Policy & Practice October 2017

The Magazine of the American Public Human Services Association October 2017

THE TECH ISSUE Maximizing Modern Tools and Platforms

TODAY’S EXPERTISE FORTOMORROW’S SOLUTIONS

contents www.aphsa.org

Vol. 75, No. 5 October 2017

features

departments

6

10

3 President’s Memo

50 Years—A Special Celebration

5 Locally Speaking

Using Data to Improve Child Welfare Decision-Making

26 Technology Speaks

Preventing Identity Theft and Strengthening the American Health Care System

27 Accelerating the Modernization of SNAP— at the Speed of Digital 28 Disrupting Disruptions: Using Technology to Improve Child Welfare Outcomes

Thinking Mobile First Health and Human Services in the Digital Age

What’s Next in the Caseworker’s Digital Toolkit? Leveraging Advanced Technologies in Child Welfare

29 Picking Your Path to CCWIS Compliance

30 Legal Notes

Legal Benefits of Mobile Digital Documentation for Human Services Agencies

14

18

31 For Mandated Reporters, Concern Is Not the Same as Suspicion

32 Staff Spotlight

Renee Kennedy, Administrative Operations Assistant, Membership and Events

40 Our Do’ers Profile

Kristen Duus, Oregon’s Chief Information Officer and ISM Chair

Next-Gen Child Welfare Tech Using Cognitive Search to Fight the Opioid Epidemic

Writing a Script for Success Accelerating Outcomes with Advanced Analytics in Los Angeles County

22

Unleashing Agile Obstacles and Opportunities in Human Services

Cover Illustration by Chris Campbell

1

October 2017 Policy&Practice

APHSA Executive Governing Board

President and CEO Tracy Wareing Evans, President and CEO, American Public Human Services Association, Washington, DC 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 Paul, MN Treasurer Reiko Osaki, President and Founder, Ikaso Consulting, Burlingame, CA Leadership Council Chair Roderick Bremby, Commissioner, Connecticut Department of Social Services, Hartford, CT Affiliate Chair Paul Fleissner, Director, Olmsted County Community Services, Rochester, MN Elected Director Anne Mosle, Vice President, The Aspen Institute and Executive Director, Ascend at the Aspen Institute, Washington, DC Elected Director Mimi Corcoran, Vice President, Talent Development, New Visions for Public Schools, Harrison, NY Elected Director Susan Dreyfus, President and CEO, Alliance for Strong Families and Communities, Milwaukee, WI

Vision: Better, Healthier Lives for Children, Adults, Families, and Communities Mission: APHSA pursues excellence in health and human services by supporting state and local agencies, informing policymakers, and working with our partners to drive innovative, integrated, and efficient solutions in policy and practice.

2

Policy&Practice   October 2017

president‘s memo By Tracy Wareing Evans

50 Years—A Special Celebration

T his year we are proud to celebrate the 50th anniversary of two of our affinity groups—IT Solutions Management for Human Services (ISM) and the American Association of Health and Human Services Attorneys (AAHHSA). Over the years, these two important and influential groups

to a fully integrated H/HS system that not only connects data across depart- ments but also across sister agencies and community partners. What’s to come in the next 50 years is anyone’s guess. Will 3-D printing enable more community-based solu- tions? Will home visits with children or

first ISM conference. At the time, the hottest things in IT included the first- ever demonstration of the computer mouse, the launch of a groundbreaking operating system called UNIX, the founding of Intel, and the first demon- stration of word processing. It is safe to say that the 1968 ISM attendees

older adults, especially those who live in remote areas, regularly occur through holograms or other virtual means? How will machine learning redirect when and how services are delivered? And what will it mean for the workforce? One thing we do know for certain: As IT continues to play a crucial role in the advancement of the H/HS system, APHSA, through the annual ISM conference and our

have contributed significantly to the advancement of health and human services delivery and our shared goal of building thriving communities in which all children and families can reach their full potential. It is fitting that ISM and AAHHSA share a common anniversary as both groups touch nearly every aspect of

growing peer community of IT leaders, will continue to highlight and promote the technological advancements and related business models that support a modern H/HS system. AAHHSA While the role of the health and human services attorney has not changed dramatically over the past 50 years, these professionals remain lynchpins of a strong and thriving H/HS system. Like ISM, many topics covered at the first AAHHSA (at the time known as the American Association of Public Welfare Attorneys, AAPWA) conference were

health and human services. Over the past 50 years, technology has provided time-saving tools for the workforce and modern customer interfaces, enabling greatly improved service delivery and the ability to measure outcomes. And, it would be nearly impossible to stay abreast of H/HS requirements without the devoted legal teams that interpret and implement the ever-changing local, state, and federal rules and regulations. As we celebrate this important mile- stone for ISM and AAHHSA, I thought it fitting to provide some historical context and a glimpse of what the future holds. ISM In 1968, a small group of IT profes- sionals gathered in Chicago for the

would not recognize many of the IT solutions of today (mobile, the Cloud), nor the language that accompanies it (such as agile, waterfall). At the same time, they might be surprised to see that several of the challenges facing today’s H/HS program administrators are similar to issues they faced back in Chicago, including the age-old chal- lenges of how to train the workforce or secure funding to upgrade systems. Over the ensuing 50 years, IT’s role in supporting efficient and effective service delivery has become increas- ingly important as H/HS agencies shifted from a focus on how to deliver a single program to an enterprise- wide approach for an entire agency connecting multiple systems through common platforms, and, most recently,

See President’s Memo on page 36

Illustration via Sutterstock

3

October 2017 Policy&Practice

Vol. 75, No. 5

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 © 2017. 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 Guy DeSilva Terri Jones Subscriptions Darnell Pinson

President & CEO Tracy Wareing Evans

Editor Jessica Garon

Communications Consultant Amy Plotnick

Design & Production Chris Campbell

2017 Advertising Calendar

Issue

Ad Deadline October 27

Issue Theme

December

Partnering for Impact

Size and Placement Two-page center spread: Back Cover (Cover 4): Inside Front Cover (Cover 2): Inside Back Cover (Cover 3):

Rate

10% Discount for 6 Consecutive Issues

$8,000 $5,000 $4,000 $4,500 $2,500 $1,000

$7,200/issue $4,500/issue $3,600/issue $4,050/issue $2,250/issue $900/issue $675/issue

Full page: Half page:

Quarter page:

$700

4

Policy&Practice October 2017

locally speaking

By Erin Dalton

Using Data to Improve ChildWelfare Decision-Making

I n August 2016, the Allegheny County Department of Human Services (DHS) implemented the Allegheny Family Screening Tool (AFST), a pre- dictive risk modeling tool designed to improve child welfare call screening decisions. The AFST was the result of a two-year process of exploration and community engagement about how existing data could be used to improve decision-making at the time of a child welfare referral. When receiving a child abuse or neglect referral, call screeners (who receive approximately 15,000 calls each year) must make important deci- sions about whether to “screen in” and investigate the case or “screen out” and offer community services. These decisions often must be made with minimal information. An analysis of prior cases found that 27 percent of our highest risk cases had been screened out, while 48 percent of the lowest risk cases had been screened in and investigated. The case was clear—a predictive risk model could provide additional infor- mation to help workers make these important decisions. In 2014, after a competitive process, we selected a team from Auckland University of Technology, the University of Southern California, and the University of California–Irvine to develop a tool to leverage the more than one billion records contained in DHS’s Data Warehouse. The result of this partnership is the AFST, an analytics tool that synthesizes data to predict the likelihood of future refer- rals and/or out-of-home placements over the next two years. The AFST is designed to inte- grate and analyze hundreds of data elements—such as previous child

welfare involvement or past criminal justice involvement—on each person added to a referral to generate an overall Family Screening Score that falls between 1 and 20. The higher the score, the greater the chance for a future event (e.g., re-referral, place- ment), according to the model. The score provides additional information to assist call screeners with deter- mining whether or not the call should be screened in. The AFST does not replace clinical judgment, but provides additional support during the decision- making process. “We recognized that such a tool could cause concern in the commu- nity, and we wanted to address that at

the beginning,” said Katie Arvay, an analyst in DHS’s Office of Children, Youth and Families. “We held several community and stakeholder meetings to gather input during the exploration and development process. All feedback and suggestions were considered, and this input helped us to develop the final product.” In addition to gathering community feedback, the AFST underwent an ethical review. In summarizing their results, the experts concluded that “… the implementation of the AFST is ethi- cally appropriate. Indeed, we believe that there are significant ethical issues

See Allegheny County on page 35

Illustration by Chris Campbell

5

October 2017 Policy&Practice

t’s been seven years since Apple told us “there’s an app for that,” and the famous phrase could not be truer today. The explosion of mobile devices, social media, and digital platforms has fundamentally changed the way that consumers interact with businesses and each other. These same con- sumers rightly expect to be able to engage with their government agencies how, where, and when they choose. GENERATIONS AND TECHNOLOGY What does this mean for health and human services agencies? For those of us still trying to catch up with the definitions of Generation X, Generation Y (also known as Millennials or Echo Boomers), and Generation Z (also known as Centennials, iGeneration, Post-Millennials, Plurals, or Homeland Generation), there are a lot of implications. Familiarity and comfort with the use of technology, including mobile and social media, increases signifi- cantly from Generations X to Y to Z. These generations also show different tendencies in terms of how they view work–life balance, politics, and other social markers. The reliance on technology alone is quite significant. One could simply view Generation X as the generation that first began adapting to technology, Generation Y as the generation that began relying on technology, and Generation Z as the gen- eration that grew up with and expects technology. This shift from adoption to reliance to expectation has implications for our future workforce as well as for the clients we serve. MOBILE FIRST Thinking Health and Human Services in the Digital Age By Michael Bostian and Doug Howard

I

7

October 2017   Policy&Practice

DOING MORE WITH LESS The use of digital technology is essential to meeting the changing expectations and culture of our society as well as driving the behav- iors and responsibilities we expect. It’s also becoming an imperative in terms of driving efficiencies and offering better, alternative channels of interac- tions. A Brookings report from 2012 indicated that government (federal, state, and local) employment had decreased, by more than 580,000 jobs since the close of the prior recession, to the lowest level in more than 30 years. 1 Even more striking, from the same Brookings report, “To examine the direct consequences of lower government employment, consider the case in which employment had hewed to its historical level. Between 2001 and 2007, the average ratio of government employment to popula- tion was 9.7 percent. Had that share remained steady, government employ- ment would have been more than 23.6 million in June 2012 as compared to its actual level of 21.9 million. That is, employment would be 1.7 million jobs higher today if the share had remained constant.” We know that public demand for services did not decline and has, in many cases, increased. We are often

truly asked to do more with less. That is a reasonable, albeit challenging, public expectation. Getting more positions (i.e., full-time employees, or FTEs) is a rarity; demands must be met by increased technology use, redeployment of staff (which can also be supported via technology), and new partnerships. If you haven’t already, do an exercise to determine the amount of time your staff spends on the phone across the entire workforce. Think about how many FTEs are handling mail (inbound and outbound) and the costs associated with mailings. Think about all of the verifications and legal notices across programs and the questions and work they generate. Think about the time lag between field work and inputting information into a central system. One core question often asked by outsiders is whether the population served in health and human services is ready for the digital age. The answer is that it’s no different than any other population. A majority will be able to utilize it, many will embrace it, and you will need contingencies for others. According to the Pew Research Center, 64 percent of adults making less than $30,000 per year own a smartphone. 2 That number has grown significantly, just in the last couple of years, as smartphone penetration continues to outpace desktop and laptop use. Additionally, comScore research shows that 71 percent of online minutes in the United States

are spent on mobile devices. 3 There is no question that citizens have adopted mobile as their primary method of accessing the Internet, and their expec- tations have subsequently evolved. IMPROVING CUSTOMER SERVICE AND OPERATIONAL EFFICIENCY With technology continuing to evolve at a rapid pace, there are a number of proven avenues that agencies can pursue, with goals of improving customer service and operational efficiency. The key is to identify specific consumer behaviors and needs, and then translate them for government service. Whether it’s providing valuable information or delivering self-service tools directly to the citizens they serve, today’s digital capabilities provide a multitude of ways for health and human services agencies to interact and engage with their core constituents. In Louisiana, MAXIMUS Digital Solutions has partnered with the Louisiana Department of Health to help Medicaid enrollees find a health plan and provider via their smart- phone. The Healthy Louisiana mobile app was designed with three key themes in mind—simplicity, speed, and security. By strictly adhering to those principles, the app allows Medicaid enrollees to choose their health plans in a matter of minutes, and on their own time—from their own devices.

Michael Bostian is the Senior Director of Mobile Products with MAXIMUS Digital Solutions.

Doug Howard is a Senior Vice President with MAXIMUS Human Services North America.

8

Policy&Practice October 2017

• Development, testing, rollout, and maintenance plans and costs • Use of the data o Informational use o Validation and verification o Interface with existing systems o Analytics o Timeliness for information sharing and decision-making • Security, authentication, and identity management • Change management o Staff o Program participants o Service delivery and community partners • Legal authority o Digital signatures o Regulatory and statutory base, such as the authority to electronically share information and provide notices • Return on investment to government o Savings such as printing, postage, and mail handling o Impact on call volumes o Ability to redeploy staff time • Program impacts o Ability to increase reporting, communication, and timeliness of notices o Ability to track and verify actions o Ability to validate information directly with the program participant • Intended purpose o Informational use only o Promoting behavioral change, such as targeted public health programs o Driving personal responsibility, such as responding to program expectations consistent with incentives and sanctions o Recruitment or engagement o Fulfilling a legal notification in a meaningful manner • Public access o Hours and convenience o Ease of navigation o Back-end support, including the ability to talk to a live person • Contingencies for those who aren’t able to access digital services, or prefer not to o Use of responsive design to enable access via desktop, mobile, kiosk, public computer, etc. o Traditional paper, phone, and walk-in access Considerations Checklist Many states have already taken significant steps toward digital. As with any change, there are several things to consider as you immerse more fully into the digital world.

be used to deposit a paper check, it can also be used to submit other kinds of paper documents. In Wyoming and New Mexico, MAXIMUS Digital Solutions launched an app that helps employers meet their federal and state reporting requirements. When a new employee is hired, the employer must submit information about that individual to certain databases. With the MAXIMUS New Hire Reporting app, an employer can take a picture of the required information and upload it. The process takes only seconds per new hire, rather than the minutes required to key in data. For the small business owners who already manage their business from a smart- phone, this type of innovation has significant value. Apps allow us to get things done quickly and efficiently, and there are vast opportunities yet to be identified and tackled. Today’s smartphones have immense power and capabilities, including GPS, augmented and virtual reality, health and fitness sensors, and the aforementioned camera. The challenge is in how to best apply these tools to solve business and process challenges faced by health and human services agencies. Another “mobile-friendly” option that states are rapidly adopting is responsive design. In its simplest form, a responsive website is one that automatically adjusts to fit the screen on which it is being viewed. When a user visits from a desktop or laptop, they will get a larger, graphic-rich experience. When that same user visits from their smartphone, the page will be slimmed down so that it can be viewed without pinching and zooming. Responsive design is an important development because it bridges a gap between desktop and mobile. For informational sites, a responsive site can be quickly accessed, read, and the user can leave with the information BRIDGING THE GAP BETWEEN DESKTOP AND MOBILE WITH RESPONSIVE DESIGN

GAINING INSPIRATION FROM THE PRIVATE SECTOR Health and human services orga- nizations should also look to the business-to-consumer world for inspi- ration and opportunity. When banks started offering mobile check deposit in their mobile apps, it opened up a whole new way of thinking about the smartphone camera. If the camera can

The feedback from Healthy Louisiana app users has validated that mobile is the channel of choice for Medicaid recipients, and other state health agencies have taken notice. Recent interest in the Healthy Louisiana app has been high, as other states look to expand their digital health offerings and provide the core offerings necessary to best serve their Medicaid populations.

See Mobile on page 35

9

October 2017   Policy&Practice

WHAT’S NEXT IN Digital

THE CASEWORKER’S Toolkit?

hild welfare caseworkers are inundated with high caseloads, many docu- mentation requirements, and a lack of insightful Leveraging Advanced Technologies in Child Welfare C

By Shelley Mills-Brinkley, Roberto Cota, Kathryn Miller, and Jamia McDonald

and emotional well-being, and that of the family unit as a whole. Imagine smart technologies taking over some of these routine, high- volume, and repetitive tasks. Imagine your child welfare information system providing intuitive decision support suggestions. It may seem far- fetched, but not very long ago using mobile technology to do casework in the field seemed futuristic. Today smartphones, laptops, and tablets are a necessity and a critical part of a caseworker’s equipment. Another example is the use of predictive ana- lytics. What was once theoretical talk about the power of machine learning to support predictive analytics to help establish a course of action that abates risk and improves outcomes is no longer theoretical. 1 It is here and

support from antiquated systems. This leaves them with less time to interact with families and make any necessary fast-paced decisions. Time- consuming processes are often put in place to respond to adverse situations. Even when all steps are perfectly followed, something may inevitably happen to a child, which results in yet another protocol being created. These protocols tend to be manual at first and have a pile-on effect. Manual processes take precious time away from what is needed most in good casework practice—time to focus on the child’s physical, psychological,

to determine if the home qualitatively meets the expectations of a foster home, but it also provides an auto- mated check of the lead inspection information without requiring a data exchange to be established with that system. This is one example. The chal- lenge is to continuously look for those low-risk, high-volume, repetitive tasks that traditionally take time away from the caseworker and support staff and give those tasks to the “bot.” Dark Data Analytics: Finding Unknown Connections Using Under-Exploited Data As a new, relatively untapped source of understanding, “Dark Data Analytics” is the ability to draw insights from unstructured data, or data that have typically never been used for analytics. These data can be found in narratives, documents, email, and even video and pictures. The data can reveal important interrelation- ships—especially across health and human services programs and data repositories that were previously dif- ficult or impossible to determine. With the explosive growth of technologies such as natural language processing and semantic analysis, deriving insights and drawing conclusions from these data has never been more real— or more important. Caseworkers make hundreds of deter- minations every day based on years of experience. This experience brings lessons learned to achieve a higher rate of positive outcomes to meet the needs of the children served. In many states, decades’ worth of data sit buried in narratives throughout systems. This is dark data—hidden and unmined by current analytic tools—data that detail caseworkers’ experience with families, services, and outcomes. How can dark data knowledge and experience be systematically leveraged to provide insights to caseworkers of all levels of expertise to create positive child outcomes more quickly? There are many examples of dark data analytics in use today in the com- mercial sector. For example, retailers use dark data analytics to drive highly personalized shopping experiences.

in use. We are once again at an inflec- tion point to test and understand how other advances in technology can be adapted and applied to improve social casework. Along with the induction of mobile in day-to-day casework, the possibilities that technology advance- ments bring to the modern casework practice are in sight. The only question is how quickly are we willing to move? The Comprehensive Child Welfare Information System (CCWIS) federal regulations are a catalyst for infusing advanced technologies into child welfare casework. The CCWIS empowers child welfare agencies to break free from their current and dated monolithic systems—designed primarily as data collection and reporting tools—to modern, modular, and nimble solutions that support contemporary casework practices. What role can modern technologies, like robotic process automation, dark data analytics, anomaly detection, micro-services and blockchain play in technology support for casework? Let’s examine some of the many possibilities. Can a “Bot” Do It? Robotic process automation (RPA) is a technology with the singular purpose of automating repeatable tasks. Unlike a typical automated system function, RPA is software that operates at the user interface level and mimics the activities of a caseworker using one or multiple applications. In the health insurance industry for example, a medical insurer used these auto- mated users (“bots”) to process claim adjustments, with a 44 percent cost savings compared to manual entry and administration. 2 Using “bots” nests with the CCWIS requirement to be efficient, eco- nomical, and effective by allowing administrative tasks to be automated, saving caseworkers and supporting staff precious time. For example, the foster family application process can take hours of worker time in repeti- tive tasks. Imagine having a bot take a scanned foster family application, enter it into the appropriate system, and even do a check in a separate system to determine if a mandatory lead inspection was completed in the home. This not only allows more time

Shelley Mills- Brinkley, MSW, is a Managing Director with Deloitte Consulting LLP’s Public Sector practice with a focus on ChildWelfare.

Roberto Cota is a Specialist Leader with Deloitte Consulting LLP’s Public Sector practice.

Jamia McDonald, JD, is a Manager at Deloitte Consulting LLP’s Public Sector with a focus on strategy and operations and a former state Child Welfare director. Kathryn Miller is a Manager with Deloitte Consulting LLP’s Public Sector practice with a focus on delivering child welfare technology solutions.

See Digital Toolkit on page 32

12

Policy&Practice October 2017

Next-Gen Child Welfare Tech: Using Cognitive Search to Fight the Opioid Epidemic

By Richard Diers

T

What if child welfare organizations could use technology to surface trend data that could help them understand and address the opioid epidemic, and even prevent a future crisis? The Impact of Opioids on Child Welfare First, how is the opioid epidemic impacting child welfare and foster care? Foster-care experts say that as the drug epidemic has intensified during the past two years, another rush of children has entered the system. State budgets are stretched, social workers are overloaded, and not enough families are willing to provide children with temporary homes. The opioid crisis is straining the nation’s foster-care systems. President Donald Trump declared the opioid crisis a national emergency in August, following six states—Alaska, Arizona, Florida, Maryland, Massachusetts, and Virginia— that had already declared a state of emergency.

here are thousands of devastating stories and anec- dotal reports across the country linking the opioid epidemic to a crisis in child welfare and foster care. And yet, we do not have enough data to make a direct link. We can track if parental drug abuse is involved when a child enters the system, but federal child welfare data do not track what type of drug was being abused. The tracked data are typically two years old by the time they are collected, analyzed, and reported out, which limits organizations’ insight into what is happening right now and their ability to affect change. According to the Pew Charitable Trusts, “National data doesn’t identify how many children are removed from their homes because of a parent’s substance abuse. And there’s no one standard for how states report substance abuse and child neglect. But many state officials say the surge in foster care cases is a direct result of the drug epidemic.”

We can all agree; the issues are vast: � Not enough resources. Resources are limited in every facet. There are not enough caseworkers to handle the volume and increasing complexity of cases, not enough foster homes to take in displaced children, and not enough funding for board and care costs or necessities like car seats when foster homes are available. � Lacking support for parents. The recovery period for opioid addiction is longer and the chance of relapse is higher than other drug addic- tions. Often treatment is not readily available, which means termination of parental rights is more likely. Parents often face legal repercus- sions or incarceration that can also cause separation. � Long-term effects on children. Children of parents with substance use issues are more likely than their peers to experience abuse and neglect, to be referred to the child welfare system, and to be placed in foster care (overall and for longer periods of time), according to non- profit research organization Child Trends. When exposed to opioids during pregnancy, children have more complex medical needs. They may develop behavioral and attention problems requiring specially licenses and trained foster homes, which are even fewer in supply and costlier. � Overwhelmed caseworkers. Opioids can devastate a family. Front-line caseworkers are experiencing sec- ondary trauma, which leads to higher turnover. This increases recruitment and training costs, and overtime costs for remaining workers taking on additional cases. It also taxes the

terms can be mentioned outright in medical reports from hospitals, or indi- rectly in caseworker narratives or case notes about interactions with families. There are multiple references and multiple sources of data that all point to one topic; however, even the best case management and document manage- ment systems do not offer a way to bring data collected across the organization into usable insights. Now, imagine if your organization could surface data that show any con- nection to opioids using cognitive search and knowledge discovery—terms recently explained by Forrester as “The new generation of enterprise search solutions that employ AI technologies such as natural language processing and machine learning to ingest, understand, organize, and query digital content from multiple data sources.” 1 In short, cognitive search combines several new technologies—things like indexing, natural language processing, and machine learning—to understand, organize, and establish links between information from various internal and external sources to help users.

already limited supply of caseworkers who have to pick up the pieces, and threatens continuity of care for the children (See graphic above). Where Does Technology Come In? There is no shortage of tools available for a child welfare organiza- tion: case management, document management, business intelligence (reporting), iPads, and other mobility tools… the list can go on. Simply throwing technology at the issue is not enough. Technology tools have to be applied in a way that empowers caseworkers and organiza- tions to collect and surface the right data at the right time. When done right, technology can make a huge dif- ference to organizations addressing the issue in the community at large or to an individual caseworker working to improve the life of one child. Cognitive search is emerging in the market. Could it be an answer? Identify Community Trends A key problem is the category of opioid drugs goes by many names, and there are drugs used for treatment asso- ciated with abuse. Opioids and related

Richard Diers is the Executive Vice President and Chief Technology Officer at Northwoods.

See Opioids on page 36

16

Policy&Practice October 2017

WRITING A SCRIPT FOR SUCCESS: Accelerating Outcomes with Advanced Analytics in Los Angeles County

e all want safe neighborhoods, good schools, and clean environments. Citizens are constantly evaluating how well their governments deliver these public services. In order to understand and meet demands, government organizations collect a vast array of information on what they do and how it works. But merely reporting these results to elected officials and the public is not the sole intention. Effective governments can use these data to make better decisions and develop strategies that will improve performance. All it takes is the right mindset, purpose, and strategy. By Michael J. Sylvester II and Joseph Fiorentino W

Illustration by Chris Campbell

The Value of Performance- Based Analytics Public agencies are no strangers to the value of data. But the digital age has upped the ante. Analytics are redefining performance norms, and government is taking notice. Social services agencies can now glean new insights from data and use them to fundamentally transform the relation- ship between workers and their tasks, between workers and their clients, and between clients and the services they receive. Law enforcement agencies, for example, have already effectively implemented performance-based analytics models in their own opera- tions. They use comparative statistics to identify spikes in crimes, allowing ranking officers to address those spikes through targeted enforcement. These statistics measure the effective- ness of efforts to reduce crime and pinpoint areas that need improvement when crime increases. In using this analytics approach, for example, the New York City Police Department, through its COMPSTAT initiative, suc- cessfully drove down crime to levels not seen in decades. There is no doubt these results are impressive. But can its success extend to social services? Case in Point: Los Angeles County With a workforce of more than 14,000 employees, the County of Los Angeles Department of Public Social Services (DPSS) serves an ethnically and culturally diverse population of more than ten million people, or three out of every ten Los Angeles County residents. It is one of the first organi- zations to use a performance-based analytics model in a social services environment. Known as DPSSTATS, the system uses modern analytics technology and processes to help the county manage the increasing complexity of public assistance and employment programs more efficiently. The DPSS is responsible for admin- istering public aid programs that help alleviate hardship, promote health and personal responsibility, and advance the economic independence

of county residents. And while it has invested in a number of initiatives over the last decade to improve its performance measurement tech- niques, collaboration and consistency in monitoring results across depart- ments remained a challenge. The department’s existing tech- nology lacked standard operating processes, relying instead on a manual process for managing data. Not only was it prone to human error, but it also presented inconsistent metric definitions. This cumbersome process resulted in three-month-old reports with little to no insights into root cause issues, limiting the department’s ability to make effective and informed decisions in a timely manner. For those depending on welfare to support their livelihoods, any delays or uncertainty The department recognized that it needed to improve the timeliness and accuracy of its determinations. But ensuring efficient and effective welfare administration depended on accurate and comprehensive data and the ability to capture detailed insights. So it partnered with Accenture to apply a performance-based analytics model and to develop a customized eligibility system that integrates the functionalities of multiple disparate legacy systems into a single data repository. The Business Intelligence Platform automatically consumes all shared welfare data, determines benefit eligibility, and delivers timely and actionable information about the state of DPSS welfare programs for executive leadership and key managers across the county to review. With a new data mindset, the depart- ment used the Business Intelligence Platform to move beyond compliance to uncover analytics insights faster. This approach improves decision- making processes through prioritized actions, aligns valuable resources to actual results, and measures perfor- mance for speedier outcomes. It also reduces the implementation costs of proved onerous. The Power of Data-Driven Insights

Michael J. Sylvester II is the Assistant Director, Bureau of Contract and

Joseph Fiorentino is the Managing Director, Health and Human Services, at Accenture. Technical Services, at the County of Los Angeles Department of Public Social Services.

See Los Angeles County on page 37

Policy&Practice October 2017 20

October 2017   Policy&Practice 21

hen it comes to information technology IT human services agencies are at an inflection point There is growing recog nition that systems built using “big bang” waterfall approaches U N L E A S H I N G AGILE W Obstacles and Opportunities in Human Services BY RAFAEL LÓPEZ AND DOUG ROBINSON

have failed to deliver intended benefits or support intended outcomes Many have missed their schedule and budget targets as well All the while agencies are working to reshape their services to deliver “whole person” support to be er serve children and families To sum it up many are asking “Are we just doing it wrong? And how might we do be er?” For a growing number of states including California Connecticut and Tennessee the answer lies in the agile movement A recent study by Accenture and the National Association of State Chief Information Officers NASCIO affirmed that most state CIOs recognize the value of agile development yet still face some barriers

said their IT functions fail to hire. Tapping into Agile experience through flexible models—namely, by engaging coaches or consultants—is one way to bridge the gap. Yet, just 6 percent of

Here are some of our key findings about what is holding states back—and how to overcome the obstacles: 1. More of what you want, less of what you don’t. Most state CIOs and IT executives agreed that using Agile supports increased customer engagement and business ownership (74 percent), improved customer satisfaction (71 percent), improved quality (68 percent), improved transparency (65 percent), greater flexibility (59 percent), and less risk (50 percent). At the same time, Agile helps prevent some of the most pernicious chal- lenges: wasted money from ineffective IT projects (70 percent), large IT project failures (66 percent), delayed implementation (60 percent), programs that do not meet business needs (58 percent) and programs that do not meet needs (43 percent). Regardless of development meth- odology, it’s always wise to evaluate business processes before automating them. Accenture and NASCIO asked states that implement Agile and tackle process analysis or re-engineering before project kickoff how they 2. “Processing” improvements.

approach those initiatives. Business process mapping (78 percent), LEAN process (49 percent), process re-engi- neering (46 percent), design thinking (24 percent) and Kaizen (24 percent) emerged as most popular. As human services agencies seek to innovate, human-centered design (also called design thinking or service design) may be an ideal place to start. These techniques help in challenging existing business processes and in bringing powerful user perspectives to the table. 3. All or nothing? Not necessarily. More than half of respondents (53 percent) told us they frequently blend Agile with other implementation meth- odologies. What’s more, 87 percent agreed that success with Agile comes from starting with discrete projects and then building up. Interestingly, the study found that there is no consistent leadership force driving Agile. When we asked who is spearheading Agile in state govern- ment, answers ran the gamut—from “no single person” (24 percent) to appli- cation development lead (23 percent), CIO (11 percent) and agency-level head of IT (9 percent). The most cited answer was “all others” (33 percent). Agile can’t thrive as a “cottage industry” within the IT department. It requires leadership from the top of the many agencies whose hands are ulti- mately in the mix, including rethinking how the organization operates. The era of leaving “tech stuff” to the IT department is over. Rather, new and innovative partnerships must be built and cultivated at every turn, with a focus on creativity and risk taking. Finding the right solution for the right challenge is critical when attempting to better serve the clients in whose names these systems are built. 4. Skills: In short supply. Fifty-eight percent indicated that less than one-fifth of their state IT work- force is highly skilled in Agile. Nine percent admitted that their IT work- force has no skills in Agile. Yet, building skills isn’t as simple as recruiting new talent. Forty-seven percent said their IT functions struggle to recruit and hire, but eventually fill, positions; 6 percent

respondents are doing so. 5. Culture clash.

Among the most-cited cultural chal- lenges: embracing change (57 percent), extent of business involvement (36 percent), business and IT being able to work together (32 percent), sharing project ownership (30 percent) and collaboration across functions (30 percent). As one human services IT leader noted, “Constraints for Agile adoption are cultural and procurement. Change of process adoption is easier for newer staff than staff that have been engrained in linear processes.” 6. Easy? No. Worthwhile? Absolutely. Respondents pointed to two other organizational barriers: lack of training or knowledge in how to use Agile (75 percent) and procurement not being set up for Agile projects (70 percent). The most common tech- nical barriers were legacy solutions (77 percent), integration with other systems (58 percent), and not having DevOps to support Agile (53 percent). Just 47 percent of respondents believe Agile is just as easy to implement in government as in the private sector. Even so, the vast majority believe Agile is effective for state government (98 percent) and does a better job of engaging the customer (96 percent). “Agile is the best software devel- opment methodology we’ve found,” commented another human services IT executive, who explained Agile enables learning from failure and the ability to implement new requirements based on real-world interactions. The executive explained that, in the end, with Agile “we’ve not had a project fail.” As agencies transform to meet the 21st-century challenges of serving children and families, the goal is greater than simply avoiding failure. We know the needs of clients and ben- eficiaries are dynamic. Human services IT should be, too. And Agile is a proven method for delivering more value, more quickly.

Rafael López is the Managing

Director, Health and Public Services, at Accenture, North America.

Doug Robinson is the Executive Director of the National Association of State Chief Information Officers.

Policy&Practice October 2017 24

technology speaks By Justin Hyde

Preventing Identity Theft and Strengthening the American Health Care System

E very day both individual fraudsters and organized criminal enterprises attack and defraud federal and state agencies and health care systems of as much money as they can. Just as Willie Sutton robbed banks because “that’s where the money is,” criminals are constantly looking for new ways to defraud government programs, insurers, doctors, hospitals, and ordinary individuals. The increasing use of the Internet to streamline appli- cations, operations, and access to information opens up new avenues for criminals to operate at a much lower risk than robbing banks. In response, government agencies and health care systems are working to take the steps necessary to combat identity theft and protect their programs and members from its ramifications. The Impact of Medical IdentityTheft Integrating the Internet into appli- cation, enrollment, and delivery of health care services can result in significant savings and overall opera- tional efficiencies through streamlined processing. Medicaid, the single largest government health care program, spends more than $550 billion 1 annually in providing services— anything that can cut overhead and administrative costs means more effec- tive care delivered to patients. But the Centers for Medicare and Medicaid Services estimates 2 that more than 10 percent of that is being paid improp- erly, with at least 3 percent attributed to eligibility authentication problems. This means that by increasing the ability to keep the bad guys out of our programs could save billions of dollars.

And that’s just the direct financial impact. Besides driving up health care costs, it also means the health records have probably been corrupted for persons victimized by health care identity theft. In an August 2016 article, 3 Consumer Reports estimated that one in five of these victims suffered a negative health impact. Moreover, the onus is generally on the victims to correct their affected health records. While it is estimated that medical identity theft is growing at more than 22 percent 4 each year, the problem is far from limited strictly to health care identities. According to the Identity

Theft Resource Center, 5 as of August 16, 2017, there have been 917 data breaches this year so far compromising more than 16 million records containing personally identifiable information. All individuals, government agencies, as well as health care providers, need to be on high alert to ensure they are not impacted by these criminals. Agencies Have to Keep Fighting Back Government agencies at all levels are investing in stronger cybersecurity

See Identity Theft on page 34

Illustration by Chris Campbell

Policy&Practice October 2017 26

technology speaks By David Mounts

Accelerating the Modernization of SNAP—at the Speed of Digital

T he Supplemental Nutrition Assistance Program (SNAP) offers one of the most promising opportuni- ties for accelerated modernization within health and human services. The in-market availability of the technology, its proven effectiveness in reaching and engaging program participants, and the many benefits that would be derived make improving SNAP an expedient reality. A singular, comprehensive solution would enable program-wide opti- mization. The successful solution will holistically address systemic challenges and advance the Food and Nutrition Service’s goal of healthier outcomes for constituents. That solution—that digital, mobile solution—exists today. Leveraging Proven Technology While the explosive growth in e-commerce has only recently domi- nated business headlines, digital technology has been powering retail for decades. Each day retailers and manufacturers successfully employ digital technology to engage, serve millions of customers, and securely execute billions of transactions. Their collective success achieving greater operational efficiency, enhancing system security, and improving service to external audiences clearly demonstrates that this time-proven technology can be leveraged to immediately accelerate needed mod- ernization for SNAP. This digital platform can be utilized by state agencies to enhance SNAP recipient engagement and to optimize SNAP operations. Further enhanced through

greater mobile access, and combined with advanced data analytics, this technology will drive improved outcomes for both SNAP recipients and administrators. Maximizing Mobile Engagement Digital technology has changed how Americans across demographics pursue their wellness and savings goals and gives further credence to the need for expanded digital utiliza- tion by SNAP; smartphone adoption now exceeds 81 percent 1 —with 64 percent of Americans earning less than $30,000 per year owning a smartphone. 2 Access to the Internet via a smart- phone is particularly prevalent among lower-income individuals as a signifi- cantly lower percentage of this group

has high-speed broadband connec- tivity at home. 3 Given these trends, implementation of mobile-optimized, digitally driven benefits management for SNAP would enable richer and more convenient engagement with program partici- pants. Leveraging a centralized user portal, this system would provide a one-stop, full-service destination for users to access their accounts and receive information on better eating habits and healthier food options to consider when shopping. An opt-in feature would also allow recipients to easily “clip” digital coupons for discounts on healthier foods. This last item is a unique— and central—advantage, as these paperless coupons would give SNAP

See SNAP on page 38

Illustration by Chris Campbell

October 2017 Policy&Practice 27