A new strategic direction for mental health care in Milwaukee County

A recent series of articles in the Milwaukee Journal Sentinel on safety issues at Milwaukee County's Mental Health Complex is the latest to raise questions about the level and quality of mental health care in our community. Unfortunately, while these exposes have ranked high in shock value, they have yet to produce the comprehensive redesign of the public and private mental health systems that many feel is needed.

A report released today may provide the impetus for such change. The report - authored by Massachusetts-based Human Services Research Institute - culminates a two-year project initiated by the Milwaukee Health Care Partnership (a collaboration headed by the five major health systems in Milwaukee County), the Medical Society of Milwaukee County, and the Milwaukee County Behavioral Health Division. The project’s objective was to bring in national expertise to examine gaps in the existing adult mental health care delivery system and devise ways to transform that system into one that more closely mirrors national best practices. The Public Policy Forum has served as local facilitator for the project.

Readers of the report should be forewarned - in many respects, this is a technical document that contains dozens of pages of data findings and analysis and lots of references to mental health policies and practices that may not be familiar to the average citizen.

But that also may be its strength. Indeed, by suggesting a new strategic direction based on data and facts, it is hoped that this report can de-politicize and de-sensationalize a set of complex issues and challenges that must be confronted for the sake of the overall health of our community and the fiscal health of Milwaukee County government.

Some of the report's recommendations may be controversial, and some may require new fiscal resources (though the report emphasizes re-directing existing dollars, as opposed to finding new ones). Implementing those recommendations will not be easy, and will require teamwork and cooperation from several levels of government, law enforcement, consumers, advocates, community-based organizations, and private sector payers and providers. Yet, the diversity of the stakeholders group that has brought the project this far certainly provides hope.

The media release accompanying the report - which provides additional details about the project's history and the stakeholders that have guided it - can be accessed here. The executive summary and full report can be accessed here and here.

What’s the right peer group for Metro Milwaukee?

Identifying the right group of metro areas with which to compare Milwaukee is a frequent dilemma for Public Policy Forum staff. Our answer is ever evolving. Typical decisions affecting our choices include level of geography (city, metropolitan statistical area, seven-county region), population size, data availability, and project timeline and resources. Depending on the project, we may be looking for best practices that might be replicable in our region or how other cities tackled similar issues to those faced by Milwaukee.

In our Innovation Index, launched in spring 2010, a narrow list of benchmark cities was adopted, combining typical Midwest metros (Indianapolis, Minneapolis, and Cincinnati) and a few existing or rising innovation leaders (Austin, Portland, and Kansas City). The benchmark cities were chosen to provide both a regional context and a set of peers that could set the bar high for Milwaukee’s innovation strategies.

Recent studies from the Brookings Institution Metropolitan Policy Program and the Federal Reserve Bank of New York may reshape how peer groups are determined. Both studies establish new comparison typologies based on the shared economic and/or demographic characteristics of metro areas, as opposed to geographic location alone.

In State of Metropolitan America, Brookings establishes new metro groupings that include Border Growth and Mid-Sized Magnets, Diverse Giant/Next Frontier, New Heartland, Skilled Anchor, and Industrial Core. Milwaukee falls into the Skilled Anchor category, which is defined as “slow-growing, less diverse metro areas that boast higher-than-average levels of educational attainment.” Brookings’ broad analysis of social, demographic, and economic data shows that metro regions can be grouped based on the types of challenges they’re facing, which the authors argue may allow similarly positioned regions to develop “common solutions.”

The Federal Reserve Bank’s Knowledge in Cities assigns cities to 11 different knowledge clusters based on occupational skills requirements and existing industry employment patterns. The clusters include Making Regions, which have high knowledge of manufacturing, but low knowledge in commerce occupations; Understanding Regions, which have very high knowledge of arts, sciences, and the humanities, but low knowledge of manufacturing; and Building Regions, which have high knowledge of construction and transportation. Several areas in Wisconsin (Eau Claire, Green Bay, Racine, and Wausau) fall into Making Regions. Milwaukee is grouped with the Enterprising Regions that have high numbers of jobs in commerce and IT fields. Other enterprising regions are Atlanta, Charlotte, Cincinnati, Denver, Kansas City, Minneapolis, Portland, and St. Louis.

Ultimately, determining the most appropriate metro peer groups may depend on how the Milwaukee region defines itself and its vision for the future. Will the City of Milwaukee’s ranking as the 4th highest in poverty level define the city and link us with similarly impoverished regions? Or will the rise in a skilled computer workforce be leveraged for regional economic gain and link us with the Austins, Pittsburghs, and Seattles who are strengthening their information infrastructure? The answer may lie in how our region responds to its challenges and whether it is able to successfully build on its strengths.

Local nonprofits still feeling impacts of recession

The 14th annual "Report Card on Charitable Giving" - released by the Forum today in partnership with the Greater Milwaukee Foundation - shows moderate improvement over last year in the fiscal health and general outlook of Metro Milwaukee nonprofit organizations. Nonetheless, nonprofit leaders continue to express a healthy dose of pessimism toward the state of philanthropy and continue to feel the impacts of the economic downturn in varied ways.

The report card is based on a comprehensive survey of nonprofit organizations in southeast Wisconsin. More than 150 nonprofits responded to this year's survey, with a little more than half (52%) from the human services sector, 17% from arts and culture, 16% from education, 10% from health organizations, and 3% from the environmental sector.

Among the key findings that emerged:

• For the second year in a row, nearly two-thirds of respondents feel that economic conditions are causing local giving to be less generous than usual. The 2010 result of 66% is slightly improved, however, from the 68% who felt that way in 2009.


• More than a third (38%) of this year's respondents report decreased total revenue, while half report increased total expenses.


• Half of the respondents feel they are financially healthy but vulnerable in the future, an improvement over the 57% who felt this way in 2009. Meanwhile, 30% feel they are financially healthy with no foreseeable problems in the near future, also improved from the 24% who responded that way in 2009.


• Arts and culture organizations expressed the greatest concern about their financial health among the various nonprofit sectors, with 35% reporting chronic financial problems, and another 50% reporting they are financially healthy but vulnerable in the future.


• Survey respondents cited the need for several personnel-related actions to address budget constraints, including salary freezes (40%), reductions in benefits (20%) and lay-offs (18%). Nearly half (48%) say they have considered collaborating with other organizations and 22% say they have considered merging with other organizations.


• A quarter of the respondents say their expectation of long-term sustainability is very high, while another 41% report it is high. Only 3% have low expectations for long-term sustainability.


• Nearly half (46%) of the respondents say they expect gifts from corporations to decline, while 43% expect gifts from individual donors to decline and 41% expect foundation grants to decline.

An executive summary of this year's report card and a copy of the full report can be accessed here. The report card is published and sponsored by the Greater Milwaukee Foundation, and co-sponsored by the Donors Forum of Wisconsin, Faye McBeath Foundation and United Way of Greater Milwaukee.

MATC facing growing demands, shrinking resources

Today, the Forum released the third in its series of financial reports on local taxpayer-funded entities in Metro Milwaukee: a comprehensive fiscal assessment of the Milwaukee Area Technical College (MATC). This report uses the same fiscal monitoring methodology as 2009 reports on Milwaukee County and the City of Milwaukee, which were recognized with an award for "most effective education" earlier this year from the Governmental Research Association.

Like the city and county reports, the report on MATC paints a somewhat alarming picture. It finds a local institution that has taken on increased importance in light of the economic downturn and community-wide efforts to increase the number of college degree-holders, but one that has been hit hard by the recent decline in property values.

Key findings from the MATC fiscal assessment include:

• Property tax revenues comprise roughly 60% of MATC's budget, causing it to rely on the property tax more than most local governments and school districts. MATC's budget has mirrored the ups and downs of the real estate market, with revenues climbing much faster than the rate of inflation from 2005 to 2009, but falling in the next two years.


• MATC has seen a steady decline in revenue from the state. The college was able to weather this decline when overall revenue growth was strong, but faces difficulty doing so in today's revenue climate.


• Student charges have been the college's fastest-growing revenue source of late, with tuition and fees rising nearly 40% since 2005, raising questions about impacts on student access.


• Fringe benefit and salary increases were responsible for about three-quarters of the college's expenditure growth during the five years under review, with health care expenditures rising twice as fast as those at the City of Milwaukee and Milwaukee County.


• A newly developed imbalance between ongoing expenditure needs and revenue capacity will continue to grow without substantive budgetary corrections, reaching a projected $11 million to $62 million within the next five years.

This turbulent financial picture leaves MATC little choice but to examine current levels of employee staffing, pay and benefits, which are quite robust based on comparisons with state and national peers. For example, the report finds that MATC ranks first among a group of 85 national peers in operating expenses, salary expenditures and fringe benefits expenditures per full-time equivalent student.

The report cautions, however, that any significant expenditure reductions must weigh impacts on the college's academic quality and its capacity to meet recent double-digit increases in enrollment. It also suggests that college leaders step up efforts to establish clear performance goals and collect performance data as part of the effort to address difficult budget issues.

Finally, the report offers an opportunity to compare the fiscal practices and condition of MATC - which operates as a local authority and is governed by an unelected board - with local governments operating under traditional elected models. It notes both similarities and differences in the manner in which these entities have responded to common fiscal challenges, and offers insights into what this tells us about the debate over government structure in our region.

A full copy of the report can be accessed here, and our media release here.

Merit-based pay for students and parents?

The notion of linking teacher salaries to student outcomes has been one of the country's most talked-about education reform topics of late, causing us to wonder in an earlier blog whether Milwaukee's new superintendent had this controversial idea on his radar screen.

But now, out of Houston, comes a concept that undoubtedly would generate even more controversy if attempted locally: paying students and parents for improved academic performance.

A recent article in the Houston Chronicle describes a $1.5 million pilot program approved by the Houston Independent School District (HISD) that will allow families at certain HISD schools to earn more than $1,000 for enhanced student achievement in fifth grade math. The program will be funded by a Dallas foundation.

According to the article, fifth graders at the selected schools will be able to earn up to $440 for passing tests showing they have mastered certain mathematical concepts. Parents of successful students can earn another $400 as a reward for making sure their children did the necessary work to pass the tests, as well as $180 for attending nine parent-teacher conferences. There's also something in the deal for teachers, who can earn up to $40 per student for holding the parent-teacher conferences.

Interestingly, a third party to this seemingly radical idea is Harvard University's Education Innovation Laboratory, which has formed a research partnership with HISD. The same Harvard researchers conducted a comprehensive experiment of the "pay for grades" concept in Chicago, Dallas, New York and Washington that was featured last spring in Time magazine. The research team will compare student test scores at HISD schools that are participating in the program with schools that are not. It also will examine the incentives' impacts on other barometers of student success, such as attendance rates and behavior.

The Chronicle story engendered howls of outrage from readers commenting on the paper's website, many of whom questioned why anyone should be rewarding parents for fulfilling their parental responsibilities and students for doing what's in their own best interest. School district officials quoted in the article argue, however, that over-worked and over-stressed low-income parents may need an incentive to become more involved, and at this point it's just a research project aimed at determining whether financial incentives truly would make a difference.

Given the political outcry that likely would occur even if the pilot turns out to be successful, it's difficult to imagine it taking hold across the country. Still, in light of the constant refrain for bold and innovative reform in our urban schools, can you blame Houston for trying?

Wisconsin ranks in top ten in child care costs: child care more expensive than college

Wisconsin ranks among the 10 most expensive states for child care in a new report from the National Association of Child Care Resource and Referral Agencies.


The NACCRRA found that full-time care for an infant in the average Wisconsin child care center, at $10,520 per year, exceeds 13% of the annual median family income for a two-parent family, placing Wisconsin among 36 states for which the cost of infant care exceeds 10% of the median family income. For a family earning at the poverty line, full-time infant care would exceed 57% of annual income.

In addition, Wisconsin is 4th most expensive when the cost of center-based care for a 4-year-old is considered ($9,039 per year, or over 11% of the median family income) and 3rd most expensive for afterschool care for school-aged children ($8,223 per year, or over 10% of the median family income).

As someone who no longer needs full-time child care with last week's start of the school year, I was well aware of the cost. But I was quite surprised by the report's finding that child care has become one of the largest monthly outlays for Wisconsin families, costing more than the average monthly rent payment, grocery bill, utility bill, and even health care. In fact, average child care costs for two children exceed the average mortgage cost for Wisconsin families.


The good news, if you choose to see it that way, is that these Wisconsin families should have no problem affording college tuition when the time comes--they are already paying more for child care than they would for most of our state's public four-year universities.

PPF annual analysis of school district performance: How's your district doing?

The Forum's annual analysis of public school districts in southeast Wisconsin is released today, and finds the regional academic achievement scores continue to come more in line with the statewide scores. Unfortunately, lower scores in the rest of the state contribute to the smaller difference as much as improved scores in the seven-county region.

The report also finds that while the region does well on ACT and AP exams, as compared to the rest of the state, it is lagging more and more in graduation rates, mostly due to the low graduation rates in MPS.

The region's large racial achievement gap has been highlighted in several previous editions of the report. This year's analysis shows little progress has been made toward closing the gap in scores between white and African-American students--it is nearly as large now as it was five years ago and is persistent across all districts. All districts also show a significant gender achievement gap in reading, with girls outperforming boys at every grade level.

Other findings:

• This year's 8th graders' reading proficiency rate slipped down as compared to the rate for last year's 7th graders, a trend that has been true statewide in previous years but has occured in the region for the first time this year.


• Total enrollment in the region remained virtually static, but the number of minority students attending public schools in the region grew by 39%.


• The number of students participating in the free or reduced-price lunch program grew significantly this year for both the region and the state as a whole. Almost all districts in southeast Wisconsin had more students qualify for the program serving low-income children.

The full report, as well as a poster-sized summary detailing data from individual districts, can be found here.

Underwriters of this year's edition include: Alverno College, Multiple Listing Service, Northwestern Mutual Foundation, Southeastern Wisconsin Schools Alliance, Stifel Nicolaus, and Waukesha County Technical College.