Policy & Practice August 2018

The Magazine of the American Public Human Services Association August 2018

INNOVATING FOR THE FUTURE Maximizing Modern Tools and Platforms

TODAY’S EXPERTISE FORTOMORROW’S SOLUTIONS

contents www.aphsa.org

Vol. 76, No. 4 August 2018

features

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Igniting the Potential Investing in Your Workforce and Moving Up the Value Curve

Gaming the System How the Misuse of Data Impedes Innovation

Innovating Child Welfare Service Delivery A Next-Generation System of Engagement

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Data Sharing Drives Positive Outcomes What Social Services Agencies Need in the Opioid Battle

ReImagining Data at ACF Agency Prioritizes Data Sharing Actions in Response to State Feedback

Using Data To Improve Policy Decisions Insights To Help Governments Address Complex Problems

departments

3 President’s Memo

32 Legal Notes

34 Staff Spotlights

Defining Success by 2022: Moving Toward the Generative State

The Legal Contours of Child Endangerment

Malik D. Baker, Policy Fellow

35 Yangyang Geng, Policy Fellow

5 From Our Partners Connecting Family First with CCWIS

33 Association News Top Five Reasons for

44 Do’ers Profile

Gregory S. Jackson, Chief Information Officer, Ohio Department of Job and Family Services

Attending the NSDTA Annual Education Conference

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Charting New Pathways: Navigating the Future of Work in Health and Human Services

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August 2018 Policy&Practice

APHSA Executive Governing Board

Elected Director Brenda Donald, Director, DC Child and Family Services Agency,

Chair David Stillman, Assistant Secretary, Economic Services Administration, Washington Department of Social and Health Services, Olympia, WA Vice Chair and Local Council Chair Kelly Harder, Director, Dakota County Community Services, West Saint Reiko Osaki, President and Founder, Ikaso Consulting, Burlingame, CA Leadership Council Chair Roderick Bremby, Commissioner, Connecticut Department of Social Paul, MN Treasurer

Washington, DC Elected Director

Susan Dreyfus, President and CEO, Alliance for Strong Families and Communities, Milwaukee, WI Elected Director David Hansell, Commissioner, NewYork City Administration for Children’s Services,

NewYork City, NY Elected Director

Anne Mosle, Vice President, The Aspen Institute and Executive Director, Ascend at the Aspen Institute, Washington, DC

Services, Hartford, CT Affinity Group Chair

Paul Fleissner, Director, Olmsted County Community Services, Rochester, MN

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Policy&Practice August 2018

president‘s memo By Tracy Wareing Evans

Defining Success by 2022: Moving Toward the Generative State

E arlier this year, at our annual National Health and Human Services Summit, we released our

Strategic Playbook, which serves as the guidebook for our members’ action plan for the next five years. In April’s issue, we shared our newly adopted vision and mission statements, reflecting the shared belief of leaders across the country that health and human services (H/HS) are a cornerstone to building a strong, dynamic, and healthy nation made up of thriving communities. We also shared the key elements of the Playbook as captured in our Theory of Action, which guides the steps and strategies we take daily, with and through our members, to influence sound policy, build agency capacity, and connect leaders through shared learning platforms. This month, we want to share, as a membership body, howwe define success at the end of the five-year plan and howwe intend to measure our progress along the way. The Human Services Value Curve (VC) is a helpful lens for guiding our collective journey to enable all families to live healthy lives and thrive in their communities. As such, we have embedded it in how we define success through the following six indicators. The descriptions below capture the impact we want to see by 2022: n Productive National Narrative. APHSA membership is a key influencer and driver of a widely adopted meta-narrative that facili- tates finding common ground and advancing solutions that are adapt- able locally, centered on the whole family, and that help build thriving communities (VC stages 3 and 4). n Modern H/HS Policy. National policy is increasingly focused on

and program design across the country from a political, partisan perspective to practical, data- informed decisions that drive the desired outcomes we all share: more timely, accurate, and compliant program delivery (VC stage 1); any door into the system allowing com- prehensive needs assessment and efficient interventions (VC stage 2); high-need individuals and families triaged into consultative service planning and mutual engagement tailored to achieve economic and social mobility (VC stage 3); and places or populations experiencing chronic cycles of poverty developing more effective ecosystems to change this pattern (VC stage 4). n Agile H/HS Workforce. Broadly, we observe an increased focus and capacity within agencies and

whole-family approaches and addresses social determinants across sectors and systems (VC stages 3 and 4); it also incentivizes and enables use of the latest technology (all VC stages), provides for optimum use of data to drive decisions through a race equity lens (VC stages 3 and 4), and supports cross-sector partner- ships (VC stages 2, 3, and 4). using modern researchmethodologies to help identify and spread evidence- informed factor models and front-line practices (VC stages 3 and 4). We have also further validated the impact of the Value Curve and our Organizational Effectiveness practice through third- party evaluation (VC stages 3 and 4). n Data Optimization at All Levels. Broadly, we observe a shift of policy n Evidence-Informed Investments. APHSA has established strong, stra- tegic relationships withmultiple researchers and academia who are

See President’s Memo on page 36

Photo via Shutterstock

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August 2018 Policy&Practice

Vol. 76, No. 4

www.aphsa.org

Policy & Practice™ (ISSN 1942-6828) is published six times a year by the American Public Human Services Association, 1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036. For subscription information, contact APHSA at (202) 682-0100 or visit the website at www.aphsa.org. Copyright © 2018. All rights reserved.This magazine may not be reproduced in whole or in part without written permission from the publisher.The viewpoints expressed in contributors’ materials are the authors’ own and do not necessarily reflect the policies or views of APHSA. Postmaster: Send address changes to Policy & Practice 1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036

Advertising Natasha Laforteza ads_exhibits@aphsa.org

President & CEO Tracy Wareing Evans Editor Jessica Garon jgaron@aphsa.org Communications Consultant Amy Plotnick

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Policy&Practice August 2018

from our partners By Shell Culp

Connecting Family First with CCWIS

T he Family First Prevention Services Act (FFPSA or Family First), passed as part of the Bipartisan Budget Act of 2018 (H.R. 1892), is a monumental shift on how child welfare services are provided and financed that aims to improve outcomes for vulnerable children in the care of states. The act “…includes long-overdue historic reforms to help keep children safely with their families and avoid the trau- matic experience of entering foster care, emphasizes the importance of children growing up in families, and helps ensure children are placed in the least restrictive, most family-like setting appropriate to their special needs when foster care is needed.” 1 The effects of this new law will have significant impacts on child welfare programs across the country. These changes are coming on the heels of the recent Comprehensive Child Welfare Information System (CCWIS) final rule that is guiding the next generation of state child welfare data reporting and case management systems. Although Family First and CCWIS were devel- oped along separate tracks, states now must figure out how to reconcile the two new federal mandates so that the new CCWIS system can support programs in the best way possible. The CCWIS rule makes funding avail- able to states, tribes, and territories to transition existing systems or build new systems at a more favorable federal match. From its new focus on child welfare data, the CCWIS rule aims to provide more and improved support for evidence-based practices that provide better outcomes for kids. The Family First Act dovetails nicely with the move toward greater importance of data. Much of the Family First approach targets standards for foster family home

“meta data” behind it. Get strategic about it; address how the data will be managed across the enterprise and consider the impacts of sharing data with other organizations. > Clean it up. Be sure you under- stand where the quality of the data degenerates and provide mitiga- tion measures that solve most of the problems.  Strengthen relationships with partner agencies. The CCWIS rule requires “bidirectional” data exchanges. Exchanging data with outside entities will present some issue that you may not have encountered before: > Extend a hand. Make sure you start discussions with them early and move toward “co-creating” a mutually beneficial solution. > Establish sound governance. Who owns the data? How do they get updated? Where is the “source of truth”?

licensing and limits on claiming Title IV-E funds for congregate care facili- ties. However, with the CCWIS focus on data, and the Family First focus on prevention, you can start to prepare for upcoming, dramatic change. Data —Data by itself will not be enough to comply with Family First. The data will have to be used in meaningful ways to prevent child maltreatment and substantiate evi- dence-based decisions.  Leverage CCWIS activities: > Critically examine your child welfare processes and identify improvement areas. >Capture data on trauma-informed care and “evidence.” Your organiza- tionmay not need to be the “owner” of this data, but if the data are used in child-welfare decisions, you’ll need tomaintain it in the state system.  Strengthen existing data across the enterprise: > Assess your data assets. You’ll want to get a complete picture of the condition of your data, and the

See CCWIS on page 34

Photo Illustration by Chris Campbell/Shutterstock

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August 2018 Policy&Practice

from our partners By Libby Bacon, Jeric Huang, Mike Moreno, and Eric Wilson

Charting New Pathways: Navigating the Future of Work in Health and Human Services

H ealth and Human Services (H/HS) leaders know the challenges their more than 2.5 million staff members face: an intense work environment, high turnover, and growing caseloads. This helps explain why workforce and talent management are top concerns for agency leaders. Despite a keen awareness of these issues, only 15 percent of leaders say they have a well-defined strategy for workforce management. 1 The future of work, characterized by a growing work- force ecosystem, increased mobility, demographic shifts, and technological advancements is opening new pos- sibilities to address these lingering challenges. 2 Looking to the future of work uncovers new ways of acquiring, developing, and managing the work- force, enabling H/HS agencies to focus on the core mission of serving citizens in need. Agencies can improve their work- force for the future of work by reexamining three factors: Where: Where can virtual work, distributed work, remote work, or redesigned workplaces be deployed to induce greater productivity? Who: Who can do the work across the workforce eco- system from traditional full-time and part-time employees to contractors, freelancers, gig workers, and crowds? What: What work, presently done by humans, can be complemented by smart machines and automation using advances in cognitive technologies? The Where. We exist in a completely intercon- nected world, which opens up new options for where work gets done. This

n What is your starting point? Does your organization look like the blue triangle: heavily reliant on close,

physical proximity, traditional staffing, and low automation?

n How can you push the boundaries to rely less on physical location,

leverage additional staffing categories, and automate repetitive tasks?

means that work is no longer confined to a physical office location. Leveraging a virtual workforce strategy can allow states to deliver services more effi- ciently on multiple fronts: realizing cost savings from reduced physical office footprints, routing the right work to the right worker at the right time, and providing a better overall experi- ence for customers and employees. Advances in productivity, mobility, and collaboration tools, as well as the next wave of virtual presence technological innovation has acceler- ated the ability to deliver on a flexible workplace. One state that embraced workplace mobility implemented a model that allowed a large majority of their workforce to work from home. Underpinning the advancement

of virtual work is strong employee engagement and a workplace culture that supports digital and agile ways of working. H/HS leaders at the forefront of fostering this culture are positioned to reap the benefits of a more engaged and productive workforce; thus attracting talent more effectively and reducing voluntary turnover rates. The Who. The demographic drivers of the future of work are reshaping the H/HS workforce. The number of career changes in an average life is increasing, as the concept of having a job for life gives way to the next

See Pathways on page 39

Image via Deloitte Consulting, LLP

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Policy&Practice August 2018

The Health and Human Services Workforce

Investing in Your Workforce and Moving Up the Value Curve PART 4

By Charmaine Brittain and Carl Ayers

uman services agencies achieve their mission of serving children, families, and vulnerable populations through their people—their workforce. An emphasis has always been placed on providing good practice, but not so much on the workforce that facilitates services.

increased pay, will result in significant differences in employee retention. Rather, it requires a multi-pronged approach using a variety of interven- tions, both small and large in scope, to make a difference in reducing turnover. Approaches should be cus- tomized to the individual context and resource availability of each agency. Like service delivery with families, the process starts with a comprehensive assessment to understand the agency’s unique strengths, issues, and chal- lenges and then the development and implementation of a plan specific to the agency. The Virginia Department of Social Services (DSS), responsible for the administration of child welfare services and child and adult protective services training, decided to address their workforce issues, starting with a training system assessment. Through a partnership with the Butler Institute for Families at the University of Denver, they conducted a mixed- methods approach to understanding their current training system and scanning for training system best practices across the nation through a survey of more than 20 state and local agencies. The internal assessment of Virginia’s training system found that work- force stability is a key challenge in administering a statewide training system. Due to high turnover, newly hired staff is expected to carry a full caseload and engage in foundational training simultaneously, which does not lead to the ideal learning envi- ronment. Also, given the distances to training sites, there is a need to balance online and in-person trainings and make training consistently avail- able across the state. Adult services training is significantly underfunded compared to child welfare training and the available offerings need to be greatly enhanced. Overall, advanced training opportunities are lacking in the state, and transferring information from learning experiences could be improved. Key findings from the national scan of child welfare and adult service agencies included:  Forty-seven percent of child welfare staff and 58 percent of adult services

In the early 2000s, high turnover in the workforce arose as an issue and much has been done in these intervening years to determine what makes a good workforce and how to achieve it. At the same time, many in the human services field adopted the Human Services Value Curve to improve the value generated by the agency and client outcomes. A blue- print for activities associated with the Value Curve helps human services agencies strive for growth on the curve. As agencies have integrated the Value Curve in their practice and learned what it takes to have successful outcomes for the populations served, well-qualified and highly trained staff at all levels of the organization have emerged as keys to these successes. The model challenges our workforce to be knowledgeable of both micro- and macro-practices to create lasting systemic changes in the family and community that ultimately benefit those we serve. Virginia’s commitment to moving up the Human Services Value curve and improving the agency has led to investing in their workforce. Research shows the impact of turnover both on the agency’s bottom line and on client outcomes. In one study in Texas, the Sunset Commission found the cost of turnover to be $54,000 per employee needing to be replaced. 1 As human services agencies face higher turnover rates, some well over 40 percent, the fiscal impact can be enormous (for example, $21 million per year for a 1,000-person agency), not to mention the disruption to conti- nuity of services, changes in goals, and the burden on remaining staff who need to cover for departed employees. Furthermore, research going back to the initial Child and Family Services Reviews in the early 2000s shows that high turnover leads to a failure to respond to child abuse complaints expediently, a lack of case plan completion, reduced worker contact with children and families, maltreatment recurrence, and a lack of timely permanency. Achieving an effective workforce requires a substantive investment in time and resources and a commitment to the process. No one intervention, such as improved training or even

Igniting the Potential is a recurring theme for 2018. In each article, we introduce our readers to various efforts underway in the H/HS workforce. If your organization has a compelling story to share about how you are supporting and advancing the H/HS workforce, we would love to hear from you. Contact Jessica Garon at jgaron@aphsa.org. Igniting the Potential

Charmaine Brittain is the Director, Organizational Development, Butler Institute for Families, at the University of Denver.

Carl Ayers is the Director, Division of Family Services, at the Virginia Department of Social Services.

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Policy&Practice August 2018

The Human Services Value Curve

Ef ciency in Achieving Outcomes

As training systems advance to this more holistic set of priorities, they can become truly Generative partners within their agency’s leadership team, helping them to focus on an even broader set of challenges and oppor- tunities and earning their seat at the table:  Knowledge management programs and policies, especially in light of an aging workforce and an incoming workforce with different orientations to technology  A truly strategic staff talent recruit- ment and retention program that systematically and proactively addresses the turnover challenges we noted at the beginning of this article  The use of continuous improvement and critical thinking methods and tools at each organizational level, ensuring investments in development “stick” within the broader culture  Outcome and performance measures that clearly link workforce improve- ments to service improvements and Regulative Business Model: The focus is on serving constituents who are eligible for particular services while complying with categorical policy and program regulations. Collaborative Business Model: The focus is on supporting constituents in receiving all services for which they’re eligible by working across agency and programmatic borders. Integrative Business Model: The focus is on addressing the root causes of client needs and problems by coordinating and integrating services at an optimum level. Generative Business Model: The focus is on generating healthy communities by co-creating solutions for multi-dimensional family and socioeconomic challenges and opportunities.

Generative Business Model

Integrative Business Model

Collaborative Business Model

Outcome Frontiers

Regulative Business Model

Effectiveness in Achieving Outcomes

© The Human Services Value Curve by Antonio M. Oftelie & Leadership for a Networked World is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Based on a work at lnwprogram.org/hsvc. Permissions beyond the scope of this license may be available at lnwprogram.org.

Virginia realized from the report that their efforts could not just be focused on training, but instead must embrace a holistic workforce devel- opment model. Guided by the study findings, Virginia is moving forward with a cross-agency implementation team to begin transforming their approach to workforce development and, specifically, training. Practical strategies will include:  Employing a comprehensive work- force development model  Using an academy approach to training  Integrating a practice model and race equity lens into all training modules  Employing hybrid training approaches  Recruiting trainers with recent or current field or subject matter expertise  Increasing frequency and depth of ongoing/refresher/booster training  Conducting worker and supervisor certification  Implementing practical, doable, and meaningful transfer of learning strategies  Evaluating for outcomes

staff carry caseloads while attending training.  For new workers, the average number of training days for child welfare is 34 while for adult services workers it is 7. For new supervisors, the average training days for child welfare is 27 and for adult services it is 7. Required training for middle management is mixed.  State child welfare systems have high regard for their university partnerships.  About 75 percent of child welfare agencies and 39 percent of adult services agencies employ an academy approach.  Approaches to trainer preparation vary widely—from none at all to a trainer academy. The study found many opportuni- ties for states to improve their training systems (and ultimately their work- force) and that significant differences exist between child welfare and adult services training systems. See the box (page 40) for a sample of best practices in training gathered by the study.

See Igniting the Potential on page 40

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August 2018 Policy&Practice

How the Misuse of Data Impedes Innovation

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Policy&Practice August 2018

By Ken Miller

The public sector has invested great hope and massive fortunes in the promises of performance management. From dashboards and scorecards to STAT systems and big data platforms, we’ve bought into the idea that “what gets measured gets done” and if we want better results we need to hold people accountable for the achievement of measurable goals. But after all this time and investment, what have we really achieved? Has all of this measurement produced great insights and innovations? Has performance management increased engagement and overhauled performance? What good has it done your agency?

same reason the VA health centers fudged patient wait time data—hiding thousands of patients off-book with scores of patients dying without ever being seen. The exact same reason teachers and principals cheated on standard- ized tests in DC, Chicago, Atlanta, and countless other places. And it’s the same reason public assistance agencies gamed the payment accuracy performance standard. Fear. Performance measurement, rather than being a flashlight that illuminates insights and improvements, was used as a hammer to hold people accountable for systems that were beyond their control. Gaming the system occurs any time someone is held accountable for a broken system without the power or resources to improve that system. Quite simply, how can we make the numbers if we can’t make improvements? And this is precisely where performance management has led us astray. Performance management believes that the only variable that matters is effort or motivation. Therefore, data and measurement are used as tools to incentivize and motivate; for control and accountability.

Wells Fargo is the canary in the mine for performance management. Rather than an aberration or a group of bad actors, they are the poster child for following the per- formance management playbook. Top management had crystal clear priorities (increasing the number of accounts customers had with the bank), SMART measures with a stretch target (8 accounts per customer because, as the CEO testified, “8 rhymes with great”) and then cascaded those measures from the top all the way to the front line. Each individual employee had a performance goal (the number of new accounts opened) with direct line of site to top management’s priority. Employees who met their goals were rewarded—those who did not were coached up or coached out. With such a robust performance manage- ment system, what could go wrong? Well, ask the millions of customers who had unauthorized accounts opened in their name, the CEO and much of upper management that had to resign and the millions Wells Fargo is spending to apologize and rebrand itself. More than a century of trust was wiped out. Why did the employees do it? For the exact

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August 2018 Policy&Practice

Figure 1: Avoiding the ‘Fear Hole’

Rarely is performance the sole domain of individuals. Granted in areas of personal development (preparing for a 10K, losing weight, stopping smoking) the tools of performance management can be helpful. Setting a goal, measuring your progress, and incentivizing your behavior can all help you get what you want. But in each of these cases the motivation is intrinsic and the vari- ables are under your control. Imagine instead if the weight loss goal was mandated to you by your significant other, and you were to report your progress daily to them. Now imagine that you have no control over what foods you eat, the gym is 45 minutes away and you work two jobs. How would you feel? For most people in organizational life this is exactly how it feels. Measures and targets are imposed upon them. Accountability is geared upward in the organization to someone they are likely to fear. Performance is dependent on count- less variables and constraints, over which they have little control. When we are held accountable for a broken system without the power or resources to improve the system, often our only recourse is to game the system. Improvement in our organizations comes from improving the design and operation of our systems—our methods—how we do what we do (sometimes even starting over and coming up with a new method). Improvement in method comes from insight—those “aha” moments that come when we see something new or see something old in a new light. This is the purpose of measurement—to provide us with feedback on how our vital systems are performing so we can convene, understand the data, gain new insights, and develop new

Innovation/Improvement

Method

Insight

Learning Path

Feedback

Measurement

Targets Accountability Path

Judgment

Consequences

Fear/Gaming/Disengagement

points with no variance, all showing improvement strains credulity and is statistically impossible.) So what are we doing as leaders to create fear and make insight so illusive? Falling Down the Fear Hole Wells Fargo had every right to want to sell more products to its customers and was wise to measure how many products each customer currently used. VA leadership was right to want to know patient wait times, just as USDA/FNS was right to want to know payment accuracy. Wanting to know something is the purpose of measure- ment. It is the first step toward insight. However, the next step you take makes all the difference in whether you get insights and improvement or fear and gaming the system. The diagram above shows the two paths we can take with performance management. Both start at a neutral place with measurement. From

methods. The purpose of measure- ment is not to hold those systems accountable. Systems are finely tuned to give you the exact results you are getting. Systems don’t respond to stretch targets, incentives, or exhor- tations. If you want better results, you have to fix the system. Doing that doesn’t require accountability, it requires knowledge. Insight will not appear where fear persists. One of the enduring legacies of the quality movement was W. Edwards Deming’s exhortation to drive out fear. Fear is toxic. Fear corrodes. Fear gums up our systems and processes. Fear distorts our data and makes it hard to find the truth. (Two examples: (1) Ford’s CEO’s question to his leader- ship team—How can the company be losing billions of dollars if all their dashboard metrics are green; (2) How is it possible that the crime rate went down in a major U.S. city every quarter for 13 years? It’s likely and applaudable that the trend would be down over that period, but over 50 consecutive data

Ken Miller is the Founder of the Change & Innovation Agency.

See Gaming the System on page 42

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Policy&Practice August 2018

T

O

Innovating Child Welfare Service Delivery A Next-Generation System of Engagement

ne sentence. Just one sentence in a five-year-old case file can drastically change the life of a child.

Identify the best placement for a child entering care. Ensure a family gets timely assessments. Uncover a hidden kinship connec- tion. Or simply find someone who can provide a safe place for a child to spend the night. But, since case files can include hundreds of pages of information, including history from past cases, insight contained in that one sentence is often virtually impossible to retrieve. Sometimes, workers don’t even know it exists. Although physically available, critical information from things like court records, emails, medical reports, psychological evalua- tions, and case notes becomes hidden, leading to “dark data.” As a result, social workers struggle to digest and apply the right knowledge at the right time when making decisions. Until now.

By Rupam Chokshi

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August 2018   Policy&Practice

The ideal solution must be capable of supporting CCWIS requirements, featuring a flexible, lightweight, intuitive and user-centric interface, plus the ability to perform a bi-directional data exchange.

Increasing the Potential for Positive Case Outcomes Modernizing to the new Comprehensive Child Welfare Information System (CCWIS), or building new systems to meet CCWIS requirements, opens the door for child welfare organizations to better collect, view, share, and understand informa- tion, not just record it. Agencies can leverage next-generation technologies designed for engagement, efficiency, and service delivery that align with their unique program requirements and support their core practice model. A system of engagement works together with an agency’s existing system—or as a module in a new system—to enhance how workers manage information and interact with children and families, both in the field and at the office. The ideal solution must be capable of supporting CCWIS requirements, featuring a flexible, lightweight, intui- tive and user-centric interface, plus the ability to perform a bi-directional data exchange. It should also help social workers take full advantage of their data and content, regardless of their location or level of connectivity, empowering them with knowledge that can be applied when making critical decisions about safety. This way, CCWIS becomes much more than just a set of regulations (see System of Engagement on page 19). Let’s dive deeper into five reasons to consider a system of engagement as part of a state’s CCWIS modernization. n Promote data quality. A system of engagement performs a bi-direc- tional data exchange with other systems and can serve as an anytime mobile data collection tool. This

information, or insufficient evidence that can result in a failed audit and cause financial ramifications. A system of engagement facilitates an agency’s ability to present specific evidence and matching documen- tation to support compliance on federal IV-E and CFSR reporting requirements and mandates. It can also collect—on the same interface— specific data elements that support individual states’ child welfare laws, regulations, policies, practices, and reporting requirements. n Reduce turnover. Turnover trends continue to increase, and agencies pay the price. The National Child Welfare Workforce Institute estimates the cost for each worker leaving an agency to be $54,000 (see http:// ncwwi.org/files/Why_the_Workforce_ Matters.pdf ). The problemworsens when you consider how turnover neg- atively affects children and families: when continuity of care is disrupted, families struggle to make progress and can be kept in the system longer than necessary. Of course, this places additional financial burden on the agency by increasing the cost of out-of-home care. The right tools—including a system of engage- ment—can help break this endless cycle. Burnout, stress, and other pressures that contribute to turnover can be minimized by providing easy access to information so social workers can focus on serving children and families, not data entry.

reduces duplicate entry and elimi- nates the potential for human error, while allowing all public and private agency workers a line of sight into the past and present. For example, case, client, and service provider data provided by CCWIS are auto- matically filled into electronic forms. Similarly, data that social workers capture in the field can be automati- cally synced back to other modules within CCWIS. n Increase productivity. Inefficient, uneconomical, and ineffective tools and processes limit social workers’ ability to build trust with vulnerable children and families. Since a system of engagement is user-centric and designed for daily work, it allows social workers to repurpose up to two hours per day by minimizing time spent on administrative func- tions to maximize time spent doing high-value work with families to reduce trauma. n Improve program outcomes. A system of engagement enables social workers to spend as much time as possible meeting with families, visiting children in care and youth under supervision, attending court hearings, and more—all while having access to detailed knowledge about the case to support major deci- sions. This leads to safer children and stronger communities. When a system of engagement includes case discovery, it also provides real-time data about significant case topics and their prevalence across an agency or state, which helps organizations get an even better understanding of the challenges confronting the commu- nities they serve. n Demonstrate compliance. Manual data collection processes increase the potential for errors, such as incomplete documents, conflicting

Rupam Chokshi is the Director of Product Marketing at Northwoods.

Case Discovery: An Emerging Solution

A system of engagement that includes a dedicated case discovery module can further improve outcomes. While case discovery is not a CCWIS requirement, it’s one of the most impactful tools in a social worker’s arsenal.

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Policy&Practice August 2018

System of Engagement in Action A system of engagement has helped the child/family and adult units at Houston County Department of Human Services (DHS) in Minnesota spend more quality face-to-face time with families. They can connect these families to services faster and help them experience better case conti- nuity, which the agency believes will lead to improved outcomes now and in the future. Social workers use web-based software in the office to scan and upload documents, and a companion mobile application to easily take photos and complete forms when meeting with children and families. The mobile application automatically syncs new data and content back to the office, which provides workers with immediate access to critical information they need. That way, workers can make decisions focused on safety and outcomes, not just meeting mandates. Agency leadership recognized from the beginning the importance of a system designed to work the way social services agencies work. “As we talked with the county board, we said this is something that will help us with our efficiency with things that we’re required to do,” said DHS Director John Pugleasa. “We can get more face-to-face value with the same staff because we’re doing the adminis- trative work more efficiently.” Houston County Commissioner Justin Zmyewski added, “If you're not using the latest and greatest software, you’re behind. This is an opportunity to try and expand the potential capa- bilities within our Human Services.” Social workers are saving two hours per day, which helps them hit dead- lines and feel more efficient, and has reduced their stress. “We’re able to take action a lot faster in regard to what our next steps are going to be when meeting with the families, making referrals, getting services in place when needed,” said Andrea Onstad, a child protection social worker.

search to surface dark data through a child welfare lens. It presents a complete picture of a child or family’s past and present to safeguard their future. Social workers are informed about prevalent topics, potential risk factors and safety threats, important people and collaterals connected with families, and key events critical to safety and permanency. Case discovery, along with content collection and data collection, can help child welfare organizations minimize delays when making decisions, which reduces trauma to children. It can uncover insights and trends across the community and equip decision-makers with specific examples and data to confirm areas of concern, recom- mend potential solutions, and justify resource allocation.

Imagine for a minute that a case file could speak. What questions would a social worker ask it? Would the answers make that worker feel empowered to make the right decision? Would they help someone understand not just what happened, but why or how it happened? Every piece of content has the poten- tial to contain critical information about a case, but it gets buried deeper in the file as more new information gets added. If a social worker only looks at the now without the why from the past—including the dark data that contribute to a root cause—he or she risks making decisions based on con- firmation bias or missing critical signs and making the wrong decision. An effective system of engagement leverages next-generation technology like artificial intelligence and cognitive

See Engagement on page 40

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Data Sharing Drives Positive Outcomes What Social Services Agencies Need in the Opioid Battle

By Denise Winkler

that America’s opioid epidemic has left many broken souls in its wake. With estimated opioid-related overdose deaths now totaling more than 42,000 per year and annual costs associated with the epidemic topping $500 billion, the devastation is widespread in com- munities across the nation, impacting family, friends, and neighbors—people we know. In almost every case, an addict and their family will be involved with a lab- yrinth of federal, state, and local public and private systems that all collect information and provide services to the individual, and likely, the family. In some way, each system works to help. Yet, when it comes to helping that addict get clean and avoid a continued downward spiral or even death—these systems have failed. Why? They aren’t sharing information! It is no secret

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could ensure the man’s doctor knows what has happened, that his rehabilita- tion program is notified of his relapse, and that his support group knows to reach out. Beyond helping the individual, collecting, analyzing, sharing, and predicting with data can help refine and leverage insights for the benefit of multiple clients. Among promising technology and delivery models is the use of program matching algorithms. For example, if a treatment program in Indiana has success with a special- ized group that matches medical and demographic data with a single parent in Kentucky, today’s operating approach would rarely connect the dots. But, if a caseworker has access to the information and tools to predict the fit, the two can be matched. Of course, the data have to prove the success of the program, they have to assess the parent as a good candidate, and that data and program accessibility have to be shared across state lines. Moreover, that successful program could be rep- licated in other places and, through sharing data and predictive analytics, addicts everywhere could be more effectively matched with services that improve outcomes and reduce the overall cost of treatment and support. Examples of Success We have examples of data sharing making a difference. In Prescription Drug Monitoring Programs (PDMP), 45 states have executed memoran- dums of understanding (MOUs) to enable secure sharing of prescription data across state lines. This provides pharmacists and physicians with a way to identify patients who cross state lines to shop for pharmacies and abuse prescription drugs. The program currently processes more than 17.8 million requests and 39 million responses per month. Looking for ways to build on that success, the Opioid Crisis Response Act of 2018 stream- lines federal rules around PDMPs and encourages more information sharing. This is a welcome advancement, ideally followed by funding. Several states are utilizing state- of-the-art architecture to pave the

Concerns about security and privacy are hard-wired into regulations that often date back to the 1980s. Program funding and operations have always been separated, generally with each program having its own culture, benefit request forms, and custom system. Simply put, we need new oper- ating models and tools that support collaboration that addresses today’s needs. Data sharing across public and private agencies is one of the critical new models. It can help the addict and his or her family have a better life by providing a more comprehensive and better tailored match of services across the multitude of systems. It can also help continuously improve practice and policies by identifying programs that work, so scarce resources may be assigned more effectively. Integrating Multiple Points of Contact A single, struggling addicted parent might receive food assistance to feed the children and day care services while at work or treatment, Medicaid to ensure their medical care, mental health services, or community support services that often involve at least one stay in a rehabilitation facility, and subsidized housing. Public assistance programs often come with a work requirement and workforce develop- ment program. If lucky, the other parent is paying child support through the state’s child support program, engaging yet another “system.” There is a good chance the children of addicted parents are in the child welfare system. Too often, the children of addicts become ensnared as mom or

dad loses the ability to parent safely. If the addiction has ever resulted in a public overdose or criminal activity, that brings involvement with the police and courts, and likely housing with a foster family or congregate care. If, by chance, the parent lives in an area bordering another state, it is even more complicated: the parent may be involved in all of these systems in more than one state. In almost every case, an addict and their family are involved in many dif- ferent government and community programs. Each program is trying to help the parent and family, yet their operation and technology systems operate in silos. Would the loss of life be so great if the multitude of case- workers had a comprehensive view of the client or if the addict did not have to make sense of the complex maze of government and community program silos? Clearly, public and private agencies must change the approach and industry needs to provide the tools needed to fight this epidemic. Barriers to Data Sharing Often the answer to sharing data in public and private agencies is an emphatic “no.” It used to be that tech- nology was a huge barrier: antiquated legacy systems couldn’t talk to each other. Capacity, bandwidth, quality, nonstandard systems—these are all old problems. This isn’t true with modern technology. What about security and privacy? While security should always be a concern, most modern systems are accompanied by sophisticated security that can protect data and privacy even through the process of sharing. When it comes to privacy, sharing data does not have to violate a client’s privacy. Opportunities exist that enable limited data sharing while maintaining the protection of private information. For example, if a father overdoses on a street corner, responding police officers might want to have access to information that he is a father, so they are able to notify the local public chil- dren’s services agency that his children need to be checked on. Having some data connection to this man, other than his criminal record, could be key to helping his children. Further steps

DeniseWinkler is the Industry Director, Public Sector, Enterprise Services Division, at Unisys.

See Opioids on page 38

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ReImagining Data at ACF Agency Prioritizes Data Sharing Actions in Response to State Feedback

By Christopher Traver and Christi Dant

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readily shared across organizational boundaries. HHS acknowledges this fundamental reality and has launched an effort called ReImagine HHS, focusing on aligning programs and “Putting People in the Center of HHS Programs.” As the name implies, this means taking a fresh look at how to best serve individ- uals and families and re-imagining our programs and service delivery models. Human services represent an inter-connected and inter-dependent community. But the silos we have created organizationally, financially, and technologically serve to create additional complexity that hampers our ability to coordinate and col- laborate. Too often, the people we serve struggle with divergent applica- tion processes, conflicting eligibility rules, redundant documentation requirements, incompatible payment

he Administration for Children and Families (ACF) in the federal Department of Health and Human Services

their individual needs. For example, caseworkers too often cannot see both parents’ and children’s informa- tion because it is stored in different systems, making it difficult to make data-informed decisions. While many of these factors may currently be outside our control, data sharing is within our reach now. Data sharing could ultimately allow people to navigate our programs seamlessly. Our partners in state, territorial, local, and tribal governments are addressing these issues often in creative ways, but with limited consistency across programs and unnecessary duplication of effort in doing so. ACF recently completed a series of regional listening sessions with states and territories to delve deeper into the feedback survey results obtained by the Office of Regional Operations. A major topic was data integration, with numerous recommen- dations for improving federal agency

(HHS) promotes the economic and social well-being of children, families, individuals, and communi- ties with leadership and resources for thoughtful and effective delivery of human services. ACF adminis- ters more than 60 programs with a budget of more than $53 billion, in partnership with states, tribes, ter- ritories, local governments, and other grantees. Increasing reliance on data and analytics are common themes among human services agencies and their partners. Data are a strategic asset that drive case management, program administration, analytics, and research. Our data are most useful for agencies, the families we serve, direct service providers, and decision-makers at all levels when they are appropriately and

mechanisms, and case decisions made without the full context of

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