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Southeastern counties develop bold ways to stretch dollars

Paul Fleissner has led a collaboration on services for the mentally ill and the chemically dependent — and now they’re in new territory.

Paul Fleissner
MinnPost photo by Sharon SchmicklePaul Fleissner

ROCHESTER, Minn. – Like his counterparts in county and city offices across Minnesota, Paul Fleissner is straining against a seemingly relentless budget squeeze.

Since 2003 the staff has been cut by 10 percent at Olmsted County Community Services, where Fleissner is the director. Meanwhile, the caseload has grown by 24 percent.

Sure it hurts.  

Instead of limping along, though, Fleissner has huddled with human service directors in 11 other Southeastern Minnesota counties and come up with bold approaches for stretching dollars by collaborating on services for the mentally ill and the chemically dependent. And now they have taken a step that is unprecedented in Minnesota: designing a regional model for delivering human services.

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“This is a wonderful example of government not acting as normal,” said Kelly Harder, director of Dakota County Community Services. “The easy thing to do would be to do nothing – and that, in my biased opinion, would be typical of government.”

Collaboration is going on at some level across Minnesota’s 87 counties. But nowhere else is it happening with the same measure of sophistication and innovation, said Harder, who formerly worked for Steele County where he participated in the early stages of the regional initiative.

Joiners, not followers

Don’t call Fleissner the leader of this groundbreaking group. That’s not his style.

The collaboration that is driving the change, Fleissner said, “isn’t about one person or one agency, but rather about building partnerships that are effective.”

Ask others involved in the initiative, though, and you hear a different story.

“He certainly has been a leader, whether he wants to admit it or not,” said Terry Smith, human services director for Wabasha County. 

Fleissner sums up his own notion of effective leadership by borrowing a quote from Marv Levy, former coach of the NFL’s Buffalo Bills: “Leadership is not about getting people to follow you. It’s about getting people to join you.”

Those are more than nice words.

“He genuinely likes collaboration,” said Sheila Kiscaden, a former state senator who represented Rochester and nearby rural areas.

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‘He doesn’t need to dominate’

Kiscaden has worked occasionally with the southeastern Minnesota counties as a neutral facilitator at critical stages in their planning sessions. So she has seen Fleissner in action.

He is “kind of humble,” she said, even though he represents the largest county, by far, in the region.

“He doesn’t need to dominate, and he can share leadership very easily,” she said. “He does it in a way that is mutually respectful. He isn’t demanding. He isn’t angry. He is calm. … He is arguing for what he believes is the right way to go, and that becomes very persuasive because you sense he really respects your point of view and he is genuinely looking for solutions.”

Harder also used the word humble to describe Fleissner’s style.

“He has what I call that servant leadership,” Harder said. “It’s a humble approach to leadership that’s not about himself. It’s about the best interests, ultimately, of the people we serve.”

Shaped by hard times

The humility is rooted in a childhood that set Fleissner on his path toward a career in human services.

Fleissner, now 49, calls himself “somewhat like an Army brat within Minnesota.” His family moved around a lot. The huge difference was that they didn’t have an Army paycheck.

When he was 11 years old, a family business failed and his parents filed for bankruptcy.

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“After that, my dad went from job to job, and we went from an average, middle-class family to living in poverty,” he said.

They bounced from the Twin Cities to Duluth to small towns like Foley, near St. Cloud. By high-school graduation day he had attended 13 different schools.

Other kids lived in homes their parents owned. His had to rent.

“In Foley in my last few years of high school, we really went through hard times,” he said.

He found work and put in long hours – not to save for college, but to pay for groceries and help his family survive.

“When I took my girlfriend to prom, I had to pack the back seat with rags because our car had holes in it, and my date lived on a dirt road,” he said. “I was worried all the dust would ruin her dress. I was also told by my dad before I left that night that we had lost our insurance so I had to drive carefully.”

Along the way, the family stayed “very close knit,” he said.

Developing deep sensitivities

Meanwhile, he began to develop deep sensitivities to the way individual opportunity can be shaped by factors beyond a person’s control, by differences in income, race and culture.

Living in a tough neighborhood in Duluth, for example, Fleissner said he saw “huge issues,” including gang fights, between white kids and Native American kids.

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“I was invited to play in a football game,” he said. “Seems innocent enough, but kids were intentionally trying to hurt one Native American boy.”

Young Fleissner spoke up, and barely escaped a beating himself.

“That stayed with me,” he said. “My mother had faced some similar issues as a child, and I think she planted the seed (of concern for) fairness and equality that made me speak up.”

Despite the hardship, Fleissner made it to college, earning a bachelor’s degree in psychology from St. Cloud State University and also a degree in accounting from Winona State University. His first professional job was in a group home for troubled youth in Minneapolis, followed by work as a behavioral analyst at the former Cambridge State Hospital.

The move to Rochester came through a job at Hiawatha Homes, which serves developmentally disabled children and adults. Finally, Olmsted County hired him as a social worker 18 years ago, and he rose through the ranks to take the director job.

Now Rochester is home where he lives with his wife, also a social worker. They have three children, the oldest attending the University of Minnesota and twins still living at home.

Starting with mental health

The strategy of enhancing services by reaching across county lines goes back at least to the 1990s in Southeastern Minnesota. It was an era when the state had moved away from big institutions like state hospitals for treating the disabled and the mentally ill. Instead, the services were to be based in communities where people lived, a goal that cities and counties were scrambling to meet.

Ten Southeastern Minnesota counties joined forces to pool funding and leverage resources for some of the mental health services under an initiative called CREST [PDF].

It made sense that Olmsted County would be the hub. Not only was it the largest with the most resources in place, but also people throughout the region traveled there to work in Rochester, see medical specialists and shop.

Over the years, the counties expanded their collaboration into housing and other services.  With millions of federal and state dollars at play, the smaller counties eventually needed contract managers, for example, and nine of them arranged for that service through Olmsted.

“That built a lot of trust over time,” Fleissner said.

New approach for treating chemical dependency

The trust grew as the counties approached the state with a proposal for fixing what Fleissner described as a broken system for treating chemical dependency. At the time, the state allowed limited options for the dollars it dedicated to treating chronic dependency. Basically the choices were standard in-patient treatment, out-patient treatment and half-way houses.

“We sent some of our clients through that system 20 times with no results,” Fleissner said.

In a bid for better outcomes, the counties successfully lobbied the Legislature in 2009 for more flexibility. Their strategy for what Fleissner called “deep end folks” was to integrate treatment with other support such as mental health services and primary health care. They also proposed a system in which “navigators” would help the chemically dependent and their families find their way through the intricate systems intended to aid recovery.

With better outcomes, the counties argued, they could save money on services such as detox, law enforcement and courts. Washington County joined them to test the strategy in pilot projects.

The final report on the projects isn’t due until next year, but Fleissner predicted it will show the approach succeeded.

“What we have learned is that if you provide stable housing, build relationships through peer support or even work with people to get employment, then they are more motivated to be successful in treatment,” he said. “I know that we had people who had been in our system for 15 or 20 years that under our pilot have gone through a year of complete sobriety.”

Everything on the table

Having gone that far together, the human services directors from counties across the region were at a point where they were meeting regularly on the second Friday of every month at a government center in downtown Rochester.

Ever tighter budgets were a struggle in every one of their counties. Were there other services, they wondered, that could be delivered more efficiently through regional collaboration? About three years ago, they came up with a list of 26 categories of service they were providing, and started evaluating the categories one by one.

How many could be done collaboratively? All of them, the group concluded.

Now, more than ever, they needed the trust they had built in one another. This would be a bold step, unprecedented in Minnesota.

Cutting your own job

The meetings were intense, recalled Harder, who was with the group at the time. Redesigning their delivery system to a regional model might actually eliminate some of their own jobs.

“In two to five years, I don’t think my job is going to exist anymore,” said Smith, the Wabasha County human services director.

“I’m fine with that,” Smith said. “It’s something that needs to happen. We don’t need 12 human service directors in Southeastern Minnesota.”

Still it’s a leap that many people couldn’t take easily.

Throughout the tough-but-honest dialogue, leadership from Olmsted County was critical, Harder said. And Fleissner delivered, but under a structure where leadership was shared with the 12 county directors rotating onto the project’s steering committee.

Initial help from the Rochester Area Foundation, followed by grants from the Bush Foundation, have moved the idea through design phases and finally to the point where implementation recommendations should be ready to present to the county boards in March.

Low-touch, high touch

Beyond gains that can be made by sharing technology and management functions, the plan taking shape calls for some “low-touch” services to be centralized in the region. These services – determining eligibility for public assistance, for example –  typically involve more paperwork than face-to-face meetings. 

Meanwhile, “high-touch” services like child protection would remain local. But counties could pool some elements of those programs too.

Put simply, the pooling mechanism could be a co-operative, much like the agricultural co-ops that have operated throughout Minnesota for decades. In this case, the regional co-op would offer a veritable cafeteria of services that counties could choose to purchase. For more details, see this MinnPost story.

So far, the county boards have given the green light to the planning and analysis needed to get the initiative this far. Whether they now agree to actual implementation depends on tough-minded business decisions.

“Can we save a buck, and does it really improve services to clients?” Fleissner asked.

Those are the tangible deciding factors.

Losing identity

In the end, though, some intangibles may sway votes on the county boards.

For decades, the move toward regionalization has punished small towns across Minnesota. Local schools closed, and kids went off to regional education centers. Local stores gave way to malls and big-box retailers in cities like Rochester, Mankato, St. Cloud and Duluth.

Going regional might have made economic sense. But hundreds of towns paid a price in terms of identity and vitality.

Will this move be seen as the latest painful leap in that direction?     

“There is an inherent dynamic that we have talked about early and often in this project.” Fleissner said. “Is Olmsted going to take over the world and take over the other counties?”

For its part, Olmsted worries “that the other counties will just want to chew on our tax base, leverage our resources to offset their own,” he said.

‘The money just isn’t there’

Smith, in relatively small Wabasha County, said he thinks economic necessity will override that inherent tension.

“It’s pretty clear that we can’t keep going the way we are right now,” Smith said. “The money just isn’t there. We’ve got to work this out smarter. … And Paul (Fleissner) can lead the way on many of those things.”

Indeed, necessity is driving the initiative, Fleissner said.

“I’ve been in the director job for 10 years now, and for about nine of them we’ve faced budget cuts,” he said. “At what point is that working for us when I have to start cutting things that are critical? We have to find new models for doing business. We have to leverage technology. We have to leverage partnerships. The biggest thing to me is finding partners who are willing to do things differently.”

There is another driver, though: the deep sense of human need that drew Fleissner to this line of work in the first place.

‘We’re better than that’

Fleissner expressed it this way when he listed the reasons for revamping the system for treating chemical dependency: “We’ve been hooked on traditional ways of doing it, and traditional treatment works for some people just fabulously, but we have to develop other models that work for the other people. I don’t believe we should be in a society where people are dying under bridges because we won’t house them, we won’t find new models of service. That’s not something I signed up for. I think we’re better than that.”

Whether it involves tutoring kids, chauffeuring the elderly or singing in the church choir, volunteer work can be one of life’s most engaging and rewarding experiences.

Fleissner considers himself to be something of a professional volunteer, even while he holds a demanding administrative job.

“You hear people talk about their volunteer experiences and what it means to them. Well I get to do that every day,” he said. “Our job here is to make people’s lives better.”

To be sure, administrative duties keep him away from the bulk of his department’s face-to-face work in assisting needy families, vulnerable kids, veterans and others.

“But we are continually working to improve service systems so that kids, adults and families have a better chance of being successful in our community,” he said.  “That’s cool. That is a mission I can come to work every day and feel good about.”

For a long-time administrator, Fleissner’s sense of mission is unusually fresh and focused, said Kiscaden, the former state senator.

“In a lot of organizations the employees’ needs … or political attitudes start to drive the way an organization is managed,” she said. “Sometimes it’s just fatigue – you know, what’s the easiest thing to do. There are a lot of things that can detract from the focus on the overall mission. … He never loses sight of it.”