DHR report, 1997

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Table of Contents

Introduction

1

A Day in the Life of DHR

2

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Mainstreaming
\I\Ielfare Reforrtl

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Caring for Children and Families

11

Keeping Communities Healthy and Safe

17

Aging Independently

23

The 1996 Olympic Games

26

Looking Ahead

28

Budget and Organization

30

DH R Services 1997

34

Department of Human Resources 1997 Board Members
Lasa Y. Joiner, Decatur, chair; Cyler Garner, M.D., Gordon, vice chair; Jane Carithers, Marietta, secretary; James K. Davis, Atlanta; Sheila A. Robinson, M.D., Atlanta; G. Terrell Allen, LaGrange; Brenda Hodges-Tiller, Ed.D., Albany; Hilton H. Howell, Jr., Atlanta; J. Gregory Jones, M.D., Macon; Guida S. Kelley, Brunswick; John Reed, M.D., Gainesville; Romeo Adams, Royston;
Todd Jarrell, M.D., Columbus; George David Gowder, III, M.D., Blairsville; Robert J. Shelley, M.D., Savannah

Streamlining and mainstreaming are recurrent themes in this report covering two years (FY 96-97) of the department's activities.
By streamlining I mean reducing duplication and cutting red tape. For example, previously each DHR division had its own budget and planning staff. After considerable thought and deliberation, we combined these operations in one unit. Now, the Office of Planning and Budget Services plans and manages expenditures for the department as a whole.
Changing direction is never easy, but it is often necessary. We have tried to be sensitive to the concerns of employees and the emerging organizational needs. I believe we made substantial progress over the past two years in becoming more efficient and responsive. But, we're not at the end of the road, and DHR will continue to look for more costeffective ways of giving services.
For many years, the concept of mainstreaming has been associated primarily with placing children with special needs into regular classrooms. I want to broaden that definition to include more of the people who need help to manage their lives. They include mothers on welfare, people with mental illness, and people with physical or mental disabilities. Many of them have

been standing on the sidelines too long.
More than ever we realize that everybody wants to be in the middle of things, to live like everybody else. That's one of the reasons we are closing some state-run hospitals. And it's why our welfare offices have become job-focused support centers. By focusing on work for welfare recipients and community services for people with disabilities, we're encouraging more of them to participate in the mainstream as much as they are able.
We know that we couldn't accomplish anything without teamwork. My vision is that DHR will become a unified human services team recognized for integrity, compassion and accountability. After you read this report, I hope you will agree that we are reaching this goal.
The opening sections highlight some of the major accomplishments of the past two years: welfare reform, support for families and children, mainstreaming and protecting the community's health. The data section shows the range of the department's activities - from child protective services to child care inspections to TB treatment -and the numbers of people touched by them.
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Commissioner

INTRODUCTION "

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II

A DAY IN THE LIFE OF DHR

On a given day in FY 97, DHR programs

opened 210 new child abuse cases

ran 10,000 laboratory tests

reviewed 477 disability claims

gave 150 tests for HI\!, the AIDS virus

provided hospital and outpatient care for 53,381 adults who were mentally ill

provided hospital care and training to 13,488 people with mental retardation

processed 453 applications for welfare and 1,476

applications for food stamps

.

treated 20,095 people who had substance abuse problems

screened 480 children for health problems

immunized 2,000 people against infectious diseases

provided help with daily living to 3~~500 elderly people in their home and commUnities

inspected 15 day care centers

gave WIC food vouchers and nutrition advice to
10,440 women and children

provided family planning services to over 1,350 women and men
helped 13,800 welfare recipients gain job skills and find jobs
enabled 28,500 people with physical or mental disabilities to live more independently
collected $1.25 million in child support payments
helped 18,144 severely emotionally disturbed youngsters and their families
provided child care subsidies to over 30,000 families
developed work plans for 20 people with disabilities

I

STREAMLINING

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Because it is charged with handling some of society's most difficult problems, DHR must use its limited resources carefully. That's why the department takes the concept of streamlining so seriously. By restructuring to reduce duplication and increase efficiency, DHR has both improved services and cut costs.
Moving ahead
To increase efficiency, the department has had to overcome its own history. DHR was formed in 1972 by combining several human services agencies, each with its own person nel department and budget and planning staff. Each of these DHR divisions also developed its own computer system. Aware that this administrative structure had become unwieldy and divisive, DHR began streamlining its operations.
Consolidations
By merging all planning and budget functions into one entity - the Office of Planning and Budget Services - DHR was able to improve efficiency and reduce staff. The same improvements resulted from merging all personnel functions into the Office of Human

Resource Management. Personnel operations were greatly simplified and staff was reduced by 20 percent. Positions were reduced by attrition so most current employees kept their jobs.
Integrating information systems
Many DHR clients receive help from more than one program or office, yet the programs have not been able to communicate with each other electronically. Although 80 percent of client information collected by each program is identical, every agency starts from scratch with each new client. For example, if a mother who needs child care assistance from DFCS takes her children to the health department for immunizations, she has to give essentially the same eligibility information twice.
During the past two years, the department began developing an integrated information system so that each program can pass on client information electronically when they refer people to other DHR services. The long-term goal is an overall case management system that allows each program to access each client's complete history with DHR.

Working smarter
While DHR was simplifying its overall administrative structure, similar steps were taken at other levels of the organization. For example, by consolidating and contracting out its client assessment and case management functions, the Division of Aging Services eliminated duplicate record keeping and reduced administrative staff, while improving services to clients.
The Division of Rehabilitation Services has begun shifting staff from regional offices to a network of smaller team headquarters or "hubs" located throughout the state. This allows staff to spend more time working with clients in their homes and workplaces and reduces office overhead.
In FY 97 the Divisions of Public Health and Family and Children Services combined resources to open Teen Plus, DHR's first interdivisional office. Teen Plus will coordinate all DHR's teen pregnancy prevention activities.

Uniform geographic areas

Until recently, each DHR division divided the state into a different set of service areas. The number of districts varied from 8 to 19, and boundaries rarely coincided.

II

STREAMLINING

Mental Health, Mental Retardation and Substance Abuse Services (MHMRSA) reduced the number of its regional planning boards from 19 to 13. Rehabilitation Services increased its districts from 8 to 12 and the Division of Aging Services consolidated its service areas to 12.
Consolidating geographic boundaries has saved money and staff. It has also helped move toward DHR's goal of all divisions sharing the same 12 service areas. This consistency will be less confusing for clients and make it easier for programs to collaborate.
Privatization and technology Privatization and more sophisticated technology are also helping DHR to streamline and improve services. This is happening throughout the agency, but Child Support Enforcement (CSE) offers an impressive example. CSE now contracts out collection of some of its most difficult cases as well as non-welfare cases in six locations. Private collection agencies are bringing the state $2.5 million a month, 10 percent of the total amount collected. Thanks to CSE's new STARS computer system, families receive their support
I

money much sooner than in the past. Checks are now mailed out daily instead of weekly. STARS is one of Georgia's largest computer systems and operates in 85 locations.
Working together Numerous other dedicated Georgia agencies, churches and community groups are involved with everything from foster care and adoption to teen pregnancy prevention and child abuse prevention. Since the most effective and least expensive way to get any job done is through teamwork, DHR has intensified its efforts to form partnerships with these other concerned groups.
The Family Connection DHR is a major player in the Family Connection, a collaboration between public agencies and private groups. It organizes communities to find better ways to strengthen families and improve children's health. Family Connection activities are as diverse as the communities involved. At most sites health and human services are grouped together in schools or neighborhood centers in a way that works better for

families. For example: In Ware County the Family Connection
helped the school system employ a registered nurse and established the Ware County Family Practice Center.
Polk County's Family Connection focuses on child care, paying for half of a parent's child care costs, and offering a resource library for parents and caregivers.
The Family Connection Center in Rome provides a neighborhood hub for scout troops, art programs for elementary school students, tutoring, after school programs, mental health and support groups.

MAINSTREAMING

In the past, having a mental or physical disability often meant being confined to an institution far from. home. Today we realize that most Georgians with disabilities want - and are able - to live and work in their community just like everyone else, although they may need help. DHR has continued to develop an innovative array of support services to help Georgians live as normal a life as possible - in their home towns.
Better lives for people with mental disabilities
With the development of more effective medications and the growth of new services, a record number of people with mental illness, mental retardation and substance abuse problems are being served in their communities. This not only improves their quality of life, but also makes communities safer and uses taxpayers' funds more wisely.
Georgia's MHMRSA services were reorganized following reform legislation passed by the General Assembly in 1993. Through regional boards, those who use the services participate in planning and decision making. As a result, consumers have more choice. The reforms led to many improvements by FY 96-97.

For the first time, Georgia is investing more money in community services than in hospitals, and regional hospitals have seen a 30 percent drop in admissions since 1995. By the end of FY 97, all areas of the state had some of these new community services, and 16 of 28 areas had the whole range. Community services include supervised living arrangements, day treatment, case management, and 24 hour stabilization for people in crisis.
Taking services to clients
Treating people with mental illness in the community often means reaching out to people rather than waiting for them to show up for clinic appointments. For the past two years, Mobile Crisis Teams in many areas have been going to people in crisis and immediately linking them up with treatment and support. This often prevents a repeat hospitalization.
Assertive Community Treatment (ACT) teams in nine regions pay special attention to people who have been hospitalized frequently. They monitor treatment and medication and help former patients with the problems of daily living that they find most

challenging, such as transportation, money management or housing. These teams are available around the clock if there is a crisis. They follow clients for up to 18 months before transferring them to less intense forms of intervention.
In southwest Georgia, hospital use by the first group of 34 former patients served by an ACT team decreased by 90 percent. Twenty-two people, many of whom had been homeless, moved into independent housing, 17 found jobs, and five are completing GED or attending vocational school.

MAINSTREAMING

Hospitals help patients live independently
State hospital staff serve on some of the Assertive Community Treatment teams, and they are finding other innovative ways to serve patients. Four group homes on the grounds of Central State Hospital serve 30 people who had

been long-term hospital residents; three of these homes opened in 1996. After intensive training in independent living skills, eight residents were discharged to other community programs, and only two have been readmitted to the hospital.

"Lori has adjusted beautifully in the community. She has her own
bedroom in a new group home, attends the local mental retardation services center, receives physical therapy and has a nurse who visits twice a day. Lori is just more alert and responsive and she looks wonderful. " - Beth English, executive director, Southwest Georgia Easter Seal Society
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Severely emotionally disturbed children and teens
It's especially difficult for children to live away from their families and familiar surroundings. Thanks to new community options, DHR has closed half of its shortterm hospital beds for children and adolescents and shifted those funds into additional community services. The whole state now has the complete range of nonresidential services children may need, and most communities also have residential services.
Serving people with mental retardation at home
People with mental retardation now can use federal Medicaid funds for community services instead of just institutional care. These funds can purchase supervised housing, specialized medical equipment, home-based health care, day training and programs that help them to earn a living. The number of consumers using these services has doubled since 1995, from 848 to 1,938.

"I could talk all day about the difference Rehabilitation Services made in my life. For one thing, it opened up a
considerable network for me that would have taken a lot of work and
knowledge that I didn't have. Now,
Rehab has arranged for me to get some equipment that will allow me to use the
state-of-the-art classroom facilities at the university and do research that is closer to the type done by students with sight. II - Roger Keeney, doctoral student, University of Georgia

Moving from the hospitals to the community
With communities having so much more to offer consumers with mental retardation, the department began cutting back on hospital facilities. In 1996, Rivers Crossing was closed. Thirtyfive of the 37 children and teenagers who had lived there are living successfully in community homes, and two were transferred to other institutions.
In 1996, DHR began planning to close Brook Run, a DeKalb County facility with 326 residents. The institution will close by the end of 1997, and residents will move to homes in their communities, usually with one or two roommates and staff, or into other hospitals. The funds saved will allow a total of 476 people to move to the community, including 150 currently on waiting lists for residential services and 164 in other state hospitals. Another 50 people will receive supported employment.
A chance to work
With the right support, many people with mental and physical disabilities who once were considered unemployable are getting jobs and keeping them.
Rehabilitation Services staff help people get training and any special equipment

they may need. They advise employers on adjustments in technology, communications and other aspects of the work environment that will enable people with disabilities to be productive. They may also serve as short-term "job coaches" at the workplace, heading off problems and increasing the chance that the new employee will succeed. Rehabilitation staff helped 2,929 people find and hold jobs in FY 97.
Over half the people helped by vocational rehabilitation have mental disabilities, including mental retardation and chronic mental illness. People with mental retardation can also get long-term help on the job from MHMRSA's supported employment program.
Former patients helping their peers
People who have been treated for mental disabilities or substance abuse have been making important contributions to improving care. DHR leads the nation in employing over 400 people who have used MHMRSA services. They help evaluate the services and help their peers recover and become selfreliant. They are especially effective as role models for others who are learning to live in their communities.

WELFARE REFORM

With the passage of the federal Personal Responsibility and Work Opportunity Act in 79961 the whole direction of welfare changed. Cash assistance changed from an unlimited benefit for poor single parentsl to time-limited assistance with a work requirement.
Welfare reform in Georgia began several years prior to the national biWs passage. DHR has been on the cutting edge in requiring recipients to fulfill certain responsibilities and offering support services to enable them to find and keep jobs. This has already paid off in dramatic decreases in the welfare rolls and significant increases in the numbers of former recipients becoming employed.
From January 79961 when workfirst!
was implemented statewidel to July 79971 the number of families receiving cash assistance decreased by 30 percentl or 401 606 familiesl resulting in
welfare savings of $ 722.7 million.
workfirst!
DHR's welfare-to-work program is called "workfirstf" This concept, first developed in 1995, makes finding a job the number one objective for everyone who goes to a county welfare office to

IIBarbara has obtained an FCC license and operates all of the station equipment. She also assists me and serves as overall office manager. She wears all of these hatsl and wears them quite well. Now nearing her third year of continuous employmentl Barbara is a shining example of success in job training programs. II - William Goodsonl general manager, WSST- TV

apply for public assistance. Eligibility workers work individually
with welfare applicants and recipients to determine what they need to get a job. DHR helps them obtain child care, health care coverage, transportation, and child support, all of which are key to becoming

self-supporting. They also refer them to job skills training and education. As a result, almost 12,000 applicants have avoided the welfare rolls in the last two years. DHR helped them find jobs, ranging from child care worker and receptionist to truck driver and welder.

WELFARE REFORM

Time limits and work requirements
Temporary Assistance for Needy Families (TANF) replaced the old cash assistance program, Aid to Families with Dependent Children (AFDC), in more than name. Unlike AFDC, TANF is shortterm. Georgia recipients are limited to a lifetime maximum of four years, one less than the five years allowed by the federal legislation that created TANF.
Work is a major component of TANF. All adult recipients with children over age one are required to participate in a workrelated activity. The number of welfare recipients participating in these activities - including skills training, job search or on-the-job training - increased from 37,000 in 1995 to 58,248 in 1997.
Child care
For many families, the lack of affordable day care is a major impediment to working. With child care often amounting to over $60 a week per child, parents who work at low-paying jobs often find it an impossible expense.
During the past two years, DHR's child care budget grew dramatically to meet the increased need created by welfare recipients entering the workforce.

Parents on TANF receive free child care for one year after they first go to work and while they are in training. Lowincome working families pay on a sliding scale fee.
Encouraging personal responsibility
DHR recognizes its responsibility to supply the structure and supports people's need to move off welfare. It also recognizes that TANF recipients must act on their own behalf to better their lives.

To symbolize this partnership, each applicant must sign a contract spelling out a plan for independence. Among the actions required of parents receiving aid are to attend school conferences, have their children vaccinated, and seek prenatal care if they become pregnant. Teenage parents are required to live with a parent or responsible adult and stay in school. A mother who has another child after receiving TANF for ten months will not receive additional cash assistance for that child.
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WELFARE REFORM
DHR works with employers
To encourage businesses to give TANF clients a chance, DHR offers companies a recipient's TANF check for nine months to help pay for training and wages. There are also federal tax credits for employers who provide child care and job training.

DHR staff contact business and civic organizations, education departments and other agencies that might help clients with job placement.
Working with the community in new ways
In Mitchell County, DFCS worked with everyone from rehabilitation services to the Chamber of Commerce to set up a "one stop" job service center. Clients can get adult literacy programs, GED instruction, career assessment, skills training, case management and

rehabilitation services all in one location. Bibb County DFCS, in cooperation with
several local businesses and community groups, opened a child care center for low-income families and teen mothers. Women who need child care to get a job can bring their children to the center while they work or attend classes. The center's staff includes former welfare recipients who have completed training as child care workers.
DeKalb DFCS links welfare recipients with metro Atlanta employers who are currently hiring, holding job fairs at the DFCS office twice a month.

CARING FOR CHILDREN AND FAMILIES

Helping babies from the start
Having healthy babies begins with prenatal care. DHR provided perinatal case management for 42,500 women who had high risk pregnancies in FY 97. Nurses and social workers make sure that these women get needed medical care and social services to have a healthy pregnancy. They also help mothers properly care for their newborns.
Right From the Start Medicaid paid prenatal care and delivery costs for almost 36,000 low-income women in FY 97. Medicaid also covers health care costs for low-income children up to age 19.

Almost 350,000 Georgia children live with their single mothers. Forty percent of these children

Prevention Teams). These men use educational materials developed by DHR to promote positive parenting and ways

have not seen their fathers in the last

to prevent child abuse in their

year. Recognizing the importance of

communities.

fathers' involvement in their children's

The Fatherhood Initiative, created by

lives, DHR launched major initiatives in

DHR's child support program, works

the past two years to teach young men

with men who are unable or unwilling

how to be more knowledgeable and

to pay their child support. It offers

responsible parents.

these men counseling, vocational

"Parent'Hood - /t's a Man's Thing,

training and job placement and a

Too" is a statewide public awareness

chance to playa supportive role in their

effort which uses men volunteers to

families. This pilot program is expanding

form Captain's Teams (Child Abuse

statewide.

III

CARING FOR CHILDREN AND FAMILIES

Preventing teen pregnancy
Teen pregnancy rates in Georgia have dropped nine percent in the past two years, an encouraging sign that prevention efforts are paying off. Yet, far too many young, unmarried teens are having babies, and these children are more likely to grow up in poverty, have health problems and develop difficulties in school.
To focus and streamline its prevention efforts, DHR created Teen Plus, an interdivisional office that coordinates all DHR teen pregnancy prevention programs. Communities with high teen
I

pregnancy rates will have a teen center. The 27 teen health centers provide counseling on abstinence and on family and school problems that contribute to risky behavior. The centers offer HIVjAIDS prevention and contraception, as well as other health services such as sports physicals and nutritional counseling. They are designed to be "teen friendly" and are located in shopping centers, community centers, welfare offices or vans that can visit several locations.
For the past two years, DHR has also worked in partnership with the Georgia Campaign for Adolescent Pregnancy

Prevention, a statewide nonprofit organization, sharing information, training and technical assistance.
Infant mortality
Infant mortality dropped 25 percent since 1990, and at 9.2 deaths per 1,000 live births, Georgia now has the lowest infant death rate in its history. More women are getting prenatal care early, and treatment of sickly newborns has improved.
There has also been a substantial drop in deaths due to Sudden Infant Death Syndrome (SIDS), the leading cause of infant death in Georgia. In the past three years, 33 percent fewer babies have died of SIDS. DHR's "Back to Sleep" campaign informs parents and child care professionals that SIDS risk is lower when babies sleep on their backs instead of their stomachs. The campaign also promotes other risk reduction measures such as breastfeeding and protecting babies from tobacco smoke.
Children 1st
Almost 30 percent of Georgia's newborns have physical or family problems that put them at risk for later health or learning problems. These children need attention so they can get

CARING FOR CHILDREN AND FAMILIES

help early, when it does the most good. The Children 1st program identifies babies who may need help and works with their parents to ensure that they have regular checkups and social services support. Children 1st followed 13,270 children from birth to age 3 in FY 97.
Many children are referred by hospital staff or physicians, but 70 percent of atrisk newborns are identified from information on their birth certificates. The department has installed electronic birth certificate software in most hospitals that deliver babies. Now information is transferred directly to DHR's vital records office and is immediately available to Children 1st.
Babies Can't Wait
The Babies Can't Wait program provided education and therapy to 6,000 children up to age 3 with developmental delays. Thanks to a new telehealth project, families can consult experts anywhere in the state without leaving their living rooms. Anyone in the program who has a television and telephone can participate.
Infant hearing screening
DHR has provided 14 hospitals with

equipment to screen for hearing problems in infants. This should reduce the need for later therapy and special education services.
Protecting kids from disease
Georgia now has one of the best childhood immunization rates in the country. In 1996, 88 percent of Georgia children seen at Public Health clinics were immunized, a significant achievement, considering that only 33 percent were immunized just ten years ago. By using a new computer program to analyze information from county health departments, DHR can spot areas where immunizations are falling behind. This system has been adopted by other states and by physicians.
Children's Medical Services
Many parents can't afford the specialized care needed by children with disabilities or chronic health problems.

Children's Medical Services (CMS) provides a range of health care services for these children and helped 14,400 in FY 97. CMS offers case management at 16 sites and contracts with physicians, dentists, therapists, audiologists and equipment providers for services.
Child care
More parents moving from welfare to work or job training have increased the demand for affordable day care. DHR
I

CARING FOR CHILDREN AND FAMILIES

has worked with the private sector to develop and support day care that is available to low-income families on a sliding fee scale. The number of children who received subsidized child care through DHR increased, and waiting lists for the working poor were reduced. By June 1997/ an average of 67/000 children a month were being cared for, a 74 percent increase over 1995.
DHR has also collaborated with other agencies to offer additional hours of care for children in Head Start programs so their parents can work a full day. Also, many children whose parents receive welfare attend the pre-K programs established in 1993 by Governor Miller.
Protecting children from abuse and neglect
For the first time in a decade, Georgia had a significant decrease in both reports and confirmed incidents of child abuse and neglect. Reports dropped from 77/640 in 1995 to 71/404 in 1996/ while confirmed reports declined from 15/833 to 14/359.
Since 1996/ the department has conducted a multifaceted public education campaign to teach responsible

parenting and encourage male involvement. Prevention messages were seen on bus cards and theater screens, and on T-shirts given to every baby born in Georgia during April 1997/ child abuse prevention month. This ongoing educational effort attracted hundreds of organizations across the state, who distributed the information and contributed items such as smoke detectors for fire prevention.

Because almost all cases of severe abuse involve drug use by a parent or caretaker, DHR's Child Protective Services set a policy for requiring immediate intervention when a newborn tests positive for exposure to drugs. Mothers are interviewed before they leave the hospital to ensure that they are referred for treatment and that the child is protected.

III

CARING FOR CHILDREN AND FAMILIES

Foster care
When children are in danger, the courts may award temporary custody of the child to the state. Most are placed with foster care families. DHR started a successful toll-free hotline to support and advise foster parents.
Some children have medical problems that make it difficult for foster parents to care for them at home. DHR collaborated with Atlanta's children's hospitals and other providers to offer specialized training to foster families who care for these children.
The Division of Family and Children Services was named "State Agency of the Year" by the National Foster Parent Association for its outstanding partnership with foster parents.
Finding families for children
Some cases of abuse and neglect are so severe that the court severs parental rights. DHR's job is to give these children a chance to be adopted as quickly as possible. In FY 97 a record number of children in the permanent custody of DHR, 744, were adopted through the Division of Family and Children Services.

The department has established a State Office of Adoptions to streamline its adoption process.
Georgia law has changed so that in certain severe cases of abuse, it is no longer necessary to try to reunite an abused child with its parents before adoption is considered. The expected effect is that children will be adopted at a younger age, giving them a more promising future.
Supporting children
Child support is crucial to the economic survival of many families. DHR collected $314 million in child support in FY 97, up from $255.8 million two years ago. This increase is due to a number of innovations. The state can now revoke or suspend the professional or driver's licenses of non-paying parents; they can intercept state and federal tax returns, unemployment compensation and lottery winnings; and they can collect child support from parents with children in

foster care. Also, private collection agencies now handle some of the most difficult cases.
Helping emotionally disturbed children Children with severe emotional problems require highly structured, intensive treatment, but they also long to be near familiar people and places. All of these children in Georgia now have access to care within their community, including counseling, 24 hour crisis teams that go to the home, day treatment
III programs and respite care. Most also
have access to therapeutic foster care and

CARING FOR CHILDREN AND FAM

group homes. Last year, community programs served 12,000 more of these youngsters than in FY 91, when few community services were available.
When children are seriously disturbed, they may need residential care. The Multi-Agency Team for Children (MATCH) arranges and purchases the intensive treatment that is right for each child. No Georgia child is placed out of state.

Stopping family violence
DHR funds a network of shelter and support services which offer victims of domestic violence a safe haven and a chance to take control of their lives. Since 1995, six new shelters were given funding and technical assistance. With the Georgia Coalition on Family Violence, DHR started a toll-free hotline, which links callers automatically to the nearest domestic violence program.

"I investigate allegations of abuse and neglect. But the part of my job that gives me the most satisfaction is helping families resolve their problems and work out better relationships. II - Roxanne Douberly, social services case manager, Toombs County DFCS

HEALTHY AND SAFE

Sometimes DHWs success is best measured by speculating on what might have happened had the department not been there. A recent example is the case of the suspect strawberries.
In the spring of 7997, DHR was
informed that strawberries linked to a hepatitis A outbreak in Michigan had been shipped to 30 south Georgia school systems. DHR sent public health staff to check school records and pinpoint where and when the berries had been served. The department then notified families, distributed information to anxious citizens and gave shots of

immune globulin to those who had been exposed recently enough for the inoculations to protect them.
Educational materials, permission slips for parents and other paperwork were transmitted instantly by computer, assuring that the inoculations could be given before the "window period" of effectiveness ended. No one developed symptoms related to the strawberries.
Detecting public health problems
DHR is uniquely positioned to analyze the health status of an entire community. Doctors, hospitals and laboratories from

around the state routinely send information about cases of infectious diseases to DHR's Division of Public Health, and state epidemiologists continually analyze the data for troublesome patterns. When a problem is discovered, DHR can mobilize resources to control it and evaluate the results. This surveillance system has been upgraded during the past few years to produce more complete and accurate data, a result of close collaboration with infection control nurses, physicians, and laboratories statewide.
Controlling outbreaks
A number of disease outbreaks have been detected and contained by the department in the last several years. Examples include a chicken pox outbreak in a day care center; staphylococcal food poisoning at a benefit dinner; a serious form of E. coli spread by a trailer park swimming pool; and an outbreak of syphilis among teenagers in an affluent Atlanta suburb.
One of the more unusual problems cropped up just before the 1995 holiday season. An Atlanta hospital reported treating small children for severe diarrhea caused by a bacteria found in the

HEALTHY AND SAFE

intestines of pigs. Investigators found that these children had one thing in common - they had been in a house where raw chitlins were being prepared for a holiday meal.
The following year, DHR responded by producing press releases, fliers, radio spots and brochures on how to safely prepare chitlins, based on scientifically tested information gathered from older women in the community. The fliers and brochures were distributed by county health departments, churches and community groups across the state.
I

Spotting trends
DHR's Vital Statistics office collects information from birth and death certificates and publishes data on numerous health and lifestyle factors, including the leading causes of death, teenage pregnancies, births to unmarried women, infant mortality rates, and marriage and divorce rates. This information, including breakdowns by county, is published annually. Last year, DHR put these statistics on the Internet so physicians, researchers and the public can have immediate access.

Public health research
The department conducts special surveys on many public health issues. The findings can be used by public and private groups to set policy, develop prevention and treatment programs, and measure the success of previous programs.
The Georgia Women's Health Survey, done two years ago in partnership with the federal Centers for Disease Control and Prevention, interviewed women on reproductive and other health topics including sexually transmitted diseases, drug and alcohol use, cancer screening, and patterns of child rearing.
The Behavior Risk Factor Surveillance System surveys Georgians yearly to determine the need for prevention education about matters such as tobacco and alcohol use, seatbelt use, bicycle helmet use, nutrition and exercise.
The Pregnancy Risk Assessment Monitoring System collects information from pregnant women about prenatal care and their health-related behaviors before and during pregnancy and after delivery.
Tuberculosis
Tuberculosis cases have declined from a peak of 909 cases in 1991 to 790 in

HEALTHY AND SAFE

1996. Last year, DHR closed the state TB hospital unit in Rome. Georgians with tuberculosis are now monitored carefully and cared for in their own communities by local specialists, at one-tenth the cost of hospital care. Public health staff makes sure that contagious patients take their medication so they can no longer spread TB, recover fully and do not develop drug-resistant strains of the disease. The department has contracted with the Georgia chapter of the American Lung Association to provide directly observed therapy, housing, food and social services for homeless TB patients in their own communities for a fraction of the cost of hospitalization.
Sexually transmitted diseases
Over one million Georgians were diagnosed with a sexually transmitted disease (STD) within the past year. Chlamydia is the most frequently reported infectious disease in the U.S., and in Georgia, officials estimate that there may be seven times more cases of chlamydia than there are of gonorrhea. An estimated 100,000 cases of chlamydia occur among Georgia women annually. The disease has no symptoms in women until serious complications develop.

The department is now screening for chlamydia as part of the routine preventive health services offered to young women in 35 public health clinics. The state can save more than $51 million in annual health care costs for chlamydia and its complications by detecting and treating the disease in its early stages.
To stop the spread of all STDs, the health department offers testing, counseling, education, treatment and partner notification.
Since there is a clear link between STDs and drug abuse, the department has begun special training for public health staff about substance abuse issues, and for substance abuse counselors about STDs, tuberculosis and other health problems.
AIDS
DHR distributes funds to 15 outpatient clinics and has teams in all 19 public health districts that manage the treatment and prevention of HIV/AIDS. In the past few years the rate of increase of AIDS cases has levelled off, and many people with HIV/AIDS are living longer due to improved medication. However, cases among women and minorities are increasing, especially in rural Georgia.

III do HIV/AIDS education. I go to the high risk areas where people are using alcohol and drugsl way down in the country far away from the health department. Someone will come up to me and saYt IWe appreciate your coming outl because no one else comes out here to provide us this information. I Thats the best reward I can have. /I - Joel Myersl health educator, Glynn County

HEALTHY AND SAFE

DHR has funded 22 community organizations to carry out local grassroots HIV prevention campaigns, especially in minority communities.
Community networking
Tracking the spread of infectious diseases takes public health "disease detectives" beyond the traditional method of interviewing family members. Getting to know a community and its unique social patterns can be critical.
For example, when investigating an outbreak of tuberculosis in south Georgia, public health staff discovered that the disease was being passed through social contacts including an illegal "floating" card game. By winning the trust of community members, they were able to detect the pattern and contact more people who had been exposed, preventing new cases of TB.
In an Atlanta pilot project, DHR has stationed public health staff in neighborhoods that have clusters of health problems. The staff gets to know the people and social life in the community to track and head off the spread of infectious disease, as well as help identify individuals in need of prevention and other medical or social services.

Preventing and controlling chronic diseases
DHR works throughout the state to reduce and prevent chronic diseases such as cancer and heart disease. Through its cancer control program, 10,000 lowincome women received free mammograms and 127,000 were screened for cervical cancer in FY 97. Six hundred Georgians with curable cancer received life-saving treatment paid through the State Cancer Aid Program.
Stroke and heart attack prevention clinics served 16,000 Georgians who suffered from hypertension and other risk factors for heart disease.
A clean and safe environment
DHR is responsible for ensuring that Georgians have safe, sanitary basic services and high quality emergency services. The department inspects restaurants, schools and sewage systems, and certifies and licenses emergency medical technicians and ambulance services. It also licenses and inspects nursing homes, personal care homes, home care providers, hospices, drug treatment programs, outpatient facilities, X-ray machines, adoption agencies, maternity homes, hospitals and day care centers.

"My wark is impartant because clean water and sewage are the main things yau need far public health; they're what yau have ta start with far basic sanitatian. I inspect abaut six ar seven sites a day and I like knawing that I help keep the public safe. "
- Marvin Pough, environmental specialist, Fulton County Health Department

HEALTHY AND SAFE

The department conducts criminal records checks for employees of day care centers, personal care homes, and residential facilities for troubled children, and maintains a nurse aide registry which lists people ineligible to work in nursing homes because they were found to have abused, neglected, or stolen funds from a resident.
DHR environmentalists, in cooperation with Emory University, are investigating blood samples of former employees at a hazardous waste site near Brunswick to detect possible health problems.
Preventing injuries
Through community coalitions and county health departments, DHR promotes ways to prevent unnecessary injuries, especially to children. The department provides car safety seats and bicycle helmets to children of low-income families.
State hospitals
The state operates eight hospitals for patients with mental illness or substance abuse problems who are in crisis. Patients are usually hospitalized for a short time until they can be returned to community

programs. DHR also offers institutional care to people with severe or profound mental retardation.
Warm Springs Institute for Rehabilitation
The Roosevelt Warm Springs Institute for Rehabilitation provides residential educational, vocational and physical rehabilitation for people with disabilities. Last year, the Institute opened

a therapeutic recreation center, the South's only totally accessible indoor and outdoor recreation complex. The center opened in time for 110 Dutch athletes to train for the 1996 Paralympics games.
The Institute also opened a footcare program to prevent amputations related to diabetes, and five satellite clinics across the state to provide evaluation and followup.
Warm Springs

HEALTHY AND SAFE

Substance abuse treatment
Substance abuse is a major health problem in Georgia. DHR continues to develop specialized treatment for people addicted to alcohol and drugs. The department recently opened three new treatment programs in Albany, Americus and Thomasville for pregnant women and new mothers who have alcohol or drug problems. They offer treatment, a safe place to live, referral to prenatal care, and help with job skills and child care. DHR also sponsors statewide substance abuse prevention projects, including the annual Georgia Red Ribbon Campaign, and supports community prevention services through the MHMRSA regional boards. Community services include preschool and parenting programs, teen centers, and mentoring or tutorial programs to help youngsters avoid alcohol and other drug use.
Curbing drunk driving
Fines and jail sentences alone do not change drinking and driving behavior for people who have a problem with alcohol or other drugs. Since 1990, DUI offenders have been required to participate in an

assessment of their risk for problems and an intense educational program in order to have their licenses returned. DHR's Alcohol and Drug Risk Reduction program certifies DUI programs and trains their staff.
Tobacco use
DHR works with community groups throughout the state to educate the public about tobacco use and strengthen public policy to prevent this major cause of disease and death. The department is also conducting a federally mandated survey that tracks illegal sales of tobacco to children.

AGING INDEPENDENTLY

Older Georgians want to live independently in their own homes for as long as they can, but many with disabilities or chronic medical problems need help to stay at home. DHR funds a network of community services enabling an increasing number of people to stay in familiar surroundings and avoid or delay entering nursing homes.
Remaining at home
The Medicaid-funded Community Care Services Program (CCSP) offers older people an array of services in their homes and communities, including meals, some health care, personal care, help with housework, respite care for caregivers, alternative living arrangements, and emergency response services. In FY 97, 13,850 Georgians at risk of institutional placement were served by this program, which saved taxpayers approximately $171.7 million in state and federal Medicaid funds that would otherwise have been spent for nursing home care.
Options for independent living
DHR offers alternative living arrangements for frail older people who can't live at home or with family. In

FY 97, over 700 were served in small family settings and 1,153 in larger group facilities through CCSP, an increase of 14 percent since FY 95. The department is expanding this program so that people throughout the state will have more choices in their home communities.
Other community services
DHR also offers many services to older people regardless of Medicaid eligibility. For example, during FY 97, the department delivered meals to over 45,500 people in their homes or in senior centers. DHR also provides transportation to health care, social services and community activities; homemaker services; adult day care; and programs for people with Alzheimer's disease.
Protecting the vulnerable
The Long-Term Care Ombudsman Program advocates for residents of nursing homes and personal care homes, and works with these institutions to resolve problems. Last year DHR's ombudsmen helped resolve 5,720 complaints and gave information to over 120,000 people.
In cases where older Georgians are

AGING INDEPENDENTLY

abused or financially exploited or neglected, the department investigates and intervenes on the senior's behalf, through DFCS Adult Protective Services (APS). Last year APS helped about 12,000 people over age 60.
The Elderly Legal Assistance Program provides legal advice and representation

to seniors. The program helped almost 26,000 Georgians in FY 97.
Understanding the insurance maze
Health insurance options can be confusing. Health Insurance Counseling and Referral (HICARE) assists older

Georgians who need help understanding Medicare, Medicaid, doctors' bills or supplemental and long-term care insurance. Over 6,500 people were helped in FY 97.
Alzheimer's programs
DHR offers a variety of services to Alzheimer's patients and their caregivers, including day care; respite care for caregivers; and education for medical professionals, police, clergy and caregivers.
Jobs for older people
Employers sometimes overlook older job seekers. DHR finds part-time community service jobs for low-income seniors and helps them find nonsubsidized jobs through the Senior Community Services Employment Program (SCSEP). SCSEP found jobs for 1,860 people last year.
Home adaptations
Pilot programs in two regions help many people with disabilities carry out daily activities, through simple changes in their homes such as ramps, remodeled kitchens, and "grab bars" in bathrooms.

AGING INDEPENDENTLY
Some of these changes allow caregivers with physical disabilities to continue to look after relatives with Alzheimer's disease, while others benefit people with disabilities who live alone. A Medicaid waiver has been requested to fund expansion of the program.
Services for people with developmental disabilities During the past two years, the Division of Aging Services has been offering CCSP services to people under 55 who have physical problems that make daily living difficult. The agency has joined with the disability community to advocate for improved accessibility and other issues affecting people with disabilities, regardless of age.

THE 1996 OLYMPIC GAMES

The 7996 Olympics drew 2 million visitors to Georgia during the hottest time of the year. With them came thousands of temporary food vendors/ portable toilets/ overheated tourists and the potential
for disaster. It was DHWs responsibility to protect the health and safety of all
visitors outside the venues where the games were taking place.

Prepared for anything
For three years before the Games, DHR's Division of Public Health worked with district and county staff on strategies to deal with heat illness, food contamination and other possible health hazards. They also met with other federal and state agencies to train and develop disaster management plans in case of terrorism.
Keeping watch
DHR developed an electronic surveillance system to collect information from key hospitals and physicians daily throughout the Olympics, so that epidemiologists could quickly detect disease outbreaks and any other unusual health problems. This resulted in a strengthened relationship with medical professionals who report diseases, and has led to improvements in the ongoing surveillance system.

Safe games
During the games, DHR opened a 24hour headquarters in downtown Atlanta to respond to emergencies, coordinate food inspections and organize distribution of prevention information and supplies.
Environmentalists performed over 14,600 food service inspections during the Olympics and made 144,000 inspections of solid waste disposal facilities, water systems, swimming pools and toilets. Food safety and heat illness had caused problems at previous games, but there were no significant problems in Georgia.
An ounce of prevention
One of the department's greatest concerns was heat illness. There was an influx of visitors from allover the world, many of whom had never experienced Georgia heat and humidity. DHR set up tents in downtown Atlanta and Savannah that distributed water, prevention information, sunscreen, fans and the popular Foreign Legion-style paper hats. The department also dressed comic strip heroine Brenda Starr in cool, comfortable clothes and a broad hat and displayed her image on posters, bus cards and a

downtown billboard, reminding the public to take precautions against heat.
DHR printed 180,000 children's identification tags and worked with a coalition that placed bags of health and safety information on 30,000 hotel room doorknobs.
The bomb After the bombing in Centennial Park, the department contacted area hospitals and made a complete list of victims and their conditions. Emergency mental health counselors went to hospitals to work with victims and their families. DHR

also opened a support center in cooperation with other agencies, offering counseling to anyone affected by the bombing.
Friendship centers The crowds drawn
to downtown Atlanta were sure to cause extra stress for many people with mental illness. DHR worked with a coalition of

THE 1996 OLYMPIC GAMES

t

churches and mental health service consumers to open five "friendship centers" in Atlanta where people could escape from the confusion in the streets. The centers offered recreation, refreshments and volunteers who were ready to listen and help anyone in crisis. One third of these counselors were people who were in recovery from mental illness. The project won an award from Emory University. DHR and the churches have reopened three centers in Atlanta on a permanent basis.

LOOKING AHEAD

During the next few years, DHR will continue to improve service to the public and increase efficiency by emphasizing programs that promote self sufficiency and community involvement and by streamlining and improving service coordination.
Streamlining the mental health system
The operation of state mental hospitals will be streamlined by consolidating administrative functions. Two groups of hospitals will combine administrative and support staffs and end duplication of functions such as food service, personnel and plant operations.
Brook Run will have closed by the end of 1997 so that more people with mental retardation can be served in the community. A proposal to close the Georgia Mental Health Institute will be submitted to the legislature. The regional boards will continue to improve access to community mental health services and reduce hospital use even further.
Plans are to complete the comprehensive network of community services for adults with mental illness and children and teenagers who are severely emotionally disturbed. Substance abuse treatment for pregnant women and
Ii

mothers of small children will be expanded. This will help some women on welfare become employed.
New ways to help people with disabilities
Rehabilitation Services will complete the switch from district offices to a statewide network of small "hubs" that send staff out to clients and employers. Using new technology, rehabilitation specialists will be able to create "virtual workplaces" to help people with disabilities prepare for employment. A mobile technology lab is already going to people in rural areas to evaluate them and help them choose technology needed for their work. A new medical case management system will help clients handle medical problems that can interfere with their ability to work.
Moving more people to work Federal guidelines require 50 percent of welfare recipients to be in work activities by 2002. To ensure that more parents can enter the labor force, DHR has entered into a contract with the state Department of Labor (DOL) and the Department of Technical and Adult Education (DTAE). DHR will continue

supporting them with social services such as child care and transportation, while DOL and DTAE handle job training and placement.
Many applicants who are hardest to place remain on the welfare rolls. They may have mental or physical disabilities or substance abuse problems. Some are taking care of grandchildren. DHR will offer specialized services to help these people become self-sufficient.
long-term care The department is implementing a plan to coordinate services for people of all ages who have chronic physical or mental disabilities requiring care for a long period of time. The aim is to make these services easier for clients to use, reduce paperwork, and reduce the need for care in nursing homes or hospitals.
Regulatory challenges
DHR's Office of Regulatory Services will continue to be confronted with a proliferation of new types of health care providers, new technology, and new services that don't always fit into the old regulatory categories. For example, ORS now monitors informal child care providers - usually relatives - whose services are subsidized by DFCS to help

LOOKING AHEAD

low-income parents hold jobs. The office will review licensing standards for child care and for hospitals and nursing homes, and provide more information to the public about licensing and regulation of services in Georgia.
Coalitions for healthy communities
DHR and the Department of Medical Assistance have contracted for a study of services for children with chronic conditions or disabilities who are frequent users of medical care, to find better ways to provide and pay for those services in a managed care environment.
State and county public health agencies will continue to work with community groups and private providers on many complex public health issues. One coalition is concerned with the impact of STDs.
Teen Plus will continue to work toward its goal of lowering Georgia's teenage pregnancy rate by 15 percent by the year 2,000. The program enlists the efforts of nonprofit community organizations as well as DHR agencies in a comprehensive approach emphasizing abstinence. An important component will be a thorough evaluation of the program's effectiveness.

A state-of-the-art state laboratory
By the end of 1997 a new state health laboratory will have opened in Atlanta, which will bring this key public health service into the 21 st century. For the first time, DHR will have training facilities for laboratory technicians; greatly improved security; and improved ability to meet any new challenges, such as the HIV/AIDS epidemic that has strained the lab's capacity in recent years.
Caring for more children
New federal funding will enable Georgia to expand medical insurance to thousands more low- and moderateincome children who are not now covered by Medicaid or private insurance. DHR is helping to determine how best to provide the new insurance.
Children 1st will expand statewide. This means that for the first time all Georgia newborns who are at risk for developmental disabilities or other problems can be identified and linked with medical care and other services. Children will now be followed until they are eligible for the pre-K program at age 4.

Getting there
Clients who need rides to clinics, to senior centers and to job training sites will have better access to transportation through a coordinated transportation system.
High-tech benefits
One dramatic change will be a switch from welfare checks and paper food stamps to debit cards that clients can use to make purchases or withdrawals at automated teller machines and grocery stores.
This system, called electronic benefit transfer (EBT), is expected to reduce theft, fraud and illegal sale of food stamps and eliminate paperwork for grocery stores. It will also eliminate the cost of printing, handling and delivering the paper benefits. EBT has already been piloted successfully in several areas and will be implemented statewide during 1998.
Cutting paperwork
Pilot projects will test ways to reduce paperwork and red tape for people who need help from different DHR programs. Highest priority will be given to eliminating multiple eligibility forms.

BUDGET & ORGANIZATION

ne Georgia Department of Human Resources was created by the General Assembly in 1972 and provides the widest range of services of any agency in state government. In
FY 97 DHR's share of the state budget
was 10.1 percent. Most of DHR's 23,000 employees
provide direct services. The state employees, along with county health department and community service board staff, include: nurses, caseworkers, child abuse investigators, rehabilitation counselors, child support agents, therapists, hospital aides, data entry clerks, nursing home and day care inspectors, lab technicians and epidemiologists.
The services are administered by five divisions and two offices: Aging Services; Family and Children Services; Mental Health, Mental Retardation and Substance Abuse; Public Health; Rehabilitation Services; the Office of Regulatory Services; and the State Office of Adoptions.
Division of Aging Services
Director - Judith Hagebak
The division administers a statewide system of services for older Georgians. Most of these services are provided by the 12 regional Area Agencies on Aging

Georgia Department of Human Resources Organizational Chart
Office of the Governor

Board of Human Resources

Commissioner's Office

Policy and Government
Services

I
Office of Audits

I
Office of Technology and Support

Office of Human Resource
Management

Office of Planning and Budget Services

I
Office of Financial Services

I
Office of Hu man Resource and Organizational Development

Office of Regulatory
Services

Division of Family and Children Services

Division of Mental Health, Mental Retardation and
Substance Abuse

Division of Rehabilitation
Services

I
Division of Public Health

I
Division of Aging Services

I
State Offkeof Adoptions

(MAs) with whom the department subcontracts.
The services offered to Georgia's seniors include:
home-delivered and congregate meals
in-home health care and housekeeping

adult day care information and referral to
community resources
ombudsmen for people in long-term care facilities
employment opportunities support and care for people with
Alzheimer's Disease

BUDGET & ORGANIZATION'

.

counseling about health insurance and legal matters
FY 97 expenditures: $58.5 million, including $29.4 million in state funds.
Division of Family and Children Services
Interim Director - Peg Peters*
One hundred and fifty-nine county departments of Family and Children Services (DFCS) administer protective services, employment and financial assistance programs for low-income families, and child support enforcement.
DFCS is responsible for: protective services for children and
adults Medicaid eligibility determinations
foster care subsidized child care troubled children placement welfare and food stamps job training and job search assistance
for welfare applicants and recipients child support enforcement
FY 97 expenditures: $1.07 billion, including $385 million in state funds. *Michael Thurmond was director FY 96-97.

Mental Health, Mental Retardation and
Substance Abuse
Director - Carl E. Roland, Jr.
Thirteen regional boards, with strong consumer and family membership, decide how public funds should be spent to serve people with mental illness, mental retardation, and substance abuse problems. The boards contract with eight state hospitals (located in Atlanta (2), Augusta, Columbus, Milledgeville, Rome, Savannah, and Thomasville), one mental retardation institution, 28 community service boards, boards of health and other providers to offer:
inpatient and outpatient treatment, support services and residential treatment
emergency services and respite care
day programs to teach work and daily living skills
group homes, supervised apartments and other living arrangements
community case management services
prevention and education programs
supported employment FY 97 expenditures: $697.4 million,
including $498 million in state funds.

Division of Public Health
Director Kathleen E. Toomey, M.D., M.P.H.*
Health departments located in every Georgia county are responsible for protecting public health and safety and preventing or reducing incidences of disease or disability. The state division provides grants-in-aid and technical assistance to the counties. The state also monitors disease outbreaks and maintains records of all births and deaths.
Health departments
investigate community health problems
regulate and inspect public facilities and services
test for and treat sexually transmitted diseases, HIVjAIDS, and tuberculosis
provide immunizations and prevention education
promote good health habits
FY 97 expenditures: $283.2 million including $153.2 million in state funds
*Patrick J. Meehan, M.D., was director
FY 96-97.

BUDGET & ORGANIZATION

Division of Rehabilitation Services
Director - Peggy Rosser
Local offices throughout Georgia coordinate employment readiness and other services for people with physical, mental or emotional disabilities.
Rehabilitation services enable people with disabilities to lead fuller lives by providing: vocational rehabilitation focused on
going to work assistive technology information and
aids independent living services comprehensive residential
rehabilitation at the Roosevelt Warm Springs Institute employment through Industries for the Blind and the Business Enterprise program FY 97 expenditures: $147.4 million, including $24.6 million in state funds.
Office of Regulatory Services Director - Martin J. Rotter
This office inspects and licenses a variety of health and child care facilities and investigates complaints from citizens

and consumers. Also, ORS certifies hospitals and some other health care facilities to receive Medicaid and Medicare funds.
ORS is responsible for regulating:
day care centers
adoption agencies laboratories and x-ray machines
nursing homes and personal care homes
hospitals, home health agencies, hospices, and other health care facilities
FY 97 expenditures: $12.6 million, including $6.7 million in state funds.
State Office of Adoptions
Director - Forrest Burson
Since January 1, 1997 the office has administered a system of adoption services for children in permanent custody of DHR. State staff work with 13 regional adoption coordinators, county departments of Family and Children Services, and private adoption agencies. Services include:
assessments of children needing adoption and families Wishing to adopt them
adoption assistance to families following placement

respite and crisis intervention for adoptive families
public education and recruitment of families
information and referral FY 97 expenditures: During FY 97
expenditures for the State Office of Adoptions were administered by DFCS.

BUDGET & ORGANIZATION

Where DHR Funds Come From



State $1.2 billion

Federal $904 million
Other $237 million
Other funds include: DOAS indirect funds Child Support Enforcement incentives Medicaid interagency transfers Patient fees and insurance

TOTAL FY 97 BUDGET: $2.3 billion

Where DHR Funds Go ...

Grants to county health departments, county departments of Family & Children Services and
~~~~-
community mental health, mental retardation and substance abuse services

Direct services to .-------- children, elderly,
and disabled

Regulation/enforcement, licensing, child support,-~~ fraud and abuse

Administration, including / .

district and regional offices

i

AFDC/TANF benefits

.~
Hospitals and Roosevelt Warm Springs Institute for Rehabilitation

DHR SERVICES 1997

AIDS Cases recorded

2,424 *

Drug Assistance Program - people given medication 1,429

HIV tests administered

89,576

Ambulance services licensed

265

Assistive technology recipients

.426

Cancer Breast cancer screening - free mammograms

10,000

Pap tests given

127,000

Treatment paid for low-income people

600

Children Adoptions arranged by DHR

.744

At-risk babies monitored for health/development problems

13,270

Car safety seats distributed

.3,500

Child abuse reports confirmed

14,359*

Child abuse reports investigated

51,981 *

Children served in subsidized day care (monthly average)

56, 160

Chronically ill/disabled children served by Children's Medical Services

14,400

Day care centers licensed

1,184

Developmentally delayed children who received early

intervention services

6,000

Family day care homes registered
II' Calendar year 1996

6,037

Foster care - children served (monthly average)

12,000

Foster care homes

4,300

Group day care homes licensed

222

Health screenings - low income children

200,000

Immunization - 2-year-olds seen by Public Health adequately

immunized

88 percent

Infant mortality rate (deaths under age one per 1000 live births)

9.2 *

Infant mortality rate decline 1994-96

10%

Lead poisoning prevention - children tested (number found

with high blood lead levels)

12,435 (1,013)

Screened in school for vision, hearing, scoliosis

200,000

Severely emotionally disturbed placed in therapeutic residential care (MATCH program)

1,203

Child Support Amount collected
Collections increase since 1991 Parents under court order to pay

$314.1 million 102%
244,559

Criminal records checks for staff of day care centers, personal

care homes and residences for troubled children

.35,029

Disabilities

Average annual income of disabled clients helped to find

jobs

$1,329 before; $9,834 after

SSI and SSDI claims decided

118,338

Blind people (125) employed as food vendors by Business

Enterprise Program - average annual income

$21,745

DHR SERVICES 1997

Blind people (149) employed in manufacturing by Georgia

Industries for the Blind - annual sales

$9.2 million

Disabled adults served

24, 169

People helped to become employed

2,929

. Roosevelt Warm Springs Institute for Rehabilitation - people

served

3,605

Treatment for people with mental disabilities: see mental illness, mental retardation and/or substance abuse.

Domestic violence Calls to hotline

52,485

Victims assisted through shelters .3,663 women, 4,304 children

Elderly Adult day care - served Alzheimer's disease - people in day care Frail elderly helped to live at home by CCSP Group meals - people served

678 307 13,850 20,026

Health insurance counseling for elderly (HICARE) people served

6,541

Helped to find jobs by Senior Community Service Employment Program

1,860

Home delivered meals served

25,516

Homemaker services

6,464

Legal Assistance helped

25,948

Long-term Care Ombudsman - complaints mediated 5,720

Protective services for abused or neglected - people helped 12,000

* Calendar year 1996

Transportation services - people helped

14/1 78

Emergency medical technicians certified

600

Energy assistance grants to low-income families for heating

and cooling

82/000

Family Connection community collaborations to serve

families better

86

Family planning - women and men served

164/520

Family services to strengthen families and help children stay at

home safely - people served

8/280

Food stamp recipients (monthly average)

.728,720

Food stamps issued

$621 million

Forensic services - people accused of crimes given psychiatric

evaluation

1/024

Laboratory tests performed

over 2.5 million

Medicaid Applications reviewed for eligibility
Right From the Start, children under age 19 covered
Right From the Start/ paid for prenatal care and deliveries

225,425 342/354
35/850

Mental illness/ mental retardation and/or substance abuse People served in outpatient community programs ......161,446

People served in state-supported community residential

arrangements

25/917

People served in state hospitals

19/261

Children and adolescents, severely emotionally disturbed, served in

community programs

33/772

DHR SERVICES 1997

Children and adolescents, severely emotionally disturbed,

served in state hospitals

1,829

People served by day treatment or day training programs

23, 111

Substance abuse - children and adolescents treated in

community programs

1,380

Migrant farm workers given primary health care

.7,249

Nurse's aides listed on registry

60,000

Nursing homes inspected

368

Nutrition - Women, Infants and Children (WIC) program -

people served (monthly average)

230,000

Perinatal case management - high risk pregnant women

served

42,552

Personal care homes inspected

1,902

Primary health care centers - people served

11,500

Refugees - received primary health care

2,232

Refugees - received social services

8,600

Restaurant inspections (including temporary Olympics

vendors)

61,436

Sewage systems inspected and approved

30,000

Sexually transmitted diseases reported: early syphilis/gonorrhea/

chlamydia

2,013/19,937/13,596

SSI eligibility - see Disabilities

Stroke and heart attack prevention clinics people served

17,000

Teenage pregnancy rate decline 1994-96

11 %

Em * Calendar year 1996

Teenage pregnancy rate (pregnancies per 1,000 girls 15-19)...96.7*

Troubled children - see Children, severely emotionally disturbed

Tuberculosis - cases reported

.790*

Welfare

Applicants diverted from rolls Jan-June 1997

.7,380

Cash assistance paid

$321 million

Decrease in rolls (savings) .40,606 families ($122.7 million)

Employment found for recipients

19,850

Families receiving - decline Jan 1996-June 1997

.30%

Families receiving (monthly average)

97,855

Sanctions due to family cap

6,088

Welfare and food stamp fraud cases investigated;

overpayments discovered

.25,744; $15.3 million

X-ray facilities inspected and regulated

5,450

DHR Management Team
Tommy C. Olmstead, Commissioner Yvonne Johnson, Deputy Commissioner Alan Essig, Assistant Commissioner for Policy
and Government Services Sharon Bivens, Assistant to the Commissioner
Jim Bricker, Assistant to the Commissioner Floyd Wood, Assistant to the Commissioner Forrest Burson, Director, State Office of Adoptions Judith Hagebak, Director, Division of Aging Services
Peg Peters, Interim Director, Division of Family & Children Services
Carl E. Roland, Jr., Director, Division of Mental Health, Mental Retardation and Substance Abuse
Peggy Rosser, Director, Division of Rehabilitation Services Martin J. Rotter, Director, Office of Regulatory Services
Kathleen E. Toomey, M.D., M.P.H. Director, Division of Public Health David Allen, Director, Office of Technology and Support Joyce Goldberg, Director of Communications
Lynn Ladd, Director, Office of Planning and Budget Services Reuben Lasseter, Director of Human Resources Management
Kate Pfirman, Director, Office of Financial Services Larry Ricks, Director, Office of Audits
Dennis W. Yarman, Director, Human Resource and Organizational Development

Produced by DHR's Office of Communications - Joyce Goldberg, Director
Writing and editing - Lisa Crowe, Barbara ]oye, Renee Huie
Design and production - Dianne Phillips Photography - Bill Gwynn, George
Armstrong
Special thanks to ... the DHR clients and staff who agreed to appear in the photographs, and to all the DHR staff who gathered the information for this report, especially Harry Burkett, Aging Services; Roger Smith, Family and Children Services; Xenia Wiggins, Mental Health, Mental Retardation, and Substance Abuse; Lynda Pittman-Cotton, Public Health; Dennis Fennell, Rehabilitation Services; Rosserlyn Andersen and Velma McCrayDuncan, State Office of Adoptions; Enid Klapper, Office of Regulatory Services; and Rebecca Roper, Office of Planning and Budget Services.