Crucial County Services Need Audit Attention
No audit office can cover everything, but the Multnomah County Audit Office needs to focus far less on informational reports and audits of administrative and management functions and far more on helping to improve the effectiveness of crucial county services and access to those services.
In the last 10 years, the office has not scrutinized or helped improve the effectiveness of numerous important services, among them: mental health services, addiction treatment, the District Attorney’s office, the Sheriff’s Office, probation and parole, health clinics, dental treatment, programs for women and infants, juvenile justice, public health services and the library system.
Health services, public safety and justice, and social services are also the three largest spending categories at the county.
As a state auditor, I scrutinized crucial state services and wrote in-depth reports that helped improve welfare services, state delinquent debt collection, teacher investigations, transparency and evaluation of business subsidies, oversight of alternative and online schools, and the state’s troubled foster care system. That followed on my 23 years of work as a reporter, largely focused on holding public agencies and businesses accountable. I want to bring that independent, in-depth focus to Multnomah County.
Below are examples of audits that could make a big difference in important services. I will seek more ideas as the campaign continues.
School mental health and family support services
In recent audits at the state, administrators and teachers at every alternative and traditional school we visited said they badly need more mental health counseling. Multnomah County provides mental health services and assistance in the county’s schools, but teachers and administrators say students face substantial wait lists and there are not enough services to go around.
- What is the status of mental health services in the county’s schools, and how much unmet need is there?
- Are administrative obstacles or regulatory obstacles preventing students from getting more care?
- Can students whose families are eligible for the Oregon Health Plan easily access care? If not, how can access be improved?
- What are the county and state doing to help reduce stigmas against receiving mental health care among students or their families?
- Have other counties or states found effective ways to deliver more care to students, including students eligible for Medicaid?
Addiction Treatment Services
The county contracts for addiction treatment services from outside providers. Nationwide, the success of addiction treatment programs is low, placing a priority on determining which programs and approaches work best and replicating those efforts.
- Are county contracts requiring strong information on program effectiveness?
- Are providers reporting that data, and is it accurate, consistent and complete?
- Is performance data being used to improve programs, and are those improvements built into future county contracts?
- How is the county evaluating these programs?
- What do providers and service recipients think would improve the services?
- Are providers surveying recipients about program effectiveness and it is informing program changes?
- Have other counties developed effective practices for identifying performance outcomes and using those measurements in program evaluations?
Racial Disparities in the Justice System
Multnomah County constitutes a substantial part of the justice system. The District Attorney’s office makes charging and prosecution decisions, argues for bail, and makes sentencing recommendations. The Sheriff runs the county’s jails and patrols areas not covered by city police departments. The Department of Community Justice provides probation and parole services and runs a juvenile detention center. The county has made significant efforts to reduce racial disparities in these areas, but they persist, helping feed the racial disparities in Oregon’s prisons.
- What do experts and non-profit groups within communities of color suggest to further address the problem?
- How well are programs designed to reduce inequities in the criminal justice system working now? How could they be improved?
- Does data analysis show where the inequities are greatest, and are the county and its partners addressing those areas?
- Are there successful programs in other counties and states that Multnomah County could emulate?
- Are bureaucratic obstacles preventing the county and law enforcement agencies from sharing or disclosing data that would help policy makers address the problem with more certainty?
Inmate Treatment in Jails
A year ago, Disability Rights Oregon released a devastating report on treatment of inmates with mental illnesses in the downtown jail, including excessive use of solitary confinement and restraints and “routinized force.” In response, the Sheriff’s Office has made changes, including added staff and training. But a checkup is in order, with a particular focus on the use of tactics such as solitary confinement that can be subject to abuse.
- What do jail records indicate is the current use of solitary confinement and restraints, and the level of use of force? Do detailed records show changes in management and staff practices?
- What system is in place to work with staff who are most likely to use restrictive techniques? Does this work follow best practice recommendations from disability rights activists?
- What do newly hired mental health staff and advocates for the disabled suggest could be done to make further improvements?
- Have those additional techniques proved effective in other jails or in prisons? What are other states and counties doing to address this issue?
- What is the state of access to mental health care in the jails, and how is the jail population affected by limits to care outside the jail system?
Performance Management of County Contractors
County contractors provide many of the county’s crucial services, including services such as mental health care, addiction treatment, road and bridge construction and in-home elderly care. Multiple audits since 2000 have pointed to deficits in county management of contracts. The latest audit, in 2016, once again warned of redundant steps between departments and a lack of performance management. A new audit can up the ante, examining contractor records, talking with people served by contractors and their advocates, and finding other counties or cities that manage contract performance well. This approach will allow auditors to more clearly state the problems created by a lack of performance management and provide concrete examples that show that high-quality management is attainable. That ground-level detail will help convince the public, management and policy makers that change is both required and do-able.
- What are the effects on the ground of the county’s long-term struggle to manage contracts effectively?
- Are there standout contract managers within the county whose efforts can show others how to do a more effective job?
- How does the county’s contract performance management miss or match national best practices?
- What have other jurisdictions done that the county might learn from?
Other Important Issues
+ Potential management issues at the Department of Community Justice: With the director departing, now is a good time for the Auditor’s Office to check on potential management and cultural issues in the department, which oversees probation and parole and juvenile justice. A March 2018 Willamette Week story said “multiple sources” described a troubled department plagued by poor communication. Another red flag: A late 2016 ethics survey by the Auditor’s Office found results for DCJ were relatively low. For example, DCJ employees were the least likely among county departments to agree that their supervisors create an environment in which staff are comfortable raising ethical concerns. At the state, our audit of the Teacher Standards and Practices Commission found that poor communication and high distrust between staff and management reduced productivity. We made practical recommendations to improve the work environment – having management and staff working together to plan for open communication, for example, and creating a mechanism for staff to report unaddressed concerns to the board – which the agency pledged to implement.
+ Evaluating the County’s Housing Assistance Programs. In 2014, the Audit Office surveyed and identified the county’s housing assistance programs, and an audit this year of the Joint Office of Homeless Services provided more detail, identifying a lack of program evaluation. These reports lay the groundwork for more detailed audits evaluating gaps in housing assistance programs, how the Portland area’s services are working, and how they could be improved.
+ Improving the Auditor’s Good Government Hotline The Auditor hotline is designed to expose fraud, waste, and abuse and help the auditor identify systemic issues that an in-depth audit can address. But the hotline received only 47 calls in 2016, the last year reported. Employees report mistrust of the system, and awareness by employees and the general public appears to be low. We need to review effective hotline practices in other city, county and state governments, talk with employee groups and stakeholders about the value of the hotline, review reports, outcomes and outreach, and develop a plan for building Hotline awareness and trust that the auditor’s office will handle complaints thoroughly and impartially.
+ Monitoring Efforts to Reduce Racism within County Employee Ranks Recently, county employees have come forth alleging institutional racism within the county. That’s both morally repugnant and financially hazardous, creating tremendous legal and human resource risks. The county has passed an equity resolution and has hired a consultant to examine the issue. At a minimum, an independent auditor can be a referee to make sure the actions that come out of the equity resolution, the county’s upcoming equity strategy, and the consultant’s report are implemented successfully and that employees of color believe they are making a difference.