Pediatric physician Jack F. Coyne remembers the day in 1990 when he was working at the Roberto Clemente West Side Health Center. His patient was a 10-year-old girl who was seven months pregnant.
"She'd never had a period," he told Erie County legislators.
At the time, he said, he had no idea what services could be pulled together to help save this child. Now, as a member of a county committee developing recommendations for children and families, he said much has changed. But tremendous need still remains.
The work of the Erie County Community Coordinating Council on Children and Families is to ensure that those needs are met. The council was created by the County Legislature in 2014 after a series of high profile child deaths shined a harsh light on Social Services.
The committee's first report, released Thursday, recommends policy and resource changes to help more children grow up to be healthy adults.
Families have changed a great deal over the years, said AnnMarie Correa, program manager for the Buffalo Home Visiting Program, which provides home-based services to families for 3 to 5 years after a child is born.
Substance abuse and mental health issues have become much bigger issues in poverty-stricken communities, she said. The region needs to evolve its strategies for child and family care to meet them, in an environment of declining dollars and poor data sharing.
"If we can have a green code for buildings, what is the code for our children?" said Chairwoman Amber M. Dixon, former Buffalo Public Schools superintendent and executive director for the Buffalo Center for Arts and Technology. "What is keeping us from being as efficient as we can, each of us with a different piece of the puzzle?"
The committee has developed four overarching recommendations that they hope will be adopted by those with the power, influence and resources to make a difference.
But they still need others to come up with the time, resources and money to make anything they recommend a reality.
"We’re a citizens' advisory council," Dixon said. "We’ll speak out and find ways to get this done."
Committee member Robert M. Bennett, chancellor emeritus for the Board of Regents, said the committee can appeal to university legal experts and local foundations to assist in moving some of their recommendations forward.
Here are four key problems and recommendations outlined in the report:
Problem: Privacy laws greatly hinder the ability for education, health care and government organizations to share information about the people they serve. That makes it impossible for providers to get a complete picture of what issues a child or family faces.
Recommendation: Service providers should collaborate and commit legal staff to drafting a "universal release of information" form, similar to what exists in Ohio, that families can sign to allow agencies to work together, share information and coordinate care. The State Legislature needs to be lobbied to encourage a loosing of restrictive privacy laws.
Frontline view: Community agencies want to work more collaboratively, but limited funding still encourages turf battles. Legal barriers seem insurmountable.
"We’re seeing a lot in the community, this cry for communication," said Correa, program manager for the Buffalo Home Visiting Program. "There’s this territorial thing that goes on, again, because everybody’s fighting for a piece of the pie."
Problem: Many organizations that interact with struggling families and children lack the training and support to recognize and address signs of negligence, abuse, and trauma.
Recommendation: The relocation of Social Services staff to other agencies and school systems that directly serve children should continue. In addition, a full-time pediatric child abuse specialist should be hired to assist and train those employed at hospitals, Child Protective Services, police and other organizations.
Frontline view: Though Social Services is making progress in moving staff into the community, more needs to be done. The medical community must do its part to ensure that children who come to the emergency room for treatment don't later wind up dead or return with serious injuries.
"What we don’t have is a coordinated effort in this community to address this," said Coyle, medical director with the Child Advocacy Center of Buffalo and Niagara.
Problem: Many nonprofit human services agencies exist to help poor and struggling families and children, but all are vulnerable to funding "vagaries." Grants and contracts are often awarded without regard for service duplication or a coordination of outcomes measures.
Recommendation: Conduct a market analysis with the goal of reducing duplication and bureaucracy, and redesign systems to streamline and better measure results. Restructure nonprofits so they can deliver strong services with the biggest impact at the lowest cost. Expand county youth programs as a preventative measure for troubled children and work to eliminate the months-long waiting list for parents to enroll in parental education programs.
Frontline view: All of this is easier said than done. It will be up to the committee to serve as a watchdog and pressure maker to ensure this recommendation gets addressed.
"It's so complicated," said Legislator Lynne Dixon, chairwoman of the Health and Human Services Committee. "I guess we just take this one piece at a time."
Problem: Though government departments and local human services agencies collect a ton of information about the children and families they serve, the data is kept internally for practical purposes, not to drive major, strategic improvements.
Recommendations: By partnering with research foundations, organizations that work with high-risk populations can study their data over time and use the findings to come up with better ways to improve services for children and families.
Frontline view: Children will continue to fall through the cracks of our existing human services system if we don't take advantage of the collected data that Social Services and community groups already have.
"The data is useless if we don't use it," said Mary Iwanenko, committee member and director of pediatric educational and diagnostic services for Erie County Medical Center.
Though the committee was asked to look at Erie County policies and practices, committee members said they see the problem facing children as one that an entire community must collaborate together to solve.
Social Services Commissioner Al Dirschberger said that now that the report is out, it's up to the council to ensure that it remains an active document and that people are held accountable for making changes.
"That’s the next step of the committee," he said. "How do we want to address the recommendations and what we can do creatively?"
Health and Human Services Committee Chairwoman Lynne Dixon encouraged the committee Tuesday to continue its work. The committee plans to disseminate its report broadly to gain more community support and will continue to report annually to the Legislature.