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Rhode Island
streamlines human services
(July 2005
Issue)
By Nan Shnitzler
Rhode Island is depending on key inter-agency collaboration and
increased community outreach to better serve the state's most vulnerable
residents while saving taxpayers money.
In March 2004, Gov. Donald L. Carcieri created the Office of Health
and Human Services (HHS) by executive order to coordinate health
care and social services delivered by five departments: Elderly
Affairs; Health; Human Services; Mental Health, Retardation and
Hospitals; and Children, Youth and Families (DCYF). By consolidating
back-office functions such as finance and administration, the governor's
"Fiscal Fitness" team expects to save $70 million per year.
The five agencies' $2.4 billion budget represents 42 percent of
the state total, so clearly Rhode Island supports human services,
says HHS Managing Director Jane A. Hayward. As a result of economics
of scale, Rhode Island has not made Medicaid cuts, she says.
"It's become clear to everyone that what the governor began as
fiscal fitness has become an enormous opportunity to improve service
delivery and that has become the focus," Hayward says. "The tremendous
good will of the five directors will make it happen."
One supporter is DCYF Director Patricia Martinez whom Carcieri
appointed in January saying the safety and well being of children
depends on partnership between the state and the community. Martinez
was formerly the governor's director of community relations.
"We're now at a point where we need to engage families in the community
to become the glue to move forward with programs," Martinez says.
"DCYF has not had as good a relationship with communities as it
could have," Hayward says. "As we develop programs in HHS, we need
to bring everyone to the table who could possibly be affected."
For example, Hayward convened a working group that spans the spectrum
of Rhode Island's health and human services stakeholders, including
agencies, insurance companies, hospitals and parents, to help pass
legislation to establish a single evaluation point for children
who need mental health services. The group will form the basis of
a task force to further address DCYF priorities, Hayward says.
Too many kids are in the hospital because they were not evaluated
to see if an alternative was available, Martinez says. Or they are
stuck there because there's no plan for their discharge or use of
step-down programs to transition them back to the community.
"The legislation holds everyone accountable," Martinez says.
Elizabeth Burke Bryant, executive director of Rhode Island Kids
Count, welcomes the collaborative approach at DCYF, especially in
the wake of last fall's federal review of the Adoption and Safe
Families Act that showed Rhode Island needs improvement in areas
of child safety, permanency and well being.
"They are paying attention to the fact that departments do not
effectively work in silos," Burke Bryant says. Martinez sees the
federal study as an opportunity, because Rhode Island was not alone.
In outcomes of child safety, permanency and well-being, each of
the other New England states met only one guideline, according to
the U.S. Department of Health and Human Services Web site. Martinez
was on the DCYF System of Care Task Force whose recommendations
are part of Rhode Island's improvement plan. She says the failure
was not for lack of committed individuals but for lack of resources.
"Both System of Care and the federal review highlight the need
for us to look at the need to share responsibilities with everyone,"
Martinez says. "We cannot do it alone. Family engagement is critical
to this type of reform. I see that federal review as an opportunity
for a strategic plan and road map to move the department forward."
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