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Targeting — But more extensive services — in Minnesota
50
Kamerman
and Kahn
The state has recently become more supportive of children’s issues, as can be seen from its adoption of the recent federal option for medicaid coverage for low income pregnant women and young babies. The current governor has announced that children will be a priority in his administration, as has the Secretary. The Secretary has broad programmatic aspirations, has made some progress, and hopes to accomplish more. He selected the abuse-neglect priority as a start, having a series of other priorities in mind. The HRS secretary and the secretary of education are now working together regarding children. Three new child-oriented initiatives are planned: a special focus on children aged 0 to 5, including a new compensatory education program for children aged 3 and 4, that will include links to child care as well; a drop-out prevention program; and a drug abuse prevention program. A major new public/private initiative has been launched to provide comprehensive early childhood intervention services (the Florida Ounce of Prevention program). As noted above, a new plan focused on improving mental health services for children has been developed as a next priority, and waiting lists for day care services, alcohol, drug abuse, and mental health services have been ranked. Innovative approaches to linking public health nurses and high risk children have been initiated as well. We have elaborated all of this because the targeted CPS solution is common, and Florida illustrates that when combined with energy and strong management it can move things. Our coverage of districts serving Miami, Tampa, and Orlando provides ample evidence, which we shall not reproduce, that nonetheless, this is certainly not yet an adequate response to the totality of serious needs in the child and family services field. And we note, too, that even in a state-administered system which is led and controlled there remain important local differences reflecting leadership, local politics, special local financing, the presence of private resources, and the nature and degree of serious social problems. Targeting - But More Extensive Services - in Minnesota We draw upon Hennepin county as a jurisdiction which, while targeting, illustrates the enhanced child welfare delivery system. The fact that the system offers much more than a constricted CPS model does not mean that it fully satisfies staff, leadership, or major constituencies. Indeed its director is in search of ways to bring child welfare into better alignment with major new needs. Following this more detailed presentation (Ramsey offers an equally interesting if somewhat different illustration), we also make brief mention of other variations on the enhanced child welfare mode, referring to the State of Maryland, a Massachusetts area office and New York City. In
Patterns of Coping: States and Counties each instance we note what is attempted beyond CPS, how or why this can be undertaken - and the serious limitations which nonetheless are also a fact of life. The Minnesota State Department of Human services, giving leadership to a county-administered, state-supervised system, has a mandate which includes public assistance, child welfare, refugee services, mental health, non-institutional services to the handicapped, eight regional treatment centers and two nursing homes. The Department of Human Services has over 7,000 employees and a budget well over $2 billion - in a state with a population of roughly 4.5 million. (Hennepin has over one million and Ramsey county about half that.) During the 197Os, in the midst of national excitement about services integration, local-level planning of social services, and integrated delivery systems, Minnesota took a unique step with the passage of a Community Services Act (1979), building on an even earlier tradition. This act created a state block grant system: The state would relate to its counties as the federal government did to the states under Title XX. Counties would develop plans for development of social services to qualify for formula grants. They would have major autonomy both in the planning and the implementation. Categorical barriers would thus be minimized by a state/county block grant system. The several years since about 1986 have seen a distinct trend towards partial recutegorizdon, variously interpreted, and largely the product of legislative initiatives, inevitably encouraged by relevant interest groups. The detail need not be reviewed here. Reports over several years by the Office of the Legislative Auditor created great concern, especially in the state legislature, about: programs for the chemically dependent, the deinstitutionalized mentally ill, and AFDC recipients. The resulting processes, including related studies, task force activity, interest-group advocacy, and work in the department, have resulted in increased state requirements of and controls on the counties in these areas, as exemplified in the rather substantial mandates of a 1987 mental health bill, building on early chemical dependency legislation. Currently, state “welfare reform” is mandating a pattern on counties and the entire protective services system is subject to relatively stringent state monitoring. However, because the increased service needs under welfare reform will be largely met through contracting, they will not immediately change the child and family social services pattern. At the same time, a state consent decree also has required a shift by counties to comply with state demands with regard to better integrated mental retardation services. Indeed, so dramatic was the state turnabout in its steps towards recategorization, and in the specific requirements imposed on counties, that
52
Kamerman
and Kahn
there was inevitable discussion as to whether Minnesota would become a state-operated social welfare system, joining the majority of states. The consensus appears to be that while this could occur with regard to public assistance and related programs, there is still interest in encouraging county variations and initiatives in the service domain. Because levels of the services currently provided are regarded as too uneven among the counties, the state department has worked on the concept that citizens have the right to a minimal floor of service from their counties, and the state should improve its capacity to define, specify, assist, and monitor that minimum. It does not anticipate a takeover. Given the state’s history and general milieu one is not surprised to note almost immediately that Hennepin (and Ramsey): share a tradition of good-quality public services; have large complements of responsible, intelligent, and competent/trained personnel on all levels; show unique (but hardly perfect) staff stability because of good salaries and strong union and civil service traditions; and have impressive county social service leadership. The response to legislative mandates and the generally heightened local expectations that there be efficient management, has been an increasingly targeted delivery system. In a national perspective, however, this is a humane system that goes well beyond the severely constricted offerings one sees in many other places. Hennepin County Community Services Department Hennepin has a Bureau of Social Services which, essentially, has four separate units (of different sizes), devoted to community services, income maintenance, veterans, training and employment assistance. The Community Services Department director reports to a deputy administrator for the Bureau of Social Services who, in turn, is responsible to the county administrator. Hennepin has, as noted, a population of over 1 million. The Community Human Services Department has a staff of over 1,000 and its budget was running over $110 million at the time of our review. The creation of the present structure may be traced to the block grant provisions of the State’s Community Services Act (1979) and the state’s subsequent partial recategorization efforts in recent years. Thus, the Hennepin department reflects impulses towards integration and coherence, as well as pressures to fulfill categorical state mandates (which are often not adequately funded), in a context of comoeting pressures for resources from other human service programs. The Community Services Department identifies some 45 to 50 program centers (each with a manager), all subsumed under 8 programs. These program centers are also cost centers and become the basis for planning and monitoring as well. They provide for attention simultaneously both to the directly delivered services and the contracted services in a
Kamerman
and Kahn
The state has recently become more supportive of children’s issues, as can be seen from its adoption of the recent federal option for medicaid coverage for low income pregnant women and young babies. The current governor has announced that children will be a priority in his administration, as has the Secretary. The Secretary has broad programmatic aspirations, has made some progress, and hopes to accomplish more. He selected the abuse-neglect priority as a start, having a series of other priorities in mind. The HRS secretary and the secretary of education are now working together regarding children. Three new child-oriented initiatives are planned: a special focus on children aged 0 to 5, including a new compensatory education program for children aged 3 and 4, that will include links to child care as well; a drop-out prevention program; and a drug abuse prevention program. A major new public/private initiative has been launched to provide comprehensive early childhood intervention services (the Florida Ounce of Prevention program). As noted above, a new plan focused on improving mental health services for children has been developed as a next priority, and waiting lists for day care services, alcohol, drug abuse, and mental health services have been ranked. Innovative approaches to linking public health nurses and high risk children have been initiated as well. We have elaborated all of this because the targeted CPS solution is common, and Florida illustrates that when combined with energy and strong management it can move things. Our coverage of districts serving Miami, Tampa, and Orlando provides ample evidence, which we shall not reproduce, that nonetheless, this is certainly not yet an adequate response to the totality of serious needs in the child and family services field. And we note, too, that even in a state-administered system which is led and controlled there remain important local differences reflecting leadership, local politics, special local financing, the presence of private resources, and the nature and degree of serious social problems. Targeting - But More Extensive Services - in Minnesota We draw upon Hennepin county as a jurisdiction which, while targeting, illustrates the enhanced child welfare delivery system. The fact that the system offers much more than a constricted CPS model does not mean that it fully satisfies staff, leadership, or major constituencies. Indeed its director is in search of ways to bring child welfare into better alignment with major new needs. Following this more detailed presentation (Ramsey offers an equally interesting if somewhat different illustration), we also make brief mention of other variations on the enhanced child welfare mode, referring to the State of Maryland, a Massachusetts area office and New York City. In
Patterns of Coping: States and Counties each instance we note what is attempted beyond CPS, how or why this can be undertaken - and the serious limitations which nonetheless are also a fact of life. The Minnesota State Department of Human services, giving leadership to a county-administered, state-supervised system, has a mandate which includes public assistance, child welfare, refugee services, mental health, non-institutional services to the handicapped, eight regional treatment centers and two nursing homes. The Department of Human Services has over 7,000 employees and a budget well over $2 billion - in a state with a population of roughly 4.5 million. (Hennepin has over one million and Ramsey county about half that.) During the 197Os, in the midst of national excitement about services integration, local-level planning of social services, and integrated delivery systems, Minnesota took a unique step with the passage of a Community Services Act (1979), building on an even earlier tradition. This act created a state block grant system: The state would relate to its counties as the federal government did to the states under Title XX. Counties would develop plans for development of social services to qualify for formula grants. They would have major autonomy both in the planning and the implementation. Categorical barriers would thus be minimized by a state/county block grant system. The several years since about 1986 have seen a distinct trend towards partial recutegorizdon, variously interpreted, and largely the product of legislative initiatives, inevitably encouraged by relevant interest groups. The detail need not be reviewed here. Reports over several years by the Office of the Legislative Auditor created great concern, especially in the state legislature, about: programs for the chemically dependent, the deinstitutionalized mentally ill, and AFDC recipients. The resulting processes, including related studies, task force activity, interest-group advocacy, and work in the department, have resulted in increased state requirements of and controls on the counties in these areas, as exemplified in the rather substantial mandates of a 1987 mental health bill, building on early chemical dependency legislation. Currently, state “welfare reform” is mandating a pattern on counties and the entire protective services system is subject to relatively stringent state monitoring. However, because the increased service needs under welfare reform will be largely met through contracting, they will not immediately change the child and family social services pattern. At the same time, a state consent decree also has required a shift by counties to comply with state demands with regard to better integrated mental retardation services. Indeed, so dramatic was the state turnabout in its steps towards recategorization, and in the specific requirements imposed on counties, that
52
Kamerman
and Kahn
there was inevitable discussion as to whether Minnesota would become a state-operated social welfare system, joining the majority of states. The consensus appears to be that while this could occur with regard to public assistance and related programs, there is still interest in encouraging county variations and initiatives in the service domain. Because levels of the services currently provided are regarded as too uneven among the counties, the state department has worked on the concept that citizens have the right to a minimal floor of service from their counties, and the state should improve its capacity to define, specify, assist, and monitor that minimum. It does not anticipate a takeover. Given the state’s history and general milieu one is not surprised to note almost immediately that Hennepin (and Ramsey): share a tradition of good-quality public services; have large complements of responsible, intelligent, and competent/trained personnel on all levels; show unique (but hardly perfect) staff stability because of good salaries and strong union and civil service traditions; and have impressive county social service leadership. The response to legislative mandates and the generally heightened local expectations that there be efficient management, has been an increasingly targeted delivery system. In a national perspective, however, this is a humane system that goes well beyond the severely constricted offerings one sees in many other places. Hennepin County Community Services Department Hennepin has a Bureau of Social Services which, essentially, has four separate units (of different sizes), devoted to community services, income maintenance, veterans, training and employment assistance. The Community Services Department director reports to a deputy administrator for the Bureau of Social Services who, in turn, is responsible to the county administrator. Hennepin has, as noted, a population of over 1 million. The Community Human Services Department has a staff of over 1,000 and its budget was running over $110 million at the time of our review. The creation of the present structure may be traced to the block grant provisions of the State’s Community Services Act (1979) and the state’s subsequent partial recategorization efforts in recent years. Thus, the Hennepin department reflects impulses towards integration and coherence, as well as pressures to fulfill categorical state mandates (which are often not adequately funded), in a context of comoeting pressures for resources from other human service programs. The Community Services Department identifies some 45 to 50 program centers (each with a manager), all subsumed under 8 programs. These program centers are also cost centers and become the basis for planning and monitoring as well. They provide for attention simultaneously both to the directly delivered services and the contracted services in a