Birth to 3 Program in Dane County

The purpose of this paper is to report on the accomplishments of programs for children with developmental disabilities & their families, funded by the Dane County Human Services Department. It will also describe the current environment within which our programs work, the responses we have made to that environment & the results of our responses. It is the fourth report in a series of regular reports published by LINK, a coalition of Dane County children's service providers. LINK offers this information to families, county officials, taxpayers, & other interested people involved in planning, evaluation, and advocacy on behalf of children with disabilities.

Last year was a year of significant change for our service system. In January 2004, the State of Wisconsin created the Children's Long Term Support (CLTS) waiver program & transferred an existing therapy benefit for children with autism, previously administered directly by the State, to the new county-administered CLTS program. This change brought $5.1 million into Dane County's system to pay for a pre-existing therapy program for a targeted population of children with autism. At the same time, state dollars allocated to the therapy benefit were greatly reduced. The change created an interesting paradox: although the budget for our system more than doubled from $4.3 million in 2003 to $9.3 million in 2004 & although the number of children & average cost per child appear to have increased significantly as a result of this change, services to children and families were actually reduced during 2004.

ACCOMPLISHMENTS
LINK programs work together to meet three broad goals for our system and community:
o Children remain at home with their families
o The Dane County community & its resources welcome & support children with disabilities
o Funding is sufficient to meet the needs of all eligible children

For the past 20 years, the first two goals have been the impetus for significant program planning and development. Since 1983, when 65 Dane County children with disabilities lived in out-of-home placements, our system has maintained its effectiveness at preventing high cost interventions & reducing significantly the number of children with disabilities who live in institutions or foster care to only seven children.

Efforts continue to enable even the most challenging children in our community to remain at home.
+ County-funded programs include effective early and preventative in-home support services, such as Birth to 3 & Respite Care.
+ We aggressively pursue reunification or adoption for children placed out of home.
+ Although many of our services have long waiting lists, we work collaboratively through LINK to identify & respond to families in crisis or children at high risk of out-of-home placement.
+ Short-term help for families on waiting lists as well as increased availability of crisis support for children most at risk of out-of-home placements are also instrumental in relieving and averting crises.

TRENDS IN DANE COUNTY
THAT AFFECT OUR SERVICE SYSTEM
2000-2004

GROWING DEMAND FOR SERVICES:
- While Dane County's population has grown 7.45% since 2000, our service population has grown by 36%.
- Many families of children with disabilities move to Dane County because of its reputation for quality services.
- Increasing numbers of children with autism are being diagnosed at earlier ages &/or are moving to Dane County.
-Increasing numbers of Spanish-speaking families require more bilingual staff and translated materials.
PARTIALLY FUNDED GOVERNMENT MANDATES:
- State-imposed entitlements to Birth to 3 services & in-home autism therapy are inadequately funded but also override all other service priorities, creating long waiting lists for non-mandated but equally important services.
- County Living Wage Initiative mandates important wage increases to entry level direct care staff (14% increase since 2000) without commensurate increases for other agency staff.
LESS MONEY & LESS FLEXIBILITY:
- Annual budget cuts from Dane County (actual reductions in funding &/or failure to provide cost-of-living adjustments)
- Less flexibility to use available funding to meet priority or changing needs
- More unproductive administrative paperwork requirements

SYSTEM RESPONSES:
We have tried, in multiple ways, to lessen the impact on children & families of decreases in public support:
+ We have continued our commitment to & success in preventing out-of-home placement of children.
+ We have increased our fundraising efforts in the private sector in order to provide assistance for families & childrn on waiting lists & to fill gaps created by eroding support from state and county.
+ We have increased collaboration & worked for system efficiencies, developing service models & web-based technology that can provide less intense services to more people.
+ We have made resource allocation decisions that preserve direct services to families at the expense of agency infrastructure.
- We have gutted our operating budgets.
- We make do with outdated technology & inadequate office space.
- Staff compensation is losing ground; we offer less competitive salaries & fewer health benefits to our employees.

RESULTS: A SYSTEM STRETCHED BEYOND ITS CAPACITY
- We are reactive, with little time to plan or be pro-active.
- We are less flexible & less responsive to family or system needs.
- We have less capacity to respond to emergencies.
- Staff morale & energy is flagging.
- It's harder & harder to hire new, good staff.
- Waiting time for basic services such as respite care or after school child care for teens is now at least six years. Familes are not coming off of waiting lists, & many children will age out of eligibility for services before receiving help.
- Children with significant needs for support & intervention are at high risk of ending up in expensive institutional placements.
- Funding limits in the adult service system result in young adults, who were successfully supported at home during childhood, ending up in institutional placements following high school graduation.
- System development is driven by piece-meal state, federal, & local mandates, instead of a rational planning process or resource allocation.

WHAT NEEDS TO HAPPEN NOW:
+Just like any business in Dane County, our programs need annual funding increases that reflect inflationary changes in our expenses. We can't deliver the same or more services each year with the same or less money.
+We need restored flexibility in our funding partnership with Dane County. Too much administrative time is wasted in justifying & approving minor budgetary adjustments. Agencies with a track record of providing high quality services should be trusted to determine the best structure & resource allocation for their programs & should be able to move funding among programs & budget line items as best serves their service objectives.