Human Services Transition Team

Final Report and Recommendations by

Susie Cambria, MSW, Deputy Director/Public Policy

DC Action for Children

C. Mustaafa Dozier, Esq., Government Affairs and Labor Relations

Department of Youth Rehabilitation Services

Introduction The Human Services Transition Team was tasked with making specific recommendations for achieving better outcomes for District residents in need of services provided by human services cluster agencies. The human services cluster is responsible for delivering a diverse and complex set of services that literally cover all aspects of life from conception to death providing services ranging from pregnancy prevention to burial assistance. The cluster is comprised of the Department of Human Services, Department of Health, Department of Mental Health, Department of Employment Services, Office on Aging, Department of Youth Rehabilitation Services, and the Child and Family Services Agency. In order fully assess the wide variety of challenging issues under the purview of these agencies the human services team assembled seven work groups to develop recommendations in the following services areas: 1) Senior Services 2) Child Welfare; 3) Homelessness; 4) Developmental Disabilities; 5) Juvenile Rehabilitation; 6) Family Support Services; and 7) Positive Youth Development. This report will include the specific recommendations of the work groups as well as recommendations that the co-team leaders have identified as areas that should be given focused attention during the first year of the administration. Recommendations where possible are stated in three month, six month, and twelve month deliverables. The work group recommendations are the result of online chats and face-to-face meetings during which the groups addressed: 1) identifying priority needs/issues; 2) barriers to service delivery; and 3) solutions/recommendations. This report will discuss each of the areas discussed above with detailed attention on recommendations that will enhance the administrations ability to prioritize initiatives and reform efforts in the human services cluster during the next year resulting in better outcomes for District residents. Recommendations from Co-Leaders As indicated in the introduction this report will include recommendations developed by seven work groups. The co-leaders had the opportunity to participate in the on-line chats and face-toface meetings of each sub-committee allowing us to determine common barriers, themes, and solutions amongst the work groups. The following recommendations are those of the co-leaders and are made in addition to the work group recommendations. These recommendations reflect issues that are common to multiple agencies and service areas.

Interagency Collaboration The most common re-occurring theme that was shared between the work groups was the need for increased interagency collaboration. This theme is not a new one, and in fact was one that was often discussed as a priority by the outgoing Williams administration. While we will not use this report as a vehicle to critique the past, we cannot stress enough that universal agreement on the need for interagency collaboration reflects the Districts failure to develop and implement programming that effectively marshals multiple agency resources to achieve better outcomes for District residents. While there are successful interagency models that exist throughout the nation there is no one model that can easily be duplicated addressing the wide array of challenges posed to the District. The administration will need to champion a very balanced and innovative approach, striking harmony between best practices and tailoring programs to the unique needs and culture of the District. The work group reports will include more detailed recommendations for specific interagency collaborations, below are recommendations the co-leaders would advise the administration to explore during the next year: Blended Funding Managing and effectively providing human services is a challenging task because individuals seldom require services from only one of the neatly compartmentalized departments of District government. A TANF recipient who requires training to become job ready may also need substance abuse counseling. A court-involved youth may require mentoring, substance abuse counseling, and mental health services. The challenge to the government is funding services for multiple needs delivered by multiple agencies while not duplicating services or wasting resources. Currently the agency that initially places a client on a caseload carries the fiscal burden associated with providing for their multiple needs. Commonly District agencies enter into MOUs with sister agencies to provide services to clients of the other agency. While the logic of MOUs is clear, however it is not as clear whether we are getting the most for our money. Blended funding and collaborative case management would streamline service delivery, create operational savings, and most importantly remove layers of bureaucratic barriers that impede or dissuade residents from accessing needed services. The unfortunate reality is that District agencies are hesitant to wholeheartedly enter into interagency collaborations because of the fiscal impact these ventures have on their agency budgets. The Executive has the ability to enhance the likelihood of successful interagency collaborations by blending funding and eliminating a major hurdle that has continued to discourage collaboration the agencies themselves. Information Sharing Another common theme identified by the Team co-leaders and the work groups was information sharing. Residents, clients, providers, and advocates alike view many agencies as guarded when it comes to sharing information. This issue is one that we could take several pages illustrating. But routinely our agencies fail to openly share program details with clients and advocates; fail to share information related to new opportunities and programming changes with providers/vendors; as well as sharing basic operational information with sister agencies. Far too often individuals are left feeling like investigators when they seek to access services or do business with our agencies. The time is ripe for the incoming administration to raise the blinds and open the doors to our government. The incoming administration should challenge all agency directors to change the mindset and culture of customer service and information sharing within their agencies. Individuals seeking services or information should not be left to feel like they are an annoyance or a burden. Our agencies have failed to embrace the spirit of partnership with the community,

and as a result residents, clients, providers, and advocates are left pursuing information from agencies rather than the agencies openly sharing information with the public as they would with any respected partner. One example that stands out was discussed in the Developmental Disabilities Workgroup. When MRDDA relocated their main office many parents of consumers were not aware of the move. It should be unacceptable for an administration to relocate and the consumers that access their services are not provided notice in advance. We would recommend that the Mayor examine this issue with each agency within the human services cluster. While there is not a one size fit all solution, there are great improvements that can be made for each agency in the human services cluster. Agency directors and designated staff often attend ward based and larger community meetings. These directors should be proactive and host smaller meetings geared only toward the consumers and providers within their service areas. The District also has to improve its capacity to effectively collect, maintain, and share information and data within the government. The District is on the verge of making the Safe Passages database, also known as HSMP, a live and robust tool that achieves its promise for tracking services delivered to children and youth. However, a number of significant challenges remain and this is where the Fenty administration can make a real difference. Some of the challenges are: o Coordinating with EdSMP, the DCPS data collection and management system. DCPS is struggling to make EdSMP fully operational. While the Fenty administration may or may not choose to assist DCPS with the challenges, the fact remains that without the integration of EdSMP and HSMP the promise of better tracking services, reducing duplication of efforts, maximizing resources and ensuring the best outcomes for the city's children and youth will not be realized. Millions of dollars have been invested in both systems and every effort must be made to make them live and integrated in the very near future. Ensuring line staff enter data in a timely manner. While there is great promise with both EdSMP and HSMP, the fact remains that the success of both systems rests on the shoulders of already busy staff. FACES, the Child and Family Services Agency data system, is a good example. At the same time that social worker caseloads have been reduced, workers continue to struggle with inputting case management and service data that would assist that agency and others with providing the most appropriate services while at the same time reducing the need to re-enter basic information. Multiple solutions for CFSA and other agencies exist. The Fenty administration should make solving this problem a priority. Resolving outstanding confidentiality issues. The city must move quickly to pass the "Safe Passages Information Exchange Amendment Act of 2006" in order to facilitate the sharing of information in HSMP and EdSMP.

Personnel and Procurement The incoming administration inherits two issues that have historically challenged District leadership personnel and procurement. These issues have been such challenges that in the year 2000 when the Department of Mental Health and the Child and Family Services Agency were exiting receivership it was determined that independent personnel and procurement authority would be critical to their sustained success. Years later many would proffer that District agencies with independent personnel and procurement authority are every bit as dysfunctional as the centralized system they were empowered to escape. Whether it be agencies with independent authority or the agencies under the purview of the centralized departments, personnel and

procurement issues continue to create barriers to effective service delivery. The Districts inability to hire qualified staff in reasonable timeframes routinely turns away qualified candidates from government service. Even more, our inability to compensate vendors in a timely fashion strains relationships with providers/vendors and in some drastic cases cripples the livelihood of small providers resulting in the provider ceasing operations. The Human Services Team accepts the expertise of the District of Columbia Contracting and Procurement Task Force and as such, supports their recommendations. In addition, the Team urges the Fenty administration to move to performance-based and outcome-based contracting in order to ensure that the goals of the contracts are being met and that the lives of District residents are positively affected. Reconnecting Disconnected Youth As teens prepare to enter adulthood it is generally expected that they are engaged in school or are employed. Youth in their teen years that are neither engaged in school system or employed are considered disconnected youth. For our purposes disconnected youth include s youth ages 12 24. There are many contributing factors that may lead a young person to become disconnected from school and employment, as a result there a different levels and classes of disconnected youth. While there may be different classifications of disconnected youth all disconnected youth are at risk of experiences long bouts of unemployment, lower earning potential, and contact with the criminal justice system. A 1995 brief issued by the Annie E. Casey Foundation concluded that, Among disconnected youth, there is a sub -group of young people who face even worse odds: teens in foster care; youth involved in the juvenile justice system; teens who have children of their own; and youth who never finished high school. 1 The co-leaders believe the administration should focus immediate attention on providing services to the sub-groups identified by the Casey foundation. We understand that there has been a fair amount of conversation related to the Reconnecting Disconnected Youth movement during the transition process, the following are our recommendations for the first 12 months of the administration as related to the sub-groups noted: o School Drop-outs Though we have defined the universe of disconnected youth as youth ages 12 24, almost all youth disconnect during the years they should be enrolled and engaged in school. This reality is supported by an examination of the academic credentials of disconnected youth 18 24 years old. In most cases you will find that youth 18 24 years old lack a diploma or GED, reinforcing the nexus between education and successful transition into adulthood. The first safety net for reconnecting disconnected youth in the District will be the school system. The ability to implement effective intervention strategies reducing school-drop outs will have a significant impact on reconnecting disconnected youth. Though we have identified four sub-groups you will find that youth in the other three sub-groups (teen parents, teens in foster care, teens in the juvenile justice system) are in many cases also school drop-outs. Keeping youth meaningfully engaged in education is a critical tool to not only preventing youth from disconnecting, but also to effectively reconnecting youth. The incoming administration has made it clear to District residents that aggressive steps will be taken to improve public schools. The issue of reconnecting disconnected youth highlights the complexity of the reform effort that awaits the administration. Not only must steps be taken improve the conditions of the school buildings, the systemic
1

Kids Count Indicator Brief, Annie E. Casey Foundation, July 2005, Page 2.

management infrastructure, and curriculum, but also steps must be taken to insure that school-aged youth remain engaged and on track to graduate. Highlighting the need for interagency collaboration, DCPS will have to become more involved with its sister agencies that provided services to disconnected youth. Collaborative strategies must be designed to reconnect disconnected youth and implement prevention strategies at the same time. This will require aggressive measures to accurately determine the universe of youth who are currently disconnected and identify youth most at-risk to disconnect in the near future. We would recommend that a strategy to accurately determine the size of these populations be completed during the first months of the administration and data collection to begin no later than 30 days after the completion of a strategy. There are currently ongoing collaborative strategies underway examining the issue of reconnecting disconnected youth. We would request that the Deputy Mayor, or his designee, join these efforts making the issue of reducing school drop-outs a priority. The immediate involvement of the Deputy Mayor from Education will demonstrate the administrations commitment to this issue as well as allow the process to be guided with insight and support from the Executive office of the Mayor. o Teen parents The District has enjoyed recent success with efforts to reduce out-of-wedlock births and teenage pregnancy. Success however has not eliminated these issues. Teen parenthood continues to create significant barriers to the teen completing their education and also often places a strain on public resources. Strategies must be developed to keep teen parents engaged in school while also delivering the compliment of necessary services to better prepare the teen to be a competent parent. Teen parenthood can easily be an issue that spirals into a series of human services challenges. Upon completion of the data collection noted above, we would recommend that the Deputy Mayor for Education lead efforts in collaboration with the Maternal and Family Health Administration and Early Care and Education Administration to develop a comprehensive strategy to keep teen parents engaged in school and wrapped around with the requisite services to prepare and support them as young parents. It is important to remember that the parent is the first teacher of the child. The quality of the parent s education will have a great impact on the learning and development of the teen parents child. Successful strategies will keep the teen parent engaged and result in improved development of the teen parents child. o Teens in foster care Teens in foster care inherently face greater challenges successfully navigating school and gaining meaningful employment. Most youth who graduate college do so with a large amount of support and resources from their families. Teens in foster care are expected to navigate high school and eventually gain employment with scarce resources and support. Approximately 25% of youth aging out of foster care are homeless within four years of aging out. Strategies must be designed to support this population in their academic pursuits as well as connect them to job opportunities with career opportunities. The Mayor should have CFSA develop a comprehensive strategy to support foster teens focused on: 1) keeping them engaged in school and on-track to graduate; 2) participating in job training connected career opportunities; 3) mentorship connecting the teen with

responsible and caring adults who can remain engaged in the youths life when they age out of the system. o Teens in the juvenile justice system Teens in the juvenile justice system are also faced with unique challenges. Research on youth incarcerated in Arkansas found that being incarcerated was the single greatest predictor of future criminal behavior, four times as influential as the youth having carried a gun during the offense, nearly seven times more predictive than the youth being in a gang and thirteen times more predictive than the youth having poor relations with his or her parents. Contact with the juvenile justice system can have a disconnecting impact that in many instances is never overcome for the youth. This should not be the case. DYRS is making improvements in the services provided to youth in their care, however collaborative efforts must be designed to support this population. Steps must be taken to support this population returning to their home schools and eventually graduating; to provide these youth with jobs connected to career opportunities; to provide the requisite case management and support services in the youths home community enhancing the childs chances of sustained success while eliminating the likelihood of recidivism.

SENIOR SERVICES WORKING GROUP Executive Summary Addressing the needs of District seniors should be placed high on the agenda of the Fenty Administration. According to the 2005 American Community Survey, 86,024 District residents 16.7% of the District population are age 60 or older. The Seniors Working Group of the Human Services Transition Team brought together a diverse group of organizations committed to the District's senior population. Coordinated by AARP District of Columbia, it included representatives from legal and advocacy organizations, universities, hospitals, research institutes, nursing homes, labor unions, District Office on Aging network service providers, District government employees from several agencies, and the Long Term Care Ombudsman. While the participants often see the same matters from a different perspective, there was broad consensus in several key areas areas in which we believe the Fenty Administration could make important and substantive improvements in its first year. We urge the Fenty Administration to set goals for each agency that touches the lives of seniors; establish benchmarks and timetables for realizing those goals; and hold these agencies accountable for their successes and failures. We also believe it is critical to improve interagency coordination of senior services to ensure that they are neither duplicating efforts nor leaving service gaps. It should also be an Administration priority to ensure access to quality long-term care in all settings. The Working Group provides recommendations for improving the care received by the Districts nursing home residents and expanding home and community -based services. We also call for implementation of the Assisted Living Regulatory Act of 2000 and the establishment of programs to expand choice and improve quality of services available in seniors homes and communities. See also, The Report of the Taskforce on Long-Term Care for more information.2 The Working Group has also developed recommendations in several other critical areas each of which could be realized in one year or less. Working Group proposals would ensure greater attention to and coordination of seniors health and nutrition services. They would expand outreach, support and protections for seniors struggling to pay for home repairs. They would also improve access to needed transportation services and expand seniors opportunities for paid and unpaid public service. We are talking about the most basic of necessities a home, the means necessary to live in that home as long as possible, access to high-quality and appropriate care, transportation to and from medical appointments or the grocery store, and the coordination to make all of this work. By taking the concrete steps recommended here, the Fenty Administration can make real progress toward ensuring the well-being and dignity of our citys seniors and honoring the contributions these seniors have made throughout their lives. The work here was culled in less than a week, and the Working Group calls your attention to the need for more research and thought, particularly in the areas of transportation and affordable housing.

Report of the Taskforce on Long-Term Care. (2005, November 4). Council of the District of Columbia Committee on Health, Councilmember David Catania, Chairman.

SENIOR SERVICES FINAL REPORT AND RECOMMENDATIONS LONG-TERM CARE Problem statement: Nearly 3,000 District residents live in nursing homes at a cost of more than $175 million Medicaid dollars in 2006. We know that many would prefer to live in their own homes, and in some cases it would cost the city less to provide care in the least restrictive setting possible. We must make sure that residents who need long-term care get quality care in all settings and that necessary resources and services are available to provide home and community based care as appropriate. Recommendations: 1. Implement the Assisted Living Regulatory Act of 2000 so that facilities can be licensed, surveyed using an outcome based tool and become eligible to receive reimbursement from Medicaid and private long term care insurance. Timeframe: 3 months. 2. Review the case mix reimbursement system for nursing homes implemented in January 2006 and establish a mechanism whereby the Medical Assistance Administration (MAA) routinely furnishes calculations/formulas of data to set rates so that is may be reviewed to make sure it is accurate and that it does not discourage quality care. Timeframe: 3 months. 3. As the District prepares the Request for Proposal (RFP) to renew the contracts of the two nursing home facilities it owns and operates, the objectives and quality measures should be restructured to insure the highest quality of care and by using the latest proven practices. The current contracts for these facilities expire in October 2008 and 2009, so now is the time to begin preparing the RFP. Timeframe: 6 months. 4. Include all long term care direct care workers under the Living Wage of $11.75 an hour, and appropriate necessary funding in agency budgets. Timeframe: 12 months. 5. The Elderly and Physically Disabled (EPD) Medicaid home and community-based services waiver is underutilized. The EPD Waiver provides a vital option to remain in the community to those who would otherwise be institutionalized. Continue outreach and education about EPD Waiver services and the enrollment process to providers serving disabled and senior populations. Build a long-term care information technology system to automate and streamline the assessment and reporting requirements for the EPD Waiver, as well as other Long-term Care (LTC) services. The two-person administrative staff of the EPD Waiver cannot keep up with the demands for processing new beneficiary applications and also managing the current caseload demands for the 1200 current beneficiaries. Timeframe: 12 months. 6. Implement the Consumer-Directed Personal Care Attendant Program, approved by the Center for Medicare and Medicaid in 2002, to enable consumers to choose their own personal care attendants and to make choices about the best services for their own needs. Time frame: 3 months. 7. Establish an interdisciplinary Board to regulate quality of all direct care long-term care workers. Improve quality of care by standardizing and strengthening the direct care worker training curricula and requirements so that workers can more easily shift from one care setting to another to better meet the desires of consumers. Establish District-wide training curricula for home and institutional workers that cover relevant skills and subjects, and include a common core curriculum of no fewer training hours than is currently required. Timeframe: 12 months. COORDINATION OF SERVICES Problem Statement: Currently, seniors face barriers in accessing the services they need. Often this occurs because of an arbitrary delineation of responsibilities among and artificial restrictions

within government agencies, including the District Office on Aging (DCOA), Department of Health (DOH), Housing Authority, Department of Mental Health (DMH), Mental RetardationDevelopmental Disabilities Administration, and Metro (MetroAccess). Recommendations: 1. The District should move quickly to let the contract for new management of the Aging and Disability Resources Center (ADRC). The ADRC should be a collaborative initiative, involving MAA, DCOA, DMH and providers and consumers, with a clear allocation of responsibilities. The ADRCs focus must be on creating a real single pointof-entry that refers seniors to the right neighborhood agency for appropriate services, including assessment, eligibility, and ongoing case management. Timeframe: 3 months. 2. Establish a comprehensive electronic data warehouse to link District agencies and aging network organizations. The District should place a high priority on developing an information technology strategy to accomplish this type of linkage. Timeframe: 6 months. 3. The Office on Aging should develop a federal liaison officer to serve as the prime collaborator with federal agencies, including the Administration on Aging, Department of Health & Human Services, and the Center for Medicare and Medicaid Services. An effective relationship can better equip the District to take advantage of federal funds for pilot and demonstration projects, as well as new and innovative funding opportunities. Timeframe: 12 months. 4. The Mayor should convene a visioning retreat with all aging network organizations, District government agencies serving seniors and consumers to develop a vision and strategic plan for serving the next generation of seniors. Timeframe: 12 months. HEALTH AND NUTRITION Problem Statement: Many low-income seniors lack needed health and dental care services and have only limited access to healthy food options. In addition, issues surrounding several senior populations victims of self neglect, individuals with serious mental health problems, and those with extremely high-cost care needs are not garnering the attention and coordination they require. Recommendations: 1. E-Prescribing (the electronic transmission of a prescription from the doctors office directly to the pharmacy) is not yet available in the District. Recommendation: Insist on a date-certain when the Board of Pharmacy will report an implementation plan, budget and assignment of responsibilities. Timeframe: 6 months. 2. Increase access to locally-grown fresh fruits and vegetables through the federally-funded Senior Farmers Market Nutrition Program, which provides vouchers for low-income seniors to spend at farmers markets, by raising the income eligibility level to match federal law and improving outreach. Timeframe: 12 months. 3. Monitor placement of residents with mental health issues in long term care settings for appropriate placement. Establish a multi-agency response for patients in the community and in institutional settings suffering from dementia and manifesting agitated or aggressive behaviors that compromise their care. This should include the police, emergency mental health resources, Ombudsman, and family members, psychiatrists and emergency department physicians, and facility administrators. Timeframe: 6 months. 4. Self-neglect is the most common form of elder abuse in the community and has not been included in the Adult Protective Services (APS) scope of work. Request an implementation plan and budget from APS to assure adequate staffing and training for dealing with self-neglect cases in the community. Timeframe: 6 months.

5. Convene a group of local experts to examine how to reduce the costs of providing quality care to high-cost (or high-risk) patients. Timeframe: 6 months. 6. Develop a subsidized program at local hospitals and universities to assure that older adults have access to dental services. The Mayor can establish through a public/private partnership with dental offices to provide free and/or affordable dental care for those without adequate coverage. This is especially a problem in nursing homes. Timeframe: 12 months. HOUSING Problem Statement: Long-term changes to the Districts housing market have created unique housing problems for seniors, most of who live on limited incomes. Senior renters are facing displacement due to development, a lack of available affordable housing units, and few supportive housing options. Senior homeowners who cannot afford necessary repairs to their aging homes or increasing property taxes sometimes fall victim to predatory lenders and high-risk home finance schemes, and cannot access the resources needed to age safely in their own homes. Recommendation: 1. Coordinate with DOH and DCOA to identify an appropriate and effective method of educating low-income seniors about how to access and use the EPD Waiver to make health-related modifications and repairs to their homes. Timeframe: 6 months. 2. Increase financing of affordable housing projects. Timeframe: 12 months. 3. Work with the Offices of Zoning, Planning, and DHCD to develop amenities packages for developers that would create direct benefits for neighborhoods, community groups, and local agencies to use to assist seniors make necessary repairs to their homes. Timeframe: 12 months. TRANSPORTATION Problem statement: The transportation problems faced by seniors and people with disabilities have made front page news in recent months. Limited hours of operation and service area not to mention wait times that can extend to hours can turn a simple doctors visit into a terrible ordeal. Many buses, vans, and other means of transportation are available from MetroAccess, nonprofits, and nursing homes, however, the overall effectiveness and efficiency of these services is severely reduced due to poor coordination. Recommendations: 1. Make easily accessible by seniors and the disabled, comprehensive information on available transportation services, explain eligibility and whether the service is "curb-tocurb" or "door-to-door. Timeframe: 6 months. 2. WHETS transportation should extend transportation services for medical appointments to 4:00 p.m.; and transportation to medical appointments outside the beltway. It should shorten the turnaround time for medical appointments. Timeframe: 6 months. 3. Review the Call and Ride program using taxi-cab vouchers for seniors to make program more user-friendly and customizable for individual needs of consumers. The District Office on Aging sponsors this program through the United Planning Organization. Timeframe: 6 months. WORKFORCE Problem Statement: Many of the Districts 50+ population are healthy and well educated. As they leave their full-time jobs for other pursuits, their potential to address serious social and community issues is enormous, as are the benefits to their health and the Districts economy. The

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District needs to catch up with other jurisdictions by creating opportunities and infrastructure for post-retirement jobs and volunteering. Recommendation: Plan a multi-faceted campaign for engaging mature workers in paid and unpaid public service. Start with appointing a Task Force to recommend practices, programs and legislation that will result in more attractive and flexible paid and stipend positions in public service work, plus affordable training for that work. In so doing, the Task Force would fulfill the new Older Americans Act mandated strategic plan for civic engagement of Americans as they age. Timeframe: 12 months.

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CHILD WELFARE WORKING GROUP Summary The District of Columbia child welfare system is responsible for supporting families and children in the District who are at risk of experiencing, or experience, child abuse or neglect. While historically the system has served its families and children rather poorly, recent changes in the operations of the Child and Family Services Agency (CFSA) have led to some improved outcomes. This progress, however, has had a narrow scopefocusing more on compliance and meeting performance standards than achieving child and family centered outcomes. As a result, the system has not served its families and children as effectively and efficiently as possible. An examination of the current system revealed four key gaps hindering success in the child welfare system: 1. 2. 3. 4. Prevention Efforts and Capacity Internal Infrastructure and Operations Interagency and Community Linkages/Coordination State Level Policy Efforts

Looking ahead, the Fenty Administration must redefine how it fulfills its responsibility to prevent and respond to child abuse and neglect by addressing these barriers and adjusting their child welfare vision to include not only compliance outcomes, but child and family centered outcomes as well. The subcommittee recommends the following guiding vision: Children should experience safety in all aspects of their liveshomes, schools and communities. Families should have the supports they need to care for their children. When children and families come to the attention of the child welfare system, they should receive high quality and effective support to address critical needs that are identified early on to avoid placement whenever safely possible. Children belong in families---families that are their own permanent families who have the resources to support them. When children come into care, they should have the best and shortest stay possible, experience the fewest possible placements, and maintain their connections to their own families and communities throughout their time in care.

Progress towards all these outcomes should be reported through CAPStat. Key levers to achieve progress toward these outcomes will need to include: Commitment to prevention throughout the system continuum. Excellent front-line practice. Excellent administrative and management practices. Youth, family, and community participation at all levels. Accountability for results at all levels. Flexible and high quality resources and supports for vulnerable children and families. Responsive and strategic partnerships with other key public agencies.

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CHILD WELFARE FINAL REPORT AND RECOMMENDATIONS I. Define Issue/Service Area

In general, the child welfare system is responsible for supporting families and children in the District who are at risk of experiencing, or experience, child abuse or neglect. The child welfare system in the city has not worked effectively/successfully for all children and families for a long time, but significant progress has been made in recent years, particularly with regards to the operations of the Child and Family Services Agency (CFSA). 3 However, this progress has been overly focused on compliance and process-based measures rather than on child and family outcomes. Moving forward, the Fenty administration must redefine how it fulfills its responsibility to prevent and respond to child abuse and neglect. The subcommittee recommends the following guiding vision: Children should experience safety in all aspects of their liveshomes, schools and communities. Families should have the supports they need to care for their children. When children and families come to the attention of the child welfare system, they should receive high quality and effective support to address critical needs that are identified early on to avoid placement whenever safely possible. Children belong in families---families that are their own permanent families who have the resources to support them. When children come into care, they should have the best and shortest stay possible, experience the fewest possible placements, and maintain their connections to their own families and communities throughout their time in care. What's Missing/Barriers in Current Environment

II.

Key gaps and barriers for the child welfare system need to be addressed at 4 different levels: 1. Prevention efforts and capacity: Currently, the city has no comprehensive child abuse and neglect prevention or early intervention strategy. While quality programs exist in the city, there is no overarching effort to integrate these or to guide the development of new and/or improved resources. CFSA has just completed the first phase of asset mapping to identify these key resources, but the difficult work of defining a strategy has not yet begun. Truly achieving substantial prevention of child abuse and neglect will require alignment of resources and accountability across public agencies and the communitys non -profit sector. 2. Internal infrastructure and operations: One of the most significant barriers to the agencys progress continues to be its weak contracting and payment capacity. These barriers
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For example, CFSA hotline staff are appropriately prioritizing investigation response times and identifying child vulnerability factors, allowing social workers to initiate timely investigations. The quality of investigations has also improved. Social workers are interviewing several core investigative contacts, including alleged child victims, all other children in the household and abuse/neglect reporters, and are completing safety and risk assessments within the required timeframe. Extracted from: An Assessment of the Quality of Child Protective Services Investigations in the District of Columbia. The Center for the Study of Social Policy. February 7, 2006.

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slow down the delivery of services to vulnerable children and families, unnecessarily burden providers, and disincentivize the development of new programs/services. Additional concerns also exist in the area of worker supervision; areas of weakness that must be attended to include: ensuring that family and sibling visits occur in a timely and substantive manner and that clinical issues are identified early on and attended to quickly. 3. Interagency and community linkages/coordination: Though they have improved, interagency and community linkages are still uneven, and the resulting gaps have negative effects on children and families. Of particular concern are gaps and delays in service in the mental health arena, the disconnect between public schools and CFSA and other child/family serving providers and how this affects educational placements, coordinated services for children with developmental disabilities, and the integration of services for older youth who are at risk of, or actually involved in, the juvenile justice system. 4. State level policy efforts: Much has been made of the fact that District government has a dual role and must fulfill both city and state function; the blurring between these two roles, combined with inadequate attention to the state planning and accountability role, has hampered the development of an effective child welfare system. Of immediate concern are: the effectiveness of the Medicaid strategy, resolution of inter-state issues related to placement, and the lack of state-level coordinated planning for effective supports to vulnerable children and families. III. Vision/Vision for Change Statement Moving forward, the Fenty Administration should focus on the following core child and familycentered outcomes to guide transformation of the child welfare system: Safely reduce the number of children at risk for coming into the formal child welfare system by investing in family strengthening efforts and strategically addressing key risk factors for child abuse and neglect, including poverty, substance abuse, mental health problems, domestic violence and teen parenting, through a results-focused prevention strategy. Safely reduce the number of children who come into care once families become known to the system by increasing the agencys front-end capacity to respond to families through comprehensive assessment, quality community referrals, and wrap around linkages for families before placement to specialized services for high-end behavioral, emotional and/or educational needs, that if unmet, might otherwise drive children into care over time. Ensure that children who are removed are well cared for while in foster care and that children achieve permanency quickly and successfully. Specifically, the city should: o Reduce the number of placements children experience o Safely reduce the average length of time children spend in placement o Maintain family and community ties for children in care o Increase the number of children who are successfully and safely reunified with family and extended family members o Increase the number and rate of children exiting foster care successfully, by increasing reunification, kinship care, adoptions, guardianship and ensuring that these permanency strategies are well supported. o Dramatically improve outcomes for teens transitioning to adulthood from foster care, particularly as pertains to adult support, educational attainment and economic security.

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Ensure that children in care are healthy and receive preventive health and dental care and that they are quickly linked to quality mental health and other therapeutic services as needed. Progress towards all these outcomes should be reported through CAPStat. IV. A. Group Recommendations Short Term (90 Days) Correct inadequacies in the contracting and payment system. Fully implement the Family Team Meeting Process for all cases entering the system where there is risk of removal, actual removal, risk for disruption or actual disruption. This service must be available to all children and families served by private providers. Fully implement CFSAs policy of connecting all low-moderate-risk cases to community based services. Resolve long-standing issues related to Interstate Compact so that children can be placed promptly with relatives living in other jurisdictions. Establish an interagency working group to address cross-system linkages for the citys most vulnerable children. This interagency group must include the active and continuous participation of the school system and must, at a minimum, develop: 1) an integrated prevention strategy that structures real supports for vulnerable families; 2) an implementation strategy to serve children with special educational, mental and behavioral needs; and 3) address the needs of older youth who are at risk of or who currently are under the supervision of the juvenile justice system. Mid-term (180 days) Define and begin implementation of a city-wide child abuse and neglect prevention strategy that addresses core risk factors, including: poverty, parental substance abuse, undiagnosed and untreated mental health issues, and domestic violence. o Ensure financial and housing supports are available to prevent entry into the systems, as well to support both relatives caring for children who may not qualify for existing services and older youth preparing to exit the system. o Increase the timely availability of substance abuse treatment, particularly family based care, through joint efforts with APRA. o Target parent support services in high poverty neighborhoods. o Ensure services and supports are available before a child comes into care by integrating high quality crisis intervention services at intake. Implement the following recommendations to aggressively reduce the number of children experiencing multiple placements: o Design and deliver a model of specialized/therapeutic foster care that features clear guidelines on the types of emotional and behavioral needs that are best served by the model. o Develop 24 hour crisis response and stabilization services which include prioritized access to individualized wraparound services o Identify appropriate scope of formal and informal psychotherapeutic resources and other supports for children and foster parents.

B.

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Develop written standards for caseload size, social worker visitation and social worker accessibility to foster parents. 4 o Develop a pool of resource families that are adequately trained, supported and supervised to meet the needs of children in care; appropriately matched to children and youth they can care for; and who are prepared to manage crises. Implement the following recommendations to address and reduce the trauma children experience as a result of child abuse and neglect while in care: o Ensure universal screening for educational, behavioral, or mental health needs of all children under supervision or care of the agency; screening should at a minimum fulfill EPSDT requirements. o Increase the number of providers with trauma treatment skills and competencies. o Ensure prompt and sufficient payment to mental health providers. Implement the following recommendations to increase the numbers of children who are reunified with their immediate or extended families and those who are successfully adopted: o Increase connections between children and their families and communities by dramatically and immediately increasing parent and sibling visitation rates. o Strengthen support to birth parents and other family members, particularly with regard to educational and employment assessments/linkages. o Strengthen post-permanency supports for all children, while making specific investments in supports for children with special behavioral, emotional or educational needs. Focus on improving front-end assessment and planning, broadening the scope of assessment so that more than the presenting problem is assessed o Strengthen hotline assessment and documentation to move beyond incident based reporting. o Retrain workers in the use of CFSAs structured decision-making tool to improve the overall quality of worker assessment. Implement the Quality Service Review Process (QSR) with contracted providers across the service continuum to ensure alignment with the practice model Long-Term (year or more) Implement in full key recommendations of inter-agency working groups (identified above). Establish budget transparency and regular public reporting on key performance indicators. Implement a school-based early identification/intervention program for at-risk children and families. Implement performance-based contracting in a manner aligned with the systems core values and implement incentives to sanction persistently poor practice and reward excellent services to children and families. (For example, freeze referrals to group homes where children are making little to no progress toward permanency.) Develop/fund services to fill key system gaps, e.g. mental health services for traumatized children. needs,

C.

D. Personnel (including staffing levels, skills, training/professional development etc.)

Extracted from: Assessment of Multiple Placements in the District of Columbia. The Center for the Study of Social Policy. July 2006.

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Stabilize agency leadership and invest in capacity of mid- and low-level managers, particularly supervisors, to guide quality practice. Ensure a highly trained, motivated and supported cadre of resource families who can meet the needs of children when they do come into care, and consider whether additional professionalization of all or some segment of foster parents is needed. Invest in improving training for line and supervisory staff in the following areas: clinical skills, cultural competency, attachment, crisis intervention and work with older youth. Ensure that administrative staff receives training in accountability, management and contracting and comply with recommendations of Contracting and Procurement Taskforce. Policy/Legislation Address the ICPC barriers to placement with caregivers in Maryland and other states. Clarify the age at which children can be left with caretakers under the age of 18 and at what age children can be left alone. Implement Council for Court Excellence recommendations for the use of APPLA goals. Extend adoption subsidy to age 21 for children adopted over a certain age or who have special needs. Current limits on subsidies of older youth function as a barrier to permanency. Identify and implement strategies for ensuring timely and adequate Medicaid payments. Review policies of DC Medicaid, specifically regarding medical necessity criteria for mental health services and therapist reimbursement; assess whether those policies meet the actual therapeutic needs of our children; and explore other options to subsidize these services that DC Medicaid does not provide and/or revamp Medicaid guidelines. Coordinate timely compliance with court oversight requirements. Strengthen external oversight of CFSA so that sufficient external accountability exists to ensure gains are maintained once exit from court oversight is achieved. Budget

E.

F.

Lack of transparency in the child welfare budget proved to be a barrier for the transition subcommittee. To ensure greater and more facile use of the budget, the Fenty Administration should provide significantly more detail in the CFSA budget, per DC Fiscal Policy Institute recommendations, as well as pilot outcomes-based budgeting with CFSA. Additionally, the subcommittee recommends the agency prioritize the following: Establish baseline funding for Child Advocacy Center. Complete an impact/efficiency analysis of current strategy and expenditures for older youth programming, as city expenditures are significantly above the norm but produce substandard results. Implement mechanisms to tracking cost savings resulting from reduced placements. Work to maximize Medicaid reimbursement. Intensify efforts to recruit DC-based homes, such placements would result in better care for children and increased savings in transportation, educational fees, and purchase of services. G. Efficiencies/Systemic changes Weak and disjointed internal efforts to keep children out of care once they have come to the agencys attention drain the citys resources. Similarly, policy supports, and programs for older youth are woefully inadequate and ineffective. A complete restructuring of both inhome supports and older youth efforts should be prioritized.

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Interagency coordination to establish enhanced access to specialized services must be improved in order to allow the agency to invest internal funds on service gaps rather than stop gap measures, as has been the case with mental health services. Payment and support to foster parents must be improved. Weak performance in this area creates a cycle of failure, extending childrens time in care due to unnecessary disruptions; foster parents leave the system, costing the city additional dollars in recruitment; and the public perception of system inefficiencies hampers recruitment of qualified foster parents. Uneven and poor quality of services by private/contract providers is a barrier to quality care and reunification. The agency must establish performance-based contracting in alignment with agency values and track measurable improvement in service delivery and aggressive use of flexible funding to support individualized plans. Accountability Tools

H.

The agency needs to establish strong internal accountability measures to ensure that practice is aligned with vision, particularly with regards to opening and closure of cases, as well as removal of children. These key decisions should be subject to a routine threshold of supervisory/managerial assessment, review and approval/redirection. The agency should establish a set of scorecard outcomes that are child and family centered and that reflect quality of care and child/family gains. Progress towards these outcomes should be made public on a semi-annual basis. I. Boards and Commissions Recommendations The committee recommends that the city invest in the further development of the Citizen Review Panel. Specific recommendations include the following: The panel should be facilitated by a qualified individual who is not employed by CFSA in order to ensure the independence and effectiveness of the body. The panel should include participation by youth, birth parents, foster parents, and advocates. The agency should be directed to cooperate in full with this body. J. Conclusion The Fenty Administration has the opportunity to transform the citys child welfare system into a model of effectiveness and responsiveness if it can shift the systems focus to child and family centered outcomes and bring accountability to all operational levels. As outlined above, key levers to achieving dramatic progress will need to include: Commitment to prevention throughout the system continuum; Excellent front-line practice; Excellent administrative and management practices; Youth, family, and community participation at all levels; Accountability for results at all levels; Flexible and high quality resources and supports for vulnerable children and families; and Responsive and strategic partnerships with other key public agencies.

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HOMELESSNESS WORKING GROUP

Introduction: Solve the crisis of homelessness Homelessness in the District of Columbia has reached epidemic proportions. Indeed, the problem is so large that many see it as intractable. But tho ugh homelessness in Washington is a crisis, it is not an unsolvable one. Over 100 people participated via e-mail, chats, or public meetings in the formation of comprehensive recommendations to: 1) create of more affordable housing, 2) increase and preserve emergency capacity with an emphasis on the Housing First Model, 3) improve conditions at existing shelters, 4) improve quality of services and coordination among service providers and government agencies and 5) expand prevention efforts. Create more permanent affordable housing The number one cause of homelessness is the lack of very low cost and subsidized housing. Each year from 2000 to 2004, the District lost approximately 2,300 units renting for $500 or less a year. In 2004 there were over 20,000 low-income renters who needed to rent units at this level, but could not find them. Homeless No More calls for the creation of 6,000 net units of affordable housing by 2014. To meet this goal and to make up for annual losses, the District would have to construct over 3,000 units a year. The new administration should: Rapidly increase Housing Production Trust Fund spending to implement the Districts plan to construct 6,000 net units of affordable housing. (one year) Increase the funding for the Rent Supplement program to maintain current clients and assist at least 200 additional families and individuals to move off the wait list each month. (one year) Increase funding for the project-based rent supplement program for 250 additional SROs each year. Create an Office of Affordable Housing Preservation with staff from DCHA, DCRA and DHCD and use DC discretionary repair funds when necessary to preserve housing or shelter. (180 days) Identify District-owned buildings (including closed schools) which could be redeveloped as permanent supportive housing. (180 days) Provide tax incentives to encourage religious institutions and private landlords to identify permanent affordable housing for use by homeless youth and families. (180 days) To encourage small, dispersed, residential shelters, and to fight NIMBY-ism, change zoning law to permit 2 unrelated individuals in each bedroom in a residentially zoned house (one year) Increase and preserve emergency capacity with an emphasis on the Housing First Model Children, youth and adults living in cars, streets, parks, and abandoned building are turned away from shelter because of lack of space. For the cost of $2,500 a month DC provides a family in crisis with communal style hypothermia shelter, and for approximately $300 a month provides an individual with a bed in a communal shelter. Under a Housing First model, this money could go toward placing a family or individual into higher quality, permanent housing. The new administration should: Increase capacity for families and individuals by funding more Housing First programs. (one year) Reconfigure low-performing transitional housing contracts to be modeled on Housing First permanent supportive housing programs. (one year)

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Purchase privately-owned publicly-funded shelter buildings in order to preserve their use as shelters in rapidly gentrifying areas. (one year) Increase capacity for youth who are homeless, especially low-barrier services. (There must be more options for housing youth who are homeless than juvenile detention facilities.) (one year) Identify opportunities where vacant units and available rental apartments could be converted or rented by the government for the purpose of permanent supportive housing. (90 days) Create eligibility criteria that do not discriminate on the basis of age, criminal history, sexual orientation, citizenship, physical or mental disability, drug use or credit.

Improve conditions at existing shelters Too many of the Districts shelters are in physically deplorable condition and in dire need of additional services and resources. Most facilities need a drastic overhaul to make them beneficial for residents. Studies show that good conditions and services reduce shelter stays. Future facilities should be smaller, more accessible to individuals with disabilities, provide privacy and be dispersed throughout the city including the downtown corridor. The Fenty administration should focus on five overarching goals in this area: Change contracting to improve shelter management and services Divide all large contracts into smaller contracts to encourage competitive bidding. (one year) End contracts with providers who fail to meet contract requirements, violate the housing code, or violate clients rights. (one year) Require all contracts for facilities management to stipulate that an independent Residents Council be created to give input into how the facilities are managed. (90 days) Require all contracts for facilities management to stipulate that security should be present at all times and should regularly patrol the facility. FSA contracts should stipulate that firearms should never be brought into shelter, either by security, clients, or staff. (90 days) Contract directly with providers of services whenever practical (rather than maintaining the current system of a primary contractor that sub-contracts for actual services). (90 days) Alter contracts to require all shelters to be open 24 hours. (90 days) Alter contracts to require all shelters to eliminate all barriers to employment. (90 days) Alter contracts to require all shelters to make telephones available for client use. (90 days) Contract for the provision of shelter to adult childless couples who enter the shelter system so that they have another option besides separation or staying on the street. (90 days) Contract for services to meet the special needs of GLBTQ people who are homeless. (90 days) Alter contracts for the provision of communal-style shelter to require daily access to recreation equipment and quiet homework space. (90 days) Operate the homeless services system fairly, consistently, and in compliance with DC law Require all shelters to be ADA compliant, including changing policies and procedures that act as barriers to people with disabilities. (one year) Develop regulations for all programs operating without legal authority and for emergency actions, monitoring, and ADA compliance. (180 days)

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Develop eligibility regulations that place individuals or families who are homeless with special needs (e.g. mobility impaired, HIV +, chronically ill) directly into permanent housing. (180 days) Promulgate regulations that require proper training and criminal background checks for staff. (180 days) Dedicate more lawyers to writing policy and protecting clients rights. (9 0 days) Dedicate a government level ombudsman to respond to emergency situations at shelters and to be on call after working hours, on weekends and on holidays. (90 days) Comply with DCs Language Access Act. (90 days) Carry out unannounced inspections at facilities and monitor compliance with DC laws (enforce compliance with the HSRA and Disability Rights laws, wage and hour, housing code, client rights etc.). (90 days) Improve and maintain the physical conditions of facilities Allocate resources and develop a plan for prompt maintenance to prevent DC owned buildings from falling into disrepair. (180 days) Promulgate regulations that provide minimum standards for each facility (ratio of people to bathrooms, climate control). (180 days) Improve quality of programs Create model shelter facilities for men and women in the downtown area. (one year) Enhance services and facilities for special needs populations such as the elderly, medically fragile, Latino population, and victims of domestic violence. (one year) Provide onsite health care at all of the Districts shelters. (one year) Increase locker storage capacity at shelters to reduce theft. (one year) Create empowering volunteer opportunities for shelter residents to work together, using skills and relying on one another to improve their situation. (180 days) Enforce a zero tolerance policy for staff members who steal, solicit sex, provide drugs, threaten residents, or diminish the safety of the shelter facilities. (90 days) Provide drug treatment on site to reduce addiction. (90 days) Require reports to police of all violent crimes that take place in shelter and require that facilities management take steps promote a safer environment in shelters. (90 days) Improve quality of programs for families Comply with the law by providing more apartment-style units for families by renting additional scattered- site apartments. (180 days) Until enough apartment style units are created, FSA should transfer families from communal facilities to more appropriate shelter or housing within 21 days of initial placement. (180 days) Provide free-standing case management to families in shelters and on the waiting list. (90 days) Immediately place vulnerable families (e.g. pregnant women, infants, HIV + people, battered women) in non-communal settings. (90 days) Hire a trained service provider to conduct a child and family needs assessment for each family upon entry into the shelter system to determine the educational, psychological, developmental and medical needs of the child and make immediate referrals. (90 days) Improve quality of services and coordination among service providers and government agencies In order to end homelessness a functioning Interagency Council on Homelessness that demands communication between the various agencies that provide services for those who are homeless is required. Better coordination between service providers and a separation of case management

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from facilities management will help to deliver services to clients in a more orderly fashion. The Fenty administration should focus on the following three goals: Improve agency and provider coordination DMH: Train shelter staff to work with clients with mental illness, provide more occupational therapy and employment support services for people with mental illness, add to the number of people who can perform involuntary commitment, and do more aggressive outreach at shelters and in the community to assess the mental health care needs of clients. (180 days) DMH: Expand access to mental health services through the DC Healthcare Alliance. (180 days) DMH: Assess children and adults upon arrival to shelter. (90 days) MPD: Designate a Homeless Liaison to replicate the Homeless Outreach Teams approach to responding to people who are homeless. (180 days) DOES: Create work programs focused on placing workers who are homeless into permanent jobs in order to circumvent the predatory practices of temporary labor agencies. (180 days) DOES: Provide training to people who are homeless so that they can participate in renovation and construction jobs. (180 days) RSA: Focus resources on the homeless population seeking employment. (180 days) APRA: Provide drug treatment on demand. (180 days) Introduce legislation to establish a tax break for hiring people who are homeless. (180 days) Introduce legislation to require shelters, DHCD grantees and contractors to give employment opportunities first to DC residents who are homeless. (180 days) Contract with an affordable housing/shelter database such as www.socialserve.com; require FSA, DCHA, DMH and their sub-contractors to post all housing and shelter vacancies to the database. (90 days) Strengthen the Interagency Council on Homelessness (ICH) Dedicate staff in the City Administrators office to coordination of the ICH, evaluating gaps in services, and responding to crises in the continuum. (90 days) Dedicate staff in the City Administrators office to act as a liaison between the Government, the ICH, and the homeless community. The liaison should coordinate DC efforts with the surrounding jurisdictions, through MWCOG or some other vehicle. This person should hold monthly meetings with the homeless community to give progress reports and hear grievances and communicate issues raised to the City Council. (90 days) Create a committee on Youth Homelessness within the ICH which will have responsibility for developing a coordinated plan for receiving and caring for homeless youth in the District. (90 days) Require that all recommendations be funneled through the ICH to ensure coordination across departments and efficient use of resources. (90 days) Appoint more people who are homeless to the ICH. (90 days) Track government attendance at ICH and compliance with the HSRAs ICH provisions. (90 days) Collect more accurate data on the number of homeless individuals, families, and youth, in the District and the numbers that are turned away from services. (90 days) Improve Case management Increase funding and alter most existing and all new contracts so that independent, separated, case management can be provided for all people in the continuum of care at a ratio of 20 clients per case manager. A case manager should be assigned to a client upon

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entering the system and follow that client through the system and into housing. (one year) Require all DHS contractors to go through accreditation process (e.g. www.coanet.org.) (one year) Establish a transportation program for case managers to distribute bus passes to those clients who are working or connected to a program. (90 days) Train case managers to provide a comprehensive needs-assessment for all clients and to provide the same information to all clients entering the shelter system. (90 days) Utilize web-based HMIS as a uniform case management system. (90 days)

Expand prevention programs In order to properly confront the problem of homelessness in the District, the next administration needs to work not only to alleviate the existing problem, but also to prevent the growth of homelessness. Proper discharge planning and a more robust eviction prevention program would help curb the influx of new men, women, and children into homelessness. The Fenty administration should: Require Pre-release planning Prisons: CSOSA should develop comprehensive services for ex-offenders before and upon release in order to keep them from transitioning directly into the shelter system. (one year) Foster care: CFSA should develop appropriate discharge planning to prevent youth from transitioning directly from foster care into homelessness. (one year) Psychiatric hospitals: DMH should create discharge plans that prevent people with mental illness from returning to shelter or the street. Provide DMH with sufficient funding for permanent supportive housing for persons with mental illness. (one year) Hospitals and nursing homes: Develop regulations that require hospitals and DOH to have appropriate discharge planning to provide alternatives to patients other than discharge to shelter. (one year) Prevent Evictions Increase funding for Low-Income Home Energy Assistance. (one year) DCRA (the Office of the Tenant Advocate), DCHA, and others should collaborate to create an eviction prevention program. Landlords would call on the program to intervene before starting the court process against tenants and the program would help tenants put in place direct payments to landlords and emergency assistance for unpaid rent. (180 days) Require intervention and dispute mediation (modeled on the Alternatives program) before an eviction that would render a DC subsidized tenant homeless. (180 days) DHS needs to revise overly restrictive regulations for the Emergency Assistance program and to co-locate Emergency Assistance with landlord and tenant court. (90 days) Conclusion We believe that the next administration will have the vision and leadership necessary to affect a genuine and immediate impact in this historically underserved and neglected community. A commitment from the highest levels of the District government will ensure that these recommendations receive the resources, attention, and coordination that they require.

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DEVELOPMENTAL DISABILITY SERVICES WORK GROUP Definition of the issue and service area A developmental disability (DD) is defined as a severe, life-long disability that is attributable to a mental and/or physical impairment that is manifested before age 22; is likely to continue indefinitely; and results in substantial functional limitations in three or more major life activities.5 Children may be determined to have a developmental disability if between birth and age 9, they have a substantial developmental delay or specific congenital or acquired condition.6 While the definition of a developmental disability may cover a broad range of disabilities, the Districts human service system primarily focuses its resources and attention to residents with cognitive disabilities through the Department of Human Services, Mental Retardation and Developmental Disabilities Administration (MRDDA). MRDAA serves approximately 2,000 individuals annually. It is estimated that 1% to 3%, or 5,505 to 16,516, residents of the District of Columbia have a developmental cognitive disability.7 People with developmental disabilities and their families often require a variety of services and supports spanning the full range of the Districts health, human services, educational, housing and employment agencies. Every day in the District of Columbia, residents with developmental disabilities confront challenges that impact on their quality of life as a result of poor inter-agency coordination; inconsistent service delivery; and inadequate resources as a result of the Districts failure to fully access and utilize federal dollars. Gaps and Barriers in the Current Environment Residents with developmental disabilities and their families face significant gaps and barriers, both within programs offered by MRDDA and across programs offered by other agencies. While MRDDA serves individuals with cognitive disabilities, no one agency provides services to all persons with developmental disabilities in the District of Columbia. Children and youth with cognitive disabilities, and adults with developmental disabilities that are not cognitive, are ineligible for MRDDA. These residents instead seek assistance from a number of human service agencies, including the Department of Human Services Early Care and Education Administration and Rehabilitation Services Administration, the D.C. Public Schools, the Child and Family Services Agency, the Department of Health, and the Department of Mental Health. Whether they are eligible or ineligible for MRDDA services, residents with developmental disabilities often have complex needs and are forced to navigate through a maze of agencies offering a patch work of programs with varying eligibility criteria. This problem is exacerbated when multiple agencies must collaborate to deliver a service. In these situations, all too often individuals languish for months or years without much-needed services. The lack of a unified service structure and effective interagency coordination hinders access to available services and has contributed to significant gaps in service delivery. Furthermore, MRRDA itself lacks the authority and resources needed to eliminate barriers to interagency coordination and is currently

Developmental Disabilities Assistance and Bill of Rights Act 2000, 42 U.S.C. 1501 Section 102 (8)(A) (B). 6 Id. 7 The Arc of the U.S., Introduction to Mental Retardation, and the U.S. Census Bureau, Census 2000.

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under court order. 8 The agency has had 19 administrators in the last 12 years, which has contributed to an agency that has does not have a coherent infrastructure to support the complex needs of individuals it serves. Additionally, MRDDA faces a budget shortfall currently estimated by its leadership at $28.8 million in FY 2007, which will have a profound impact on the efficacy of the agency. The Districts inability to maximize federal Medicaid dollars contributes to its failure to meet the program needs of its clients. At the same time, current MRDDA provider reimbursement rates, as well as pay and training for direct support workers and clinical staff, are inadequate to recruit and retain quality providers and to develop a well-trained, stable workforce. Both at MRDDA and at other agencies, the lack of a unified plan for accountability and transparency at all levels of service delivery persistently hinders quality, efficiency and meaningful consumer choice. At the systems level, there appears to be no plan for objectively and consistently tracking and evaluating the work of various government agencies and their contractors. At the planning level, the consumers and families who are in the best position to develop and benefit from accountability measures are not at the table. At the service delivery level, individuals and families frequently report poor customer service and are offered no clear process for problem resolution, particularly with regard to MRDDA case management. In addition to these overarching issues, the DDS Work Group highlighted the following specific gaps in community services: affordable and accessible housing; reliable transportation; medical, dental and clinical services; family supports; effective transition services from age 3 to 5 and again for youth aging out of foster care or the public schools; community employment; and services for individuals and families who do not meet the Medicaid income criteria. The DDS Work Group also found that without an effective home and community-based services Medicaid waiver, options for quality community services are needlessly limited. As a result, the District has the second-highest rate among states of reliance on Medicaid-funded Intermediate Care Facilities for persons with Mental Retardation (ICFs/MR).9 These medically-intensive, institutional group homes separate people with developmental disabilities from the community and cost more on average per person than Medicaid waiver community services. Finally, the DDS Work Group found that without any central point of information, consumers and families often lack awareness of available services, their rights, and options for problem resolution... This appears particularly true for Medicaid-funded community services where roles of the service-delivery agency versus the Medicaid agency lack transparency and accountability from consumers perspectives. Specific language access and cultural barriers also exist for the deaf and for individuals with limited or no-English proficiency. Vision for Change The District will become a city where children, youth and adults with developmental disabilities live in the most inclusive community setting and are able to realize their potential as full, active participants in the Districts social and economic life. To make this vision a reality, the District government will develop an effective, efficient system for delivering quality services and supports across the lifespan to all residents with developmental disabilities and their families.

8 9

Evans v. Williams. Table 3.9 in Residential Services for Persons with Developmental Disabilities: Status and Trends Through 2005, Prouty, R.W., Smith, G. & Lakin, K.C., Eds. Minneapolis, MN: University of Minnesota.

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Group Recommendations Short term (90 day) 1. The Mayor should recruit stable, visionary leadership for MRDDA and, with the DC Council and stakeholders, resolve the agencys cabinet -level structure for FY 2007 and 2008. 2. The City Administrator should lead a 90-day initiative to revise and/or establish interagency agreements between MRDDA and key agencies that serve residents with developmental disabilities.10 Consumers and families should actively participate in this process. The resulting Memoranda of Understanding (MOUs) should: a. State funding commitments by each agency; b. Include performance standards and an evaluation process; c. Require agencies to issue policies to implement their MOU commitments; d. Require agencies to make MOUs available to consumers and families; e. Require agencies to participate in an interagency taskforce composed of all MRDDA MOU partners. The taskforce should meet monthly to work on MOU implementation; f. Spell out a process for transitioning and referring consumers from one agency to another, which includes designation of interagency liaisons for front-line staff; and g. Provide for regular (monthly or quarterly) cross-trainings of line staff at key agencies. 3. The existing MRDDA Waiver Advisory Taskforce should meet weekly to write the renewal application for the MRDDA Medicaid waiver in a way that maximizes waiver use (due: May, 2007). The Taskforce should include all stakeholders, particularly parents and consumers. 4. MRDDA should convene a taskforce with strong representation by consumers and families to reform the process by which MRDDA Individual Support Plans (ISPs) are developed. Within 6 months the taskforce should present a person-centered ISP process which is convened and managed by the consumer or someone who knows the consumer well (not a contractor) and which upholds consumers dignity and privacy. Implementation should occur in 6 months. 5. MRDDA should immediately institute a conflict of interest policy which prohibits MRDDA case managers from also working for MRDDA contract providers. 6. The Mayor should support the DC Superior Courts request for $2 million to help recruit and train Mental Retardation Advocates to act as advocates for consumers who have been committed by the court to MRDDA services, as authorized in DC ST 7-1304.13. Mid-term (180 day) 1. The MRDDA Waiver Advisory Taskforce should make recommendations for new Medicaid waivers, such as an autism waiver and family support waiver, to maximize the use of federal Medicaid dollars to improve and increase services for individuals and families. 2. MRDDA and its MOU partners should regularly inform all consumers and families about available services across all agencies, and should offer ongoing education on how to access services, rights, and problem resolution. In particular, this initiative should: a. Expand the DHS Answers, Please! hotline to provide comprehensive information and referral for all services for residents with developmental disabilities (across agencies) and to include a guide to all area services in the Answers, Please! online database; b. Initiate a comprehensive orientation system for MRDDA and related services; and c. Institute a peer-to-peer counseling and education program for MRDDA consumers.
10

Including: Department of Health, Medical Assistance Administration (MAA); Department of Human Services, Rehabilitation Services Administration (RSA), Early Care and Education Administration (ECEA), Family Services Administration (FSA) and Income Maintenance Administration (IMA); Department of Mental Health (DMH); D.C. Public Schools; Department of Employment Services (DOES); and D.C. Housing Authority (DCHA).

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3. The City Administrator should organize a swat team to establish partnerships between MRDDA, DCHA, and other city housing agencies to expand housing opportunities for residents with developmental disabilities and their families using tools such as Section 8 voucher set-asides, consumer education, and a central database of accessible housing. 4. MRDDA should strengthen collaborations with RSA, DOES, and DCPS to help consumers get real jobs for real pay in the community. MRDDA and RSA should lower their staffing ratios for supported employment and provide for jobs at minimum wage or higher. 5. MRDDA and MAA, in collaboration with stakeholders, should increase reimbursement rates to expand the pool of medical, dental and clinical services (e.g., nutrition, RN/LPN, psychiatry, OB/GYN). MRDDA should continue and potentially expand trainings to educate providers about working with individuals with developmental disabilities. 6. The City Administrators office should work with MRDDA, MAA, families and residents to expand ICF/MR leave so that residents can take home visits or hospital leave without fearing the loss of their ICF/MR bed. 7. In collaboration with families and consumers, MRDDA should develop and implement a plan to ensure language access and culturally competent services for the deaf and individuals with limited or no-English proficiency. Long-term (year or more) 1. Within 1 year, the interagency taskforce, in collaboration with families and consumers, should develop a single point of entry for services to individuals with developmental disabilities and their families. The single point of entry plan should include interagency data sharing that complies with federal health information privacy law, cross-agency tracking of person-centered outcomes, and participation in CAPStat. 2. Within 1 year, MRDDA and MAA should identify ways to serve individuals and families who do not meet current Medicaid income guidelines and should introduce any Medicaid State Plan amendments and/or legislation needed to increase access. 3. MRDDA should promote access to community recreation opportunities by requiring residential providers to have a recreation coordinator and establishing recreation-related benchmarks for providers. 4. MRDDA should identify resources for a start-up fund to help recruit new providers. Personnel 1. Within 90 days, the City Administrator, MRDDA, MAA and stakeholders should identify strategies, funds and agree to a timeline for increasing hourly wages for direct support staff to a minimum of $11.75 across all services, regardless of funding source. 2. Within 90 days, MRDDA should partner with the University of the District of Columbia (UDC) and all stakeholders to develop a unified training curriculum for direct support staff, and with the public schools to develop curriculum for youth interested in direct support work. Within 1 year, the Mayor should fund the UDC training program and MRDDA should establish basic, minimum training standards for all professionals. 3. Within 180 days, MRDDA case management should adopt a person-centered, culturally competent, advocacy- and strengths-based approach. MRDDA should maintain continuity of case managers as long as the customer is satisfied, establish flexible work hours for evening and weekend visits with consumers, set minimum training standards, and revise staff qualifications and performance expectations to reflect the new approach. 4. Within 1 year, the Mayor should amend the D.C. Public School Nurse Assignment Act of 1987 to require that all public and public charter schools have a full-time nurse. Policy/Legislation

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1. The MRDDA Management Advisory Council should convene a collaborative process inclusive of all stakeholders to rewrite D.C. Law 2-137, the Mentally Retarded Citizens Constitutional Rights and Dignity Act of 1978. Discussion should include addressing the need for a system to serve the full range of developmental disabilities across the lifespan. 2. Within 6 months, the Mayor and Council should approve permanent legislation to provide supports for MRDDA consumers who need help making health-care decisions. 11 Budget 1. MRDDA and partner agencies should aggressively apply for all federal grant opportunities. 2. Mayor Fenty should resolve the FY 2007 MRDDA funding deficit and develop a realistic FY 2008 budget mark for MRDDA. 3. As discussed earlier, MRDDA and MAA should immediately act to maximize use of federal dollars through the expanded use of Medicaid waivers to deliver community services. Efficiencies and Systemic Changes The DDS Work Group refers the critical issues of transportation and government hiring of people with disabilities to the Cross-Disabilities Transition Team for recommendations. Accountability Tools 1. Within 90 days, MRDDA should establish a single hotline for consumers and families to call to resolve problems with MRDDA services including Medicaid- and locally-funded services. 2. Within 90 days, the City Administrator should use CAPStat for a targeted 3-month project to monitor MRDDA, MAA and RSA phone call return rates and customer service ratings. 3. For the FY 2008 budget, implement outcome- and consumer-satisfaction driven performance measures, developed in collaboration with consumers and families, for MRDDA and key MRDDA staff (particularly case managers) and for MAA. 4. Within 1 year, the interagency task force should develop and implement an outcome- and consumer-based evaluation system for all developmental disability services. Aggregate data on outcomes and consumer evaluations, by provider, should be readily publicly available (on the internet etc.) and should be linked to contract evaluations and renewal. Boards and Commissions Work with the Developmental Disabilities Council to identify ways to maximize the alreadyeffective involvement of the Council in consumer needs assessment, satisfaction, and evaluation.

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Emergency Act 16-480 is currently in place; Temporary Act 16-486 will expire in approximately October, 2007.

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Juvenile Rehabilitation Work Group Vision Statement The vision of the Juvenile Justice Rehabilitation Workgroup is for the District of Columbia to be the national leader in supporting young people successfully transition to becoming productive citizens. This vision is actualized when the following exists: 1) accountable, transparent and forward-thinking leadership; 2) youth, their families, and community are actively engaged in decision making process 3) ownership for justice, care and integrity is shared by all. Background The Juvenile Rehabilitation system has been under court supervision over the last several years. In order to ensure continued progress, the following are required: I. Building an Integrated System of Care and Support; II. Creating Internal and External Capacity within DYRS and Community; and III. Requiring Communication between DYRS, youth, their families, community-based providers and the community. I. Building an Integrated System of Care and Support

Problem Statement: Young people need to be holistically and positively re-integrated into community. Recommendations 1. DYRS must develop a continuum of care for juvenile justice youth and their families. (3 months). Benefits: Eliminates gaps and duplication of services, saves on spending; common approach by agencies working with youth and their families; understanding of terms and implementation; requires seamless services/programming/accountability. 2. Assign DYRS (LISW) social worker in New Community sites. (6 months). Benefits: DYRS support positioned in community; build continuum of support with family case management teams located in New Communities; enhances opportunities for holistic approach to working with youth, family and overall community. 3. Where possible, DYRS and case management services at the New Community sites will blend funding. (6 months). Benefits: Expands range of funding resources available to customize support for young person/family; requires agencies to collaborate and coordinate services. 4. Decentralize and place DYRS Social Workers within at least 3 schools that do not have CSS licensed Social workers and 3 DPR Recreation Centers. Wherever co-locations occur, cross-training will be required among key staff. (3 months).

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Benefits: Improve access to young person; improve understanding of young persons whole life; visibility in community; increased coordination of services; identification of new, additional services. 5. DYRS establish a Best Practice Team comprised of youth, families, community-based providers, and the community through a self identification process to research the best practices in the District. DYRS will publish and use this information to design support for young people. (3 months). Identify Best Practices in the District that are not being funded. 6. DYRS establish a Best Practice Team to include representatives from youth, families, community-based providers and DYRS on researching best practice infrastructure to design comprehensive youth development oriented rehabilitation support for young people in the juvenile rehabilitation system. (6 months). Benefits: Technological infrastructure: Multi-Agency Planning; Identify Best Practices that will provide foundation for development of young people. 7. DYRS implement the Youth and Family Team Meeting model and require the participation of youth and their family, community-based providers, DYRS staff and the community prior to their release. (3 months). Benefits: Deeper understanding of family context in which young person is returning; ensures a holistic approach to working with young person; and increased accountability communication and coordination of services by all parties. 8. Establish a Family Support Network to support the young people in the DYRS system. (3 months). Benefits: Family system receiving support while young person is detained; increases referrals for support and accountability; intentional steps toward preparing for young persons return home. 9. Build incentives to encourage carrying of double / multiple jackets when appropriate and to dissuade closing cases when one or more agencies are involved. (3 months). Benefits: Ensures the comprehensive coordination of services; advocates for building holistic systems of support by the use of blended funding that will address unique assets and needs of the young person and their family. Expand resources to educational/vocational/work-ready programs. Enforce stronger relationship and coordination with DOES, Workforce Development Council, DCPS and charter schools. (First year). Benefits: Young people will successfully transition into educational/vocational and work ready programs to ensure economic self-sufficiency and career development. 11. Develop a young fathers/mothers initiative to support young people as they reconnect with their children; learn parenting skills; receive counseling, case management services to foster healthy parenting. (6 months).

10.

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Benefits: Prepare young people with parenting skills; provide emotional support process to assist with new parental role and responsibilities; young men will receive specific training in child support laws and requirements. 12. Develop MOU with reputable independent agency to map the Districts juvenile justice system and to make specific recommendations on fostering improved sharing of information and coordination of services between DYRS and Court Social Services. (First year) Benefits: Clarify the roles of authority between federal/local agencies; identify potential for expanding resources/referral process; establish clear understanding of number young people involved in overall system. 13. Review procurement process to ensure contract requirements, agreements and payment schedules. Build agreed upon timelines, accountability and protocol. (6 months). Benefits: Foster improved services; promotes non retaliatory communication that leads to mistrust between parties. 14. Ensure current DYRS group homes (that have been licensed under CFSA) are licensed. (3 months). Benefits: Improve services; eliminate mistrust between partners. 15. Implement comprehensive review of interagency referrals especially those concerning DMH and AAPRA, to determine if social workers are making appropriate and timely referrals. (3 months). Benefits: Youth will take advantage of resources that are needed and underutilized. 16. DYRS and other child serving agencies must develop and adopt a common definition of Family Centered Practice. The definition will recognize the following: that healthy strong families are the key to success for children of all ages, and that all systems must work together seamlessly to give parents and other custodial guardians the skills and resources to provide their children a safe and nurturing environment to meet their full potential. (3 months). Benefits: A common approach to working with families, a platform for cross agency staff development, better capacity to identify resources to support families and recognize gaps in the existing network, more skilled families that are better able to provide direction and guidance for their children. II. Creating Internal and External Capacity within DYRS and Community

Problem Statement: Young people are not fully benefiting from their interactions with DYRS staff due to the lack of professional development and trainings opportunities at DYRS. Recommendations 1. Implement individualized professional development plans/goals for all full time DYRS staff; must complete at least 50 hours training per year. Require trainings in Positive

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Youth Development; Substance Abuse/Mental Health Assessment; Family Team Meetings; Cultural Awareness; Family Development, etc. Require cross-training with DYRS staff and DYRS contractors. (First Year). Benefits: Increased competencies among workers; better understanding of the range of needs/supports/interests of young person in order to more effectively identify potential resources and referrals. 2. Bring DYRS into compliance with the Language Access Act. (3 months) Benefits: All youth and families have access to important information and relationships that will impact their overall progress through the system. 3. DYRS will evaluate effectiveness of all current community-based programs and services. (3 months). Benefits: To ensure continuity and sustain effective programs and take steps to eliminate those not working to improve lives of young people. III. Requiring communication between DYRS, youth, their families, community- based providers and the community

Problem Statement: The DYRS philosophy and vision guiding the juvenile rehabilitation system is not understood by its staff and the community. Recommendations: 1. Develop and implement a comprehensive public relations strategy that will educate and promote the vision and outcomes of DYRS. (3 months). Involve youth advocates to represent their interest of young people. DYRS senior staff will convene at least quarterly community forums in each ward to respond to and engage the community in building a community-based support network for young people. DYRS will convene and host monthly meetings with youth serving organization, youth leadership groups and contractors. Establish Ombudsman with DYRS to provide objective forum for youth, parents, contractors to express concerns and questions. Capacity to perform administrative review of contract disputes. (6 months). Benefits: Build positive, transparent relationship/culture between DYRS and community; youth leadership groups in particular; assists youth leadership groups in understanding system and how to proactively advise young people.

2. 3.

4.

5.

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FAMILY SUPPORTS WORKING GROUP A few common themes wove their way through all of our conversations about Family Supports over the past few weeks both online and offline. 1 The District has one of the strongest economies in the nation alongside one of the worst poverty rates in the nation. Economic gains have not trickled down. There needs to be a renewed focus on ensuring that the citys poorest residents are enabled to participate in the strong economy. The way to enable poor residents is to get those who are disconnected from the workforce prepared for work and working steadily, and to get those who are working on a career path to which they can devote themselves long-term. While the District has done a good job of providing income supports (with one of the most expansive Earned Income Tax Credits and one of the highest food stamp participation rates in the country), affirmative programs that move people from poverty to work are lacking. There is no person/body responsible for connecting the hardest-to-serve residents those with low literacy, education, and other skills, coupled with the need for work supports that range from child care to mental health and addiction counseling to jobs they can get, keep, and translate to a career track. Moreover, resources like full-scale employment services and community college-level education have not been brought to bear for this population. Because District agencies often operate as silos, it is difficult to connect hard -to-serve residents to all of the supports they need to make progress. The District needs one person/body that will bridge the gaps. Moreover, while families are moving into work and toward self-sufficiency, the District needs to ensure that its public benefits and other supports cover basic needs.

The Family Supports workgroup focused on three areas 1) Income Supports; 2) Building Healthy Families; and 3) Food Security. A number of recommendations are made that can be accomplished in 3, 6, and 12 month timeframes. A few deserve to be highlighted. They reflect those main themes echoed over the weeks and are essential to progress. The new administration should: Create a high-level person/body (possibly a workforce development czar, similar to the Virginia model) to coordinate moving to work activities. (High -level because agencies have to be responsive to this person/body). Appoint members to the Commission on Poverty (authorized in 2006) and charge them with making recommendations toward the goal of reducing poverty by five percentage points for the population as a whole and by 10 percentage points for children over the next five years. Make the Mayor the face of the Earned Income Tax Credit campaign to help reach the more than 10,000 residents who are eligible but do not claim the credit. Make access to fresh food a health issue and make someone responsible for attracting grocery retail to currently underserved areas of the city. 1) Income Supports TANF, Child Support, Emergency Assistance, Interim Disability Assistance, Earned Income Tax Credit, and Opportunity Accounts Background. The District is one of the most effective jurisdictions in the country in terms of reaching residents who are eligible for TANF and other income supports. Most of these

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federally-funded programs, however, simply do not provide enough support to families who are either working toward self-sufficiency or who depend solely on benefits because they are elderly or disabled. According to the DC Fiscal Policy Institute, DC is one of only eight jurisdictions where the current TANF benefit is lower than it was in 1990 and that is without adjusting for inflation! Barriers TANF benefits are too low lower than in a majority of states including MD and VA. This is problematic considering DC is one of the costliest places in the country to live. The Child Support Services Division (CSSD) focuses only on enforcement. As a result, noncustodial parents are treated antagonistically and child support is unreliable as an income source for TANF/post-TANF families. Further, CSSD does not serve non-custodial parents (i.e. doesnt connect them to employment or training), thereby not addressing the very issues that cause the parents to be involved in the child support system in the first place. The Opportunity Accounts Program has a problem just getting their funds into the budget. More than 10,000 families who are eligible for the EITC do not claim it. Vision. Although the overall goal is to move families toward self-sufficiency by connecting them with work, thousands of DC families depend on public benefits while they travel that road. Others, like seniors and individuals with disabilities, will likely always depend on some public benefits. Still there are others who work, but in low-wage jobs. Almost 30 percent of DC households earn less than $25,000 per year. While the District generally does a good job with benefits programs, the city could do more. Recommendations Short-Term Increase TANF benefits by 30 percent (to make us consistent with Marylands level) and add an annual cost of living adjustment. Allow a 100 percent pass-through of child support payments. Currently, there is a $150 pass through, but the rest of the payment is used to offset the familys TANF benefit. This is administratively difficult and a disincentive for non-custodial parents to pay child support. A 100 percent pass-through would allow families to keep the entire payments without facing a reduction in TANF benefits, addition to being easier to administer. Fund Opportunity Accounts at $200,000 in the FY 2008 budget. (This is the amount the District had previously guaranteed the program.) Increase funding over time to $2 million to fund additional Opportunity Accounts to support education and job training. (By 2007, the program will have $2 million in federal funding for which a non-federal match is needed.) The mayors office should become more involved in EITC outreach to get more eligible families to claim the credit. The new mayor should become the face of the DC EITC campaign placing his picture on campaign posters/flyers, placing EITC information and links more prominently on dc.gov throughout tax season, funding and appearing in radio and television public service announcements, organizing media events around free tax prep center kickoffs, and creating an incentive program for District government employees to staff free tax prep centers. The mayor should herald DC for having the most expansive EITC in the nation, while promoting the credit to eligible families. Both the Office of Latino Affairs and the Office of Asian and Pacific Islander Affairs should become more involved in the EITC outreach campaign. Language barriers are a big factor in reaching more of the eligible population. The EITC campaign has done much both locally and nationally to expose how Refund Anticipation Loans (and their year-round counterparts, the pay-day loans) exploit low-wage earners and cut into their already low salaries. The mayors office should propose model

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legislation to regulate pay-day loan businesses. The role of the Department of Insurance, Securities, and Banking should be expanded to serve this purpose, or some other entity should be made responsible. Recommendations One Year (or more) Link child support to workforce development. Currently, the CSSD focuses mainly on enforcement, but they should also focus on connecting non-custodial parents to parenting and employment services to help them make child support payments and improve their capacity as caregivers. 2) Building Healthy Families Moving-To-Work activities, Fatherhood Initiative, Home-Based Services, and Marriage Support Services Background. According to the Brookings Institute, there are between 51,000 and 61,000 lowincome residents (below 200 percent of poverty) who could benefit from workforce development services to increase their skills and employment levels. A third are single parents. A third have less than a high school diploma. A third worked only sporadically in the past year, and another 40 percent did not work at all. Some ten percent are disconnected youth, not in school but also not working full-time. Almost 20 percent are seriously disconnected from the workforce, meaning they have not worked in the past five years. Research from both the Brookings Institute and the DC Fiscal Policy Institute indicate that these residents are also highly geographically isolated in the eastern and southeastern portions of the city (wards 7 and 8), which compounds the effects of already high poverty levels. Barriers One of the biggest barriers to the effectiveness of income supports like EITC and Opportunity Accounts is actually getting low-income residents connected to jobs. Directly related to this point is the lack of a viable education and vocational education system to prepare them for those jobs. DOES is mostly responsible for connecting District residents with jobs, but hasnt done a good job of serving residents with major lacks in literacy, education, and skills (TANF recipients, ex-offenders, etc.). DC lacks a true job readiness assessment that would figure out where people should be and place them there. Some residents need more intense services/guidance than others. There are a number of barriers concerning fathers and boys. Fatherhood activities are limited because they have been run on a small pot of federal funding. The funding has been too inadequate to allow programs to reach all of the ex-offenders and other fathers who need the programs. Vision, The District needs to craft a holistic approach toward repairing and building families, particularly those headed by low-wage workers with low literacy, education, and skills. Lowincome residents need to be connected to jobs, but also the education and training that will get them on career tracks. In order to get on that track, however, they often need to be connected to a number of supports that exist across different agencies. Currently, there is no one person/body who connects all of the dots for hard-to-serve residents. Benefits programs (like TANF) are often limited in what they can do with federal funding, and employment/training programs (like a DOES) often are not designed to reach residents with very low literacy and skill levels. The District needs to create a system that bridges the gaps for these residents.

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Recommendations Short-Term Create a high-level person/body (possibly a workforce development czar, similar to the Virginia model) to coordinate moving to work activities. (High -level because agencies have to be responsive to this person/body). Appoint members to the Commission on Poverty (authorized in 2006) and charge them with making recommendations toward the goal of reducing poverty by five percentage points for the population as a whole and by 10 percentage points for children over the next five years. The Commission would focus on moving to work activities, work supports, career counseling, and moving low-wage workers to career ladders, in addition to methods for improving low-wage jobs like raising the minimum wage, providing paid sick leave, and improving First Source. Provide free weekday bus passes to children from families with income below 200 percent of the poverty line attending DC Public Schools and Charter Schools out of boundary. Waive the $75 summer recreation program fee for children from families with income at or below 200 percent of the poverty line. Many low-income families cannot afford $75 for two weeks of activity. (The new administration should also examine waiving fees in all facilities for either TANF children or children in households with income under 200 percent of poverty.) Recommendations Mid-Term Develop a cross-agency plan that connects residents to both the hard and soft skills they need to get and keep jobs. Create an assessment system that determines where residents fall on the spectrum in terms of what kind of services they need whether they are career-track-ready; jobready, but would require additional education/training to get onto a career-track; essentially job-ready but need some soft skills; in need of hard and soft skills, etc. That system would also determine their other needs in terms of benefits and health and human services. Embed fatherhood initiatives in re-entry programs. Structure those initiatives so that they deal holistically with the ex-offender and his family, considering their need for parenting skills, mental health assistance and help dealing with anger issues/domestic violence, assistance navigating the child support system, mediation services, and literacy and job training/placement. The new infusion of HHS dollars into fatherhood activities should result in approximately 25 new organizations doing this work. Some of those new organizations should be encouraged to embed in re-entry programs. Recommendations One Year (or more) Create a no-failure experience at one-stop centers. Everyone who comes into a one-stop, regardless of literacy, education, skill level, or experience, should leave connected to education, training, and/or a job. Create a similar no-failure experience at agencies, so wherever clients enter they get served or get quickly to the right place. (This could involve reviving the Districts General Social Services program, defunded some 10 years ago, which employed skilled social workers who acted as the first point of contact for residents, guiding them to the services that they needed. These social workers did not keep cases, but generally provided more guidance than simply providing a referral.) Create community schooling in which the schools also become a focal point for providing services to people in the community connecting them to employment and training, but also to other human services.

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3)

Food Security Food Stamps, WIC, and Free/Reduced School Breakfast/Lunch

Background. While the Districts Food Stamp Program has one of the highest participation rates in the country, serving almost 90,000 individuals with an average monthly household benefit of close to $200, almost 70,000 residents (including 35,000 children) live on the edge of hunger according to DC Hunger Solutions. While the Food Stamp Program can make some improvements in areas like reaching out to seniors and immigrants, the largely lingering issue appears to be access to healthy food. For example, in a recent report DC Hunger Solutions states that while wards 2 and 3 have one supermarket for every 12,000 residents, wards 7 and 8 have one supermarket for every 70,000 residents; and in fact, ward 8 currently has no supermarket at all (though there are plans for one in the near future). The District is also underserved by alternatives to supermarkets grocery co-ops, farmers markets, and community gardens. Lack of access to fresh healthy food has led to above average rates of obesity, diabetes, and hypertension in underserved areas. Obesity rates averaged 34 and 32 percent respectively in wards 7 and 8 compared to 17 and 8 percent respectively in wards 2 and 3. Barriers All charter schools do not participate in School Breakfast, which could be covered by federal funds if the schools would agree to participate and serve meals that meet federal nutrition requirements. Seniors tend not to participate in the Food Stamp program because their federally-set benefit level is so low. The lowest income areas of the city are underserved by grocery stores. Residents have to travel long distances by public transportation or at great expense by hired transport to reach grocery stores in other parts of the city. Farmers markets, which could provide fresh food in low-income areas face numerous regulatory and other difficulties starting up. Vision. The District should recognize access to healthy food as a health issue and should be proactive in connecting low-income families (particularly those who reside in Wards 7 and 8) to fresh foods. Recommendations Short-Term Create a more specific mandate for the Mayors Commission on Food and Nutrition. Currently the Commission monitors nutrition programs in the Office of Aging, State Education Office, Department of Health, and the Department of Human Services. The Commission needs to be given the power to make changes in poorly-performing programs, not just monitor them. Locally fund an increase in SSI to benefit seniors and the disabled, who tend not to participate in the Food Stamp program because their benefit level is so low. Raise the income eligibility level of the Senior Farmers Market Nutrition Program to match federal law and improve outreach, accountability and transparency in the WIC and Senior FMNP voucher program. Mandate school breakfast for charter schools. Recommendations Mid-Term Decouple supermarket development from the retail/economic development track altogether and give oversight to someone in the Mayors office (perhaps a new position in the Office of Planning). This person should be responsible for bringing new food retailers into the District,

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and coordinating with DOH and DCRA to determine how that happens and where the markets locate. The Department of Health and the Department of Consumer and Regulatory Affairs should be involved in attracting supermarkets and determining where they should be in the city. Improve the phone and mail applications for food stamps. Target food stamp outreach to seniors and immigrants, creating materials that advise them on accessing and maximizing the benefits of the program. Increase cultural competency of front-line food stamp division staff and improve overall customer service by requiring competency and service trainings, hiring more bilingual staff, decreasing case management ratios, and making offices less depressing. Streamline the permitting and licensing process for farmers markets and ensure that they have the technology to accept food stamps.

Recommendations One Year (or more) Create a task force on food access, which could look at short- and long-term ways to improve access to healthy food in low-income communities. Increase capacity at small neighborhood stores in underserved areas to transition them into small grocers and allow them to offer fresh fruit/vegetables, dairy products, and other proteins. This could be done through small grants administered by community development organizations. (The citys Department of Housing and Economic Development currently has a similar (competitive grant) model which they use to distribute faade improvement grants.) Set up co-ops in underserved areas (possibly run by nonprofits that could also get TANF funding for the project by training and employing TANF recipients). Develop neighborhood shuttle routes to connect seniors to grocery stores, farmers markets, and health care centers. Conclusion. The District needs to begin to look holistically at what it takes to ensure that lowincome families thrive along with the rest of the city. The city has many resources. It is time to examine how services are delivered and whether the delivery encourages the overall healthy development of families and their children. Attachments 1 DCFPI TANF Report 2 Brookings Workforce Brief 3 Brookings Workforce Presentation 4 Urban Institute Food Stamp Report 5 DC Hunger Solutions Healthy Food Report 6 DC Plan to End Hunger 7 Federal Food Funds Brochure 8 Ed Lazere Workforce Article (Hill Rag) 9 Washington Post Workforce Article 10 DC EJC One Stop Report 11 DCFPI Poverty Report I 12 DCFPI Poverty Report II

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POSITIVE YOUTH DEVELOPMENT WORKING GROUP Vision All young people learn and develop across a range of developmental areas taking into account their cognitive, physical, social, moral, civic and vocational well being and to augment the range of expectations and range of supports offered to young people. To ensure this vision is realized we make the following range of recommendations: Mayor mandates Positive Youth Development philosophy and standards integrated across all government agencies; Office of Youth Development (OYD) fully staffed to perform broad, cross agency support and change; Create mechanism where young people are integrally involved in establishing OYD agenda for the first year of the new Administration and beyond; Policy development; Train and build up Positive Youth Development practice within 9 agencies. Recommendations Mayoral Declaration on Positive Youth Development: Mayor Fenty will announce the establishment of the Office of Youth Development within the Office of the Deputy Mayor for Education and the cross-agency shift to Positive Youth Development philosophy and standards. It is the hope of the Working Group that the OYD will evolve into a cabinet level position during the Fenty Administration. The creation of the OYD would take to scale the great work accumulated over the past few years. Taking the system to scale under the leadership of a dedicated office is the only way to create the sustainable improvements needed to significantly improve the odds for children and youth and their families. The time is right to move Positive Youth Development (PYD) to scale and mandate the integration of PYD philosophy and standards throughout the government. Timeline: First 30 days. Mayor Fenty will set initial example by participating in the DC Best Advanced Youth Development one day training for policy makers and require all senior level positions within the Executive Office of the Mayor, the Office of City Administrator and MPD Chief of Police. Councilmembers will be strongly encouraged to attend. Timeline: First 60 days. Mayor Fenty will deliver First Annual State of the DC Youth speech near the beginning of the summer and to close out school year. Timeline: Late June/early July Benefits: Public declaration positions the Mayor as lead advocate for systemic and communitywide shift to value young people for who they are and affirm their interests, passions and dreams; transform system to an asset based, positive youth development model. Strong message to agencies that change to new model is real and overall effective; improving outcomes for youth requires fundamental and deep changes in existing institutions and systems; establish commitment to priorities and method on how government will achieve; build consistency and

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continuity throughout systems; every program that touches the life of a young person will be held to core standards; develop shared vision, shared accountability and interconnected change strategies. Office of Youth Development will be fully staffed to perform broad, cross-agency support and change Senior Advisor for Youth Development and Policy position will be elevated within the Office of the Deputy Mayor for Education and provided up to five staff members. Director (senior level) o Policy development function (agenda setting) o Includes outcomes and budget activities o Applying for federal grants and local funding o Practice activities: competencies, training, profile development Deputy directors: o Community liaison for community based organizations o Liaison for public agencies with focus, but not limited to, youth-serving agencies Contracting Research and Evaluation Timeline: Immediately Benefits: Fully staffed OYD will facilitate and manage systemic shift within government agencies to PYD philosophy and support change to PYD based best practices; sustain and expand accomplishments and begin to build accomplishments into the fabric of how government values and engages young people. Create mechanism where young people are integrally involved in establishing OYD agenda for the first year of the new Administration and beyond A 9 member Interim Advisory Group (IAG) will help develop the District's comprehensive, citywide plan for the implementation of goals and objectives that are focused on a common vision for youth that aligns with the city's outcomes. The 9 members will be selected by the Deputy Mayor for Education in consultation with the Director of OYD and PYD Working Group. The IAG will be convened by the Director of the OYD and will consist of (3) senior level staff from DC government youth serving agencies with PYD background; (2) young people; (2) members of the youth advocacy community; and (1) member of the PYD Working Group.

Responsibilities of the Interim Advisory Group will include: Establish process to include DC youth as a part of the development of a city-wide agenda for youth; Develop mechanism in which young people can collaborate with government policy makers and partner with other youth leaders ; Establish process in which permanent/ongoing Advisory Board will be selected in year 2 by including young people in the selection process; Conduct focus groups with youth serving community based organizations in coordination with CYITC and other youth development oriented foundations to assess how to best integrate PYD into their current services; Conduct focus groups with young people in foster care, juvenile justice system, disabilities community; Assist with the planning of the State of DC Youth event in early summer to outline the citys comprehensive vision for youth;

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 Coordinate regular youth town hall meetings to keep youth issues in the forefront; Meet at least three times with youth advocacy groups and youth; Contribute to the development of a Youth Scorecard; Review structures/policy/practices of PYD offices in other jurisdictions; Timeline: To be completed in 6 months. Benefits: Youth involvement in policy decision making process and creation of the OYD; establish OYD infrastructure to ensure dynamic, developmental relationship between OYD and DC young people. Policy Development The OYD will focus on the development of the following budget and policy issues: Develop FY 2008 Childrens Budget Report showing citywide investments in children and youth services and programs by agency and by six citywide goals. Publish Childrens Budget Report as separate document and distribute widely in community to increase awareness of children and youth investments. Complete youth program scan/inventory detailing youth programs and services across all agencies. Services should be categorized by age-target, goal/development outcome area. Scan should also note geographic area served, number of youth served currently vs. total capacity and community based contractors if service not provided directly by agency. Work with interagency summer coordination team to assess outstanding summer programming needs and any pending service gaps caused by lack of FY 2007 TANF bonus funds. If necessary, identify funding for summer programming to be sub-granted by DC Children and Youth Investment Trust Corporation. Revise or include at least one key result measure for two different youth serving agencies in the FY 2008 budget. Suggested agencies: DOES, DPR. Key result measure should reflect positive youth development focused outcome rather than output or deficit focused measure. Establish citywide youth programs grants planning body to monitor and coordinate community based contracts and grants for youth services, analyze resource distribution and identify gaps or unnecessary duplication. This may only require elevating current grants planning committee managed by Justice Grants Administration to include more than criminal justice and juvenile justice grants. Establish formal mechanism for review and feedback of youth policy proposals by DC Youth Advisory Council. Strengthen relationship between DC YAC and Office of Policy and Legislative Affairs, Office of the City Administrator and Deputy Mayors offices. Timeline: To be completed in first year. Benefits: Incorporate PYD philosophy and standards in planning, budgeting and implementation of youth programs throughout government; reshape culture of how to think about, engage and value young people. Train and build up Positive Youth Development practice within 9 agencies In addition to the one-day trainings mentioned above for the Executive Office of the Mayor, other cabinet level officials, and members of the Council of the District of Columbia, 9 agencies have been identified for first year of training in the DC Best Advanced Youth Development. Those

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are: DCPS; DOES; DOH; DPR; CFSA; MPD; DYRS; DCHA; DMH. In order to successfully integrate the PYD philosophy throughout the agency, all levels of senior management and front line staff should participate in the trainings. Four AYD Overview-Briefing for Mayor, cabinet-level staff, agency directors, and Councilmembers up to 30 participants per workshop equals 120 trained. Timeline: First 90 days. Four AYD 15-hour Supervisors Course for agency managers and supervisors of frontline youth workers up to 20 participants per course equals 80 trained. Timeline: First 6 months. Six AYD 30-hour Courses for agency frontline youth workers up to 30 participants per course equals 180 trained. Timeline: To be completed in first year. Benefits: 380 DC government employees ranging from the Mayor, Council Members, Cabinet Level to front line workers completed Advanced Youth Development training; build consistency and continuity throughout systems; every program that touches the life of a young person will be held to core standards; develop shared vision, shared accountability and interconnected change strategies.

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