[Dome]
January 1998		Final Report of the
HUMAN SERVICES RESTRUCTURING
TASK FORCE
Published by the Legislative Service Bureau

AUTHORIZATION:The Legislative Council established the Human Services Restructuring Task Force with the following charge:

Build upon the efforts of the 1996 Department of Human Services (DHS) Restructuring Task Force by developing a comprehensive proposal for transferring control of human services delivery to the local level, eliminating program duplication within DHS and between DHS and other state agencies, and reducing the amount of paperwork, red tape, and bureaucracy to improve quality of services delivery and consumer satisfaction. Evaluate the adherence of DHS to the department's mission statement. In addition, the Task Force may consider other proposals for service restructuring, such as granting local authority for service delivery, using public institutions and facilities, feasibility of creating a separate agency for disability and rehabilitation services, and creating a "seamless" system for child day care assistance. The Task Force may meet monthly and may establish subcommittees which may include legislators and public members who are not members of the full Task Force. Legislators serving on a subcommittee are entitled to reimbursement for actual expenses associated with attendance at subcommittee meetings. The Task Force may hold public hearings and other meetings outside Des Moines.

1. Background.
During the 1996 Interim of the General Assembly, the Legislative Council authorized the establishment of a Department of Human Services (DHS) Restructuring Task Force based upon a directive in Senate File 2446, 1996 Iowa Acts, chapter 1213, section 25. In part the legislation charged the Task Force with reviewing the structure and function of DHS to improve services to Iowans.
The Task Force held two meetings and made an informal recommendation that the chairpersons and ranking members of the Joint Appropriations Subcommittee on Human Services meet during the legislative session to develop a work plan for consideration by the full Task Force. During the 1997 Session of the General Assembly, the Appropriations Subcommittee discussed continuation of the work of the Task Force and included language to that effect in the appropriations bill developed by that Subcommittee. The language in House File 715 included a request that the Legislative Council "_continue the task force established for the 1996 interim of the general assembly in order to develop a comprehensive proposal to accomplish all of the following:
  1. Devolution of the control of service delivery to the local level.
  2. Elimination of program duplication within the DHS and between the DHS and other departments including but not limited to the Iowa Department of Public Health, the Department of Education, and the Judicial Department.
  3. Reduction of paperwork, red tape, and bureaucracy to improve the quality of services and deliver consumer satisfaction.
  4. Evaluation of the adherence of the DHS to the Department's mission statement."
In addition, the request provided that the Task Force may address the following topics: granting local authority to deliver public services, use of public institutions and facilities, the possibility of creating an agency for disability and rehabilitation services, and development of a "seamless" system for referral of families to child day care resources and public financial assistance and collaborative programs.
Based upon the request in House File 715, the Legislative Council approved the establishment of the Task Force.
Meetings Held. The Legislative Council authorized five meetings of the Task Force. The meetings were held on September 10, October 27 and 28, November 25, and December 18, 1997. The Task Force also established two Subcommittees: the Institutions and Facilities Subcommittee and the Program Duplication and Resource Utilization Subcommittee. The two Subcommittees included legislative members in addition to the legislative and citizen members of the full Task Force. The Institutions and Facilities Subcommittee met six times as follows: September 10, September 25, October 10, October 23, November 6, and December 11, 1997. The Program Duplication and Resource Utilization Subcommittee met three times as follows: September 10, November 4, and November 24, 1997.
Citizen Members. The citizen members have the following backgrounds:
2. Task Force Meetings.
a. September 10, 1997 - First Meeting of Five.
Overview. The first meeting was held at Woodward State Hospital-School. Following a welcome by Dr. Michael Davis, introductions of members and staff, and adoption of rules, the Task Force elected Senator Maggie Tinsman and Representative Hubert Houser as Co-chairpersons for the Task Force.
Facility. Staff members of Woodward State Hospital-School conducted a tour of the facility for Task Force members.
Workplan. The Task Force reviewed a tentative workplan for the Task Force. The full workplan included a two-day meeting to review restructuring of human services, with the assistance of national experts, to be held on October 27 and 28, 1997, in Des Moines, and two later meetings to be used in developing recommendations of the Task Force for submission to the General Assembly.
Subcommittee Workplan. The two Subcommittees met separately during the first Task Force meeting. The goal of the Institutions and Facilities Subcommittee was to refine the long-term plans of the institutions administered by DHS to ensure that they meet the needs of Iowans and to ensure effective utilization of resources. Representative Houser served as chairperson of this Subcommittee. The goal of the Program Duplication and Resource Utilization Subcommittee was to review programs and services across agencies, focusing on the 0 through 5-year-old age group in order to reduce duplication and to ensure that children are prepared for school, while bringing control and delivery of services closest to the consumer. Senator Tinsman served as chairperson of this Subcommittee.
Presentations. DHS Director Charles Palmer presented an update of the DHS strategic plan, Ms. Jayne Jochem, Department of Management, presented information regarding Innovation Zones, a new statutorily authorized means for local service providers and public officials to work collaboratively to address children and family needs, and Mr. Marc Baty, DHS Regional Administrator, Linn County, presented information regarding child welfare funding decategorization in the Cedar Rapids area.
b. October 27 and 28, 1997 - Second and Third Meetings of Five.
Overview. The members of the Task Force and its Subcommittees held a two-day planning meeting on October 27 and 28 which focused on approaches used in Iowa and in other states for improving the overall human services system and strengthening local, grassroots involvement in human services delivery. The meeting was coordinated and sponsored by the National Conference of State Legislatures (NCSL) with support from the Annie E. Casey Foundation, a national foundation dedicated to helping build better futures for children in the United States. During the planning meeting, the Task Force members discussed and were presented with many ideas, concerns, strategies, and issues associated with improving the human services system and strengthening local, grassroots involvement in human services.
Presentations. The agenda included presentations relating to developing a results-based framework for planning, budgeting, and establishing accountability; establishing results and strategies for Iowa; negotiating state and local roles in human services; and devolving human services to the local level. The format of the meeting provided for a large amount of small group and large group discussion on these points. Presenters included Susan Robison, NCSL, Denver, CO; Ira Barbell, Senior Associate, Annie E. Casey Foundation; Mark Friedman, Executive Director, Fiscal Policy Studies Institute, Baltimore, MD; Steve Renne, Deputy Director, Missouri Department of Social Services; Tim Decker, Neighborhood Development Coordinator, Local Investment Commission, Kansas City, MO; and Chuck Short, Director, Montgomery County Department of Health and Human Services, Montgomery County, MD.
Follow-Up Strategies. At the close of the two-day session, the Task Force developed follow-up strategies to be used by the Task Force in future meetings. The main points of the follow-up strategies are:
c. November 25, 1997 -- Fourth Meeting of Five.
Task Force Members Update. Members of the Task Force who had held local forums reported the results of these to the full Task Force. Co-chairperson Tinsman provided a progress report of the Program Duplication and Resource Utilization Subcommittee to the full Task Force.
State Policy Objectives. Ms. Mary Reavely and Mr. Marv Weidner, Department of Management and staff to the Council on Human Investment, provided an overview of the development of a results-based performance management system in Iowa. The Task Force members discussed the role of the General Assembly in identifying results and the process for doing so.
Innovation Zone Panel. Members of an Innovation Zone located in western Iowa discussed the development of a local community board, selection of a focus for the Innovation Zone, identification of desired results, status of state-local communication and collaboration, and the need for institutionalizing a local governance entity.
School Representatives Panel. A panel of school superintendents and school board members from around the state provided recommendations to the Task Force regarding improving school collaboration with human services.
Task Force Discussion. The Task Force began a discussion of potential recommendations to the General Assembly. The Task Force addressed statewide desired results and also discussed models for expanding local governance structures, pooling of funding, and possible populations to focus on for expansion of decategorization funding. The Task Force decided to finalize the discussion of recommendations at its final meeting on December 18, 1997.
Program Duplication Subcommittee. During discussion, the Task Force determined that the issues remaining to be addressed by the Program Duplication and Resource Utilization Subcommittee were also issues to be addressed by the full Task Force. Therefore, the final meeting of the Subcommittee scheduled for December 2, 1997, was cancelled and the members of the Subcommittee were invited instead to participate in the discussion of the full Task Force on December 18, 1997.
d. December 18, 1997 - Fifth and Final Meeting.
Overview. The full Task Force was joined for this meeting by the members of its Subcommittees who were not also full Task Force members. The Co-chairpersons, Senator Tinsman and Representative Houser, invited Mr. Ira Barbell, Senior Associate at the Annie E. Casey Foundation in Baltimore, MD, to assist by facilitating the process of developing recommendations. The Foundation and Mr. Barbell had previously provided for facilitation and other assistance, with the National Conference of State Legislatures, at a two-day retreat held in October. The Task Force developed overall recommendations and accepted recommendations in specific areas developed by its two Subcommittees.
Full Task Force Recommendations. The Task Force used a listing of concepts for discussion in considering the full Task Force recommendations. In addition, the full Task Force considered and modified recommendations from each of the two Subcommittees. The Task Force developed detailed recommendations. The full Task Force recommendations are attached in Appendix I.
Institutions and Facilities Subcommittee. This Subcommittee developed and the Task Force accepted more than 35 specific recommendations associated with institutions and facilities administered by DHS. The specific recommendations are intended to move the institutions further toward the role of diverse, multi-use regional resource centers for public and private providers to address a variety of public needs while filling their traditional role of providing direct services to persons with difficult-to-treat conditions. The recommendations address a variety of programs, including dual diagnosis substance abuse and mental health treatment, shared services campuses such as Clarinda and Mt. Pleasant, and opportunities for expanded uses of the campuses.
The full Task Force revised and approved the vision statement, the listing of recommendations, and other information are included in Appendix II and Appendix III.
Program Duplication and Resource Utilization Subcommittee. The full Task Force recommendations emphasized many of the recommendations submitted by this Subcommittee. The set of Subcommittee recommendations accepted by the full Task Force are attached in Appendix IV.
3. Institutions and Facilities Subcommittee Meetings.
a. September 10, 1997 - Woodward State Hospital-School - First of Six Meetings.
This Subcommittee met upon adjournment of the Task Force. Woodward staff completed their presentations, Subcommittee members identified issues, and the meeting schedule was confirmed.
Woodward. Superintendent Davis underscored the efforts made to change the role of this institution. It was noted the name "Iowa Resources for Community Support" is now being used in the institution's letterhead. He suggested that it may be appropriate to revise the budgeting system used for institutions to incorporate this changed role. Currently, the budget and staffing allocations use a time-honored approach based upon the number of beds at the institution but staffing demands relate increasingly to community programs. The staff have developed considerable expertise and the changed role utilizes this expertise to support community-based programs for persons with disabilities. It is a role similar to that of the specialized hospitals in the general health care system. Examples of special programs for persons with developmental disabilities include programs addressing autism and sexual behavior.
Issues. The following issues and purposes were identified by members: need to review existing facilities and programs, presence of persons with mental illness or a developmental disability in the prison system, presence of elder persons with chronic health care needs in the prison system, and importance of appropriately utilizing the public investment in the human services institutions and staff. In addition, the Subcommittee plans to review budgeting methodology and the effects of Iowa's noncompetition law on institutional activities.
b. September 25, 1997 - Cherokee Mental Health Institute - Second of Six Meetings.
Cherokee MHI. Following a tour of the facility, Superintendent Tom Deiker and other staff discussed the downsizing of the MHI over a five-year period; the alternative uses of the facility which include inpatient substance abuse treatment, juvenile detention, and juvenile residential treatment; ongoing discussions with the DOC to provide programs for corrections populations with special needs; provision of an array of psychiatric services to the population in the 45-county catchment area of the MHI; and the positive results of shorter patient stays.
Managed Care. The Subcommittee discussed the DHS request for proposals (RFP) for a vendor to provide managed care of adult mental health and substance abuse services under the Medicaid program. Currently, the RFP includes application of managed care to child welfare services. The Subcommittee discussed concerns with the current draft of the RFP including the exclusion of adult mental health services at the MHI from a managed care contract; concerns of members of the General Assembly with the RFP, especially those related to inclusion of child welfare services; the possible negative effect of a managed care contract on the decategorization program; provider concerns; and the use of an outcomes-based strategy as opposed to the medical insurance model utilized under Medicaid.
Central Point of Coordination (CPC). A three-person panel presented information regarding the use of CPCs in managing county funding of mental health and developmental disability services. The panel and the members discussed the positive efforts of the Cherokee MHI in coordinating services with the CPCs; the problems associated with substance abuse services at an MHI only being provided at the Mount Pleasant facility; the proposals for expanding dual diagnosis treatment of mental illness and substance abuse; provider costs; out-of-state placements; and the current managed care RFP.
c. October 10, 1997 - Glenwood State Hospital-School and Clarinda Treatment Center - Third of Six Meetings.
Overview. The Subcommittee toured and reviewed programs at Glenwood State Hospital-School (SHS) and Clarinda Treatment Center. The review included both state-operated programs and programs operated by other entities in buildings on the campuses.
Glenwood Tour. The large buildings which previously housed persons with mental retardation are now either used to house programs or services to consumers or are leased to outside groups. The tour included the up-to-16-bed home settings located in a development on the grounds. Consumers reside in these home settings and leave during the day to participate in work, school, or other activities. More than 20 entities are using renovated state buildings or buildings constructed on the grounds. The entities include the local school district, area education agency, human services cluster offices, and a brain injury services provider.
Glenwood Presentations. Representatives of various groups utilizing the facilities or services addressed the Subcommittee. Clarinda Tour. Senator Jeff Angelo introduced Mr. Mark Lund, superintendent of the treatment complex. The primary programs administered by the Clarinda Mental Health Institute are a 20-bed acute psychiatric in-patient care program and a 63-bed long-term nursing care program providing psychogeriatric services for persons with mental illness. The other major programs are the Clarinda Correctional Facility which houses nearly 1,000 inmates in a new facility opened in 1996 and the Clarinda Academy, a private youth program with 239 beds for adjudicated juveniles. All of these programs were reviewed during the tour.
Correctional Facility. The tour of the correctional facility focused upon the special needs unit. Of the nearly 1,000 inmates, approximately 200 have been identified as having a special need such as mental retardation, a mental disorder, a personality disorder, or are determined to be socially ill-suited to integration with the general prison population. The majority of such individuals are housed in the special needs unit.
Comments. There was discussion of the need in the state for programs to serve persons with Alzheimer's syndrome who have developed a pattern of physical outbursts. It was noted that turnover among the MHI staff has been very low and that the low rate contributes to a high quality of care. Recently, the Council on Human Services recommended adding beds to the psychogeriatric program.
d. October 23, 1997 - Independence Mental Health Institute and Toledo Juvenile Home - Fourth of Six Meetings.
Overview. The Subcommittee toured and reviewed programs at the Independence Mental Health Institute (MHI) and Toledo Juvenile Home. The review included state-operated programs and programs operated by other entities on the campuses.
Independence Tour. Tour stops included both open and locked wards for treatment of up to 128 adults with serious mental illness, a program, for up to 20 adjudicated delinquent boys, operated in leased space by Four Oaks of Cedar Rapids, an adolescent psychiatry unit for up to 20 males and females in a locked ward, and the Cromwell children's unit for up to 33 children ages 7 through 14.
Independence Presentations.
Toledo Tour. Superintendent Robert Eppler provided an overview of the programs and facilities. Toledo serves up to 92 children ages 12 through 17 years, up to 30 of whom are females adjudicated as having committed a delinquent act and the remainder males and females adjudicated as children in need of assistance (CINA). Toledo facilities toured included the school building operated year-round by DHS, locked and open residential areas, and special program areas such as one in which toddlers with special needs from the surrounding communities are assisted by students placed at Toledo.
School Presentation. School Principal Mike Sawyer provided an overview of the education program. Typical students are two to three grade levels behind their age level, and the school works with the students to catch up on educational programs. Most students have been in five to seven out-of-home placements prior to Toledo. The school is increasing its vocational emphasis and works with local businesses to provide students with work experience.
Capital Improvements. Plans call for renovation in fiscal year 1997-1998 of a locked cottage to provide residential facilities for delinquent girls. The cottages or residential facilities typically house 12 to 24 youths each with a partitioned dormitory sleeping area, eating area, and common area.
Other Programs. A day treatment program designed to eliminate the need for out-of-home placement of delinquent youths rents space on the Toledo campus. A program administrator and a participating youth made a presentation to the Subcommittee.
e. November 6, 1997 - Mount Pleasant - Fifth of Six Meetings.
Overview. The Subcommittee toured and reviewed programs at Mt. Pleasant Treatment Center. The Treatment Center is a shared campus consisting of a state MHI and a correctional facility. Agenda items included tours, an overview of the pilot dual diagnosis program which combines mental health and substance abuse treatment, and presentations by the directors of the Departments of Human Services and Corrections.
MHI Tour. The MHI has a 20-bed adult psychiatric unit serving 15 counties in southeastern Iowa. Of the 20-bed unit, six beds are designated for the dual diagnosis pilot project. In addition, there is a 60-bed substance abuse treatment program serving adults from throughout the state. The tour included an MHI building area which is not currently in use for programs. The facilities include an Iowa Communications Network (ICN) connection and computers used for training staff in the development of a paperless record system.
Correctional Facility Tour. The correctional facility is housed in buildings originally constructed for use by the MHI. These buildings have been secured and converted to use as a medium security prison. The designed capacity is for 528 inmates and the facility operates with approximately 900 to 1,000 inmates. The facility has specialized programs for substance abuse and sex offenders. The tour included a building used by a private business employing inmates in the manufacturing and processing of steel for parts.
Substance Abuse Program. In discussion it was noted that a great proportion of patients have a history of using methamphetamine drugs and that many of the behaviors from those drugs are similar to psychoses. Members observed that the geographic location of the MHI causes transportation expenses and difficulties for persons who reside in other areas of the state.
Corrections/Human Services Discussions. Mr. Walter "Kip" Kautzky, Director, DOC, and Mr. Palmer, Director, DHS, related recent discussions as to possibilities for corrections use of buildings and other resources administered by DHS. It was noted that a recent federal court ruling requires DOC to address special needs inmates. Mr. Kautzky said that one of the possibilities under review is to establish at Mt. Pleasant a 100-bed correctional unit for women with special needs. He suggested that the proximity of the University of Iowa Hospitals and Clinics to Mt. Pleasant is viewed as very beneficial.
Dual Diagnosis Program. A committee has been meeting in response to legislation providing for submission of a proposal for establishing an ongoing program in place of the current pilot project. Budget projections have been predicated on a 24-bed unit with a statewide catchment area. This program would be targeted to adults although there was interest among members in creating a similar program for children. One of the challenges is establishing the amount to be charged because current charges for mental health and for substance abuse treatment are significantly different.
f. December 11, 1997 - Farm Bureau Corporate Headquarters, West Des Moines - Sixth and Final Meeting.
State Training School. Superintendent Steve Huston described the Training School which is located near Eldora, Iowa, and provides programs for delinquent boys. Member discussion focused on the need for after-care programming as only a small number of youths continue to receive services upon turning age 18. Follow-up services for younger youths are provided by DHS and the juvenile court. It was noted that the number of young children (ages 12 and 13) placed at the school has been very few in recent years.
Service System Panel. A panel addressed the role of the state institutions in the service systems for the various problems treated by the institutions. Panel members included Ms. Linda Hinton, Iowa Association of Rehabilitation and Residential Facilities, Ms. Margaret Stout, Alliance for the Mentally Ill of Iowa, and Mr. Rik Shannon, Governor's Developmental Disabilities Council. Concerns raised by this panel include the following:
Institution Admissions Policy. This panel consisted of Mr. Templeman of DHS, Ms. Joy Higgins and Ms. Geneva Brumgardt, who are parents of children with mental retardation, and Mr. Merv Roth and Mr. Curt Sytsma of Iowa Protection and Advocacy Services, Inc. (P & A). This panel briefly touched on MHI admissions but primarily focused on admission policy at the State Hospital-Schools (SHS). The existence of a federal consent decree resulting from a lawsuit brought by P & A, known as the "Conner decree" has a special effect on these admissions. The parents expressed dissatisfaction with the effects of the decree in making placement at an SHS very difficult to obtain. The DHS representative noted the consent decree solidified a long-standing policy of discouraging SHS placement when another placement is appropriate. The P & A representatives noted their efforts have focused upon enhancing the use of community placements rather than seeking outright closure of the SHSs as has been done by advocates in other states.
Staff Presentations. Ms. Margaret Buckton, Legislative Fiscal Bureau, described the pilot project implementing "net budgeting" at Glenwood SHS. This approach to appropriations and operations is intended to encourage more creativity and greater efficiency at an institution. Mr. John Pollak, Legislative Service Bureau, described the Iowa Noncompetition by Government Law. The Subcommittee had previously noted this statute may discourage implementation of new programs by state institutions.
Excess Space-Corrections Uses. Mr. Palmer, Director of DHS and Mr. Kautzky, Director of DOC, met with the Subcommittee for a second time. A listing of vacant space at DHS institutions which indicated the state of readiness for other uses was distributed. It was suggested that unusable buildings should be demolished. Mr. Kautzky reiterated previously discussed interest in developing a 100-bed program for female inmates with special needs at the Mt. Pleasant campus. He provided written information projecting inmate growth, relative costs for renovation at Clarinda and Mt. Pleasant, and responded to questions. Other needs mentioned include additional special needs beds at Oakdale and Fort Madison, and two 150-bed units for placement of offenders just prior to release for parole.
Recommendations. Subcommittee members reviewed a draft list of 34 recommendations compiled by Chairperson Houser from the various discussions among Subcommittee members and from presenters. The draft included a statement of principles for changing the state institutions and the Subcommittee requested preparation of a vision statement reflecting member views on changing the focus of the institutions. Specific recommendations include endorsement of developing the correctional program for females at Mt. Pleasant, reshaping admissions policies at all institutions, expansion of efforts to open DHS institutions' campuses to additional regional uses, applying budgeting changes, and many more. Members made changes and deletions of the draft and requested a redraft be prepared as soon as possible for members. The redrafted document was submitted for consideration by the full Task Force the following week on December 18.
4. Program Duplication and Resource Utilization Subcommittee Meetings.
a. September 10, 1997 - Woodward State Hospital-School - First of Three Meetings.
Program Duplication Subcommittee. The Program Duplication and Resource Utilization Subcommittee discussed the goals of the Subcommittee, received information from Ms. Buckton, Legislative Fiscal Bureau, regarding possible means of evaluating programs for duplication, received information from DHS Director Palmer regarding agency director review of programs and services, and scheduled future meetings.
b. November 4, 1997 - Second of Three Meetings.
Overview. The agenda focused on state policy objectives and interagency coordination between DHS, the Iowa Department of Public Health, and the Department of Education. The Subcommittee also was presented with information regarding the State Children's Health Insurance Program, a federal initiative recently made available to the states.
Budgeting for Results. Ms. Reavely and Mr. Weidner, Department of Management, presented information regarding the state's effort to utilize a performance-based management system and state agency efforts to link state-identified policy objectives with budgeting known as "budgeting for results." They discussed the process used to develop state policy objectives for use by state departments in planning and budgeting, the Governor's state policy objectives which are those objectives prioritized by the Governor, the implementation schedule for budgeting for results, and the way in which all of the elements of the system align with one another.
Interagency Planning. Mr. Palmer, Director, DHS; Mr. Chris Atchison, Director, Iowa Department of Public Health; and Mr. Ted Stilwill, Director, Department of Education, presented information in a panel format regarding interagency planning, programming, and budgeting. The directors discussed the various collaborative efforts that the agencies have undertaken to identify priorities in building strong families in Iowa; noted that each department is charged with providing specific enduring functions to the state as a whole and at times these must be weighed against issues and needs that arise based upon popular opinion; discussed the strategies of system redesign, community capacity building, early childhood development, and use of information technology in addressing the critical issues affecting families; discussed specific partnerships developed between the agencies; and provided historical examples of collaboration. Director Atchison also discussed the work of a group reviewing the various home visit programs and a proposal to coordinate these efforts at the local level.
Children's Health Insurance Program. Mr. Don Herman, Administrator, Division of Medical Services, DHS, discussed the State Children's Health Insurance Program (SCHIP) which is an initiative established in the federal Balanced Budget Act of 1997 which added a new Title XXI to the Social Security Act to provide health care coverage to certain uninsured, low-income children. Federal funding is provided in exchange for a state match. Mr. Herman reviewed the general requirements of the program, discussed the working of the SCHIP Work Group and the SCHIP Task Force, and noted that actions include presenting recommendations to the Governor, the Governor's presenting a proposal to the General Assembly, submitting a state plan to the federal government by July 1, 1998, and implementing the program by October 1, 1998.
c. November 24, 1997 - Third and Final Meeting.
Early Childhood. The Subcommittee received information regarding the report of the Governor's Commission on Educational Excellence for the 21st Century and early childhood education programs from representatives of the Department of Education.
Criminal and Juvenile Justice Planning. The Subcommittee received information from Mr. Dick Moore, Administrator, Division of Criminal and Juvenile Justice Planning, regarding what Iowa should do for children ages 0 through 5 and their families to prevent entry into the juvenile justice or criminal justice systems.
Optimal Development in Children. Dr. Edward Schor, Iowa Department of Public Health, presented information regarding the needs of children in achieving optimal brain and other development in the early years. Dr. Schor focused on brain development and the need for stimulation to achieve optimal development.
Evaluation and Auditing of Human Services Programs. Representative Wayne Ford presented proposals for improving evaluation of human services programs, primarily those established through grants. Mr. Warren Jenkins, Office of the Auditor of State, provided additional information in this regard, recommending the use of preaward surveys and the use of current statutory or administrative code language, such as that relating to Iowa Code chapter 28E, which would provide for consistent auditing of programs.
Recommendations. The Subcommittee reviewed a listing of recommendations and agreed to adopt the following as a mission statement for children ages 0 through 5 in the state:
"A child of Iowa should possess a healthy body; be part of a loving family and a caring community, beyond the family, that listens, emotionally supports, teaches, and advocates for the child; live in a safe home; have a self-sufficient family; and be ready to learn by receiving strong brain stimulation through early education."
Final Meeting. The Subcommittee agreed to review additional proposed recommendations at its final meeting. During the meeting of the full Human Services Restructuring Task Force on Tuesday, November 25, 1997, the members of the Subcommittee present determined that the issues remaining for the Subcommittee to address should also be addressed by the full Task Force. Therefore, the Subcommittee meeting scheduled for Tuesday, December 2, 1997, was cancelled, and the Subcommittee members were invited to attend the full Task Force meeting on December 18, 1997, to share their knowledge and to discuss these issues.
Recommendations. Many of the concepts contained in the Subcommittee's recommendations were incorporated into the full Task Force's recommendations. A copy of the Subcommittee's recommendations, as amended and approved by the full Task Force is attached as Appendix IV.
5. Materials Distributed and Filed With the Legislative Service Bureau - Full Task Force.
a. September 10 Meeting.
  1. ) Iowa Department of Human Services Strategic Plan, distributed by DHS Director, Mr. Charles Palmer.
  2. ) A handout summarizing Innovation Zone enabling legislation, operation, and roster of communities, distributed by Ms. Jayne Jochem.
  3. ) A handout regarding the Linn County decategorization project, distributed by Mr. Marc Baty.
  4. ) A packet of information summarizing Iowa Resources for Community Support, distributed by Ms. Ann Thoreson-Aller.
  5. ) Information binder regarding institutions administered by DHS, distributed by DHS.
b. October 27 and 28 Meeting.
  1. ) Materials from Fiscal Policy Studies Institute:
    • Choosing a Common Language.
    • Results-Based Decision-Making and Budgeting Accountability.
    • Trading Outcome Accountability for Fund Flexibility.
    • Program Performance Accountability Within an Outcomes Framework.
    • Moving Toward Results: An Emerging Approach to Community Accountability for Child and Family Well-Being.
  2. ) Missouri's Caring Communities.
  3. ) Local Investment Commission of Kansas City.
  4. ) Reinventing Human Services: Issues and Challenges for State Legislatures.
c. November 25 Meeting.
  1. ) Iowa State Government's Enterprise Strategic Plan, provided by the Department of Management.
  2. ) Documents relating to programs in Maryland including the Montgomery County Program.
  3. ) Iowa statutes relating to budgeting for results and Innovation Zones.
d. December 18 Meeting.
  1. ) Minutes of November 25, 1997, meeting.
  2. ) Materials on results-based accountability provided by Mr. Marc Baty, Linn County.
  3. ) Memo from Mr. Marc Baty providing a proposal for community-oriented governing.
  4. ) A brochure entitled, Early Childhood Education and Parent Partnerships: An Investment for Iowa, prepared by the Early Childhood Community Coalition and distributed by Dr. James Austin.
  5. ) An analysis of state actions on behavioral health parity prepared by the Health Tracking Service of the National Conference of State Legislatures and distributed by the Legislative Service Bureau in response to a Subcommittee request.
  6. ) A summary of the public forums held in Cedar Rapids and Iowa City on December 8 and 9, 1997, prepared and distributed by Representative Ro Foege.
  7. ) A summary of the southwest Iowa public forums held in Council Bluffs and Red Oak on December 12, 1997, by Representative Hubert Houser, Representative Brad Hansen, Senator Nancy Boettger, and Ms. Julie Schmidt, submitted by Ms. Schmidt.
  8. ) A letter addressed to Representative Houser and members of the Institutions Subcommittee of the Task Force from Mr. Merv Roth and Mr. Curt Sytsma of Iowa Protection and Advocacy, suggesting legislators hold a public forum and schedule visits to community-based residential and vocational programs for persons with disabilities.
  9. ) Human Services Restructuring Task Force Concepts for Discussion, prepared by Mr. Brad Trow, House Republican Research Staff, and Ms. Suzanne Johnson, Senate Republican Research Staff.
  10. ) Recommendations of the Program Duplication and Resource Utilization Subcommittee.
  11. ) A vision statement and draft recommendations of the Institutions and Facilities Subcommittee and other proposed institutions recommendations.
6. Materials Distributed and Filed With the Legislative Service Bureau - Institutions and Facilities Subcommittee.
a. September 10 Meeting.
b. September 25 Meeting.
  1. ) A table supplying revenue, employment, usage, and cost information for the Cherokee MHI from FY 1992-1998, distributed by MHI Superintendent Tom Deiker.
  2. ) A chart comparing the cost per episode vs. per diem cost from FY 1992-1998, distributed by MHI Superintendent Tom Deiker.
  3. ) A description of the duties of the Central Point of Coordination Administrator, distributed by Ms. Robyn Wilson, State-County Assistance Team.
  4. ) A report on DHS Institutions prepared by the Auditor of State, and distributed by Mr. Brad Trow, House Republican Research Staff.
  5. ) A description of the Northwest Iowa Youth Emergency Services Center, a multicounty juvenile detention center, distributed on the tour by the center.
c. October 10 Meeting.
  1. ) A packet of materials assembled by the Glenwood State Hospital-School.
  2. ) A videotape produced by the Glenwood State Hospital-School.
  3. ) A general description and map of the Clarinda Treatment Complex.
  4. ) Statistics and a brochure concerning the psychogeriatric program at Clarinda MHI.
  5. ) A brochure concerning the Clarinda Correctional Facility.
  6. ) A packet of materials concerning the Clarinda Academy Program.
  7. ) A copy of the federal Developmental Disabilities Assistance and Bill of Rights Act Amendments of 1993 distributed by Ms. Sybil Finken.
d. October 23 Meeting.
  1. ) An overview of Independence MHI prepared by Dr. Bhasker Dave, Superintendent.
  2. ) A history of Independence MHI, general overview, and brochure.
  3. ) A memorandum prepared by Mr. Timothy Fox, Buchanan County Economic Development Commission.
  4. ) An orientation brochure for parents and for students placed at the Iowa Juvenile Home at Toledo.
  5. ) A description of the Iowa Juvenile Home Education Department.
  6. ) A description of the Toddler Program provided at the Iowa Juvenile Home.
  7. ) A newsletter from the Iowa Juvenile Home.
e. November 6 Meeting.
  1. ) Informational brochures for the Mt. Pleasant Correctional Facility, the Center for Psychiatric Care at the MHI, the Iowa Residential Treatment Center at the MHI, and the MHI.
  2. ) The Mt. Pleasant MHI Mission Statement.
  3. ) Handouts on the average daily census and the total number of clients served at the MHI over several years.
  4. ) A map outlining the counties served by the Iowa Residential Treatment Center (IRTC) and the Center for Psychiatric Care.
  5. ) A handout on dual diagnosis programming a the MHI and an outline of staff psychologist Ms. Sarah Tandy's dual diagnosis presentation at the meeting of the Subcommittee.
  6. ) A description of and statistics on the sexual offender treatment program at the correctional facility.
f. December 11 Meeting.
  1. ) Eldora State Training School FY97 Annual Report.
  2. ) Iowa Association of Rehabilitation and Residential Facilities handout.
  3. ) Alliance for the Mentally Ill (AMI) of Iowa memorandum.
  4. ) Governor's Developmental Disabilities Council handout.
  5. ) Iowa Protection & Advocacy Services handout.
  6. ) Net-State Budgeting handout from Ms. Margaret Buckton, Legislative Fiscal Bureau.
  7. ) Iowa Noncompetition Law memorandum from Mr. John Pollak, Legislative Service Bureau.
  8. ) Draft of Reengineering of Prerelease Procedures Project Proposal.
  9. ) DHS Institutions Available Space Table.
  10. ) DOC Special Needs Study Preliminary Findings Presentation.
  11. ) DOC handout on relative cost for renovation at Clarinda and Mt. Pleasant.
  12. ) DOC projections for actual and estimated inmate population and capacity.
  13. ) Draft recommendations prepared at the request of Chairperson Houser by Mr. Brad Trow, House Republican Research Staff.
7. Materials Distributed and Filed With the Legislative Service Bureau - Program Duplication and Resource Utilization Subcommittee.
a. September 10 Meeting.
b. November 4 Meeting.
  1. ) Council on Human Investment document and "Iowa's Foundation for Strategic Planning" document, provided by the Department of Management.
  2. ) State of Iowa Budgeting for Results Handbook, provided by the Department of Management.
  3. ) "State Government Is One Enterprise," provided by the panel of state agency directors.
  4. ) Enterprise Planning Work Group document, provided by the panel of directors.
  5. ) "Collaboration Efforts of State Agencies," provided by the panel of directors.
  6. ) State Child Health Insurance Program documents, provided by Mr. Don Herman, Department of Human Services.
  7. ) Iowa Programs for Children matrix, developed by the Legislative Fiscal Bureau.
  8. ) Evaluation Proposal Considerations document, developed by the Legislative Fiscal Bureau.
  9. ) 1990 Population Distribution of Persons 5 Years of Age and Under, developed by the Legislative Fiscal Bureau.
  10. ) Iowa Review of Family Assets document, provided by the Iowa Department of Public Health relating to family support programs.
  11. ) Background information packet, provided by the Legislative Service Bureau.
c. November 24 Meeting.
  1. ) "The Governor's Commission on Educational Excellence for the 21st Century" report, September 1997.
  2. ) State Policy Objectives, from the State of Iowa Budgeting for Results Handbook.
  3. ) The "Iowa Department of Public Health FY 1999-2000 Budget Request" document.
  4. ) The "Iowa Department of Human Services Budgeting for Results State FY 1999" document.
  5. ) "The First Years Last Forever" documents.
  6. ) Iowa Legislative Fiscal Bureau issue review, "The Healthy Opportunities for Parents to Experience Success (HOPES) Program."
  7. ) "Evaluation, Audit and Review of DHS Services and Programs" document, provided by DHS.
  8. ) Recommendations letter from Mr. Warren G. Jenkins, Office of the Auditor of State, and the report of the investigation of the 3rd Judicial District.
  9. ) "The Walbridge Caring Communities Program" (MO) document, distributed by the Legislative Service Bureau.
  10. ) "School-Based Health Centers," National Council of State Legislators LegisBrief.
  11. ) Child Development Coordinating Council fact sheet.
  12. ) "Iowa Kindergarten Program Models" document, distributed by the Department of Education.
  13. ) Detailed listing of Department of Education Programs, provided by the Department of Education.
  14. ) "Family-Based Crime Prevention by Ecological Context" document, provided by Mr. Dick Moore, Division of Criminal and Juvenile Justice Planning of the Department of Human Rights.
  15. ) "40 Developmental Assets" document, provided by Mr. Dick Moore.
  16. ) "Overview of Comprehensive Strategy," provided by Mr. Dick Moore.
  17. ) "Risk Factors for Juvenile Crime Model," provided by Mr. Dick Moore.
8. Recommendation Appendices.

OTHER INFORMATION FOR THIS COMMITTEE:

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