AFRICAN AMERICAN MALE INITIATIVE

Michigan Office of the
Auditor General
Thomas H. McTavish, C.P.A.
Auditor General

EXECUTIVE DIGEST #3963998
AFRICAN AMERICAN MALE INITIATIVE

INTRODUCTION
This report, issued in November 1999, contains the results of our performance audit of the African American Male Initiative, Department of Community Health (DCH).

AUDIT PURPOSE
This performance audit was conducted as part of the constitutional responsibility of the Office of the Auditor General. Performance audits are conducted on a priority basis related to the potential for improving effectiveness and efficiency.

In addition, the Office of the Auditor General conducted this performance audit to address a legislative concern as to whether DCH could substantiate the reported amount of financial support directed toward African American male health issues.

BACKGROUND
In 1993, the Department of Public Health (DPH) began a strategic planning process to:

a.    Establish long-term State health directions, goals, and objectives.

b.     Ensure that DPH's actions lead to the accomplishment of goals and objectives.

c.     Define and direct resources.

The process included the identification of four strategic issues critical to fulfilling the mission and vision of DPH:

a)     Influence over health risk behaviors.

b)     Survival of the African American male.

c)     Influence over the reduction of adverse environmental and occupational health effects.

d)     Public health system evolution.

The overall goal of the strategy relating to African American males was to: "Reduce the incidence and mortality of those health problems and risk behaviors which contribute to the poor survival of the African American male."

In March 1995, DPH convened a 65-member Statewide task force to address the major health problems that disproportionately affect African American males. In June 1995, the task force produced a report that presented numerous recommendations aimed at improving the life expectancy of African American males in Michigan.

Executive Order 1996-1, effective April 1, 1996, created DCH by combining the Department of Mental Health, most of DPH, the Medical Assistance Program (commonly known as Medicaid), and other programs.

In July 1997, DCH created the African American Male Initiative as a response to the Statewide task force formed to suggest actions to combat the alarming health status ofMichigan's African American male citizens. The Initiative's efforts have generally been to:

(a)     Advocate for and promote responsive, consumer-oriented health care providers and          services.

(b)     Advocate for and support development of activities to bring about healthier lifestyles.

(c)     Support research and policies that can lead to improved health status.

(d)     Educate individuals and families to take charge of their health.

DCH reported that a major thrust of the staff activities has been to assist local communities in developing community-based coalitions to address the health needs of African Americans on the local level. DCH also reported that, by using a model developed in Washtenaw County prior to the Initiative, staff have been working in several local communities to promote this concept. Calhoun County, the first county to successfully adopt the concept, has formed the African American Health Issues Forum.

In addition to the 3 employees assigned to the Initiative as of August 31, 1998, DCH supports health services for African American males through its varying programs. As of August 31, 1998, DCH had 5,728 employees. Its fiscal year 1997-98 appropriations totaled approximately $7.2 billion.

AUDIT OBJECTIVES, CONCLUSIONS, AND NOTEWORTHY ACCOMPLISHMENTS
Audit Objective: To assess DCH's effectiveness in identifying health needs of African American males and planning for related services.

Conclusion: DCH was effective in identifying the health needs of African American males and planning for related services. However, our assessment disclosed a reportable condition pertaining to the mission, goals, and objectives of the Initiative (Finding 1).

Noteworthy Accomplishments: DCH reported that Michigan is a leader in the launching of a statewide initiative to address health concerns of African American males. Since the Challenge of a Lifetime report was published in the spring of 1996, over 43,000 copies of Volumes I and II have been distributed across the State and nation to a wide variety of community-based and government organizations. DCH also reported that staff have made roughly 410 presentations to community groups as well as appearances on television and radio talk shows within the State.

In addition, in the summer of 1998, a program brochure was published that highlighted the intent and focus of the Initiative. DCH reported that approximately 17,000 of those brochures have been distributed throughout the State.

Audit Objective: To assess DCH's effectiveness and efficiency in ensuring the delivery, monitoring, and evaluation of health services provided to African American males.

Conclusion: DCH needs to improve its effectiveness and efficiency in ensuring the delivery, monitoring, and evaluation of health services provided to African American males. Our assessment disclosed two reportable conditions related to evaluation of the Initiative (Finding 2) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevention services (Finding 3).

Noteworthy Accomplishments: DCH reported that it is preparing an updated version of the Challenge of a Lifetime report, based on 1997 health status statistics for the African American males in Michigan.

DCH also reported that it awarded Henry Ford Health Systems in Detroit $320,000 for fiscal year 1998-99 to develop screening and treatment services for African American men who are uninsured or under-insured in the City of Detroit.

Audit Objective: To determine the amount of resources that DCH expended on health services for African American males during fiscal year 1996-97.

Conclusion: During fiscal year 1996-97, DCH expended approximately $17.1 million on health services for African American males, excluding funds for mental health, the Office of Drug Control Policy, the Office of Services to the Aging, and the Medical Services Administration.

Although DCH had reported $19.4 million of resources expended on health services for African American males during fiscal year 1996-97, we identified errors in the documentation that overstated the amount by approximately $2.3 million. A separate audit finding was not included under this objective because the audit finding and recommendation on developing an evaluation plan (Finding 2) should help improve DCH's ability to provide accurate and complete data for evaluation and reporting purposes.

AUDIT SCOPE AND METHODOLOGY
Our audit scope was to examine the program and other records of the Department of Community Health and, more specifically, the activities relating to the African American Male Initiative. Our audit was conducted in accordance with Government Auditing Standards issued by the Comptroller General of the United States and, accordingly, included such tests of the records and such other auditing procedures as we considered necessary in the circumstances.

Our audit procedures included examining records and activities for the period October 1, 1996 through August 31, 1998.

Although African American males were recipients of services from a variety of DCH programs, we concentrated our audit procedures on selected programs that reflected a high proportion of services utilized by African American males. Also, these services were germane to our determination of the accuracy of data reported by DCH pursuant to our third audit objective.

To accomplish our first objective, we obtained an understanding of the Initiative's activities by conducting a preliminary survey. This included reviewing applicable statutes, policies, and procedures; evaluating any relevant strategic plans, goals, and objectives; and interviewing various staff, especially within Community Public Health (CPH) and the Community Living, Children, and Families Administration. We evaluated the organizational structure of the Initiative, analyzed the processes for planning services, reviewed funding allocations to various diseases and/or populations, and determined whether comparable programs existed in other states.

To accomplish our second objective, we reviewed a selection of programs conducted by CPH, the Community Living, Children, and Families Administration, and contracted service providers; the process for monitoring service delivery; and the process for evaluating whether services reached the intended populations.

To accomplish our third objective, we evaluated the documentation to support a CPH memorandum that identified the extent of DCH program funds serving African American males during fiscal year 1996-97.

AGENCY RESPONSES
Our audit report contains 3 findings and 3 corresponding recommendations. The agency preliminary response indicated that DCH agrees with all 3 findings and recommendations.

Full Audit Report - #3963998 - AFRICAN AMERICAN MALE INITIATIVE

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INTRODUCTION This report, issued in November 1999, contains the results of our performance audit of the African American Male Initiative, Department of Community Health (DCH).

AUDIT PURPOSE This performance audit was conducted as part of the constitutional responsibility of the Office of the Auditor General. Performance audits are conducted on a priority basis related to the potential for improving effectiveness and efficiency. In addition, the Office of the Auditor General conducted this performance audit to address a legislative concern as to whether DCH could substantiate the reported amount of financial support directed toward African American male health issues.

BACKGROUND In 1993, the Department of Public Health (DPH) began a strategic planning process to: a. Establish long-term State health directions, goals, and objectives. b. Ensure that DPH's actions lead to the accomplishment of goals and objectives. c. Define and direct resources. The process included the identification of four strategic issues critical to fulfilling the mission and vision of DPH: a) Influence over health risk behaviors. b) Survival of the African American male. c) Influence over the reduction of adverse environmental and occupational health effects. d) Public health system evolution. The overall goal of the strategy relating to African American males was to: "Reduce the incidence and mortality of those health problems and risk behaviors which contribute to the poor survival of the African American male." In March 1995, DPH convened a 65-member Statewide task force to address the major health problems that disproportionately affect African American males. In June 1995, the task force produced a report that presented numerous recommendations aimed at improving the life expectancy of African American males in Michigan. Executive Order 1996-1, effective April 1, 1996, created DCH by combining the Department of Mental Health, most of DPH, the Medical Assistance Program (commonly known as Medicaid), and other programs. In July 1997, DCH created the African American Male Initiative as a response to the Statewide task force formed to suggest actions to combat the alarming health status ofMichigan's African American male citizens. The Initiative's efforts have generally been to: (a) Advocate for and promote responsive, consumer-oriented health care providers and services. (b) Advocate for and support development of activities to bring about healthier lifestyles. (c) Support research and policies that can lead to improved health status. (d) Educate individuals and families to take charge of their health. DCH reported that a major thrust of the staff activities has been to assist local communities in developing community-based coalitions to address the health needs of African Americans on the local level. DCH also reported that, by using a model developed in Washtenaw County prior to the Initiative, staff have been working in several local communities to promote this concept. Calhoun County, the first county to successfully adopt the concept, has formed the African American Health Issues Forum. In addition to the 3 employees assigned to the Initiative as of August 31, 1998, DCH supports health services for African American males through its varying programs. As of August 31, 1998, DCH had 5,728 employees. Its fiscal year 1997-98 appropriations totaled approximately $7.2 billion.

AUDIT OBJECTIVES, CONCLUSIONS, AND NOTEWORTHY ACCOMPLISHMENTS Audit Objective: To assess DCH's effectiveness in identifying health needs of African American males and planning for related services. Conclusion: DCH was effective in identifying the health needs of African American males and planning for related services. However, our assessment disclosed a reportable condition pertaining to the mission, goals, and objectives of the Initiative (Finding 1). Noteworthy Accomplishments: DCH reported that Michigan is a leader in the launching of a statewide initiative to address health concerns of African American males. Since the Challenge of a Lifetime report was published in the spring of 1996, over 43,000 copies of Volumes I and II have been distributed across the State and nation to a wide variety of community-based and government organizations. DCH also reported that staff have made roughly 410 presentations to community groups as well as appearances on television and radio talk shows within the State. In addition, in the summer of 1998, a program brochure was published that highlighted the intent and focus of the Initiative. DCH reported that approximately 17,000 of those brochures have been distributed throughout the State. Audit Objective: To assess DCH's effectiveness and efficiency in ensuring the delivery, monitoring, and evaluation of health services provided to African American males. Conclusion: DCH needs to improve its effectiveness and efficiency in ensuring the delivery, monitoring, and evaluation of health services provided to African American males. Our assessment disclosed two reportable conditions related to evaluation of the Initiative (Finding 2) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevention services (Finding 3). Noteworthy Accomplishments: DCH reported that it is preparing an updated version of the Challenge of a Lifetime report, based on 1997 health status statistics for the African American males in Michigan. DCH also reported that it awarded Henry Ford Health Systems in Detroit $320,000 for fiscal year 1998-99 to develop screening and treatment services for African American men who are uninsured or under-insured in the City of Detroit. Audit Objective: To determine the amount of resources that DCH expended on health services for African American males during fiscal year 1996-97. Conclusion: During fiscal year 1996-97, DCH expended approximately $17.1 million on health services for African American males, excluding funds for mental health, the Office of Drug Control Policy, the Office of Services to the Aging, and the Medical Services Administration. Although DCH had reported $19.4 million of resources expended on health services for African American males during fiscal year 1996-97, we identified errors in the documentation that overstated the amount by approximately $2.3 million. A separate audit finding was not included under this objective because the audit finding and recommendation on developing an evaluation plan (Finding 2) should help improve DCH's ability to provide accurate and complete data for evaluation and reporting purposes.

AUDIT SCOPE AND METHODOLOGY Our audit scope was to examine the program and other records of the Department of Community Health and, more specifically, the activities relating to the African American Male Initiative. Our audit was conducted in accordance with Government Auditing Standards issued by the Comptroller General of the United States and, accordingly, included such tests of the records and such other auditing procedures as we considered necessary in the circumstances. Our audit procedures included examining records and activities for the period October 1, 1996 through August 31, 1998. Although African American males were recipients of services from a variety of DCH programs, we concentrated our audit procedures on selected programs that reflected a high proportion of services utilized by African American males. Also, these services were germane to our determination of the accuracy of data reported by DCH pursuant to our third audit objective. To accomplish our first objective, we obtained an understanding of the Initiative's activities by conducting a preliminary survey. This included reviewing applicable statutes, policies, and procedures; evaluating any relevant strategic plans, goals, and objectives; and interviewing various staff, especially within Community Public Health (CPH) and the Community Living, Children, and Families Administration. We evaluated the organizational structure of the Initiative, analyzed the processes for planning services, reviewed funding allocations to various diseases and/or populations, and determined whether comparable programs existed in other states. To accomplish our second objective, we reviewed a selection of programs conducted by CPH, the Community Living, Children, and Families Administration, and contracted service providers; the process for monitoring service delivery; and the process for evaluating whether services reached the intended populations. To accomplish our third objective, we evaluated the documentation to support a CPH memorandum that identified the extent of DCH program funds serving African American males during fiscal year 1996-97.

AGENCY RESPONSES Our audit report contains 3 findings and 3 corresponding recommendations. The agency preliminary response indicated that DCH agrees with all 3 findings and recommendations.