Publicly Operated Community Services
As persons with developmental disabilities and those with mental illness have increasingly moved from large state institutions to smaller community-based facilities and services, over 40 percent of the states have maintained responsibility and a role in the provision of services in these community-based settings rather than relying solely on the private sector for community services.
As of June 1996, 14 states operate small community-based residential facilities for persons with developmental disabilities — Arizona, Colorado, Connecticut, Louisiana, Massachusetts, Minnesota, Mississippi, Nevada, New Hampshire, New York, Oregon, Rhode Island and Texas.20 Other states, such as New Jersey and Iowa, do not own the community residences, but provide state employees to staff them.
Over 40 percent of the states have maintained responsibility and a role in the provision of services in community-based settings rather than relying solely on the private sector for community services.
It is reported that in 1996, the State Mental Health Authority in these jurisdictions directly operated community-based mental health programs: Arkansas, Connecticut, Delaware, District of Columbia, Kentucky, Louisiana, Maine, Michigan, Missouri, Nevada, New York, North Dakota, Oklahoma, South Carolina and Texas.21
In addition, numerous counties across the country operate services for persons with mental illness and developmental disabilities.
It is AFSCME’s hope that councils and locals faced with the growing trend for community-based care will benefit from the solutions developed by their brothers and sisters over the years — the development of publicly run community-based systems of care. Here are highlights, in alphabetical order, of what some states and counties are doing:
IOWA
It has been more than a year since Glenwood Hospital School, one of the two state-operated MR/DD centers, began a project in which eight to ten state employee residential treatment workers (RTWs) are based in two community “waiver houses.” These houses are rented by the clients with their own funds, with three or four people living in each house. Four or five RTWs work with the clients in each house. (They are in the same job classification as institutional workers.) AFSCME Council 61 members staff these houses and have found that they have flexibility in setting their own schedules.
MASSACHUSETTS
Massachusetts operates group homes with four-eight beds, apartments and some vocational, rehabilitative and day treatment services for individuals with developmental disabilities. Council 93 represents the majority of direct care workers in the residences and a smaller number of “non- or para-professionals” in the supportive services. In March of 1992, Council 93 and the state reached a 3-year agreement called the “Social Unity Agreement.” It provided that 360 of the next 600 community beds would be state-operated. Management initially failed to live up to the agreement and the dispute went to arbitration. Management agreed to settle the case and is expected to establish those 360 beds this year. (See Appendix A.)
It is AFSCME's hope that councils and locals faced with the growing trend for community-based care will benefit from the solutions developed by their brothers and sisters over the years — the development of publicly run community-based systems of care.
MINNESOTA
Today, over 1,000 AFSCME members work in state-operated community services. For individuals with developmental disabilities, the state operates a total of approximately 100 four-bed waiver homes, six-bed ICF/MR homes and some “3-plus-1” waiver homes in community settings. (These residences are intended for three clients, with one bed available for short-term crisis or respite needs.) To answer the need for having beds staffed and ready to go for short-term placements, there are some 4-bed crisis homes in metro counties.
There are also four campus-based 12-bed pods for developmentally disabled individuals who are a danger or whose behaviors make them likely to end up in the court system. Most of these individuals have been out in the community and private-providers found them too challenging. In the 1998 legislative session, the department asked for funding to expand this alternative, called “Minnesota Treatment Options,” from four pods to 12 pods.
“Regional crisis teams” of state employees work out of the RTCs, but are beginning to be freestanding.
NEBRASKA
When it became clear several years ago that state mental health officials intended to close at least 200 beds in the state’s Regional Centers for mental health services, the Nebraska Association of Public Employees(NAPE)/AFSCME went to work to protect the Centers from irresponsible downsizing and to build community and legislative support for state-operated community-based services. (See chapter V for more information) In 1998, Nebraska approved legislation (initiated by NAPE) that should ensure that as resources move from the institutions to the community, state direct-service capacity (including state employees) will also shift. The legislation states the legislature’s intent to maintain Regional Center services at levels that meet demand until such services are available at the community level. Furthermore, it provides for the development and use of state-operated community services. (See Appendix E.)
NEW JERSEY
Like many other states, New Jersey is downsizing its institutions for people with developmental disabilities and referring the clients to community-based programs. In the process, there were no provisions for the employees to follow the work. However, AFSCME Council 1 in collaboration with a parents association, established Vineland Facilities, developmental disabilities community-based treatment services, that would satisfy everyone affected by the state’s downsizing objectives. It satisfied the state’s need to move clients to the community to save money; the consumer advocates and parents were satisfied that their family members were living in home-like settings; and, the union was satisfied because they were able continue representing workers as they moved the community settings. As a result, a system of group homes owned by a parents association, funded by the state and staffed by state employees was established. Vineland Facilities contains 24 group homes and four apartment buildings.
NEW YORK
The state of New York operates one of the largest community-based programs in the country. Over 8,000 state employees, represented by the Cival Service Employee Association(CSEA)AFSCME, have been redeployed from institutions to community settings in the New York service delivery system. Governor Pataki’s 1998-99 proposed budget supports the development of 127 state-operated residential and day opportunities for clients currently residing in developmental centers. The budget also provides for funding of 191 state-operated respite beds and continued funding for 1,200 current state community facilities.
The public sector and its experienced workforce is well equipped and willing to serve those with the most complex needs.
GENESEE COUNTY, NEW YORK
Members of the Genesee County CSEA General Unit/AFSCME staff the Genesee County Mental Health Clinic. As a publicly owned and operated agency, the clinic provides a wide range of critical services in a rural area as the community’s needs dictate: incident debriefings, court ordered evaluations, emergency room and jail evaluations, services to Native American people at the Tonawanda Reservation, outreach and home assessment when deemed necessary, as well as crisis services to the community 24 hours a day. A “Day Opportunity Center” provides quality treatment to individuals on a more intensive level. Case Management and Intensive Case Management Programs provide in-home services to those with the greatest need. As a public agency, no one in need is turned away due to inability to pay.
OHIO
For over a decade, Ohio has had state-operated community services in a joint effort with the state. The Ohio Civil Service Employees Association’s (OCSEA)AFSCME proposed language was included in the 1988 Ohio Mental Health Act which authorized the State to provide community as well as institutional services for the mentally ill. (See Appendix F.)
The State Operated Services (SOS) program has grown from six workers in 1990 to its current roster of over 600 employees. More than 6,300 persons receive SOS services, ranging from intensive community support services to participation in work programs and day camps. There are two basic types of SOS programs: “Stand Alone” and “Side-by-Side.” Stand Alone programs are clinically supervised by SOS supervisors and the SOS program performs administrative and billing functions for the services provided by the program. In Side-by-Side programs, the SOS program staff is clinically supervised by supervisors from the host community agency, which also bills for services provided by SOS staff and retains the revenue. Administrative supervision is provided by the SOS program. For example, former hospital maintenance department staff now in the SOS Maintenance/Apprenticeship Program provide vocational training for clients, while also including them in the daily upkeep and maintenance of buildings in the community.
OREGON
Since 1989, 10 state-operated group homes staffed by Council 75 members have been created to serve “intensive medical” and “intensive behavioral” clients. Three more “medical” group homes and two sex offender homes are slated to be created this year. The state’s Mental Health and Developmental Disabilities Services Division prepared a long-range plan for service provisions for the U.S. Department of Justice and the Oregon Legislature. Under this plan, state officials recognize that some state-operated programs are necessary for the most difficult to serve clients, as well as to assure that sufficient capacity exists to respond to civil commitments or emergency situations.
RHODE ISLAND
Rhode Island provides services to individuals with developmental disabilities through approximately 200 group home facilities. AFSCME Local 1293 (Council 94) members staff approximately 50 of these group homes; the remainder are privately operated. The state also operates three special care facilities, which can accommodate severely handicapped and developmentally disabled individuals, and 10 apartments for the elderly developmentally disabled. In addition to the housing units, the state operates three day sites which offer programs where specialists work with developmentally disabled individuals on a variety of basic functions to aid in their development.
WASHINGTON
The state of Washington has state-operated living alternatives (SOLA) in all regions of the state that had Regional Habilitation Centers. SOLA services are provided in apartments and duplexes. The treatment facilities are known as Tenant Support and Intensive Tenant Support. AFSCME Council 28 members provide 24-hour support and supervision per day in the intensive tenant support programs. SOLA, which began in FY 1990, accounts for 12 percent of the Division of Developmental Disabilities’ non-facility-based community residential expenditures.
FOOTNOTES
- Prouty and Lakin, loc. cit.
- The National Association of State Mental Health Program Directors Research Institute, State Mental Health Agency Program Highlights, November 1996.
