Out of curiosity and with a touch of suspicion, Estelle B. Richman, then Philadelphia's director of social services, decided one day to investigate what families faced when they sought help from the city's human services programs.

THE FRAYING SAFETY NET
Steve Mellon, Post-Gazette Estelle B. Richman, Pennsylvania's secretary of public welfare, wants to make sure vulnerable families get needed help. Click photo for larger image. Related stories: Nonprofits economize by combining services Cambria County rethinks human services Previous stories in this series: Day One: The social services safety net is fraying Day Two: Nonprofit groups' survival may depend on clients' image

"Some of them had 12 to 13 case managers," she said recently, her eyes widening at the recollection. There might be a case manager for housing needs, another for child services, another for mental health, another for substance abuse treatment, another for the elderly grandparent living with the family. The list just kept going.

Thinking back on that today, Richman remains astonished by the illogic of it.

"How can anybody get better with 12 case managers?" she asked.

Against that backdrop, no one should be surprised that once Gov. Ed Rendell named Richman the secretary of public welfare in 2003, she started pushing for better coordination of public welfare services across Pennsylvania.

Her first year in office, Richman told counties to submit plans for restructuring their children's services so there'd be a single point of entry for each family. She also wanted one inventory listing all services offered by every agency from each county.

Her idea of effective human services is to coordinate the programs all family members need, rather than treating each family member and each of their ailments as separate sets of problems.

"If there's a problem with the adults in the family, that impacts the children, too," she said.

When fully implemented, the Integrated Children's Services Plan -- one of the most ambitious initiatives from the department in years -- will coordinate the work done in mental health and mental retardation, child welfare, juvenile probation, and drug and alcohol treatment.

That's the plan, anyway.

"There was some push-back," she admitted. "The providers are having a bit of a hard time."

But people have learned that Richman is a force to be reckoned with.

"Anyone who has met Estelle Richman face to face is always impressed with her style, with her vision, with her ability to see things in an insightful way," said George Kimes, executive director of the Pennsylvania Community Providers Association.

Because his members provide many different kinds of services, Kimes said they like the idea of removing barriers.

"But the devil is in the details," he cautioned. One fear is that pooling agency programs could multiply the number of regulations and forms everyone will have to process.

"Bureaucracies are slow to change, regardless of the dynamic vision that's in front of them."

But if the speed and breadth of Richman's changes have providers holding their breath, no one questions her commitment to see them through, especially if she has four more years after the 2006 gubernatorial election.

"She has a definite vision and she is very directed in achieving that vision," said Bernadette Bianchi, executive director of the Pennsylvania Council of Children, Youth and Family Services, a statewide organization of private agencies.

As a 2001 Philadelphia Daily News profile noted, Richman's motto is "Ready, fire, aim," a nod to her preference to move ahead now and work out the wrinkles as she goes.

Richman, who holds a master's degree from Cleveland State University, was the first woman and first non-physician to head Philadelphia's health department, and she made her presence known.

In 1998, Richman was awarded the first national Good Housekeeping Award for Women in Government. She was chosen because she "successfully saved the city of Philadelphia millions of dollars while providing innovative and creative solutions for a variety of social problems."

Whether she can have the same success statewide may depend, as much as anything, on her ability to overcome administrative inertia and avoid overstepping federal rules restricting how money can be spent.

After she landed in Harrisburg, Richman said she soon realized that "DPW is not a department. It's six departments."

Rather than collaborating, the departments -- Children, Youth and Families; Income Maintenance; Medical Assistance; Mental Health and Substance Abuse; Mental Retardation; and Social Programs -- at times competed, and not always in a healthy manner, she said.

As one example, she cited what she described as "a shadow mental health system" that had emerged because of the difficulty faced in moving troubled teens from child welfare programs into the adult mental health system after they turned 21.

"So [child welfare officials] started their own system" to provide mental health therapy to young adults, she said. "They had the money, and they said, 'If you're going to put [our clients] on a waiting list, we'll just start our own.' "

Besides the obvious inefficiency of duplicating services, there were funding implications, too. The state got 55 percent matching federal funds for the adult programs, Richman said, but nothing for the shadow program.

"They need to work together," she said.

She understands time is short. Rising health care and pharmaceutical costs, especially in an aging state, mean Pennsylvania could be facing serious difficulties for the 2006-07 budget, she said. While the proposed cuts in Medicaid this year kept everyone on the rolls, that may not be possible next year and the prospect clearly troubles Richman.

"When you start cutting eligibility," she said, "then you're cutting into muscle."