Pa. county recognized for innovation

John Kravas, Tioga County human services administrator, and Linda Stager, director of family services, review a few details before presenting their program to the judges of the "Innovations in American Government" competition, Oct. 8, at the National Press Club in Washington, D.C.

Tioga County, in northern Pennsylvania's Allegheny Plateau, is known for its fishing, canoeing and hiking. This rural county of farms and forests that calls itself the home of "Pennsylvania's Grand Canyon" is fast developing another tourist attraction - the human services agency.

In the past nine months representatives from 10 of the state's 67 counties have visited the agency and another 34 county officials in the state have called. Everyone is interested in Tioga County's "Decategorized Human Services Delivery Program," which was recently recognized nationally by the Ford Foundation and Harvard University as a finalist in the "1997 Innovations in American Government Awards" competition. This national recognition has already brought national visitors and will likely bring more.

Tioga County officials are happy with the decategorized program, which has reduced paperwork, closed service gaps, improved internal communication and created a holistic approach that focuses on the family. The program saved the county $872,000 this year, contributing to a total savings of about $8 million since the program began 12 years ago, according to John Kravas, Tioga County Human Services administrator.

Kravas said he expects the decategorized program to work very well with welfare reform and also Pennsylvania's proposed managed care system. "Our experience with welfare reform is minimal, but we believe the delivery system can handle it well. We're concerned about our clients, though," he said.

Kravas said he and his staff are "proud and humbled" to be a finalist in the national competition. "There was a quieting sense of satisfaction knowing that the staff, who worked so very hard, would be recognized beyond the hills of Pennsylvania."

"We, as an agency, accepted innovation as our first social responsibility," Kravas said. "This is confirmation that change is not only possible, but cost effective."

Stewart Wakeling, a senior program associate at the Malcolm Wiener Center for Social Policy at Harvard University, visited Tioga County in connection with the innovations competition and was impressed with what he found.

"For a county of this size (about 42,000), it's a tremendously sophisticated approach. They have smart people and they're doing it right," Wakeling said. "The idea behind decategorization is to create better service for families, and Tioga County has done that."

The way it was
In the mid 1980s, Tioga County's Human Services Agency reflected federal and state systems. Separate agencies delivered separate services for separate problems. Each program had a director, case manager and a support staff.

Tioga County officials started developing the comprehensive decategorized program in 1985 when they realized more than 60 percent of their clients received help from at least two county agencies. This meant duplicated paperwork and higher administrative costs. Also, there was little communication between departments because of "turf issues," Kravas said.

"Clients with more than one categorical problem trekked from agency to agency for help as the paperwork was duplicated. It's what we call the 'ping-pong effect,' " Kravas said.

The categorized system meant that clients might have to tell their stories to four different case managers who were restricted to arranging services in one program and then make referrals to other programs.

Growing pains
Tioga County didn't decategorize its human services agency overnight. Kravas said the agency moved slowly and was careful to make sure the staff was comfortable with the pace of change. Even so, decategorization brought with it some problems.

"The categorical delivery system was very 'turf conscious,'" Kravas said. "The staff thought they had been schooled in a particular discipline. We had to show them they had been generically educated, then trained by the organization."

When the program began, the county created an internal multi-disciplinary team to review cases. Case managers could go to the team with a problem outside their initial area of expertise and get advice. As the boundaries between categories came down and the case managers became more comfortable with decategorization, the team evolved. The team is now made up of external experts, such as doctors, lawyers, psychologists and police officers, who can look at cases from a different perspective, Kravas said.

To make the transition to decategorized human services as smooth as possible, Tioga County adopted a policy Kravas calls the "weakest link or the strongest regulation." If the staff thought change was coming too fast, the agency slowed down. If one area had stronger regulations than another area, the agency adopted the stronger regulations. The result is a staff that has a sense of belonging and an agency that meets all applicable regulations, Kravas said.

"We've spent a great deal of time on staff development. We ask our staff how we can help them meet their individual goals. We found that many people on our staff wanted to continue their education. Our closest graduate schools are three to five hours away. We arranged with Temple University to offer two graduate programs in six years. The county helped with tuition and books," Kravas said.

Try this at home
One of the criteria in the Innovations in American Government awards program is that the program be replicable by other government units. Kravas believes Tioga County's decategorization program would work in many different areas.

"I don't think you can take all that is here and simply supplant it," Kravas said. "You need to be selective in how you redesign a system in a county, because it must meet the needs of the county. You can replicate what we've done here, but do it with prudence and focus on your county's needs."

Although Tioga County is large geographically (at 733,440 acres it is the second largest county in Pennsylvania) and has a population of about 42,000, Kravas said he thinks counties with larger populations could model the decategorization system.

"If I were doing this in a larger county, I would go back to the neighborhood system and replicate Tioga County six times," he said.

He said he would also make sure to have political support for decategorization from a county government that is patient and willing to share the risk of moving to a new system.

"Decategorization is prudent and responsive to the needs of the public, but the supporters of categorical systems, over time, have become powerful and that makes advocates of decategorized systems politically vulnerable," Kravas said.

Wakeling agreed that Tioga County could be a good model for other counties, but cautioned that it could be harder to make this transition in urban areas because of political and budgetary pressures. "You'd have to do more work, but the basic idea is robust and can be applied equally," he added.

The competition
There were 1,540 applicants for the Innovations In American Government award this year. As a finalist, Tioga County will receive a $20,000 grant. The program is sponsored by the Ford Foundation and administered by Harvard University's Kennedy School of Government in partnership with the Council for Excellence in Government.

The awards program encourages replication of innovative government programs. The program's grants are intended for use in disseminating information to both the public and other government agencies.

If you would like more information about the 1998 Innovations in American Government competition, (application deadline Jan. 7, 1998), write to: John F. Kennedy School of Government, Harvard University, 79 JFK Street, Cambridge, MA 02138. The competition's Web page is <http://www.ksg.harvard.edu/innovations/>.

If you're interested in talking to Kravas about Tioga County's experiences with decategorization, he can be reached at Tioga County Human Services Agency, P.O. Box 766, Shumway Hill Road, Wellsboro, PA 16901, or by calling 717/724-5766.

How decategorization works

A client walking into the Tioga County Human Services Agency meets with a single case manager, who enters information about the client into the agency's computer system and does a detailed assessment of the client's needs. The case manager then guides the client through the system, ensuring that all the needed services are provided.

Case managers use two computerized application forms common to all services and developed by the county when the program began. A case manager in any location within the agency can enter a client into the system and then arrange for services from elsewhere in the agency, as well as from a number of private companies that subcontract with the agency. Tioga County calls it "one-stop shopping."

"The clients love decategorization," said John Kravas, Tioga County Human Services Administrator. "Imagine not having to tell your story multiple times. Imagine having one case manager instead of four or five. Imagine having a case manager who considers the whole family. We've been able to send one case manager into a home and provide several services in a short time."

As part of his 1997 Innovations in American Government Awards" competition evaluation, Stewart Wakeling, a senior program associate at the Malcolm Wiener Center for Social Policy at Harvard University interviewed several families in the system. The families told Wakeling they like decategorization because they can find help with one phone call and that having a single case manager makes them feel they have an advocate in the system.

"The family doesn't have to figure out what their problems are," Wakeling said. "All they have to say is, 'I'm struggling. I need help.' They have one number to call and they get the help they need quickly. These stories are always painful and it takes a while to build trust with a caseworker."