County Services and Who Delivers Them
The Multnomah County government serves all residents with general programs such as libraries, elections administration, and roads and bridges. It also serves sub-sets of the population that require more specific services. Within services the County provides to particular populations, there is a range of discretion for the County in deciding who should receive services. In some cases, there is little or no discretion, such as individuals who are sentenced to jail or directed by the state or a court into probation/parole. On the other end of the range, the County has complete discretion in determining who would benefit most from some specific services, such as those paid for by the County’s general fund. The Department of County Human Services’ Community Healing Initiative is an example of one of these programs that is paid for by the general fund. The majority of services provided by the County fall somewhere in the middle, where federal or states rules and/or funding sources impact who is eligible for services and the level of those services.
County programs deliver services directly – using County staff – or through contracted service providers. Programs have the greatest control over service delivery when they provide services directly; control over contracted services is only as precise as the contract language used and the County’s ability to oversee contractor behavior and practices. The County delivers services from fixed locations such as clinics and senior centers as well as in client homes and other community settings.
Objectives, Scope and Methodology
The objectives of this audit were to identify 1) the extent to which County service delivery is mirroring population changes, 2) County efforts to match services to intended service recipients and 3) barriers to achieving these goals. We focused our review on 55 County programs that were both large – having a fiscal year 2014 budget of approximately $1 million or more – and where the County has some discretion in deciding who will receive services or how they are provided. The extent to which the County has discretion over how or who receives services varies significantly among the programs we reviewed.
We looked at programs in the Departments of Community Justice, Community Services, County Human Services and Health, as well as the Library District and District Attorney’s Office. We did not review Sheriff’s Office programs due to the County’s limited discretion related to detention and patrol, nor did our scope include the Departments of County Management or County Assets, as they generally provide internal services to other County departments.
To achieve our objectives, we interviewed staff members about all 55 programs, reviewed program data and mapped program data when possible. We worked with a County GIS specialist to develop maps conveying County demographics, provision of County services and/or aggregated client locations. We analyzed the resulting maps for relationships between fixed service locations, mobile services, and distributions of eligible populations or service recipients.
To create maps, we used data that were sufficiently reliable in regard to our objectives. The main demographic data source was the U.S. Census Bureau American Community Survey Five-Year Estimates for 2009-2013. We used five-year estimates because they are more reliable than one- or three-year estimates, and they are the only estimates available for smaller geographic units, such as census tracts.
We assessed the reliability of County client data by interviewing program staff members knowledgeable about the data, and reviewing documentation about the data and/or the systems that produced them. We also assessed the reliability of service location addresses. In addition, we collected some descriptive program data, such as the number of clients served. For the majority of programs, both descriptive and mapped data represented FY 2014 activity; maps for Health Department home visiting programs convey calendar 2013 data, as this was the most recent final data available. Because the descriptive data were not material to our objectives, we did not assess their reliability. We relied on program managers to provide accurate data and information about the services provided.
We conducted this review in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe the evidence obtained provides a reasonable basis for our findings and conclusions based on our audit objectives.