Governor-elect Charlie Baker knows from experience that the state’s human services system — child protection, mental illness, welfare, and juvenile justice — will pose the stiffest challenge for his new administration at the highest stakes. Baker served as secretary of health and human services from 1992 to 1994, a time when scores of people died under the care or control of state human service agencies — 42 suicides in the state mental health system in 1994 alone, according to a Globe article from that period. Human services advocates pointed — as they often do — to insufficient budgets. State officials pointed — as they often do— to better record-keeping that accounted for more suicides.
Perfection is impossible in a field that deals hourly with family pathology, psychosis, abused children, and people surviving on the fringes of society. Despite the grim statistics, Baker did a good job of distributing resources in the early 1990s, especially in a state that was just emerging from a fiscal free fall. There is not a governor or human services secretary alive who can promise — credibly — that no one will die under state care. All that state officials can pledge — and be held accountable for — is that reliable systems and competent workers are in place wherever they are needed.
The first and most important challenge for Baker is to appoint a human services secretary with the ability to restore public confidence in the Department of Children and Families. The agency (formerly the Department of Social Services) fell apart during the Patrick administration, reaching its nadir in April with the discovery of the body of 5-year-old Jeremiah Oliver of Fitchburg. A state social worker assigned to make mandatory visits to the boy’s home had failed to do so, which turned out to be an all-too-common occurrence across the state’s child protection system.
Baker describes himself as “a what works person.” Now he needs to find a human services secretary of similar mindset. The human services post calls for a great public manager. Someone with deep experience in the helping professions would be an added benefit, but it’s not sufficient. The failure to provide sound human services in Massachusetts has never been a lack of compassion. The problem is rooted in a lack of organizational and management skills across the system.
During the campaign, Baker said he would try to come up with “a single case management approach,” which essentially calls for the integration of services across several human service agencies. It’s common for someone to have contact with the state’s child protection agency, mental health practitioners, and welfare system at the same time. But each agency poses separate application procedures and administrative obstacles. Massachusetts needs a secretary who can simplify and improve client access to benefits and services. And done well, such reforms should lead to potential savings in the state’s $5.6 billion human services budget.
In the early 1990s, former Governor William Weld charged Baker with the task of removing human services from the list of “budget busters” blamed for pushing the state to the fiscal brink. He accomplished that by placing more patients in Medicaid-eligible facilities and expanding a system of nonprofit, community-based group homes for the mentally ill and developmentally disabled to replace the larger and more expensive state hospitals. But chronically low salaries make it difficult for these groups to attract and retain a qualified, privatized workforce. And despite the passage of rate-setting legislation in 2008, annual salary increases rarely keep up with inflation.
Baker will inherit a lawsuit from the Providers’ Council — composed of 270 private, community-based providers — aimed at the state’s failure to fund the salary increases. He promised during the campaign to make good on the raises, which is only right given his role in the creation of this system. But Baker also needs to rid the human services network of “redundant, preposterous regulations,” according to Providers’ Council president Michael Weekes. Ensuring that providers document their services and justify their costs is imperative, said Weekes. But providers are drowning in financial reports, audits, personnel minutiae, and endless documentation that goes well beyond the requirements of accountability.
Baker will need to bring his management skills from the private and public sectors to bear on this overregulated industry. It’s not getting any easier out there. And providers need the flexibility to respond to new human service and medical challenges, including an upswing in childhood autistic disorders and traumatic brain injuries suffered by returning veterans.
Baker is a pragmatist. His reputation for finding practical solutions to intractable problems will be tested first and foremost by how he approaches the state’s human services system.