City of Philadelphia - Need and Social Services. Susan Kretsge, Deputy Mayor

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1 City of Philadelphia - Need and Social Services Susan Kretsge, Deputy Mayor

2 Philadelphia 5 th largest city in the United States Located in the NE corridor of the US between New York City and Washington, DC Population of 1.5 million 41% of the population is white, 43% black or African-American, 6.5% Asian and 13% Hispanic or Latino

3 Poverty in Philadelphia

4 US Federal Poverty Guidelines Poverty Guidelines Persons in Family/Household Poverty Guideline 1 $11,770 2 $15,930 3 $20,090 4 $24,250 5 $28,410 6 $32,570 7 $36,730 8 $40,890 For families/household with more than 8 persons, add $4,160 for each additional person. (*excludes Alaska and Hawaii)

5 Poverty in Philadelphia Philadelphia is the poorest of the 10 largest cities in the US Current poverty rate is 26.3%, approximately 400,000 people National rate is 15%, approximately 46.5 million people 123,000 children in Philadelphia live in poverty, about 36% About 32,000 seniors are living in poverty Deep poverty (income below half of the poverty line) affects 12.2% of Philadelphians; national rate is 6.3% Shared Prosperity, 2014

6 Philadelphia Poverty Rate

7 Poverty in Philadelphia Race and ethnicity - Black Philadelphian are almost twice as, Latinos more than twice as, likely to be poor as whites Disability - poverty is high among people with disabilities (40%) Family composition - poverty is high among households headed by single mothers (38%) History of incarceration o Creates employment barriers, reduces earnings and decreases economic security through criminal debt, fees and fines, makes access to public benefits difficult or impossible o Nationally, people entering the criminal justice system are overwhelmingly poor and people of color o 40,000 Philadelphians return from incarceration each year; 50,000 people living in Philadelphia are on probation or parole Shared Prosperity, 2014

8 Poverty in Philadelphia Education 200,000 Philadelphians lack a high school diploma o o An estimated 550,000 are considered low literate, meaning they do not have the full range of economic, social and personal options that are open to Americans with higher levels of literacy skills By 2030, an estimated 600,000 Philadelphians, nearly 39% of the current total population, will not have the skills to secure the types of jobs that will be available in Philadelphia Help Wanted, 2009

9 Education

10 On-Time Graduation Rate

11 Adults with Some College Attendance Large Cities, 2011

12 Impact of Educational Attainment Median Lifetime Earnings, 2009 dollars 3,252,000 3,648,000 2,268,000 2,671, ,000 1,304,000 1,547,000 1,727,000 Source: Carnevale, Anthony P., Rose, Stephen J., Cheah, Ban. The College Payoff, Education, Occupations, Lifetime Earnings,. cew.geargetown.edu. Georgetown University Center on Education and the Workforce, 5 Aug Web. 8 Aug 2013

13 Job Openings by Educational Attainment Philadelphia, June 2013 Bachelor's and higher Associate's Some college; training 221 2,613 10,652 Of 21,639 online job postings, 51 % required education at a Bachelor's degree level or higher 1 Postsecondary non-degree 587 HS diploma; experience HS diploma; long-term training HS diploma; some training Less than HS; some training 1, ,439 1,556 4 out of every 5 job seekers tested for literacy at a PA Careerlink scored at the 5 th 8 th grade level for reading and math 2 Job Postings Source: 1 (and Data) 2 City of Philadelphia, Shared Prosperity Plan, p.29.

14 Employment

15 Manufacturing Workers Source: Geolytics, Inc: US Census 1980 Data

16 Manufacturing Workers Source: Geolytics, Inc: US Census 1990 Data

17 Manufacturing Workers Source: Geolytics, Inc: US Census 2000 Data

18 Change in U.S. Employment by Industry Type

19 Employment Gain/ Losses by Sector Philadelphia, May May 2013 Government -6,400 Other Services -1,600 Leisure & Hospitality Education & Health Services 2,100 17,600 Professional & Business Services Financial Activities -5,200-3,000 Information Trade/Transportation/Utilities ,300 ** Manufacturing Mining/Lodging/Construction -46-1,400-10,000-5, ,000 10,000 15,000 20,000 25,000 Net Change Source: Bureau of Labor Statistics, Mid-Atlantic Area Employment, Employees on Nonfarm Payrolls City of Philadelphia, May 2008 May 2013

20 Safety net programs

21 Federal programs Supplemental Nutrition Assistance Program Medicaid, Children s Health Insurance Program Temporary Assistance for Needy Families, Child Care and Development Block Grant Low-Income Home Energy Assistance Program Earned Income Tax Credit (EITC)

22 Federal programs - Philadelphia About 39,000 Philadelphians eligible for the earned income tax credit (EITC) do not apply Nearly 500,000 city residents receive Supplemental Nutrition Assistance Program (SNAP) benefits, but 180,000 qualified Philadelphians are not enrolled

23 Federal programs Millions do not receive the benefits for which they are eligible different eligibility and documentation requirements, people are unaware of programs, multiple steps often required to obtain and retain assistance o Use existing data sources for eligibility determination o Allow verification by one agency to serve for others o Create a data warehouse o Automatic renewal using data matches

24 Health and Social Service Programs Health and Opportunity - the departments in the cluster provide the public services that impact those most affected by poverty, poorer education, unemployment and poor health. Service areas o child welfare o juvenile justice o mental health o substance abuse o intellectual disability o public health o homeless and supportive housing

25 Health and Opportunity About $2 billion spent annually majority of funds from the state or federal government, often categorical Over 800 provider contracts Behavioral health services for about 170,000 residents Emergency shelter serves an average of 1,500 single individuals and 450 families every night 5500 children in placement due to abuse or neglect; another 5000 receive in-home services About 90,000 patients visit city health centers, roughly ½ are uninsured

26 Improve access and effectiveness We know we do not serve everyone in need 2 factors one is a lack of resources, the other is flaws in our system Over 1000 families turned away from emergency shelter; the number is increasing as is the percent who return resource issue Estimates of the unmet need for substance abuse services in Philadelphia is 89,000 individuals both a resource and access issue Access is affected by multiple factors Some of our efforts: o Define our population by geography, by personal characteristics, by what people say they need and want

27 Improve access and effectiveness Surveys and focus groups completely changed substance abuse treatment program based on consumer input Community advisory boards that include consumers o Behavioral health o Health centers o Child welfare neighborhood locations o Recreation centers

28 Improve access and effectiveness Geographic access o Neighborhood-based services - put services in the community, decentralize service delivery, make sites physically accessible o Map service locations, look at travel time of consumers coming to current sites and locate new sites in underserved areas. 8 community health centers operated by the city o Go to people where they are homeless street outreach o At times, stymied by NIMBY (not in my backyard) issues Co-location o Behavioral health services in health care centers o Behavioral health services in schools o Behavioral health services in child welfare agencies o Behavioral health services in emergency housing sites

29 Improve access and effectiveness BenePhilly Centers - six benefits access centers across the City. Work with low-income Philadelphians to access all federal, state and local benefits. o Supplemental Nutrition Assistance Program (SNAP); o Temporary Assistance for Needy Families (TANF); o Health insurance like CHIP, Medicaid and Medicare; o Low Income Home Energy Assistance Program (LIHEAP); o Earned Income Tax Credit (EITC); o Child Care Tax Credit; and o State and City property tax credits

30 Improve access and effectiveness Cultural competency ouse community-based organizations for language access and cultural sensitivity, improved connection to other community resources ofaith-based organizations help get the message out oalmost no city staff deliver services, instead contract with community-based agencies ofederal government used this model to assist people to enroll in Affordable Care Act health insurance program

31 Improve access and effectiveness Peer staff o Substance abuse programs now use certified peer specialists (individuals in recovery who attend a training program) o Also work in our permanent supportive housing programs Data o We use to target geographic areas and subpopulations o Homeless services: determine who meets the federal definition for chronically homeless o Children most at risk: mapped children 0 5 with one or more of 9 risk factors. Targeting children with 3 or more risks for early intervention services and early childhood education programs o Measure effectiveness: assessed new permanent supportive housing program - did we serve our target population

32 Health Impact Pyramid Examples Smallest Impact Largest Impact Counseling & Education Clinical Interventions Long-lasting Protective Interventions Changing the Context to make individuals default decisions healthy Socioeconomic Factors Eat healthy, be physically active, have safe sex Rx for acute and chronic conditions Immunizations, brief intervention, cessation, colonoscopy Smoke-free laws; counter-advertising campaigns; immunization mandates; pollution emissions standards Poverty, education, housing, inequality Frieden T, AJPH 2009

33 Improve access and effectiveness Change the context - cost effective way to reach larger audience, make the healthy choice the easy choice. Get Healthy Philly uses o Media campaigns o Partnership with Parks and Recreation Department - smoke free playgrounds, new walking trails o Partnership with Streets Department - bike paths o Increased farmers markets in low income communities o Offered funds to neighbor corner stores to change inventory o Instituted menu labeling in restaurants o Partnership with schools - lunches, vending machines Rates of obesity and severe obesity among Philadelphia school children decreased by 6.3% and 13.9%, between 2006 and 2013, the increase in adult obesity has slowed 18% reduction in smoking among adults since 2008 and a 30% reduction among youth since 2007

34 Improve access and effectiveness Change the context Mental Health First Aid o Public education program teaches community members to identify, understand, and appropriately respond to individuals experiencing behavioral health challenges o Designed to counter stigma and misinformation hampering efforts to connect people with appropriate care

35 Improve access and effectiveness Research and use evidence-based practices o Behavioral health system provides training to service providers, rates them on their use of these practices and uses bonus system to motivate use o MOM home visiting program, based on 3 year research project at local children s hospital o Permanent supportive housing have housed 1200 people with histories of homelessness and behavioral health issues, 90% are stably housed since 2008

36 Supports for local governments Resources Philadelphia will end veterans homelessness this year; would not have happened without an influx of federal aid Ability to tailor programs to local need Data systems difficult challenge for local governments, need technical assistance along with the system Best practices research Performance measures Learning community

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