2011 Annual Report
to the Board of Commissioners
November 2012
Report Prepared by the Office of Research and Evaluation
Ramsey County Government Center East
160 East Kellogg Blvd., Saint Paul, Minnesota 55101
Cameron Counters, Manager
Ida Arnold, Kathy Gilmore, Mark Herzfeld,
Sue Keskinen, Allan Malkis, Jan Pitlick, and
Wolde Selameab
2011 Report Summary
The Introduction includes our mission, an overview of county human services, programs and innovations. The first five chapters describe people we serve and programs we offer. Chapter six describes and measures five key outcomes. The final chapter gives a picture of revenue and expenses for Community Human Services people and programs.
Contents
Cover, Table of Contents and Introduction (10 pages)
Cover, T of C & Introduction MS Word Cover, T of C & Introduction PDF
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Children: in need of protection or with mental illness, youth in juvenile justice system, youth and children whose families are unable to raise them, foster care and child care licensing (34 pages)
Children MS Word Children PDF
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How Effective are We Meeting These Outcomes: vulnerable adults and children are safe; disparities in access to and outcomes of County services for diverse populations are eliminated; basic needs of residents are met, including food, shelter, health and jobs; proactively delivering services that improve the quality of life for residents with special needs; county services adapt to meet the needs of the aging population (44 pages)
Effectiveness MS Word Effectiveness PDF
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INTRODUCTION
A. Community Human Services Mission
Making a Difference: Helping people survive and thrive
Ramsey County Community Human Services contributes to the vitality of the community by providing services that support individuals and families. In a thriving community people can:
- Meet their basic needs for food, clothing, shelter and medical care
- Be safe
- Live independently and lead stable lives
- Heal and recover through effective treatment and interventions
- Have access to effective services regardless of their racial or cultural background.
These are the outcomes by which we measure the effectiveness of our services.
The people who turn to Ramsey County for help in our community are:
- Children
- Adults and Children with Disabilities
- Elderly
- Low Income Men, Women, and Children
- Men and Women with Mental Health or Chemical Health Problems
An estimated 125,192 Ramsey County residents were being served by CHS on June 1, 2011 (point-in-time estimate). With an estimated 2011 population for Ramsey County of 514,696, that means that every day roughly one out of four Ramsey County residents is a consumer of the services provided by the Community Human Services Department.
B. Overview of the Community Human Services Environment
In Minnesota, counties are responsible for administering human service programs that address the social and economic needs of the community. State and federal laws mandate most of these services. The County Board of Commissioners establishes local policy in some service areas and directs the Community Human Services Department in the administration of all services. The Department delivers services in collaboration with other County departments and community agencies.
This section discusses recent changes or trends that affect our community and, in turn, the human services that our community needs. Significant changes include:
- There is increasing need for Medical Assistance and food support services
- Publicly-funded health care coverage is replacing private insurance
- The number of individuals who are homeless continues to increase
- Health care programs continue to change
- Funding pressure reduces our capacity to provide preventive services
- Ramsey County residents are becoming more racially and culturally diverse
- The economic context of 2011 affects the human services system.
There is increasing need for Medical Assistance and food support
The economic downturn that began in 2008 has had a direct impact on the demand for Medical Assistance and food support services provided by CHS. Comparing calendar year 2010 to 2011, the monthly average number of cases that received one or more financial assistance services has increased by 12% (52,846 cases in 2010 and 58,948 cases in 2011). The average number of food support cases open each month increased 21% during the same time period. The average number of Minnesota Family Investment Program (MFIP) and Diversionary Work Program (DWP) cases open each month in Ramsey county was nearly the same in those two years.
Publicly-funded health care coverage is replacing private insurance
The portion of the population in Minnesota without health insurance had been increasing prior to the most recent economic downturn. In 2001, 6.1% of the population was uninsured. The latest data available to CHS shows that by 2011 that percentage had increased to 9.1% (MN Dept. of Health: Health Economics Program, “Fact Sheet 2012.”) State-wide the number of people who were enrolled in publicly- funded health care insurance programs increased from 21.1% of the state population in 2001 to 29.2% in 2011. Ramsey County has experienced a similar increase in residents looking to the County for access to health care coverage. According to the Minnesota Department of Health this is primarily because of a decrease in workers being covered by employer provided health plans. The impact of the increase in the uninsured residents is that more of the uninsured seek publicly-funded healthcare because they are unable to afford to purchase coverage on their own.
The number of individuals who are homeless continues to increase
A study published in 2010 estimates that on any given night, approximately 1,685 people are homeless in Ramsey County (Wilder Research Center, Homelessness in Minnesota 2009: Results of the Wilder statewide survey, October, 2010). These are people who are staying in emergency shelters, domestic violence shelters, and transitional housing programs or are living on the street, in cars, or in abandoned buildings. While percentages will vary on any given night, in general, of the homeless in Ramsey County:
- 1,146 (68%) are adults 18 years or older
- 592 (32%) are children and youth
- 496 (92%) of the children and youth are with one or both parents
- 96 (8%) of children and youth are not with a parent
The information that is currently available indicates that the situation has worsened since the night of October 26, 2000, when the statewide homeless survey identified 1,067 men, women, and children homeless in Ramsey County. The most recent data available shows that on October 22, 2009 the statewide survey found 1,685 homeless people in Ramsey County. Although significant increases in both adult men and women helped account for this surge in homelessness, youth under the age of 21 saw a considerable increase, from just 5% of the homeless population in the 2006 survey to 14% in 2009. Furthermore, these results are likely to be a significant undercount, as they do not include large numbers of people who are believed to be unsheltered; living in camps, vehicles, or in other places not fit for human habitation.
Since 2006, over 14,000 homes in Ramsey County have gone into mortgage foreclosure, the yearly number increasing 39% between 2006 and 2011. This dramatic scenario has placed many more households in danger of becoming homeless. In 2011, Ramsey County had the 12th highest county foreclosure rate in Minnesota - 1.4% of all residential parcels (2011 Annual Foreclosures in Minnesota: A Report Based on County Sheriff’s Sale Data. February 24, 2012. Housing Link, Minneapolis, MN).
As the numbers of homeless people increase, other troubling trends are emerging. From 2005 to 2009, the percentage of homeless people who were employed fell from 28% to 20%, and those working full-time fell from 12% to 6%. At the same time, those reporting serious mental illness rose from 52% to 55%. Two-thirds (67%) of homeless adults experiencing homelessness in 2009 reported at least one of three major health issues: mental illness, substance abuse, or other chronic physical health condition (Wilder Research Center, Homelessness in Minnesota 2009: Results of the Wilder State-wide Survey, October, 2010).
Housing affordability is a major factor in homelessness. Fifty one percent (51%) of the homeless respondents to a 2009 statewide survey said a lack of a job or income (43%) or lack of affordable housing (24%) is currently preventing them from obtaining housing.
The primary federal government response to the need for affordable low-income housing is the Housing Choice Voucher Program, frequently referred to by its original name, the Section 8 Program. Unfortunately, the Housing Choice Voucher Program is funded far below the actual level of need. Waiting lists for the program have become so long, and the turnover of vouchers is so low, that every waiting list in the Twin Cities Metropolitan Area is closed. St. Paul Public Housing Agency reports 8,849 people on the public housing waiting list and 3,981 on the Section 8 waiting list, which has been open only 3 days since 2002.
Clearly, the mortgage crisis and the economic downturn have resulted in more people losing their homes. The impact of job loss and economic instability has disproportionally impacted very low income households. In the 2000 statewide homeless survey, 42% of all homeless adults were employed and 26% were employed full time. In 2009, those numbers had dropped to 26% employed and only 8% employed full time, the lowest rate since the triennial survey began in 1991(Ibid.).
Funding pressure reduces our capacity to provide preventive services
Since 2003, CHS has experienced several years of reduced funding and cost shifts from the State and Federal governments. The County has been forced to increase local property taxes in order to continue some services. However, CHS has also been forced to reduce funding for preventive services that improve the quality of life for vulnerable and disabled individuals. Programs, including ones that enable disabled individuals to participate in their community, have been reduced or eliminated as CHS has sought to preserve services that meet safety standards and basic needs of our clients. For some programs for adults with disabilities, caseloads have increased without additional staff. It is likely that further reductions in state and federal funding for some services will continue to exacerbate this problem.
Ramsey County residents are becoming more racially and culturally diverse
In 2000, 24.7% of the Ramsey County population was people of color which includes the 5.3% who were of Hispanic ethnicity. The 2010 U.S. Census population for Ramsey County is that 33.1% of the residents of Ramsey County are people of color and among them 7.2% are of Hispanic ethnicity (U.S. Commerce Department, Bureau of the Census, 2011 American Factfinder). That is a 34% increase in the racial and cultural diversity of the residents of Ramsey County. Twenty-five year population projections for Minnesota and Ramsey County indicate that both will continue to become increasingly racially and ethnically diverse. The residents of Ramsey County are already the second most diverse county population in the state (Mahnomen County, with a significant American Indian population, is the county in Minnesota with the highest proportion of residents who are people of color).
CHS is committed to eliminating racial disparities in service delivery for communities of color. As CHS has examined its delivery of services, there are a number of instances where service utilization and service outcomes are not equivalent across racial or ethnic groups. These disparities raise questions about whether we are providing equitable access to services for all groups, and whether the services are effective in achieving comparable results across cultural and racial groups.
Examples of service disparities include:
- Southeast Asian children are less likely to access children’s mental
health services than other groups
- Hmong elderly are much less likely to be aware of support services that can help them remain in their homes
- African American children are slightly more likely than White children to be removed from their home by child protection workers
- Hispanic /Latino individuals with disabilities are under-represented as consumers of I/DD services
Descriptions of CHS’s work on issues related to racial disparities are included in the individual sections and the chapter “How Effective Are We?”
Economic context of 2011 affects the human services system
Many of the trends that have been described in this chapter will be influenced by the duration of the economic downturn that began in late 2008. The recession has had a cascading effect on the entire human services system. The reduction in financial resources available to federal, state, and local government has forced a reduction in the services available to Ramsey County residents. Conversely, the mortgage crisis and the increased level of unemployment have increased the need for Ramsey County to provide a safety net for individuals and families who have been negatively impacted by the economy. The anticipated increase in Ramsey County residents looking to the County for help will further challenge CHS’s ability in the near future to adequately serve the community.
C. Community Human Services continues to be a place of change and innovation
From program services to staff training to inter-departmental coordination, CHS continues to adapt to changing needs and tries to improve on our previous successes. The following are a few examples of how CHS is finding new ways to continue to help Ramsey County residents survive and thrive.
Community Human Services
One of CHS’s goals is to decrease race/culture-based disparities in services, ensuring that all residents of the County receive effective services. The umbrella organization guiding this work within CHS is the Anti-Racism Leadership Team (ARLT), made up of staff from all divisions and levels in the organization. The mission of ARLT is to recognize racism within our institution and create a transformational strategy for change. It is the vision of ARLT that CHS will become a multi-cultural, anti-racist organization.
Responding to the County Board goal, of “being a leader in addressing the changing demographics of the County”, the Anti-Racism Leadership Team has laid a foundation to create effective human services for all Ramsey County residents. The accomplishments below have formed the foundation for eliminating institutional level racism by targeting change in policies, practices and procedures that maintain racial disparities in client and organizational outcomes:
- Development of a common conceptual foundation and language around systemic power and race - Concepts and definitions were established recognizing individual power over people, power which preserves advantage for White people, and power which socializes White people and people of color to follow racial expectations.
- Implementation of an organizational structure to address institutional racism
–A leadership team and a set of workgroups were established to begin evaluating and changing CHS’s policies and processes in key institutional areas including hiring & retention, contracting, staff training and communication.
- Implementation of new service strategies by Service Teams - The results of some of these efforts are reported in the chapter entitled, How Effective Are We: Disparities in access and outcomes for diverse populations are reduced.
CHS will continue to identify and address disparities in services. While Divisions within CHS are working directly to implement strategies to reduce racial disparities, the Anti-Racism Leadership Team will continue to break down organizational level barriers that are maintaining the status quo of racial disparities. Its strategic plan aims to create supports across the organization to achieve racial equity in service outcomes by building alliances to strengthen leadership, broadening staff perspectives through training, creating mechanisms for accountability, and addressing policy and practice that result in racial and ethnic disparity in access to services and outcomes.
2011 Innovations
The needs of the residents, the funding available for services, the demographic characteristics of the population, and the demand for human services all change over time. To keep up with change CHS places a high value on innovation. The following are a few examples of the type of innovation that is occurring in CHS:
- The Adult Services and the Administrative Services divisions coordinated planning of the program services and building construction for the East Metro Behavioral Health Crisis Center. The Center opened on schedule in 2012. The new building houses several CHS and multi-county services including: an expanded detoxification facility, mental health crisis intervention, commitment court, and chemical dependency assessments.
- Adult Services is working closely with Housing Access Services (HAS) to find housing for seniors and persons with disabilities who want to live in their own home. HAS is a partnership of The Arc of Minnesota and the Minnesota Department of Human Services. The new program helps adults of all ages who are eligible for Medical Assistance home care or waiver programs with achieving independent living. The efforts of Adult Services case workers to maximize the use of the HAS benefits is demonstrated by the level of participation by residents. Recent information indicates that Ramsey County residents are approximately 20% of the program participants state-wide.
CHS received Federal stimulus funding to partner with the City of St. Paul to embed two Financial Workers in the Central Point of Contact program to expedite Financial Assistance applications for those seeking assistance under the Rapid Rehousing program::
- Completion of a scanning center and implementation of electronic document imaging system in the Financial Assistance Services (FAS) Division began in 2011. The entire FAS Division was using electronic documents by mid-2012. Electronic documentation is expected to significantly improve the efficiency of case processing and case management.
- Administrative Services began a pilot test of a telecommuter program. The first cohort of 19 CHS staff from Adult Services and Children & Family Services began telecommuting in late 2011. In 2012 the telecommuter program continues to increase the number of telecommuting staff to over 50.
- Children and Family Services continued to implement a new quality assurance system for monitoring compliance with Medicaid requirements for billing and ensuring that high quality services are provided consistently to CHS clients. Called the Service Quality Assurance (SQA) project, this system supports supervisors in monitoring staff caseloads for best practices and documentation related to client assessment and case planning, as well as mandated reporting and billing. The first phase of the new system was complete in 2011.
- The Adoptions Opportunities grant continues to support efforts to increase the number and speed of adoptions for waiting children by increasing the number and diversity of foster homes available to provide a safe and stable home for children.
- Children and Family Services continue an emphasis on locating kin who are willing and able to provide foster care to children who need to be removed from their family home. Kinship foster care tends to be less disruptive for children who experience out-of-home placement.
- Children and Family Services also received a grant that supported the use of a nation-wide database service to conduct searches for relatives of children who need foster or adoptive homes.
- Children’s Mental Health program and Ramsey County Workforce Solutions initiated a pilot program where a children’s mental health caseworker has a caseload of families in the MFIP program. The pilot program is intended to help MFIP families who face significant barriers to achieving stable employment because of the mental health of their children.
- Children and Family Services initiated the use of Recovery Coaches to help women who are participating in the Mothers First program. The Recovery Coaches provide guidance and support to women as they recover from chemical dependency.
- Children & Family Services continue to expand the use of Comprehensive Family Assessment (CFA) practice by providing training to contracted service providers. The CFA approach facilities successful behavioral change in parents’ ability to parent safely and successfully.
