Cuyahoga County HHSA committee approves foster children, homeless services contracts

The Cuyahoga County Health, Human Services and Aging (HHSA) committee met February 19 to discuss two new contracts, one for the Department of Child and Family Services (DCFS) and another for the Office of Homeless Services. Additionally, the committee heard a presentation from the Western Reserve Land Conservancy.

Children and Family Services

Christine Alexander, from the Cuyahoga County Department of Health and Human Services, on behalf of DCFS, testified to the committee requesting approval for a contract with MetroHealth for $1,067,000. The contract runs from January 1 to December 31, with two optional one-year extensions. Alexander explained that the contract with MetroHealth provides medical services to children in custody of DCFS and their caregivers. From the moment that a child enters foster care, they receive medical services, including a pre-placement physical (also known as triage). After placement, there is also a medical assessment, which includes vision and hearing tests (and must be done within 30 days) and toxicology testing. Children also receive a psychotropic medication consultation or second opinion for children in custody who have previously been prescribed medications for mental/behavioral health issues. Caregivers also receive medical services through MetroHealth, including toxicology testing for the assigned caregivers and other members of the home. Finally, as youth age out of the foster care system, MetroHealth provides connections to health care providers, so individuals can continue to receive health support.

The contract was a result of a Request for Proposals that was issued in April 2019. The county received five responses, and MetroHealth scored the highest. The contract is fully funded by money from the state’s general revenue fund, allocated in the most recent state biennial budget through the State Child Protection Allocation. These funds are designated by the Ohio Administrative Code for the protection of children from abuse, neglect or dependency.

From the moment that a child enters foster care, they receive medical services, including a pre-placement physical (also known as triage).

Councilwoman Shontel Brown wanted to know if the funding for this new contract was the same as the last contract. Alexander said there is a slight increase. Brown also wanted to know who else responded to the RFP. Alexander explained that respondents were given the option to respond to the RFP for all of the services or just for the toxicology testing. MetroHealth and University Hospitals were the only respondents who offered to provide all of the services. Expressive Healthcare Academy, Averhealth, and Forensic Fluids Laboratories responded to the RFP only to provide toxicology services. Of the options, MetroHealth was chosen as the winner to provide all services, including toxicology testing.

Last year, according to Alexander, 3,039 children received a pre-placement physical, and 768 received a post-placement medical assessment through MetroHealth. It was later clarified that while all children receive a post-placement physical, not all go through the MetroHealth system, as some children may have geographic limitations to assess MetroHealth, and so their caregivers may get physicals done elsewhere.

Chairwoman Yvonne Conwell wanted to know why the contract came before the committee so late, considering that the contract was to begin in January. Alexander explained that the contract details were complex and took both the county and MetroHealth’s law departments to iron out key details, even after the RFP was awarded. Conwell also wanted to know where the services would be offered. Alexander said that services would be offered at MetroHealth’s main campus on West 25th Street.

The contract was approved under second reading suspension, which means that the contract will not have to be heard again, and passed to the full council.

Office of Homeless Services

Council also heard a presentation from Ruth Gillett of the Office of Homeless Services (OHS), for a new provider on an existing electronic county data collection and tracking system known as the Homeless Management Information System (HMIS). As mandated by the United States Department of Housing and Urban Development (HUD), Cuyahoga County is responsible for managing the electronic data system, to enter client data into the database, including name, age, race, veteran’s status, HIV/AIDS status and other data points. Much of the data comes from Coordinated Intake, the centralized gateway to homeless services across the county which is typically the “front door” to county homeless services. It’s also known as the “Continuum of Care” (CoC).” This is the first documentation and indication that a particular individual is homeless, according to Gillett. Gillett did note that while the data is valuable to assist the county track outcomes and the homeless population, the provision of individual data from the homeless person is voluntary and clients can decline to have their information entered into the system. Homeless services provider agencies also have the ability to enter data into the HMIS system, so there can be ongoing tracking of outcomes, throughout the continuum of care.

26 percent of citizens who were referred to permanent housing ultimately ended up back in the homeless shelter.

By analyzing this data on a regular basis, according to Gillett, the county can track homeless trends, hold providers accountable, as well as answer questions such as who is being served and who is not being served. For example, 26 percent of citizens who were referred to permanent housing ultimately ended up back in the homeless shelter. Gillett presented the council with the data from 2019, which showed the number of adults served, as well as the number of children under the age of 18 who received services. Most of the people who went through Coordinated Entry, were referred to a homeless shelter.

The data from HMIS can also be cross-referenced with data from other services including if individuals (children or adults) who are homeless are also involved with the criminal justice system or receive TANF or child welfare. According to Gillett, the HMIS system is vital to analyze that data and for the betterment of the entire health and human services system.

Conwell asked what the county learned from the fact that 26 percent of individuals return back into the shelter from permanent housing. Gillett said that she was uncertain of what that data point necessarily meant, and that can be explored, but the HMIS system can alert a homeless services provider that a person has been homeless before.

Asked to explain the history of the HMIS contract, Gillett said that for the past 16 years, the county has used a homeless services software called ServicePoint provided by a parent company called WellSky. The county issued an RFP last year, and the county chose a new vendor called Bitfocus who offers a HMIS software system called Clarity.

Councilwoman Cheryl Stephens wanted more information about Bitfocus, and why it offers a better system. Gillett said that counties are given leeway on which software they use, but that input from homeless services providers on the ease of data entry is equally as important. In this RFP process, several homeless service providers in Cuyahoga County were given the option to evaluate software options from RFP respondents. Gillett wanted to ensure that the county selected a user-friendly, reliable software solution with good customer service. She said that WellSky has struggled with customer service, as they have gone through several acquisitions in recent years, which has affected the overall quality of support. Ultimately, Bitfocus scored the highest and was given the contract. Bitfocus won the contract over WellSky and another RFP respondent, Eccovia.

Gillett also explained some of the details of the $546,560 contract. Approximately 70 percent of the amount will be federal funded by HUD and 30 percent will come from the county’s Health and Human Services levy. HUD approved the first year of the grant, but has not yet approved funding for years two, three, four and five. Those additional years are expected to be approved in the coming months, as funding is allocated to HUD for distribution to local projects.

It is important to note that Cuyahoga County is the first Continuum of Care provider in Ohio to leave WellSky, according to Gillett. Gillett said that Franklin may be the next county to leave. HUD doesn’t endorse any particular software, but each software system must meet minimum federal requirements.

Stephens said that she would like to know about other Bitfocus clients that are the size of Cuyahoga County, particularly those communities with populations that top one million people. Gillett said that she would track down that information.

The contract was moved to the full council under second reading suspension.

The committee meeting concluded with a presentation from Thriving Communities, an initiative of the Western Reserve Land Conservancy.

At the conclusion of the presentation, the meeting was adjourned.