Read the executive summary on this page and download the pdf for the full report.
What We Found
The mission of the Multnomah County Intellectual and Developmental Disabilities Services Division (the Division) is to increase people’s quality of life by helping them fully access their community through coordinated case management. The Division provides case management services to approximately 1,800 adults and 2,100 children with about 90 case managers and receives approximately 85% of its funding for these services through the state of Oregon.
We found the Division’s ability to provide quality care is at risk because of the number and pace of significant changes mandated by the state. The state has not adequately funded all of these changes and has put a complex funding system into place. The destabilizing impact of these changes and funding pressure at the county level have resulted in high caseloads and turnover, case manager strain and burnout, morale issues, and complaints from clients and their families.
Organizational change is difficult under the best of circumstances. When the magnitude of changes are transformational and the organization’s systems are already complex, changes must be skillfully managed and adequately funded to prevent or at least minimize problems. Even though the state requires implementation of its changes, the Division still has the responsibility of maintaining the quality of services to clients as well as the stability of its program.
The Division continues to adjust operations to accommodate state changes. For example, the Division is evaluating the services it is not required to provide, analyzing its organizational structure, reducing the time it takes for case managers to complete required documentation, and providing templates and tools that help case managers do their jobs. The Division is negotiating funding levels and payment rates with the state and working to improve staff retention and overall morale. Case managers in the Division are still struggling to fulfill state-mandated changes. Some of the problems we found will take time to resolve.
Why We Did This Audit
This audit was included in the issued audit schedule for 2018 by the previous Auditor. Auditor McGuirk continued the audit because the Division serves a vulnerable population in our county.
What We Recommend
The Division should:
- Continue its efforts to respond effectively to state-mandated changes.
- Keep demonstrating to the state the risk to clients and negative impacts of rapidly paced, transformative changes on the stability of the Division’s system and case managers.
- Complete documentation in a timely fashion.
- Strengthen its case note monitoring.