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HomeMy WebLinkAboutCOM 0067.004 2006-2008 Testimony of Dan Landis, Ph.D on the Proposal by the Director of Planning to change the Definition of "Family."~ Council Bill Number 345 January 4, 2007 Chair Hoffman, members of the County Council, thank you for allowing me to testify on this most unwise proposal put forward by the Director of Planning and introduced by Councilman Pilago. Of course, I am opposed to this Bill and the reasons are based on an extensive review of the literature of group home sitting. This proposal has been generating a good deal of controversy with people from all over the island weighing in on its merits or demerits. It is interesting, and even germane, to note that all of the letters submitted to the Planning Commission (which resulted in a negative recommendation) from individuals were in opposition, while all of the letters in support were from operators or governmental organizations that either fund or supply clients to operators. Most of the oppositional comment has been temperate and to the point; some has been a bit more emotional. However, the emotion often comes from a feeling of being put upon by organizations whose primary aims seem often the enrichment of their coffers rather than the rehabilitation of their clients. The reasons given for the necessity of changing the definition of the family are five fold: 1. "They aze low impact..." Impact level is in the `eye of the beholder." But, should a property have, say, two houses (e.g., in the case of an ohana), the move from 10, plus cazetakers to 16 plus caretakers is certainly not "low impact." Without a definition of "impact" it is hard to see how this azgument can be made. Such a definition might include noise levels, traffic, number of visitors, number of police calls, etc. Simpl} asserting something does not make it so. 2. "..that are licensed and regulated by the Department of Health." Inspection of the attached documents of the Department of Health show that they deal primarily with the physical aspects of the property. While an annual evaluation plan is required (for STF- type houses), no provision is made for review by interested members of the community. It would seem appropriate for some local involvement in deciding if a group home is meeting some sort of reasonable objectives in terms of client improvement. In the case of drug rehabilitation, close monitoring of clients for at least a yeaz past discharge would seem to a reasonable minimum. Recent findings of forged and highly selective reseazch results in otherwise highly reputable laboratories should make us vigilant to the possibility that a similar phenomenon may infect human service providers. Local community members may be in a good position to test the validity of the evaluation results. The delegating of such an important responsibility to a remote agency would not seem to azgue for the approval of the Director's recommended changes. Further, suppose there aze difficulties in the operation of the home that aze cleazly appazent to the neighbors. To whom do they voice their concerns when the operator seems deaf? To Honolulu? Would it not be better to have a mechanism for a local response (up to and including terminating the facility) to such issues? 3. The Lemming and the magical number 8 argument. "Honolulu and Maui allow up to eight residents so let's join the bandwagon." How many times have we told our children, something like, "If Jack jumps off a bridge should you also do it?" There is nothing magical about the number eight. There is NO evidence that program goals will be accomplished better with eight residents than with five. Indeed, what evidence there is mm. No.a~ ~ Prepazed for the Hawaii Island Planning Commission meeting on September 7, 2006 in Hilo, Haw~iQ Ref. To: Pr Ref. Uate suggests that smaller is betterz. In any case, the reason why the operators have requested an increase is NOT that they will be more effective; but that it is only way that they can meet the overhead expenses. Ms. McIntosh in effect admits as much, when she said in her letter to the Commission, "It is impossible to operate this home with this limited (i.e., five) number of occupants." No reason was given as to why it would be impossible. It is also interesting to note that in the same letter, she wants eight to be the LOWER number, not the maximum. The reason may be that it is in the Department of Health's (or other funders) best interest to increase the number of clients being served in a single facility since this would allow limited funds to be more efficiently used. Increasing the size of a "family" means that overhead costs (which form part of the per-client allocation and include such items as rent, mortgage service, staff costs, administrative expenses, and other indirect costs, etc.) can be reduced when compazed with a smaller set of "families" having to reside in more locations. I have to wonder if local neighborhoods should suffer due to unwise expenditure commitments by operators. 4. The son-of-SLAPP (Strategic Lawsuits Against Public Participation) argument. The Director seems to believe that the limit of five unrelated persons is so onerous that it would be seen by the courts as an "unreasonable" restriction on the rights of the handicapped to live in residential neighborhoods. The fear here is that an operator, acting for a disabled person or persons, will file suit against the county. The argument would have force if it could be shown that a) there is no procedure for increasing the limit or b) if there is a procedure, its invocation inevitably results in denial. Neither aspect is true: an operator may apply for a special use permit to allow an increase to ANY number of clients and, I suspect, that when this has occurred it has more often than not been approved. Cleazly, the present process works. To grate the teeth of an old saw, "If it ain't broke, don't fix it!" If you increase the number to eight, how long will it be before some operator files a request to increase the number to 10, 12, 14, or some even greater number arguing that eight is "onerous?" As a hazbinger of things to come, an operator has already threatened a suit against a Homeowners' Association if the owners persist in opposing the sitting of a drug treatment group home in their development. In fact that threat was made at the very first meeting of the operator and the owners. 5. That such an increase is necessary to provide safe and reasonable housing for the mentally ill and disabled. Most of the testimony supporting the change at the Commission meetings came from advocates for the mentally ill and disabled. All of this testimony is beside the point. Present regulations provide for a waiver for such operations. The proposed bill would only affect one segment of the rehabilitation community: those focused on rehabilitating drug users. In other words, the bill flies under deceptive colors and for that reason alone it represents a case of legislation enacted to benefit one operator, though its effects may be far-reaching. Our recommendation is simple: operators who wish to place more than five unrelated residents in a house should use the process now available to them. This would allow neighborhood residents to have their views respected and integrated into the decision making process on a case-by-case basis. Nobody is asking for a veto power, only to not be stereotyped as some wild-eyed people pushing the disabled back into the snake pits. While we might like the definition of a family to be restricted to people related by blood, marriage, adoption or "hanai," we recognize that the "horse left the bam a long time ago." However, we can ask that the local government prevent the neighborhoods from becoming stables with consequent negative effects on the quality of life. Let me be cleaz: we want to work with the Council, the Planning Commission, and the Planning Department to support operators who are truly interested in client improvement and who forgo aggressive autonomy as a sitting strategy while at :Nagy, M.P., Fisher, G.A., and Tessler, R.C. (1988) Effects of facility characteristics on the social adjustment of mentally ill residents ofboard-and-caze homes. Hospital and Community Psychiatry, 39(12), 1281-1286. the same time weeding out those whose motivation is primazily pecuniary, something the Department of Health seems either unable or unwilling to accomplish. The rationales for the above conclusions aze given in the rest of my statement, below. First, I want to give you a sense of both my history and second, the history of group home sitting. This will allow my conclusions and recommendations made above about the proposed bill to be placed in a reasonable context and, one can hope, make it more persuasive to you and others. In the middle 1970s, I was the Chair of a fairly lazge Psychology Department in a Midwestern state. We developed the first doctoral program in Rehabilitation Psychology in that state. This program developed against the background of the closure of lazge mental hospitals across the country and the initiation of the community mental health movement. We took as our aim to provide highly trained professional staff for these new institutions, although few knew what those institutions would look like or where they would be located. Later on in the 1980s some colleagues and I evaluated the case management system for community mental health centers for an entire but different state3. I tell you this because this background gives me a unique perspective, that of a social researcher, on the proposal that is before you today. The group home movement grew out of the deinstitutionalization (what the British called "normalization") of inmates of large state run mental institutions. These edifices often mixed the mentally ill, the retarded, and even the criminally insane. Horrors were perpetrated on the inmates due to poor staffing, uncaring administrations and the primitive state of our understanding of mental illness. Such therapies as pre-frontal lobotomies, insulin coma and shock, electric shock, sterilizations, and experimental drug regimes were common as were physical attacks including rapes and murders. These were truly the snake pits of their time. As these horrors became common knowledge through various press accounts, pressure developed to close these large institutions. The feeling was that the size and isolation of the institutions kept the patients from developing the skills that would be necessary before they could be allowed back into the wider society. The solution was to develop community based facilities that would duplicate family structures so that the clients could eventually be released to live on their own or with their families. A close reading of the literature on deinstitutionalization would suggest that these new institutions were not to be simply smaller fortresses plunked down into communities, but were to be integrated into their surroundings with local citizens playing important roles in the rehabilitation of the clients. Unfortunately, this did not occur for two reasons: funding cycles and good old American capitalism (doing the least for the maximum return). While on this was going on, another movement, that of sitting of noxious and environmentally degrading facilities (e.g., sewage plants, waste dumps, power plants, etc.) was gathering notice. As local protests against some of the potential sites increased a set of acronyms came into common usage: NIMBY (not in my back yazd), NODS (not on our stree~, LULU (locally unwanted land uses) and others. In an otherwise excellent paper Michael Dear stereotypes the protesters as prejudiced, probably unwashed, and certainly opposed to progress. Developers fought back with SLAPP suits (strategic lawsuits against public participation) and some communities and individuals counterattacked with SLAPP-back suits some of which were quite successful. The protester demonization by developers formed the political substrate for the next important stage: the passage of the Fair Housing Act and its later modifications extending the definition of protected classes. 3 Fisher, G. ,Landis, D. and Clark, K.(1988) Case management service provision and client change. Community Mental Health Journal, 24, 134-142. Clark, K.A., Landis, D., and Fisher, G.(1990) Client characteristics impact on case management service provision. Evaluation and Program Planning, l3, 221-229. ~ Dear, M. (1992). Understanding and overcoming the NIMBY syndrome. Journal oftheAmerican Planning Association, 58(3J. Initially, group homes were limited to either mentally ill or intellectually retarded individuals requiring minimal therapeutic intervention. Gradually, this was extended to individuals requiring constant monitoring and other medical/psychiatric services. But, as time went on, other groups found that services were either not available in the community mental health centers or were not covered by vazious third party payers. Such groups included the homeless, individuals afflicted with HN/AIDS, recovering alcohol and drug addicts, newly released felons in half-way houses, as well as others. A philosophy developed that these individuals did not require intense hospital type supervision, but could be helped in "family" type small group living situations. However, they did not fit any recognized category and the sitting of these homes in residential neighborhoods was problematic. Because the original philosophy was to integrate the group home residents into the surrounding community and involve local citizens in the rehabilitative process, the eazly operators (after a period of what Dear called "autonomous" approaches to sitting), engaged in intensive community outreach- often in an attempt to defuse community opposition. Sometimes this worked, but sometimes the opposition was too well organized and intense. At this point, the mutual stereotyping of both the operators and the communities began in earnest bringing in the vazious acronyms that were noted above. Earlier, I alluded to the issues of the funding cycles as a reason why the early philosophy of community involvement was discazded. Governmental and other fenders, who would provide the money under vazious contract and grant arrangements, found that they could not justify paying unless services were actually being delivered to clients. This meant that residents had, in the case of group homes, to be living in the home and receiving documented (and approved) services. Opportunity costs (e.g., community outreach prior to sitting) were not covered since they could not be firmly allocated to particulaz clients. Operators had to demonstrate that they had a suitable site that was up and running before they could even apply for funds. Additionally, the finite funding cycle (often a single fiscal year) meant that funds have to be, at the very least, encumbered within a short period of time after being allocated by the legislatures. Failure to spend might mean a lower allocation in the next funding cycle. This approach virtually guazanteed that opposition to sitting would develop since operators were encouraged to obtain a suitable facility first, then apply for funds, and then move the clients in, all without any necessary involvement of the surrounding neighborhoods. Indeed, various legal authorities advised candidate operators to quickly close on properties before any opposition could develop. Into this situation, stepped the Federal government in the guise of the Fair Housing Acts. The Fair Housing Acts which had originally prohibited housing discrimination on the basis of race, national origin, etc. later expanded the protected classes to include the disabled (including those with various emotional or mental conditions). This was certainly a laudable aim since many of these groups had nowhere to go and were often left to the mercies of houses in unsafe and unstable neighborhoods. Since the acts were originally designed to combat racial and religious prejudice (does anybody remember that many new developments at the end of World Waz II had covenants prohibiting sale to blacks and Jews?), they assumed that neighborhoods would be opposed to locating any member of a protected class in their midst. Therefore, the acts (and the court cases that followed) discouraged pre- sitting outreach. Again, the opposition was demonized and had its motivations attributed to the basest of reasons. Following the guidance outlined above, most prospective operators abandoned any interest in pre- sitting outreach and adopted a tactic called aggressive autonomy. No neighborhood attitudes could be possibly helpful to the clients and therefore they were to be combated with every legal tactic possible, if not simply ignored. Any impediment or restriction deployed by a community was to be fought, politically if possible, legally if not (both approaches aze on display in the proposal before us today). The aim was two fold: beat down the barriers to sitting and collect the prize-the money that was now available to provide services. The more clients could be served with the highest of overhead expenses, the larger the size of contracts that could be awazded. Despite the use of aggressive autonomy, other voices, most notably the National League of Cities (see Whitman and Paznas, 19995) have recommended that group homes "enter into good neighbor agreements, which promote positive relationships with the community." The guidelines that prospective operators use only deal with one side of what one researcher (Cowan, 20036) called the dilemma. That author notes that "...the guidelines therefore take no account of the potential for a lack of consultation to become a topic of opposition in itself on the grounds that local people have a right to know about things that will affect them." While the guidelines referred to come from Scotland, they are remarkably similaz to those promulgated as a result of the Fair Housing Acts. Of course, in the process, the original concept behind deinstitutionalization was lost because it was in no operator's interest to allocate the necessary resources. Rather, program design focused on aspects that could be given within the hermetic environment of a single closed house. In the substance abuse realm, the so-called California plan (which was based on the AA model of peer service delivery) is one such "closed" house plan. Unfortunately, the evaluations of these plans aze, at best, mixed and whether they represent the best allocation of taxpayer dollazs has yet to be conclusively answered. It is uncleaz when the focus on defining a "family" became the entee of these programs into neighborhoods, but that is the current method being used to attack zoning regulations. This then is the backdrop against which we made the recommendations that appear at the beginning of this document. We respectfully hope that the Council will give those recommendations careful consideration and turn down this unwanted and unwise proposal. Thank you for allowing me to express my opinion on this proposal. I hope you will now send it back tc, the Planning Department with a clear and unequivocal denial. s Whitman, C. & Parnas, S. (1999). Local O~cials Guide: The Siting of Group Homes for the Disabled and Children, Washington, DC: National League of Cities. e Cowan, S. (2003). NIMBY syndrome and public consultation policy: The implications of a discourse analysis of local responses to the establishment of a community mental health facility. Health and Social Care in the Community, ! 1(5). ~ Borlcman, T., Kaskutas, L., Room, J., Bryan, K., and Barrow, D. (1998). M historical and developmental analysis of social model programs. Journal of Substance Abuse Treatment, /S(!), 7-17.