h_phc_2016a_2016-01-07t09:04:04z1 Hearing Summary

Date: 01/07/2016

09:07 AM -- SMART Government Act Briefing - Department of Human Services



Reggie Bicha, Executive Director, Colorado Department of Human Services (DHS), made introductory remarks and provided three handouts to the committee (Attachments B, C, and D). Director Bicha referred to attachment A throughout his presentation and discussed the organizational structure, oversight responsibilities, and the budget of the department. He told the committee that DHS has service sites throughout the state. Director Bicha discussed the need to update DHS facilities. He listed the strategic priorities of the department, explained that DHS strives to provide every Coloradan with the opportunity to thrive in the community of their choice, achieve economic security through meaningful work, and prepare for education success throughout their lives.



160107 AttachB.pdf160107 AttachC.pdf160107 AttachD.pdf



09:19 AM



The committee discussed the services provided to youth who are in the care of the Division of Youth Corrections (DYC) and that all of the children who serve time in DYC are returned to the community. He explained that DHS has made strides in the areas of engaging family members of a child who is in the care of DYC, working with DYC residents toward obtaining a high school diploma or a GED, and promoting post secondary education. The committee briefly discussed restorative justice practices.



The committee discussed funding and oversight for community center boards (CCB). Director Bicha stated that, in light of a recent audit of a local CCB by the Denver Auditor, he is reviewing the oversight mechanizes that are in place to ensure that CCBs are acting in a fiscally responsible way.



Committee discussion ensued about whether food services workers at the state's regional centers earned a living wage. Discussion also focused on the Grand Junction Regional Center and the recent report highlighting the cost of keeping the campus open. It was noted that there are 25 clients being served at the facility that is designed to house 900 individuals. Director Bicha discussed ways to provide Intermediate Care Facility (ICF) services on the western slope without maintaining a 900 bed facility. The committee then revisited the issue of wages earned by food services employees at the Pueblo Regional Center and discussed issues around involuntary commitments.



09:33 AM



Committee discussion continued about the procedures for administering medications to youth in the care of DYC. Dr. Patrick Fox, Chief Medical Officer for DHS, came to the table to discuss the medication needs of individuals who move between DYC, local law enforcement jurisdictions, and the Colorado Department of Corrections (DOC). He explained that DHS has been working to create uniform formularies that can be accepted across the different systems. Dr. Fox explained that there is no authority to make different systems of care use the same drug formularies, but DHS is working with DOC and the Denver jails to evaluate the feasibility of a shared formulary, as well as exploring a buying cooperative for medication to limit the budgetary impact a single formulary may place on rural law enforcement jurisdictions.



09:39 AM



Director Bicha continued his presentation. He discussed the current status of the implemented recommendations made by the State Auditor, and the Governor's budget request for DHS. He told the committee about DHS' effort to create a Children's Savings Account program for children who are enrolled in the Head Start program. Committee discussion about the provisions of the Children's Savings Accounts followed. Director Bicha told the committee that parents can access the money that they put in their child's savings account for any reason, but they would only be able to access the matching dollars to pay for the child's education. He told the committee that matching funds would be donated to the program by private organizations and foundations, and that parents who save regularly will receive bonuses.



09:52 AM



Committee discussion about the budget decision item "Institute Suicide Mitigation Phase II" followed. Director Bicha stated that this funding is used to updated DHS institutions to prevent residents for harming themselves. He continued his presentation and discussed the federal Child Care Block Grant Reauthorization Act of 2014 and extending ReHire Colorado program.



09:59 AM



Mary Anne Snyder, Director, Office of Early Childhood, joined Director Bicha at the witness table. Director Bicha explained that the role of the Office of Early Childhood is to improve child care, offer training to providers, educated parents about the advantages to high quality child care, and administer the child care assistance program for low-income families who are going to school or working. He explained that the office is working to help providers move up to higher ratings in the quality rating program. Committee discussion focused on efforts to reduce the cost of child care and the study being conducted by Colorado State University to determine what factors are involved in the cost of child care.



10:07 AM



Ms. Snyder told the committee about the Colorado Shines Quality Rating program. She explained that all licensed child care facilities receive a Level 1 rating, and that in order to receive a higher rating, a facility must meet specific criteria. She explained that federal grant money is available to help providers increase their quality rating. The committee discussed wages for child care workers and the fees associated with relicensure.



10:12 AM



Levetta Love, Director, Office of Economic Security, came to the table. Director Bicha explained the assistance programs administered by the Office of Economic Security. He explained that Colorado Works provides cash assistance to needy families and the federal methodology used to determine work participation rates for recipients of Colorado Works benefits. He explained that this formula does not accurately reflect the work participation of recipients in Colorado.



10:20 AM



Ms. Love responded to questions about the process of determining work participation rates. Committee discussion followed about the types of activities that count as work participation. Director Bicha further discussed the federal methodology used to determine work participation rates and the most recent work participation rate in Colorado.



10:27 AM



Director Bicha told the committee that the Refugee Resettlement program administered by DHS is a federal program funded by the federal government.



10:28 AM



Nancy VanDeMark, Ph.D., Director, Office of Behavioral Health, DHS, came to the table. Director Bicha provided an overview of the needs of the behavioral health system in Colorado. He discussed the need for additional behavioral health beds. He highlighted the Crisis Response System which includes the statewide crisis hotline, walk-in crisis stabilization centers, mobile crisis services, and crisis respite. Discussion ensued about the steps taken to train behavioral health providers in suicide management and prevention, the population served by the Crisis Response System, whether the Crisis Response System staff can initiate an mental health M-1 involuntary hold, and accessibility to crisis services. Dr. VanDeMark told the committee that there are 14 crisis stabilization units across the state. Committee discussion then focused on whether law enforcement officials can place individuals in stabilization centers.



10:44 AM



Discussion about funding options for behavioral health services, the use of mental health M-1 involuntary holds in the rural areas of the state, and the lack of beds for individuals who need to be placed on a mental health M-1 involuntary hold followed. Director Bicha responded to concerns about the lack of behavioral health beds available in the state. He explained that DHS is working with the Colorado Hospital Association to alleviate the shortage of behavioral health beds. Further committee discussion focused on the need to increase the number of behavioral health beds.



10:54 AM



Director Bicha discussed the challenges DHS faces with court order competency evaluations. He told the committee that although the courts are ordering more competency assessments, there is not an increase of those being found incompetent. He also stated that DHS had received supplemental funding to hire three new psychologist to conduct competency evaluations of individuals in jails.



11:00 AM



Mark Wester, Director, Office of Community Access and Independence, DHS, came to the table. Director Bicha discussed the following Regional Centers Task Force's recommendations that are specific to DHS: enhancing the transition care coordination and crisis intervention processes, and pursuing consolidation and efficiency opportunities. The committee discussed the possibility of converting regional center facilities in to psychiatric care facilities.



11:09 AM



Director Bicha discussed the difference between the use of background checks and protections for caregivers who work with juveniles and those caregivers who work in facilities for at-risk adults.



11:13 AM



Robert Werthwein, Ph.D., Director, Office of Children, Youth, and Families, DHS, came to the table. Director Bicha discussed the Colorado Child Abuse Reporting Hotline System and the steps taken to reduce the number of children in congregate care. He reviewed the county child welfare workload. He discussed the idea that DHS should be allowed to use funding earmarked for caseworkers to hire other child welfare professionals, such as nurses.



Dr. Werthwein responded to questions about congregate care. Committee discussion continued about workloads for child welfare caseworkers and medical professionals. Dr. Werthwein discussed programs aimed at identifying at-risk families and providing services and supports prior to the occurrence of abuse or neglect. In response to questions from the committee, he explained that all calls reporting abuse to counties and to the state abuse hotline are tracked by the state. The committee discussed the number of children in foster care who also have an Individual Education Plan.



11:29 AM



Dr. Werthwein addressed the Colorado Statewide Youth Development Plan, homelessness among youth populations, and human trafficking concerns.



11:35 AM



Director Bicha discussed the Division of Youth Corrections Medication Management Audit. He explained the department's focus on developing clinical oversight of prescribing practices, a uniform system to strengthen medication administration practices, medical monitoring protocols, and best practices for handling and disposing of controlled substance. He told the committee about the budget request to add 100 new staff to DYC so that the department will be closer to the federally mandated staff-to-client ratio. He expressed his hope that the increased staff will reduce the number of fights and assaults in youth corrections facilities.



Discussion about the department's policy on strip searches and the current one to ten staffing ratio followed.



11:45 AM



The committee continued discussion about the staffing ratio in youth corrections facilities. Director Bicha told the committee that he would provide the committee with statistical information about the types of assaults that occur within DYC.



11:48 AM



Discussion returned to the funding of the congregate care program. Director Bicha discussed foster care provider reimbursement rates.



Discussion about seclusion policies within youth corrections followed. Director Bicha stated that the department has revamped its seclusion policy, and that he will provide the committee with additional statistical data about the number of clients who are placed in seclusion at a later date.



11:55 AM



Committee discussion focused on DYC's policy on isolating youth who are disruptive and threatening others, and the ability for DYC employees to protect themselves against aggressive youth. Director Bicha indicated that federal rules govern the use of seclusion for youth and that he would provide clarification about the federal rules to committee members at a later date.



12:00 PM



Representative Primavera state that no one from the public signed up to provide testimony. The committee recessed.