the Commission by staff, advocates, other government agencies, and the private sector.
An innovative effort was employed to develop strategies dealing with alternative future scenarios. This "futuring" exercise was developed by a joint Commission-staff task force and culminated in a one-day community workshop involving approximately 80 members of the public and staff. This proved to be a valuable tool for dealing with the incredible amount of uncertainty in the human services environment. For example, when the Commission was first created, it seemed certain that some type of health care reform would be passed by Congress; reform which would expand and stabilize health coverage. Less than two years later, this near certainty had transformed radically into Congressional efforts to eliminate Medicaid as a federal entitlement and restructure Medicare.

Thus, it became clear that the Commission could not act on the latest news from Washington and Richmond, while recognizing that local options and limitations are inextricably linked to what happens in both places. The futuring process provided a way to consider futures with strong governmental roles in human services (as experienced from Roosevelt until Reagan) and futures with a declining governmental role as promoted by the current Congressional leadership and the current State administration.

Based on the futuring process and all the other information compiled, the Commission sought to develop strategies "for all seasons" -- policies that are important for Arlington to follow regardless of what happens at the State and federal levels.

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Detailed Response to the Human Services Commission (Including Proposals for Implementation)

The following discussion addresses each section of the Commission's report and describes how staff proposes to implement the Commission's recommendations. The recommendations contained in this staff report (Recommendations 1 through 9). are referenced at the relevant points. Additionally, page numbers corresponding the Commission's report are also noted so that staff recommendations and the Commission's text can be cross referenced.

Philosophy. The Mission and Values Statement of the Department of Human Services was developed prior to the formation of the Commission to serve as an initial guide through the process, with an understanding that the mission and values statement was itself subject to revision based on the Commission's work. Overall the Commission's philosophy statement is compatible with the Department's mission and values statement; however, certain elements in the Commission's recommendation are not sufficiently highlighted. Staff will use the diverse staff team, which developed its current Mission and Values statement, to reexamine it in light of the Commission's recommendation. An effort will also be made to make the Departmental statement more succinct and to develop a plan for training all DHS employees in the meaning and application of the Mission and Values. This effort should be completed by the end of FY 1996.

The Guiding Principles of Independence/Self-Sufficiency and Prevention. Staff recommends that the County Board adopt the Commission's recommendations around the two "Guiding Principles" of Independence/Self-Sufficiency and Prevention as County policy. These principles provide anchors or touchstones for the assessment of what services will be provided, to whom, and for what reasons. To translate these policy goals into concrete actions, DHS leadership has begun a review of all programs and services in context of the "Guiding Principles". This review has involved all program managers in the Department and the major non-profit service providers. An initial effort to consider services in this context will be presented as part of the County Manager's FY 1997 Proposed Budget.

The most extensive immediate program review related to self-sufficiency is welfare reform. As a separate agenda item, staff will present a detailed proposal for the County Board's review and action. It addresses moving people from welfare to work and makes important changes in assistance programs.

With regard to prevention, the Human Services Commission included a number of "Implementation Measures. These include expansion of Clarendon House, additional psychiatric services, implementation of the Healthy Families early intervention program, expansion of Project Family, and lead poisoning prevention. Staff is evaluating each of these ideas as part of the Fiscal Year 1997 budget process, including assessing the potential benefits of these programs against current prevention efforts. Recommendations will be made as part of the County Manager's FY 1997 Proposed Budget.

Continuum of Care and Care Coordination/Case Management were additional concepts considered by the Human Services Commission. They were addressed as part of the prevention section, but are also relevant to self-sufficiency. These concepts also relate to the theme presented by the Commission in its discussion on community resources: "that government should increase its role as facilitator, problem identifier, and catalyst for community actions, and in that role should work toward greater collaboration with the broader Arlington community in providing needed services. Staff supports this direction.

Access to Services: Information and Referral. Because the human services system in Arlington and throughout the U.S. has evolved as a collection of many different public and private services, it has become a rather fragmented system. The role of government, as proposed by the Commission, is to provide a focal point to link the system together and to facilitate access by the public. Current technology and staffing do not make this possible. Staff is currently working with the State and the Northern Virginia Planning District Commission to evaluate new technology to make more timely and accurate information about services available to different providers and to the public. Staff is also reviewing options on how to provide an appropriate central point of contact for information on human services. This was previously available in DHS, but the resources were reallocated in the 1980s to form a central point of contact for all County information. This reallocation provided a critical service, but, because of its breadth, cannot be expected to provide information in sufficient detail in an area as complex as human services.

Access to services: Intake and Assessment. To coordinate entry into the system and services once one is in the system, the Commission has recommended enhancements to intake and assessment. Today, intake and assessment is done separately on a program by program basis. The five policy centers described above will be used as the framework for exploring improvement, including intake consolidation. Barriers to improvement, however, include the inability to collocate services and the inadequacy of automated information systems -- both of which are further discussed below.

Access to services: Location of Services. The Commission did not re-examine the work of the previous siting process to determine a location for a new DHS office building, nor did it re-examine the County Board's policy decision to proceed with such. Neither of these areas were part of the Commission's charge. The Commission's review of service delivery did, however, reaffirm the value of collocation of services. The Commission acknowledged the need for a central home base which would be more user friendly and which could achieve administrative efficiencies. At the same time, the Commission's discussion also supports the County's move toward neighborhood service delivery: "Understanding that satellite delivery does not equate with de-centralized services, the Commission recommends that the County continue and expand its focus on neighborhood locations for certain types of services" (page 21). Examples include immunizations (now possible with new technology approved by the County Board), health fairs, parent education, and other health education and outreach programs.

With the major changes occurring in the health field, we find ourselves in a period of such extreme uncertainty that it is not likely that the land swap with Arlington Hospital will be a feasible way to achieve an alternative location for a collocated DHS office building. Staff is currently exploring other alternatives and expects to bring forward recommendations in 1996. Meanwhile, DHS continues to experience fragmentation of related services, severe maintenance problems, critical overcrowding, and inadequate parking at the Edison Street complex, the Fenwick Center, and services at Court House Plaza.

Recommendation 4. Technology. The inadequacy of the current technology is a concern that affects many of the Commission's implementation strategies: information and referral; intake and assessment; care coordination; and evaluation. It is a problem not unique to Arlington; in fact, few communities have attempted the type of integrated system which Arlington has been working toward since the first commission on human services in the late 1960s. Arlington's CASE system -- our integrated, automated client data base -- has been a model for the last ten years; however, its capability is inadequate for today's demands. It offers no capacity for information and referral, is extremely complicated to use, requires continuous maintenance, and does not produce adequate or timely management reports. As a consequence of these deficiencies, some programs have been exempted from CASE in order to take advantage of more appropriate program specific technology; however, this fragments the data base and programmatic and management information which could be derived from such.

Two factors have constrained the development of a more useful system: cost and availability:

Cost. Building a powerful and useful management information system -- even one which improves service delivery -- may be seen as competing with the services themselves for resources. What the Commission has shown is that appropriate technology does not exist for its own sake but is integral to service delivery; consequently, information technology needs to be evaluated for investment along with other service enhancements such as direct service workers or medical equipment.

Availability. Were resources not an issue, only recently have improvements in hardware and software made available systems suitable to our needs and approaching a reasonable cost. Indeed, staff has yet to find a model information system which would achieve all of the goals addressed in the Commission's report. Thus, achieving the goals of efficient, integrated information is not as simple as buying a product off a shelf.

To implement the Commission's recommendation to conduct a comprehensive needs assessment/cost benefit analysis, DHS and the Office of Technology and Information Systems (OTIS) have initiated a 12-month technology project. A senior systems analysis from OTIS has been assigned to work full-time with a DHS staff team to develop an Information Technology Strategic Plan. The plan will contain recommendations for technology related to communications, hardware, software, and training which are in harmony with the Commission's guidance. To provide critical expertise and an outside perspective, an Advisory Panel, composed of experts from State agencies, other local jurisdictions, private providers of human services, and private technology firms, will be formed to provide input and review recommendations throughout the process. Consultant services may be needed for some of the specialized aspects of the project, such as the cost-benefit analyses.

The project will also explore various opportunities for collaborative efforts, such as higher level of coordination with State agencies and opportunities for outside funding and public/private partnerships. The technology assessment project will look into ways the technology can streamline and improve the services to the community including intake, assessment, referral, and record keeping. There is also a strong commitment to eliminate multiple data entry and to provide for the appropriate sharing of information among providers to eliminate repetition and inefficiency.

Recommendations resulting from the study will be reviewed by the existing commissions and presented to the County Board as part of the County Manager's FY 1998 Proposed Budget. The Advisory Panel of experts will provide a valuable outside perspective as the County rethinks its technology strategy. This is proposed as an alternative to the Commission's suggestion for a citizen task force.

Oversight: Program Evaluation and Benchmarks. Staff fully embraces the Commission's recommendations in this area and is working toward demonstrating improvements in evaluation efforts through the information provided as part of the County Manager's FY 1997 Proposed Budget. Specifically, all program managers and major non-profit service providers have been asked to conceptualize program evaluation as having three components and to present with its FY 1997 budget request data on each or a plan to collect appropriate data in the future:

Workload measures. This information describes how much service is being provided: the number of clients served, number of client visits, number of immunizations given, etc.

Performance measures. This analysis provides information about how well services are being provided. Two sub-categories are particularly important: efficiency and quality. The former examines cost and productivity. The latter examines issues such as consumer satisfaction, quality improvement committees, audits, utilization reviews, professional standards, and others.

Outcome measures. This is the most important and most difficult part of evaluation. Under the guiding principles recommended by the Human Services Commission, all human services programs should have outcomes related to prevention or independence/self-sufficiency. Defining and measuring quantitative outcomes in these areas are extremely difficult and rarely done; however, without such information it is not possible to know if one is achieving what one intends.

The concept of benchmarks applies to each of the three types of evaluation. Benchmarks are the measures against which one judges one's own performance. They may come from data in other localities, national data sources, or measures against one's own past performance. Benchmarks are especially important to outcome measures because they establish the overall community goals toward which one is working. This is the area where the State of Oregon has done pioneering work, which can serve as a guide to our efforts. As noted above, staff will examine such community benchmarks in each of five policy areas.

It is anticipated that the development and refinement of evaluation will be a continuous learning process which should show improvement each year. The annual budget will be the mechanism for reporting on evaluation and benchmarks.

Oversight: Citizen Oversight; Commission on Children and Families. This is a variation on an idea recently submitted to the County Board by the School Board's Early Childhood Advisory Committee, and a number of other groups over the years.

Staff agrees that the current commission structure does not provide broad oversight for services to children and their families; however, certain needs of children are considered by a variety of more focused oversight bodies, among which include the following:

The School Board and its many advisory committees provide oversight for education, including extended day, and ancillary services such as school health.

The Community Services Board considers children's needs related to developmental disabilities, mental illness, and substance abuse.

The Parks and Recreation Commission considers children's needs in leisure and developmental activities.

The Extension Service Advisory Council considers issues related to 4-H programs and a number of family services.

The Community Policy and Management Team reviews services for children in foster care, special education, and the courts or children at risk of the same.

Other groups influencing children's services include ACTION, the Better Beginnings Coalition, the Early Intervention Interagency Coordinating Council, the United Way, and others.

In defining the role of a new advisory commission on children and families, it would be important to distinguish its role from that of the other groups and to avoid making it so broad as to be unwieldy. Attachment 2. Preliminary Staff Report on a Children and Family Commission provides additional staff research on such a commission and outlines some of the issues which need to be considered. Staff recommends that the County Board provide guidance on what direction it wishes to pursue with this recommendation and that staff then bring a more developed recommendation forward for public comment and County Board consideration.

Oversight: Monitoring Implementation. The primary mechanism for reporting on implementation on the Commission's recommendations and other policy matters is the County's annual budget process. This process, in sequence, includes a public forum conducted in the fall by DHS and the Community Services Board, a County Manager's public hearing, the County Manager's budget and policy recommendations, public hearings by the County Board, and intensive work sessions between the County Board and staff. The County Manager's Recommended Budget provides a mechanism to report explicitly on implementation, and the County Board hearings and review provide for its assessment and additional guidance to staff. Additionally, DHS prepares an annual report, which will also be used to report on progress toward implementation.

Housing: Staff concurs that housing is a critical foundation for success both with prevention efforts and independence/self-sufficiency. DHS is currently working with the Department of Community Planning, Housing, and Development to reformulate the interagency Housing Coordination Team to provide a mechanism for improved housing planning and implementation. Progress on the policy goals proposed by the Commission would be made as part of the annual Consolidated Plan.

Homelessness. The Commission wrote in its report that it "favors opening the Emergency Winter Shelter every night from November 1 though March 31 as recommended by [a] Program Area Committee". This proposal is not referenced in staff recommendations in this Board report since this is but one of the many examples of implementation measures which the Commission thinks would support its broader recommendations. A separate staff report has been developed for the County Board's consideration of this issue. It recommends opening the shelter nightly from November 28 to February 29.

Community Resources Private Sector and Public-Private Partnerships. Partnerships have been an increasing focus of DHS in recent years, a direction reinforced by the Commission's report. In addition to extensive contracting for services (over $20 million in contracts), DHS is also active in the United Way and sponsors quarterly meetings of public and private providers. Based on the recommendations of the Commission, staff will be evaluating additional services for contracting including some health and mental health services, home care services, and day support services.

Community Resources: Intergovernmental and Regional Relations. The County's interdependence with other area local governments and subordinate relationship to the State and federal governments have a significant impact on human services. Coordinating efforts with the other entities for the many different human services and working to help shape policies is an extraordinarily time consuming task. As described by the Commission, however, it is critical that staff give priority attention to intergovernmental relations unless we want to be purely in a reactive position.

Community Resources: Consistent Fee Scales. Staff agrees that inconsistent fee scales are confusing; however, since services are targeted to persons who have limited capacity to pay full fees, there would be relatively little consequence from the immense effort to develop consistent fee scales. Staff recommends that consistency be set as a policy goal and that improvements in this direction be considered as opportunities become available. We do not, however, recommend a major, concentrated staff effort.

Community Resources: Role of Volunteers. Staff appreciates the Commission's recognition that effective recruitment, training, and use of volunteers requires an allocation of staff resources. Staff currently works with the County's volunteer coordinator to use community volunteers on a limited basis. Alternatively, staff has found that the most effective approach to volunteer involvement is through promoting our many non-profit partners. DHS also places an emphasis on developing relationships with professional schools to obtain interns.

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Conclusion

The fear of every commission, especially one which worked as long and hard as the Human Services Commission, is that its recommendations will become another dusty report sitting somewhere on a shelf. In this report, staff has attempted to demonstrate its deep commitment to follow through on the guidance this commission has provided for the next generation of human services. Staff considers this effort a critical component in the County's larger effort to develop a high performance organization which is grounded in the County's vision for a diverse and caring community and which is faithful to our Principles of Government Service.
What the Commission has provided is broad consensus on the objectives of human services and strategies for achieving them. This is an essential starting point. The next steps involve developing the Commission's recommendations into implementation measures as part of the budget process and the on-going efforts to achieve quality, efficiency, and effectiveness. The recommendations above describe how these steps will proceed and the mechanisms for reporting back to the County Board, its continuing commissions, and to the community at large.

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