Making good, informed decisions about how to allocate limited resources is an ever-evolving process. The Allegheny County Department of Human Services (DHS) strives to make the most equitable decisions when allocating scarce resources for individuals and families in need. Housing is a critical resource for which demand far exceeds supply; thus, DHS is dedicated to making sure that those most at need have priority for the housing services that are available. Since 2017, DHS has developed predictive risk models that utilize administrative data to assign a risk score that is used to determine the appropriate course of action. Two of these models were developed to support prioritization of housing resources.

Allegheny Housing Assessment (AHA)

In 2020, DHS launched the Allegheny Housing Assessment (AHA), a decision support tool designed to help prioritize admissions to supportive housing services for individuals or families experiencing homelessness. The AHA forms the infrastructure for DHS’s coordinated entry system for those in a housing crisis.

The tool uses administrative data from Allegheny County’s data warehouse to predict the likelihood of three types of events occurring in a person’s life if they remain unhoused over the next 12 months: 1) a mental health inpatient stay, 2) a jail booking and 3) frequent use (4 or more visits) of hospital emergency rooms.  These events serve as indicators of harm if a person remains unhoused. The AHA assigns a risk score that is used as part of the housing prioritization process; it is far more objective and unbiased than earlier assessment tools and it doesn’t require the time or trauma associated with asking sensitive questions at the time of housing crisis.

Select from the following documents to learn more about the AHA tool:

• • • Using Predictive Risk Modeling to Prioritize Services for People Experiencing Homelessness in Allegheny County: Methodology Report for the Allegheny Housing Assessment Tool (September 2020)
    • Methodology Update (December 2020)
    • Frequently asked questions about the implementation of the Allegheny Housing Assessment tool
    • Summary of client feedback on the new housing prioritization process
    • Independent ethical/data science review of the Allegheny Housing Assessment
    • DHS’s response to the ethical review

Mental Health – Allegheny Housing Assessment (MH-AHA)

After a couple of years of experience with the AHA, DHS leadership realized that a similar tool could help prioritize admissions to residential services for individuals with a diagnosis of serious and persistent mental illness. Using the AHA as a starting point, the team developed the Mental Health – Allegheny Housing Assessment (MH-AHA) and launched it in February 2023.

Similar to the AHA, the MH-AHA utilizes administrative data from Allegheny County’s data warehouse to predict the likelihood of two potential types of adverse events that may occur in an individual’s life if they do not receive adequate support for their MH condition over the next 12 months: 1) a mental health inpatient stay and 2) frequent use [4 or more visits] of hospital emergency departments. These events serve as indicators of harm and are things we would like to prevent. The MH-AHA assigns a risk score that is used as part of the prioritization process. Individuals who are not eligible or who do not receive a risk score likely to lead to a placement in the near future will be introduced to other supportive services options instead of waiting a long time on a waiting list for a placement that might not occur.

By prioritizing those most in need of MH residential services, the MH-AHA will simplify the referral process, decrease uncertainty and reduce wait times. In addition, it will help Allegheny County document unmet MH residential needs created by the gap between limited MH residential resources and the number of high-risk eligible individuals. An external impact evaluation by researchers at Stanford will document progress toward these goals.

Select from the following documents to learn more about the MH-AHA:

• • • Methodology Report for the Mental Health-Allegheny Housing Assessment Tool (November 2023)
    • Frequently asked questions about the implementation of the Mental Health-Allegheny Housing Assessment Tool
    • Video overview of Mental Health – Allegheny Housing Assessment Tool to Behavioral Health Providers (July 2024)

From May through August 2024, Allegheny County Department of Human Services (DHS) engaged in a comprehensive needs assessment. The purpose of the assessment was to determine how DHS can best address the needs of individuals and families living in poverty and promote stability and economic security using Community Service Block Grant (CSBG) funds and other flexible funding across the agency. The assessment included collection and analysis of qualitative and quantitative data from community members and service providers.

Read the new report here.

What are the takeaways?

• Despite a decrease in the overall poverty rate, there remain deep disparities in poverty by demographic groups. Black people, women with children and people with less than a high school diploma experience poverty at twice to three times Allegheny County’s rate.
• Finding job opportunities was the number one challenge reported by survey respondents seeking employment. Additional barriers to employment include transportation and resumé/application preparation.
• Workforce participant engagement for those receiving SNAP and TANF (i.e., those with low income, for whom relevant data are available) increased from 2021 to 2022, possibly explained by COVID-related participation extensions. The demand for job readiness/training programs among this population, particularly for SNAP recipients who are female and Black, is expected to increase further as SNAP work requirement waivers expire in 2025.

In May 2022, Allegheny County assembled a taskforce of leaders to reduce intimate partner violence (IPV) through improved coordination, information sharing, training, and implementation of interventions that target both those who use violence and those who are victims or survivors of it.

Historically, the County’s understanding of IPV has been based on national data, which, though useful, fails to capture local nuances that lend greater insight into specific community needs. The county published a report and dashboard to provide more local context to problems of IPV in Allegheny County by describing trends in demographics, human services involvement, and criminal histories among victims and perpetrators of intimate partner homicides (IPH). The report covers January 2017 through September 2022. The dashboard includes more recent information and is updated annually.

The analysis point to a disproportionate impact on individuals who are disadvantaged not only by their gender identity, but also by systemic racial and socioeconomic inequalities. Though IPV has traditionally been framed as an issue related to gender alone, a more intersectional understanding of risk and impact can better inform strategies for effective prevention and mitigation.

Key Findings from Report

• There were 45 victims (43 incidents) of IPV and IPV-spillover homicides from January 2017 through September 2022.
• The demographic trends among individuals involved in IPH are similar to those of overall homicides: victims and perpetrators are disproportionately Black, young (aged 25-34) and living in high-need areas. Black women represent the highest proportion of victims (37%, n=16), while Black men constitute the highest proportion of perpetrators (56%, n=23).
• Unlike homicides at large, IPH victimization disproportionately impacts women: 63% of victims of IPH are women.  While IPH accounted for roughly 7% of all homicides from January 2017 through September 2022, they made up 30% of all homicides with female victims.
• Both victims and perpetrators of IPH had high rates of involvement in human services.  74% of perpetrators had prior involvement with child welfare, publicly funded behavioral health, or homeless and housing systems.
• 58% of victims had prior involvement with child welfare, publicly funded behavioral health, or homeless and housing systems.
• Across all gender, race and role categories, about 53% of individuals involved in IPH – 47 of 88 – had criminal justice involvement at some point prior to the homicide incident: 63% of perpetrators (27 of 43) and 44% of victims (20 of 45). Among perpetrators with criminal justice involvement, both Black and White men had higher rates of involvement than either Black or White women.
• Roughly 24% of all IPV perpetrators had indicators of IPV history in either the criminal courts or child protection system. This is likely an undercount of true IPV history, as data limitations, legal restrictions and underreporting make identification of non-fatal IPV in the data difficult. Among those with domestic violence related criminal cases, the majority occurred in the 18 months prior to the homicide incident.

Allegheny County residents face significant challenges in accessing behavioral health services, an issue highlighted by recent studies and surveys. Notably, a Countywide survey revealed that 42.7% of respondents believe improving access to mental health care, particularly for young people, should be a priority. This finding is supported by research from the University of Pittsburgh, which documented long wait times for appointments and challenges in connecting with providers. These issues stem from a critical shortage of behavioral health professionals and are compounded by time-consuming provider search processes.

In response, the Allegheny County Department of Human Services (DHS), along with Community Care Behavioral Health (CCBH), the County’s behavioral health managed care organization, are pursuing a series of investments and initiatives aimed at addressing these barriers and increasing service availability.

To improve access and reduce wait times, DHS and CCBH are focusing on:

• Creating visibility into appointment availability so clients and providers spend less time searching for services.
• Supporting the behavioral health workforce through loan repayment and cohort-based training programs to increase the number of providers.
• Investing in community-based mental health supports to offer additional options outside the traditional system.
• Expanding access to proven treatments like medication-assisted therapy for opioid addiction, cognitive behavioral therapy and group therapy.
• Augmenting clinical decision-making to ensure those who need help most get it quickly

The Allegheny County Department of Human Services (DHS) funds programs to assist young adults who are transitioning out of the child welfare system (also known as transition-aged youth) to secure employment, education, housing, behavioral health services, financial advice and more. Despite these service offerings, transition-aged youth have higher rates of homelessness, substance use, mental health challenges and incarceration, as well as lower rates of high school graduation compared with people who were not involved with the child welfare system. While targeted services are important, some human service needs result from poverty, which can be mitigated by providing direct financial assistance.

What is this report about?

In the summer of 2023, DHS launched a direct cash support program called Cash Assistance for Allegheny Young Adults (CAAYA), which provided a one-time payment of $4,000 to young adults, ages 18 through 22, with a history in the child welfare system, who were experiencing homelessness or were young parents who had an open case with Allegheny County’s child welfare office. In this report, we present a mixed-methods approach to evaluating the impact of CAAYA, including longitudinal surveying, a quasi-experimental analysis of administrative data in the Allegheny County Data Warehouse, and semi-structured interviews with cash recipients.

What are the takeaways?

• CAAYA recipients demonstrated significant financial need. At the launch of the program, only 35% reported being currently employed and only 29% reported being in school either full-time or part-time. Those who had some form of formal employment in the 12 months before the program had mean annual earnings of $10,174. Twenty-eight percent had one or more children.
• CAAYA recipients also lacked financial support within their community. Two-thirds of recipients reported not knowing anyone who would lend them $500 in a time of crisis.
• Overall, the program encouraged about 100 individuals to open a bank account. Seventy-five percent (n = 774) of recipients chose to receive the money via bank account transfer and 25% via a virtual gift card.
• Recipients used the cash assistance quickly. On average, $2,769 of the $4,000 was spent within the first month.
• Car-related expenses ranked as the number one item for planned expenditures, and there was a 41% relative increase in car ownership three months after receiving the money.
• The program improved self-reported well-being after receiving financial assistance, but the effects faded in the subsequent months.
• CAAYA recipients increased their use of mental health outpatient therapy by 7% compared to a control group of individuals who were narrowly ineligible for the program. There was no change in utilization of crisis and inpatient services. In contrast to self-reported well-being, the program’s impact on usage of outpatient mental health services persisted for at least eight months after receiving funds.

How is this report being used?

As a result of this program, we are exploring additional opportunities to leverage cash assistance with this population to increase engagement in holistic supports and services. We are also considering longer-term programs with more frequent, smaller payments to targeted populations.  For future programs, we hope to receive state waivers for the impact of cash assistance on public benefits, especially if a program is designed to include ongoing payments.

For other local governments or providers who are considering cash assistance programs, we hope this report serves as a resource for program design and evaluation. Local governments should note that the success of the CAAYA program would not have been possible without our partner organizations. Trust in government significantly impacts the accessibility of services, particularly for marginalized communities. When first hearing about the cash assistance, many individuals who were eligible to receive the money thought that it was a scam. This skepticism was eased by having multiple trusted intermediaries ensure that it was a real program and that they should apply.

The 2008 Act 33 Amendment to the Pennsylvania Child Protective Services law requires state and local reviews of all child fatalities and near fatalities that result from suspected child abuse. In response, the Allegheny County Department of Human Services (DHS) conducts a comprehensive and multidisciplinary review of child fatalities and near fatalities in cases where there is suspicion of child abuse or neglect. These reviews are a component of DHS’s continuous quality improvement process.

What is this report about?

This report covers child fatalities and near fatalities (critical incidents) in Allegheny County reviewed in 2022 and 2023 with a focus on drug ingestions, which have been a growing cause of these critical incidents. The increase in child ingestions and fatalities has been a nationwide trend in recent years and has worsened amidst the nation’s opioid epidemic. The County seeks to understand how these incidents happen and the circumstances surrounding them so that it can develop strategies to minimize them.

What are the takeaways?

• There were 50 critical incidents that occurred during 2022 and 2023. Forty percent (20) of these incidents were the result of unintentional drug ingestion. Unintentional ingestion comprised one-third of the 2022 incidents, rising to nearly one-half in 2023. The number of ingestion-related incidents has been rising year-over-year since 2019 and has been the primary cause of the County’s fatalities and near fatalities since 2022, surpassing blunt force or penetrating trauma and abusive head trauma.
• In 18 of the 20 ingestion cases, at least one of the substances ingested was an opioid. Eighty-six percent of the near fatal and 100% of the fatal ingestions involved opioids.
• The majority (70%) of ingestions occurred in children below the age of three. 40% of victims of ingestions were between one and two years of age compared to 27% of victims of non-ingestion fatalities and near fatalities. This age group are especially at risk for unintentional ingestion as they begin to gain mobility, which increases the likelihood of coming into contact with substances.
• Only 4 (20%) families of ingestion-related critical incidents had active child welfare involvement at the time of the incident, though three quarters (15) of families had a history of child welfare involvement prior to the ingestion incident.
• Sixty-six percent of alleged perpetrators in ingestion cases had received publicly funded substance use disorder services prior to the critical incident.  However, there was a reduction in engagement with these services within a year (43%) and within a month (36%) prior to the critical incident.
• Of the known alleged perpetrators in ingestion cases, 41% had utilized medication for opioid use disorder (MOUD) at some point before the critical incident. There was a steady decrease in MOUD use leading up to the critical incident with 31% using MOUD within the year and 13% within the month prior to the critical incident. 

How is this report being used?

Allegheny County is taking an active role in addressing the ramifications of the opioid epidemic and the rising trend of unintentional ingestions. This includes enhanced training for Child welfare staff and access to naloxone, lockboxes and fentanyl test strips for caseworkers to provide to clients. The County, through its opioid settlement funds, has expanded convenient access to MOUD and evidence-based treatment (e.g., mobile medication, telemedicine prescribing, and incentives for abstinence from stimulants and opioids) and launched a Countywide marketing campaign in April 2024 warning about the dangers of opioid ingestions and the safety of administering naloxone to children. In addition, it has invested in preventative programming like residential substance use disorder treatment that allows families to reside together during a person’s treatment and in the Hello Baby approach, a collaboration which is designed for parents with newborns to improve family outcomes and maximize child and family well-being, safety and security.

Other information

Explore updated annual data and prior reports here.

What is this dashboard about?

The Allegheny County Department of Human Services (DHS) partnered with Pittsburgh Regional Transit (PRT) to launch a transportation assistance program called Allegheny Go. This program offers half-price PRT rides for county residents ages 12 to 64 who receive Supplemental Nutrition Assistance Program (SNAP) benefits, and do not receive any other transit fare discounts. 

Allegheny Go builds on the success of the Allegheny County Discounted Fares Pilot Program, which ran from November 2022 through June 2024.  

This dashboard describes the application process and reports on application statistics and participant demographics.  

How is this dashboard being used?

DHS has set a goal of enrolling 15,000 participants in Allegheny Go. This dashboard tracks progress towards that goal. Staff monitor how many applications are received, how many are eligible, and make sure eligible participants receive their discounts.  

Overview: 

In 2021 and 2022, states and localities reached historic settlements with manufacturers and distributors of opioids, as well as pharmacy chains and a consulting firm, for their roles in the opioid epidemic. The settlement funds were designed to promote the long-term goals of (1) reducing fatal overdoses and (2) reducing the harms from opioid use disorder. As a result of these settlements, Allegheny County will receive annual payments in varying amounts through at least 2038. To date, Allegheny County has received two payments in 2022 totaling $8.4M and a third payment in 2023 totaling $6.05M.

Analysis: 

This report is meant to provide background on the national opioid settlements and share updates on how Allegheny County invested the first two payments received from opioid settlements to bolster our ongoing investments in the broader substance use services system. The dashboard provides additional information about the fund and the initiatives the money is supporting.

 

Trouble viewing the dashboard below? You can view it directly here.

 

Allegheny County Department of Human Services developed these dashboards to provide information to the community about violence trends in Allegheny County and the City of Pittsburgh.

What is this dashboard about?

The dashboard contains information about all homicides in the county and city (as reported by the county’s medical examiner) and contains a link to the Pittsburgh Bureau of Police’s dashboard showing shootings within the City of Pittsburgh. The dashboard shows trends in homicides, including trends in demographic data for victims and trends in homicide locations. The dashboard also shows information on human service, physical and behavioral health, income supports and justice involvement for the victims prior to their death.

What data is available?

Data on homicides is available through the Allegheny County Medical Examiner’s office. It is available from 2007-present and is updated monthly. Data on program involvement (including prior justice involvement) comes from Allegheny County’s data warehouse, which integrates information from more than 20 distinct sources. Read more about the county’s data warehouse here.

Read about how Allegheny County responded to an 82% increase in reports of need to Older Adult Protective Services.

Click here to read more information about older adult protective services and access real-time data.

Since 2016, the Allegheny County Department of Human Services (DHS) in Pennsylvania has utilized the Allegheny Family Screening Tool (AFST), which assists child welfare call screening caseworkers in their assessment of general protective service (GPS) referrals regarding potential child maltreatment.

What is this report about?

This report reviews the research evidence on algorithms in child welfare, specifically focusing on the causal impacts of the AFST and comparable predictive risk models (PRMs). It begins by summarizing the influence of these tools on child welfare decisions. The report then explores the discrepancies between perceived and actual effects of these models, highlighting the importance of bridging the gap between perception and reality to alleviate concerns and maximize the effectiveness of these tools.

What are the takeaways?

The impacts of predictive risk models in child welfare must be compared with alternative approaches to augmenting call screening caseworker decision-making. Traditional risk assessments in child welfare have been largely manual, prone to inconsistencies, and often omit critical information. Before implementing the AFST, Allegheny County did not employ any structured risk assessment.

The main conclusions from recent research on the AFST are:

• The AFST changed the composition of investigated referrals. The introduction of the AFST decreased the probability of investigation for referrals with low risk of removal and increased the probability of investigation among referrals with high risk of removal. The introduction of the AFST also reduced the racial gap in investigation rates, particularly among higher risk referrals.
• The AFST is reducing, not increasing, racial disparities. Researchers found that the introduction of the model reduced racial disparities in investigation rates across AFST scores, although the size and precision of the reduction varied. The AFST reduced the racial disparity in investigation rates for the highest risk referrals by 83%, from 10.6% to 1.8%. The researchers estimated that the AFST reduced the Black–White gap in removal rates of screened-in referrals by 73%, from 4.3% to 1.2%.
• Screeners use the algorithm but with caution. Researchers found that call screening case workers are integrating information from the AFST effectively, aligning their decisions more closely with predicted removal risk compared with the period before the tool’s introduction. The tool is seen as a helpful source of additional information rather than a replacement for professional judgment. 

How is this report being used?

The application of algorithms to support decision-making, especially in sensitive areas like child welfare, mandates high transparency. It is critical that the complexities of predictive risk models are communicated clearly to all stakeholders to maintain trust and prevent misuse. DHS is committed to keeping the public informed about the use and impact of algorithms at the Department and draw upon current research to shape the implementation of these tools in the field.

Read more about AFST here.

What is the Community Need Index?

The Allegheny County Department of Human Services (DHS) conducts a Community Need Index (CNI) to identify specific areas that are in greater need, and face larger socioeconomic barriers, relative to others. The newest version of the CNI index ranks neighborhoods by need level by looking at:

• The percentage of families who live below the poverty line
• The percentage of unemployed or unattached males
• The percentage of those aged 25 and up without at least a Bachelor’s degree
• The percentage of single parent households
• The percentage of households without internet access
• Rate of homicide per 100,000 residents
• Rate of fatal overdoses per 100,000 residents

The researchers used a census tract level to break up the region and assess needs. Census tracts are static, relatively small subdivisions of a county.

How can I view the findings?

An interactive map allows users to view and extract data from the 2024 CNI (which uses 2022 five-year data estimates and totals). The new report focuses on all of Allegheny County, examines changes in need over time, and places emphasis on the connection between race and community need. Earlier reports are linked below.

What are the takeaways?

• In Allegheny County, we continue to find the highest levels of need in specific sections of the City of Pittsburgh (Hill District, South Hilltop, parts of the West End, Upper East End neighborhoods, Upper Northside) as well as census tracts outside the City of Pittsburgh (Mon Valley, sections of the Allegheny County River Valley, sections of Penn Hills, sections of Wilkinsburg, Stowe-Rocks).
• There are vast discrepancies between the lowest need communities, which have an average poverty rate of 2%, and the highest need communities, where the average poverty rate is 38%.
• With few exceptions, census tract-level community need is persistent over time.
• Only about one-third of Allegheny County’s Black residents live in lower-need communities. For every other racial and ethnic group in the County, the majority of residents live in lower need communities. Black communities in Allegheny County have disproportionately high levels of need, as do a number of racially mixed communities. 
• Poverty status alone does not account for where various racial and ethnic groups tend to live by level of need; poor Black and Latino families are more likely than other poor families to live in higher need communities. Even Black families above the poverty line are many times more likely than their Asian, White and Latino peers above the poverty line to live in higher need communities.

How is this report used?

The geographic dimensions of community need can help inform many aspects of DHS’s strategic planning and resource allocation decisions, such as decisions on where to locate Family Centers or new after-school programs.

Where can I go for more information?

For more information, you can read previous reports below. Or you can reach out to DHS-Research@alleghenycounty.us with any questions.

 

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Previous reports in this series 

• 2018 update (all county)
  • 2018 Storymap
• 2014 update (suburbs)
• 2012 update (suburbs)
• 2000-2009 (suburbs)
• 2000-2012 (city)

Previous datasets in this series

• 2018 (all county)
• 2014 (suburbs)
• 2000-2012 (city)

Recently, DHS announced it was eliminating some Education Specialists Position. Read a summary of that decision and click here to find some resources if you need assistance.

The Allegheny County Department of Human Services (DHS) partnered with Pittsburgh Regional Transit (PRT) to launch a new transportation assistance program in November 2022 called the Discounted Fares Pilot. This program offered free and reduced-price PRT rides for county residents ages 18 to 64 who receive Supplemental Nutrition Assistance Program (SNAP) benefits, along with their 6- to 17-year-old children. The fare discounts were allocated using a lottery. Each household in the pilot was randomly assigned to one of three groups, each with equal probability. One group received unlimited free PRT trips, a second group received a 50% discount on all PRT trips, and a third group received no discount. The fare discounts lasted for at least 12 months for the free-fare and half-fare groups.  

What is this report about?

This report first describes the results from the first year of the pilot.  It describes the design of the pilot, the characteristics of the participants and provides estimates of the causal impact of the fare discounts on travel behavior and health care utilization.  It also reports on impacts on self-reported outcomes related to employment, financial stability, and well-being.

What are the takeaways?

• A total of 9,544 adults and 4,928 children enrolled in the Pilot during the three-month open enrollment period. The majority of adult participants were female (72%) and Black (59%). Participants reported taking an average of ten PRT trips per week and spending an average of nearly $30 on public transportation per week at the time they enrolled in the Pilot.
• Most participants successfully received their Pilot-issued farecard and used the card at least one time. 90 percent of adults in the free-fares group tapped their assigned farecard at least once. 82 percent of the half-fares group and 81 percent of the no-discount group tapped their farecard at least once. The majority of farecard non-users likely never received their assigned card.
• Larger fare discounts resulted in greater use of Pilot-issued farecards. Participants in the half-fares group tapped their assigned farecards an average of 1.6 more times per week than the no-discount group. Participants in the free-fares group tapped their assigned farecards an average of 3.3 more times per week than the half-fare group. 
• The fare discounts yielded improvements in certain measures of financial savings and transportation security. In particular, the free fares reduced self-reported weekly spending on PRT trips by more than $17 relative to no discount while there was an $8.92 decrease in weekly spending on average for the 50% discount group. Free fares led to a 26 percentage-point decrease, while 50% discounts resulted in a 10 percentage-point drop in the self-reported likelihood of missing work or other appointments in the past four weeks due to transportation issues.
• Discounted fares had limited effects on health care utilization, with no clear patterns emerging in terms of increased or decreased use of care. The fare discounts had no discernible impact on participants’ likelihood of receiving Medicaid-funded health care in the first 270 days after they enrolled in the Pilot.

How is this being used? 

DHS is using the Pilot results to better understand the ways that low-income households may benefit from reduced PRT fares. We will continue to refine our understanding by analyzing longer-term outcomes and by incorporating insights from qualitative interviews that were conducted with a subset of participants. These findings will be shared in a future publication.

DHS has also used the preliminary Pilot results to inform the design and implementation of a longer-term program that will offer a 50% PRT discount for working-age county SNAP beneficiaries and their children. This new program, called Allegheny Go, is scheduled to launch in June 2024.

Other information

Research Plan

DHS has set five goals to guide us and our partners in serving our community well. We aim for our network for human services to improve access to care, prevent overuse of coercive services, prevent harm, increase economic security and ensure quality.

What is this report about?

DHS can reach our goals more quickly if we devote time and attention to several big, bold initiatives that will make our systems and our organization work better for everyone we serve. This document outlines our key initiatives in 2024—which are in addition to our core work of running effective systems of care for people.