Letter from the Director
Oregon Children's Plan breaks new ground
Building a more accountable Department
Oregon Health Plan
Waiting lists targeted by Staley settlement funding
Legislators launch Home Care Commission
In the best interest of children
Letter from the Director
We never know where we will find inspiration. Browsing in a bookstore recently, I picked up a copy of "The Alchemist" by Paulo Coelho. I was struck by how the difficult journey of the hero, the shepherd boy Santiago, resembles that of the Department of Human Services and its partners across the state.
Santiago's story is a metaphor for personal and professional opportunity, for making belief in ourselves greater than our fear of failure, and for creating a "personal legend" that maps our path.
In 1971, Gov. Tom McCall and state lawmakers created the Department with the promise, or "legend," of creating integrated human services for clients with multiple needs. But from the worker in our field system to my office, we have long recognized that we never completely fulfilled that promise.
This has resulted in clients being expected to navigate up to five DHS field systems, partners forced to negotiate multiple administrative offices across the Department, and accountability for our outcomes falling short of the need.
A highlight of the 2001 legislative session was legislative approval and the Governor Kitzhaber's signing of House Bill 2294, which enables us to change how we do business.
We are replacing the fragmentation of the Department with an integrated system to better assist the 42 percent of the people we serve who have three or more needs. We have centralized our administrative structure to make it easier for partners, providers and even our own employees to work with us. And we have established a Continuous System Improvement office for ongoing research, evaluation and training.
As a result, we should be able to identify needed services faster and more effectively than in the past, which in turn should mean that some clients will need our services for shorter periods. It is no longer necessary for a vendor, say, to deal with multiple DHS contract offices to secure a single contract with us. And we will tell state lawmakers in the 2003 legislative session that we will be more accountable than ever before for the outcomes the Department and its partners are achieving for Oregon's most vulnerable citizens.
Testimony to the importance of this work is contained in legislative decisions to maintain Oregon's commitment to human services programs, many of which are chronicled in this document, despite some of the most difficult fiscal challenges in years.
True, in changing how we do business we may face difficult times. Because Oregon is believed to be the national leader in this work, we will confront hurdles, make mistakes and learn lessons. But, like Santiago after he was robbed on his journey, we have a choice between thinking of ourselves as "the poor victim" or as "adventurers" in quest of the Department's promise.
Indeed, we are adventurers. The people we serve will receive the "treasure" of improved lives from the system we create and the discoveries we make. And we will have the satisfaction of being part of a watershed change in how a state, perhaps even a nation, helps people to the self-sufficiency, independence and dignity to which they are entitled.
A reality in human services is that clients and families often face multiple, related needs. The key to their success is ready access to a full range of supports in a coordinated, seamless way.
The Oregon Legislature created the Department of Human Services in 1971 with the hope that grouping human-service agencies would produce the holistic help clients and communities need.
Although many of the Department's services have gained national recognition, the original structure hasn't been successful in achieving the goal set by the Legislature 30 years ago. Here's an example of how clients often must "shop" for services. A client might have to visit several DHS offices, sometimes in different towns, to find public-assistance programs and employment services, drug or alcohol treatment, and support in caring for an aging parent or a child with disabilities.
Finding a new way
About a decade ago, we began testing a concept called service integration and building the necessary partnerships to make it work. Locally, there has been much progress in integrating services and building partnerships. Indeed, DHS and its community partners have built a national reputation for reform.
But after 10 years of practicing new approaches, it became clear that the Department's organizational structure was a significant barrier to our ability to work together.
Planning a new department
Before deciding how to change our structure to better meet client and community needs, we conducted extensive research, such as looking at similar agencies in other states, examining the laws that affect the Department and holding client focus groups.
In February 2001, we published Remaking DHS, version 1.0, the initial plan built on our research.
We submitted legislation (House Bill 2294) to the 2001 Oregon Legislature, to remake DHS and overcome the barriers faced by our staff and clients. Governor Kitzhaber signed HB 2294 into law on August 2, 2001.
An open approach
Improving the social and economic well-being of Oregonians is a collaborative effort. Multiple state and local partners work with the same clients and strive to improve conditions in Oregon communities.
In recognition of this, the Department's reorganization planning continues to include regular consultations with representatives of local governments, advisory groups, contracted providers, client-advocacy groups and others.
Key elements of the new DHS
The old DHS consisted of six divisions and three program offices, five of which provided services through separate networks of field offices. HB 2294 abolished that structure.
The new structure combines front-line service functions into a single, integrated Community Human Services group.
The new DHS also includes an Administrative Services group, which brings together information technology, human resources, contracts and other services; a Continuous System Improvement group, focused on research, evaluation and training; and three policy-and-program groups.
These last three groups will develop policy and programs supporting Seniors and People with Disabilities Services; Children, Adult and Family Services; and Health Services. All three will address program and policy related to employment and independence, elements critical to all clients' well-being.
The new structure brings staff with specialized knowledge into teams to support clients and families in a coordinated way. It also consolidates and streamlines administrative-support functions for better management across DHS. This increases efficiency and simplifies the Department's contractual and other relationships with local governments and partners.
The work ahead
In August 2001, we published Remaking DHS, Phase II, which outlines the steps necessary to begin making the new DHS a reality.
We're now starting to weave together the programs from the old divisions into the new program-and-policy groups.
The five existing field structures now are part of the Community Human Services group. The boundaries for the new service delivery areas have been set and managers have been hired. These managers now begin working within their communities to figure out how to best deliver services locally.
Moving the field to the new integrated-services approach will be done in three groups of counties, beginning in September 2001 and ending in January 2002.
The new DHS structure will use teams of specialists to provide services efficiently and comprehensively, in a way that involves clients and families in finding solutions.
The end result? Clients will find and be able to use DHS services more easily and they'll get better results.
For more information, visit the DHS Web site (www.hr.state.or.us) and select the Remaking DHS button on the right side of the screen.
Remaking DHS: for staff
Marita Baragli, Yamhill County Services to Children and Families branch manager, has seen a lot of change and improvement during the four years her area has been developing a team approach with other parts of the Department, other agencies and community partners.
"Before, other divisions working with a client were doing one thing, we were doing another and the clients were spinning around, wondering where to go and what to do," says Baragli.
Baragli sees the Department's reorganization as the next step in making services easier for clients to navigate. "Having those people at the table, working as a team and looking at all the client's needs, we can come up with one plan. That's the key to reorganization: How do you bring services to families that need them and make it as efficient as possible so they won't have to go to two or three different places to get service plans?"
Remaking DHS: for clients
Wavel and Judy Hunt of Summerville know how difficult it is to work with many parts of the human-services system at the same time.
They live 15 miles northeast of LaGrande. They've been married 40 years, have 10 children, seven of whom are adopted, five with severe disabilities.
To get the kind of help they need for their family, they've worked with three divisions of the Department: Senior and Disabled Services, Services to Children and Families, and Mental Health and Developmental Disability Services.
After 16 years of frustration trying to meet the needs of his children, Wavel sees promise in the new DHS. "I was excited when I heard about the combining of services and one-stop shopping."
Wavel sees his family as tenacious and is proud of what they've accomplished. "I feel like some of our tenacity has paid off. But many people can't be such active advocates for themselves and their families, and a reorganized DHS, where services were coordinated, would be a big help."
Oregon Children's Plan breaks new ground
In the final weeks of the 2001 legislative session, lawmakers approved the Oregon Children's Plan, the first program of its kind in the country.
One of Governor John A. Kitzhaber's top legislative priorities, the $60 million effort offers voluntary screening of all first-born children for medical and social risks, and increases services to children and families in all 36 counties.
"Sixty percent of Oregon children are born with risks that can affect their success in life," says Governor Kitzhaber. "Early investments in our children will benefit Oregon communities, families and schools."
The Oregon Children's Plan, which attracted wide bipartisan support, identifies and addresses these risks early in order to help children succeed in school and avoid future problems such as drug abuse, school failure, delinquency or incarceration.
Under the plan, nurses and other professionals visit the homes of new parents. Children who screen positively for one or more risks will receive services to address these problems.
Participation is voluntary, but state officials expect most parents will opt for the screenings. In a pilot project in seven counties, 93 percent of families elected to participate.
"No other state is doing this," says Pam Curtis, one of the governor's policy advisers. She says three things make the plan unique.
"First, we start our screenings as early as possible and offer supports to kids with the highest risk," says Curtis. "Second, our approach is comprehensive. And finally, we weave together a variety of services into a coordinated effort."
Curtis says the Oregon Children's Plan will increase services in about 20 counties beginning in the fall of 2001. The remaining counties will receive the new coordinated service starting in February of 2002.
DHS, the Oregon Commission on Children and Families, and the Department of Education will jointly oversee the program. About 25,000 children will receive some level of service over the next two years. Between 4,000 and 5,000 of these children will receive intensive services.
According to Curtis, about $39 million of the plan's $60 million budget is built from existing programs. For example, the $15 million Healthy Start program, which helps newborns and young children, will continue its existing services, as well as offer new ones.
Other changes included in the Children's Plan:
- Expanding Healthy Start to 16 new counties.
- Increasing the percentage of eligible children served by Head Start, the early childhood education program, from 50 percent to 60 percent in the second year of the biennium.
- Changing county funding formulas so money for mental health and alcohol and drug treatment follows patients who move between counties.
Curtis says that while some of the benefits of the plan, such as readiness to learn, may not be apparent for years, others will be evident much sooner. "Within 18 months we'll be able to do detailed comparisons between children participating in the program and those who are not."
Oregon Children's Plan investments in babies
and their parents will benefit Oregon families
Photo by Curt Shaw
Building a more accountable Department
For the Department and its partners, accountability was a key theme of the 2001 Legislative session.
"If we expect the Legislature to adequately fund our programs, we must meet their expectations and deliver quality outcomes. We are accountable for the results we achieve," says Director Bob Mink.
During the session, legislators sometimes challenged our results and our responsiveness. For Mink, the criticism was a learning opportunity, "What the Oregon Legislature says is important, even when it stings."
The 2001 session presented some very difficult budget choices. The challenge was particularly pressing for members of the Ways and Means Committee. The stark budget reality drove legislators to look for stronger relationships between funding and outcomes.
While the Legislature was very supportive of the services we provide, members expressed frustration about some outcome-measurement systems that failed to provide adequate information. They wanted to see a relationship between past investments and results.
Rep. Jackie Winters, R-Salem, championed DHS reorganization efforts. Winters chaired the Human Services Subcommittee of Ways and Means and serves on the Emergency Board, which allocates funds between legislative sessions.
Winters' support for the Department's new organization hinged on a strong customer focus. "Included in the notion of accountability is a focus on the customer, not the 'programs,'" says Winters.
And when budget times are tough, the stakes are particularly high. "If you can't show results for the population served, funding becomes at risk."
Another key legislator looking for answers was Rep. Kurt Schrader, D-Canby. Like Winters, Schrader served on the Ways and Means Subcommittee on Human Services and sits on the Emergency Board.
Rep. Jackie Winters, R-Salem
Oregon Health Plan
When Eustaquia Mendoza moved from Mexico to California in 1987, her husband worked in the fields for $3.75 an hour. They now live in Woodburn, and her husband drives a forklift for a Portland-area company that provides medical insurance for the family.
Mendoza family members, including children ages 15 and 11, still receive Oregon Health Plan dental care at Salud Medical Center in Woodburn, where about 60 percent of patients are Health Plan members. "With what my husband makes, without this program there is no way we could afford dental care," she says.
She says she knows people without health-care coverage who cannot qualify for the Oregon Health Plan because they are over the income limits. "It's very important because it keeps you healthy," she says of health-care coverage. "Without that health, you can't do much."
For some low-income Oregonians, that may change beginning October 2002, as a result of legislative action. That is when the state's pioneering Health Plan is scheduled to expand by 42,000 people, roughly the population of Albany, or about one in eight uninsured Oregonians.
"These are the most significant changes in the Oregon Health Plan's history," says Hersh Crawford, state Medicaid director.
Among the myriad changes approved by the Legislature are restructuring benefits to pay for covering more people, expanding coverage for children and pregnant women, and expanding coverage to help low-income workers afford employment-based health coverage. A family of three will be able to earn up to $27,061 annually, up from $14,628, and still qualify.
State health-care officials held public meetings during the summer of 2001 to gauge public priorities about benefits. If changes in benefits are made, they will not affect vulnerable Oregonians (seniors, children under 19, pregnant women, people with disabilities and those receiving public assistance).
Creating a Preferred Drug List, meanwhile, sparked hot debate during the 2001 legislative session. The list, expected to be operational by April 2002, will encourage physicians to voluntarily prescribe drugs that are classified as most effective and least expensive. The list applies only to Oregon Health Plan members not in managed-care plans, which already use such lists.
"Physicians understand that by helping to control costs," Crawford says, "the state can do a better job of funding other health-care services." The list is expected to save about $7 million a year in pharmaceutical costs if even half of prescriptions are written for drugs on the list.
The plight of low-income seniors who are unable to afford expensive prescription drugs has become a national issue. State lawmakers approved a Senior Drug Assistance Program to begin in 2002.
For $50 a year (to pay administrative costs), low-income seniors age 65 and older who have less than $2,000 in cash assets and are uninsured for drugs will be able to buy prescription drugs at Medicaid prices or less.
Waiting lists targeted by Staley settlement funding
The 2001 Legislature approved funds to eliminate waiting lists for state services provided to people with developmental disabilities. The source: a landmark settlement between people with developmental disabilities and the state.
James Staley, a 33-year-old Beaverton resident with severe mental retardation, was the lead plaintiff in a case against the state of Oregon. He has been waiting 15 years for a group-home placement. Staley is essentially non-verbal and needs assistance with daily tasks such as cooking, shopping and riding the bus. He lives with his retired parents, who are in their 50s.
In September 2000, the class action lawsuit named after Staley was settled. The agreement requires the state to increase funding for people with developmental disabilities by $350 million over the next six years. Federal Medicaid matching funds will pay 59 percent of the settlement cost.
Since 1981, services have been provided in state training centers or in community-based settings such as group and foster homes. Like most other states, Oregon established a waiting list because there were insufficient funds to provide for all those who requested services.
The settlement agreement accepted with some modifications the state's "Universal Access" plan, prepared in response to the 1999 Legislature's Senate Bill 919.
"One critical aspect of this plan is the provision of support services to all eligible adults with developmental disabilities in a manner that assures fairness, equity and universal access across the state," says Mike Maley, the program manager for the Department's Universal Access Program.
DHS developed the plan with assistance from affected parties, including individuals and representatives of consumer, family, provider, advocate, contractor, county government and other groups.
The state will establish 14 "brokerages," including county and private non-profit institutions or other non-governmental entities, to help design and put in place support services for adults with developmental disabilities.
Support services are defined in the agreement as in-home or personal supports that may include personal care, job coaching or employment supports, in-home staffing, respite care, community activities such as shopping and using public transport, minor physical-environmental adaptations, or other supports that assist the individual to live and work in his or her community.
"These support services would typically supplement those things provided to the individual by his or her existing circle of support, including family and friends," Maley says. The plan would provide up to $20,000 in services a year per individual.
The plan also calls for expanding "comprehensive services" that cost more than $20,000 a year for a limited number of adults, to increase case-management services and reduce workers' caseloads.
Cost to the state General Fund for the 2001-2003 biennium is $39.3 million. The Legislature appropriated half of that amount, about $19 million, to the Department, and budgeted the rest to the Emergency Board. The E-Board will allocate the remaining funds in 2002, contingent upon a report from the Department on the expenditures of the first half.
For more about the Staley settlement, go to oddsweb.mhd.hr.state.or.us
Eddie Mertes, left, resident of a Salem group home, is an
example of the people who could benefit from the Staley
settlement. He was photographed last year with Conrad
Bozlee, a nurse manager.
Photo by Patricia Feeny
Legislators launch Home Care Commission
Home care for seniors and people with disabilities makes a huge difference in the lives of many Oregonians. About 14,000 Oregonians now rely on DHS to pay for such services through Medicaid. Tens of thousands of others make their own private arrangements. "Home-care workers are our neighbors and friends," says Cindy Hannum, an assistant administrator with Seniors and People with Disabilities Services at DHS. "The services they provide, such as cleaning, shopping, or preparing meals, allow the people they serve to live independently."
Hannum says home-care workers come from many walks of life. "Some are certified nursing assistants, most are not."
Whatever their background, many often care for severely impaired people. "The people who do this work have one of the most demanding jobs around," says Hannum.
Not surprisingly, persuading people to stay in the profession can be tough. "There's a high turnover in home-care providers," says Jane-ellen Weidanz, legislative coordinator for Seniors and People with Disabilities Services. "Some employers find themselves constantly hiring and training caregivers."
That may soon improve, thanks to Ballot Measure 99, approved by voters in November of 2000, which established the Oregon Commission on Home Care. To implement the law, legislators in this session approved House Bill 3816, together with a $300,000 appropriation for staff and services.
The new nine-member commission, made up mostly of advocates and consumers, is charged with improving the quality of home care. Specific goals include setting worker qualifications, providing training, creating a statewide caregiver job registry and making referrals to interested employers.
"I'm very excited about these tasks, especially the registry and training," says Hannum, who will represent the Department on the Commission.
"Until now, employers had little choice but to turn to newspaper ads to fill vacancies while workers had to learn their skills on the job."
Alice Dale, executive director of the Oregon Public Employees Union, says that helping employers retain workers is one of her group's top priorities. "It is estimated that there is a 50 percent turnover among home-care workers," says Dale. "This is very hard on clients who have to keep training new workers."
Passage of Ballot Measure 99 also means economic changes. Under the new law, home-care workers paid by the state may now unionize and the unions can negotiate wages on their behalf with the State Department of Administrative Services (DAS).
Currently, DHS set one statewide rate for its Medicaid clients. Home care workers who receive it now earn between $8.12 and $8.34 an hour.
Hannum says the commission will hold its first meeting this fall. She expects immediate tasks will include setting priorities and creating a work plan.
In the best interest of children
From protecting the health and safety of infants to securing the college education of children in state foster care, legislators devoted several bills to the welfare of Oregon's children.
A former foster care child inspired the Legislature to allocate $100,000 to the Former Foster Youth Scholarship Fund. "Passage of House Bill 2431 is a major step toward providing Oregon's most vulnerable population of young people the chance at a brighter future," says Adam Cornell, who lived in foster homes from kindergarten through high school. The Oregon Student Assistance Commission will administer the fund, beginning this fall.
Although the incidence of abandoned infants are rare in Oregon, the 71st Legislature established a "safe haven" for infants. Led by Sen. Peter Courtney, D-Salem, Senate Bill 199 states there will be no criminal penalties for parents who leave infants with an adult in a safe place, such as a hospital or fire station. "It saves the lives of the most vulnerable of humans," said Courtney.
The safety and protection of children and teens was the focus of HB 3330, which requires wilderness programs to receive a license and oversight from DHS. The bill also creates an advisory board of wilderness program providers to assist the Department in the development of administrative rules.
Chief sponsor Rep. Ben Westlund, R-Tumalo, said his goal is to ensure the programs are safe for children and teens, and the communities and wide-open spaces where they operate.
In an effort to further protect children, SB 656 expands the crime of child neglect in the first degree to include leaving a child at a place that has been determined unfit because of illegal drug manufacturing.
The most significant piece of legislation aimed to ensure the overall well-being of children is the Oregon's Children Plan (see full story), which was developed to resolve potential health, safety and developmental problems in early childhood.
Other legislative highlights affecting families and children include:
- Booster seats: Current law requires every child who is younger than 4 or who weighs less than 40 pounds to use a booster seat. HB 3155 raises that requirement to any child younger than 6 or less than 60 pounds.
- Baby cribs: Unsafe cribs were also the target of more stringent requirements this session. HB 3962 outlaws cribs that don't conform to modern safety standards.
- Child care: Under HB 2716, families who pay for child care but do not earn enough to pay state taxes will receive 40 percent of their child care costs as a refundable child-care credit. Previously, the credit could only be taken as a deduction on a family's state income taxes.