Recent News & Views
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The delivery of human services has been revolutionized over the past 40 years, but in at least two important aspects Massachusetts has lagged—failing to reform the administrative structure of the human services agencies, and retaining too many large institutions for clients who could be better treated in community settings. When the Executive Office of Human Services was formed in the early 1970s, the plan was to streamline and coordinate the disparate configuration of regional and area offices of the human services agencies. While some refinements have been made over the years, today there are 149 area offices spread often randomly across the Commonwealth under the umbrella of the Executive Office of Health and Human Services (EOHHS).
Similarly, four decades ago Massachusetts led the nation in moving clients out of large isolated institutions into community treatment, the policy known as deinstitutionalization. But the Commonwealth now trails many other states with its continued undue reliance on institutions at great expense and with lost opportunities for clients to live in the community.
The current administration deserves credit for taking significant constructive steps in both of these areas.
However, the recommendations in this paper urge more sweeping initiatives. The state is experiencing an unprecedented fiscal crisis which demands urgent action. To the maximum extent, every human services dollar should be spent on care for clients. The analysis in this paper focuses on the seven largest human services agencies within the EOHHS: the Departments of Mental Health (DMH), Public Health (DPH), Transitional Assistance (DTA), Children and Families (DCF, formerly the Department of Social Services), Developmental Services (DDS, formerly the Department of Mental Retardation) and Youth Services (DYS), as well as the Massachusetts Rehabilitation Commission (MRC). MassHealth, the Commonwealth’sMedicaid program, is included in some of our analysis, but does not use area or regional offices or operate institutions.
Recommendations
I. EOHHS should consolidate its 149 individual area offices into 20 to 24 comprehensive EOHHS centers serving consistently defined service delivery areas, which would save approximately $15 million annually and improve services to clients.
II. The Department of Developmental Services and Department of Mental Health should close ten antiquated and expensive institutions, which would reduce an estimated $50 million in expenditures annually and ensure that all clients can live, receive services and participate in their communities near their families.
These changes are necessary to improve the quality of services delivered by EOHHS agencies. Adopting these recommendations would ensure that every possible human services dollar goes to direct service delivery rather than to state infrastructure, administration, real estate costs and energy bills. These savings should be reinvested to maintain the human services that are vital to Massachusetts residents.
What are the human services addressed in this paper?
• Rehabilitative, supportive, vocational and residential services for adults with physical, developmental and mental health disabilities. (DDS and MRC)
• Treatment to promote recovery from serious mental health, substance abuse and chronic or complex medical problems. (DMH and DPH)
• Protection for children who have been abused or neglected. (DCF)
• Rehabilitation for juveniles who engage in delinquent behavior and protection of the community from those juveniles. (DYS)
• A financial safety net for families. (DTA)
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