APHSA Annual Report 2017

INFLUENCE BUILD CONNECT

2017

ANNUAL REPORT Working With and Through Our Members

FROM THE PRESIDENT AND CEO Dear APHSA Members, Friends and Colleagues, As 2017 comes to a close, and we reflect on the year’s achievements, we are reminded just how much we have learned together. We are motivated more than ever to continue the journey with you and advance our shared desire that all people – no matter where they live, work and play – can reach their full potential. We hope that you will take the time to read this annual report – and see how each of you as leaders in the field are driving a systems- level transformation of health and human services and achieving better outcomes for children and families in your communities. We continue to see the guiding principles laid out in our Pathways initiative taking root throughout the nation. As we move towards a whole-family, generative approach and away from a system rooted in compliance and programmatic outputs, we are experiencing a seismic shift in thinking about human services across the country. Leaders at all levels of government and across political parties are embracing innovative ideas that more effectively address root-cause issues and improve the return on taxpayer investment. As key officials in the new Administration have taken office, we shared our member-driven Pathways transition paper (available at http://bit.ly/2yjbsAD ) that provides an overview of how these efforts are driving better outcomes and identifies how we can accelerate that change by further modernizing and aligning federal policy with state and local innovations and proven practices. We are especially appreciative of the contributions of our Leadership Council in advancing these efforts. You can read more about how we have engaged these new leaders and members of Congress regarding these modernization efforts in this report. At the foundation of our work at APHSA is the Health and Human Services Value Curve, which we often refer to as simply the Value Curve. As many of you already know, the Value Curve has gone “viral.” By our count, more than one hundred jurisdictions and partners are using the Value Curve as a lens for assessing delivery of health and human services in their organizations and communities, and at all levels of leadership. It is through this lens that organizations are driving change in practice and lifting-up areas for modernizing policy to get at root-causes and achieve better population-level health and well-being. To support our members’ effective use of the Value Curve to drive desired change in their states and counties, we have worked in partnership with universities, sister associations and foundations to illustrate its usefulness at all levels – across sectors, communities and organizations, as well as within departmental units and at the individual leader and staff levels. Included among these efforts:

2018-2022 APHSA

STRATEGIC PLAN We would like to thank you – our members – for your invaluable input in the development of APHSA’s strategic plan for the next five years. Our work - carried out for and with our members – reflects your observations and insights about what you are experiencing and anticipating. This insight helps us develop the policies, practices and principles that guide our work. We look forward to sharing our new Strategic Plan in early 2018.

Ø Ø Our Local Council members convened multiple times throughout the year to advance the collective learning of counties through the lens of the Value Curve, and identify key policy, practice and organizational levers for accelerating the spread of that learning throughout the nation. San Diego County hosted the annual retreat of the Local Council members, which highlighted the concrete results of multiple local jurisdictions which have used the Value Curve for numerous years. Ø Ø In partnership with Harvard’s Leadership for a Networked World and Accenture, we convened the 8 th Annual APHSA Leadership Retreat and Harvard Health and Human Services Summit; this is where the Value Curve originated, and the national peer community that has developed around it is a driving force in its collective impact. Ø Ø In response to members’ requests for a tool to better understand how the Value Curve can be used, in partnership with the University of Minnesota, Hubert Project, APHSA contributed our expertise on how to incorporate the Value Curve into health and human services. The purpose of Hubert Project ( www.hubertproject.org ) is to connect public affairs educators through the creation and exchange of engaging teaching materials that enhance learning. Ø Ø With the generous support of the Kresge Foundation, we are working with multiple local agencies and their community partners to better understand the enablers and barriers to progression along the Value Curve. Ø Ø We are also happy to report that the Value Curve has taken hold globally, with several European countries, Canada and Australia incorporating its principles into their health and human services framework. This year we continued to develop practical guidance for the health and human services (H/HS) field and to provide as many opportunities as possible for our members and partners to learn from each other. As highlighted in the work of our three Collaborative Centers and our Organizational Effectiveness team, you will see how we are delivering on this commitment. You will also see how we are brokering new linkages at all levels of government across sectors such as education, housing and justice that encompass the broader human-serving system and address the social determinants of health and well-being. 2017 also marked an expansion of our efforts to promote strategic collaboration between dedicated H/HS professionals from the public and private sectors, as well as with philanthropy and academic institutions. Many of these partnerships are highlighted throughout the report. Of note is our collective impact work with the Alliance for Strong Families and Communities (the Alliance). In partnership with the Alliance, the 2017 APHSA National Health and Human Services Summit brought together, for the first time, leaders from both national networks to discuss ways to improve service delivery and outcomes. APHSA is also partnering with the Alliance, Oliver Wyman and SeaChange Capital Partners on a nationwide study – A National Imperative: Joining Forces to Strengthen Human Services in America – to assess the health of the social sector and community-based human services organizations, identify the internal and external forces creating challenges across the sector and drive cross-sector solutions and recommendations that will ensure the sector’s strength and vitality into the future. Funded by the Balmer Group and Kresge Foundation, this report will be released later this year. We also celebrated the 50th anniversaries of our information technology (ISM) and attorney (AAHHSA) conferences. It is fitting that these two affinity groups share the same anniversary, as both touch nearly every aspect of H/HS and are integral in the advancement of the human services field. We are fortunate to work with such dedicated leaders around the country. Thank you again for your service to the nation and commitment to creating a modern, responsive health and human services system. We look forward to continuing this journey with you in 2018 and beyond. Best regards,

Tracy Wareing Evans President and CEO American Public Human Services Association

APHSA EXECUTIVE GOVERNING BOARD 2017 OFFICERS Chair DAVID STILLMAN Assistant Secretary, Economic Services Administration WA Department of Social and Health Services Vice Chair and Local Council Chair KELLY HARDER Director Dakota County (MN) Community Services Treasurer REIKO OSAKI President and Founder Ikaso Consulting President and CEO TRACY WAREING EVANS President and CEO American Public Human Services Association ELECTED DIRECTORS MIMI CORCORAN Vice President and Talent Development New Visions for Public Schools SUSAN N. DREYFUS President and CEO Alliance for Strong Families and Communities ANNE MOSLE Vice President, The Aspen Institute Executive Director Ascend at the Aspen Institute AFFINITY COUNCIL CHAIR PAUL FLEISSNER Director Olmsted County (MN) Community Services LEADERSHIP COUNCIL CHAIR RODERICK BREMBY Commissioner CT Department of Social Services

FROM THE EXECUTIVE GOVERNING BOARD CHAIR

Greetings, APHSA Members and Friends! As the Chair of the American Public Human Services Association (APHSA) Executive Governing Board, I have seen first-hand the passion of our members and partners working collaboratively to help those we serve to realize their full potential. Across the country, state and local health and human services agencies are developing inventive ways to improve the delivery of services and at the center of our collective work is a commitment to well- being – health, education and economic – of individuals, families and communities. Thank you for being an integral part of these accomplishments. It is an honor and humbling to work alongside leaders who are deeply committed to advancing transformation initiatives that drive better outcomes for all citizens. Over the past year, the APHSA Leadership Council, the State and Local CEO Councils and our members have worked directly with the APHSA legislative and collaborative center teams to draft policy and program guidelines on the future of the SNAP and TANF programs; created guiding principles for local agencies to use their collective strength and knowledge to promote systems change at the local level; and issued a report outlining the health and human services community’s priorities for the new administration and Congress. These are the best examples of the power of peer-to-peer engagement and how we, the health and human services community, can work together to change the lives of the people we serve. Throughout the annual report, we have recapped stories and learnings from our members and partners that confirm it is only with and through you – our members - that our shared vision for better, healthier lives for children, adults, families and communities can become a reality. We are living in a time of unprecedented change and opportunity, and as human service leaders, I want to thank you for continuing this journey with us. We look forward to influencing, building and connecting with you in 2018 and beyond!

David Stillman Chair, APHSA Executive Governing Board Assistant Secretary, Economic Services Administration, WA Department of Social and Health Services

TABLE OF CONTENTS

From thePresident andCEO ..................................................... i-ii From the Executive Governing Board Chair .............................. iii 2017 APHSA Executive Governing Board ................................. iii Center for Employment and EconomicWell-Being (CEEWB) .............................................. 3-5 Center for Child and Family Well-Being (CCFWB) .................. 6-8 The National Collaborative for Integration of Health &Human Services (NC) .......................................... 9-12 Organizational Effectiveness (OE) ....................................... 13-15 National Council of Local Human Service Administrators ...................................... 16 Deputies Plus Initiative ............................................................ 16 National Electronic Interstate Compact Enterprise (NEICE) ................................................... 16 50 Years – A Special Celebration ............................................ 17 2017 APHSA & Affinity Groups Leadership & Staff .................................................................... 18 APHSA Affinity Groups ............................................................. 19

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THE HUMAN SERVICES VALUE CURVE (VALUE CURVE)

GENERATIVE Using a population-based health and well- being approach to find solutions that get at root causes and are implements collectively with families and communities. INTEGRATIVE Working across sectors to address problems at their root through data analytics and a customized service array. COLLABORATIVE Working towards a single-door approach to link services across programs and agencies, easing access and reducing duplication. REGULATIVE Accurate and timely administration of programs to assure compliance and integrity; focus on efficiency and accountability for proper use of funds.

© Leadership for a Networked World. 2011. Antonio M. Oftelie. The Pursuit of Outcomes: Leadership Lessons and Insights on Transforming Human Services: A Report from the 2011 Human Services Summit on the Campus of Harvard University.

More than 100 state and local agencies have implemented the guiding principles of the Value Curve, and the numbers are increasing every day.

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The Center for Employment & Economic Well-Being (CEEWB) is the central source of information for human service leaders regarding effective workforce engagement policies and practices. The CEEWB facilitates collaboration across agency leaders, business leaders, researchers and other thought partners to promote innovative practice models as well as modern funding structures and policies that best enable gainful employment and economic well-being for all people. The APHSA Affinity Groups under the CEEWB umbrella – American Association of SNAP Directors (AASD), National Association of State TANF Directors (NASTA), National Association of Program Information and Performance Management (NAPIPM), IT Solutions Management for Human Services (ISM), American Association of Health and Human Services Attorneys (AAHHSA) and National Staff Development and Training Association (NSDTA) – play an integral role in the policies, practices, guidelines and positions that the CEEWB promotes. Throughout 2017, the CEEWB, in concert with our members who are on the daily front lines of engaging with clients around their employment and family needs, expanded its influence on policymaking at the federal level by providing lawmakers from both sides of the aisle with a positive, sensible approach to human services funding and service delivery. Also, CEEWB expanded partnerships with organizations where we have common goals in SNAP, TANF, Low Income Tax Policy and workforce issues to further increase influence over policy-making decisions. Ø Ø Policy Papers : Issued and distributed two important policy papers on the reauthorization and modernization of SNAP and TANF. These recommendations have generated numerous calls from agency 3 INFLUENCE WORKING WITH AND THROUGH OUR MEMBERS

staff in HHS-ACF and USDA-FNS as well as key staff and members from House and Senate Committees wanting to learn more about APHSA/CEEWB policy suggestions. You can find "The Future of SNAP: A Modern and Responsive Program" at www.aphsa.org/ content/AASD/en/home.html and “TANF at 20: Time for Rational Changes” at www.aphsa.org/ content/NASTA/en/home.html . Ø Ø Congressional Testimony: In March, CEEWB Director, Russell Sykes testified on the Next Farm Bill: Future of SNAP before the House Agriculture Subcommittee on Nutrition along with other key organizations such as the Center on Budget and Policy Priorities and the Food Marketing Institute. His testimony generated numerous follow-up discussions with key staff to the committee as well as one of its Majority members from New York. APHSA has provided language to the Agriculture Committee staff on one important item critical for states that are often overextended in their current workload – the ability to use non-government staff to conduct eligibility and other administrative tasks that are currently not permitted under SNAP (unlike other programs such as Medicaid). APHSA remains optimistic that this language will be included in the Next Farm Bill. Ø Ø Federal Partner Engagement: in coordination with AASD and NAPIPM, the CEEWB continued to engage with senior FNS staff through bi-monthly calls and other avenues regarding SNAP Employment and Training, clarifying the revised SNAP quality control (QC) processes, best practices and innovations, as well as budget and program reforms. Ø Ø Federal Partner Engagement: in 2017, the CEEWB has also made it a priority to meet with key politically appointed agency staff in HHS-ACF and USDA-FNS to share our specific policy, regulatory and practice suggestions as well as the need to better coordinate systems to create more cost and client- effective program delivery in multiple programs including SNAP, TANF, Workforce Innovation and Opportunity Act (WIOA) and Medicaid.

BUILD BUILDING CAPACITY AND EXPERTISE Ø Ø Affinity Group Partnerships: bringing the AASD, NASTA and NAPIPM Affinity Groups into the CEEWB has allowed it to grow and evolve, providing greater benefit to our members. In response to direct member feedback, the CEEWB presented its first “Hot Topics” webinar series, providing opportunities for members to learn more about practices, initiatives and innovations happening in states and localities throughout the nation. Featuring the work being done by APHSA’s members, the webinars covered topics ranging from WIOA, TANF and SNAP Employment and Training alignment to evidence-based strategies for serving job seekers with disabilities. Through our Policy & Practice magazine, we highlighted the work states and localities are doing to provide the opportunities and supports that help low- income individuals get a job, keep a job and start down a sustainable career path. Ø Ø Partnering for Influence: with support from the Robert Wood Johnson Foundation, the CEEWB, in partnership with the American Enterprise Institute, began conducting a two-year project on child care, non-standard work hours, and child health and well-being. The first component of the project includes analyzing Fragile Families and Child Well-Being Study data to assess the relationship between non-standard hour work, child care and child outcomes. The second focuses on state-level policies, and what challenges and opportunities states are experiencing as they seek to serve non-standard hour workers. CONNECT MEMBER ENGAGEMENT AND LEARNING Ø Ø Webinars: the CEEWB Special Topic Webinar Series created a broad, influential reach beyond our core state and local networks to nonprofit and other organizations with similar issues and policy goals. Our work with Convergence on a broad-based economic mobility project has helped us build new and strong relationships with employers in many sectors, particularly areas where our clients are most likely to find employment: retail, health, hospitality and technology support positions. Two major corporate employers led one of the webinars and provided their perspective on what

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employers look for and need regarding soft and technical skills when assessing candidates. This information was beneficial to members and partners as it provided them with suggestions on how to prepare and train potential employees for new careers. Ø Ø 2017 Affinity Group Education: NAPIPM in Cincinnati and the joint AASD/NASTA Conference in Memphis – attracted hundreds of participants from across the country. Both conferences highlighted innovative initiatives and proven programs in states and localities. State and local agency program experts and industry thought leaders shared lessons learned, best practices and ideas for successful program implementation. Federal partner engagement was also a top priority with representatives from FNS, ACF, GAO and others providing updates on Federal legislative and regulatory issues and listening to attendee feedback and suggestions. Ø Ø Federal Partner Engagement: AASD and NAPIPM leadership hold bi-monthly meetings with senior FNS staff to discuss a variety of topics including general SNAP policy, regulations and guidance, SNAP Employment and Training and SNAP QC. This enables APHSA membership to stay abreast of what is happening at the federal level and discuss the potential effects of policy, rules and regulations on state and local agencies. THE IMPORTANCE OF FRAMING How we speak about our work matters. We should speak strategically and artfully, creating a degree of cognitive dissonance that gets people to think differently about something that they have believed in for a long time. APHSA continues to interject framing science into our work, helping to create positive associations with health and human services and the services our members deliver every day.

MEMBER SUCCESS FROM THE COLLABORATIVE TO THE INTEGRATIVE BUSINESS MODEL: SETTING THE STAGE FOR TRANSITION TO THE GENERATIVE BUSINESS MODEL The enactment of the WIOA transformed the public workforce system to reflect the realities of the twenty-first-century economy and emphasize opportunities for public assistance recipients to gain the skills and supports necessary to attain sustainable, gainful employment. An essential part of the WIOA vision is a comprehensive, integrated and streamlined system for serving job-seekers, workers and employers. However, this requires a high level of coordination and alignment of the workforce, education and human services systems, which is much easier said than done. Massachusetts is one state that has made considerable strides in this area. Following the successful development of its state WIOA combined plan including TANF and SNAP Employment at Training, in 2017, the Massachusetts Department of Transitional Assistance (DTA) partnered with the Department of Career Services to provide direct funding for infrastructure and shared costs at its One-Stop Career Centers. The purpose/expected outcomes for 2017 and beyond include increased partnership between DTA and the One-Stop Career Centers on behalf of TANF and SNAP clients; joint articulation of career pathway models for low- income individuals, including DTA clients; increased DTA client engagement and participation at the Career Centers via prioritization of TANF/SNAP recipients; and increased DTA client job placement and retention. Like Massachusetts, Washington State also developed a state WIOA combined plan including TANF and Basic Food Employment and Training (BFET) in 2016. In 2017, Washington embarked on a unique initiative to explore the potential for even greater alignment of the human services and workforce development systems. Utilizing WIOA discretionary funds, Washington is investigating how two generation and Neuroscience, Epigenetics, ACE’s and Resilience (NEAR-science) informed approaches, which are already being implemented in its TANF and BFET programs, can be applied to its workforce development efforts and the impacts on outcomes.

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The Center for Child and Family Well-Being (CCFWB) connects APHSA members and partners who share responsibility for healthy child development, preserving and supporting families and empowering communities. Through multi-generational, whole family approaches and an understanding of the social determinants of health, this Collaborative Center promotes innovative practice models as well as modern funding structures and policies that best enable children to be healthy and be well in healthy families and communities. The APHSA Affinity Groups under the CCFWB umbrella – National Association of Child Welfare Administrators (NAPCWA), National Association of State Child Care Administrators (NASCCA), ISM, AAHHSA and NSDTA – play an integral role in the policies, practices, guidelines and positions that the CCFWB promotes. Ø Ø Federal Partner Engagement: NAPCWA convened a workgroup comprised of state child welfare directors to review the new data elements included in the new Adoption and Foster Care Analysis and Reporting System (AFCARS) regulations. This workgroup reviewed the new data and identified items that are unclear or need further explanation. The workgroup compiled these questions and submitted a letter to the Children’s Bureau in October 2017 to improve AFCARS regulations and to make state compliance more efficient and less burdensome. Ø Ø Member Engagement on Federal Policy: NAPCWA staff monitored child welfare finance reform, and the increasing interest in identifying a means for extending child welfare waivers if finance reform does not progress. NAPCWA staff remains active in these discussions with members and federal agency staff. Ø Ø Partner Engagement: NAPCWA staff joined the National Indian Child Welfare Association INFLUENCE WORKING WITH AND THROUGH OUR MEMBERS

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nation. CCFWB and NASCCA are formulating a plan to disseminate member comments to the appropriate federal agencies. Ø Ø Member Engagement: NASCCA held a three- part, All-Member call series to provide members with an opportunity to share best practices, insights and discuss the challenges associated with several high priority topics on Child Care and Development and Block Grant (CCDBG) implementation. Ø Ø Member Engagement: as part of the APHSA 2017 National HHS Summit, the members of NAPCWA and CCFWB staff met to discuss NAPCWA’s primary vision and focus and lay out priorities for the next 18 months. Leaders from Indiana and Fairfax County (VA) discussed how their agencies are applying the Value Curve and Framing Science to improve service delivery and provided members with a framework for implementation of these principles. MEMBER SUCCESS MOVING FROM THE INTEGRATIVE TOWARDS THE GENERATIVE BUSINESS MODEL: REDUCING TEEN VIOLENCE The City of Hampton, Virginia Department of Human Services (DHS) is recognized for operating by the principle that families are the experts in their situations and possess the means to progress and reach their full potential. Accordingly, the agency has for many years customized programs for the families it serves. As a result, Hampton has achieved stunning results related to family preservation and avoiding the need for out-of-home placements without increases in abuse and neglect. Since 2015, the City of Hampton has been experiencing an exodus of families living in its boundaries versus commuting in from neighboring places. As a result, the city is facing tax base reductions. At the same time, it has experienced a significant increase in teen violence. Armed with the insights gleaned not only from its history but participation in both APHSA’s annual conferences and Harvard’s annual Leadership Summit, Hampton’s human services director Wanda Rodgers called together a community partnership group to address this challenge, including the school superintendent, county public health director, chief of police, juvenile court services director, city manager’s office, area community college dean and local youth-focused nonprofits.

(NICWA) quarterly partners meeting. Through the final updated Bureau of Indian Affairs regulations and the final rules on AFCARS data collection requirements for American Indians/ Alaskan Native Children, there is an opportunity to expand joint efforts on compliance with the Indian Child Welfare Act. NICWA presented its Kids First Campaign to create a Native Child’s Agenda Well-Being and APHSA, through NAPCWA, will provide subject matter expertise and ongoing support for the project. Ø Ø Member Engagement: NAPCWA held multiple member calls to discuss the 2017 outlook for child welfare and facilitated a dialogue on the key principles for financing child welfare. BUILD BUILDING CAPACITY AND EXPERTISE Ø Ø Webinars: In partnership with ACF, CCFWB staff participated in the Advancing Family Economic & Social Well-Being Webinar Series, a six- part series highlighting innovative state and local approaches to increase family economic mobility and social well-being. Several APHSA members were featured, and numerous state and local members presented. Ø Ø Member Engagement: NAPCWA convened a workgroup of members to discuss the implementation of the provisions of the Every Student Succeeds Act (ESSA) related to students in foster care. Through this forum, members discussed their challenges in implementing the legislation and how to develop a set of best practices to assist with implementation. The discussion was augmented through a partnership with the Director of the Legal Center for Foster Care and Education at the American Bar Association, and, the Director of Policy at the Children’s’ Defense Fund, to provide additional information to members about the implementation of ESSA. CONNECT MEMBER ENGAGEMENT AND LEARNING Ø Ø 2017 Affinity Group Education: NASCCA held its Annual Business Meeting to connect child care administrators as part of the State and Territory Administrators Meeting. During the meeting, a robust discussion was had on the challenges faced by child care agencies in implementing the Child Care and Development Fund final rule, as well as success stories across the

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Through APHSA’s facilitation and applying the Value Curve as a lens to look at this challenge – especially the root-causes of teen violence as currently understood by the community partners and the available research – this team developed a comprehensive risk factor model to understand the impact of their collective services. The model is comprised of a cluster of factors associated with the capacity of teens themselves, and another cluster associated with the environment within which teens live and develop. Using this model and through collaboration with Old Dominion University’s technology and analytics resources, the city has now embarked on a multi-year strategy to: Ø Ø collect related risk factor data on roughly 700 families in the defined cohort; Ø Ø map current, collective programs and supports to these risk factors; and Ø Ø use this data, analysis and ongoing monitoring efforts to test and refine the shared services and intervention strategies of this team, the risk model itself and the outcomes and measures being collectively tracked related to teen violence. The resulting platform for resource sharing, learning, program adjustment and collaboration in many other forms denotes a significant shift from the human service agency’s Integrative service and practice platform to building an ecosystem capable of driving Generative breakthroughs on behalf of the teens growing up in Hampton.

MEMBER SUCCESS OHANA NUI – HOW HAWAII USES THE HSVC AS A LENS FOR CONTINUOUS IMPROVEMENT The State of Hawaii Department of Human Services (DHS) has embarked on a broad and inclusive effort to realize the guiding principle of Ohana Nui, or One Family, in how it serves its clients, partner with its constituents and evolves the organization. This framework for thinking about the public and the staff drives a mentality of inclusion and active participation in defining and solving problems and overcoming barriers to desired outcomes and organizational performance. Newly-hired staff members are oriented to Ohana Nui from the time they start to consider an application for an open position through initial orientation and throughout their employment. DHS is also linking Ohana Nui with their use of the Value Curve as a system assessment and improvement lens. Since 2012, the agency’s executive leadership has participated in the Human Services Summits held at Harvard each fall, which focuses on the Value Curve and how various jurisdictions are progressing through its four stages. Hawaii joins more than 100 states and localities who are applying this lens to their periodic system assessments and ongoing improvement efforts. Hawaii’s leadership is also participating, through fellowship in the Aspen Institute Ascend Network, on Two-Generation practice and service approaches, with a link to both Ohana Nui and the Value Curve’s Collaborative and Integrative stages. In 2016 the agency launched a multi-year effort to integrate client data across its programs and with its community partners and to raise the level of its analytical capabilities far beyond that of a unified needs assessment across those programs. Such analytics include: Ø Ø how data-driven decisions impact service access and quality; Ø Ø how programs affect the risk factors and protective factors underlying desired outcomes; and Ø Ø how the investments in human services – especially as they become more preventative and capacity-building in nature – generate a return on investment in the form of reduced trauma and its associated costs, including the high costs of healthcare services. DHS asked APHSA to assist the department to strengthen the operating approach of its data governance team, tasked with generating and

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testing solutions for a range of related tools and methods, drawing initially on “best in class” examples being collected and shared by APHSA through its National Collaborative for Integration of Health and Human Services: Ø Ø Inter-agency and cross-jurisdiction data sharing agreements Ø Ø Client consent, privacy, rights and responsibilities Ø Ø Data access and release standards and protocols Ø Ø Policies and procedures for ongoing data management. DHS is concurrently engaged in a range of system improvement initiatives, including: Ø Ø Developing its specific analytics templates Ø Ø Launching a baseline assessment of organizational capacity and readiness Ø Ø Ramping up its overall internal and external communications strategy Ø Ø Mapping business processes to the desired practice and service model Ø Ø Embedding a continuous quality improvement and learning cycle within its ongoing operations. These concurrent efforts will ensure the DHS vision of Ohana Nui, and the Value Curve progression succeeds well beyond the point of one-stop eligibility determination and into root cause-driven service planning, client-co-creation and ownership of their plans, and state-wide efforts to proactively address the environmental and structural root-causes of trauma and its associated costs.

APHSA’s National Collaborative for Integration of Health and Human Services (National Collaborative) drives innovation through the horizontal integration of the health and human services system. It promotes a system anchored in seamless, streamlined information exchange, shared services and coordinated care delivery and payment models that are person- and family- centered. The National Collaborative supports state and local health and agencies and their partners in the community through guidance and tools to improve the customer experience, to reconfigure access and increase administrative efficiencies within the context of the evolving healthcare delivery system and to improve population well-being. With and through our members, the National Collaborative is advancing several initiatives that will improve policy, practice and the collective impact that is possible through the integration and alignment of H/HS systems. APHSA’s Affinity Groups, ISM, AAHHSA and NSDTA play an essential role in helping inform sound modernization recommendations and advancing the work of the National Collaborative. INFLUENCE WORKING WITH AND THROUGH OUR MEMBERS Worked together with our members to advance their priorities at the federal level. National Collaborative staff built strong relationships with our new federal partners and elucidated the needs of our members and the H/HS community. These efforts include: Ø Ø Member Engagement: with significant input from members, issued and distributed an important position paper to the new administration and Congress. The National Collaborative for Integration of Health and Human Services: Promoting Greater Health and Well-Being outlines APHSA’s guiding principles and policy priorities about the current human services ecosystem and maps

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its needs and gaps. This paper explains how the administration and Congress can work with APHSA and its members to improve overall health outcomes and achieve efficiencies through an integrated service delivery model. Ø Ø Federal Partner Engagement: facilitated members’ input and coordinated the Social Security Administration (SSA) and the Center for Medicaid and Medicare Services (CMS) efforts to sign a historic agreement that streamlines data sharing with states and enables more integrated eligibility processes for Medicaid, SNAP and TANF beneficiaries. Specifically, eligible state Medicaid agencies will be permitted and encouraged to use SSA data that they obtain via the CMS Federal Data Services Hub for determining eligibility for SNAP and TANF applicants when making Medicaid eligibility determinations. Ø Ø Federal Partner Engagement: after extensive member engagement, provided comments to HHS and USDA on the Managed Care Final Rule sub-regulatory guidance. Ø Ø Federal Partner Engagement: working with the APHSA Leadership Council and building from the guiding principles and priorities laid out in the National Collaborative position paper: Promoting Greater Health and Well-Being , provided input and comments and submitted letters to Congress on the multiple health care reform efforts. Ø Ø Federal Partner Engagement: met with representatives from the Division of Data and Improvement within ACF’s Office of Planning, Research and Evaluation, to obtain a better understanding of their priorities under the new Administration. ACF shared that there is still a focus on the National Information Exchange Model (NIEM) and agile approaches to system development across ACF. Also, met with representatives from Health Resources and Service Administration, to discuss their priorities and where APHSA can connect on projects and initiatives. BUILD BUILDING CAPACITY AND EXPERTISE Ø Ø Member and Partner Engagement: for the third year in a row, the National Collaborative has sponsored an Analytics Committee comprised of subject-matter experts from around the

country. Committee participation was high, resulting in three separate work groups: Data Management & Proven Data Governance Practices, Privacy & Confidentiality Impact on Data Sharing and Predictive Analytics & Modeling. The work of the committee has resulted in various compendia, practical tools, use cases, case studies and summaries, and is available through an online Guide to Data Management, Privacy & Confidentiality and Predictive Analytics (http://aphsa.org/content/ APHSA/en/pathways/NWI/NCAC3.html) . The work was initially presented at the Medicaid Enterprise Systems Conference in Baltimore, MD, and the final product showcased at the 2017 APHSA ISM conference. Ø Ø Webinars: in partnership with our Industry Partners, provided multiple learning opportunities about state care coordination and integration, leveraging social services in value-based purchasing, state development of Comprehensive Child Welfare Information System, and more. Ø Ø Federal Partner Engagement: a time-limited task force was convened, composed of subject matter experts from around the country, to submit comments on the HHS proposed Healthy People 2030 framework. Ø Ø Member and Partner Engagement: National Collaborative members and staff presented at and participated in several H/HS conferences and summits throughout the year including: Health Care Education Associates’ Medicaid Managed Care Leadership Summit, Medicaid Enterprise Systems Conference, Governing’s H/HS Policy Breakfast, National Association of State Chief Information Officers Mid-Year Conference and the Association of State and Territorial Health Officials Integration Forum. CONNECT MEMBER ENGAGEMENT AND LEARNING Ø Ø Federal Partner Engagement: APHSA continues to facilitate Community of Excellence (CoE) calls with several federal partners. The calls explored new opportunities for states through the SSA & CMS Data Sharing Agreement, allowing state Medicaid agencies to share SSA data verified by the CMS Hub with their SNAP & TANF programs. SSA & CMS recently began phasing in different states to modify their data feeds and processes. The CoE heard

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the Idaho Department of Health and Welfare and the North Carolina Department of Social Services shared how they designed, tested and implemented their WSS supports and shared advice and best practices with other states undertaking this work. Ø Ø Public/Private Collaboration: each year, the National Collaborative team meets with the industry partners who support the National Collaborative to understand better what the private sector is experiencing when working with states and localities on H/HS integration efforts. These interviews help APHSA and the National Collaborative learn about national trends around horizontal integration and inform membership as to what initiatives are proving successful and how to potentially implement similar programs in their agency. MEMBER SUCCESS MOVING FROM THE INTEGRATIVE TO THE GENERATIVE BUSINESS MODEL: IMPROVING ACCESS TO HEALTHCARE AND MOVING FAMILIES FROM SURVIVING TO THRIVING Hennepin Health is an accountable care organization (ACO) serving complex Medicaid enrollees in Minneapolis, MN, and surrounding communities. Through its county-operated health plan, Hennepin County assumes the fully-capitated risk for a subset of the geography’s Medicaid enrollees. Within this Medicaid managed care structure, Hennepin Health has created a defined provider network that is linked to a shared electronic health record, a risk- sharing funding arrangement and a collaborative governance structure. Bringing together a county- operated managed care organization, hospitals and clinics, and human services and public health functions, Hennepin Health aims to reduce avoidable acute care and capture those savings to improve the local delivery system. Hennepin Health’s members are disproportionately impacted by the social determinants of health. At any given time, nearly one-third of their members are unstably housed, and the majority are eligible for Medicaid under the Affordable Care Act’s Medicaid expansion. These individuals are disproportionately men of color, affected by mental health and chemical dependency, and involved in the justice and corrections systems. Through intensive care coordination and the integration of social services with the delivery of healthcare, Hennepin Health has been able to improve health outcomes and drive 11

from Pennsylvania and other pilot states about their experience and impact of this streamlined process. Ø Ø Federal Partner Engagement: the National Collaborative, in partnership with a private consulting firm, was awarded the U.S. Department of Health and Human Services Assistant Secretary for Planning & Evaluation (ASPE) Grant to identify the extent to which health and human services organizations have strengthened their efforts across four areas of interest to HHS: systems integration, data interoperability, program entry processes and the governance of data sharing. APHSA developed a detailed survey questionnaire and administered the survey to SNAP, TANF, Child Care, Medicaid eligibility and operations, Child Support, CHIP eligibility and operations, and Child Welfare staff from across the country. Also, ASPE was interested in knowing what areas respondents thought technical assistance from HHS would prove most helpful in overcoming obstacles in the areas studied. Ø Ø Member Engagement: as part of the APHSA 2017 National HHS Summit, the members of the National Collaborative met to discuss policies and other regulations focusing on Expanding Partnerships: Defining the Path Forward . Attendees included stakeholders from state and local agencies, private and nonprofit sectors, public health organizations and providers. The meeting concentrated on various agencies’ innovative integration work, the barriers the field is still facing on the road to horizontal integration and how to address those obstacles through innovative solutions. Based on the information gathered, the National Collaborative produced a set of documents to assist members in their horizontal integration effort, including business case templates that help frame and tell the story around the benefits of integration. Ø Ø Webinars: staff from the National Collaborative and the Center for Law and Social Policy presented a webinar, Improving Access, Cutting Red Tape: State Lessons from Work Support Strategies . The webinar highlighted the Work Support Strategies (WSS) initiative, which six states received funding and technical assistance to design, test and implement more effective, streamlined and integrated approaches to delivering key supports for low- income working families. Representatives from

to understand the root-causes of this fatigue factor, and found five primary elements with high consensus: Ø Ø Making the Value Curve “real world” to all CS staff. The model was being conveyed in ways that did not enable the workforce to apply it to their roles, teams and functions within the greater system. This finding resulted in related exercises between supervisors and their staff and within cross-program groups, which addressed the issue and generated significant insight and support. Ø Ø Communicating “two-way” versus “top-down.” The agency leadership has engaged in an array of activities to strengthen dialogue between senior management and the organization, reinforced by the awareness that solutions to complex problems are best discovered through empowered teams comprised of staff at all levels. Ø Ø Using continuous improvement tools to make changes, versus adding new initiatives “on top of” current work with no baseline assessments. The agency has adopted improved methods for facilitating problem-solving methods and planning groups focused on improving the overall efficiency of the agency. Ø Ø Using effective meeting management, facilitation and project management resources. These skill sets are being fostered and used more intentionally as a result of this finding. Ø Ø Thoughtfully managing limited staff capacity. The agency is learning how to phase and stage new activities and priorities in ways that build capacity. CS is also using lessons learned from this information to take another look at the revamped performance management system that was instituted in 2015. The agency is now able to track the impact of performance changes on the root-causes that drive specific outcome goals for the populations it serves. These new strategies include modern client assessments that go beyond holistic needs to the underlying factors that move families from surviving to thriving. They also include a potential national model for understanding and proactively addressing the “financial cliff effect” that families often face when they begin to experience financial success.

costs down while reinvesting annual savings into further care delivery reforms www.ncbi.nlm.nih.gov/ pubmed/25367993 . Hennepin Health is actively extending its model to serve complex families and children in addition to the Medicaid expansion population. Through a return on investment model, Hennepin Health is leveraging health care dollars, to address social determinants of health and value purchasing social services as a means to reduce overall costs and improve wellness in their patient population. Investing in housing, employment supports, intensive harm reduction efforts for chronic inebriates, child well-being, and other social supports to improve health, Hennepin Health has realized significant cost reductions and has annually been able to reinvest in new system innovations for continuous population improvements. MEMBER SUCCESS The Dakota County (MN) Community Services Agency (CS) has been widely recognized within the state, as well as nationally, as a resource on how to drive collaboration, innovation and partnership within the agency, and within the broader communities it serves. CS has authority for the traditional human services program array and the county's corrections and healthcare services. Agency leadership has established a highly collaborative and energized workforce and was an early adopter of the Value Curve as an organizing framework and lens undergirding their overall strategic plan. Building off a stable platform for program integrity and collaboration across these programs, CS has recently sought to apply more efficient root- cause assessments, not only with their clients but also within their organization. The agency was challenged by significant “innovation fatigue” in their efforts towards integrating services and progressing through the Value Curve stages and sought collaboration with APHSA. This demonstrated a willingness of senior leadership to let go of “knowing the solutions,” make themselves available to new ways of thinking and systematically collect data to learn and adapt their efforts. APHSA conducted a survey and focus groups for all CS management and supervisory staff

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Using the Framework of the Value Curve, the Organizational Effectiveness (OE) team worked to advance multiple projects and strategies within select cities and counties. These chosen projects will enable the integration of health and human services to reduce downstream trauma and associated demands on the health care and human services support systems. They will also improve outcomes so that everyone in those chosen communities can live healthily and be well. APHSA’s Affinity Group, NSDTA is an essential partner in the work of the OE team, providing valuable insight and information to help members build a stronger, stable workforce. Ø Ø Partnering for Influence: APHSA partnered with the Kresge Foundation to conduct two system-wide assessments in Washington, DC and Milwaukee County, WI to understand the factors that impact health outcomes and reduce healthcare costs for high- risk individuals, with a focus on upstream prevention enablers and human service integration. Using the framework of the Value Curve as a lens, learning was co-produced with a design and project team from each locality. This provided a powerful learning opportunity for each site to begin translating the Value Curve to more tangible applications. Both localities identified priority strengths and barriers toward improving outcomes and developed an implementation plan. In Washington, DC the focus was on the identification of the factors impacting well- being outcomes of young parents ages 17-25 with children ages 0-6 with histories of or at-risk for drug/alcohol abuse, child abuse, or mental health challenges. Based on the data gathered, a prioritized plan for developing an interagency collaboration and root-cause integration strategy is being developed. Additionally, levels of risk for the young parent population are being assessed, 13 INFLUENCE WORKING WITH AND THROUGH OUR MEMBERS