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Albany Matters In Social Services


New York State's constitution requires it to support its neediest residents. New York State also puts one of the largest financial burdens in the nation upon its local governments, who must match the state's own spending on many types of social services. These constraints limit the extent of debate between state and city governments. No matter how conservative a governor may be, or how much he owes to upstate voters, Article 17 of the state constitution prevents him from entirely cutting off support to even the least politically appealing impoverished residents. No matter how liberal a New York City mayor may be, any impulse to increase aid to the city's poor is tempered by competing needs in the city's budget.

Still, who is in office does make a difference. The winner of this fall's gubernatorial race will set the rules for the next round of welfare reform. By September 30, the federal government is expected to make several broad changes to the current law when it is re-authorized. New choices will be presented to the states.

According to "Lost In The Balance: How State Policies Affect The Fiscal Health Of Cities," New York State aid to its suburbs has increased faster than aid to its cities, and New York City received less state aid in 1997 than in 1995. The authors of this report, Howard Chernick and Andrew Reschovsky, suggest that this change may "reflect the shift in political power in New York State in 1994, with a Republican governor replacing a three-term Democratic governor. Since the core electoral strength of Republican candidates for governor in New York comes from the suburban and upstate areas, it would not be surprising if these areas were rewarded with additional state aid."

There are many ways that the state government in effect controls the city's social service policies.

DECISIONS ABOUT DISTRIBUTING FUNDS

During the five years since welfare reform began, the state has received a total of over $12 billion in federal funds for public assistance, of which nearly 30 percent has been diverted to other uses. For example, $380 million will be spent this year alone to support the Tuition Assistance Program, a program that is clearly of no benefit to current welfare recipients, most of whom are unable to attend college. That is because they were forced to drop out in order to fulfill work requirements. The state's welfare reform program does not recognize earning a college degree as a valid way for welfare recipients to prepare for employment.

ELIGIBILITY FOR PUBLIC ASSISTANCE

New York State determines the rules by which the city can deem someone eligible for public assistance. In some ways, the state is relatively generous, given the options allowed by federal law. When a New York family is sanctioned because a parent does not meet the work requirement, the children are still eligible for family assistance and Medicaid. Survivors of domestic violence can receive exemptions from work requirements and other rules on a case-by-case basis.

However, some of New York State's rules for eligibility are less lenient than is allowed by federal law, and than is practiced by other states. New residents of New York must wait a year after they have moved here to receive full benefits; until then, they can receive only the amount available in their former state, or half of the New York benefit level, whichever is higher.

Another restrictive choice made by New York State was to test welfare applicants and beneficiaries for alcohol and drug abuse, and ban them from both family assistance and Medicaid if they will not take a test or accept treatment. Despite this emphasis on treatment, clients who agree to be treated must often settle for a place on a waiting list instead, because the supply of treatment slots in the city is too small.

In the food stamp program, most immigrants cannot receive federal benefits. However, states can choose to buy food stamps with their own funds for use by immigrants. California, with the nation's largest immigrant population, chose to spend over $6 million a month on behalf of all needy legal immigrants in that state -- approximately 100,000 people -- who were not eligible for federal food stamps. New York State, with the second largest immigrant population, has a much smaller program serving about 600 immigrants, who are primarily elderly or survivors of domestic violence, for a cost of about $75,000 in state funds.

OVERSEEING THE CITY'S ADMINISTRATION OF PUBLIC BENEFITS

Under the administration of Governor George Pataki, Albany sometimes failed to keep former Mayor Rudy Giuliani's less law-abiding tendencies in check. When the city's welfare offices disqualified families from receiving cash assistance, for several years city employees violated the federal requirement to inform clients that they could still receive food stamps and Medicaid. The state overlooked this violation and allowed the number of people on food stamps and Medicaid to drop nearly as much as the welfare rolls until advocates intervened, drawing federal attention to the problem. The state agency charged with responsibility for overseeing the city's Medicaid operations was named as a defendant in the lawsuit against the city, which resulted in a court decision finding the city had caused "irreparable harm" to some of the plaintiffs.

MENTAL HEALTH AND DRUG ABUSE TREATMENT

In addition to its indirect influence on local services, a few social service functions important to specific populations are largely controlled by the state. Two of these are residential care for people with mental illness and drug abuse treatment.

The state controls the rate at which it discharges people from state mental hospitals. Theoretically, this process allows patients to move back into "the community" with the assistance of outpatient treatment and supportive services, resulting in lower costs to the government and a better quality of life for patients. Decades after it was clear that many discharged patients were not returning to a supportive community, but ending up homeless in New York City, the state is reauthorizing the Community Mental Health Reinvestment Act, which applies savings from downsized state psychiatric facilities to community-based mental health programs. However, there never seem to be enough community-based services to meet the needs of the city's mentally ill homeless population.

During the New York City fiscal crisis of the 1970's, the city eliminated all local spending on drug treatment. Since then, the state has directly contracted with local providers for substance abuse treatment supported by federal and state funds. The city's role in the drug treatment system is limited to coordinating and monitoring contracted services.

It grows increasingly obvious that substance abuse treatment is necessary to achieve many local goals, such as reducing homelessness, helping welfare recipients move to work, reducing crime and prison recidivism, and caring for people with a dual diagnosis of mental illness and substance abuse disorders. To the extent that Albany controls the nature and supply of substance abuse treatment in the city, local officials have limited ability to coordinate it with other services for people with related, multiple needs.

CONGRESSIONAL SUPERWAIVER=GUBERNATORIAL CONTROL

As if New York's governor doesn't wield enough power already, the welfare reform reauthorization bill passed in May 2002 by the House of Representatives allows "superwaivers," proposed by President George Bush last February, giving governors, the president, and cabinet heads the power to bypass their respective legislatures in making major changes to programs affecting low-income people. The superwaiver idea was not included in the U.S. Senate version of the reauthorization bill, passed in June, but is likely to be raised as an issue during the negotiations required to reconcile the House and Senate bills.

Under the House bill, a state governor could request and receive a waiver from the federal agency overseeing a given program, permitting that state to fundamentally change its version of that program for five years. No public input or legislative approval would be required. Programs subject to superwaiver changes would include food stamps, homelessness programs, public housing, child care, job training, and adult education. If any version of superwaivers becomes law, New York State will no longer be ruled by "three men in a room," the usual description of the decision-making process in which the governor, the Republican majority leader of the New York State Senate, and the Democratic Assembly speaker settle their differences before bringing bills to a vote. Instead, Albany will be a one-man gubernatorial show at which New York City's low-income population will be a captive audience.

Linda Ostreicher, a former budget analyst for the New York City Council, is a freelance writer and consultant to nonprofits. She is currently on the staff of Bronx Independent Living Services.

AIDS At 20: Frontline STD Clinics


Martin Algaze knows that, twenty years after acquired immune deficiency syndrome was first identified, many New Yorkers have relaxed about it. "We know there's been a 'complacency effect' setting in over the last few years among all the populations at risk for AIDS," says Algaze, who works for Gay Men's Health Crisis, the oldest AIDS service and advocacy group. "They think AIDS is over."

The result is another in a long line of tragedies. "It appears that more people are having unsafe sex," Algaze says.

One reason health workers know this is that the syphilis rate in New York City has more than doubled in the first quarter of this year. The numbers seem too puny to be alarming. Dr. Susan Blank, assistant commissioner of the health department's Sexually Transmitted Disease Control Program says there were 57 cases of infectious Syphilis in the first three months of this year, up from 26 during the last three months of 2000. But the health department fears that this upswing may foreshadow another rise in HIV infections, particularly among men having sex with men.

The connection between sexually transmitted diseases (STDs) and AIDS transmission is not generally known to the public. But specialists in the field have known since the early 1990's that syphilis, gonorrhea, chlamydia, and trichomoniasis increase a person's vulnerability to AIDS by two to five times. These STDs also make a person with HIV much more infectious to their sexual partner(s).

Thus the alarm about the spike in the syphilis rate, and the effort by the Department of Health to get the word out about how prompt diagnosis and treatment of STDs are important facets of AIDS prevention. Says Blank, "Every time we can cure a case of syphilis, we're preventing HIV."

That underscores the importance of New York City's ten STD clinics.

The free and confidential clinics in the five boroughs provide confidential diagnosis and treatment on a walk-in basis. Upon arriving at the clinic, patients are asked to fill out a form (and identified by a number, not a name), stating their reasons for coming to the clinic. A clinician does an examination. (All are board-certified doctors and physician assistants who specialize in diagnosing and treating STDs). If necessary, specimens are taken, and tested at the on-site laboratory. If it is indicated by the tests that a patient has an STD, he will be given medication before he leaves the clinic. HIV counseling and testing are also offered at the clinics.

The free clinics are an invaluable service for those who are uninsured and unable to afford a doctor's care. Minors, says the Department of Health, do not need parental consent for examination and treatment. And unlike AIDS, syphilis is curable.

The complacency towards AIDS is a result of a regiment of drug treatment called HAART, which stands for Highly Active Anti-Retroviral Therapy, which has been mostly a blessing, Algaze admits. "That these drugs are working is very good news. Many of these people were preparing to die. Now many of them are even going back to work." Still, he warns, HAART isn't an unmixed blessing. The drugs don't work for everybody. Some people suffer side effects so bad they can't take the drugs.

And they are very expensive-"they can cost as much as $15,000 to $20,000 yearly." The co-payment, even with insurance, can be as much as $100 a month, for just one class of drugs. Algaze added that "the most affordable way for people to take these drugs is via mail-in programs through your insurance company," as this can be much cheaper than getting them from a pharmacy.

Another thing to keep in mind: the HAART drugs, as far as clinicians know, have to be taken for life. There are no long-term studies on lifelong effects yet. They are not a cure. There is still no vaccine for uninfected people. And the new-case rate for AIDS in the U.S. is a steady 40,000 per year. In the past 20 years, AIDS has killed 75,000 New Yorkers,or about one fifth of all the Americans who have succumbed to it.

More Resources on AIDS:

  • For information about getting help with STDs and treatment, see the Health Department's web site. Anyone wanting more information on syphilis can call the city's STD HOTLINE at 212-427-5120, Monday through Friday, 9:00 a.m. to 4:00 p.m., or ask their doctor.
  • GMHC - Oldest and largest voluntary AIDS crisis organization. Information about AIDS, services and treatment, and extensive list of links to other on-line AIDS resources. GMHC Hotline: 1-800-AIDS-NYC.
  • The Body - Doctors' answers to questions from people living with HIV, chat and bulletin boards on AIDS-related topics, 30,000-document library that is updated daily.
  • Critical Path AIDS Project - Critical Path provides easy access to the full range of potentially life-extending or life-saving AIDS prevention, treatment, and referral information.
  • Michael Callen-Audre Lorde Community - Provides information about the services they offer to the gay, lesbian, and bisexual community, plus volunteer and job opportunities.
  • POZ Magazine - Monthly magazine that reports on the impact AIDS has on life, politics, culture, and society, plus the Spanish POZ magazine, POZ en Espanol, and MAMM, a magazine for anyone whose life has been affected by breast and reproductive cancers.
  • Centers for Disease Control - CDC's Divisions of HIV/AIDS Prevention-with recent headlines, FAQs about AIDS, and links.
  • God's Love We Deliver - Provides highly nutritious meals, free of charge, for all people living with AIDS. Features nutrition information and information on how to become a client.
  • National Minority AIDS Council - This website supports NMAC's mission of developing leadership within communities of color for the fight against AIDS.
  • New York City Department of Health- Provides HIV/AIDS treatment, prevention, and counseling information and surveillance data for the city.
  • Healthopedia - AIDS resource
  • Allrefer.com - AIDS resource

Foster Children Still at Risk?


Public Advocate Mark Green, a Democratic candidate for mayor, released a report this month concluding that "foster care remains a dangerous or losing proposition for too many children" in New York City. At a press conference held to announce the findings, Green stood beside Cecil Reed, a man whose son died while in foster care. Green said that the number of verified reports of maltreatment of children in foster care doubled from 1996 to 2000, even while the number of children in foster care fell by 24 percent. He added that one in 40 children throughout New York City is reportedly abused, compared to one in 20 children in foster care.

Immediately, officials at the Administration for Children's Services dismissed Green's study as a political ploy, a hastily assembled document lacking independent research. "We do not find it very helpful for real reform," said Jack Deacy, spokesman for the agency.

Green's report and press conference, and the reaction by the city, present a case study in the difficulty politicians have during the election season calling the public's attention to government performance. During campaigns, it may be hard for public servants running for office to resist making a play for headlines by overstating damaging information that comes their way. At the same time, when candidates are the bearers of bad news, city officials may find it tempting to accuse the candidates of political grandstanding, and thus avoid addressing troubling facts.

Examination of the Green document shows that it lacks original research and focuses almost exclusively on a set of negative findings in recent evaluations of the Administration for Children1s Services. These qualities, at first glance, make the report appear less substantial than it actually is. A close reading, however, reveals that the authors worked diligently to divulge the contents of a New York State study that state authorities have been shielding from public view since December 2000. It is not the fault of the authors of the report that the findings of the state's own study are, on the whole, damning.

The New York State Office of Children and Family Services examined case records of 401 children who were in foster care in New York City during 1999. The review was ordered in the settlement agreement of the Marisol et al. v Giuliani federal class action lawsuit. The Public Advocates office had to submit a Freedom of Information Act request in order to see the document. Journalists are also prohibited from seeing the document without a Freedom of Information Act request. Public information officials at the Office of Children and Family Services did not respond to requests for an explanation as to why they are making it difficult for the public to gain access to the document.

State auditors found evidence that the Administration for Children's Services has made great strides in some areas, especially in providing counseling services to foster children, and domestic violence services and housing assistance to parents. However, the reviewers also found many areas in which the performance of the system either did not improve or actually worsened. Comparisons are possible because the state did a case record review of New York City foster children in 1997.

In 71 percent of cases where the goal for a foster child was reunification with his or her parents, caseworkers failed to arrange a minimum of two visits a month between children and parents, as state law requires. (Visits when they do occur typically last an hour and a half in accordance with standard casework practices.) The failure rate was up from 57 percent in 1997.

Sixty percent of foster children were moved from placement to placement at least once, up from 54 percent in 1997. Agency officials failed to notify parents that their children had been moved in a third of cases. Only a quarter of children with siblings in separate placements were able to visit with brothers and sisters as state law requires, down from 38 percent in 1997.

The state mandates a twice-yearly conference between agency caseworkers, supervisors and parents. By statute, the conference is supposed to serve as a forum for parents to learn what the agency requires them to do to win their children back and a place for parents to make plans to meet those requirements. Following the conference, the plans are codified in a document called the Uniform Case Record. Failure to comply with the Uniform Case Record is one of the most common transgressions cited in city petitions blocking reunification of parents and children. State auditors found that in 70 percent of the records they reviewed, conferences took place without parents present. In 62 percent of those cases, parents had not been invited to attend. An additional 10 percent of parents had been invited but had been unable to make it because caseworkers scheduled them when parents could not attend. Following conferences that took place in the absence of parents, only seven percent of parents were given a copy of the resulting Uniform Case Record. Fifty-six percent were not informed in any way of the results of the conference.

While it is true that Green did not mention the positive trends found by the Office of Children and Family Services, it is also true that the Office did not find nearly as many positive as negatives trends. Still, Green should have included the positive findings because they would have added credibility to his report - and because they were spectacular. Seventy-one percent of parents who needed parenting skills classes were given referrals to those classes in 2000, up from 38 percent of parents in 1997. Sixty-seven percent of parents who needed housing assistance got it, up from 25 percent in 1997. Eighty percent of parents needing psychiatric treatment were referred to psychiatrists, up from 37 percent in 1997. A stunning 76 percent of parents needing domestic violence services got them, up from 13 percent in 1997. Nothing stands in the way of the city itself from trumpeting the positive findings in the New York State audit. On the other hand, there was a real obstacle - a governmental gag order - stopping advocates and the public from seeing the negative findings and calling the city to account.

It is entirely understandable that officials at the Administration for Children's Services felt assaulted by Green's report, particularly since Green unveiled it in front of reporters at a news conference calculated to highlight the risks to children's safety in foster care. That many more reports of child maltreatment in foster care are being substantiated today hardly proves that the risks to child safety in foster care are increasing. It may just as easily indicate that child protective investigators are taking the abuse of children in the city1s foster homes more seriously than ever.

Still, the agency's sense of injury should not have given it license to avoid explaining the genuinely negative findings made public by Mark Green. The Administration for Children1s Services has much to be proud of, but even its officials must know that foster care remains, as Green said, a dangerous and losing proposition for many children.

Peggy J. Farber is freelance journalist specializing in children's issues. Her reporting on conditions of NYC children has appeared in City Limits Magazine as well as on National Public Radio. 



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