B u i l d i n g W e l l - B e i n g f r o m t h e G r o u n d U p
From the President and CEO
Dear APHSA Members, Colleagues and Partners,
2018 was a pivotal year for our members and the future of the health and human services (H/HS) system. At our National Health and Human Services Summit, we introduced our Strategic Playbook—a living, adaptable strategy which outlines the direction of the association over the next five years. Informed by our members, partners, and staff—and approved by our Executive Governing Board—the Strategic Playbook is designed to keep a laser focus on our core mission, assure our work is aligned with the desired future state of the field, connect us through common tools and language and provide clear direction for how each of us—in our respective and collective roles—can contribute. As one of our members put it, “We are past the conceptual stage. Health and human services transformation is a movement. We are all in this together, and together we will improve the lives of the people we serve every day.” Pragmatic approaches and model frameworks like social determinants of health, human-centered design, behavioral insights, neuroscience and the Value Curve are now playing a more significant part in the design and delivery of services. The system is embracing a whole-family, generative approach and shrugging off the old, siloed system rooted in compliance and programmatic outputs. Our Collaborative Centers continued to work in partnership with our affinity group leadership to promote innovative, practical solutions that lead to gainful employment , child and family well-being and overall population health and well-being —the three pillars of the desired future state. These efforts are buttressed by our Organizational Effectiveness team who work on-the-ground with state and local agencies to close the gap between the results and vision they desire and where they are today. We also continued our efforts to foster collaboration between dedicated H/HS professionals from the public and nonprofit sectors, as you’ll see in multiple examples in the pages that follow. One ongoing effort that I’m particularly proud of is our continued partnership with the Kresge Foundation. In May, we wrapped up a multi-year grant, facilitated by the APHSA Organizational Effectiveness team, which helped four jurisdictions build capacity and create change.
The Strategic Playbook is shaped by our newly adopted vision and mission statements: Vision Thriving Communities Built on Human Potential Mission APHSA advances the well-being of all people by influencing modern approaches to sound
policy, building the capacity of public agencies to enable healthy families and communities,
and connecting leaders to accelerate learning and generate practical solutions together. ...Because we build well-being from the ground up.
Also of note in 2018 was the release of the National Imperative: Joining Forces to Strengthen Human Services in America —the groundbreaking report, developed in partnership with the Alliance for Strong Families and Communities, Oliver Wyman and SeaChange Capital Partners. This report assessed the health of community-based human services organizations (CBOs) who are integral to the H/HS delivery system and a core partner to public sector agencies. It captures the internal and external forces creating challenges across the sector and provides recommendations under five north star solutions. Several of our members are now working hand-in-hand with CBOs in their communities to implement these recommendations on the ground, and we’ll continue to follow and highlight those efforts as they move from concept to reality. Thank you again for your continued support of our collective mission to improve the lives of the people you serve every day by building well-being from the ground up. We look forward to working with you, our members and partners, to promote innovation throughout the H/HS system in 2019 and beyond.
Tracy Wareing Evans American Public Human Services Association (APHSA) President and CEO
APHSA Executive Governing Board 2018
From the Executive Governing Board Chair
OFFICERS CHAIR DAVID STILLMAN Assistant Secretary, Economic and Health Services VICE CHAIR AND LOCAL COUNCIL REPRESENTATIVE KELLY HARDER Director, Dakota County (MN) Community Services Services Administration, WA Department of Social
Dear APHSA Members and Friends,
Serving as the Chair of APHSA’s Executive Governing Board, I am energized by the association’s latest action plan we finalized earlier this year—the APHSA Strategic Playbook for 2018-2022. The Playbook displays our commitment to advancing the potential of all people in all places, and I have seen our members and partners working together to act on that commitment throughout the year. As we continue to work with leaders across the country, there is increasing energy aimed at advancing economic and social mobility with and through the communities in which we all live, work, learn and play. It is truly humbling to work alongside each-and-every one of you as we continue to build well-being from the ground up! Throughout the annual report, you have front row access to the stories and learnings from our members and partners that reflect our shared mission to advance population health and the well-being of all people through gainful employment, education and so much more. Although our annual report provides us with the opportunity to reflect and record our progress once a year, it is evident all year long that it is only with and through you—our members—that we can make our future desired state a reality. As we continue to engage in policy work to help move us toward a modern, outcome-based, human-centered system designed to strengthen communities and increase overall health and well-being for everyone, we thank you for being an integral part of the journey. Here’s to another year of partnership, innovation and generative solutions for the future!
TREASURER REIKO OSAKI President and Founder, Ikaso Consulting PRESIDENT AND CEO TRACY WAREING EVANS President and CEO, American Public Human Services Association
AFFINITY COUNCIL REPRESENTATIVE PAUL FLEISSNER Director, Olmsted County (MN) Community Services
LEADERSHIP COUNCIL REPRESENTATIVE RODERICK BREMBY Commissioner, CT Department of Social Services
BRENDA DONALD Director, DC Child and Family Services Agency SUSAN N. DREYFUS
President and CEO, Alliance for Strong Families and Communities DAVID A. HANSELL Commissioner, New York City Administration for Children’s Services ANNE MOSLE Vice President, The Aspen Institute Executive Director, Ascend at the Aspen Institute
David Stillman Chair, APHSA Executive Governing Board Assistant Secretary, Economic Services Administration WA Department of Social and Health Services
Table of Contents
From the President and CEO .................................................................................... i-ii
From the Executive Governing Board Chair ............................................................... iii
Gainful Employment and Mobility ............................................................................. 2-4
Child and Family Well-Being ..................................................................................... 5-8
APHSA worked with MDRC; a nonprofit organization focused on improving the lives of low-income individuals, families and children, on a project called Building Evidence on Employment Strategies for Low-Income Families (BEES). MDRC is the lead contractor in the project, which is funded by the Office for Program Research and Evaluation (OPRE) within ACF. APHSA’s role in the first year of this six-year, random assignment research project, is to work with our affinity groups, particularly the National Association of State TANF Administrators (NASTA), the American Association of SNAP Directors (AASD) and the National Association of State Child Care Administrators (NASCCA). Together we identified sites where promising efforts are underway that can be studied in depth, evaluated as to their effectiveness in assisting work-ready adults to find and retain employment, and could be brought to a larger scale and replicated in other areas. APHSA is also a subcontractor to BLH Technologies in a second project funded by ACF. APHSA is working with our affinity groups to identify and feature six to seven states or localities where there is strong and effective coordination in service delivery to low income, work-ready clients between the TANF agency and the American Job Centers under the Department of Labor Workforce Innovation and Opportunity Act (WIOA). Through the insights of these sites, APHSA is developing a virtual online TANF-WIOA toolkit featuring best practices and concrete ideas to better align how state and local agencies can integrate service delivery to clients among different state and local workforce agencies. This new product will launch in 2019.
FEDERAL PARTNER ENGAGEMENT In April, the President issued Executive Order (EO) 13828: “Reducing Poverty in America by Promoting Opportunity and Economic Mobility,” which required federal agencies to submit a report to the administration detailing specific policy changes that would be implemented as a result of the EO provisions. Working with the APHSA Leadership Council and building from APHSA’s guiding principles and priorities laid out in the Strategic Playbook, APHSA submitted comments and recommendations for implementation to the Administration for Children and Families (ACF) in response to the EO. Also, an appendix highlighting APHSA members’ successful programs, which support and promote opportunity and economic mobility was submitted to ACF. APHSA’s members also shared on-the-ground experiences and insights with federal partners from ACF during listening sessions at the APHSA National Health and Human Services Summit and the Local Council Retreat. PARTNERING FOR IMPACT APHSA has partnered with national public policy and research organizations on federally-funded projects to feature state best practices impacting gainful employment and mobility. APHSA is working with and through our members to identify and lift promising employment and training programs and organizational and programmatic collaboration between Temporary Assistance for Needy Families (TANF) and Department of Labor Workforce programs.
FARM BILL AND NUTRITION TITLE Every five years the nation’s Farm Bill must be reauthorized, and of most concern to APHSA and our members is the Nutrition Title which reauthorizes the Supplemental Nutrition Assistance Program (SNAP), America’s largest anti-hunger program providing food purchasing benefits to over 40 million individuals. APHSA, along with our affinity groups, AASD and NAPIPM, worked with key staff on both sides of the aisle in the House and Senate as they advanced their separate and starkly different Farm bills. The House Farm Bill (The Agriculture and Nutrition Act of 2018) would impose work requirements for all non-disabled, adult SNAP recipients. Whereas, the Senate Farm Bill (The Agriculture Improvement Act of 2018) would leave SNAP mostly unchanged. APHSA has worked closely with Committee staff throughout the process to provide our members’ unique policy and system perspective as the agencies responsible for delivering SNAP benefits nationwide as provisions within the bill were developed and negotiated. APHSA has offered member feedback on some of the more critical changes proposed in the bill, including work requirements and expansion of Employment and Training programs, and provided practical and outcome-focused perspectives on structuring the system to emphasize employment, training and upskilling. We also developed in-depth, widely distributed analysis of both bills, which are available on APHSA’s website (www.aphsa.org). As of this writing, while conferees from both sides have been appointed to reconcile differences in the two Farm bills, no agreement has been reached.
TANF REAUTHORIZATION APHSA has worked with key staff on both sides of the aisle as Congress has once again taken up the issue of TANF reauthorization. House Staff routinely sought our members’ perspectives as they developed their proposed five-year TANF Reauthorization bill that also proposes dramatic changes in multiple areas, particularly work requirements and program outcome measures. APHSA continues to advance principles developed through and with members to advise on TANF reauthorization, including the elimination of Work Participation Rate as the performance measure, stronger coordination across the workforce, education and employment and training programs. The House Ways and Means Committee put forth the House Jobs and Opportunity with Benefits and Services (JOBS) for Success Act of 2018 (H.R. 5861). APHSA developed a section-by-section analysis and response to this bill, in collaboration with members of our affinity group, NASTA, the TANF Modernization Work Group and APHSA’s Leadership Council, including an analysis of how the substantial changes the bill would make to the TANF program and gathering input on how state agencies and TANF customers would be affected. The JOBS for Success Act would achieve a significant overhaul of not only the TANF program but also the TANF block grant as a significant funding stream for providing services aimed at keeping low-income families together by helping them meet basic needs for a healthy, productive life including the promotion of parental employment. The full analysis is available on APHSA’s website (www.aphsa.org).
Member Stories FAIRFAX COUNTY
Fairfax County (VA) Department of Family Services has leveraged data and analytics to develop new approaches to serving TANF participants through the development of the Fairfax County Department of Family Services Data Analytics Fellowship Academy (DAFA), a voluntary, ten-month data-informed professional development program for a class of 20-25 “Fellows” who are employees from all levels and divisions. The program teaches Fellows how to leverage data and research principles to improve service delivery and to ultimately improve the lives of children, adults and families in Fairfax County. DAFA explores high priority program areas identified by agency leadership. Fellows analyze client-level data and conduct in-class exercises based on real-life challenges in the selected program areas. Fellows learn how to ask questions, analyze data and use relevant data to tell the story of their findings. DAFA includes two presentations where Fellows present their findings, practice presentation skills and propose recommendations to agency leadership and stakeholders aimed at improving services and outcomes. The Inaugural DAFA Class of 2017 focused on family economic stability and analyzed data from approximately 5,000 clients who were approved for TANF over a two-year period. The Fellows’ recommendations led to the development of a new procedure that integrates self-sufficiency and child care services and experiences. Clients who are receiving either Medicaid/SNAP and child care benefits are connected to specially trained workers who enhance the benefits process for families. The DAFA program recommendations are also informing the development of a pilot program for mothers with young children in two identified zip codes. The mothers in the pilot will construct a self-driven plan for success that focuses on capitalizing on their strengths and collaboration with family supports.
Child and Family Well-Being
practitioners on services available for agencies serving children involved in child welfare with parents in the detention and removal processes, including a review of policy guiding parental engagement in child welfare proceedings, access and visitation and methods to facilitate repatriation. Following the passage of the historical increase to the Child Care Development Fund, Senate Appropriations and Health, Education, Labor, and Pensions Committee staff joined APHSA’s affinity group, the National Association of State Child Care Administrators (NASCCA) to provide an overview of the bi-partisan agreement. Staffers offered insight into the Congressional intent behind the increased appropriations, which is to improve child care quality and access for all working families. NASCCA leaders presented ideas for leveraging the increase to promote quality and access for child care programming in their states. NASCCA continues to partner closely with the Office of Child Care to ensure full implementation of the 2014 Child Care Development Block Grant reauthorization. NASCCA has facilitated a national response to the notice of rulemaking related to new administrative requirements for the state annual planning process, as well as maintaining an ongoing dialog with the Office of Child Care to support states in implementing challenging aspects such as interstate criminal background checks and health and safety requirements. under its Future of Work portfolio, provided a two-year grant to APHSA to survey state child care directors and update the Fragile Families Research (FFR) database to study the impact of non-standard work hours and how states are addressing child care needs for workers. APHSA is partnering on this project PARTNERING FOR IMPACT The Robert Wood Johnson Foundation,
INFLUENCE APHSA continues to provide support to members in influencing national policy and strengthening state and local strategy in developing programs focused on child well-being outcomes and whole-family approaches, including child welfare and child care. APHSA and leading members guiding child welfare and legal counsel continue to provide critical policy, and practice supports for the public child welfare system, especially following the passage of the Family First Prevention Services Act. Representatives from APHSA’s affinity group, the National Association of Public Child Welfare Administrators (NAPCWA), as well as the APHSA Leadership Council, held several conference calls and in-person briefings with Assistant Commissioner, Jerry Milner regarding the Children’s Bureau’s implementation plan. As states work to implement the new law, NAPCWA’s Family First Prevention Services workgroup continues to collect policy question and recommendations, which APHSA shares with the Children’s Bureau on our members’ behalf. NAPCWA members also provided comments on proposed changes to the Adoption and Foster Care Reporting System, including advocating for the Children’s Bureau to facilitate the collection of data to ensure compliance with the Indian Children’s Welfare Act. NAPCWA also led responses to the Children’s Bureau request for comment providing feedback on the Evidence-Based Clearinghouse to ensure that the needs of the unique communities among APHSA members are considered and reflected in the final product. Representatives from the U.S. Immigration and Customs Enforcement presented a webinar for child welfare and legal
Member Stories STATE OF WASHINGTON
through a subcontract with the American Enterprise Institute (AEI) to update the FFR research and release findings on how non-standard hour child care affects the health and well-being of children. An advisory council of state child care directors formed by APHSA and AEI has helped inform the project since its beginning in April 2017. Preliminary findings of the project were presented at APHSA’s Annual National Summit in May. A final report combining the research findings and the survey data, as well as suggesting potential solutions to address this growing need for safe, affordable and quality child care during non-standard hours will be published and presented by APHSA and AEI in various research and best practice conference venues. APHSA and the Migration Policy Institute (MPI) initiated a partnership to help state and local child welfare agencies strengthen their understanding of issues that may arise for child welfare systems relating to immigration, particularly in the context of detention or deportation of parents. APHSA and MPI consulted with state and local child welfare agencies to identify areas of concern and interest and conduct a research review and policy scan including interviews with state and local agencies to identify promising child welfare agency policies and practices for families with unauthorized family members. The results of this work resulted in an action manual providing recommendations for policy and practice including examples from relevant state legislation, policy manuals and training materials.
The State of Washington launched the Department of Children, Youth, and Families, a cabinet-level agency, focused on the well-being of children. The agency’s vision is to ensure that Washington state’s children and youth grow up safe and healthy—thriving physically, emotionally and academically, nurtured by family and community. The reorganization brings together child welfare and early learning programs to align operations, data, policy and funding to invest in prevention services that provide the right services at the right time to children, youth, families and communities at the most significant risk for adverse outcomes. The agencies guiding principles include: • A relentless focus on outcomes for children; • A commitment to collaboration and transparency; • A commitment to using data to inform
and evaluate reforms, leveraging and aligning existing services with desired child outcomes; and
• A focus on supporting staff as they contribute to the agency’s goals and outcomes.
By aligning Child Protective Services’ investigations and family assessment response, licensed foster care and adoption support with preschool programming, child care and home visiting, Washington State will create a continuum of services for children, youth and parents that provides prevention and early intervention services to reduce impact and promote healthy development and well-being for children. The agency will focus on service delivery sequencing, blending and braiding of funding to maximize impact and
coordination of data collection and analytics to gain insights into the effectiveness of programs across the continuum. MECKLENBURG COUNTY, NORTH CAROLINA With a population of more than one million people in Mecklenburg County, the Mecklenburg County (NC) Department of Community Resources opened its first Community Resource Center (CRC). The CRC, located at the Valerie C. Woodard campus in West Charlotte, is one of six locations that will be strategically placed throughout Charlotte- Mecklenburg providing integrated health and human services to county residents. The CRC provides service to Mecklenburg County residents seeking assistance in Food and Nutrition Services, Medicaid, Temporary Assistance for Needy Families, Emergency Assistance, Child Support, Veterans Services, Women, Infants and Children services, Immunizations, Care Coordination for Children and Pregnancy Care Management. In addition to those services, CRC community partners include; • Charlotte Works: the local Workforce Development Board that provides opportunities that prepare people for education and available careers and connects businesses to skilled workers; • Loaves and Fishes: a local nonprofit emergency food pantry program that provides nutritionally balanced groceries to individuals and families in short-term crises; and organization, inspiring underserved children to achieve their dreams through book ownership, encouraging life-long reading, assisting in creating an integrated service model to stabilize families and promoting pathways to well-being. In its first month of operation, over 7,100 persons were served with over 5,100 customers receiving core services, while • Promising Pages: a nonprofit
the remaining 2,000+ received assistance through other supportive services located within the Center. In just two weeks of operation, of the twenty-seven people served by Charlotte Works, twenty received full-time employment; over 178 children received books; and over 900 families received food to meet nutritional needs through the partnership with Loaves and Fishes. Stabilizing families is a crucial component of the work at the CRC. Mecklenburg County has employed a strategic approach to utilize subsidized services through the lens of the Social Determinants of Health (SDOH) to ensure that families receive household stability while journeying on the pathway out of poverty. The County continues to build partnerships that align with the SDOH to ensure that residents can receive services to stabilize their entire family, in one visit, at one location. In the coming months, future onsite partners will provide services in the areas of housing stability, education and primary medical and behavioral health services. The Douglas County (CO) Department of Human Services and the Larimer County (CO) Department of Human Services created the Colorado Predictive Risk Modeling Project: Implementation and Randomized Control Trial Evaluation of a Call Screening Decision Aide. The project, launching in January 2019, utilizes predictive analytics methods to help health and human services agencies, particularly child welfare agencies, improve practice and inform decision-making. Predictive analytics is the practice of “extracting information from data sets to determine patterns and predict outcomes and trends.” In Douglas County, efforts are underway to put such a tool to use, building on a similar tool implemented in Allegheny County, Pennsylvania in August 2016. DOUGLAS COUNTY AND LARIMER COUNTY, COLORADO
The prototype is a high performing model using machine learning methods that when compared to current call screening practice, shows significant potential to improve decision-making by screening in more high-risk referrals to direct preventive resources earlier and prevent future maltreatment as well as screen out more low-risk referrals to prevent undesirable intrusion into family’s lives. The screening score will predict the likelihood of placement/court action/re-referral within one year and two years of the original call. The higher the score, the greater the likelihood. The development of a prototype model was led by the Auckland University of Technology (AUT) with research partners at the University of Southern California and Carnegie Mellon University. AUT used two years of Colorado child welfare data to help build a prototype that identifies children that are at risk of being removed from their home. The prototype was found to show good levels of accuracy in identifying children who are at the highest and lowest risk of placement and has created the opportunity for leadership to refine screening protocols and direct efforts to children and families most in need of services. Douglas County has made clear that this supportive decision-making tool is just that—a tool. It will not replace human review and assessment by child welfare professionals. Instead, it will speed up the current manual process of reviewing data from various systems/ cases to assess a given referral. The next stage in the project is to implement the predictive model in the Douglas County IT system using current individual data. The final stage is an evaluation—test the effectiveness of the model by using a Random Control Trial. STATE OF VIRGINIA In 2016, the Virginia Department of Social Services (VDSS) convened a workgroup of approximately fifty stakeholders from
across Virginia to evaluate the child care needs of specific target populations (children in underserved areas, infants and toddlers, children with special needs and children in need of care during nontraditional hours).The workgroup identified potential strategies to increase the supply and quality of child care, shared ideas and formed collaborations to implement selected strategies. The workgroup formulated thirty-two recommendations addressing these areas. As a result of the needs assessment, VDSS initiated Child Care Provider STEPS (Shared Training, Education and Professional Services), a pilot project to establish shared services networks for family day homes in the Western, Piedmont and Eastern Regions of the state. The networks will focus on improving the capacity and sustainability of family, day and home child care providers to increase the availability of quality child care for infants and toddlers, children with disabilities and children in need of care during non-traditional hours. VDSS has contracted with a state higher education institution to operate a network “hub” in each region. Specific services offered through the “hubs” will be determined by the participating family day homes and may address such areas as business operations (billing, accounting, etc.); special use permits; connections to discount pricing for materials/services; marketing; assistance with child care licensing, Child Care Subsidy Program, Virginia Quality and Child and Adult Care Food Program participation; and improving competencies through professional development. Connections to existing services and support organizations (such as Virginia’s Infant and Toddler Specialist Network) are a critical part of the strategy. Through participation in STEPS, providers become stronger, more efficient, more financially sound and better positioned to deliver higher-quality child care services.
Organizational Effectiveness Member Stories STATE OF NEW HAMPSHIRE During the first half of 2018, APHSA played an instrumental role in supporting Public Consulting Group and The Alliance for Strong Families and Communities, in a system-wide assessment of the New Hampshire Department of Health and Human Service’s child and youth-oriented programs and practices. APHSA’s role on this project was principally focused on ensuring the Value Curve lens was employed in the overall assessment approach, and that the voice of parents in New Hampshire was fully incorporated in the assessment. APHSA worked with the agency’s senior leadership team to internalize critical principles of the Value Curve: effective systems progress from program and functional integrity to improved user service across programs for complex family needs to problem-solving at the cause- level for individuals and families, as well as for population-level challenges like the opioid crisis. APHSA also presented and reinforced these ideas with the agency’s management team and with a broad set of community partners in education, the courts, law enforcement and with private providers. APHSA co-facilitated the assessment input from the agency’s parent advisory group, who provided highly insightful and practical suggestions. The resulting assessment and related findings from Public Consulting Group and the Alliance were shaped around a framework and set of desired state indicators for a system of care focused on whole-family support and upstream prevention. The report’s recommendations were shaped around the causes of related gaps identified between the desired state and current state. These
Igniting the Potential
This year kicked off our special initiative
focused on “Igniting the Potential” of the H/HS workforce. In our 2017 member survey, several concerns about the agency workforce topped the list of what keeps leaders up at night: the ability to recruit and retain staff with the right talents and capabilities; how best to develop and train the workforce in a fast-paced, ever-changing world; how to equip that workforce with the right tools; and how to ensure the on-going well-being of front-line staff and managers. Building on the field’s shared learning through the Value Curve and using APHSA’s strategic platforms, including our three Collaborative Centers, affinity groups, Organizational Effectiveness practice, educational events and communication vehicles— we used this year to further support the field in developing a modern workforce that is healthy and well. Here’s what we were focused on: • Designing the indicators of a healthy H/HS workforce with clinical and field experts; • Providing new tools/guidance
for agency leaders to support the professional development of the workforce/what the future workforce needs to look like;
• Infusing content focused on
supporting the H/HS Workforce in all APHSA-sponsored 2018
conferences and events and as part of our Policy & Practice magazine and blog; and • Leveraging peer communities who influence the H/HS workforce
including the National Staff Development and Training Association (NSDTA).
We will continue to shine a spotlight on the role of a healthy H/HS workforce in igniting and unlocking the potential of people and places in 2019!
are both core techniques of APHSA’s “DAPIM” model for critical thinking and continuous improvement. The report drafts were refined through rounds of review between APHSA’s project team and the agency’s steering committee. Recommendations were ultimately organized into appropriate phases, covering all system of care elements and Value Curve stages. The primary areas of focus for system change include: • Matching system capacity with
juvenile justice. We are making significant progress in aligning our programs to integrate more fully with behavioral health and substance use disorder services, and we are working upstream to prevent children and families from needing DCYF intervention. Our highest priority should be to fund a system of care that will integrate services for youth served by DHHS.” MONTEREY COUNTY, CALIFORNIA Developed in partnership with the community, local, state and national partners, the Monterey County Roadmap to Strengthen Child Well-Being is a community plan that aligns with the recommendations from the Commission to Eliminate Child Abuse Neglect Fatalities Report viewed through the lens of the Value Curve. In partnership with the Monterey County Department of Social Services (MCDSS) , APHSA supported the second year of Roadmap implementation work in two main areas: the development of Mandated Reporter County-wide Training, and the design of a Community Navigator program model. The county-wide, six-hour Mandated Reporter Training was developed and piloted through guidance from a multi-disciplinary team of human services, law enforcement, education, public health, behavioral health and legal staff. This training, geared towards new, multi-sector mandated reporter staff throughout Monterey County, will be the required avenue of professional development identified within California’s Child Abuse Neglect and Reporting Act. Revised from its previous one-hour training format the new curriculum supports the transfer of learning for new staff in the following areas: • Their role as a Mandated Reporter; • The five types of child abuse and neglect; • Identifying the indicators of child abuse and neglect;
demand and with emerging evidence;
• Workforce retention and development strategies; • Improved individual and family assessment tools; • Moving services further
upstream towards prevention and early intervention; • Further integrating program and functional areas of the system; and • Advancing data integration towards needed analytics. While most of the changes needed in New Hampshire are in front of us as of this writing, the sponsorship for this work is strong within the agency and the state overall. “Over the past 18 months, we have taken significant steps to rebuild New Hampshire’s DCYF system,” said Governor Chris Sununu. “This report will help us identify, understand, and address areas of need within our child welfare system… I am confident that combined with the findings of the report, these firsthand accounts will help us continue to build a better system for New Hampshire’s children.” DHHS Commissioner Jeffrey A. Meyers added, “The recommendations provided in the PCG report reflect our ongoing commitment to transforming the entire child welfare system, not just child protection or
• Summarizing the Child Abuse and Neglect Reporting Act; • Recognizing when a Mandated Report should be made; and • Understanding the impact and emotional effects on the person who is making the report. Community-based health and human services agencies identified the transfer of learning support leads from those who participated in the pilot training program to augment their ability to provide ongoing learning support throughout their agency after the initial training session. The second major initiative during the past year included the development of a Community Navigator Program Model. Through a national assessment of 100+ health and human services agencies, Monterey County defined a Community Navigator as a trusted individual or place within the community/local neighborhood that assists residents in navigating and accessing resources or services that will enhance the well-being of children and families. The national assessment and focused interviews with thirteen like-demographic agencies included the collection and synthesis of information around leadership and community-based partners, finance, staff support and evidence-based practices. A multi-sector team including families who have received services through the MCDSS were the drivers of the Community Navigator Program Model. The goal is for the Navigator to provide a whole-family (2-Gen) experience to parents/caregivers with, or expecting, children up to age six and connect them to services and programs while enhancing the family’s Protective Factors (through a focus on Social Determinants of Health) and continued self-support. Parent cafes of parent-to-parent community-based events are another critical component of the County’s Community Navigator Model.
National Electronic Interstate Compact Enterprise (NEICE) Update The National Electronic Interstate Compact Enterprise (NEICE) raised the bar on data sharing almost five years ago when APHSA and the Association of Administration of the Interstate Compact on the Placement of Children (AAICPC) received an innovation grant. This grant was awarded to build a data exchange system to enable data about children to be transmitted from one state to another to facilitate a more permanent placement. With support from the Children’s Bureau, by October 2018, there will be twenty-seven states using the NEICE with another ten working through the administrative and technical onboarding process. The NEICE project evaluation has noted the impact on permanency outcomes for approximately 35,000 children by reducing time to placement and increasing accountability in the ICPC process. With a legislative mandate to onboard by 2027, efforts will continue to bring more states onboard over the next year.
Building Effectiveness through Health and Well-Being ORGANIZATIONAL EFFECTIVENESS APHSA’s Human Services Integration Institute, funded through a grant from the Kresge Foundation, ended during the first half of 2018. The purpose of this virtual institute was to build capacity within organizations and community teams by positioning them to initiate, implement and monitor an integration change plan. APHSA’s Organizational Effectiveness team provided facilitation and change management support to advance this purpose in each of the four jurisdictions. The association is supporting six North Star Convenings that Kresge is hosting with its human services grantees. These convenings will bring a collective group of leaders who share our commitment to advancing social and economic mobility. The first convening will focus on lifting racial equity in human services.
NEICE Commitment Progress (September 2018)
Analytics Symposium for Action on the downtown campus of the University of Chicago. Underwritten by Optum, the Lewin Group and Chapin Hall at the University of Chicago, its purpose was to bring together H/HS thought leaders from across the country who were heavily invested in the transformative power of analytics to drive sustainable outcomes and build their organization’s analytical capabilities at the state and local levels. Sixty-one members from eighteen states and localities, along with sponsors, participated in the symposium. Follow- up activities will focus on highlighting strategies that participants are now working to implement within their state or locality. A white paper highlighting the insights gleaned from the Symposium is available on the APHSA website (www.aphsa.org). Member Stories CHIPPEWA COUNTY, WISCONSIN The Chippewa County (WI) Department of Human Services is learning how to effectively engage the broader community eco-system through the lens of the Value Curve to achieve better outcomes with fewer resources expended for its citizens. It is collaborating with community partners and integrating the underlying needs of families in service design. In November 2014, the County Health and Human Service Board approved the formation of the Children, Youth, and Families Committee (CYFC). The committee is a partnership compromised of government, education, business, law enforcement, the United Way, faith-based, nonprofit, health care, public health, legal, education and economic development organizations; and consumers of services. CYFC is committed to incrementally moving county partners toward collective action with a shift toward whole-person and family-centric service design. Through technical and financial support from the
DATA INTEGRATION AND INTEROPERABILITY APHSA continues to advocate for integrated policy and financing structures
that enable states to integrate data systems better, consolidate back- end support functions and leverage
technology to implement outcome-focused decision-making. APHSA has developed and shared “use case” examples from member states which highlight how state system modernization efforts facilitated by the A-87 cost allocation exception have had positive impacts in customer service, program integrity, data security and improved program and customer outcomes. APHSA staff has engaged with legislative and administration staff to highlight members’ critical needs for system modernization and data optimization. APHSA will continue to advance policy solutions like the A-87 through and with partners from industry, research and federal partners to further policy advances aimed at creating enabling conditions for states to achieve data integration and interoperability, and leverage analytics. ANALYTICS SYMPOSIUM In keeping with our 2018 Strategic Playbook, APHSA launched a Special Initiative—Igniting the Potential of the H/HS Workforce. APHSA held a two-and- a-half day Health and Human Service
HEALTH AND HUMAN SERVICES FOR ACTION ANALYTICS SYMPOSIUM
HYATT REGENCY CHICAGO UNIVERSITY OF CHICAGO-GLEACHER CENTER JULY 20−22, 2018
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Peer-to-Peer Integration Institute through APHSA, with sponsorship from the Kresge Foundation, CYFC has taken the initial steps toward realizing this vision. Through the Integration Institute, the department has utilized APHSA’s Organizational Effectiveness’ DAPIM change management framework to define the desired future state of the community with community input and feedback, and then assessed its current status. As a result, it has learned that its citizens do not view the purpose of the human services system truly as a service of the community. APHSA’s facilitation process has helped the department to define its collective vision of Hope, Healing, and Health; understand where it currently is about its vision; and identify a plan moving forward informed by the causes that have been barriers to moving the community toward hope, healing and health. In addition to utilizing the maturity model self-assessment to evaluate the state of system integration for Chippewa County DHS and its human serving partners, Chippewa focused a qualitative portion of its assessment on understanding the perspective of the people and communities that it serves. Two-hour, in-home interviews were designed to understand the life goals of the community members as well as gaps and causes related to the services and
programs provided by DHS and its human serving partners. These interviews were conducted by CYFC members external to DHS and revealed that for the people of Chippewa County, hope was commonly regarded as a positive attitude toward the future, and centered around good health, education and employment, leading to family economic self-sufficiency, owning a house and raising healthy and prosperous children. The community interviews identified primary gaps of a general lack of coordination throughout the system and lack of connection and inability to access relevant information through the system. As a result of the assessment and roadmap planning efforts, Chippewa County’s strategy focuses on developing its services integration and alignment with social sector partners, shared community metrics around community identified outcomes, developing of community social capital, multisector work groups for collective impact and influencing the community toward solutions, policies and methods that address root causes of poverty. Another critical impact was the strengthening of the capacity of the Chippewa CYFC through a partnership with the University of WI extension, identification of community leaders dedicated to advancing hope, health and healing and a feeling of goodwill generated from the interviewees who had an opportunity to share their story and feel heard.
“Through the Peer to Peer Institute, we have engaged an APHSA Organizational Effectiveness (OE) Facilitator and learned to utilize APHSA’s OE unit’s change management framework called DAPIM (Define, Assess, Plan, Implement and Monitor). Through this process of defining our desired future state of our community, with our community, and then assessing our current status, we’ve learned that our citizens don’t view the purpose of our human service system as truly in service of the community: “The system serves the system.” Although the ‘system’ espouses that it serves individuals and families based on their hopes and dreams, little evidence supports this belief in practice from the citizen’s perspective. The facilitation process thus far has helped us define our collective vision of Hope, Healing and Health, understand where we currently are about our vision and identify a plan moving forward informed by the causes that have been barriers to moving our community toward hope, healing and health.”
– Larry Winter, Director, Chippewa County Department of Human Services
• User Interviews: One of the foundational components of HCD is spending time with the actual users of the system and building empathy. A firm is working with MDHS, DOM and the vendors to conduct user research through interviews and techniques such as the “5 whys” to provide input into the design process; and • Usability Testing: Traditionally, testing is done by State staff and the vendor’s staff, but HCD puts a priority on testing with the end users. A firm will work with the vendors and the State to conduct task-based moderated usability testing.
STATE OF MISSISSIPPI In 2017, the Mississippi Division of Medicaid (DOM) struck a historic agreement with the Mississippi Department of Human Services (MDHS) , which gained the approval of a joint-Advanced Planning Document (a first for the State), and launched the Health and Human Services Transformation Project (HHSTP). DOM is implementing three modules and employing innovative approaches to unite Medicaid, SNAP, TANF and other potential programs such as LIHEAP/WIC. Goals of the project include improving and coordinating services and providing self-service capabilities, helping the “whole-family,” enhanced fraud and abuse initiatives and compliance. DOM and MDHS want to improve interoperability and integration in technology and improve case management. In the first phase of HHSTP, DOM and MDHS plan to implement three major modules: 1) Common Web Portal Module 2) Fraud and Abuse Module and 3) Data Hub Module. HHSTP is being realized through human-centered design (HCD) principles. HCD is a design and management framework that develops solutions to problems by involving the human perspective in all steps of the problem-solving process to improve the user experience. DOM used HCD concepts to define solutions that serve the needs of the users. Core decision components included: • Discovery Sessions: Convening sessions with actual users, county workers and IT staff to engage in a collaborative discovery effort to identify pain points, isolate features and product vision and feed the overall design process; • Journey-Mapping: Journey mappings are similar to process flows, but they are developed from the perspective of the user rather than the system. A firm worked with MDHS, DOM and the vendors to map the journey for users and identify pain points, positive interactions and improvements;
STATE OF MINNESOTA The Minnesota Department of Human
“[APHSA facilitators] have been just wonderful to work with — we’ve really benefited from your help and this technical assistance was great!! …You and your team have been so very helpful in moving us along with our ISBM plans!”
– Karen Mickelson, Project Manager, MN Department of Human Services
Services (MNDHS) , in partnership with its county and tribal partners, participated in APHSA’s Human Services Integration Institute. Before joining the Integration Institute, MN began a process of designing an Integrated Services Business Model (ISBM), to conceptually align the efforts of counties in integrated service delivery and drive the development of a statewide technology system modernization effort. Its principal aims in joining the virtual institute were to capitalize on APHSA facilitation toward utilizing the Value Curve and to understand the current state of program and service integration within MN, learn from peers seeking to integrate services around the country and initiate movement toward implementing integrated services across MN.