January 1998	Final Report of the HUMAN SERVICES RESTRUCTURING TASK FORCE
	Appendices

APPENDIX I

HUMAN SERVICES RESTRUCTURING TASK FORCE RECOMMENDATIONS

APPENDIX II

VISION STATEMENT FOR DHS INSTITUTIONS

APPENDIX III

BACKGROUND INFORMATION CONCERNING DHS INSTITUTIONS

• Institutions Historical Census
• Institutions Sources of Revenue (Fiscal Year 1996)
• Human Services FTE History (FY 1987 through FY 1997)
• Hospital Schools Areas
  
• Glenwood State Hospital School
• Woodward State Hospital School
• Iowa Mental Health Institutes
• FY 1997 Cost Comparisons
• Cherokee Mental Health Institute
• Clarinda Mental Health Institute
• Independence Mental Health Institute
• Mt. Pleasant Mental Health Institute
• Juvenile Institutions:
  • Iowa Juvenile Home, Toledo
  • State Training School, Eldora

APPENDIX IV

RECOMMENDATIONS OF THE PROGRAM DUPLICATION AND RESOURCE UTILIZATION SUBCOMMITTEE

APPENDIX I

HUMAN SERVICES RESTRUCTURING TASK FORCE RECOMMENDATIONS

Overview. In developing the recommendations of the full Task Force to the General Assembly, the Task Force utilized the four follow-up strategies developed during the two-day planning meeting of the Task Force held in October 1997. These strategies are:

1. Utilizing a results-based framework for human services which emphasizes accountability and flexibility.
2. Pooling funding and resources.
3. Enhancing local governance.
4. Eliminating barriers.

The recommendations for which consensus was received are:

1. Results-Based Framework.
   1. Council on Human Investment Policy Objectives. The General Assembly should identify in the 1998 legislative session desired public policy results or broad outcomes by endorsing the state policy objectives established by the Council on Human Investment (CHI). During the 1998 legislative session, at the earliest opportunity, the General Assembly should review the CHI state policy objectives to identify gaps in or changes to these objectives. The review may include the use of technical assistance provided by a national source. The review might be performed by joint appropriations subcommittees, combined appropriations subcommittees, or a broader group of legislators. Following endorsement of the initial set of state policy objectives, the General Assembly should begin working on the other components of a results focus by identifying progress indicators and by employing professionals to establish program performance measures, with these other components in place for the state by the year 2000.
   2. Results-Based Budgeting. The state budgeting process should move toward an interdepartmental, results-based system rather than using the current program-based or departmental-based system. Given the existing system in which the majority party political caucuses develop budget targets and appropriations subcommittees work with these targets, the system could be redirected in an incremental fashion. Perhaps a new appropriations subcommittee or a group of legislators from various subcommittees which forms across departmental lines could recommend certain funding amounts for common desired outcomes. An initial step might be to review the results identified by executive branch agencies in the "budgeting for results" system and then expand upon these results through legislative action. Additionally, in the future, each caucus could be informed of progress made in the budgeting for results process, including any changes in the baseline for a particular performance measure. This could encourage the caucus to set priorities based upon desired results rather than based upon specific programs within certain departments.
2. Pooling Funding and Resources.
   1. Legislative Budgeting. The legislative appropriations process should include a process for broader communications between representatives of the various education, health and human rights, and human services related appropriations subcommittees, and possibly standing committees. The process should move toward an interdepartmental, results-based system.
   2. Multiyear Grant Funding. Funding should be committed to local community efforts for multiple years and should be provided in such a way as to eliminate the constant time commitment for grant writing and attendance of meetings to ensure funding.
   3. Pooling for Results. In the pooling of funding, local governance entities must inventory the current funding streams and decide which streams could be pooled. Funds should be pooled based upon desired results. Funding for different populations must be considered in determining which funds to pool.
   4. Funding Mix. Funding should be a mixture of federal, state, local, and other funding. The steps in the process include expanding the local governance entity, bringing more money to the table from various sources, and providing for expending moneys and providing services at the local level.
   5. Decision Makers Bring Resources. Those with decision-making power should all bring resources, not solely financial, to the table so that they have a stake in achieving the results. The members of the local governance entity should not just expend funds, but should develop the community plan, and bring resources to the table.
3. Enhancing Local Governance.
   1. Three Levels of Local Governance. Each community is at a different stage of building capacity to provide local governance and necessary resources. If a community is not ready to provide local authority and collaboration, the community's effort might fail. Therefore, varying stages of local governance should be made available. The existing levels of decategorization programs and innovation zones should be retained as the first two levels of local governance. An additional third level, which provides for a broadening of local governance, should be established.
   2. Pilot Projects. The new third level should be implemented through the use of various types of pilot projects to be able to measure success and to learn lessons before these projects are expanded statewide. The pilot projects should incorporate the following:
      1. ) Options for pilot projects could include the extension of decategorization through the pooling of funds of other funding streams, or the development of projects which would focus on a particular sector of the population, such as the population of children 0 through 5 years of age.
      2. ) The third level would include establishing a state and local partnership through creation of a plan by the local governance entity. A new pilot program could begin by determining at what funding is currently expended for a particular result, from all sources. Then the local entity would evaluate the current local situation, identify desired results and the programs and services necessary to meet community needs and desired results, and redesign programs and services to meet these needs and attain the desired results.
      3. ) According to community forums held by the members of the Task Force and the Task Force's review of state-level groups, many of the same people are involved in the myriad of existing state collaborative efforts and local governance entities. At the local level, a broader local governance entity should exist to encompass all of these. Some have described this approach as a "collaboration of collaboratives." The plan would be developed through an integrated, local planning process.
   3. State Board. A state board could provide for technical assistance, evaluation, and acceptance of plans, for evaluation of achievement of results, and for compilation of lessons learned from these pilot projects to assist additional communities in developing local governance.
   4. Appropriate Names. The name of the local governance entity should reflect its work. The names and terminology currently used for local governance are not readily understood by the public. Consideration should be given to renaming "decategorization" and "innovation zones."
   5. Local Governance Structure and Membership. The local governance entity should be made accountable to those public and private bodies which provide funding to achieve the desired, identified results. An executive board might be appointed as the accountable, decision-making entity as a subgroup of the larger local governance board. The local community should select the specific members and chairpersons of the governance entity, but the General Assembly should authorize the creation of the local governance entity and should provide parameters for the entity. The leaders of the community should be allowed to emerge. The local entity should decide how the local system should function as a policymaking and fiscal entity to achieve the desired results. The local governance structure should report results to the state board or to the General Assembly. One incentive for forming a local governance entity could be that the local governance entity retains any savings to reinvest in the community. Incentives should also be provided for innovative approaches which should be given adequate time to succeed before they are labeled as failures. Other necessary considerations:
      1. ) All members of the community should be involved, including businesses and the private sector. However, the private sector should not be considered to be a bottomless financial supporter. The private sector is just one of the sources which should be included in supporting the local governance entity and plan.
      2. ) The state and the local governance entity should develop a partnership. Legislation should prescribe broad parameters for local governance and its membership, but the individual membership would be selected locally and additional members could be included. The entity should be based upon earlier successes by the community. The parameters should reflect that the local community should engage different partners to work on local problems and that populations that do not usually have power, such as consumers, should be included.
      3. ) The governing entity is not just about expending funds, but is about engaging the community in meeting its own needs. The local governance entity should be a mixture of elected and appointed members.
      4. ) One option for funding a state/local partnership is for local communities, with state assistance, to determine current funding in reaching a desired goal and the state, and other funding sources, providing that amount of money for a multiyear period to the local community to provide the programs and services necessary to reach the desired result.
   6. State Role.
      1. ) The role of the state is one of defining and providing for core services, providing administrative support, providing technical assistance, and providing for evaluation of local efforts. Core services are those services to which every Iowan has a right. The core services should be defined by the three branches of government. The local community then builds on these core services with those additional services which are specific to the local community. The local community must decide how to supplement services to achieve the desired results. The state can also develop the long-term plans for the state, as a whole, and for local communities so that efforts are not duplicated.
      2. ) A state board should be established to review the new local governance entities, to measure success, and to compile lessons learned from each level of local governance. This board could also provide technical assistance.
   7. Staffing. An analysis of human services staffing should be performed and should take into consideration the new role of staff as governance and provision of services are moved to the local community level.
4. D. Overcoming Barriers.
   1. State Agencies. Coordination and collaboration between departments should be enhanced and both the legislative and executive branches should be involved in these efforts. The progress made between the departments, to date, should be built upon and enhanced.
   2. State Board. At the state level, collaborative efforts should be combined. Collaborative boards, commissions, and other entities which include the same memberships should be combined and should then address the broader spectrum of issues or programs. The existing state boards which oversee local governance efforts relative to education, public health, and human services, such as decategorization and innovation zones, should be encompassed, to the greatest extent possible, by a broader state board as escribed above. Duties of the new state board could include the following:
      1. ) The new board would provide technical and administrative assistance, coordination, and other assistance to local governance entities.
      2. ) The new board would also measure the success of local communities in achieving desired results and would be the entity to whom local governance entities would be accountable.
      3. ) The existing state boards which have other functions would continue to provide those other functions and the human services-related functions, relative to local governance, could be redirected to the new board.
      4. ) The role of the state should include eliminating barriers for local communities. Each community is at a different level in building capacity.
   3. Local Entities. As described above, at the local level, existing collaboration efforts should be combined and a new governance entity formed which encompasses all of the interests and which will then address the more comprehensive set of needs of the community.
   4. Special Federal Relationship. A dialogue with the federal government should be initiated to establish a special relationship with the federal government to enable the state to pool funding streams, to overcome barriers of laws, regulations and other federal requirements, to encourage development of innovative programs, and to implement state initiatives. The effort should be coordinated through the Iowa Congressional delegation.
   5. Administrative Rules. Existing administrative rules, which create barriers for local governance entities and which limit the collaboration between departments, should be identified and addressed to eliminate these barriers. The new state board, individual departments, or other appropriate entities should be directed to analyze the federal and state rules for these barriers and to advocate for necessary modifications.
   6. Information Technology. A system wide computer interface should be developed to provide connectivity between departments at the state level, between the public and private sectors, between the state and local communities, and between local communities. The state central information technology (IT) unit should be directed to move ahead with developing this system. The General Assembly should direct the IT unit or the Legislative Oversight Committee to review the current system and to report any barriers to developing this system and to develop a long-range plan to implement such a system. The system should be research-linked and data-linked in a results-based system so that there will be accountability for achieving results.

APPENDIX II

VISION STATEMENT FOR DHS INSTITUTIONS

Background. The Department of Human Services (DHS) institutions have provided important services to the people of Iowa for many decades. They are located in diverse geographic locations throughout the state, have significant physical facilities, and employ talented, dedicated staff providing services to Iowa's families.

Changes in treatment approaches over time have reduced the degree of need for placement of great numbers of people at individual institutions. Nevertheless, every region of the state will continue to have some individuals with needs which can be best met by a DHS institution. Although excess capacity exists at some of the institutions, the investment in the physical facilities has already been made, and the capacity should be redeployed for addressing different public needs. In addition, as community-based services expand, an institution's staff resources should be refocused accordingly to support the community-based services located in the region surrounding the institution.

Vision. Department of Human Services (DHS) institutions provide a vital "safety net" of services to Iowa families and communities. While the institutions were originally established as single purpose facilities, in the future they will evolve into diversified, multi-use resource centers with a mixture of public and private providers.

Reduced demand for some services has changed the role of some DHS institutions. As reduction in demand for traditional services of a DHS institution creates excess capacity in the buildings, land, and other resources of the institution, those resources should continue to be redeployed to meet the public needs of the region surrounding the institution. To this end, the institution's staff should be encouraged to work even more closely with local governments, school districts, other state agencies, and private providers of services to invite uses and fill service gaps compatible with the institution's physical resources. Public services appropriate for inclusion on an institution's campus may include health, education, corrections, and other public services in addition to human services.

Many DHS institutions have classic buildings, and it is hoped that future construction and renovation will be designed to be compatible with the existing structures.

The quantity of persons receiving an institution's traditional services for an extended period becomes fewer as these persons are served in community-based settings. In response, the institution's staff are experienced with seeing perhaps as many different persons for shorter stays who exhibit more difficult, chronic problems. This experience should be utilized to develop and support community-based services. Possibilities include providing training, education, and consultation to community-based service providers and brief targeted treatment to their clients.

As these efforts proceed, it is hoped the public will come to view DHS institutions as regional resource centers where many public services are located in conjunction with the important services these institutions have traditionally provided.

Human Services Restructuring Task Force Institutions and Facilities Subcommittee
RECOMMENDATIONS
(as approved by the Task Force on December 18, 1997)

Introduction

The state of Iowa has had a strong tradition of providing services to those persons with mental health problems or mental retardation and to troubled youths. Many of the services are provided through the Department of Human Services' institutions. These facilities have undergone a major transformation in the way they deliver services to their clients. The perception that the facilities continue to warehouse patients is unfounded, as Iowa's state institutions have undergone radical changes and are now leaders in their fields of service.

In travelling to the various facilities, it is quite evident that the people and programs at these institutions are among the strengths of the Department of Human Services. While the need for the level of care provided by these facilities has diminished over the years, these facilities are still a key element in the continuum of care. In many cases, those being cared for by the institutions are individuals who no other provider will serve or is able to serve. Maintaining these facilities to provide this "safety net" is very important to providing the best services to Iowans. Yet improvements can be made to the system so that Iowa's institutions are ready to meet the challenges of the twenty-first century.

This Task Force recognizes that in making changes, several guiding principles must be adhered to. They are:

• Actions must be taken in a manner which does not lessen the care given to clients.
• Programs must be results-based and cost effective.
• Programs and facilities need to be able to adjust with the changes in demand for services, to the extent funding is available.
• Programs and facilities at the institutions are part of the continuum of care for mental health, mental retardation, and juvenile services.
• Changes must not be implemented in a manner which results in increased cost to counties or otherwise increases property taxes.

General

1. The state should act to change the public mindset that DHS institutions are big, old, warehouse-style places that are falling apart and provide poor quality care. Instead, the state should emphasize the high quality care provided at a relatively reasonable cost. The buildings have been well-maintained and are located in a manner to serve as regional resource centers. Many people being served would not have other options for services. Examples of quality care, such as the psychiatric care provided at Cherokee and the Independence Cromwell unit, can be found in each institution.

2. To reflect the changes in services and attitudes, the Legislature should adopt a new name for the state institutions. Any new name should reflect the change in the way these facilities serve Iowans. One possibility would be "Community and Residential Resource Centers."

3. The Legislature should amend the mission statements of the institutions to reflect the intent of the Legislature that these facilities serve as regional resource centers, while continuing to specialize in certain statewide programs.

4. The Legislature should undertake a rewrite of the Iowa Code chapters related to these facilities. The rewrite should focus on reflecting the modern practices of the services provided. This process should involve representatives of the institutions, clients, and advocacy groups. The group should complete its work for presentation during the 1999 legislative session.

5. The Legislature should rewrite the admissions policies for the institutions. This would modernize Iowa's admissions practices, while providing a more consistent and flexible admissions process.

6. The Legislature should request the Department of Human Services and the Attorney General's Office work with Iowa Protection and Advocacy Services, Inc., concerning modification of the Conner consent decree to accommodate the wishes of the patient's family and to allow greater involvement of the local institutions in determining when an admission is appropriate.

7. The Legislature should enact legislation amending the current admissions policies to permit the admissions of patients needing specialized mental health or mental retardation treatment and assessment without previous in-patient placement. This would be similar to the actions taken last year by the Legislature in changing the admissions requirements for the State Training School.

8. The Legislature should implement a policy that would allow the institutions to serve as a training resource for community facility staff, university medical students, and other professional training programs.

9. The subcommittee heard repeatedly about extreme growth in difficult-to-treat addictions to drugs such as methamphetamines. Will this growth increase the need for additional treatment options? Legislators should be informed of the statistics concerning drug-affected infants, toddlers, school children, and adolescents. Policymakers should be aware of options for early intervention to prevent the need for long-term interventions, prison stays, and other heavy costs to individuals and society.

10. Policymakers should commence discussions with other state institutions, such as the School for the Blind at Vinton, to determine whether these institutions could also be enhanced by the colocation of compatible programs.

B. Programs - Mental Health Institutes

11. The Legislature should implement policy so that, when appropriate, the usage of the facilities and services at the Mental Health Institutes is maximized, helping to minimize the cost to Iowans.

12. The Legislature should implement the dual diagnosis program and locate a 24-bed unit at the Mount Pleasant Mental Health Institute. The Legislature should direct the Department of Human Services and the Department of Public Health to explore ways to expand this type of treatment to other parts of the state, either through private providers or a unit located at a state facility.

13. The Legislature should consider permitting other facilities to offer specialized treatment currently offered at just one institution. The treatment could be provided by a private provider or other cost-effective approach. Examples of this include dual diagnosis and psychogeriatric services.

14. The Legislature should authorize the Department of Corrections to open a 100-bed facility for female inmates at the Mt. Pleasant MHI. This facility would be for those inmates with special needs.

15. Currently, more than 400 inmates are serving life sentences in correctional facilities. In the future, this will lead to greater numbers of inmates with geriatric conditions. The Legislature should authorize the Department of Corrections to hold geriatric patients at MHIs or other appropriate state institutions with unused space.

16. The Legislature should permit the Mental Health Institutes to provide direct services or to lease out available space to private providers of residential care facility services, children's services, and other services for which there is an inadequate supply or an inadequate level of services. Other community needs, such as low-income housing, may be appropriate for development on unused land.

17. Some MHIs do not have much of their operation committed to providing MHI services. DHS should be asked to propose criteria for use in determining when size is reduced to the point the quality of a program becomes impaired and the public cost becomes too high. At this point, consideration should be given to merging the program with other institutions, community hospitals, or other community-based providers.

C. Programs - State Hospital-Schools

18. The Legislature should authorize the Glenwood SHS and the Woodward SHS to expand their respite care services programs. This is in recognition of the fact that these services provide better treatment conditions for patients at less expense to the state.

19. If demand exists, the Legislature should authorize the State Hospital-Schools to increase their Time-Limited Assessment programs. These services allow trained professionals to determine the needs of an individual and design a care strategy that best serves them.

20. If demand exists, the Legislature should authorize the State Hospital-Schools and other DHS institutions to establish special units to serve patients under an agreement with Nebraska, Illinois, or other states bordering Iowa. To this end, DHS should be authorized to begin discussions with bordering states for each state to utilize facilities and programs in the other states. Any actual arrangement should be cost-neutral to Iowa.

D. Programs - State Training School and State Juvenile Home

21. The Legislature should request that the State Training School, in conjunction with the school's local Area Education Agency, develop a program for students who are appropriate to interact with young children and to provide other practical means for learning about parenting.

22. The Legislature should consider the possibility of separating delinquent girls from child in need of assistance (CINA) placements, which is currently the practice at the Iowa Juvenile Home. Possibilities for accomplishing this objective include creation of a separate facility at another DHS institution or creation of small regional centers.

23. The Legislature should consider creating additional alternatives for those juveniles who, for various reasons, cannot return to their communities or to their families.

24. The Legislature should provide additional FTEs to the State Training School and to the State Juvenile Home to alleviate the staffing concerns and overtime needs at these facilities. Also, additional funding should be provided for training of current and future employees of these facilities as necessary for these employees to deal with increasingly difficult children.

E. Financial Issues

25. The Legislature should consider moving the remaining state institutions to the net budgeting process being tested at Glenwood SHS, with Independence going forward in FY 1998-1999. The remaining institutions could implement net budgeting in FY 1999-2000, after running a paper net budgeting trial in FY 1998-1999.

26. The Legislature should enact legislation to allow all or a percentage of the portion of Medicaid payments for infrastructure maintenance to be given to the facilities, instead of being deposited in the General Fund.

27. The Legislature should authorize the State Hospital-Schools to "unbundle" the cost of pharmaceuticals and other costs, in order for Medicaid billings for these institutions to be equivalent to that used by other ICFMRs.

28. The Legislature should review school funding policy associated with children placed at state institutions and other out-of-home placements.

29. The Legislature should review the noncompetition by government law to determine whether additional exceptions are appropriate in order for DHS institutions to achieve a new vision and a revised mission.

30. The Legislature should consider requiring state facilities to purchase needed products that are competitively priced and are currently being produced by the clients at the State Hospital-Schools and at other public and private sheltered workshops and programs employing persons with disabilities.

31. With the additional program options given to the states for Medicaid, Iowa needs to explore the possibilities of changing its Medicaid program to better meet the needs of Iowans. As part of the budget process, the Legislature should request a report from the Department of Human Services and from counties on what potential changes could be made and how they would benefit Iowans.

32. The Legislature should study the University of Iowa's Hospitals and Clinics' role in providing health care through the "state papers" program to inmates and in the mental health and mental retardation service system.

F. Infrastructure Issues

33. The Legislature should instruct the Department of Human Services to work with the Department of Corrections to create a treatment program for inmates with mental retardation problems who are sexual offenders. This program could be modeled after the program at the Woodward SHS. The General Assembly should be provided information concerning outcomes of the program at Woodward SHS.

34. Because of the unique topography and historical significance of the land surrounding the Glenwood SHS, the Legislature should transfer management of this land from the control of the Department of Corrections to the Glenwood SHS.

35. The Legislature should appropriate funds for the various facilities to remove those structures that are no longer usable. The labor for the removal could be provided by prison labor. DHS should sell what can be salvaged from these buildings.

36. The Legislature should request a report from the Department of Human Services on the infrastructure needs of the facilities and a prioritization of these needs for each facility.

37. The Legislature should authorize DHS institutions to permit construction of new buildings on their campuses by other parties for the purpose of housing various nonstate functions that fit with the role of the campus. Current policies requiring payment or leasing at fair market value should be continued. Examples of possible facilities include nursing homes for low-income seniors and low-income housing for the medically needy.

APPENDIX III

BACKGROUND INFORMATION CONCERNING DHS INSTITUTIONS

Institutions Historical Census
Provided by Legislative Fiscal Bureau

Institutions Sources of Revenue (Fiscal Year 1996)

Institution	Federal	%	State	%	County	%	Other	%	Total
Toledo	0	0	3,526,320	68%	1,444,116	28%	236,396	5%	5,206,832
Eldora	0		8,517,130	94%	0		588,394	6%	9,105,524
									0
Total Juvenile	0		12,043,450	84%	1,444,116	10%	824,790	6%	14,312,356

 

Cherokee
Institution Expend	1,553,297		10,114,451		2,531,567		253,059		14,452,374
Other State			171,648						171,648
Total	1,553,297	11%	10,286,099	70%	2,531,567	17%	252,059	2%	14,624,022
Clarinda
Institution Expend	699,915		2,204,511		3,058,033		101,282		6,063,741
Other State			106,296						106,296
Total	699,915	11%	2,310,807	26%	3,058,033	50%	101,282	2%	6,170,037
Independence
Institution Expend	2,002,437		10,158,796		5,479,226		321,080		17,961,539
Other State			188,098						188,098
Total	2,002,437	11%	10,346,894	57%	5,479,226	30%	321,080	2%	18,149,637
Mt Pleasant
Institution Expend	683,674		3,228,848		888,829		74,481		4,875,832
Other State			62,617						62,617
Total	683,674	14%	3,291,465	67%	888,829	18%	74,481	1%	4,938,449
MHI Total	4,939,323	11%	26,235,265	60%	11,957,655	27%	749,902	2%	43,882,145

Institution	Federal	%	State	%	County	%	Other	%	Total
Glenwood
Institution Expend	23,677,999		2,210,196		9,039,012		17,646,688		36,691,895
Other State			1,364,597						1,364,597
Total	23,677,999	62%	3,574,793	9%	9,039,012	24%	1,764,688	5%	38,056,492
Woodward
Institution Expend	19,495,330		262,887		8,415,548		1,667,326		29,841,091
Other State			799,046						799,046
Total	19,495,330	64%	1,061,933	3%	8,415,548	27%	1,667,326		30,640,137
SHS Total	43,173,329	63%	4,636,726	7%	17,454,560	25%	3,432,014	5%	68,696,629

Human Services FTE History (FY 1987 through FY 1997)
Provided by Legislative Fiscal Bureau

Hospital Schools Areas

Glenwood State Hospital School
Provided by the Department of Human Services

Purpose: The Glenwood State Hospital-School provides diagnostic evaluation, treatment, training, care and habilitation, and support to persons with mental retardation and serves as a resource center to communities.

Program Service Components:

• ICF/MR residential services
  • Habilitation services
  • Vocational training/leisure services
  • Medical treatment services
  • Sexual abuse treatment and evaluation
• Evaluation services
  • Diagnostic and evaluation clinic
  • Time limited assessments
• Specialized services
  • Assistive technology
  • Respite care
  • Foster Grandparent and Senior Companion programs
  • Feeding and swallowing team
  • Home and Community Based Waiver services
• Campus also houses additional regional and local area services

Woodward State Hospital School
Provided by the Department of Human Services

Purpose: The Woodward State Hospital-School provides diagnostic evaluation, treatment, training, care, habilitation, and support to persons with mental retardation and serves as a resource center to communities.

Program Service Components:

• ICF/MR residential services
  • Habilitation services
  • Vocational training/leisure services
  • Medical treatment services
  • Adaptive Pro-social Performance learning Environment program for persons with mental retardation who have documented histories of unacceptable behavior of a sexual nature or who are survivors of sexual abuse
  • Autism services
• Evaluation services
  • Diagnostic and evaluation clinic
  • Time limited assessments
• Specialized services
  • Assistive technology
  • Respite care
  • Foster Grandparent program
  • Feeding and swallowing team
  • Home and Community Based Waiver services
  • Treatment/Education of Autistic and related Communication for Children with Handicaps (TEACCH) training
• Campus also houses additional regional and local area services

Iowa Mental Health Institutes

FY 1997 Cost Comparisons
Provided by Legislative Fiscal Bureau

Cherokee Mental Health Institute
Provided by the Department of Human Services

Purpose: The Cherokee Mental Health Institute provides inpatient and outpatient psychiatric treatment for adults, adolescents and children through a psychiatric rehabilitiation program of counseling and skill training.

Program Service Components:

• Acute psychiatric inpatient
• Outpatient services: psychiatric diagnosis, medicaiton managment, individual therapy, family therapy
• Regional mental health transportation
• Mobile crisis program
• Pastoral care
• Campus also houses additional regional and local area services

Clarinda Mental Health Institute
Provided by the Department of Human Services

Purpose: The Clarinda Mental Health Institute provides short term inpatient psychiatric treatment for adult persons with mental illness and long term care for persons need psychogeriatric services not available in the community.

Program Service Components:

• Acute adult psychiatric inpatient care
• Long term nursing care for adult patients with chronic psychiatric or behavioral problems
• Campus includes and adult medium security correctional facilty
• Campus also houses additional regional and local area services

Independence Mental Health Institute
Provided by the Department of Human Services

Purpose: The Independence Mental Health Institute provides comprehensive, inpatient psychiatric treatment for adults, adolescents, and children.

Program Service Components:

• Acute psychiatric inpatient treatment including psychiatric and medical diagnostic evaluations; medication and psychotherapeutic modalities; patient and family education; forensic evaluations
• Clinical training programs for twelve disciplines
• Campus also houses additional regional and local area services

Mt. Pleasant Mental Health Institute
Provided by the Department of Human Services

Purpose: The Mt. Pleasant Mental Health Institute provides short term inpatient psychiatric treatment for adult persons with mental illness and residential treatment for adult substance abusers..

Program Service Components:

• Acute psychiatric inpatient
• Treatment for adult substance abusers
• Pilot project for adults with a dual diagnosis of mental illness and substance abuse
• Campus includes an adult medium security correctional facility

State Training School, Eldora

Purpose: The State Training School is designed to provide institutional care to children adjudicated by the courts as delinquent in order to increase community safety and to re-direct negative behaviors and reinforce positive behaviors.

Program Service Components:

• Individual, group and family counseling
• Substance abuse treatment
• Education and vocational training
• Health care services

Juvenile Institutions
Iowa Juvenile Home, Toledo

Purpose: The Iowa Juvenile Home is designed to provide institutional care to children adjudicated by the courts as delinquent or Child in Need of Assistance (CINA), in order to increase community safety and to re-direct negative behaviors and reinforce positive behaviors.

Program Service Components:

• Individual, group and family counseling
• Substance abuse treatment
• Education and vocational training
• Health care services

APPENDIX IV

RECOMMENDATIONS OF THE PROGRAM DUPLICATION AND RESOURCE UTILIZATION SUBCOMMITTEE

The Program Duplication and Resource Utilization Subcommittee held three meetings during the 1997 Interim. The meetings focused on systemwide interagency cooperation and collaboration, the needs of children ages 0 through 5 and their families, and specific programs and services.

Through Subcommittee discussions, the Subcommittee determined that the basis for any change in the human services system should begin with the establishment of systemwide objectives. The Subcommittee also determined that program duplication and resource utilization can be addressed in ways other than by focusing on individual program overlap.

The following is a listing of recommendations for actions to be taken to achieve a reduction in or elimination of program duplication and to improve utilization of resources:

1. Take legislative action to endorse/develop objectives for the entire human services system.

A. During the 1998 legislative session, direct the interdisciplinary appropriations subcommittee (referred to in recommendation 3), to review and monitor the human services related state policy objectives developed through the Council on Human Investment (CHI). The subcommittee should make recommendations regarding state policy objectives to be endorsed by the General Assembly for FY 1999.

B. During the 1998 legislative session, the General Assembly should take action to provide direction regarding the state policy objectives. A resolution should be drafted which endorses human services related state policy objectives for FY 1999, and which authorizes the interdisciplinary appropriations subcommittee to perform an ongoing review of the objectives during the legislative interim for use in FY 2000.

C. During the 1998 legislative interim, the interdisciplinary appropriations subcommittee already stated in paragraph A should review the data compiled by CHI, and should use focus groups, local forums, or other grass roots processes, as necessary, to establish and prioritize human services related objectives for recommendation to the General Assembly and for use in the next fiscal year.

2. Enact legislation to establish a human services system interdisciplinary team.

A. The team should include the directors of each human services related department (human services, public health, and education), representatives of other departments and branches of government to act as resources to the team, representatives of local governance entities, and others.

B. Duties of the team would include:

• (1) Developing an interdisciplinary budget based upon the established state policy objectives which are common to all of these disciplines. The interdisciplinary budget could be developed incrementally with the initial focus being on the 0 through 5-year-old age group.
• (2) Developing a plan for a systemwide computer interface. The plan would include a date certain by which time the system would be fully implemented.
  • The system would provide a centralized, interdisciplinary, integrated information management system to be used to maintain the inventory of all human services related programs and to provide for intake, assessment, referral, case management, and monitoring of consumers in the system. The system would be used at both the state and local levels.
• (3) Inventorying existing programs and services, on an ongoing basis, at the state, local, public, and private levels to determine gaps and duplication. This process can be used to coordinate programs and services through information sharing at the state and local levels.
• (4) Providing periodic reports and ongoing input to the interdisciplinary appropriations subcommittee and to the General Assembly as a whole.
• (5) Integrating/consolidating programs and services and funding streams with common objectives, across disciplines.
• (6) Combining/integrating/eliminating the myriad of councils, committees, boards, and other entities which oversee programs and services within or across departments. Instead of the identical members/interests serving on several of these entities, these identical members/interests would serve on one, comprehensive entity with responsibility over the variety of programs/services.
• (7) Additional duties as directed by the General Assembly.
  3. Establish an interdisciplinary appropriations subcommittee.
  The subcommittee would be comprised of the chairpersons and ranking members of the human services, health and human rights, and education appropriations subcommittees (the three appropriations subcommittees).
  A. The chairpersons of each of the three appropriations subcommittees would act, on a rotating basis, as the chairperson of the interdisciplinary subcommittee.
  B. Additional members of each of the three appropriations subcommittees would be selected by the chairpersons to serve on the interdisciplinary subcommittee. Representatives of other appropriations subcommittees could be involved.
  C. The subcommittee would act as a vehicle to educate legislators, across disciplines, about programs, services and needs of consumers.
  D. The subcommittee would make recommendations to the three appropriations subcommittees regarding integration of programs and the pooling/blending of funding.
  E. The subcommittee would provide ongoing review of human services related state policy objectives and would make recommendations for prioritization of objectives in the development of human services related budgets.
  4. Take actions to improve accountability and evaluation.
  A. Require DHS to enforce existing monitoring procedures to ensure that DHS receives the required information to comply with existing DHS administrative rules and to ensure that information is received by other appropriate persons to fulfill requirements of existing administrative rules.
  B. Establish, through legislation or rules, an auditing and evaluation process that is consistent across programs which receive state funding, whether the program is carried out by a public, private, nonprofit, or for profit entity. Include established time frames for evaluations/audits in all contracts which involve state funding. The time frame should be established at the time the contract is entered and should be tied to specific, measurable results.
  C. Require third-party evaluations of programs to validate results.
  D. Limit the terms of service of members of commissions, boards, and other decision making entities which award contracts which involve state funds.
  5. Take actions for improvements which are specific to the population of children ages 0 through 5 and their families.
  A. Encourage expansion of programs which provide support to families prior to the birth of a child and following the birth of a child. Provide a process for integration of the variety of state and local family support programs.
  B. Direct the human services interdisciplinary team to:

  • (1) Develop a plan and present the plan to the General Assembly for the 1998 Session to integrate the existing programs and funding streams for children 0 through 5 years of age and their families. The plan for integration would include early Head Start, Head Start, early childhood programs, preschool programs, and family support programs such as HOPES.
  • (2) Following the development of the plan for integration of the programs under (1), develop a plan to provide these programs statewide through coordination/integration of federal, state, and local programs and funding streams.
  6. Develop a "site-based" or geographic area-based service system.
  Establish a pilot project in a rural and an urban area to provide a single site or a network of sites in each local governance area for common intake, assessment, referral, case management, tracking, and provision of services for the continuum of needs presented. The pilots could be developed in existing innovation zones or decategorization areas.
  (1) The pilot could be based on the caring communities program in Missouri (neighborhood-based, integrated services linked to schools) or on another model. A school or another physical location, such as a family resource center, library, hospital, human services office or other location, or a network of these physical locations, could act as the "hub" for the system.
  (2) A locally selected multidisciplinary team could provide coordination and daily management of the site/network.
  (3) The pilot could be implemented incrementally by initially coordinating programs and services for children 0 through 5 and their families and then being expanded to other populations.

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Last update: THURS Apr 30 1998
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