Policy & Practice | Summer 2023

The Magazine of the American Public Human Services Association Summer 2023

Advancing Social and Economic Mobility for Equitable, Long-Term Success

TODAY’S EXPERTISE FOR TOMORROW’S SOLUTIONS

www.aphsa.org

contents

Vol. 81, No. 2 Summer 2023

features

departments

18

3 President’s Memo

Aspirations for the Future of Human Services Part Three: Systems Alignment

5 The Human in Human Services The Power of Social Capital

6 Research Corner Opportunity Ahead: Reimagining the Role of Child Support Engagement for Child Welfare–Involved Families

8 From Our Partners Strategic Transformation: Small Steps that Help Place Children and Families at the Center

“How We Do What We Do” Enhancing Equity for Refugee and Immigrant Communities Through Expert Staffing

10 Partnering for Impact How State Administrators Can Protect and Empower Families: Insights from the Consumer Financial Protection Bureau 12 From Our Partners Addressing the Youth Mental Health Emergency: Lessons from New Hampshire’s Comprehensive Response 14 Partnering for Impact Economic Mobility: Building Sector Strategies that Work for the Workers

22

40 Technology Speaks

Bridging the Digital Divide: Improved Digital Literacy Creates Better Long-Term Outcomes

Tech for Success Aligning and Supporting the Workforce with Modern Technology

42 Technology Speaks Opportunity in Crisis: A Nevada County’s Race to Prevent Homelessness

2023 Farm Bill A Roadmap for Building a More Effective, Resilient, and Customer-Centered SNAP Program MARCH 2023

44 Association News APHSA Recognizes Outstanding Leaders in Human Services

26

45 Special Note In It Together

51 Staff Spotlight

Amaya Alexandra Ramos, Project Associate, Refugee and Immigrant Social Services Staff Spotlight Khristian Monterroso, Project Associate, Economic Mobility and Well-Being

52 Staff Spotlight

Alex Clermont, Senior Content Writer

2023 Farm Bill A Roadmap for Building a More Effective, Resilient, and Customer-Centered SNAP Program

Staff Spotlight Allegra Henry, Organizational Effectiveness Consultant

SNAP Policy Areas of Focus Improving Customer Experience in Benefits Access

APHSA has developed its 2023 Farm Bill recommendations through a member led process, leaning on the unique expertise of its network of state and local agency executives, SNAP Directors, QC Managers, Chief Information Officers, SNAP Employment & Training leads, SNAP-Ed and Outreach coordinators, and more. The recommendations set forth reflect the bipartisan consensus of public administrators that provide the critical infrastructure needed for SNAP to realize its potential as an essential tool that promotes thriving families and communities.

1

Summer 2023 Policy & Practice

Creating Pathways for Economic Mobility

Strategic Industry Partners

APHSA Executive Governing Board

Chair Dannette R. Smith, CEO, Nebraska Department of Health and Human Services Vice Chair Rodney Adams, Former Director, Mecklenburg County (NC) Department of Community Resources Immediate Past Chair David A. Hansell, Former Commissioner, New York City Administration for Children’s Services Treasurer Kathy Park, CEO, Evident Change Elected Director Derrik Anderson, Executive Director, Race Matters for Juvenile Justice Elected Director Vannessa L. Dorantes, Commissioner, Connecticut Department of Children and Families

Elected Director Grace B. Hou, Secretary, Illinois Department of Human Services Elected Director

DIAMOND

Sherron Rogers, Vice President and CFO, Johns Hopkins All Children’s Hospital Elected Director Terry J. Stigdon , Agency Head/Executive Director, Indiana Department of Child Services Elected Director Jennifer Sullivan , Senior Vice President for Strategic Operations, Atrium Health Elected Director Eboni Washington , Assistant Director, Clark County (NV) Juvenile Justice Services Local Council Representative Dan Makelky , Director, Douglas County (CO) Department of Human Services

PLATINUM

SILVER

2

Policy & Practice Summer 2023

president’s memo By Tracy Wareing Evans

Aspirations for the Future of Human Services Part Three: Systems Alignment

L ast year, APHSA created a space for us as leaders in the human services sector to discuss not only our current approach to delivering services, but what objectives we should aspire to in order to better advance the social and economic mobility of the people and communities we serve. In the first column of this series, published in the December 2022 issue of Policy and Practice , I provided a broad overview of three themes that emerged from these interactive sessions: (1) community engagement, (2) systems alignment, and (3) the human services workforce. I took a deeper dive in my second article, published in the Spring 2023 issue, to expand on the changing paradigm for how leaders are approaching community engagement, and proactively investing in opportuni ties for co-discovery and co-design of the human services system with the people it serves. Now, we’ll tackle the second theme, the long-standing need for systems alignment , and the growing under standing of what the optimization of human-serving systems—from educa tion to health to human services to justice—means for communities. As highlighted in this column, human services leaders are striving to make those seemingly lofty ambitions into real-world advancements.

many systems that support health and well-being for people, we can better address the underlying factors that contribute to social inequities. This long-term strategic thinking can lead to more sustainable and impactful solutions that promote equity and racial justice. From a nuts-and-bolts perspective, it also becomes easier to track outcomes and measure the impact of services and programs when our systems are better aligned—from funding sources to eligibility require ments to service delivery mechanisms to feedback loops. Creating alignment across systems helps identify where the gaps exist and supports informed investment decisions. Achieving more efficient, effective, and equitable human services systems is the aim of every leader in the sector. Hitting those targets requires us to reach outside our siloed programming

and service-array and engage with other system leaders. While many of the barriers to system alignment are long-standing (e.g., fiscal limitations, regulatory requirements, procure ment rules), leaders are not waiting on changes to federal law and rules to make important advances. Nor are they deterred by the unproduc tive narrative that permeates so much of what people believe and misun derstand about the human services system. Leaders are investing in building relationships deep within and across the many sectors that impact all of our lives. Initiating Change Begins with Leadership The following are more ideas and insights gathered from leaders across the country.

Systems Alignment at its Core

Our deep commitment to advancing equity is furthered by systems align ment. By working to better align the

See President’s Memo on page 48

3

Summer 2023 Policy & Practice

Vol. 81, No. 2

www.aphsa.org

Policy & Practice™ (ISSN 1942-6828) is published four times a year by the American Public Human Services Association, 1300 N. 17th Street, Suite 340, Arlington, VA 22209. For subscription information, contact APHSA at (202) 682-0100 or visit the website at www.aphsa.org. Copyright © 2023. 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 1300 N. 17th Street, Suite 340, Arlington, VA 22209

Advertising Anna Nogueira ads_exhibits@aphsa.org

President & CEO Tracy Wareing Evans Communications Director/Editor- in-Chief Jessica Garon jgaron@aphsa.org

Subscriptions Jordan Ahmad jahmad@aphsa.org

Design & Production Chris Campbell

Editor Amy Plotnick

2023 Advertising Calendar

Issue

Ad Deadline

Issue Theme

Fall

July 19

Modernizing IT Systems for the Future: Emerging Technology and Process Innovation

Winter

October 11

Community-Led Solutions: Partnerships for System Change

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

Rate

Discount for 4 Consecutive Issues

$8,000 $6,000 $5,400 $5,400 $3,000 $1,200 $1,050

$7,200/issue $5,400/issue $4,860/issue $4,860/issue $2,700/issue $1,080/issue $945/issue

Full page:

Half page, horizontal: One-third page, vertical:

APHSA’s blog, The Catalyst , encourages the exchange of creative ideas and promising initiatives to strengthen the human services sector and accelerate our collective impact. Featuring content from members, partners, and staff, our blog posts focus on what it takes to build well-being from the ground up. Organized around areas of impact as well as a variety of special series, our goal is to spark new ideas and accelerate the spread of promising approaches that help realize our shared vision for thriving communities built on human potential.

Read the Latest Post, Visit APHSA.org/APHSABlog/default.aspx

4

Policy & Practice Summer 2023

the human in human services By Yi-Hui (Bessie) Chen

The Power of Social Capital S ocial capital is a network of con nections and relationships. Each link in this network has resources and In my town, the CFCE program

among families allowed the CFCE com

The Human in Human Services is a recurring article featuring authors with lived experience as clients of the human services system. In this issue, we highlight Yi-Hui (Bessie) Chen ’s experiences and insights. Bessie works with parent leaders and organizations from cities and towns to boost Massachusetts’ family social and civic engagement. Previously the Founder and Executive Director of Global Cooking Inc., she focused on international cooking classes, facilitating intercultural dialogue, and promoting healthy eating and wellness. Bessie has a Master of Science degree in Leadership from Northeastern University, a Bachelor of Science in Psychology from Chung Yuan Christian University, and a Certificate of Diversity and Inclusion from Cornell University.

information offered by individuals and groups connected with each other. These connections allow its members to access benefits from this social network. Research shows that these social relationships provide upward economic mobility in certain circumstances. For example, children who grow up in a community con nected across economic and social statuses are more likely to rise out of poverty. These children acquire valuable information about schools, internships, and job opportunities through cross-class relationships. 1 Promoting cross-class interaction is challenging because people are unlikely to connect organically with those who have different life experi ences. For example, families with low incomes cannot afford private children’s services, or parents with higher incomes avoid sending their children to the programs where the families with lower incomes go. In Massachusetts, the Coordinated Family and Community Engagement (CFCE) programs, funded through the Department of Early Education and Care, provide child development services and resources to families with young children, regardless of economic status. 2 There are more than 90 CFCE programs across the state that serve 350 cities and towns in Massachusetts. With CFCE programs being designed for any family with young children, families gain oppor tunities to interact with other families from different backgrounds through playgroup activities and parent educa tion workshops.

munity to diversify, which allowed families to feel more welcomed and increased overall enrollment. The staff also become motivated to learn new tools to communicate with any parents who did not speak English. I brought this family engagement experience to Families First, a non profit organization in Massachusetts that provides parent leadership training. I mentored parent leaders from CFCE and Head Start programs across the state. My focus was to remove barriers, like language, for parent leaders so they could learn, connect, and collaborate with others from different backgrounds on a com munity project that benefits everyone. In my parent leadership learning cohorts, most parent leaders spoke either Spanish or English. Instead of separating them into different cohorts, we hired an interpreter. The cohort was primarily conducted in English, but all parent leaders used the interpretation service to engage with each other as equals. Providing an interpreter was not just a service for Spanish-speaking parents to understand the training, but also a

used to host its activities in schools. Unfortunately, because school build ings were not open to the public, many parents did not know about the program, especially new residents and minority families who did not have as many connections with local people. In addition, if parents did not feel that they belonged to the program, they stopped participating in activities. To improve diversity and equity, I launched a family engagement project with the CFCE staff and one other parent. We invited parents to share about their families at the local library. The purpose was to create a parent-led space that brought topics as diverse as the community itself. Families shared celebrations, such as Diwali, Saint Patrick’s Day, and Black History Month. Some parents talked about their occupations; a state trooper father described how he trained a K9, and another father showcased his fire fighter equipment. Life experiences were included as well. One parent shared how her family coped with the grief of infant loss. Once people had shared who they were and their life experiences, they found connections with others they may not have made otherwise. Promoting interactions

See Social Capital on page 43

5

Summer 2023 Policy & Practice

research corner

By Meg Dygert, Kati Mapa, and Jill Duerr Berrick

Opportunity Ahead: Reimagining the Role of Child Support Engagement for Child Welfare–Involved Families

T he American Public Human Services Association (APHSA) and its affinity group, the National Association of Public Child Welfare Administrators (NAPCWA), are com mitted to ensuring the well-being of children by providing families with economic supports and preventive services to help create the conditions for all families to thrive. State and local leaders currently have a significant opportunity to improve economic sta bility for many of our nation’s families by reforming what child support engagement looks like for families involved with the child welfare system. Guidance jointly promulgated in July 2022 by the federal Children’s Bureau and the Office of Child Support Services clarifies legislative intent regarding the assignment of child support obligations when children are placed in foster care. The updated guidance “encourages child welfare agencies to implement across-the board policies” regarding assignment of child support “only in very rare circumstances.” As background, the practice of col lecting child support payments from parents whose children are placed in foster care has been ongoing for almost 40 years. The Social Security Act was amended by Congress in 1984 to include provisions for states to recoup some of the costs of foster care through the assignment of child support to parents. Federal guidance required child welfare agencies to refer Title IV-E eligible parents “where

previous child support orders already in place (Cancian et al., 2017). In the instance of an existing order, any child support funds previously directed to the custodial parent are redirected to the state. The updated federal guidance is designed to significantly reduce the number of child welfare–involved parents referred to child support services and is based on accumulating evidence that shows the practice’s negative impact on children and families. Available research indicates that child support enforcement for parents whose children are in foster care is cost ineffective, reduces the likelihood or significantly delays reuni fication, increases family financial precarity, may impact kinship care givers’ willingness to serve as foster parents, and has disproportionately negative impacts on BIPOC families.

appropriate” and under conditions that support the “best interests of the child” (U.S. DHHS, 2012). Child welfare agencies were also allowed to refer non-Title-IV-E-eligible parents. The original federal guidance gave states significant latitude to define “appropriate” and offered exemp tions to the referral if imposition of child support might create a barrier to reunification. Exemptions, however, were only allowed on a case-by-case basis and recouping expenditures through child support orders remained a common practice. Following a referral from the child welfare agency, state or local child support offices are responsible for collections, in collaboration with the courts. Referrals may be made for the birth mother and/or the birth father, though research shows that a substan tial percentage of birth fathers have

Illustration by Chris Campbell

6

Policy & Practice Summer 2023

What Does the Research Evidence Suggest? Child support collections are based on the premise that govern ment agencies can recoup the costs expanded on foster care. But are increased revenues realized? Based on cost-benefit analyses conducted in four states, it’s clear that the answer is a firm “no.” The administrative costs associ ated with child support collections from “foster care cases” far outweigh the benefits by a ratio of at least 3 to 1 (OCDCSS, 2019; Skophammer, 2017). Because foster care cases are typically more complex than non–foster care cases, child support staff expend at least 50 percent more time on collec tions efforts (OCDCSS, 2019). Public administration revenue is important but impacts on families are especially critical. When children are placed in care, one of the funda mental goals of child welfare is family reunification. Rigorous research from Wisconsin shows that when mothers pay just $100 per month toward their child support obligation, the likelihood of reunifying with their child declines by almost one-fifth. Moreover, children remain in care significantly longer. On average, children whose parents make child support payments stay in care 6.6 months longer than children whose parents are not obliged to make these payments (Cancian et al., 2017). This is especially important since children’s extended stays in care can bump up against federal requirements under the Adoption and Safe Families Act (ASFA) to pursue termination of parental rights (TPR). Given that the median length of stay for children in foster care is 15 months (USDHHS, 2022), child welfare staff are compelled to consider TPR for most children with lengthy stays in care. Indeed, in at least 12 states, TPR proceedings may be justified by the nonpayment of child support obligations (Shapiro, 2023). Although the reason for these impacts on reunification has not been confirmed yet by research, it is likely due to the increased impact of poverty families experience when any their income is diverted or reduced. According to one study, more than half of parents whose children were in foster care had no employment

earnings in the year prior to their child’s placement (Cancian et al., 2017). Another study indicated that about one third of parents paying child support had annual incomes below $10,000 (Skophammer, 2017). Income loss— just when parents need a stable income the most—can result in nonpayment of rent, utilities, or other essentials, further compromising the require ments of a parent’s case plan to create a safe and stable home for their child, which is necessary for reunification to be completed and to be successful. Parents who successfully reunify with their children may still be indebted for child support arrears, thus furthering their poverty, and increasing the likelihood of future reentry to care. Child welfare agencies that enact practices that increase family economic instability at the same time that they espouse the importance of child safety may be working at cross purposes. Moreover, given that Black children are three times more likely to experience poverty (Kids Count Data Center, 2020), that Black children are disproportionately represented in foster care (USDHHS, 2022), and that they are less likely to reunify (Wulczyn, 2020), practices that increase family poverty should be scrutinized for their differential impacts on child welfare outcomes for Black families. Finally, child support obligations may thwart child welfare efforts to encourage kinship placements—a state and federal policy preference— when children require out-of-home care. Although child support enforce ment may be little known to many child welfare professionals, one author suggests that family members are keenly aware of child support requirements and that kin may reject placement of their relative child if they suspect a child support order will be required of a relative family member (Hatcher, 2009). What Can Be Done? Imposing child support obligations on child welfare–involved families contradicts several of the goals of child welfare policy and practice. It reduces the odds of family reunification, increases the likelihood of TPR, and reduces opportunities for kin to serve

as children’s caregivers. Importantly, it increases family poverty and as a result, is likely to reduce child safety. Opportunities for reform are now available given recent federal guidance, but there is significant diver sity across states in the barriers they may face in implementing reform. There is already considerable vari ability in the application of child support enforcement (Chellew et al., 2012; OCSE Table P-12, 2021). In Arizona, Florida, Nevada, New Mexico, Rhode Island, and Vermont, for example, states collected less than $10 for every child in foster care in 2019. At the opposite extreme, Alaska, New Jersey, North Dakota, Pennsylvania, and Wisconsin collected more than $400 per child in care. 1 According to a survey recently conducted by APHSA, the Child Welfare League of America (CWLA), and Casey Family Programs, about three-fourths of states will require legislation to change their practice. Some states automate referrals, requiring adjust ments to state SACWIS systems and overarching state processes and policies. The survey also identified the barriers states face in pursuing policy or practice change, the most common of which identified by respondents were policy design, addressing budget impacts, and assessing the impact to families or agencies. In spite of these challenges, some states are providing leadership in their efforts toward policy reform. Montana, for example, passed HB 227 during the 2023 legislative session, fol lowing California’s policy change in 2022. Washington reduced child support collections through changes to their administrative regulations. Other states (e.g., NC & NY) have legislation pending. In spite of the policy or administra tive challenges, reform efforts should be pursued. Child welfare admin istrators across the states are eager to identify practices that are family centered, restorative, not punitive, and equity focused. Child support enforce ment for foster care cases is anathema to all of these goals. Meg Dygert is the Senior Policy Associate for Child and Family Well Being at APHSA.

See Research Corner on page 49

7

Summer 2023 Policy & Practice

from our partners

By Danielle Barnes

Strategic Transformation: Small Steps that Help Place Children and Families at the Center

S afeguarding children who have experienced poverty, abuse, or neglect is one of the most pressing chal lenges faced by governments around the world and in the United States. A total of 606,031 children were served by the U.S. foster care system in fiscal year 2021, according to the latest report from the U.S. Department of Health and Human Services.¹ That number is down from the 631,686 U.S. children served by foster care in fiscal year 2020. It is still a large number of children, however, who face consid erable uncertainty, instability, and insecurity during their formative years. And there are no easy answers to fix the problem. Front-line workers experience the difficult circumstances of each child on a daily basis and do their best to support them in their journey through the system. Their ability to convey these challenges to management at child welfare agencies can boost visibility and provide valuable scope and perspective into the problems children face. But everyone, from those on the front lines to the leadership team, are still working in a system with a daunting mission and a steady stream of new concerns that make the work even more difficult. The Family First Prevention Services Act (FFPSA) was signed into law in 2018 to shift the focus of the child welfare system toward “keeping children safely with their families to avoid the trauma that results when children are placed in out-of-home care.”² The intent is to provide greater access to mental health services, sub stance use treatment, or parenting skills courses and shift how the

country provides services for family and youth. While it is an encouraging step, more needs to be done to effect real change in how the child welfare system functions in the United States. It can begin with the creation of a transformation management office (TMO). Seven Key Challenges Ernst & Young LLP (EY) has identi fied seven key challenges that convey the difficulties child welfare agencies face as they attempt to do their work: 1. Increased child welfare caseloads: While the national numbers reflect a decrease in the number of new children entering the system, anec dotal evidence at the local level tells a different story. 2.Limited staff resources: Departments are challenged with hiring, onboarding, and maximizing available skill sets to create a full and effective workforce. Fewer people are taking jobs in child welfare,

while more people are leaving the profession. In addition to the job stress, workers claim they can make just as much money working in other professions that are much less chal lenging on an emotional level. 3. FFPSA: Among other things, this legislation includes a funding mech anism that helps states place kids with other members of their family rather than in the system. 4. Outdated information systems: Data are complex, incomplete, and difficult to consolidate; the systems that house that data are outdated and only make this task more difficult. 5. Ineffective oversight of over arching system changes: The need to triage operational issues in various crisis situations hinders careful over sight. When a problem arises, the goal is to solve the immediate crisis as quickly as possible. The urgency is understood, but it often leads to flawed solutions that eventually lead to additional concerns.

Illustration by Chris Campbell

8

Policy & Practice Summer 2023

it, must always be kept at the center of any transformation effort. Decisions on policy changes must not be made in a bubble without considering the real impact on the people it affects. For example, as technology continues to evolve, agencies should consider how it could help people do their jobs better. Resist the urge to invest in technology that looks cutting-edge but doesn’t have a tangible impact on how care is delivered. There is evidence that transforma tional change is beginning to happen in the area of child welfare. Several states have allocated funding to address child abuse and neglect, to upgrade system technology, and to create pilot programs that change the way care is delivered. As agencies consider their own cir cumstances and what a transformation strategy might look like, here is some guidance on how to approach three critical areas: workforce, operations, and systems. Workforce A wave of challenges in recruiting and retaining high-quality child welfare and family support workers is significantly impacting the services that agencies offer. Agencies approach these workforce challenges with one primary focus: people. A TMO will collaborate with the agency to effectively manage communication, mitigate change impacts, and train all participants. A thoughtful approach to workforce optimization, organization redesign, recruitment, and retention can lead the agency to achieve better outcomes for children and families. Approaches to consider: n Increase efforts by leveraging veteran child welfare employees to build up new staff and forge new relationships to increase support n Identify opportunities to focus on career development and investment in your supervisory staff n Address implicit bias and grow diver sity, equity, and inclusion initiatives through training plan modifications Operations The TMO works with the agency to establish interrelated processes for evaluating, selecting, prioritizing, and allocating resources against agency

needs to best accomplish organizational strategies. By setting clear standards, consistency within the organization and across individual projects can be achieved. Once processes, proce dures, and tools are developed and the TMO governance and organizational structure is defined, they must be imple n Evaluate process flow to identify gaps and opportunities to move toward objectives and goals n Execute a transformation planning session to set the overarching trans formation vision n Ingrain continuous quality improve ment skills and practices into all levels and functions within the agency Systems Child welfare systems have the following key purposes: enabling staff to effectively serve children and families; tracking, monitoring, and reporting for leadership to enable evidence-based decisions in real time; and informing financial decision making. An effective TMO will guide the agency through the process of envisioning, procuring, managing, funding, and implementing a system replacement to fulfill these purposes. Approaches to consider: n Requirement gathering and further understanding of current system challenges and dependencies n Implement a human-centered design approach to process changes through discovery and outcome based objectives n Mapping to new regulatory require ments and evolving state and federal guidelines Reference Notes 1. Children’s Bureau Express (February 2023). Adoption and foster care analysis and reporting system (AFCARS) report #29. https://cbexpress.acf.hhs.gov/ article/2023/february/afcars-report-29/ a47818711b7bd91080f4631ee54bcb8f 2. Child Welfare Information Gateway (March 28, 2023). Family first prevention services act. https://www.childwelfare .gov/topics/systemwide/laws-policies/ federal/family-first/ mented and maintained. Approaches to consider: Danielle Barnes is EY Americas Government and Public Sector Leader.

6.Interdepartmental silos: Silos hamper communication and collabo ration and make it difficult to make decisions and effectively manage new and existing technology and transformation initiatives. 7. Difficulties in redesigning child protection: Local departments have trouble maximizing investments for improving the affordability and quality of child protection. missions in human services: ensuring the safety and well-being of children. Six of these seven challenges make that mission more difficult to achieve. The seventh, the FFPSA legislation, is geared to help, but is another wrinkle in a complex system that is already tough to manage. As new challenges continue to arise for the sector, it’s time to re examine how agencies function and embrace the opportunity to transform child welfare from the inside out. With the right support, the child welfare system can work toward comprehen sive, systemic transformation designed to care for the people it serves. The transformation roadmap is one approach to consider. It lays out a plan for how to implement change and create an operating model that consistently delivers better outcomes for the commu nities that agencies serve, their partners, and the organization itself. A key part of this strategy is the TMO. The business of child welfare does not pause for trans formation, or for anything else in today’s world. Having a leader dedicated to the change effort without being distracted by unrelated needs and responsibilities is critical. The TMO can define, imple ment, and monitor compliance to achievable, realistic performance indi cators and measures of success. Listen toThose on the Front Line The importance of hearing the voice of front-line workers and using their perspective to inform decision making cannot be overstated. One of the most important functions of the TMO is to hear the voice of the front-line worker and use that perspective to inform decision making. Those who provide service, as well as those who receive Child welfare agencies are tasked with one of the most important

9

Summer 2023 Policy & Practice

partnering for impact

By Amelia O’Rourke-Owens

How State Administrators Can Protect and Empower Families: Insights from the Consumer Financial Protection Bureau

T he Consumer Financial Protection Bureau (CFPB) is a 21st-century agency that helps consumer finance markets work by making rules more effective, by consistently and fairly enforcing those rules, and by empow ering consumers to take more control over their economic lives. Recently, the CFPB assessed the challenges public benefits recipients encounter when accessing their benefits payments through program cards and other financial products. Federal government programs provide support to eligible individuals and families during life’s inevitable ups and downs, for instance, to eligible older adults via Social Security, qualified children and families via Temporary Assistance for Needy Families (TANF), individuals with disabilities via Social Security Disability Insurance (SSDI), and individuals who are recently unem ployed via Unemployment Insurance (UI) benefits. Given the often-acute needs of the populations who receive and rely on this support, full and timely access is often critical. The CFPB recognizes the vital role human services professionals play in administering complex public benefits programs and is actively engaging with the American Public Human Services Association (APHSA) and state and local administrators to better understand how to best support recipients. Recently, the CFPB was invited to join an APHSA call with state administrators to discuss the Supplemental Nutrition Assistance

received, and (3) inadequate customer service from card providers. The CFPB also found these issues compound; often, when consumers faced one issue, their difficulties were exacerbated by the intersection of other obstacles. While program cards can benefit con sumers and government agencies alike, via speedier access to funds or cost efficient distribution, there can also be disadvantages for recipients using these cards. For example, some program card providers charge numerous fees, such as maintenance, balance inquiry, customer service, or ATM fees that chip away at the client’s benefits. Offering consumers an opportunity to elect direct deposit may provide lower-cost access to benefits as some checking accounts may be a less expensive alter native than program cards.

Program (SNAP) and TANF, front-line staff training, and the ways states have been served by their respective public benefits products and their delivery. The CFPB has subsequently heard from human services administrators across the country about their experi ences of distributing public benefits by card and direct deposit. These engage ments have provided the CFPB a clearer understanding about the many roles state and county administrators play in successfully managing their programs. The CFPB remains inter ested in hearing more from state and local administrators on this issue. In researching mechanisms to deliver benefits payments, the CFPB identi fied three common challenges across multiple program cards. The themes were (1) numerous and sometimes high fees for basic financial services, (2) limited options in how payments were

See CFPB on page 50

Illustration by Chris Campbell

10

Policy & Practice Summer 2023

from our partners

By Joanna K. Morgan

Addressing the Youth Mental Health Emergency: Lessons from New Hampshire’s Comprehensive Response

F acing a historic challenge impacting millions of children and adolescents, New Hampshire has organized state resources to launch a comprehensive, statewide program that tackles the growing needs of children and families. By drawing on public- and private-sector partners and technology, and aligning traditionally separate agency functions, the state has found a way to maximize impact. pandemic shut down schools and upturned family life and develop mental milestones for millions of young Americans, mental health among children and adolescents has been a growing concern in the United States. According to Centers for Disease Control and Prevention (CDC) data, the number of children and adolescents seeking emergency help for mental health issues rose by 20–30 percent in 2020. 1 The pandemic has intensified social isola tion, economic stress, and disruptions to everyday routines and support systems, all of which have contrib uted to the increase in mental health issues among young people. Citing an uptick in emergency room visits and alarming upsurges in depression, anxiety, grief from the loss of a caregiver, and suicidality in K-12 populations, the American Association of Pediatrics has declared a state of emergency in children’s mental health. 2 A Nationwide Crisis Even before the COVID-19

Impact of the COVID 19 Pandemic on U.S.

New Hampshire’s Promising Practices: Comprehensive Assessment forTreatment (CAT) Services Program The state of New Hampshire (NH) has taken a proactive approach to addressing the increase in mental health needs, and the full scope of their efforts actually predates the pandemic. In June 2021, the Comprehensive Assessment for Treatment (CAT) program was launched as part of an intensive redesign of the state’s behavioral health services and in alignment with NH’s System of Care Law, RSA 135-F. 3 The NH System of Care Transformation ini tiative makes resources more accessible,

Children’s Mental Health While we may not know the whole story of the pandemic’s impact for many years, educators, parents, and therapists agree that the pandemic has profoundly upended the mental health landscape for young people. Academic and social setbacks, grief, and financial insecurity have all con tributed to the increase in mental health issues during the pandemic— and unfortunately, too many kids fail to get help before their burden and unmet needs lead them to emergency circumstances.

12

Policy & Practice Summer 2023

effective, and aligned with best prac tices. The CAT program provides a conflict-free assessment to all children and youth in the state with more intense service needs to determine whether they need residential treatment and, if so, the appropriate service setting to meet their needs. In addition, the CAT program works with multiple state agencies within the System of Care, including child protection, juvenile justice, courts, and community providers, as well as care management entities, local school districts, hospitals, and substance use disorder providers. The program uses the Child and Adolescent Needs and Strengths (CANS) 4 instrument to help determine the required level of services and protective factors and set treatment goals. Comprehensive Assessment forTreatment (CAT) Services Program By identifying the clinical needs and strengths of the youth and pro viding a “conflict-free assessment” process, the program aims to provide a comprehensive report and recom mendation, which helps to guide the child and family team. The program starts with referrals from the NH Department of Health and Human Services’ Division of Children, Youth, and Families (DCYF), Bureau for Children’s Behavioral Health (BCBH) or the department’s contractors. When a child requires services beyond what is currently offered in the com munity and a different level of care is indicated, Care Management Entities (CME), DCYF, and other designated service providers within the Children’s System of Care work together to determine the necessity of residential treatment and create a personalized recommendation for the child’s care. The assessment process involves close collaboration with the child, parent or guardian, referral source, and related partners in the child’s life. The assessor employs the evidence based CANS instrument and clinical questions to recommend the appro priate level of care and identify goals and protective factors. The consistent longitudinal data generated by this method is analyzed by Maximus, the state’s private-sector assessment

1. The process for the CAT program begins with Maximus staff receiving a referral via secure email. 2. Maximus reviews the referral and contacts the referral source for additional information when necessary. 3. The referral is then assigned to an assessor who reaches out to the referral source and the child’s treatment or support team to schedule interviews. 4. The assessor conducts all interviews, completes the CANS assessment, and submits the assessment to a quality reviewer. 5. Licensed clinicians review the assessment and the Determination and Recommendation Report, and when a Psychiatric Residential Treatment Facility (PRTF) is recommended, a physician will also review the determination. 6. Maximus disseminates the Determination and Recommendation Report to the required participants. From referral to the dissemination of the Determination and Recommendation Report, the process has been streamlined to approximately 14 days for Expedited Referrals—cases where the referred child or youth is currently in a detention setting, psychiatrically hospitalized, or already admitted to a qualified residential treatment facility. The process is completed in less than 30 days for other cases. n Coordination with agencies within the System of Care to deliver consistent services across program areas n Conflict-free, independent assessors employing proven instruments and methodologies n Data-driven, evidence-based analytics informs continuous improvement A New Approach: Comprehensive Statewide Design Referral Process

CAT Program Performance— Delivering Better Outcomes for Children A core objective of the CAT program and New Hampshire’s System of Care redesign is to provide the right level of services in the most appropriate setting. In the first year of operation, the CAT program has recorded a sig nificant reduction in the number of children referred to the highest level of care by utilizing all available commu nity resources and guiding youth to the most appropriate setting for care. A second core objective is to accommodate referrals from the com munity—from a parent, teacher, or community therapist—rather than solely from the courts. Promisingly, more than 20 percent of referrals in the first year came from the community, ensuring these children could access vital services without requiring court intervention or DCYF involvement. A third core objective of this redesign is to shorten the time a child may spend in higher levels of care, such as

provider, and the department, to identify areas for continuous enhance ment of services to meet the needs of the population being assessed. The CAT assessment also includes a module on caregiver needs and strengths, which helps identify areas where the child’s family may require additional support. Moreover, the CAT program provides data analysis and tools to help identify trends in the needs of both the child and family, such as substance abuse and disor dered eating, as well as informs the state on where there may need to be additional programming or supports developed within the System of Care. “The CAT program is unique in its design and implementation,” said Christa Ballew, Vice President for Clinical Services at Maximus. “They did the hard work to break down silos between agencies and stakeholders and then aligned services across multiple program areas—ensuring that all children in the state can access conflict free assessments to determine their behavioral health needs no matter how families reach out for help.”

See CAT Program on page 49

13

Summer 2023 Policy & Practice

partnering for impact

By Jess Praphath

Economic Mobility: Building Sector Strategies that Work for the Workers

A s 2023’s inflation and wage stagnation continue decimating workforces with low incomes across the country, disenfranchised workers who need it most feel like economic mobility is further and further out of reach. To help curb this, the U.S. government is putting significant investments into “sector strategies,” or workforce development approaches that focus on the needs of employers in growing industries and prepare indi viduals with the skills and credentials to meet them. For example, there’s the Department of Commerce’s $500 million 1 Good Jobs Challenge, the Bipartisan Infrastructure Law’s more than $800 million 2 in dedicated investments for workforce development, and the department’s new $11 billion semi conductor workforce initiative. 3 While it’s promising to see this significant influx of investments into sector strate gies, we must meet two critical needs to fully realize the potential of these programs and help businesses grow. Sector strategies must operate with both the precision to support the exact workers who most need the support and the sustainability to continue sup porting these workers once funding dries up. My current work at Third Sector, a nonprofit that helps government agencies to be more responsive to the communities they serve, partners deeply with government to create truly effective sector strategies. In fact, the worker-first sector strate gies we are deploying right now in two very different places, rural Texas counties outside Austin and the metro

Boston area, 4 can inform partnerships nationwide helping them become more precise and sustainable. Our learnings in these states will no doubt help us at Third Sector to refine and perfect these specific programs. They’ve also provided us with impor tant lessons that are beneficial for human services agencies and work force development initiatives across the United States. The first lesson is that we must capture and respond to worker voices to improve program outcomes. We must actively learn

what people looking for work value most about a job and help employers remain competitive by investing in worker pay, benefits, and education and career advancement opportuni ties. Doing so helps employers adopt long-term plans that continuously address worker needs and retain their skilled talent over time. For example, when we started working with employers on recruit ment strategies with our partners on the ground in rural Texas, we quickly learned that the nationally available frameworks and toolkits for developing

Illustration by Chris Campbell

14

Policy & Practice Summer 2023

sector partnerships are too broad for rural, small-business employers. And we heard from small employers that they need help finding workers, espe cially those trained in the hard and soft skills required to succeed. Workers are actively looking for training opportunities to get skills that will make them competitive for good-paying jobs, which will help them to build the lives they want. And employers need employees to stay on the job; otherwise, the employer must deal with the high cost of turnover. The second lesson is that we must connect workforce development to existing public systems, espe cially human services agencies, and public funding streams to sustain sector strategies over time. Doing so ensures we can support individuals who are furthest from opportunity to complete their training and remain employed in high-demand careers, breaking the cycle of low-wage jobs and poverty. Our solution in Texas was to identify specific strategic partners, including nonprofits, places of worship, food Employment and Training providers and case managers at county-based American Job Centers, which could serve as recruitment centers for com munities that are underserved. These targeted recruitment strategies help translate broad outreach frameworks into an action-oriented plan. Since these worker-first sector strategies are rooted in the specific needs and chal lenges facing rural Texas workers, I’m confident in their potential as a guiding model for our future efforts in Texas and in rural communities everywhere. Our concurrent work in Boston initially seems wholly separate from our work in Texas because the work in Boston focuses on the plights of early child care workers in a sprawling urban setting. However, the hard ships afflicting Boston early child care workers are symptomatic of the same systemic inequity that stymied worker recruitment and retention in rural Texas—inability to pay competitive wages and inequitably distributed resources—which con tribute to a workforce of primarily banks, as well as Supplemental Nutrition Assistance Program

At a time when we are making heavy investments in our economy via sector strategies, it’s incumbent upon the leaders in the nonprofit space to show that these investments fundamentally impact our communities. It can’t just be up to the individuals receiving the funding.

their communities achieve greater economic mobility. At a time when we are making heavy investments in our economy via sector strategies, it’s incumbent upon the leaders in the nonprofit space to show that these investments fundamentally impact our communities. It can’t just be up to the individuals receiving the funding. Those helping to direct sector strategies and human services agencies need to demonstrate a unified vision for how these seeds might spread and lead to improved education rates, family-sus taining wages, a responsive workforce, and a more robust, thriving economy. This is how we’ll unlock possibility, confront inequity, and catalyze change for our workforce together. Jess Praphath is the Managing Director of Economic Mobility at Third Sector. Reference Notes 1. https://www.eda.gov/funding/programs/ american-rescue-plan/good-jobs-challenge 2. https://www.whitehouse.gov/build/ Workforce%20Development%20for%20 Infrastructure%20Jobs&text=The%20 Bipartisan%20Infrastructure%20Law%20 includes,be%20used%20for%20that%20 purpose 3. https://www.bloomberg.com/news/ articles/2023-04-25/biden-set-to-launch 11-billion-chips-program-r-d-centerpiece 4. https://www.thirdsectorcap.org/news/ third-sector-joins-teams-in-massachusetts and-texas-to-implement-workforce programs-through-the-u-s-department-of commerces-good-job-challenge resources/equitable-infrastructure workforce/#:~:text=Equitable%20

Black, Indigenous, and People of Color women commuting to a city where they can’t afford to live. Third Sector recognized that achieving our goal in Boston to fill 850 unoccupied positions by 2025 requires a clear understanding of what early child care workers need to build the fruitful careers this industry is currently lacking. Therefore, we’re bringing together implementers across four ini tiatives for a workforce roundtable on how to leverage time-bounded funding to support and sustain the child care workforce. This strategy helps us ensure that we adopt the best possible worker first solutions to ongoing inequity in the child care sector. This leads to the last lesson, which is the inescapable fact that com mitted partners are essential to launching and maintaining effective sector strategies. Those working on sector strategies must cultivate strong relationships and roundtables with human services agencies, employers, training partners, workforce boards, and other strategic partners committed to creating thriving communities and investing in human capital. Businesses cannot fill their hiring needs without reaching into communi ties that are underserved and represent a significant portion of the labor force. When there are explicit connections between workforce development entities and human services organiza tions, there will be clearly articulated referral pathways for individuals with low income into high-quality training and good jobs in high-demand indus tries, helping these individuals and

15

Summer 2023 Policy & Practice