A. Turning The Curve On Access To Health Insurance: LA County Adds 112,000 Children to Medi-Cal Rolls in One Year
In 1997, the Children’s Planning Council, under direction from Los Angeles County Board of Supervisors, convened five broad-based work groups, co-chaired by a public and private sector leader, to develop recommendations to “turn the curve” on five key indicators related to the county’s outcome areas. Over 230 people participated: youth, parents, advocates, all county departments with direct responsibility for services for children and families, school districts, community-based organizations, representatives from various ethnic, faith, geographic and business communities, and many more. Specific recommendations included:
- Increase access to health care for children and youth.
- Create more developmentally appropriate, high-quality, subsidized child care services.
- Encourage service to, with, and by youth
- Make youth work-force ready.
- Establish secure neighborhood sites for youth and families, and safe passage.
- Conduct a public education campaign to highlight positive messages about children and youth
- Track progress on these initiatives.
Starting with health care, they set a goal of enrolling an additional 100,000 eligible children and youth in Medi-Cal (Medicaid) within a year. The directors of the Departments of Public Services, Health Services, Children and Family Services, and Mental Health, and the county’s Chief Administrative Officer were to work with the schools, private health care and community-based organizations, religious and neighborhood groups to achieve these goals.
The plan galvanized county agencies and the schools. The county convened focus groups throughout the county to learn about barriers to enrollment in health insurance. Social services, health and school staff received advanced training in culturally competent customer service techniques. Eligibility workers were out-stationed in schools and community organizations to enroll families in health insurance programs. Community based organizations were funded to assess neighborhood needs and target populations. Parks, libraries, schools and the probation department participated in a massive public health education campaign. Within a year, 112,000 additional children had insurance.
Important lessons were learned from the collaborative health insurance effort. The county departments and the Children’s Planning Council recognized that merely initiating joint efforts is not enough–a designated lead agency, formal cross-departmental communication structures or common reporting systems, are critical to successful collaborative efforts. As a result, the County has recently established the Service Integration Branch in the County Administrators Office to establish and oversee inter-departmental systems to enable the departments to work together more effectively.
B. Using County-Wide Outcomes to Re-Design Welfare and Human Services: The Long Term Family Self-Sufficiency Plan
(More information on the Long Term Family Self-Sufficiency Plan is available at the Los Angeles Department of Public Social Services website at www.co.la.ca.us/dpss.
In response to enactment of California’s welfare reform law (CalWORKs) in 199?, Los Angeles County took the opportunity to re-examine their entire human services system, and develop a plan to create a new, integrated system. Los Angeles County wanted a new system which would:
- Focus on positive outcomes.
- Provide services to families as a unit, and
- Strengthen communities
The Board of Supervisors instructed the ‘New Directions Task Force,’ chaired by the Director of the Department of Public Social Services and composed of the county’s Chief Administrative Officer, the Superintendent of the County Office of Education, and directors of the county’s 12 human services department, to develop a five-year Long-Term Family Self-Sufficiency Plan for CalWORKs and working poor populations, with strategies to ‘stabilize families by building their capacity to become self-sustaining.’
The plan was to be structured around the five county-wide outcome areas, considered by the Board to be critical aspects of family self-sufficiency: good health, safety and survival, economic well-being, education and workforce readiness, and social and emotional well-being. The Task Force identified indicators for each outcome area to guide future planning and program decisions, reflect various aspects of long-term family self-sufficiency, and be measurable through currently available or readily generated data. (See pages 13-14 of the Long Term Family Self-Sufficiency Plan) In many cases, the indicators were already included in the Children’s Score Card. Data are disaggregated by race and primary language, and sorted geographically by countywide, Service Planning Area, supervisorial district and community. To the extent possible, the data will be collected for current and former TANF participants, as well as the general population.
Between July and September 1999, five workgroups appointed by the New Directions Task force, composed of representatives of county agencies, service providers, schools, cities, advocates and researchers, were charged with identifying projects and services that could ‘turn the curve’ on the indicators. Each project was required to addresses a clearly documented need; have an adequate evaluation design; not duplicate existing services; be culturally and linguistically sensitive; and not supplant other funding. Desirable project elements included promoting service integration, proven effectiveness, positive long-term impacts, cost effectiveness, and community-level services provision.
Recommendations from the workgroups were synthesized into 59 proposals by county and community representatives. Forty-six combined projects, grouped in eight overarching strategies, were adopted by the Board of Supervisors in November, 1999. All projects are scheduled to be fully implemented within five years. Strategies include: See pages 16 and 92-93 of the Plan.
- Promoting self-sustaining employment
- Ensuring access to health care
- Supporting stable housing
- Helping teens become self-sufficient adults
- Promoting youth literacy
- Curbing violence
- Building strong families
- Integrating the human services delivery system.
The projects range from welfare-to-work strategies and mini-career centers to services for parenting emancipated foster youth, public library services, support groups for parents of teens on probation, health care transportation and emergency assistance to prevent eviction.
By February, 2001, fourteen months after adoption of the Long-Term Family Self-Sufficiency Plan, implementation has begun on nineteen of the 46 projects, and implementation plans for three others have been approved by the Board of Supervisors. By June, 2001, implementation will have started for all projects.
C. Planning and Funding Services for Children 0-5: The Children and Families Commission
(This information is summarized from the Children and Families 2001-2004 Strategic Plan. For more in-depth information, visit their website at www.prop10.org .)
The five countywide outcome areas also undergird the Vision and long-term outcomes of the Children and Families Commission, an independent public-private body established by California’s Proposition 10 to improve the health, wellbeing and school readiness of children 0-5 and their families. This commission will receive approximately $165 million each year from increased tobacco taxes to fund services in Los Angeles County.
According to the Commission’s 2001-2004 Strategic Plan, the outcomes ” embody the Commission’s commitment to develop approaches that cut across organizational, community and population-related boundaries, and strategies that address the needs of the whole child and his or her family.’
School Readiness was designatedas the Commission’s highest priority Outcome Area for fiscal years 2001-2004, in recognition that School Readiness is integrally related to, and will reflect, the other four Outcome Areas. Four indicators will be used to measure progress toward achieving Outcome Area.
- Percentage of Low Birth Weight
- Incidence/Prevalence of Disease and Disability
- Incidence of Family Violence
- Third Grade Reading Scores
The Commission plans to play an active role in Los Angeles on behalf of young children and their families:
As a community partner, the Commission will complement, build and strengthen the efforts and activities of civic leaders, parents, providers, physicians, teachers and other key players to have a greater impact on the lives of children and families;
As a trendsetter and leader, the Commission will be willing to identify, fund and replicate innovative as well as proven solutions to long-standing problems that affect children and families;
As a change agent, the Commission will help mobilize the broader community to advocate for expectant parents, young children and their families, and serve as a voice for disenfranchised members of the community that informs policy-makers and helps parents and families empower themselves;
As a convener and facilitator, the Commission will bring together from various sectors individuals, agencies and organizations with common goals,
As a catalyst, the Commission will promote the sustainability of effective programs for young children and their families.
Contact: Yolie Flores Aguilar
Los Angeles County Children’s Planning Council
500 West Temple Street, Rm. B-26
Los Angeles, CA 90012
(213) 893-0421; Fax (213) 680-1415
Resources : (All available from the Los Angeles Children’s Planning Council or United Way of Greater Los Angeles, 523 West Sixth Street Los Angeles, CA 90014 213/630-2100)
Laying the Groundwork for Change: Los Angeles County’s First Action Plan for Its Children, Youth and Families, February, 1998 (also available on-line atwww.childpc.org)
Profiles of Los Angeles County: Service Planning Area Resources for Children, Youth and Families, 1996 (also available on-line at www.unitedwayla.org)
Ethnic Community Profiles: Planning for a New Los Angeles, December, 1996. (also available at www.unitedwayla.org)