There are few cases in recent memory that sparked as much outrage and as much government study than the Banita Jacks case. The head of the Child and Family Services Agency eventually was let go. The agency continues to struggle with allegations of mismanagement and shoddy care. The Office of the Inspector General produced a brutal 212 page report on the failings in the Jacks case. Of course, a lot of children died under the District’s watch before Banita Jacks made headlines.
It is understandable that Mayor Fenty and the D.C. Council would want to step up and try to strengthen the city’s safety net. Enter the Jacks-Fogle Family Preservation Case Coordination Authorization Act of 2009 [PDF]. The act is currently being debated right now at the Wilson Building.
Essentially, the legislation calls for the development of a centralized database that would track cases involving at-risk youth and troubled families. Another layer of dc.gov eyeballs would be charged with monitoring the database and raising red flags.
You would think that any piece of legislation carrying the words “Jacks-Fogle” would be met with enthusiasm from service providers and politicians. Especially this one. After all, it calls for greater coordination across agencies and adds a layer of oversight—-ideas promoted by just about every department head and the IG’s Jacks report.
That’s not the case here. No matter what is said at today’s hearing, declares one homeless advocate: “This bill is not amendable.”
First problem: the cost. According to CFO Natwar M. Gandhi‘s calculations the first phase of the case-coordination system would cost more than $6 million. According to Gandhi’s memo to Council Chairman Vincent Gray: “The total cost for fully implementing the system in FY2011 through FY2013 would be $9,984,809. Funds are not sufficient to pay for the full implementation.”
According to service providers, it is still unclear how many families would be enrolled in this coordinated program and whether they would only consist of families who volunteer for it. One homeless advocate says that in a recent meeting, Department of Human Services Director Clarence Carter could not answer the most basic questions on this front.
The cost becomes an issue in light of the severe cuts to homeless services currently being debated this week. Providers are up in arms over the cost. While drastic cuts are being levied against shelters, the city wants to spend millions for the creation of a computer widget and another layer of oversight.
Shannon Hall, executive director of the D.C. Behavioral Health Association, believes there’s a more fiscally responsible way of tackling the oversight problems. She writes in an e-mail:
“The Jacks-Fogle bill arises from a misperception: that D.C. Medicaid does not pay for care coordination or preventive services. That is wrong. The District’s Medicaid program pays for therapy to address family problems before they become severe. It pays for most care coordination activities.
The problem is that this Medicaid benefit is only available under fee-for-service Medicaid, not under the various agencies impacted by the Jacks-Fogle bill. Why does this matter?
Eight of the eleven agencies under the Jacks-Fogle bill operate in whole or in part under D.C. Medicaid. If D.C. expanded its existing preventive and care coordination benefits to more populations, these services could be delivered with substantial federal matching funds. Unfortunately, D.C. has been limiting these benefits, rather than expanding them. For example, in June 2008, the Department of Mental Health stopped reimbursing most providers for telephone contacts.
The Jacks-Fogle bill thus spends over $6 million in FY2010 to coordinate care for 60 families; if it were Medicaid-reimbursed, the same amount of local dollars could coordinate care for 240 families.
Rather than create a care coordination function at the Department of Human Services, we would like to see D.C. Council ask the executive to explore the feasibility of restructuring existing Medicaid services under behavioral health prevention and care coordination to reach more families. We believe that, with appropriate planning, expanding these services through Medicaid is more fiscally responsible and sustainable.”
The second issue: the oversight. Oversight would rely on honest and reliable case managers and social workers. The majority of at-risk families are typically monitored by CFSA. Who believes CFSA is capable? “I think CFSA is the weak link in our service chain,” declares one advocate.
There is also a high-level of mistrust of the Department of Human Services and its Director, Clarence Carter. “He’s acting like he’s the first goddamn person to come up with holistic services,” says one advocate of DHS’ Carter. “Like he’s going to establish a national model. If I hear him say it one more time, I’m going to puke.”
It’s hard to imagine Carter going national with anything. Especially in light of the issues facing homeless families. Earlier this week, WaPo columnist Petula Dvorak outlined the problems homeless families face when they try and seek help.
A reliable and responsible intake system is still not even close to a reality in the District whether that’s for homeless families at the Virginia Williams Resource Center or neglected children seeking out CFSA. Over the past year, social workers have complained about CFSA’s hotline workers being unreliable and at times even unhelpful.
Today, during the hearing (which is still going on), Councilmember Michael Brown asked how the city could empower children to speak up about abuse. Brown was met with platitudes from Children’s Law Center about how they could call the CFSA hotline. No one raised the issue of whether or not these kids would be taken seriously.
Remember the 911 call in the Erika Peters triple murder? The 911 operator told police it might just be kids playing on the phone.
Marta Beresin, a staff attorney with the Washington Legal Clinic for the Homeless, sums up the main arguments against Jacks-Fogle in her written testimony submitted today:
“Our broad concerns about the bill include:
1) The bill may have the unintended consequence of discouraging families from seeking assistance from the affected agencies, including DHS’ continuum of care for homeless families;
2) The bill impinges on confidentiality of clients by sharing client information across 11 agencies without requiring consent;
3) The bill would increase the layers of bureaucracy that at-risk families encounter; and
4) The bill would cost more than $6 million in FY10 alone, money which could be better spent on safeguarding children through the provision of adequate shelter and services for highly at risk, homeless families.”
She then invokes the findings by the IG in the Jacks case:
“According to the I.G.’s report, Banita Jacks and her family resided at D.C. General Hypothermia Shelter in the winter of 2005/2006. While there the family was determined to be eligible for the federally-funded Shelter Plus Care permanent supportive housing program. Despite being identified as an at-risk family in need of Shelter Plus Care services, the Jacks family left DC General in April 2009 “for [an] unknown location”. Each April families are bullied into exiting DC General and falsely informed that the shelter will be closing. What if the city’s policy was to ensure that every family that exited this shelter had a safe and stable place to go to? What if the city implemented a policy of connecting every family exiting shelter to six months of follow-up case management services? Would the Jacks tragedy have occurred?”