2009 10-08 Jacks Fogle Testimony Final

Government of the District of Columbia

Department of Human Services

Testimony of

Clarence H. Carter Director

Bill 18-0356: “Jacks-Fogle Family Preservation Case Coordination Authorization Act of 2009” Committee on Human Services Tommy Wells, Chair

Committee on Health David C. Catania, Chair

October 8, 2009

The John A. Wilson Building 1350 Pennsylvania Avenue, N.W. Hearing Room 500 Washington, DC 20004 11:00 a.m.

Good morning Chairmen Wells and Catania and members of the Health and Human Services committees. I am Clarence H. Carter, Director of the Department of Human Services (DHS). I am pleased to present testimony on Bill 18-0356, the “Jacks/ Fogle Family Preservation Case Coordination Authorization Act of 2009,” which Mayor Fenty transmitted to the Council on June 26, 2009.

I’d like to begin by telling you what this legislation is and what it is not. It does represent a cornerstone in the transformation of the District’s social safety net. It is the statutory underpinning that provides the legal framework for sharing health and human services data across the eleven (11) agencies identified in the legislation that collectively comprise the health and human services (HHS) cluster of the executive branch of District government. They are the: Department of Human Services; Department of Health; Department of Mental Health; Department on Disability Services; Department of Youth Rehabilitation Services; Child and Family Services Agency; Office of the State Superintendent of Education; District of Columbia Public Schools; Department of Employment Services; Office on Aging; and Department of Health Care Finance.

In essence this legislation accomplishes the following:

1. It creates a combined data system to allow the sharing of health and human services data for the purpose of improving the coordination, administration, and management of public benefits, services, and supports in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA allows the sharing of protected health information, without consent, between covered and non-covered government agencies that provide public benefits, services, and supports, only when a combined data system is expressly created by statute that will house the protected health information. All information housed in the combined data system will contain all security safeguards required by HIPAA, and all applicable confidentiality statutes of the respective health and human services agencies identified in this legislation.

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2. It creates a Case Coordination Program for the purpose of coordinating public benefits, services and supports of those District clients determined to be in crisis. An individual or family will be considered to be in crisis when there are certain emergency risk factors across several or all of the health and human services agencies.

3. It authorizes the sharing of truancy and immunization data only from school records, which is allowed under the Family Educational Rights and Privacy Act (FERPA) exception without consent, in health and safety emergencies.

4. It imposes disciplinary, civil or criminal penalties for the disclosure or redisclosure of information not authorized by the legislation.

5. It amends applicable local confidentiality statutes that are more restrictive than HIPAA, to authorize the sharing of protected health information in a combined data system in accordance with HIPAA, and to authorize participation in the Case Coordination Program.

It does not replace the statutory responsibilities of any health and human services agency. Rather, it assists in coordinating the services to District clients who are in crisis and are receiving services from several or all of the health and human services agencies.

Next I’d like to focus on the driving force behind this legislation: the tragedy of Brittany Jacks, Tatianna Jacks, N’Kia Fogle, and Aja Fogle, whose bodies were discovered almost twenty months ago. We must never lose our sense of urgency to resolve the systematic deficiencies that prevented those girls from being with us today. The report of the Office of Inspector General (OIG) in follow-up to the Jacks/Fogle tragedy was replete with failures of existing practice and protocol within agencies that could and should have served that family much better. Through the Mayor’s leadership, and with your oversight, agencies, including DHS have made plans to address those failures. 2

In addition to the practice failures, the OIG report cried out for a better coordination of efforts. I quote from the report, “Multiple entities worked effectively, but largely obliviously to each others efforts to put in place many of the elements necessary for the family to sustain itself. Yet no single organization seemingly had the full perspective necessary to see and follow the family’s progress, and intervene when these elements of self-sufficiency began to destabilize. Our analysis of the totality of actions in this case results in a single overarching finding: segments of the District’s loosely connected social help network function individually, often with significant success; however, when the segments act in isolation, unable to coordinate effectively with the efforts of other helping hands and unaware of the necessity to do so, the effects of errors and omissions are amplified.”

It is the coordination of information and effort that permeates the OIG report that this legislation attempts to address.

DHS has worked diligently this past year to frame what a case coordination system would look like and how it would operate. We have done extensive development and modeling on:

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How health and human services agencies identify risk factors;

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How potential clients of case coordination services are engaged;

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Who has access to what level of information;

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How agency teams will coordinate efforts;

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How cross agency disputes are resolved;

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What constitutes discharge from case coordination;

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What each health and human services agency will consider to be an emergency situation;

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How each existing health and human services data system is constructed, what is required to become HIPPA compliant, and how will each existing

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health and human services data system relate to or be connected to the combined data system; •

What will be included in the required HIPAA training for system users, who will be required to receive the training, how often and when; and

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What firewalls need to be developed, in accordance with applicable confidentiality statutes.

The legislation calls for a strategic plan and regulations where these and other details will be further refined and formalized.

The training of the case coordination team is another important aspect of this initiative that will be addressed in the plan and regulations. I have been reviewing a proposed training regime which is the most cross-functional I have seen in my 18 years in government administration.

When this training is completed, the case coordination team will have a unique understanding of the District’s human services cluster and how each agency is a part of the complex puzzle of a whole and healthy District of Columbia. The development of the training has been informed by an analysis of the case management functions of every cluster agency. I am confident that upon completion, this group of people will have the most expansive view of the functioning of the health and human services agencies of any employee of District government. This team will become the centerpiece of our efforts to remake the cluster agencies into a multi-disciplinary team for the wellbeing of the residents of the District.

You have heard from other presenters today about how what we propose here is on the leading edge of human services efforts nationally to reform a system that takes a vertical or siloed approach to the horizontal issue of human well-being.

Chairman Wells I have testified before you a number of times and made reference to transforming DHS into an agency that takes a person-centric approach to the delivery of 4

human services. Person-centric means that the needs of the individual or family supersede any individual benefit, program, or agency. Person-centric means our success is measured by the degree to which our collective intervention enhanced the well-being and self-sufficiency of those we served as opposed to whether we delivered a unit of service. This legislation is an important step in that transformation as it recognizes the fact that many of those we serve are in need of intervention that crosses any number of our individual agency purviews and lays the foundation for District human services agencies to collectively serve the whole family or individual and not simply administer a singular, benefit good or service. To be person-centric, this new statutory construct is essential.

I’d like to focus the balance of my testimony on sharing the broader context of the proposed legislation in an overall transformation of DHS and the human services cluster.

While this legislation is significant, it represents only a small portion of the change in business processes and acquisition of new tools we need to better serve the residents of the District. Soon, we will submit a Planning Advanced Planning Document (PAPD) to the Food and Nutrition Service (FNS), Center for Medicaid Services (CMS), and the Administration for Children and Families (ACF) detailing our launch of a planning process for an entire system transformation and requesting the funding participation. The document sets forth a sweeping vision of new business processes that will transform the cluster agencies from “single purpose entities to a multi-disciplinary team for the wellbeing of District residents”. In addition the document requests support for an integrated enterprise technological infrastructure that allows for data sharing and reduces waste and redundancy in technology tools to serve the needs of the cluster.

Another part of this work is building the best body of research and then acquiring the tools to build the capacity of as many of our residents as possible. It is our objective to come out on the other side of this transformation as a team of agencies that provides appropriate safety net support for those that need it in a collaborative way, but with an equal emphasis of a ‘hair on fire’ sense of urgency from the moment an individual or 5

family presents to grow their capacity beyond the presenting circumstances. Our goal is to foster the greatest level of individual freedom possible for all we serve.

We do not enter into this effort alone - we have engaged the nation’s human services community in this transformative effort. No less than thirty (30) of my colleagues from all across the country at the state and local level have joined an advisory board to guide this effort. In fact a number of those individuals will monitor the broadcast of this hearing to gain insights on how our legislative body wrestles with this key issue of data sharing. They see the work we are undertaking as a way to transform our system from within. Each brings with them a rich history of experiences of the challenges of the administration of a number of single-purpose interventions with different rules, objectives and categorical funding. In addition to the human services chief executive officers, we have also formulated a national group of government technologist and lawyers that will help to guide our steps. We often take our cues in the District from what our sister cities across the country are doing. This time we are leading the pack.

We have worked closely with the advocate and partner community to explain the genesis and intent of the legislation; I personally have spent more than 10 (ten) hours in discussion with several of our community-based support organizations. While it is fair to say that many of our partners are concerned and skeptical about a number of aspects of the legislation, I am fortified by the fact that we have formed the foundation of a rich dialogue that will carry over into the rule-making and policy formulation portion that will ultimately result in a collaborative execution of the legislation.

Chairman Wells and Chairman Catania, each of us is serving at a time when more and more of our youth and families are at-risk of falling through the safety net. In considering this legislation and its potential impact, we have a decision of whether to accept years of bureaucratic inertia that yields poor outcomes OR provide the tools necessary to raise the standards for performance. This legislation represents an unprecedented opportunity to lead the nation by addressing an unspeakable tragedy with bold innovation and provides the framework to better prevent future unspeakable 6

tragedies. On behalf of the Fenty Administration, the Department of Human Services and the health and human services cluster stands ready to work with Council to refine and execute the Jacks/Fogle case coordination legislation in a way that serves as a lasting positive tribute to four young girls and their families.

I would be pleased to answer any questions.

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