HUMAN SERVICES RESTRUCTURING TASK FORCE

September 10, 1997 -- First Meeting of Five

MEMBERS PRESENT

MEETING IN BRIEF

Minutes prepared by Richard Nelson, Legal Counsel
Organizational staffing by Patty Funaro, Senior Legal Counsel

1. Administrative Business.
2. Task Force Discussion.
3. Woodward Staff.
4. DHS Strategic Plan.
5. Innovation Zones.
6. Decategorization.
7. Materials Distributed to the Task Force and Filed With the Legislative Service Bureau.

TASK FORCE BUSINESS

1. Administrative Business.

Meeting Convened. The meeting was convened at 9:46 a.m. with opening remarks by Dr. Michael Davis, Woodward State Hospital-School Superintendent, Senator Maggie Tinsman, and Representative Hubert Houser. Dr. Davis noted that Woodward is in the process of transitioning from an "institution" to a support and resource services center for individuals with disabilities.

Election of Co-chairpersons. The Task Force appointed Senator Tinsman and Representative Houser as Co-chairpersons. Senator Tinsman and Representative Houser expressed confidence in the ability of the Task Force members to move forward with the charge of the Task Force and make meaningful progress. Remarks made during introductions by the members of the Task Force reflected optimism that an already good system can be improved further and that more local level involvement will be achieved.

Recess and Adjournment. The meeting recessed to tour the programs and grounds of the Woodward facility at 10:10 a.m., reconvened at 12:10 p.m., and adjourned to subcommittee meetings at 3:15 p.m.

2. Task Force Discussion.

Following the tour, Co-chairpersons Tinsman and Houser continued preliminary remarks. Co-chairperson Houser expressed his hope that the Task Force will exhibit focus and push forward with devolution. He indicated that until now the Legislature has been left out of the devolution process, and with five full committee meetings and additional meetings by the two subcommittees, significant progress can be made. Co-chairperson Tinsman identified devolution of services to the local level, the sharing of responsibilities between local agencies and the state in new and innovative ways, and developing new services for children to age 18 with a focus on ages 0 through 5 as areas of emphasis, and indicated that other states look to Iowa regarding human services restructuring.

Two-Day Retreat. Co-chairperson Tinsman outlined a proposed agenda for future Task Force meetings. Future meetings of the Task Force will include a two-day interactive retreat scheduled for October 27 and 28, conducted with the assistance of the National Conference of State Legislatures and with the financial support of the Annie E. Casey Foundation. The retreat will be held at a location other than the State Capitol Building, with the objective of laying the groundwork for the sharing of services between state agencies and local communities, improving programs, developing a preliminary plan for a legislative agenda, and identifying the next steps necessary for putting the plan in motion.

Final Meetings. In November, the Task Force will meet again for consideration of major issues which have been raised. A November meeting date of Tuesday, November 25, was agreed upon by Task Force members. The final meeting of the Task Force will involve formulating full and subcommittee recommendations. December 18 was selected as the final meeting date.

Public Forums. In addition to the formal meeting dates, it was determined that Task Force members would hold local public forums to gain input and generate new ideas regarding how to structure local governance and develop accountability. A list of potential questions for use during the public forum meetings will be developed and distributed by Legislative Service Bureau staff. Additionally, members were encouraged to visit local decategorization projects and innovation zones.

Member Comments. Co-chairperson Houser called upon Task Force members for input and comments regarding the focus and direction of the Task Force, and the proposed agendas for future meetings:

• Representative Dan Boddicker indicated that legislative members are charged with spending their constituent's tax dollars in the wisest manner possible. The elimination of duplication and bureaucracy is a key goal.
• Ms. Arlene Dayhoff stated that cross-planning is necessary to build partner-ships and achieve integrated services. The focus should be on system reform in all the agencies of state government, and the formulation of better strategies to serve the children and families in the state. Accountability is essential both regarding changing what is not working, and building on what does. Additionally, it is impor-tant to identify what the phrase "local governance" really means. Simply pouring additional resources into existing strategies is not necessarily the answer; reallo-cating current resource levels to remove barriers and improving communication between departments may be just as effective in some instances.
• Senator Elaine Szymoniak commented that the Task Force needs to be open to societal changes necessitating system changes and consider the potential unin-tended consequences of actions taken.
• Representative Brad Hansen mentioned that a customer focus or orientation rather than a product or service focus is needed at the agency level.
• Mr. Roger Gutmann identified five key aspects of the Task Force charge -- stewardship, the recognition that process is as important an issue as structure, communication between agencies outside the traditional lines and boxes of organi-zational charts, achieving the goal of reasonable accountability, and a strategic planning, rather than tactical response, orientation in relation to prevention.
• Representative Robert Osterhaus expressed optimism concerning the process of moving decision making to the local level.
• Senator Nancy Boettger emphasized that the primary focus of restructuring efforts should be directed to programs and services for the age 0 through 5 cate-gory. She wondered whether the quality team approach utilized by private sector industry might have some increased application within the human services context.
• Senator Jerry Behn noted his background as a county official and expressed a desire to reduce antagonism between the state and local governments.
• Representative Ro Foege cited improving the transition process from one "box" in the system to another, and reducing fragmentation (as opposed to dupli-cation) as key aspects of the Task Force charge.
• Senator Pat Harper stressed the importance of increasing coordination be-tween education and human services programs.
• Mr. Thomas Wilson indicated agreement with the above comments and cautioned that these changes will come about only through a long-term process.
• Dr. James Austin expressed frustration at the inability or unwillingness of agencies to provide services outside of their respective "boxes," and noted the importance of being concerned with how services are provided by all agencies providing services to children and families.

3. Woodward Staff.

Mr. Michael Davis, Superintendent, Woodward State Hospital-School, made pre-liminary comments. Ms. Joan Schultz, Director of Community Support and Technical Assistance, provided an overview of the Consultation and Community Outreach Program. The program involves Woodward staff members providing consultation and technical expertise to staff at the local level when an individual is placed in the community, to enhance the likelihood of a successful outcome. With limited funding available for adults, the necessity to charge for consultations has arisen. The demand for consultation services has been increasing, and satisfaction surveys consistently yield positive feedback regarding the program.

Ms. Ann Thoreson-Aller, Treatment Program Administrator, described community out-reach efforts such as the "Give Me A Break" program designed to provide short-term relief for caregivers of special needs individuals. The need for relief from the responsibilities of caregiving has been identified as the top priority on needs assessment surveys completed by family members providing care to special needs individuals. The respite care program benefits both family members and the patient, and satisfaction survey feedback has been very positive.

4. DHS Strategic Plan.

Mr. Charles Palmer, Director of the Department of Human Services (DHS), provided statistics relating to the size, budget, and number of clients served by DHS and discussed a departmental strategic plan developed in 1995. Mr. Palmer indicated that the strategic plan reflects a number of environmental factors existing at the time the plan was developed, such as deficit reduction at the federal level, the growing recognition of the need for devolution, technology growth, shifting Iowa demographics, and the image of DHS as a bureaucracy. Guiding principles governing the plan include a customer focus, respect, empowerment, teamwork, and striving for excellence. The plan incorporates five primary goals:

• Recreating the service system -- improving service delivery with an outcome-based orientation.
• Collaboration and partnerships -- achieving seamlessness through the forma-tion of horizontal and vertical partnerships.
• Core business processes -- refining processes through the efficient and appropriate use of technology, patterned after similar efforts in private industry.
• Workforce enhancement -- develop a more highly trained staff adaptable to continuous change.
• Improved communication.

Mr. Palmer cited examples such as welfare reform, federal block grants, and medical service expenditures, and the state and county management group where efforts to operationalize the above goals have been successful. Major new initiatives include the state children's health insurance program; early childhood development; child assessment; empowered, creative, entrepreneurial programs in institutions and mental health and mental retardation efforts. In response to questions, Mr. Palmer discussed the interaction of managed care and decategorization, indicating that managed care can assume risk that decategorization zones cannot. He suggested and that when a link is established between the two, provider consortiums can be developed, with less micromanagement and more positive state government sector involvement. Mr. Palmer was also asked about the status of House File 702, which affects a number of provisions relating to the service system, facilities, funding, and other requirements for mental health, mental retardation, and developmental disability services. He indicated DHS is exploring the potential for administering adult disability moneys at the county level through the use of medical assistance (Medicaid), and that the issue arises as to whether or not this is permissible at the federal level. Ms. Dayhoff informed Mr. Palmer that this issue is of great concern across the state.

Co-chairperson Houser requested that Mr. Palmer return to continue his dialogue with the Task Force at a subsequent meeting.

5. Innovation Zones.

Ms. Jayne Jochem, Department of Management, addressed the Task Force regarding innovation zones. Ms. Jochem indicated that the purpose of the legislation giving rise to the project was to establish community partnerships to redirect existing public funds to achieve improved outcomes for children and their families. Both state and local jurisdictions will negotiate new relationships in the decategorization of funding appropriated and available to local jurisdictions which share the risk related to and responsibility for achieving improved outcomes. Ms. Jochem explained the distinction between innovation zones and decategorization is that innovation zones are broader in scope -- with a larger cross-section of agencies involved. The project can be characterized as a learning tool for devolution. Out of 281 collaboratives and 89 communities responding to information distributed concerning innovation zones, 17 applications were actually received. As of April 1, 1997, 13 communities have been designated innovation zones. Of that number, four communities are considered "advanced", with good strategic plans, a results-oriented focus, and a high degree of collaboration. The remaining communities fall along a continuum of varying stages of readiness. Common issues being encountered by the communities include transportation, lack of affordable childcare, juvenile justice, and intake procedures. Results to date, involving the removal of previously encountered barriers, include reallocation of funds between counties, resolving a misunderstanding regarding waiver requests which had been perceived to involve a state law barrier, and the continued operation of a youth after-school center. Currently, the project is working to reduce duplication at the state level and on the development of guidelines for innovation zones.

6. Decategorization.

Mr. Mark Baty, DHS Administrator for Linn and nearby counties, discussed decategorization efforts, primarily within Linn County. Within the context of the discussion, Mr. Baty indicated that a "community" refers to a county, and a "neighborhood" to a population center, such as Cedar Rapids. The Linn County project is in its sixth year of decategorization. At the outset, the challenge was perceived to be to make the project "concrete." Mr. Baty described the PATCH project, which is a three-year federally financed project utilizing a place-based strategy identifying high services utilization areas. In certain areas in Cedar Rapids, for example, children are 13 times more likely to become services consumers and subject to the state correctional system. In such neighborhoods, strategies for intervention includes the redeployment of existing resources and the uniting of public and private sectors to reduce unnecessary competition. Mr. Baty stated that devolution is more than simply putting resources into local hands -- a sophisticated tool path is needed. Innovation zones may be viewed as "generation two" of decategorization. The task in pursuing a place-based strategy is to develop effective partnerships at all levels of state government, which is a complicated endeavor.

7. Materials Distributed to the Task Force and Filed With the Legislative Service Bureau.

a. Iowa Department of Human Services Strategic Plan, distributed by DHS Director, Mr. Charles Palmer.

b. A handout summarizing innovation zone enabling legislation, operation, and roster of communities, distributed by Ms. Jayne Jochem.

c. A handout regarding the Linn County decategorization project, distributed by Mr. Mark Baty.

d. A packet of information summarizing Iowa Resources for Community Sup-port, distributed by Ms. Ann Thoreson-Aller.

e. Information binder regarding state institutions administered by DHS, dis-tributed by DHS.

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