Policy and Practice | June 2021

The Magazine of the American Public Human Services

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contents

Vol. 79, No. 3 June 2021

features

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16

All Aboard Toward Thriving Families Strategies to Keep Early Intervention and Prevention on Track

Designing for Trust Using Human-Centered Design to Rebuild Trust and Improve Mission Impact

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20

Designing Empathetic and Inclusive Health and Human Services Putting Resident Needs and Perspectives at the Center of Rhode Island’s COVID-19 Response

Human Services Delivery During COVID-19 (Fifth in a Series) Revising Financial Policies and Practices: Supporting the Nonprofit Human Services Sector

departments

3 President’s Memo Retrofitting Our Structures for the Public Good

25 Staff Spotlight Brandy Whisman, Project Associate, Food and Nutrition Service Partnership Grant 28 Race Equity Champions California Department of Social Services Department Team: Director Kim Johnson; Office of Equity Director Marcela Ruiz; and Civil Rights, Accessibility, and Racial Equity (CARE) Office Chief Maureen Keffner

5 Technology Speaks

Work from Anywhere: Optimizing Mobile Tools for the New Era of Child Welfare

6 From the Field

Collaborative Supervision: A Conversation with Kara Wente

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June 2021 Policy&Practice

Strategic Industry Partners

APHSA Executive Governing Board

Chair David A. Hansell , Commissioner, New York City Administration for Children's Services, NewYork, NY Vice Chair Brenda Donald , Interim Executive Director, DC Housing Authority, Washington, DC Treasurer Reiko Osaki, President and Founder, Ikaso Consulting, Burlingame, CA Leadership Council Chair S. Duke Storen, Commissioner, Virginia Department of Social Services, Richmond, VA Member at Large Rodney Adams, Principal/CEO, R Adams & Associates, Indian Land, SC Affinity Group Chair Vacant Local Council Chair Vacant

Elected Director Derrik Anderson, Executive Director, Race Matters for Juvenile Justice, Charlotte, NC Elected Director Anne Mosle, Vice President, The Aspen Institute and Executive Director, Ascend at the Aspen Institute, Washington, DC Elected Director Katherine H. Park, CEO, Evident Change, Madison, WI Elected Director Dannette R. Smith, CEO, Nebraska Department of Health and Human Services, Lincoln, NE Elected Director Jennifer Sullivan, Secretary, Indiana Family and Social Services Administration, Indianapolis, IN Immediate Past Chair David Stillman, Assistant Secretary, Economic Services Administration, Washington Department of Social and Health Services, Olympia, WA

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Policy&Practice June 2021

president‘smemo By Tracy Wareing Evans

Retrofitting Our Structures for the Public Good

blueprint, with the American people at the center. To make the most of the largest public investment in decades requires that we understand how our federalist structure came to be today, especially through our people-serving systems, such as human services, housing, and public health. It is these systems that provide the best oppor- tunity to finally repair the foundation on which this nation sits and genuinely work toward a just and inclusive society. How Did We Get Here? Not since Roosevelt’s New Deal has there been such a broad and expan- sive set of national investments in “the general welfare,” as envisioned by Article I of the Constitution. It was the New Deal that created much of the structure under which we still operate today, including the national agency

constant work in progress, functioning on a usually noisy and messy construc- tion site, and occasionally brandishing a fresh coat of paint. All the while, no matter what work is done to the structure, the foundation underneath remains unsettled—flawed in its original design, rooted in the inequi- ties of a nation founded on the land of indigenous communities and the labor of enslaved people, yet claiming to center its power in the people. The time is now to reset the founda- tion if we are ever to make good on Lincoln’s description of a “government of the people, by the people, for the people,” and, become a better union. As federal, state, and local governments implement the $1.9 trillion American Rescue Plan Act (ARPA) on the heels of the $2.3 trillion Coronavirus Aid Relief and Economic Stimulus (CARES) Act that preceded it, we need all levels of government to renovate from the same

Recently, in my role as a fellow of the National Academy of Public

Administration (NAPA), I was asked to share my reflections on federalism through the eyes of the human services sector. A fundamental question … and one, in retrospect, I haven’t thought nearly enough about over the course of my career despite working squarely within it. In taking a close look at our federalist system, I am struck by the community-driven innovation that only our federalist system can yield, while being keenly aware of its many detours and systemic flaws. It was a revealing exercise for me and I hope reading it will spark your own thinking and approach to the opportunities before us. F ederalism is integral to our democ- racy. Our decentralized governance system—distributed across multiple layers of government—stands like a building always under construction, a

See President’s Memo on page 24

Image via Shutterstock

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Vol. 79, No. 3

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Policy & Practice™ (ISSN 1942-6828) is published six 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 © 2021. 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

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Policy&Practice June 2021

technology speaks By Lauren Hirka

Work from Anywhere: Optimizing Mobile Tools for the New Era of Child Welfare

T hink about the last time your phone failed you. Maybe you lost Wi-Fi connection in the middle of using Google Maps and suddenly had to navigate on your own. Or maybe cell service was unreliable and your call got dropped after you’d been waiting on hold for 15 minutes. Frustrating, right? Now, imagine that same frustration as a child welfare caseworker in an already stressful situation where you need to quickly capture evidence that a child’s safety is at risk or complete a service referral form before leaving a family’s house. If your technology fails, the situation is no longer just frus- trating, but counterproductive to the important work being done. This scenario underscores a key question that emerges as working from anywhere becomes the norm in child welfare: if mobile solutions provided to caseworkers aren’t optimized to work when, where, and how they do, why offer them in the first place? Welfare Caseworkers Do Child welfare agencies have had to pivot multiple times over the past year to support and sustain a remote work- force, while enabling caseworkers and clients to connect in new and different ways. Now, agencies must have the right technology in place to mobilize case and client information so that workers can both make sense of it and use it to help others. User-centric mobile technology should be designed to give a worker exactly what they need when they MobileTechnology that Works the Way Child

need it—no more, no less. Looking at this through a child welfare lens, it includes features like: n Complete forms from anywhere. Caseworkers need the ability to immediately get consent, complete safety plans, and make referrals. When forms can be completed with a family, signed electronically, and submitted from a mobile device during a visit, families get services faster and are more engaged because they are collaborating with the worker in that moment. n Digitally hand off work. Facilitating digital collaboration between case- workers, coworkers, and supervisors is especially helpful for teams working remotely. For example, if a worker can send a form directly to their super- visor to sign and send back, they can minimize delays for the family while helping the agency meet required timeframes for case closure.

n Autosave progress. Beyond allowing caseworkers to access all their forms, a mobile solution should also autosave progress. That way a caseworker can start a form in the office or at home and then pick up where they left off once they’re with the family, which further helps them streamline services and save their own time for high-value work. n Make information easy to capture. Quickly capturing photos, documents, audio, and video during home visits is critical. Not only should caseworkers be able to easily capture this information using their mobile device’s camera, but also categorize it and add notes in the electronic filing structure so other workers or supervisors can easily retrieve the information as soon as it has been captured.

See Work from Anywhere on page 25

Image via Northwoods

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from the field By Molly Tierney and Kara Wente

Collaborative Supervision: A Conversation with Kara Wente

M olly Tierney has observed state-supervised, locally admin- istered child welfare systems from two vantage points: as head of a city agency and as Accenture’s Child Welfare Lead in North America. “This model can be a challenge,” Tierney says. “The state sees things one way and they’re right. The counties see things another way and they’re also right.” In working with the State of Ohio, Tierney observed that Kara Wente , Assistant Director of Human Services, and her team are excelling at making the model work. Tierney invited Wente to share her insights on engaging with and delivering value to counties. What follows are excerpts of that conversation. Tierney: Kara, I’ve noticed that you’re finding a pathway to partnership with Ohio’s counties. What’s making that possible? Wente: I think the most important part of any relationship is recognizing your role. Yes, we have to do the job of state supervision. But our role is also to build relationships and offer value to our counties—whether that’s inter- preting a policy or providing guidance or helping in the workforce space. For example, while I don’t hire for counties, I can provide excellent training to make them feel supported. I can provide some ideas around reten- tion or job sharing. That’s some of what we’re doing now: striving to alle- viate administrative burden for locals because we want them in the field, working with families and kids and making sure they’re safe.

know that we’re not just here to super- vise. We’re here to support. And we hope that when we do have to super- vise, we get good results. Most important, we keep letting them know that we’re willing to try things, evaluate, and change course. We have never expected to get it right the first time. We do a lot of phased approaches and pilots as a way of building buy-in, showing a return on our investment, and demonstrating that we’re willing to make changes if something doesn’t work. Tierney: What are some of the lessons you’ve learned along the way? Wente: I spent many years on the public assistance side, where I always steered clear of children’s services. Candidly, children’s services used to scare me. I’ve now realized that had I

We also have two strong county partners in the Ohio Job and Family Service Directors’ Association and the Public Children Services Association of Ohio. We generate a lot of ideas working with those associations and their executive committees. With these relationships, it’s not the state coming up with an idea and pushing it to the county. Instead, we’re talking to them, hearing their needs and saying, “OK, here’s what we may be able to do. Help us prioritize.” Tierney: What have you noticed about how the counties are responding? Wente: At first, we probably over- engaged and over-communicated. We continue to communicate frequently because we want them to keep hearing the same message. We want them to

Illustration by Chris Campbell

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Most important, we keep letting themknow that we’rewilling to try things, evaluate, and change course.We have never expected to get it right the first time.We do a lot of phased approaches and pilots as away of building buy-in, showing a return on our investment, anddemonstrating that we’rewilling tomake changes if something doesn’t work.

initiatives like Help Me Grow, Parents as Teachers, and Healthy Families America. And our Department of Youth Services has some of the evidence- based practices we’re leaning into for our Family First work. Tierney: Imagine it’s 10 years from now. Everything has gone perfectly with your organization. What does child welfare in Ohio look like? Wente: I want to see our network grow, which sounds somewhat odd because you usually want your caseload to shrink. Let me clarify: I want my custody caseload to shrink. But I want the families I’m engaging with to grow—and I want our cross-collabora- tion efforts to be robust at the state level. I want the community networks to be thriving, with families proactively reaching out for whatever supports they need. Families know they can come to their local community hub to get help with work, health care, child care, or behavioral health services. When families get engaged sooner, we can significantly reduce the number that reach the point where we’re taking custody.

disabilities. We have pulled those partnerships into our children’s service space. They’ve pulled us into theirs. And that has yielded some really good outcomes from the stand- point of prevention. We’ve learned that we don’t have to be the experts at everything. Our state agency partners have multi-systemic therapy and family functional therapy and great ways to set that up. Our Department of Health also has great

been involved earlier on, I would have seen the connections and the fact that public assistance is a pivotal, almost preventive service for child services. So, one of my personal epiphanies has been to eliminate those silos in my own mind. Breaking down silos across agencies has been another lesson. We’ve leaned into our sister agencies, including Medicaid, mental health and addic- tion services, and developmental

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June 2021 Policy&Practice

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All Aboard Toward Thriving Families Strategies to Keep Early Intervention and Prevention on Track By Kelly Harder and Sean Toole

A

s kids, we both loved trains. Watching them shipping grain out on the prairies or riding

them into Grand Central Terminal was a thrill. They are engineered to manage incredible loads with their powerful engines and their rails arc gracefully across the landscape, beckoning to destinations far beyond. Child welfare agencies, like trains, are tasked with enormous responsi- bility and expectations. They pull the railcars of practice and support as they chug forward on policy tracks that crisscross the child welfare landscape.

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stakeholders and influencers, followed by facilitated workshops to reimagine how the community might work together to achieve new and desired outcomes. Human-centered design can be used to tackle the big challenges in our systems; it requires your commitment to engage all of the groups that need to act to support your policy and practice goal. These include: n clients (i.e., families, and kids you serve) n direct-line staff and supervisors n the communities n the stakeholder groups that impact your practice It is important that you be inclusive in whom you involve—a cross-section that represents the diversity of the people you serve, ensuring that the decisions shaping the future state of child welfare are made with a focus on equity. 2. Ensure you have the capacity needed to power and implement ideas How often has a practice improve- ment failed to deliver the improved outcomes that were identified and promised? Or an IT system failed to deliver the hoped-for change? Unfortunately, these improvements often underperform or fail because not enough attention is given to the amount of capacity needed by a child welfare agency to accommodate the desired changes. Instead, we tend just to load more weight and railcars onto the engine with the hope our agency can handle the added work without giving much thought, if at all, to the processes that are actually needed to support the desired change. While a new set of ideas and recom- mendations might be amazing, the results of the best human-centered design process will not happen without the engine or system capacity to deliver that experience. Capacity allows systems to give staff the greatest gift of all: time. It is with additional time that Family First plans across the country can become a reality and families will thrive. The only option you have to find capacity without additional resources (i.e., money, staff) is either to stop

Today’s child welfare train is working as hard as ever, with more weight—tasks, oversight, budget limitations, and expectations—con- tinually being added, and its network of policy tracks becoming increasingly more complex. The positive national movement, since the passing of the Family First Prevention Services Act (FFPSA) toward increased efforts on earlier intervention and prevention, to assure all kids and families can thrive, is the latest addition of railcars connecting to our agency train. Any forward motion toward this new reality where families thrive, however, could be threatened if the load—such as alternative/differential response, not placing kids out of challenging but safe homes, increased depen- dency on community-based in-home parental skills and other family needs, enhanced staff training around trauma, Whole Family 2-Gen, person- centered, and other approaches—is not properly accommodated. To prevent all this exciting and important prevention work from derailing before it gets started, we must be very deliberate in our actions. To realize the benefits and desired impact that early intervention and

prevention offer, we propose the fol- lowing two strategies: 1. Engage those you serve to reimagine your work With the implementation of all this newly energized internal and necessary community-based prevention work on the horizon, we really are at an optimal point and time in our human services field to reimagine our work and make the changes necessary to modernize how we deliver services and meet the needs of children and families who des- perately need our help. Taking a very human-centered and intentional approach to designing the systems and solving the big problems in child welfare requires much more engagement with clients, community, and staff than we typically do. Today we pass a policy, define a practice, hoping to train and fully prepare staff, then go tell youth and families we know what will work best in their situ- ation and lives. Primary prevention is focused on community-based early interven- tion and prevention-based services and interventions. To do all we can to assure families are thriving, we must take the time to authentically under- stand and address whom we serve, why we serve them, and what the experience is like for all involved. This is what human-centered design is all about: developing solutions to identi- fied issues by involving the human or consumer perspective in all steps of problem solving. It is an ideal approach that moves us from our current, system-centric, vertical model of permission and approval-based operation built on 40-plus years of thought and knowledge, and toward a more “cus- tomer-driven” horizontal engagement. It allows you to address your system and all those involved in it, rather than focus on program by program, chasing symptoms. With client, community, and staff input, you can establish early inter- vention targets such as how we can reduce the number of families that are engaged with the child welfare system. You can then develop the interaction and experience models and the needs assessments of key

Kelly Harder is a Consulting Partner in the ChildWelfare Practice at Change & Innovation Agency (C!A).

SeanToole leads the ChildWelfare

Practice and serves as Client Partner at Change & Innovation Agency (C!A).

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even worse, however, is embarking on a human-centered design effort with intentions of using process improve- ment to create change and then not following through. We cannot stress enough that if you are not confident you will have adequate or increased capacity to implement and sustain any rec- ommendations made as part of a human-centered design effort, then you will be better off not to pursue or undertake a human-centered design project at all. When you engage staff and others to share their ideas about what is needed and how a process can be improved, it creates an expec- tation that action will be taken. If you do not, or cannot, take action due to capacity challenges, it makes those you engage feel unvalued and creates a high level of frustration and disappointment. Reaching our Destination In child welfare, policy, people, practice, and processes must work hand-in-hand to optimize the outcome of thriving families as illustrated in the diagram above. Our policies (“tracks”) and practice (“railcars”) are our “intention,” what

we want to occur—the stated and desired outcomes of what we wish to accomplish. We rely on people to enact the work to achieve our intention and it is they who will benefit from it. Process is “how” it all happens; it’s the engine of our train, and this is where the greatest potential lies to unearth capacity. Only when you unleash the innovation and engagement of the people, and have the necessary capacity to do so, can you turn inten- tion into action to achieve your practice and policy goals. There is no doubt that many new primary, secondary, and tertiary services are being developed that offer great promise and can reshape the child welfare landscape with a new- found focus on early intervention and prevention. By committing to a human- centered design approach in support of process improvement, you are giving Family First a fighting chance to succeed and an opportunity to make meaningful impact in child welfare. Our families and children deserve this chance. It’s up to each and every one of us to help keep the train running smoothly. Together we can get to our destination—more thriving families. All aboard!

doing certain things, many of which, if not most, are regulated by policy or law, or to reimagine how we manage the flow of the work. This is where process improvement comes in and can enable the hope of improved design. Processes are the engine of how work gets done in an agency. To make the engine more powerful—and regain the capacity needed to carry out what needs to be done—we must look where our current approaches are robbing us of time. Then we need to make that work visible and more consistent so it can be actively managed. This may feel unnatural in our practice-focused agencies, but it is essential because we know there is ample opportunity to capture capacity, reallocate it, and ensure the successful implementation of FFPSA. With this newfound capacity, agencies will have time to focus on the tasks fundamental to early intervention and prevention, like supporting families to allow children to stay in their homes or to conduct comprehen- sive relative searches. Process improvement is a critical, not an optional, step. Unfortunately, it is one we see time and again being mini- mized or completely missed. What is

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June 2021 Policy&Practice

Designing Empathetic and Inclusive Health

and Human Services Putting resident needs and perspectives at the center of Rhode Island’s COVID-19 response

n the fall of 2020, the State of Rhode Island was struggling with a situation shared across states: rising COVID-19 case volumes, fatigued residents, and increasingly evident health inequities. The state had been swift to take centralized action to combat the pandemic with widespread campaigns, mandates, and newly established resident services. They could pinpoint risky behaviors, including social activities and settings associated with spread. The data and ana- lytics were increasingly clear, but a broader question emerged: what motivated risky behaviors? How could the state better reach those individuals at greatest risk of becoming either gravely ill or a super-spreader in vulnerable communities? After moving at breakneck speed since By Melissa Geissler and Gorham Palmer I

pandemic onset, the state realized it needed to understand more about resi- dents’ unmet needs and perceptions. They needed a new lens to consider interventions around topics like contact tracing, case investigation, testing, quarantine, and isolation. They wanted to hear directly from Rhode Islanders working in their stores and factories, attending their universities, teaching in their schools, and living in high-density communities. These residents’ perspectives would lend valuable insight into the reframing of critical interventions and opportunities to better control the spread.

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Chart 1

and contractors had been guiding a set of interconnected initiatives and services, testing and tuning to meet the dynamic pandemic conditions over the past nine months, while supporting the state’s strategic goals. Each individual held a piece of the puzzle, a set of hypotheses on what was working well and what needed to change. Through a series of 1:1 inter- views, these individuals shared powerful anecdotes about Rhode Island residents, communities, and cultural consider- ations. They highlighted the growing health inequities and the desperate situation to do more to reach indi- viduals reticent to accept state-provided services. This became the canvas upon which researchers and designers built out a structured program to uncover valuable insights for the state’s response. Developing Empathy for Rhode Islanders: Conducting the Research The team launched into a set of mixed method research practices, particularly focused on populations within high density, K–12 education, university, and small business settings. This included evaluating the existing data on population trends, behaviors, and risky practices as well as insights

The Governor and her Directors of Health and Human Services com- mitted to bringing this voice into the state’s COVID response. They worked with a team of IBM researchers, strate- gists, and designers to construct a rapid insight generation program that supple- mented their existing intelligence and operations. Together, the State of Rhode Island and IBM kicked off a human- centered research and design initiative. The work was designed to complement the ongoing efforts spanning multiple agencies, the National Guard, and con- tractors united in their efforts to support Rhode Island residents. Within days, initial insights surfaced. Each week, a more complex picture emerged to inform state-supported touchpoints. Ultimately, a new viewpoint to explore and evaluate opportunities sharpened, providing a repeatable framework to guide future program design aligned to resident needs. Understanding the Context Human-centered design offers a powerful mechanism to bring an outside-in perspective, but it is exponentially more successful when grounded in current state pain points and desired outcomes. A diverse team of state leaders, community partners,

Melissa Geissler is a Partner leading IBM's design studio for Public Market clients.

Gorham Palmer is a Distinguished Designer lead- ing IBM's North America User Experience Practice.

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Chart 2

organized a set of attitudes, needs, and behaviors that spanned the resident population. Mapping these arche- types against adherence and trust in guidance further influenced the subse- quent ideation. The state could make a greater impact on those with some base level of trust, influencing them in the direction of adherence to desired health protocol. Specifically, they could focus on those major moments that matter—what do you do when you find out you tested positive? How do you keep your housemates safe and take care of your basic needs in isolation? Exploring New Opportunities Together, the State of Rhode Island and IBM applied their learnings to identify new strategies and solutions. We looked at opportunities through the lens of being empathetic to real resident needs and empowering communities to take on more responsibility. The empathy for Rhode Island residents was equally relevant in new ideation and the evolution of existing touchpoints. For example, as the state prepared to launch its first resident-facing applica- tion for case investigation and contact tracing, the product team had a new

personas, focusing on how somebody might move between categories and behaviors within a broader ecosystem. For example, Rosa highlighted the story of a high school student living in an urban, multigenerational home and working at a local restaurant. Rosa, her siblings, parents, and grandparents weren’t in a position to uniformly follow state guidelines. They needed to go to work, they couldn’t quarantine safely in their home, and they were nervous about accessing state-provided services. Rosa existed in a complex ecosystem, affected by all facets of the commu- nity around her. For her to engage in the desired behavior, touchpoints and services needed to be designed for her needs, particularly in her most vulner- able moments (see Chart 1). The representative personas and journeys opened up new insights. While the state could recalibrate aspects of its strategy to meet Rosa’s needs, it still needed to think more holistically about the individuals and moments it could influence at scale. The combination of moments that matter and archetypes helped establish a working framework to consider resident needs in strategic design (see Chart 2). The archetypes were distilled from the research and insights to date. They

from existing touchpoints, including a recently launched virtual agent and a robust contact center operation. It added a diary study that captured more than 100 videos of Rhode Islanders, within target demographics, going about their daily lives and experiences with the pandemic. Additionally, it included targeted interviews with dozens of community leaders, business owners, students, teachers, principals, administrators, front-line workers, and contractors. Each story and experience brought new depth to the resident’s per- spective, surfaced barriers to complying with state protocol, and highlighted opportunities to better connect reimag- ined services within communities. The Ecosystem: Mapping Connections and Building Out Archetypes As the multidisciplinary team analyzed research data points, the resident ecosystem and a set of resident archetypes emerged. It was no longer possible to look at K–12, high-density, and small business as independent categories. The majority of individuals fit more than one category, and many exhibited different behavior depending on their setting. The team looked at curated stories for representative

See Empathy on page 26

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Policy&Practice June 2021

for Designing TRUST Using human-centered design to rebuild trust and improve mission impact

By Amy Freckmann, Tiffany Dovey Fishman, R. J. Krawiec, and Kenneth J. Smith

T

comply with their responsibilities, the case- worker needs to earn the trust of both. CPs won’t ask for child support services unless they feel a sense of trust in the process and that there will be a positive outcome. Without trust, CPs required to cooperate with the child support program will be reluctant to divulge all the nec- essary information, such as how the child was conceived and how to find the NCP. Neither CPs nor NCPs may be willing to divulge personal details unless they trust that the caseworker will not judge them, and that the agency will not misuse their personal or financial data. Failure to provide such information can lead to delays or failure in establishing paternity, a child support order, and payment on time and in full.

rust is what brings us, as humans, together. It’s the essential bond that underpins the relationships we have with one another, but also the relationships we have with government agencies and programs. For health and human services (H/HS) and labor programs, trust affects how program partici- pants behave, in ways that help to determine how effective and efficient the programwill be. Trust impacts everything, from howwell enrollees comply with policies and due dates, to howwilling they are to participate in programs, to how likely they are to use digital self-service tools. Take child support, for example. To encourage the custodial parent (CP) and noncustodial parent (NCP) to cooperate, communicate, and

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A Crisis of Trust Trust in the federal government has declined steadily over the last six decades, from a high of 77 percent in the mid-1960s to a near historic low of 20 percent last year. 1 Even trust in state and local governments, which have traditionally enjoyed a higher level of public confidence, significantly declined during the pandemic. 2 At the outset of the pandemic, many human services programs, already strapped for funding, buckled under an unprecedented surge in demand. At the same time, human services programs were required to quickly implement new federal programs and mandates and change benefit program policies. State H/HS and labor organizations did what was necessary to respond quickly. Too often that meant making changes based on the immediate needs of the govern- ment agency administering the program rather than designing technology, pro- cesses, and communications based on the needs of the people they served. Rebuilding public trust is imperative if H/HS and labor programs are to deliver on their respective safety net missions. The Four Trust Signals Our research suggests that trust can be built and sustained by demonstrating two foundational attri- butes—delivering on the promise, all the time, with competence , and doing so with good intent . Competence refers to the ability to execute. Intent refers to the meaning behind a leader’s actions. The two foundational attributes of competencemanifest themselves in four unique trust signals: humanity and trans- parency —which demonstrate intent, and capability and reliability —which demon- strate competence (see Figure 1). Health and human services and labor agencies can instill confidence and improve public trust by focusing on four areas: n Humanity addresses the perception that an agency genuinely cares for its constituents’ experience and well- being by demonstrating empathy, kindness, and fairness. n Transparency indicates that an agency openly shares information,

motives, and choices related to policy, budget, and program deci- sions in straightforward language. n Capability reflects the belief that an agency can create high-quality programs and services and has the ability to meet expectations effectively. n Reliability shows that an agency can consistently and dependably deliver high-quality programs, services, and experiences to constituents across platforms and geographical locations. Designing for Trust Using a human-centered design approach that embraces the need for trust can provide a foundation for improving mission impact. Trust- building is not a one-off activity. It should be continuous and action- oriented. Building trust often requires changing the status quo and being laser-focused on quickly incorporating changes based on constituent experi- ence and perception. What can H/HS and labor leaders do to start building greater trust? 1. Establish their agency’s trust baseline. Conduct research to establish an agency’s trust baseline. The goal is to understand how users prefer to engage, what their biggest pain points in “doing business” are, and how they perceive programs and services across each of the four trust signals. Start by looking at your agency’s current feedback, reach out to community partners, stand up a survey. There are lots of ways to engage. The most important thing is to get that unvarnished voice of the customer and key stakeholders. Take unemployment insurance (UI), for example. Our research shows that humanity and transparency are the lowest-rated trust signals. Often one of the most challenging experiences UI claimants have is with overpayments, which occur when claimants are paid more than they are entitled to collect. While overpayments can result from fraud, they can also happen when people make honest mistakes due to confusion and a lack of clarity in the process or in the data that are sought. Often UI claimants don’t realize that they need to stop filing for UI when they go back to work, not when they

Amy Freckmann is a specialist leader in Deloitte Consulting LLP’s Customer Strategy and Applied Design practice.

Tiffany Dovey Fishman is a senior manager with Deloitte’s Center for Government Insights.

Kenneth J. Smith is Deloitte Consulting LLP’s Human Services Transformation leader and national leader and principal for its Integrated Eligibility practice. R. J. Krawiec is a Deloitte Consulting LLP principal and the leader of the Government & Public Services Advertising, Marketing, and Commerce practice.

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Figure 1. Four trust signals contribute to greater trust

public trust. Because trust is a percep- tion, government institutions should demonstrate competence and intent to rebuild trust. The four trust signals of humanity, transparency, capability, and reliability can help H/HS and labor leaders build greater trust. These signals can be measured, tracked, and improved—helping to make trust central to the functioning of H/HS and labor agencies. About Deloitte Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee (“DTTL”), its network of member firms, and their related entities. DTTL and each of its member firms are legally separate and independent entities. DTTL (also referred to as “Deloitte Global”) does not provide services to clients. In the United States, Deloitte refers to one or more of the US member firms of DTTL, their related entities that operate using the “Deloitte” name in the United States and their respective affiliates. Certain services may not be available to attest clients under the rules and regulations of public accounting. Please see www.deloitte.com/about to learn more about our global network of member firms. This publication contains general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor. Deloitte shall not be responsible for any loss sustained by any person who relies on this publication. Reference Notes 1. Pew Research Center, (September 14, 2020) Americans’ views of government: Low trust, but some positive performance ratings. https://www.pewresearch.org/ politics/2020/09/14/americans-views-of- government-low-trust-but-some-positive- performance-ratings/ 2. Jackson, C., & Newall, M. (November 24, 2020). Axios-Ipsos Coronavirus Index survey: Most Americans report changing Thanksgiving plans. https://www.ipsos.com/en-us/news-polls/ axios-ipsos-coronavirus-index Copyright © 2021 Deloitte Development LLC. All rights reserved.

the CS agency is neutral, working to promote the financial security and well-being of the child by establishing a child support order based on an unbiased assessment of ability to pay, using enforcement tools tailored to the NCP’s situation, and referring the NCP to other agencies that can help them meet their responsibilities. Using tools like collaborative design, end-user evaluative testing, and rapid proto- type iterations can lead to a balanced solution that takes into account the humanity of the solution for all parties. 3. Monitor trust, prioritize impact. As you develop a nuanced under- standing of trust along the four signals, you can identify relationships between trust perceptions and corresponding human behaviors. Our research shows that long-term care services, for example, score rela- tively high on humanity, while they fare lower on reliability. This percep- tion of low reliability may translate into increased call volume and churn in service participation, which can lead to lower participant satisfaction, higher cost to serve, and ultimately, reduced individual well-being. Health and human services and labor agencies should consider investing in building methods and feedback mechanisms to measure progress on key trust signals and use this feedback to adjust strategies and make meaningful changes in commu- nication, processes, and culture. Looking Ahead Government institutions today, across all levels, often struggle to build

collect their first paycheck. Fact- finding documents present another common source of confusion. As part of the verification process, UI claim- ants may receive two to three-page documents, containing legal and policy jargon, that don’t always make clear that the claimant needs to take action and supply verification mate- rials. Similarly, employers may receive the same type of documents to verify worker claims, which include policy jargon and a fast turnaround time, along with charging statements. To identify areas for improve- ment, UI agencies should consider probing feelings about the accuracy of communications, word choices, and understanding of policies and program rules. 2. Collaborate, evaluate, and iterate on solutions to strengthen key trust signals. Engaging end users does not end with the initial research. A design-led approach brings end users into the room with public servants and other stakeholders to engage in rapid prototyping, testing, and iteration of solutions with the people for whom they are created. The focus should be on activities, actions, policies, and behaviors that bolster an agency’s most relevant trust signals. In child support cases, there is often an erosion of trust between the CP and the NCP, and the child support process or agency is wielded as a weapon against the NCP. When the intent of the program is in question, it can be difficult to get to cooperation, communication, and compliance. The CP and NCP both need to trust that

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Revising Financial Policies and Practices: Supporting the Nonprofit Human Services Sector

By Katy Lederer, Phil Basso, and Barbara Armstrong

National Imperative: Joining Forces to Strengthen Human Services in America , 1 was a groundbreaking report published by the Alliance for Strong Families and Communities and the American Public Human Services Association. It highlighted the need for greater collaboration in the human services ecosystem among nonprofit human services, community-based organizations (CBOs), government agencies, and philanthropy to strengthen overall human services capacity and promote social and economic mobility for the people and communities they serve, especially for people of color. Yet many CBOs, whose proximity to community is the closest, have them- selves been caught in a cycle of poverty. A

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agencies frequently pass these con- straints on to CBOs in the form of underpaid, restrictive contracts. Forced to fill the gap with philan- thropic dollars, CBOs typically turn to private funders. Yet these donors have their own constraints that contribute to the nonprofit poverty cycle, including limiting how and when CBOs can use grant funds; not covering administrative costs; and limiting funding for operations. Even when public agencies and private funders drive innovations that stream- line their operations and make it easier for customers and contractors to work with them, it is often from a “more with less” resource manage- ment approach. Yet for millions of Americans, human services CBOs are a neces- sary lifeline. Fueled by an enormous sense of responsibility to meet the needs of their communities and their staff, many CBO leaders make do with insufficient cash reserves, limited capacity, and little to no financial means to drive innovation. Businesses in the nonprofit sector require the same management of revenues, operating expenditures, and cashflow as for-profit companies. Yet the perception is that a non- profit’s budget should not include an allocation of funding for its baseline operations. CBOs must spend signifi- cant staff time laboriously reporting on every dollar spent for each program they serve, as opposed to continuously rethinking how they might increase their impact through upstream solutions, their services, and return on investment. For-profit corporations and businesses would not tolerate, yet alone survive, oper- ating this way. With the onset of the pandemic, the number of families needing support has risen exponentially. But the pandemic was not the onset of the inherent problems with current financial policies and practices within the human services ecosystem. Rather, COVID-19 triggered greater transparency into the challenges and consequences that arise when funding Through the Lens of the Pandemic

Before the pandemic, more than 40 percent of human services CBOs lacked liquidity to meet their short- term obligations and 30 percent had cash reserves covering less than one month of expenses. Since the pandemic, that situation has only worsened. A report just released from Independent Sector, shows how many nonprofits are struggling to survive, with 7 percent of nonprofits estimated to close due to the pandemic and one million nonprofit jobs lost. As CBOs face increased demand for services, strengthening CBO financial capacity is critical. Public agencies are often a primary contractor to CBOs. 2 Burdened by financial constraints and the need to manage inflexible policies, regula- tions, and funding streams, public

About This Series

This is the fifth in a series of six

structures are inequitable, under- funded, and not outcomes-centered to deliver services that bolster commu- nity health and well-being. In Rochester, Minnesota, for example, in response to supporting the COVID Food Assistance Program (CFAP), Channel One Regional Food Bank 3 sought partnerships with Family Services Rochester and others to ensure that food boxes are picked up and distributed within a 14-county region. With no guarantee of increased payment for their increased volume of services and cost, Channel One has applied for additional financial support Generative Partnerships ; Essay 3, Why Regulatory Modernization Is Essential to a Nimble and Adaptive Human Services System ; and Essay 4, Service Delivery: Why the Human Services Sector Must Shift to Measuring True Outcomes , are available in the August and December 2020 issues and February and April 2021 issues, respectively. essays focusing on the adaptive and disruptive challenges that the COVID-19 pandemic brings and the steps we can take as a nation to rethink our systems in the wake of this crisis. The goal of the series is to serve as a call to action and roadmap for leaders in government, health and human services, and the philanthropic sector to address the challenges our nation faces and move toward a system that will respond not only to this challenge but the ones to come. Essay 1, How the COVID-19 Pandemic Can Lead toWidespread Changes in Our Health and Human Services Systems; Essay 2, Achieving High Impact in Health and Human Services: The Importance of

Katy Lederer is a sales and marketing executive at the Alliance for Strong Families and Communities.

Barbara Armstrong is a development director at the Alliance for Strong Families and Communities.

Phil Basso is a former organiza- tional effectiveness consultant with the American Public Human Services Association.

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