Evening Exchange; 2338; Health and Social Services in DC

In April of 2004 the D.C. Child and Family Services Agency got a new interim director. In July she became the acting director Brenda Donald Walker has for the past three years been a part of what some consider a major turnaround for the beleaguered agency. Just say the two words Brianna Blackmon and the agency's darkest days spring to mind. Brianna Blackmon being the toddler who was murdered in January 2000 while under the agency's supervision. At that time Child and Family Services was in receivership and Brenda Donna Walker had not yet joined the agency. But Child and Family Services emerge from receivership in 2001 and Brenda Walker who grew up here in the district is part of the agency's ongoing effort both to polish its once tarnished image and more importantly to serve the city's 6000 abused and neglected children and teens. Brenda Donna Walker Walker thank you very much for joining us. Thank you. Explain the interim acting thing in April you enter them in July. You're acting when are you going to be like it. The head honcho.

I'm glad you asked that question because it is confusing for a lot of people. Interim appointment to get basically a caretaker that when another director leaves you have to have someone who is going to be at the helm. And then the mayor and city administrator make a decision if they want to go out and recruit fire there or if they want to appoint the individual interim role. And in July believe it was the mayor asked and felt that I was ready and asked if I would be interested in taking it on permanently. And I said yes. The acting stays on until I go before the city council for confirmation so hopefully I'll have an unqualified title since this is a cabinet level agency so in order to be confirmed you have to go before the city council in the city council has to approve the mayor's appointment bad position absolute correct. However when you came in two hours in and one at a time when the agency's image was pretty low down you became a part of a management team that turn that agency around the very many respects got it out of receivership by

2001 would. Well we were very very fortunate to have a lot of support to have the investment from the mayor the city council. Operating under a court ordered that mandated certain things we have to do and I was including bringing in a high level director and we know we had Dr. Livia golden as acting director in creating the management team of which I was a part as chief of staff. We also had a lot of other investments the Congress created the Family Court which is a major milestone in the way that the court interacts with the agency on behalf of children. We have a legal staff now our own legal team. We made a big investment and great strides in our management information system. A lot of child welfare agencies can't track their kids we know or it's effect kids is that all the at all times and we have the ability to look at reports and analyze how we're going about our business. We combined our neglect and abuse systems which before have been split between police and the Family Services Agency.

We created an office of licensing and monitoring and for the first time in 15 years we're actually enforcing licensing standards for our group home facilities. So a lot of really important structural changes as a result of the investment that the district has made in the town and services agency. You were born of water in the blue strip of Columbia. I was actually born in France but I came here when I was four. I have to say this because in the in DC you don't get the claim. Two eyed native Washingtonian as you were born is a slight qualification but I did I came in when I was four and I grew up in Ward 8 from lower Anacostia to Congress Heights and have lived in the district almost all of my life but took a little high when I went to Michigan for a while I went away to Little Rock Arkansas actually and I worked as assistant city manager and really broaden my experience in public service and have covered everything from cable television operations to

finance H.R. and youth programs. Just before going to Child and Family Services with a VC agenda with the ABC again there was a wonderful organization which unfortunately just closed its doors but DC had and that's a nonprofit organization that was designed to really improve the civic infrastructure that kind of. Undergirding Washingtonian life. And there I had a number project that was widespread projects I was vice president for municipal programs and I was instrumental in starting the Center for Excellence in municipal management at George Washington University. The awards of excellence for this are government employees and I also have managed the project that supported the neighborhood collaborative the community based organizations that work in partnership with family services and working with families. I don't want to give the impression that there has been an overnight turnaround of the Child and Family Service Agency. Your work is clearly not done of this point in addition to the ongoing work of dealing with the powers of the Soul Children children and

teens who are under your supervision without stigma. Well you're absolutely right. The agency and any large system doesn't get broken overnight it's years of disinvestment and lack of support in. And we deal of course with families who have lots of issues. So any overhaul of any large system in particular child welfare agencies really takes a good amount of time seven or eight years is typically what has been proving as some other systems across the country get we form. We spend a lot of time in the first three years in making sure that we have enough social workers which is a huge huge accomplishment. When we came into the agency in 2001 our social workers had case loads of 60 and 70 and you know how difficult it is to really pay attention into support and serve families with those large caseload as amazing extra caseload and more social work and let me give you today's number and we're down to an average of seven teen per

casework. Yes and that is close to the standard that the court requires based on on best practices. So with caseload is now down to 17. It's time to really focus on changing the practice the day to day practice their services or services that are provided to the families in. Now it's also time for us to what I'm doing is stepping up the level of accountability. We've got caseload stare around. We provide cars for social workers to go visit their families every social worker and support staff person has a cell phone. We have resources available to serve the families. So now it's time for us to really be able to turn the long term investments and supports into some real outcomes for kids. Child welfare is supposed to be a temporary state for a child where we are here to take care of a child because the child needs protection. We're not we shouldn't be raising children. We should only be protecting them with short periods of time and then stabilizing their families

if we can in they in helping the child to move home or to move into an adoptive home if that's the best course of action want to go back to the caseload issue for a second because it seems to me that while people may argue about who was at fault one of the factors in the Brianna Backman case was that they were dealing with a social worker who had a case and the type of which you were just describing. And it's virtually impossible no matter how conscientious one is for a caseworker to be able to keep track of all of those cases at one time so I wanted to underline the fact that you know gotten the ratio down from 60 to one to now about 17 to one. If do you see as the primary obligation of your agency towards the children of the District of Columbia and has it made a significant difference in what you were able to do by being your own cabinet the agents. Our primary obligation is to keep children safe. It's to protect children and to be able to have children in permanent homes. And you know our

mandate from the federal government is safety permanence and well-being. And they clearly they basic is to keep children safe and be but do to have children in permanent homes of the first order of business is to see if a child can go safely back home if there's something that we can do in partnership with the family to stabilize the family. If there are issues of substance abuse which is a huge issue for us and it's probably the number one factor for having children in the child welfare system there are supports and are you going to talk with Dr. Greg Payne later director of health and we have a partnership with the substance abuse prevention program that is operated in the Department of Health to provide those kinds of treatment services to families. So you want to try to stabilize the housing is an issue. We work in partnership to try to find housing or to help them so there are all sorts of things you can do early on or in the run in to try to have a family stable to talk and go back home.

And let me just interrupt those listening that there are some occasions on which I can visualize you calling up the Director of Health and saying what's going on there you're killing us here. Because of the substance abuse problems running amok in the district I'm being deluged with all kinds of numbers of children to support. I guess those two agencies have to work fairly well. Well they do and actually I was in his office yesterday and it was a it was a much more cordial conversation. So she is just joining us but certainly is not government agencies who create the problem. We are in our responsibility and our mandate is to provide a safety net and to step in when we can. But the issues that confront our families are much much broader than child welfare and health than mental health with whom we also have a partnership. Housing. All of these things come together and I think your earlier question about what is the difference with us being a Cabinet level agency is that now we are part of a constellation of public agencies under the direction of the mayor and the city administrator. And

we're able to sit around the table and figure out where we come together with the families that that we touch are very often the same families. And so we're trying to be smarter more strategic about partnerships so that we can do more on that when it is so much easier when you can can go in on the buy in. Been any of our systems been after bad things have happened and you're trying to make amends and backtracking. So that's the value of being a cabinet agency one of their wins. In other words when you're a cabinet agency you are now in the room at the time. Absolutely you're not just on the Mr. screen you're in the mirror in the city and on the streets is present in the meeting and I was able to make your own point and able to elevate the issues in into work jointly. What are your current priorities. We have a number of priorities when I took the helm identified five investigations. It's a huge area for us and that's our intent that's our front door and I think it's our number one

priority because if you make a good decision early on it affects everything else the same as if you make a bad decision that happens in the life of a child. So investigations adoptions moving the children who have a goal of adoption to try to make sure that they get adopted as quickly as possible and always living with the system. It's actually doing very well we're on target this year we've already had almost 400 adoptions this year which is. Over the number we had last year. We also have a guardianship program for families. We're taking care of children in Maine that want to relinquish the right the parental rights to legal rights. But then the top can still stay with the Guardian we provide support so we have guardianship as well. And where would the hundred and fifty of those so that's a large number when we have 3000 children who are actually in foster care. About a third of them have a bowl of adoptions how to we can get those children adopted into loving homes or with their kinship there. And that's a third of the children that are

no longer have in my system and we can focus more on those who really need our our our help. But I interrupt to do what I say so I have got a list of adoptions licensing as I told you we have licensing standards for our group home facilities for the first time in 15 years. The city now has licensing that increases accountability and safety and also licensing. So we've always had for our. Foster homes and then improving the visits increasing the number of visits back to the caseload. We've got smaller caseload that expect our workers to be out there visiting the children and families on a regular basis and then placements. I'm sorry placement is the other in that. And that's our terminology for finding the foster homes or the appropriate facility for a child when we have to bring a child in the care and the Making sure that we have children in the most appropriate placements we don't want young children in group settings because children do better in particular young children in families so we're constantly looking to increase the number of foster

homes. It's a very important priority for us. Unfortunately women in the media look at this agency we tend to see the numbers we tend to see with the caseload as we tend to see in the number of young people in your career. I guess one of the reasons the Brianna Blackmon incident struck a nerve with so many people is because finally here was a name and here was a face. How do you make for those of us in the community. How do you make those nine kids real whole human being so that you can understand. There are and were there. I think it's a great question and actually it's 6000 kids. Still a large number and we don't want to only face a name for you to see to be that the tragedy. And that's what gets attention unfortunately. And of course we have issues of confidentiality so we can't raise the kids around but we do. We do have children who are available for adoption. And we are hopefully going to be partnering with a major corporation so that we can do a large media campaign that

shows all of our beautiful children who are available for adoption and then we have older children who can consent to speaking out and working with their older children which is my personal passion the older children we have in our system we have quite a few unfortunately. And there are many of them are so talented but they've grown up in the system and they. In their circumstances are not the best but I want to really be able to put to paint a picture of those children and creating opportunities for partnerships with individuals who can sponsor children as they go off to college and stay in touch with them and can do mentorships and internships and so I think we're going to be reaching out more. We have to protect the confidentiality of Children and Families. But I do want to be able to paint the picture and not to just have the public see when there's a tragedy but to know the tremendous opportunities for people to to make a difference in the life of our children.

Are there any new innovative programs on the way but our audience should know about it. We're very excited now about a model that we call family team meetings. Which is a very simple it's a simple concept but it's one most child welfare agencies are at that has traditionally have the agency as the government has told families what we're going to do and what you must do. And now research has shown that it really works better that when people can own their own solutions. So we're working now with families and this is a result of some money we get from the federal government last year a special appropriation and we're starting the family team meetings where we're before any child is actually removed that we bring everybody around the table from that child's family and maybe teachers or people who are involved in the child's life to sit around the table with the professionals and say what's in the best interest of this child. Perhaps an antoh or a grandparent or God can step in. And we have some resources that we could provide to help them out if we need to help retrofit their apartment if they

if the child is handicapped and we need to build a ramp or provide a bay and there are all sorts of services and supports we can provide. We want to do it with the family at the table in the family having a boy so we're very very excited about that some other child welfare agencies have done that and have seen every direction in the number of children coming into care and better outcomes. Is there any area of child welfare or work that is particularly meaningful to you personally. Well let's talk a little bit about the the older children. See it the Child Family Services Agency has about a third of our children who are between 16 and 21. The district is very progressive in that we keep children until 21. Most other systems keep them only until 18. And we have so many children as a result of bad practice years of bad practice where kids were brought into the system and basically in some ways forgotten and it's moved from placement to placement these kids have a lot of issues and one has to start working with these children at

younger age in really ensuring that when they leave if they're not able to go to an adoptive home or back home which we still work on there on those efforts. But if they're not and we know that they're going to be aging out of the system as it's called the 21 we want to go we quit with a college education with a set of skills with connections to support systems and families who can help them just like they help our kids I have a young daughter who is an in our second year in college and a son who's already grown and. And I want for our kids in our system to have the same kind of supports and opportunities that markets have and spending a lot of time with our older children and I'm reaching out for partnerships and creative ways of looking at how we support still. You have grown children. I do I have two grandkids. The. People who would like to become foster parents or about the parents what should they do. Well I'm going to give you the number it is 6 7 to 1 love. And we have this trick it's an urban area so we're very realistic about the requirements

for foster parents. You have to be over 21 but you do not have to be married. We do not have to be at home full time. We have working foster parents. We have training programs and we'll give you the whole litany of what is required but we also have a lot of supports internally so that our foster parents can are capable and support it in being able to take care of the children that we do provide them stipends for the children's care. So we really encourage people to call it 6 7 1. I remember when she had just graduated from college herself. She's got going from above Walker thank you very much for joining. Thank you so much for having me. In 2001 it was the anthrax scare in Washington earlier this year.

In our drinking water and always or so it seems the high infant mortality rate in the D.C. Department of Health is in the news a generally means the news is not good. But what happens on the news is good when the infant mortality rate declines or when the lead levels in the drinking water fall. Sure it gets reported but it's not a lead story not a big deal unless you happen to be the director of the one sitting in the hot seat when the news was all bad. Well the one who will be wiping the sweat off his brow at the conclusion of the next health I says there's likely to be great pain. He is the recently appointed acting director of the D.C. Department of Health. Welcome doctor. Thank you nice to be here. You were a medical doctor and a CPR certified physician certified physician executive. What's that. Well I'm a actually emergency physician by background so I have a lot of health problems there and as a result of experiencing that I decided to do what I could do about them. In one aspect that was going back and getting a master's degree in

administration and then a series of jobs I've had and then joining my Especially Association which is the American College of physician executive he's a physician to do management work that was recently called to the board. And of that group and they are the ones that render the CPE credentials so by a combination of training experience in taking a test and membership you can become a certified physician executive. When Dr. Ivan Walks hold your position and he is a psychologist which is a medical degree there was some. I guess mild criticism from time to time is he was not what people considered a medical doctor who had a medical degree. Is that is that important or is the physician executive part of the administrators part more important if you're heading the department. Yeah I think there's no one clear formula to give an MBA degree I think you're an M.D. and there's no way that you know correct background is going to prepare you for everything I think and in my case I have a lot of experience in the public health in the Veterans Administration here in

Washington. You know large state Medicaid program and then as a physician in a larger urban teaching hospital so my background I think helped prepare me for the worker in the district but there is no right formula. There are different types of backgrounds it could it could work in this job or others like it. As you point about how to turn in the District of Columbia before with the Veterans Administration Hospital Why do you decide you wanted to come back. Well actually I went home a couple years ago I'm actually from Michigan I was back in Detroit at a large health system there. But this opportunity came up it was one that was easy. So yes I'm delighted to have the opportunity from the mayor to have this responsibility and I'm going to take it seriously and give it all my energies and that the chance to work here back in the nation's capital is the most important city in the world working and prepared us working on all things that have been near and dear to me over the years that is working with the under-served and complex populations. Was it was really a golden opportunity and one that I really treasure so I'm excited to be here and

the board getting a fast start in doing the right thing in the district working closely with the community community and certainly those in the neighborhoods to fashion a new Department of Health that's that's responsive and effective and as innovative and shows a measurable results. You know actually one for many years before you got here we were always concerned about two things infant mortality rates and the rates of teenage pregnancy. And both of those rates have declined significantly in the group of Columbia during the course of the past year but you know we're not concerned about those things anymore because once 9/11 happened the threats happened we began to become more and more concerned about emergency preparedness and I guess in this department in the last one that has become a much bigger deal. It's certainly a high priority I mean we're here in Washington D.C. and we all I was here during 9/11 as I'm sure most of your viewers were and I think we take very seriously our world to help protect the nation's capital to be ready in terms of hospital prepared

for a potential attack so we're going to make this a high priority. We have the funding through the Centers for Disease Control CDC in which we have yet to expand and we're going to work closely with the community and with our providers to buy the most effective way to expend those funds and to conduct disaster training in that work with the fire service and yes in the hospitals and provider community to make sure we're ready as we possibly can be here in the district. Now that said that's a priority but certainly we have other other major priorities and I just in my early. Time in the year but nine days and I can tell you it was about how can you develop priorities in such short space. Well I've spent a lot of time before I came in in my in my prior life and I'm excited we got some great staff and the parent help in the mayor's office in the community that I'm working with a number one that we want to make a big effort on outreach and prevention we want to really be out in the community work with the community fairs in mobile vans

get the word out immunization screenings focus on children and elders. Take a look at health literacy and try to promote that you know really get out there in Meet the mayor's goal which is you know outreach and neighborhood activities so that's a that's for first and foremost that feeds close to the second goal which is to provide effective quality. Coordinated healthcare to our citizens which really gets at the goal of help the children neighborhoods and families in name to do this through DC homes project the medical home it's important to have a medical home through our Medicaid Alliance programs. And certainly through focus on you know health outcome measure so they were measurably demonstrating care across the continuum of care as you as you age in all the settings of care you might need. We mentioned preparedness already. Healthy environments another one went to clean air water and safe safe environment there for kids who grow up in. And lastly we want to really make government work a partner where appropriate results data driven decision making measurable results in the

and the like. So those are kind of the broad parameters we're going to work those and develop them or work with our. Poison department to see what that means and to work with the wider community and fleshing that out and refining it and focus in our efforts on the top priorities and showing results. I'm sure before you got here and shortly after you got here somebody probably said don't mention D.C. general because of course you probably have heard about the controversy that was concerning the closing of D.C. General Hospital as a fully service to hospital. But you do have something called DC hero Alliance which is the agency that is supposed to be making sure the uninsured in the District of Columbia get adequate care. Is that one of your own. Absolutely that really falls under that. That's the second major priority group which is really safe effective and quality health care in the linch pin certainly. Through our Medicaid program through the D.C. alliance program we cover about 160000 residents of the district low income residents and we have actually outstanding

criteria were we enroll as many people who possibly can and we're trying to be innovative in Medicaid waivers to bring as much innovation and dollars into the district cover as many people for a broader range of services possible. And that's where the linchpin of our efforts it's most of our budget and most of it is a is a venture with the private sector in that we're financing care we provide some of the care but we're largely a finance or an overseer set the standards and that help with some of the priorities conjunction with them and that's the top locus along with preparedness with the corps of the big nationally over prescription drugs that the department of providing the pharmaceutical Services little we sure do we have a pharmaceutical arm that doesn't make a very good job purchase drugs it at a great price around the department defense schedule and most things which is one of the best rates we cover them. You know certain our Medicaid program as well as the alliance it's a part of health it's increasing part of states and cities budgets because the promise of the costs are going up and so we try to purchaser and working and the access I recked

initiative with others and in terms of being sure we can purchase drugs effectively and provide them as needed. We're also. The HIV AIDS Administration working on a new waiver that would expand our pharmaceutical coverage there as well so it's really an front generator if you have gotten the phone call from the FDA the Food and Drug Administration which did not like the idea that the District of Columbia government had on its website information on how people could import drugs and the United States because the FDA says it considers that activity illegal. I have not gotten that phone call but I want to be by the phone but we're going to try to be in the vanguard of providing the right pharmaceutical at the right price to our population so we'll be in there. You mentioned D.C. homes what is that. Well you see medical homes project actually arose really from that from the private sector in our Primary Care Association and others and then a distinguished person was involved in that and we're going to have you know further discussions with them in upcoming meetings to how

to work with that program and to make it one with our own to have a coordinated integrated safety net for all our citizens very important. Those individuals who are low income who are on Medicaid or in the alliance who are uninsured have a home where they where they know they can get care have a regular provider of care whether it's the Clinic physician or other type of provider so having a medical home and getting regular screenings regular treatment for yourself or your children is a really important important aspect of health as is education hour week and training so that it's a major part of our efforts and now in the future. Despite the existence of the D.C. Health care a lot of people say that they're going to emergency rooms because in the District of Columbia emergency rooms have become the safety net of the hope care system is the only thing you can do to turn that and that's where I think a project like we discussed medical homes is important. As is having a clinic network that's available to people that has the right hours and is

in the right locations. You couple that with the outreach into the community in help where you can help people ahead of the curve I was there doing the prevention or getting the education in there also doing the primary care visits when needed and hopefully by doing that we can avoid costly and expensive hospitalizations where you're away from home where we can avoid unscheduled visits to merge departments and again I'm a musician myself by training so I'm very acquainted with the problem and we're going to through our efforts to do it in a great coordinated system to try to make sure people get care before they get really sick and have to be in the hospital. You didn't mention primary care and it would appear that on the one hand the good news is that the infant mortality rate is down in the District of Columbia on the other hand the bad news is that it's still too high. How if we now follow what it is that works in this primary care or early care prenatal care one of those things.

Yeah there is. Some good news as you mention that the more tell you rate has dropped I think on the order of 30 percent. So over the last decade that said we have a long ways to go I mean our rate for African-Americans is now I think at historical low in the District which is good it's actually down below the national average but it's nowhere near where it should be in under my watch and in terms of the progress of the department think immunizing kids lowering it from mortality rate are going to be number one number two in terms of things we just have to do. We have a large outreach primary care and prevention structure within the department with our partners in the community. We do some great work. We all have the same goal. We all want to be successful and that's one of the areas where I think we're going to make tremendous progress and we're going to focus on it we're just not going to tolerate the high rates in those areas. There is other national measures which I think we're going to take a look at the department. You know with all our stakeholders to see one of the things the department and the community think are the most important will then identify those what would be a

top 10 list. We're going to track them set a baseline and a goal and we're going to we're going to compare ourselves to other like states and situation and we're going to show measurable progress. That's the lynchpin of what we need to do. We all need to be accountable for that. See it through our budget need to be structured that way. My agreement would be structured that way with the mayor and my bosses and then we'll go from there give it heck. You mention education is that the key to continuing to lower the rates. Teenage pregnancy. Yes in our teen pregnancy rates also have gone down substantially over the last decade or so on the order I think 40 percent. We have several programs designed toward teen pregnancy but I think that's an ideal area as you mentioned that can be helped improved by you know aggressive outreach and community based care and then coupling that I think with has become well with other services in services related to access in primary care in general in a good Nutritionism are things that all I think relate and so we want to become one department

that's focused on the individual and all your needs in a matter what the addiction problem if you're seeking primary care if you're pregnant you have some of the similar. Joe Wilson objectives in dealing with the Department of Health do you. You want to get the right team ization do you want to get the right types of screenings as appropriate pap smear or breast exams or breast mammograms if you need care for your kids. Whatever it might be we want to provide it all and of course everybody's concerned about preparedness in a safe healthy environment those type of things are all in common so we're going to view the individual as a patient centered one individual and wrap around our services to meet their needs. And you mentioned HIV AIDS and these specific initiatives. Yes actually we say we've hired a new director Lydia Watts who started the same the same day I did so we're excited to have a welcome Lidia to the district from Chicago and he's going to be an I think an exciting and innovative leader. As I mentioned earlier we do have the Medicaid waiver going for pharmaceuticals who's going to expand coverage

and they're already doing some innovative programs in Ha ha. And we look forward to focusing on that area with the provider community to really make ourselves the model we want to be the model for the country people look to us look to the district to see what we're doing here. I had served on the advisory group a long time ago when I was at the V.A. And so I'm looking forward emphasizing that one of our core areas where we provide service in and want to work and be good good stewards and good luck to you. Thank you nice to be here. Dr. Greg pain is the new acting director of the D.C. Department of Health.