In our do'ers profile, we highlight some of the hardworking and talented individuals in public human services. This issue features Terry Barley of Cumberland County (Pa.) Aging and Community Services Services.

Name: Terry L. Barley

Title: Director of Aging and Community Services

Years of Service: 27

Rewards of the Job: Opportunities to create new systems don't come along very often. I was fortunate enough in the 80s and 90s to be a part of the initial movement away from categorical services and the early days of coordination and collaboration. Today we have an opportunity to create a Home and Community Based System that can meet the demands the baby boomers are going to place on it.

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My focus has always been on maximizing the amount of services available to the citizens of Cumberland County. Being able to meet the variety of needs that are presented to our agency by the disparate populations that we serve is a daily challenge that provides me with the most satisfaction.

Accomplishments Most Proud Of: In terms of innovative programs, the thing I have been most pleased with is the creation of the HealthShare Community Partnership. In the early 90s we recognized that too many social service staff (school nurses, caseworkers, etc.) were spending a great deal of time calling around to find a doctor or dentist for their consumers who were in need and low income, but didn't have insurance coverage. We created a coalition that recruited over 100 medical professionals and two hospitals who agreed to see patients on a free or reduced sliding-fee basis. There are two keys to the program: Strict adherence to whatever the medical professional agreed to contribute. They could agree to see either a set number of patients or a set number of office visits and they made the commitment for one year at a time. That way no one was overwhelmed by demand. The other key was recruitment by their peers--using doctors to recruit other doctors, etc. The program began in 1996 and has served over 5,000 people with donated services worth over $600,000. In 2003 the program received an Acts of Caring award from the National Association of Counties.

Thoughts About the State of the Medicaid Program: Over the last two and a half decades, the federal government has cut funding in a variety of programs that offered states some flexibility in meeting the needs that they faced individually. Each time states responded by shifting to a new source of federal funding. Eventually Medicaid became the federal funding resource of choice and grew by unsustainable proportions. Given the newly released Targeted Case Management regulations, it appears that the latest federal strategy to slow the growth in demand for Medicaid funds is one of restricting processes that actually work. Restricting payments to one case manager does not encourage cross-system collaboration or multi-systemic solutions to problems. Prioritizing transitions out of nursing homes and restricting case management to assist with the transitions from 180 days to 60 days is self-defeating.

Future Challenges for Public Service Delivery: Pennsylvania is one of a handful of states that delivers public services at the local (county) level using county staff rather than state employees. There is a growing gap between the federal government and states and between states and local governments in critical areas such as trust and cooperation. We all know about unfunded mandates and funding shortfalls, but trust and collaboration can go a long way toward bridging gaps in the system.

Little Known Facts About Me: In my previous career as a teacher, I was a very successful wrestling coach but had never participated in the sport while growing up.

Outside Interests: Spending time with my family--wife Julie, two sons and their wives, and four grandchildren; traveling to the Caribbean and Europe; collecting wildlife art and decoys and antiques