Policy & Practice December 2018

The Magazine of the American Public Human Services Association December 2018

Co-Creating Generative Solutions for the Future Collective Discovery

TODAY’S EXPERTISE FORTOMORROW’S SOLUTIONS

contents www.aphsa.org

Vol. 76, No. 6 December 2018

features

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Igniting the Potential A Novel Approach to Workforce Well-Being and Health

Co-Creation Building a Collaborative Ecosystem to Better Serve Children and Families

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Investing in Performance Management In response to the August 2018 article ‘‘Gaming the System’’

Demonstrated Results Successful Collaborations That Improve Outcomes in Prisoner Reentry and Child Support

departments

3 President’s Memo Building Opportunity

24 Legal Notes

28 Policy POV

Children, Sports, and Sexual Predators: Ten Commandments for Parents to Follow

Child Welfare; Opioid Epidemic

Ecosystems That Advance Social and Economic Mobility

29 Locally Speaking

Lessons Learned Innovating Human Services

5 Editor’s Note

25 Sexting, Schools, and Law

One Dream, One Team

Enforcement: Where Does Child Protective Services Fit In?

36 Do’ers Profile

6 FromThe Field

Belit Burke, Self-Sufficiency Program Design Administrator, Oregon Department of Human Services

26 Technology Speaks

Collaborative Partnerships Raise Outcomes for Transition- Age Foster Youth

Mobile Technology in Human Services: Lessons From 5 Million Downloads

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December 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 December 2018

president‘s memo By Tracy Wareing Evans

Building Opportunity Ecosystems That Advance Social and Economic Mobility

N o one sector can advance social and economic mobility alone. While it is possible to increase efficiency and effectiveness through collaboration and services integration in a person- centric way, experiences across the country have taught us that significant gains in outcomes for families are not possible unless we move beyond merely addressing the symptoms to surfacing and resolving underlying root causes so that everyone who lives in a community can thrive in it. With a resolute focus on advancing social and economic mobility for people with low income in America’s cities, we have teamed up with the Kresge Foundation Human Services Team (Kresge) to invest in six initial Opportunity Ecosystem Sites across the country. We’ve been privileged to be partners with Kresge for several years now and have our sights on the same “north star” captured in our members’ vision at APHSA as “thriving communities built on human potential.” We share the belief that an opportunity ecosystem must be fueled by the people who live there, along with multiple networks contributing value through distinct vantage points, and collective impact efforts aimed at Effectiveness (OE) practice, we are helping distill the protective and risk factors at play in each selected ecosystem site and developing the community’s capacity for change in order to advance social and economic mobility, with an explicit emphasis on achieving greater racial equity. At the heart of this work is the Human Services Value Curve. If you’re not addressing systemic barriers. Through our Organizational

directly using the Value Curve yourself, you’ve likely read about it in previous issues of Policy & Practice and how it has been widely adopted across the country by more than 100 public and community based-organizations as a helpful lens for advancing our collective work. The Value Curve has been directly embedded in Kresge’s Ecosystem Investment Tool and is helping organiza- tions build system capacity at individual, unit, agency, and community levels to enable social and economic mobility.

n Dakota County, MN (St. Paul) — working with APHSA’s OE team for several years and employing the Value Curve as part of its overall strategic framework. Likely focus as an Opportunity Ecosystem site: county- wide network level in developing a shared strategic framework, factors, analytics, and improvement strategies with the APHSAOE team; mature efforts are in place for Value Curve stage progression, ecosystemdevel- opment, and racial equity toward improved social and economic mobility. Likely focus as anOpportunity Ecosystem site: in development. n Jefferson County, CO —one of the testing locations for the Kresge Ecosystem Investment Tool; mature with a focus on structural inequity and social and economic mobility. n Fairfax County, VA —also worked

Current Opportunity Ecosystem Sites (as of October 2018)

All identified sites are in early and varying stages of defining a scope of work as an Opportunity Ecosystem. Many had already been working with APHSA’s OE Team and demonstrated a readiness for accelerating or advancing ecosystems. They include:

See President’s Memo on page 30

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December 2018 Policy&Practice

Vol. 76, No. 6

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

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Policy&Practice December 2018

editor’s note By Jessica Garon

One Dream, One Team

I t’s hard to believe another year is nearly over. It’s even harder to believe that this year has somehow brought us an even more tech-enabled world—the spread of AI, 3-D metal printing, and genetic fortune-telling— an innovation that can provide babies with DNA “report cards” at birth— crazy! And in a more familiar fashion, technology via social media has been elevated to a new level, bringing forth a wider array of voices and opinions than ever before. Depending on where you sit, this could be considered both a good and a bad thing. As a self-proclaimed optimist, I would argue that a mul- titude of voices brings us different perspectives and ideas that can, ultimately, increase our knowledge. However, if we aren’t opening our ears, minds, and possibly most important, our hearts, all these varying voices and opinions can, regrettably, start to make us feel like we are all on different teams. And, with “bots” and “trolls” increasingly used to intentionally create such divides, the need to fully understand how to best leverage the impact of digital platforms has become even more pronounced. So where do we go from here? As health and human services professionals, it should be our goal to create unity—one cohesive team. Easier said than done, right? Maybe not. At our core, we all really want the same thing: to be healthy and live well no matter where we come from or what our life experiences have been. Life inevitably has its ups and downs (even for self-proclaimed optimists). But when times get tough and communities are challenged with problems that can negatively affect health and well-being, it’s you, our

To our many contributing writers, thank you for sharing. To our readers, thank you for opening your ears, minds, and hearts. And to everyone, thank you for being a part of the team!

nation’s health and human services professionals who step in, find solu- tions, and prevent future problems. That’s why this magazine—and our yearly issue highlighting partner- ships—is so important to us here at APHSA. Through your stories, experiences, research, and dedication, we have the ability to enrich the field and impact our communities. Together we can advance sound policy and practice and generate solutions that work for everyone.

Jessica Garon , Director of Communications at APHSA, can be reached at jgaron@aphsa.org.

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December 2018 Policy&Practice

from the field By Patrick Lawler

Collaborative Partnerships Raise Outcomes for Transition-Age Foster Youth

D avid lived every day expecting to be homeless. He was behind in his rent and knew it was just a matter of time before he came home to find his belongings set out on the sidewalk. Like many other transition-age former foster youth, the young man lacked the intensive support needed to overcome housing, transportation, employment, and health obstacles to become an independent adult. Just when things looked most dire, David was given the opportunity to participate in YVLifeSet, a program model offered in Philadelphia through a collaboration that brought together the Philadelphia Department of Human Services, Turning Points for Children, Youth Villages, and local philanthropists. Every year, around 20,000 young people turn 18 in foster care without being reunited with their biological parents. Some states have extended foster care to 21, offering varying levels of continued support. Researchers tell us that without help, transition-age foster youth are more likely to be homeless; less likely to find stable employment at livable wages; less likely to finish their education; and more likely to have mental health issues. The societal costs can be up to $300,000 per young person. In 1999, Youth Villages began developing the YVLifeSet model to help this most dis- advantaged group and has since served more than 13,000 young people. The model pairs young people with specialists who have small caseloads and meet with young people in the community weekly, helping them set and achieve their goals around housing, transportation, education,

David (at left), a YVLifeSet program participant.

employment, health, and relationships through experiential learning. We’ve tracked the results of the young adults who participated in the program, and in 2015, the model showed positive impacts in a large, randomized controlled trial. 1 The five-year trial, conducted by national social research firmMDRC, showed that the model decreased homeless- ness, increased economic well-being, increased mental health, and decreased domestic or partner violence. Reaching more transition-age young people with this evidence-informed model became a driving passion for our organization. We had expanded YVLifeSet to reach every transition-age

youth who needed intensive support in Tennessee through public–private partnerships—a 50–50 split in funding between the Tennessee Department of Children’s Services and Youth Villages’ private donors, primarily The Day Foundation. We used innovative funding solutions, sometimes lever- aging Medicaid dollars, to expand in Georgia, Massachusetts, Mississippi, North Carolina, Oklahoma, and Oregon. Our audacious goal was to make the program available to each of the young people who need it across the country. But, we soon realized that we would never be able to achieve our goal

See Foster Youth on page 30

Photograph courtesy of Youth Villages

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Policy&Practice December 2018

The Health and Human Services Workforce

A Novel Approach to Workforce Well-Being and Health PART 6

ur workforces are critical to accomplishing our goals and missions across our agencies. We have long been concerned about the health and well-being of our sta and the challenges are only intensifying. The time has come to address these concerns in an organized and systematic manner. Through our respective organizations, we have joined forces to advance a collective and national e ort to “ignite the potential” of our health

By Phil Basso, Jennifer Kerr, and Beth A. Cohen

and human services (H/HS) workforces across the country.

The American Public Human Services Association (APHSA), the University of California at Davis (UC Davis) Human Services Programs, the Connecticut Department of Children and Families, and Beth A. Cohen, a clinical and organizational psy- chologist at the Organizational Mind Group, have joined forces to address H/HS growing needs by “Igniting the Potential.” Early in 2017 we began collaborating and examining our individual work, which includes (1) an organizational development unit of a public agency, (2) a national asso- ciation providing technical support for workforce improvements, (3) a university developing local agency leaders, and (4) a social scientist and workforce stress expert. Fast forward to October 26, 2018 when APHSA met with agency and community-based organizational leadership to consider if our per- ceived urgency to move forward was warranted. The response was a resounding “yes.” what it was 20 years ago. We have steadily moved from downstream rescue and recovery or assessing program-specific benefits eligibility. Today we broker partnerships at the community level with primary goals of solving root problems in an effort to stave off unnecessary trauma to the child, family, and community. ously expanding and shifting due to increased complexities and needs. We must retain the good talent we already have. We must attract new talent that is up to the new national challenges and work demands. n Nationally, we are seeing social worker responsibilities continu- n The work of our agencies and communities is different from

n Research demonstrates that by attending to the well-being of our staff and helping them develop and use their own resilience and strengths, they are far more likely to work more effectively and with greater impact on behalf of the people and communities they serve. n Moreover, it is vital for us to address the needs of our current dedicated and committed staff. We understand that these challenges are big ones. The stressors, physical and emotional symptoms, burnout, and secondary trauma that many H/HS employees face on the job is comparable to our first responders— police and fire personnel—under emergency conditions. Workforce well-being in H/HS is crucial! Those agencies that have already changed their workforce practices and policies are not only experiencing the benefits, but seeing the return on their invest- ment. It is a win-win situation. We’ve decided to begin at the beginning, using what may be a novel, but sensible, starting point: n What is workforce well-being in observable, operational terms? n How can we impact workforce well-being in practical and affordable ways? n How does workforce well-being “pay off” in terms of individual, organiza- tional, and community impacts? In order to study what we want to measure and impact, we’re developing a model of factors and indicators that define workforce well-being and impacts on workforce health. We introduced a draft version to our October leadership group, collecting feedback to include these factors and indicators:

Igniting the Potential has been a recurring theme in Policy & Practice this year. In each article, we highlighted various efforts underway in the H/HS workforce both from the public and private sectors. Our final article for the year lays out what’s still to come from us in this ongoing initiative to support and advance a healthy workforce that can ignite and unlock the potential of all people and places. Igniting the Potential

Phil Basso is the Vice President of Strategic Mobilization at APHSA.

Jennifer Kerr is an Organizational

Beth A. Cohen is the Co-founder and Administrator of the Organizational Mind Group.

Effectiveness Consultant at APHSA.

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Policy&Practice December 2018

n Include, among others, related administrative functions such as human resources and risk manage- ment staff or providers. n Focus on our roles as system influ- encers. We need to be leaders who frame and position a career in human services as valuable and satisfying. n Focus on expanding the model beyond just our public agency workforces and include our com- munity-based service providers and constituent groups. n Acknowledge that hiring practices, onboarding, employee training and development, as well as promotions and supervisory development, are critical to building strong orga- nizational cultures and enhance workforce well-being. n Recognize the importance of peer- to-peer support for workforce well-being. n Include salary and benefits, including flextime and transporta- tion subsidies, as part of the model. n Invest in the tools and skillsets of our staff—a critical indicator, especially as we tend to disinvest as service demands and financial constraints stress the workforce. n Emphasize the power of staff reward and recognition—these jobs don’t literally have to be “thankless.” n Include facilities and general working conditions as key indicators in our model. n Help us learn and evolve in step with our corresponding models of effec- tive leadership. Completing the initial version of the model will enable us to move forward in a range of ways: n Launching a range of pilot studies, in selected counties as well as national tribal contexts, where agencies are using the model to drive continuous improvement plans and activities to improve workforce well-being and understand its impact on health. n Continuing to deepen the research basis for our model, drawing from a wide range of fields that have already studied workforce improve- ment efforts and their impact, utilizing first responder fields, private industry, and those public

agencies already addressing work- force health and well-being. n Developing a separate, but related, device to define and study the stress- related behavioral and psychological indicators that underly more general workforce health indicators. This model will also enable us to establish a broader theory of change and impact that links workforce well-being and health to that of the people and communities being served. Establishing this link will substantiate the return-on-investment that will break through previous patterns of disinvesting in the workforce where the investments are most important. Reinforcing these theories of change will ideally positively validate and working to assist them inan effort to impact their individual health andwell-being. Wemust continually let ourH/HS workforce know that we understand their challenges and are

impact our H/HS professionals who work tirelessly for their communities. We must continually let our H/HS workforce know that we understand their challenges and are working to assist them in an effort to impact their individual health and well-being. We must also inform them that we are working on ways to enhance their ability to support their community impacts—the reason why many of them entered the human-serving field in the first place. Our next steps include staging a program, hosted by UC Davis in 2019, bringing together staff from a range of local agencies from California, tribal representatives, and two additional states. The general program agenda will focus on these objectives: n Raise awareness about workforce well-being and health and its impact on community well-being and health. n Introduce organizational improve- ment tools and methods that pilot sites can utilize. n Discuss and critique the emerging model of factors and indicators to strengthen and build a common understanding. n Plan next steps for pilots and investi- gational studies. We would appreciate any ideas, examples, and forms of support that readers might suggest to us. Please send this information to Jennifer Kerr at jkerr@aphsa.org.

Photograph via Shutterstock

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or many state government agencies, prioritizing computer systems changes, investment, and improvement begin, and end, with responding to new Building a Collaborative Ecosystem to Better Serve Children and Families By Peter Kelly CO-CREATION F

federal regulations. In health and human services, when our systems help to protect the most vulnerable among us, dealing with scarce resources can make us feel like we’re letting citizens down. The Ohio Department of Job and Family Services (ODJFS) works diligently to collaborate with its local county partners to ensure that this is not the case. Through the collaborative co-creation effort of state and local agencies and technology partners, the state of Ohio gained significant improvements to its Comprehensive Child Welfare Information System (CCWIS) and identifying new opportunities to improve practice through technology, ultimately improving the services to children and families in need.

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be prepared to see and hear things differently than we ever have before.” The leaders in Ohio realized that this must be true and so they asked CGI to propose new ideas to support the research and design of their CCWIS. These ideas translated into modern approaches to design, such as inclusion of eth- nographic research techniques, user-centered design, and user-focused cognitive walk- throughs of proposed solutions. Ohio and CGI found that engaging child welfare workers both energized the project team and honored county workers. The approach to understanding county workers’ pain points, and solving problems based on their direct feedback, created an important mindset shift about everyone’s roles in the solution. Centering the process on the county workers’ experiences and challenges helped to prepare the project team, as well as Ohio state leadership, to see and hear things differently. Ohio would come to realize that the benefits of this new approach to research and design were far greater than they could ever have expected at the outset. Ethnographic research is a qualitative research method involving observation and interac- tion with people in their real-life environment. Ethnography is used by a wide range of social services workers in order to understand and solve their clients’ needs. In light of this, it made sense to use similar techniques to help social services workers and the project teammembers to better understand the challenges and improve the expe- rience within the child welfare system. One of the reasons CGI proposed ethnographic research is that it can help identify and analyze unexpected issues experienced by end users. CGI has seen that traditional software design methods, not based on observation and interac- tion, often miss challenges that arise outside of a tightly controlled development process. These misses can happen because the right questions are not asked, and users feel that they do not have the authority to mention problems outside the scope of the issue at hand. An ethnographic researcher’s in-situ presence allows direct observation of users’ challenges and the impact software has on their workflow. It often makes these adjacent issues readily apparent with con- tinued dialog with the end user. Within the modern practice of user-centered design, ethnographic research is used by designers to form a deeper understanding of the design problem. The goal of this research within a human services software project is to become fully immersed in the design problem, with all of the complexities that a user actually experi- ences within their environment, not simply complexities presented on-screen. It is hoped

In December 2017, child welfare workers in Ohio gained access to a new genogram technology tool—an auto- mated and visual representation of the family unit—that helped change the landscape of how caseworkers view the family dynamic. Generally drawn by hand each time a family encounters a new caseworker, a genogram is a picture of the often complicated relationships and descriptions of an extended family unit. Automating this process saves caseworkers valuable time, provides an updated record of the current state of family relationships, and ensures that anyone viewing the case has the same consistent understanding of the family relationships. CGI’s unique process of engaging staff to identify practice and staff needs and technology solutions surfaced this opportunity. Equally as novel as the tool itself, was the process of identifying the need for it. In 2015, Ohio and CGI began a new journey, endeavoring to find solu- tions together to improve child welfare intake functionality. Determined to co- create the best solutions possible using modern processes and technology, they discovered it takes more than meets the eye. It takes both intention- ality and discipline to create room for co-creation; the people involved need to be empowered. My own experience in California during this same period reinforced for me that for ideas to co- emerge, it is imperative that leaders make space for it to happen. In her “President’s Memo” last year, APHSA’s Tracy Wareing Evans said, “…to do so requires humility and a willingness to be vulnerable because we must both acknowledge what we do not know and

Peter Kelly is a Director of Consulting Services at CGI and the former Chief Deputy Director and Chief Information Officer for the California Health and Human Services Agency’s Office of Systems Integration.

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that this tool not only meets its users’ needs, but also improves data accuracy by displaying the data in a format that is easy to visually audit. The story of co-creation doesn’t end in Ohio with the genogram tech- nology. Constant with guidance from the Administration for Children and Families (ACF), emphasizing modern modular software design to promote efficiency and economy in federal investments in child welfare tech- nology, Ohio and CGI created software that is capable of being shared, lev- eraged, and reused as a separate component within and among states and tribes. CGI and Ohio worked together to research, design, prototype, develop, and refine the genogram products using both open source and com- mercially licensed software. Ohio is making the source code available in ACF’s software repository. Coupled with a nominal license fee for the core visualization library, any state could make use of this product. It is my sincere hope that this is the first of many efforts to share investment between states. In the source code repository are: n Design documents—descriptions of Ohio’s genogram screens n Code module and working example—code is packaged with a working example n Code notes—more technical explanation of the code and imple- mentation details Last year Wareing Evans also wrote, “When we set out to co-create solutions, we engage in ‘abundance leadership’ that focuses our collective efforts on what is possible and shifts us away from the victim or deficit-based mentality to which our field has too often gravitated.” These early co-created and shared CCWIS solutions coming from the state of Ohio and CGI teamwith support from ACF are just a few of the stories that will form the foundation of the next generation of child welfare systems. I am excited and energized by the level of support from the entire ecosystem and am hopeful that every co-created improvement will impact the lives of those who need our help most.

that by achieving this, a designer will be able to truly understand the user’s experience and pain points, and therefore design a far better solution. While ethnographic research is generally conducted with the goal of solving specific problems, getting “under the skin” of a design problem often uncovers many additional oppor- tunities for improvement. Ohio’s project team was given the room to investigate and follow up on adjacent challenges and opportunities that they discovered during their CCWIS design work. These adjacent problems likely would have gone undiscovered through traditional business analysis and joint application design. Ohio made sure that it captured and catalogued findings from its research that would prove useful in future modules, projects, and long- term planning. One of the adjacent problems that researchers observed in Ohio—what they are likely to observe in every new allegation of abuse or neglect—is the process of drawing the family relationships and important facts about the people involved on a piece of paper. This visu- alization often takes the form of a genogram, a graphic representation that displays detailed data on relationships among individuals. Beyond a traditional family tree, it analyzes hereditary patterns and psychological factors that punctuate relationships. In Ohio, a request to automate the dia- graming and storage of family relationships became an initiative priority for CGI. Previous ethnographic research and user-centered design successes for the child welfare intake module functionality were again leveraged to understand and improve the diagramming process for family relationships. State and local collaboration led to stronger partnerships and helped accelerate the creation of value. The concept of the genogram is attributed to Murray Bowen as part of his family systems model in the 1970s. Genograms were later developed and popularized in clinical settings by Monica McGoldrick and Randy Gerson. The model and notation are commonly taught to social workers and have been the topic of scholarly articles specific to child welfare over the last two decades. Genograms are now very much a core tool for many social workers but have not been a prominent feature of child welfare systems. The Ohio genogram solution utilizes the standard notation that many caseworkers learn in school. Indicators for each represented person include gender, age, person in focus, relation- ships, and characteristics (mental health, developmental, prenatal status, and medical condition, for example). Ohio’s research found

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December 2018 Policy&Practice

Investing in Performance Management In response to the August 2018 article ‘‘Gaming the System’’

By Reggie Bicha and Melissa Wavelet

he Colorado Department of Human Services’ C-Stat approach is one example of a public-sector agency that is investing in performance man- agement without “tumbling down the fear hole.” It sets targets, uses dashboards, and leverages data to measure what matters. What have we really achieved? Has seven years of measurement produced great insights and innovations? Has C-Stat increased engagement and overhauled perfor- mance? What good has it done for Colorado human services? T

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December 2018 Policy&Practice

asked my leadership team to work with staff to identify what matters most (to the vulnerable Coloradans we serve, to the legislature, to our funders, to our oversight agencies, and even to legal counsel for those suing the department). Once the definition of success is identified, we ask what is the most meaningful and reliable way to measure it with existing data. And then we discuss those measures, the targets, the strategies, barriers, and examine progress, or lack thereof. Each Wednesday, I lead a two-hour conversa- tion with one of my five programmatic office directors to learn about systems, processes, and the people involved in improving the measure’s performance. This steadfast commitment (approxi- mately 240 hours per year) safeguards our persistent focus on what matters most to those we serve. Over the years, we have learned that each measure and how to improve the performance it represents is unique. Not every performance problem is only a systems or process problem. There are human actors involved, and their behaviors (what they do) play a critical role in advancing performance. The practice of holding leadership account- able or answerable is necessary but insufficient to achieve continuous improvement. Accountability does not have to equal fear, and when paired with a commitment to learning, it can accelerate performance gains. What We Are Doing and Human services agencies across this country face some of society’s toughest problems. The most productive path to solution is by creating an environment that fosters learning and curiosity. Each C-Stat meeting is a dedicated space and time when we are repeat- edly learning how to learn together. The C-Stat leadership team includes the resource managers responsible for budget, human resources, facilities, information technology, quality assur- ance, audit, and medical care. We are collectively committed to bringing resources to solve these challenging problems. At times, that has meant that I pick up the phone to call one of What You Can Do 1. Commit to learning and continuous improvement.

my peers in another state agency to remove an obstacle. Questions are asked, assumptions are challenged, myths are busted, and much of the dialogue is based in data. Rarely are we discussing hypotheticals, anec- dotes, or random musings driven by self-interest or politics. C-Stat Leadership is also willing to adjust and replace measures and targets to reflect new insights. 2. Foster data access and literacy. Counties and contractors deliver two-thirds of CDHS services to Coloradans across the state. In 2015, we released the “County C-Stat Report,” which extracts data from nine administrative databases into one report. This monthly report shows the performance of the 20+ C-Stat measures that 64 Colorado counties are responsible for achieving. We also release a one-page “County C-Stat Dashboard” that simply conveys progress toward targets over the past 12 months using red and green colors. For small and medium counties, this was the first time they were able to see their own performance data organized in a way that was accessible and action- able. County directors and their county commissioners (elected officials) have regular access to their detailed data and to CDHS staff for training and technical assistance. These efforts put the data in the hands of those doing, supervising, and leading the work. 3. Invest in methods to mitigate against gaming. At the CDHS, there are multiple methods used to give us confidence that the data are as reliable, accurate, and timely as possible. One of these methods is the “Data Integrity” review to ensure that we are actually discussing what we think we are dis- cussing and that actual performance is as it appears on the slides. The C-Stat performance analysts conduct reviews of the data in order to ensure the integ- rity of what is being discussed in C-Stat meetings, and consequently, what is driving work and informing decisions. These reviews document the “life” of a piece of data. They examine the activity or behavior the data capture, how it is written or the data entered,

In 2011, John Hickenlooper became governor of Colorado. A businessman and former Denver city mayor, he was committed to measuring what mattered to Coloradans. He appointed me to his Cabinet to serve as the executive director of the Colorado Department of Human Services (CDHS). Before this role, I led the Wisconsin Department of Children and Families and I built KidStat to understand and improve performance of child support, child welfare, public assistance, and child care programs. At CDHS, a much larger, more diverse and complex state agency, I decided to pursue a similar PerformanceStat framework. The CDHS pursues learning, truth, insights, and ultimately, improvements. Without any framework, how would my executive team and I select which of the many problems to address? How to choose which problems across the 15 divisions that live within five pro- grammatic offices? Without targets or measures, how would we know whether we were making progress or when “done” is “done”? How would CDHS staff, and our county and con- tracted partners who want to “do good,” know whether the good they are doing is making any difference? To answer these questions over the last seven years, I have continuously

Reggie Bicha is the Executive Director of the Colorado Department of Human Services.

MelissaWavelet is the Director of the Office of Performance and Strategic Outcomes at the Colorado Department of Human Services.

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Policy&Practice December 2018

Early Childhood Councils to inten- sify their education and recruitment efforts to expand the number of pro- viders who are rated high-quality and willing to care for children receiving the subsidy. Performance has improved by 184 percent, going from 21 percent in December 2014 to 60 percent in June 2018. 3. The department oversees the oper- ation of 10 state-secure youth services facilities and ensures the safety and education of approximately 645 youth in commitment and 257 youth in deten- tion. For several years, the Division of Youth Services has been moving away from a punitive correctional culture toward a trauma-responsive envi- ronment. Included in these efforts is reducing the use of isolation or seclu- sion. Research does not show that the common practice of holding youth in isolation reduces problem behavior in juveniles. In fact, this is known to result in anxiety, depression, paranoia and psychosis, re-traumatization, exacerba- tion of mental illness, and increased risk of suicide and self-harm. Since implementing these changes, youth-on-staff assaults in facilities are down 22 percent from three years ago. The use of seclusion decreased 68 percent from October 2016 through July 2018. The average time spent in seclusion has averaged under an hour for nearly two years, far better than the national average. In July 2018, the average time spent in seclusion was 39 minutes. The national field average is 4.43 hours for detained youth and 10.95 hours for committed youth. There were no incidents of seclusion of more than four hours in 2017, and only three in 2018 through July. The results show the value of implementing new approaches to caring for youth and provide a model for other jurisdictions to follow. The thought of using measures, setting targets, and rigorously managing something as seemingly subjective as the delivery of human services, might initially spark appre- hension, but it shouldn't. With the right structure, unrelenting focus, and leadership willing to critically look at practice and results, a PerformanceStat leadership strategy has the potential to drive positive change, as opposed to “tumbling down the fear hole.”

the code that generates the report, and its illustration on a C-Stat slide.

Note from Ken Miller:

4. Recognize and celebrate good performance. When a program achieves its C-Stat target on any given measure for six con- secutive months, we publicly recognize themwith a C-Stat Award. We gave our first C-Stat Award in March 2013 and have given a total of 20 awards to state, county, and even contractor staff, in C-Stat meetings and in counties. When senior executives travel to counties and CDHS facilities to celebrate success in person, this recognition exhibits our commitment to performance improvement and C-Stat as a strategy. These awards tap into both intrinsic motivation (a personal sense of accom- plishment) and extrinsic motivation (framed certificate, cupcakes, modest gift certificate) for staff. Awards are both for individual employees as well as for those who worked as a group or unit, which makes more employees winners and can boost employee morale. C-Stat has allowed us to drive systemic change in many human services programs at once. While not all program improvements are a result of C-Stat, there are several examples of performance gains that we are confident would not have been possible without it. I describe three examples below. 1. The department’s Public Assistance and Food Assistance Programs serve Coloradans who are facing financial hardship. In partner- ship with counties, program staff process five public assistance applica- tion types as quickly and as accurately as possible. In 2004, the department was sued for its slow application pro- cessing. The case was settled in 2008, requiring the state to process applica- tions within the legal limits 95 percent of the time for at least 12 straight months. To achieve this, improvement strategies included business process re-engineering that engaged counties in developing streamlined applica- tion processes and creating simplified reporting tools. Performance has improved more than 40 percent during the last six years. Processing times for Food Assistance applications in partic- ular improved from 70 percent timely

in October 2007 to more than 95 percent timely each month throughout 2017, and to date in 2018. In fact, most applications can now be sub- mitted online and applicants receive a response within 48 hours. 2. The department’s Office of Early Childhood oversees the Colorado Child Care Assistance Program while advancing high-quality, licensed child care throughout the state. Research indicates that children who receive child care in high-quality child care facilities are more likely to be ready for kindergarten. In 2014–15 and 2015–16, we prioritized increasing the number the number of low-income Colorado children enrolled in high- quality child care facilities. Targets were set each year. Improvement strategies included working with the have provided a clear example of how measurement can be used for good and the real results that come from a learning culture.Thank you, Colorado, for your example and your thoughtful challenge. In my article published in the August issue of Policy and Practice , ‘‘Gaming the System,’’ I emphasized that the true purpose of measurement is for insight and innovation and that great leaders create the conditions for those to flourish.This article from my friends and partners in Colorado demonstrates both. In their earnest rebuttal of my cautionary points, they

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December 2018 Policy&Practice

Demonstrated RESULTS

Successful Collaborations That Improve Outcomes in Prisoner Reentry and Child Support

By Dan Bloom and Cindy Redcross

I

n recent years, two enforcement-oriented public systems—criminal justice and child support enforcement—have begun to focus more on improving the economic status of their “clients.” Historically, both systems focused narrowly on their core functions—identifying and punishing law breakers and collecting financial support for children who live apart from a parent. Over time, however, it has become apparent that a somewhat more expansive approach may be necessary in order to further broader goals, such as ensuring public safety and improving the well-being of children, in a cost-effective way. The resurgence of interest in prisoner reentry is a clear example of this trend. In the 1970s, a project called the National Supported Work Demonstration tested an employment program for former prisoners with limited success. Other pris- oner-reentry-focused projects of that era similarly failed to succeed, reinforcing the notion that when it comes to rehabilitating offenders “nothing works.” In the decades that followed, a tough-on-crime view took hold. Mandatory minimum sentences, three strikes laws, and a belief in punishment over rehabilitation of offenders led to the current state of mass incarceration. The result was a fivefold increase in the nation’s prison population and dangerously overcrowded prisons and jails. The realization that 95 percent of inmates are released from prison, and that two-thirds of them will be rearrested, resulted in a renewed interest in approaches to address the underlying problems that lead to criminal behavior in the first place. The search for better strategies to reduce persistently high rates of recidivism turned the focus toward providing employment and services to help inmates reenter the community and lead productive law-abiding lives.

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more intensive coordination and collaboration. A recent example of such col- laborative approaches is worth examining. At the federal level, the U.S. Department of Labor (DOL) and the U.S. Department of Health and Human Services (HHS) ran closely related demonstration projects. The DOL Enhanced Transitional Jobs Demonstration (ETJD) and the HHS Subsidized and Transitional Employment Demonstration (STED) coordinated their efforts to better understand the effects of transitional jobs programs for a range of disadvan- taged populations. Transitional jobs are temporary, subsidized jobs in the public or private sectors designed to provide hands-on work experience to “teach people to work by working.” MDRC led the evaluation in both projects, which helped facilitate a successful partnership between the two federal agencies. The agencies maximized learning and efficiency by sharing the evaluation costs, data collection instruments, and ongoing parallel efforts around such things as consistent outcomes, performance measurement, and evaluation reports. At the state and local levels, the tone of interagency collaboration was further cultivated through funding requirements, client referrals, and service delivery. Each of the seven sites in DOL’s ETJD project was required to demonstrate partnerships involving community-based programs and the appropriate enforcement agency (i.e., corrections and child support). The institutional arrangements varied from site to site. In some cases, the grantee was a nonprofit employ- ment services provider that reached out to state or local child support or justice agencies to ask for referrals. For example, in Fort Worth, TX, the ETJD grantee was a local workforce board and program representatives recruited participants at a new arrival orientation that was mandatory for individuals released from prison to parole supervision. In a few sites, the collaboration was particularly intensive. For example, in San Francisco, the ETJD program was structured as a collaboration between the Mayor’s Office of Workforce

and Economic Development, the county Department of Child Support Services (DCSS), and a local Goodwill Industries affiliate. DCSS staff recruited participants directly from the agency’s child support caseload, ran the study enrollment process, and managed the referral of parents to Goodwill. To further promote and facilitate participation in the tran- sitional jobs program, DCSS agreed to release driver’s licenses that had been suspended due to nonpayment of child support and temporarily lowered parents’ child support obligations conditioned upon attendance at the Goodwill program. This collaboration was noted by program participants in interviews as being particularly appealing. In Indianapolis, the grantee, Recycle Force, is a nonprofit social enterprise— a business with a social purpose—that recycles electronics. Through shared interests, a process developed col- laboratively; state and local probation and parole agencies ensured that the programs had access to the individuals they sought to serve—those assessed at medium or high risk of recidivism (earlier studies have shown that reentry programing can be particu- larly effective for this group). In turn, Recycle Force allowed parole officers the opportunity to host check-ins with their clients at the worksite, avoiding disrupting their attendance at work and enabling the officers to better manage their caseloads. In addition, the program hired a former employee of the county child support agency to help participants review and under- stand their child support orders and, when appropriate, fostered a connec- tion between the parent and the child support agency, which enabled clients to reduce child support debt to $1 per pay period and get their licenses reinstated. Overall, the results thus far from the two demonstration projects are more positive than previous efforts, depending upon how one views the goals of such interven- tions. For example, nearly all of the programs succeeded in meeting their enrollment targets and increasing short-term employment and earnings far above those of the control

Similarly, the idea of providing employment and other services to noncustodial parents (usually fathers) who are unable to meet their child support obligations due to unemploy- ment or low earnings was first tested in the 1990s, but the prevalence of such services appears to have expanded in recent years—even though state expenditures on employment services are generally not eligible for federal matching funds under the child support program. Introducing services into an enforce- ment system typically requires some level of interagency collaboration because agencies like corrections, parole, and child support usually have neither experience with nor dedicated funding for such services. Perhaps the simplest type of collaboration is a referral relationship in which parole officers or child support workers, for example, refer their clients to particular nonprofit programs or public systems that offer employment services. If the service programs have funding from other sources, then no money changes hands. Such referral relationships are far from simple in practice, but some agencies have attempted to go further to design and implement models that require much

Dan Bloom is Vice President and Director of Youth Development, Criminal Justice, and Employment at MDRC.

Cindy Redcross is the Deputy Director of Youth Development, Criminal Justice, and Employment at MDRC.

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