Department of Human Services Performance Audit

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1 Department of Human Services Performance Audit October 2013 Office of the Auditor Audit Services Division City and County of Denver Dennis J. Gallagher Auditor

2 The Auditor of the City and County of Denver is independently elected by the citizens of Denver. He is responsible for examining and evaluating the operations of City agencies for the purpose of ensuring the proper and efficient use of City resources and providing other audit services and information to City Council, the Mayor and the public to improve all aspects of Denver s government. He also chairs the City s Audit Committee. The Audit Committee is chaired by the Auditor and consists of seven members. The Audit Committee assists the Auditor in his oversight responsibilities of the integrity of the City s finances and operations, including the integrity of the City s financial statements. The Audit Committee is structured in a manner that ensures the independent oversight of City operations, thereby enhancing citizen confidence and avoiding any appearance of a conflict of interest. Audit Committee Dennis Gallagher, Chair Maurice Goodgaine Leslie Mitchell Rudolfo Payan Robert Bishop Jeffrey Hart Timothy O Brien, Vice-Chair Audit Staff Audrey Donovan, Deputy Director, CIA, CRMA Dawn Hume, Audit Supervisor, CRMA Emily Owens, Senior Auditor, MPA Sergey Sologub, Senior Auditor, MAcc, MPA, CIA You can obtain copies of this report by contacting us at: Office of the Auditor 201 West Colfax Avenue, Department 705 Denver CO, (720) Fax (720) Or download and view an electronic copy by visiting our website at:

3 City and County of Denver 201 West Colfax Avenue, Department 705 Denver, Colorado FAX Dennis J. Gallagher Auditor Penny May, Manager Department of Human Services City and County of Denver Dear Ms. May: October 17, 2013 Attached is the Auditor s Office Audit Services Division s report of their audit of the Denver Department of Human Services (DHS). The purpose of the audit was to review and assess DHS management and internal control structure regarding customer service delivery and fiscal responsibility. The audit focused on three areas that included gift cards, the DHS call center, and customer service to community stakeholders. Because of records access issues, we were not able to determine whether proper controls exist regarding gift cards. However, based on our review of call center performance data, we were able to identify several areas that need improvement, such as call abandonment and the speed of answering calls. Additionally, the audit indicated a need to improve customer service delivery in areas such as services to adoptive children and their adoptive families, paying providers rates that are comparable to other surrounding counties, and serving youth who are close to aging-out of the human services system. However, the lack of sufficient access to DHS records caused an impairment throughout the audit, preventing a full assessment of the three areas reviewed. It is imperative that the Auditor s Office be granted full access to DHS records for audit purposes, as is granted to us under the City Charter. DHS serves Denver s most vulnerable population, and that population deserves the best services possible. It is therefore vital that DHS fully embrace all aspects of oversight support available to ensure that service levels remain high. The Auditor s Office is perfectly situated to provide that additional support for your invaluable City function. As highlighted in the audit report, other audit functions in counties similar to Denver have been granted the access necessary to provide support for their human services functions. With the increase in child welfare legislation in the last ten years, DHS has had an ever increasing number of requirements with which to comply. With the threat of sequestration, the need for additional oversight resources to help improve agency performance is critical. If you have any questions, please call Kip Memmott, Director of Audit Services, at Sincerely, Dennis J. Gallagher Auditor To promote open, accountable, efficient and effective government by performing impartial reviews and other audit services that provide objective and useful information to improve decision making by management and the people. We will monitor and report on recommendations and progress towards their implementation.

4 DJG/dmh cc: Honorable Michael Hancock, Mayor Honorable Members of City Council Members of Audit Committee Ms. Cary Kennedy, Deputy Mayor, Chief Financial Officer Ms. Janice Sinden, Chief of Staff Ms. Stephanie O Malley, Deputy Chief of Staff Ms. Beth Machann, Controller Mr. Doug Friednash, City Attorney Ms. Janna Young, City Council Executive Staff Director Mr. L. Michael Henry, Staff Director, Board of Ethics To promote open, accountable, efficient and effective government by performing impartial reviews and other audit services that provide objective and useful information to improve decision making by management and the people. We will monitor and report on recommendations and progress towards their implementation.

5 City and County of Denver Dennis J. Gallagher Auditor 201 West Colfax Avenue, Department 705 Denver, Colorado FAX AUDITOR S REPORT We have completed an audit of the Denver Department of Human Services (DHS). The purpose of the audit was to review DHS administrative management and internal control regarding customer service delivery and fiscal responsibility. This performance audit is authorized pursuant to the City and County of Denver Charter, Article V, Part 2, Section 1, General Powers and Duties of Auditor, and was conducted in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a limited basis for our findings and conclusions based on our audit objectives. Our audit work was impaired by limited access to data and the inability to review data prior to redaction to assess the validity of the data used to execute the audit objectives and draw conclusions in accordance with government auditing standards. Consequently, we were not able to provide audit assurance regarding our review of DHS. The audit focused on three DHS operational areas gift cards, the DHS call center, and customer service to community stakeholders. First, our review of the policy and procedure for gift cards, the gift card tracking log, and the gift card inventory results did not provide sufficient data to determine whether DHS has adequate internal controls for gift cards. Second, our review of call center performance data indicated that timeliness and responsiveness can be improved in three areas percent of calls answered within six minutes, call abandonment rate, and average time to answer calls. Finally, DHS could benefit from improved customer service delivery in areas such as services to adoptive children and their adoptive families, paying providers rates that are comparable to other surrounding counties, and youth who are close to aging-out of the human services system. We also found that counties similar to Denver have access to human services records that allows them to complete audit activities in their jurisdictions. Based on DHS management s different interpretation of the same laws, we recommend that the Mayor solicit a legal opinion from the City Attorney and the Colorado State Attorney General regarding what DHS records are confidential for audit purposes. We extend our appreciation to DHS and the personnel who assisted and cooperated with us during the audit. Audit Services Division Kip Memmott, MA, CGAP, CRMA Director of Audit Services To promote open, accountable, efficient and effective government by performing impartial reviews and other audit services that provide objective and useful information to improve decision making by management and the people. We will monitor and report on recommendations and progress towards their implementation.

6 City and County of Denver Office of the Auditor Audit Services Division REPORT HIGHLIGHTS Department of Human Services October 2013 The audit focused on Denver s Department of Human Services (DHS) administrative management and internal controls regarding customer service delivery and fiscal responsibility. Background DHS serves a wide array of Denver s most vulnerable citizens through its assistance, protection, and prevention programs. Most DHS funding comes from state and federal sources, and nearly all DHS programs are state mandated, federally mandated, or both. Oversight of DHS funding is conducted by federal, state, and local entities and thirdparty organizations through a variety of reviews and audits. Purpose & Impairment The purpose of the audit was to review and assess gift card internal controls and management, review the quality of customer service provided by and oversight within the DHS Call Center, and analyze the customer service experience of stakeholders who serve DHS clients. The audit was significantly impaired by limited access to data and the inability to review data prior to redaction in order to assess the validity of the data used to execute the audit objectives. Consequently, we were not able to provide audit assurance regarding the effectiveness, efficiency, and economy of DHS operational areas under review. Highlights DHS is subject to audit scrutiny from state and federal organizations to ensure compliance with rules and regulations and to promote fiscal accountability. However, at the local level, the ability of the Denver Auditor s Office to audit DHS has been hindered by limited access to client-related information. Although the City Charter grants the Auditor s Office access to all City records, DHS management has limited our access to information based on their premise that both state and federal law prohibits it due to confidentiality issues. Although federal and Colorado state law provides access exceptions to organizations engaging in audit work, DHS management upholds that the Auditor's Office does not meet this exception. Based on our research, other counties including one in Colorado have interpreted these laws differently, allowing accountability professionals full access to human services records containing client-related information. Our interview with the Colorado Department of Human Services also indicates that we should be granted access to records. In addition, a U.S. Government Accountability Office audit suggests that when human services organizations refuse access to data, their refusal may be based on legal advice that is overly risk adverse rather than a prohibition of the law. The Auditor is an independent elected official who is responsible for providing oversight through internal audit activities, which promote accountability and transparency in City and County operations. Although the Auditor s Office is a resource that could be used to supplement DHS s ability to improve the efficiency and effectiveness of services provided to Denver s most vulnerable citizens, the restrictions placed on our access to records have prohibited us from doing so. For a complete copy of this report, visit Or Contact the Auditor s Office at

7 TABLE OF CONTENTS INTRODUCTION & BACKGROUND 1 SCOPE 5 OBJECTIVE 5 METHODOLOGY 5 FINDING 7 Auditor s Limited Access to Department of Human Services Records Prohibits Thorough Evaluation of Services Provided to the City s Most Vulnerable Populations 7 RECOMMENDATIONS 19 APPENDICES 20 Appendix A Major Federal Legislation 20 AGENCY RESPONSE 21

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9 INTRODUCTION & BACKGROUND Denver Department of Human Services Provides Assistance to Denver s Most Vulnerable Citizens The Denver Department of Human Services (DHS) serves a wide array of Denver s most vulnerable citizens through their assistance programs, protection and prevention programs, and adoption and foster care services that aim to strengthen individuals, families, and communities. DHS provides services to children and families as well as members of the adult population who cannot provide for themselves. Assistance Programs DHS connects citizens with available public support programs that provide food assistance and financial resources. Some DHS services Child Support Services and Grandparent and Kinship tailor programs to children and families while others target specific groups such as veterans or the disabled. Long-term care, Medicaid and Medicare, housing assistance, and burial assistance are also part of the department s Assistance Programs. Protection and Prevention Programs DHS Protection and Prevention programs serve a wide variety of needs. Not only do the programs provide educational information on detecting and reporting child, adult, and elderly abuse, but DHS also offers housing and financial assistance to individuals or families affected by abuse. The DHS Family Crisis Center provides temporary shelter for children and medical services through collaboration between DHS staff and other supportive professionals, such as therapists and clergy members. Adoption and foster care services Adoption and foster care services for neglected and abused children also fall under the auspices of DHS. Staff work to place children in safe foster environments and guide interested adoptive families through the adoption process. Community programs With the help of community partners and non-profits, DHS participates in other activities to support Denver citizens in need. The Fatherhood Program, GIVE Denver, and Denver s Road Home are just a few of these community-led programs. For example, Denver s Road Home works to provide every homeless person with shelter. 1 DHS works with local nonprofits, faith-based organizations, foundations, businesses, individuals, and other levels of government to operate its programs. Department of Human Services Organization The leadership of DHS consists of a Department Manager, who reports directly to the Mayor, and three Deputy Managers who guide DHS strategic planning, policy 1 GIVE Denver is a donation center that distributes donations to Denver s vulnerable populations children, adults, families, veterans, and homeless that live in poverty. Page 1 Office of the Auditor

10 development and implementation, delivery of services, and coordination with other City agencies as well as other counties and state and federal organizations. Given the sensitive and confidential nature of the human services function, DHS has a dedicated legal resource who directs legal activities on behalf of DHS such as legal representation in court for child welfare matters. Figure 1: Department of Human Services Organization Chart Department of Human Services Legal Director Manager Deputy Manager Assistance Deputy Manager Protection & Prevention Deputy Manager Support Services Family & Adult Assistance Children & Youth Performance Improvement & Accountability Family & Adult Support Drug Strategy Business Management Child Support Family Crisis Center Financial Services Call Center & Employment First Facilities Source: DHS March 1, Seven divisions and offices provide operational, financial, and client program support to DHS. Administrative Division Manages DHS operations and includes the offices of the Manager and the Deputy Managers Child Support and Enforcement Division Provides oversight of child support services and resources Child Welfare Division Provides child protection services and adoption and foster care resources City and County of Denver Page 2

11 Family and Adult Division Provides adult protection services, cash and food assistance, and Medicare and Medicaid assistance to eligible clients Business Management Division Manages contracting services necessary to support DHS programs Financial Services Division Provides financial services and information regarding grant funds, accounts payable and receivable, and payments for foster care and child care Office of Community Impact Collaborates with internal and external partners on behalf of Denver s Road Home, the Office of Drug Strategy, and the Veteran s Services Office The DHS Advisory Board consists of seven members who serve five-year terms and provide additional policy and operational guidance to DHS leadership. The DHS Welfare Reform Board exercises its rule-making authority to spell out DHS s responsibilities related to welfare reform (e.g., Temporary Assistance to Needy Families and the Child Care Assistance Program). The Welfare Reform Board consists of five members with four-year terms appointed by the Mayor. Funding Sources The greatest share of DHS funding comes from state and federal sources, as nearly all of the programs that DHS administers are state mandated, federally mandated, or both. DHS also receives funding from a dedicated local property tax mill levy. This local funding stream is relatively constant while the state and federal funding levels tend to fluctuate every year. DHS uses a special revenue fund to account for proceeds of restricted revenue earmarked for public assistance and welfare activities to aid eligible residents of Denver such as the needy, the disabled, and those in need of energy assistance. The DHS budget for 2013 is $379.1 million with more than half of that amount approximately $231 million allocated by the State of Colorado for clients and service providers. 2 Oversight of Human Services Funds The oversight of DHS funding is conducted by federal, state, and local entities through a variety of reviews and audits, occurring annually or more frequently, to provide assurance that funding is being expended in a responsible, accountable manner as necessary according to program requirements. 3 In addition, periodic external reviews are completed by third-party organizations that advocate for child welfare policy and practice. Federal Oversight The U.S. Department of Health and Human Services performs oversight through a variety of evaluations and audits of federally funded DHS programs. The reviews primarily focus on and assess compliance with program eligibility requirements, grant requirements, and fiscal responsibility. Some reviews include elements that evaluate program quality. In addition, BKD, LLC, the City s external audit 2 City and County of Denver 2013 Budget Book, p See Table 2 and 3 for a complete listing of audit and quality review activities. Page 3 Office of the Auditor

12 firm, is responsible for completing the annual Singe Audit as required by the U.S. Office of Management and Budget. 4 All local governments who expend federal funds are subject to this type of audit oversight. State Oversight The Colorado Department of Human Services (CDHS) conducts a variety of reviews and audits of county human services organizations that administer state human services funds. Reviews and evaluations by the state occur more frequently continuous, monthly, quarterly, and annually than federal reviews. Much like federal oversight, state oversight focuses on compliance with program eligibility, performance, and fiscal responsibility. In addition to CDHS, the Office of the State Auditor also conducts audit activities in 64 counties that are more intermittent or occur at the request of the Colorado legislature. Local Oversight Most of the oversight of DHS at the local level is provided by DHS through self-monitoring. The Performance Improvement and Accountability (PIA) division within DHS assists with oversight and monitoring of DHS operations and programs. The PIA division provides support through quality improvement and compliance reviews, data and performance management, document management, and fraud control and recovery efforts. The PIA division also works with state and federal representatives to support their oversight activities. External Reviews In 2007 DHS invited two third-party organizations the Child Welfare League of America and the Annie E. Casey Foundation to review DHS policies, protocols, and practices related to investigating and intervening in possible incidents of child abuse and neglect. 5 In 2012, DHS sought assistance from the Annie E. Casey Foundation to improve DHS child welfare programs and community support services. Peak Performance Activity Using the Citywide strategic framework put in place by Mayor Michael Hancock, Denver s Peak Performance initiative directs City agencies and departments to prioritize kids and jobs and to improve economic vitality while maintaining sustainability and improving the customer experience. Innovation, strategic planning, increased collaboration and efficiency, and productivity improvements are all hallmarks of Peak Performance. DHS was one of the first City departments to embrace the Peak Performance initiative. DHS s Strategic Plan Update identifies the status and progress of each performance measure associated with its Assistance and Protection and Prevention program goals. In addition, each goal includes three goal-achieving strategies (e.g., cutting edge practice and responsive customer service) with associated performance measures. The Department has also undertaken performance reviews during 2012 to measure its performance for each goal and strategy across the first two quarters of Single Audit Act of 1984, which provides standards for consistency and uniformity among Federal agencies for the audit of states, local governments, and non-profit organizations that expend federal funds. 5 The Child Welfare League of America is a national organization that specializes in child welfare best practices. The Annie E. Casey Foundation is a private charitable organization that is dedicated to improving the future of disadvantaged children in the United States by fostering public policies, human-service reforms, and community supports. City and County of Denver Page 4

13 DHS also participated in Rapid Improvement Events (RIEs) designed to empower staff and utilize their subject matter expertise to increase efficiency and effectiveness. In the fall of 2012, the DHS grant-monitoring and contract-monitoring staff participated in RIEs. Each team identified areas for improvement such as implementing a shared information resource and establishing additional contract monitoring measures. SCOPE The audit focused on DHS administrative management and internal control regarding customer service delivery and fiscal responsibility. The audit was significantly impaired by limited access to data and the inability to review data prior to redaction in order to assess the validity of the data used to execute the audit objectives and draw conclusions in accordance with government auditing standards. Consequently, we were not able to provide audit assurance regarding the effectiveness, efficiency, and economy of DHS operational areas under review. OBJECTIVE Our audit objectives included the following: To review and assess gift card internal controls and management To review the quality of customer service provided by and oversight within the DHS Call Center, the operations of which moved from 311 to DHS beginning in the first quarter of 2013 To analyze the customer service experience of community stakeholders who serve DHS clients METHODOLOGY The audit methodology applied during the audit included the following activities: Interviewing DHS staff and management of DHS divisions regarding the administration and oversight of operations regarding internal control and customer service Interviewing personnel from BKD, LLP regarding their single audit activities of the City s financials to the extent that they might reflect financial concerns about DHS Interviewing CDHS internal audit department staff regarding their audit activities and responsibilities within the state-supervised, county-administered human services programs Interviewing CDHS officials regarding records access for Colorado organizations with audit responsibilities and the process necessary to gain access to records Page 5 Office of the Auditor

14 Interviewing the Colorado Child Protection Ombudsman regarding areas for improvement within human services programs and the Ombudsman s experience with reviews of Colorado counties Interviewing Peak Performance personnel regarding DHS Peak Performance initiatives and implementation of Lean process improvements Reviewing DHS outcomes related to Peak Performance activities and their impact on DHS operations Interviewing DHS staff as well as the DHS representative from the City s Office of Human Resources to learn about the new human resources pilot program at DHS Interviewing several community stakeholders and service providers to gain an understanding of the experience of partners and clients related to DHS delivery of customer service Reviewing policies and procedures related to DHS administrative support functions, finance, and accounting Analyzing access controls for information systems internal and external to DHS Reviewing and analyzing DHS internal gift card reconciliations, gift card tracking logs, and inventory reports to assess internal control of gift card assets Reviewing child welfare compliance reports issued by CDHS for findings related to DHS and the status of recommendations Interviewing the 311 Call Center manager and current DHS Call Center manager regarding the recent change in responsibility and management of the DHS Call Center operations Reviewing and analyzing DHS Call Center performance metrics to determine call center operational efficiency and effectiveness Interviewing seven similar counties San Francisco, CA; Stanislaus, CA; Adams, CO; Anne Arundel, MD; Baltimore, MD; Guilford, NC; and Summit, OH to understand the legal environment regarding records access of other statesupervised and county-administered human services programs. 6 Counties were selected based on similarities with Denver County that include 1) population size, 2) a state-supervised, county-administered human services (or social services) department, and 3) an established county audit office. Obtaining this information allowed us to ascertain to what extent access limitations hindered audit activity. 6 Adams County s audit activity is completed by a contractor who is allowed full access to human services records. City and County of Denver Page 6

15 FINDING Auditor s Limited Access to Department of Human Services Records Prohibits Thorough Evaluation of Services Provided to the City s Most Vulnerable Populations The Denver Department of Human Services (DHS) provides social services for the most vulnerable citizens within the City s population. DHS receives state and federal funds as well as monies from the City s general fund to serve the children, families, and adults who rely on assistance for basic human needs, such as food, health, and housing. Because DHS is a state-supervised and county-administered program, it is subject to audit scrutiny from state and federal organizations to ensure compliance with rules and regulations and promote fiscal accountability. 7 However, at the local level, the ability of the Denver Auditor s Office the City s independent audit agency to audit DHS has been hindered by limited access to client-related information. 8 Although the City Charter grants the Auditor s Office access to all City records, DHS management, acting under the counsel of their representative from the City Attorney s Office, has limited our access to information based on the premise that both state and federal law prohibits it due to confidentiality issues. 9 The Auditor s Office recognizes the importance of confidentiality regarding records that contain client-related information, and the City Charter as well as government auditing standards require the Auditor s Office to maintain the confidentiality of all records reviewed for audit purposes. Many jurisdictions, including the State of Colorado, make exceptions for access to databases or central registries and department records that contain sensitive, personal information when warranted. Specifically, Colorado Revised Statutes, Titles 19 and 26, the Children s Code and the Human Services Code, respectively, regarding records and information, specifically describe who may access records and under what circumstances. The entities allowed access according to , C.R.S., include, but are not limited to, a law enforcement agency, district attorney, county department of social services, private adoption agency including an agency located in another state and a person or organization engaged in a bona fide research or evaluation project or audit. Although the Auditor s Office performs bona fide audit work, we had to work within the boundaries of the legal guidance as interpreted by the City Attorney s Office in its capacity representing DHS. As a result, our audit team was limited in the extent to which 7 DHS is a state-supervised and county-administered program, which means that the state relies on counties to administer human services programs for Colorado citizens. 8 Limited access is defined as the receipt of redacted information rather than complete records. Redacted information does not meet government auditing standards, which require that original data be verified by the auditor. 9 Denver Revised Municipal Code Subtitle B 5.2.1(C)(F) The Auditor shall have access at all times to all of the books, accounts, reports, vouchers, or other records or information maintained by the Manager of Finance or by any other department or agency of the City and County. The Council shall provide by ordinance procedures to require the confidentiality of preliminary audit findings, to require the public dissemination of final audit findings by and through the Audit Committee, and to require response by departments and agencies to audit findings. Page 7 Office of the Auditor

16 we could evaluate elements within the original scope of the audit: gift card internal controls, call center performance, and customer service to community stakeholders. 10 Our interview with an official at the Colorado Department of Human Services (CDHS) as well as our research of local Denver code, Colorado state statutes, and laws governing other like jurisdictions suggest that DHS s interpretation of the legal guidance may be flawed, thus requiring clarification from the City and the State of Colorado. A formal legal opinion from both the City and the state regarding appropriate access of the Auditor s Office to DHS records is necessary to ensure that we can assess whether DHS is providing the appropriate level and quality of services to its clients. Limited Access to DHS Records Hindered a Complete Review of Some DHS Operational Areas During multiple previous attempts, the Auditor s Office has been materially impeded from executing our Charter-level oversight requirements due to limitations DHS has placed on our access to information. In 2009, the Auditor s Office initiated an audit of the DHS Child Support Enforcement Division. Based on our initial assessment, we did not carry out the performance audit. We took this course of action based on the fact that DHS was conducting internal quality improvement activities and was subject to oversight by the federal government; we did not base the decision on definitive evidence that DHS operations would not benefit from improvements. Later in 2010, we had to terminate our performance audit of DHS s Child Protection Program because of insufficient access to records necessary to complete the audit objectives in accordance with government auditing standards. Recognizing that DHS information is sensitive in nature and taking into account previous audits during which DHS limited our access, we were targeted in the areas we chose to examine for this audit. We focused on three DHS operational areas that we thought would be auditable despite records-access limitations: gift cards, the DHS call center, and customer service to community stakeholders. However, we could not fully review any of the three areas, based on the redacted information that DHS provided, resulting in an impairment regarding the audit assessment in each area. Unable to Assess Internal Controls for Gift Cards Provided as Client Benefits In 2012, DHS expended approximately $166,000 in gift cards to low-income clients to purchase items such as food, bedding, and other household items to help them provide for their families and children. Gift card usage is regulated in part by welfare program rules and regulations as well as DHS policy and procedures. Our review of the policy and procedure for gift cards, the gift card tracking log, and the gift card inventory results did not provide sufficient data to determine whether or not DHS has adequate internal controls for gift cards. To protect the confidentiality of client records, DHS heavily redacted the information prior to sending it to us, making it difficult to validate the data. Without reviewing documentation related to the recipient of the gift card, such as the 10 Community stakeholders, such as the Office of Colorado s Child Protection Ombudsman, the Colorado Association of Family and Children s Agencies, Inc., and Mile High United Way partner with DHS to provide services to clients. City and County of Denver Page 8

17 recipient name and signature showing receipt of the gift card, we were not able to determine if the gift card was received by the recipient. Our research of other municipalities suggests that gift cards can present a significant risk to a human services organization. For example, the Office of the County Auditor in Baltimore County, Maryland, found multiple issues including inadequate tracking of gift cards, unauthorized use and theft of gift cards, and inadequate segregation of duties over gift card administration. Our limited access to DHS records prohibited us from fully reviewing and assessing this type of risk. Inability to Perform Root Cause Analysis Related to DHS Call Center Inefficiency In our review of DHS call center operations, we were provided with recent DHS call center and 311 call center performance data. Although this data allowed us to determine that improvement is needed, we were not granted access to additional information regarding incoming calls or the ability to observe call center agents. This type of information would have allowed us to identify root causes, which could enhance our recommendations regarding how to improve call center operations. Our review of call center performance data indicated that timeliness and responsiveness can be improved in three areas. 11 First, the average speed of answer the average time spent waiting for the call to be answered increased by almost four minutes between 2012 and 2013 and reached peak levels of 25 minutes in both January and June The second measure is the percent of calls abandoned, which increased from 32 percent to 42 percent between 2012 and 2013, with rates continuing to hover above 40 percent since November Finally, the percent of calls answered within six minutes has decreased significantly. In 2012, 23 percent of calls were answered within six minutes or less and in 2013, only six percent were answered within six minutes or less. Each of these three measurements provides insight regarding call center efficiency and customer service and demonstrates needed improvement. Average hold time continues to increase with peak levels of 25 minutes resulting in a 40% dropped call rate. DHS calls were handled by the City s 311 call center until March 2013, when DHS assumed direct responsibility for its own calls. DHS plans to integrate the Family and Adult Division calls into their call center and provide case-management training for call center agents to improve customer service and allow call center agents to resolve calls more efficiently. The additional training includes eligibility processing to improve first call resolution and in the future call wait times. Aside from the time and effort that will be required to complete the training and transition process, it appears that DHS has no additional plans to develop a call center-specific strategic plan or implement a customer service phone survey to identify areas to improve. Instead the agency will continue to rely on performance measures to monitor the performance of the call center that appear in the DHS strategic plan. 12 Unless DHS management has other methods in place to identify what is causing poor call center performance, the tracking of 11 Call Center performance data reviewed included 311 call center data from 2012 as well as DHS call center data for the first six months of 2013 to measure if improvement in the quality of service had increased or decreased over time. 12 Department of Human Services Strategic Plan Update , p. 13, Goal I: Assistance. Strategy 2: Responsive Customer Service. Page 9 Office of the Auditor

18 performance measures alone will not provide enough information to improve performance and enhance customer service. Because of our limited access to information such as call intake forms and the manner in which they are recorded, it is difficult to determine what may hinder timeliness and responsiveness. In addition, the ability to observe how calls are handled would also enhance our assessment and help us determine the root causes that are preventing improvement in the process. Without the ability to determine root cause, it is difficult to offer a recommendation that would assist DHS in improving call center performance. Based on our limited review, we can suggest that DHS improve three areas average speed of answer, the number of calls abandoned, and number of calls answered within six minutes and initiate a customer service survey. Limited Review of Customer Service Effectiveness Third-party providers and stakeholders partner with DHS to provide clients with services as part of the welfare programs available at DHS. We interviewed several third-party providers who interact at various levels with human services operations. As a result of our interviews with stakeholders, we learned that DHS openly communicates with providers and that caseworkers are generally responsive. However, there may be opportunities to improve customer service delivery in areas such as services to adoptive children and their adoptive families, paying providers rates that are comparable to other surrounding counties, and youth who are close to aging-out of the human services system. Although these interviews were instructive, we were not able to discuss the quality of customer service with the most important stakeholder the service recipients. Our review of customer service effectiveness included an interview with the Office of Colorado s Child Protection Ombudsman (Ombudsman), who indicated that there are several areas in need of improvement in county human services departments throughout Colorado. 13 In its Annual Report, the Ombudsman s office identifies several issues of concern regarding child protection. 14 The report specifically notes intake inconsistencies, problems with mandatory reporting of child abuse, and systemsnavigation issues. 15 Mile High United Way confirmed that systems-navigation is an issue for its clients, especially those who have become ineligible for or have aged-out of human services programs. Our inability to review information related to the individuals who are experiencing difficulties navigating the system prevents us from understanding how the system can be improved to provide better customer service to this population. These areas center around customer service delivery, but without the ability to review pertinent data, we were not able to fully evaluate DHS customer service. However, we would encourage DHS to continue their improvement efforts by leveraging findings noted in the Ombudsman s Annual Report and by maintaining open communication with third-party providers and stakeholders through regular meetings, outreach, and collaboration. 13 Office of Colorado s Child Protection Ombudsman, an independent agency, was established in June 2011 after passage of Senate Bill Office of Colorado s Child Protection Ombudsman Annual Report pp Systems Navigation Issues are difficulties clients experience when trying to navigate through the welfare system (i.e. the courts, child welfare areas, etc.) to fully understand the decisions they need to make. City and County of Denver Page 10

19 Informal Legal Interpretation Regarding Access Rights to DHS Records May Be Flawed and Applied Inconsistently When the Auditor s Office requested information to meet our three audit objectives for this audit, DHS management routinely asserted that federal and state laws prohibit our access to DHS s client-related information. As a result of the last audit attempt in 2009 and through multiple conversations and correspondence with DHS and the City Attorney s Office, the assertion that access is prohibited by law has been informally supported by the City Attorney and CDHS. In other words, we have been verbally apprised of this position but have not received any formal legal analysis or opinions related to the matter. Recognizing that we have a duty to audit all City agencies, we researched how other counties have reconciled the competing priorities of oversight and confidentiality. Based on our research, we found that other counties have interpreted these laws differently, allowing accountability professionals full access to human services records containing client-related information. In addition, a U.S. Government Accountability Office audit suggests that when human services organizations refuse access to data, their refusal may be based on legal advice that is overly risk adverse rather than a prohibition of the law. Federal Statute and Regulations When audit staff requested information that included client-specific data, on the understanding that it would remain confidential, DHS management either provided heavily redacted information or refused to provide information all together, citing the federal statute that governs human services activities. This statute provides certain exceptions, but DHS management has interpreted that the Auditor does not fit within those exceptions. This statute states that child abuse or neglect reports and records shall only be made available to federal, state, or local government entities that have a need for such information in order to carry out their responsibilities under the law to protect children from child abuse and neglect. 16 The role of the Auditor s Office is to help strengthen governance, enhance efficiency, and improve the quality of services provided to Denver citizens by conducting performance audits. Arguably, our responsibility to the citizens of Denver satisfies the criteria set out by the federal statute. Privacy Act regulations allow disclosure of records if the requester makes advance written assurance that the records will be used solely for statistical research or reporting purposes. Additionally, federal regulations provide guidance regarding access to the records of entities that receive federal funding for programs that serve at-risk children as well as adults. Specifically, Privacy Act regulations allow disclosure of records if the requester makes advance written assurance that the records will be used solely for statistical research or reporting purposes, provided that the records are transferred in a form that does not identify the subject individual. 17 When DHS transferred information to the Auditor s Office, subject individual data was redacted as required by regulation but additional data was redacted as well, limiting the usefulness 16 Federal Statute (42 U.S.C 5106a). This statute includes all records associated with children such as child protection, child support enforcement, and foster care. 17 Privacy Act Title 45-Public Welfare, Subtitle A, Department of Health and Human Services. Page 11 Office of the Auditor

20 for audit purposes. Arguably, this additional level of redaction was not required under the Privacy Act. State Statute Colorado law allows research and audit organizations access to records containing client-identifying information for the purposes of conducting bona fide audit work. 18 When we requested information from DHS management for our audit, DHS management asserted that our intention to conduct a performance audit instead of a financial audit meant that we could not have access to information. However, our interview with a CDHS official indicated that the Auditor s Office should have access to human services records through a request submitted to CDHS by Denver DHS. Furthermore, DHS has provided records access to other organizations such as child welfare advocacy groups and foundations to provide third-party reviews of DHS programs, processes, and performance. These organizations were granted access to information containing client-specific data with the intention of improving the quality of service for DHS clients. The Auditor s Office is an independent audit function that can provide similar audit reviews while maintaining confidentiality and an unbiased approach. Further, the authority provided to the Auditor's Office through City Charter is unequivocal. The City Charter specifies that the Auditor shall have access at all times to all of the books, accounts, or other records or information maintained by any department or agency of the City and County. 19 Other County Audit Offices Have Obtained Access to Client Information for Performance Audits Through interviews, we learned that other county audit offices subject to the same federal requirements as Denver County have gained access to client-related information from their county human services departments during performance audits. 20 Five of the seven counties we contacted conduct performance audits of their human services organizations and six of the seven counties have access to client data for audit purposes as shown in Table 1. Each state in which these counties reside is required by federal mandate to ensure that human services records are protected and kept confidential, as is Colorado. To provide assurance to the human services departments that information will be kept confidential, the audit staff we interviewed cited a variety of solutions. For example, some auditors sign a confidentiality statement and redact information after they complete their analysis. In addition, local government audit offices are required by government auditing standards to maintain the confidentiality of audit work products. In Denver s case, City Charter as per a change by the people and Denver Revised Municipal Code also requires confidentiality of all audit records. 18 Colorado Revised Statutes (2) (o) Dependency and neglect records and information. (2) Records and reports access to certain persons agencies. Except otherwise provided in section , only the following persons or agencies shall be given access to child abuse or neglect records and reports (o) A person, agency, or organization engaged in a bona fide research or evaluation project or audit, but without information identifying individuals named in a report, unless having said information open for review is essential to the research and evaluation, in which case the executive director of the state department of human services shall give prior written approval and the child through a legal representative shall give permission to release the identifying information. 19 Denver Revised Municipal Code, Title I, Subtitle B, Charter (C) Access to Records. 20 Anne Arundel and Baltimore Counties, MD; Guilford County, NC; Summit County, OH; Stanislaus and San Francisco Counties, CA; and Adams County, CO (third party consultant) were contacted to determine what type of access was permitted regarding human services data. City and County of Denver Page 12

21 Table 1: Comparison of Other County Audit Office s Access to Human Services Data Audit Office San Francisco County, California Stanislaus County, California* Adams County, Colorado Denver County, Colorado Anne Arundel County, Maryland** Baltimore County, Maryland Guilford County, North Carolina Summit County, Ohio Audit Authority County-wide records, documents, and property County-wide internal controls and accounting County-wide records, personnel, and systems All City and County books, accounts, reports, voucher, or other records or information County-wide records and files related to receipt and expenditure of County funds and all agencies County-wide records and files related to receipt and expenditure of funds and performance of all agencies County-wide records and personnel Guide internal audit process; financial and performance audits Access to Clientidentifying Information *Stanislaus County no longer has an internal audit function. However, before the function was terminated, auditors had access to human services records for financial and compliance audits. **Anne Arundel County does not conduct performance or other audits of human services functions but they only access data to prepare the CAFR. GAO Finds Human Services Organizations May Be Overly Risk Averse Regarding Privacy The U.S. Government Accountability Office (GAO) recently released a report that may offer some perspective on why certain human services departments are reluctant to share data, even when laws and regulations allow it. The 2013 report discussed the data-sharing practices of human services departments at a variety of different government levels. 21 As part of the audit, GAO found that human services agencies' interpretations of federal privacy requirements are often inconsistent. One contributing factor may be overly cautious interpretations by the agencies legal departments. As a result, GAO recommended that the U.S. Secretary of Health and Human Services should clarify what data sharing is permissible under federal privacy requirements. Another recommendation was directed at the U.S. Office of Management and Budget to take a more active leadership role in identifying and disseminating useful data-sharing practices and tools that address privacy requirements. A risk-averse approach to information sharing is understandable, but it can negatively affect public welfare when external audit entities that are well trained in maintaining the Yes Yes Yes No No Yes Yes Yes 21 United States Accountability Office Report GAO : Human Services: Sustained and Coordinated Efforts Could Facilitate Data Sharing While Protecting Privacy. Page 13 Office of the Auditor

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