Policy & Practice | February 2022

The Magazine of the American Public Human Services Association February 2022

Building a Modern Health and Human Services Workforce for the Future A MORE RESILIENT TOMORROW

TODAY’S EXPERTISE FOR TOMORROW’S SOLUTIONS

www.aphsa.org

contents

Vol. 80, No. 1 February 2022

features

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12

The Child Care Workforce and Family Stability A Model of Resilience During COVID-19

Emerging Stronger When the Public Health Emergency Ends How Agencies Can Make Room for the Upcoming Wave of Renewals and New Customers

departments

3 President’s Memo

16 Research Corner Equity and Access: Ways to Reduce Administrative Burden and Center the User 18 Staff Spotlight Antonette E. Russell, Human Resources Director

The Human Services Workforce: Ingenuity, Intentionality, and Adaptability

5 Technology Speaks

Capacity for Change: Is the Child Welfare Workforce Equipped for Race Equity?

18 In Memoriam Dr. Linda A. Kauffman Wolf, former executive deputy director of APHSA

6 From the Field

Serving Our State Together: Investing in Community Collaboration

24 Association News

7 From Our Partners

New Board Members Join APHSA Leadership

How Child Welfare Agencies Can Help Reduce Secondary Trauma—and Increase Retention

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February 2022 Policy&Practice

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, NewYork City Administration for Children’s Services Treasurer Reiko Osaki, President and Founder, Ikaso Consulting 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 Kathy Park, CEO, Evident Change Elected Director

DIAMOND

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 Leadership Council Representative Justin Brown, Director, Oklahoma Department of Human Services Local Council Representative Antonia Jiménez , Director, Los Angeles County Department of Public Social Services

PLATINUM

SILVER

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Policy&Practice February 2022

president‘smemo By Tracy Wareing Evans

The Human Services Workforce: Ingenuity, Intentionality, and Adaptability

I write this column a few weeks into the new year, feeling both excited about the possibilities ahead and weary as we continue to witness the cumulative toll of ongoing hardship in the nation. We chose the theme of this first issue—the human services workforce—with purpose. There is no greater resource on which we depend to deliver effective services and supports for people experiencing adversity. In our first Cornerstone series, we captured the fundamental role the human services workforce plays: The human services workforce is an essential part of the skilled construction crew that allows us to build well-being. Like a registered contractor who knows the best tradesman and tools for the job, the human services workforce helps assess the need and connects people to services and supports that will work for them. To unleash the full potential of the workforce, we must ensure they are healthy and well, and have the modern tools they need to do their jobs. We must create more opportunities for workers to spur innovative approaches and to partner with families to co-create solu- tions together. And, we must promote workplace cultures and environments where staff and community work trans- parently together to build the muscle we need to redesign our systems and put an end to structurally driven inequities. Put another way, absent a workforce that is healthy and well-equipped, it is nearly impossible to achieve the outcomes we desire for communities. How best to support the human services workforce is not a new

progress has been incremental and too often fleeting. Notably, these challenges are not unique to the United States. Just last week, I was on a call with colleagues from the European Social Network (ESN), a membership network in the European Union (EU), and workforce challenges are top of mind for govern- ment leaders there as well. Like the United States, the challenges have been exacerbated by the direct and indirect impact of the COVID-19 pandemic, as it has stretched demand on both health care and human services systems,

issue—indeed, it has been a top contender of what keeps agency leaders up at night for as long as I have been asking that question of our members. Health and human services agencies—both public sector and com- munity based—struggle to recruit and retain quality staff at all levels; equip them with the necessary training, tools, and resources to do the job; and keep them safe and well-supported. Over the year, agencies have deployed a multitude of recruitment and reten- tion strategies, training approaches, technology investments, and trauma- informed support systems. Some have had more success than others, but

See President’s Memo on page 19

Image via Shutterstock

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February 2022 Policy&Practice

Vol. 80, No. 1

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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 © 2022. 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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Advancing Race Equity: How to Achieve Social and Economic Mobility Shifting Power to People and Place: What It Takes to Drive System Change Navigating Upstream: Achieving Better Health and Well-Being Through Prevention Innovating for the Future: Maximizing Modern Tools and Platforms

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Policy&Practice February 2022

technology speaks By Molly Tierney

Capacity for Change: Is the Child Welfare Workforce Equipped for Race Equity?

F or child welfare leaders, the phrase “workforce capacity” often connotes efforts to improve caseload allocation or case- worker training with an eye toward greater efficiency. The trouble is, child welfare is not a system that should make cost savings its goal. Child welfare is a system that needs to focus on enabling better results for the families and children it supports. In child welfare,

arguably the most important aspect of

is immersed—and on their own—with the people in the virtual environment. Once headsets are off, participants come together as a group to reflect on and learn from their experiences. Child welfare leaders who are using VR for recruiting, onboarding, and training are seeing results in the form of lower turnover. But how might we use this technology in the fight for race equity? What CanToryTeach Us? Tory is a 13-year-old boy who lives only in virtual reality. Tory identifies as gay, which is creating conflict with his dad, Ben. There may have been some violence between them. Adding to the challenges is Tory’s mom, Cynthia, who is very dysfunctional. While Tory and his family are virtual, their cir- cumstances—and complicated home

life—mirror what many people experi- ence in their real lives. While in the VR headset, the user becomes absorbed in the many facets of Tory’s world. Throughout the scenario, the user chooses from three possible questions to learn more about Tory and his parents. For example, you have a chance to ask Cynthia about her relationship with Ben. You could pose the question as “How’s your rela- tionship with Ben?” or “Is Ben a good husband?” Or you could inquire, “Is Ben Tory’s father?” At the end of the experience with Tory and his family, users come together to talk through a set of survey questions. Using a scale of one to 10, each participant responds to ques- tions, such as “How angry did you find

“workforce capacity” is our collective ability to bring empathy, demonstrate compassion, and deliver support to all families and children. Historically, our country has not per- formed well against that metric. Race bias in our work is a demographic fact, and a focus on efficiency improvements will do little or nothing to change that. How can we do the work of eradicating bias and driving race equity without increasing risks to families and children? I believe part of the answer includes technology tools designed specifically for this purpose. Virtual reality (VR), which lets case- workers practice in a realistic way, is one tool with the greatest potential. Unlike simulation rooms, VR scenarios enable dynamic interactions and a highly personal user experience. When wearing a VR headset, each caseworker

See Race Equity on page 20

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February 2022 Policy&Practice

from the field By Justin B. Brown

Serving Our State Together: Investing in Community Collaboration

T wo years ago, the Oklahoma Human Services (OKDHS) embarked upon a process called

“Finding our True North” in an effort to define the foundational philoso- phies that will drive our work over the coming decade. Each program division built their True North philosophies and the executive leadership team devel- oped nine agency-wide True North priorities that allowed the team to focus attention and limited resources on the work of the entire agency. Executive Leadership True North Priority 2 plants a stake in the ground driving the team to “remove systemic barriers that keep our families from being successful by meeting our cus- tomers where they are to provide needed resources in a more effec- tive manner.” Executive Leadership True North Priority 8 is to “move the agency to a space of prevention, going ‘upstream’ to build a system that supports families with services and resources before they are in crisis.” With those in mind, Oklahoma began to think about the best way to meaningfully deploy the Temporary Assistance for Needy Families (TANF) carryover dollars that, like many states, had begun to accumulate over the last few years. I immediately saw this as an incredible opportunity for innovation and collaboration and asked our team how we could design a process that would provide transfor- mational pathways of hope for families in our state while we partnered with community foundations and nonprofits with aligning interests. Simply put, the answer was to invest in nonprofit organizations that had

collaboration. We have been deliberate in our approach to come alongside the community, ask for feedback, and then listen to their needs. We under- stand solving a problem as complex as poverty will take all state agencies, nonprofits, and faith-based organiza- tions working together, and the agency was eager to leverage the relationships we had been building to create a sup- portive strategy. The agency defined six priority areas that tied back to the four federally

a track record of results, community trust, and aligned missions. That statement by itself does not seem earth shattering. TANF dollars are among the most flexible funds avail- able to states and many states have used those dollars to support nonprofit programs with shared populations. However, building a coordinated, strategic approach that was designed to leverage public–private partner- ships to help the nonprofit sector build capacity to expand and innovate was new territory. The OKDHS has spent the last several years building a culture of

See Collaboration on page 22

Photo Illustration by Chris Campbell/Shutterstock

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Policy&Practice February 2022

from our partners By Danielle Barnes

How Child Welfare Agencies Can Help Reduce Secondary Trauma—and Increase Retention

I n the pandemic, child welfare workers have experienced high levels of secondary trauma. This trauma, isolation, and plentiful higher paying jobs have led many to leave the profession. Government agencies can do more to help. “The pandemic has worn employees out.” That sentiment echoed around the room when I met recently with people from government health and human services agencies around the country. While that may seem a common refrain—think about the news that abounds about the “Great Resignation”—the question at the top of their minds was what to do spe- cifically about child welfare workers quitting in droves. decreased child welfare caseloads, the families and children that child welfare workers have been seeing are among the most traumatized. This is because it is often mandated reporters such as teachers, doctors, and hospitals that are required to report any injury or suspicion of neglect to state agencies for investigation. In normal times, after investigation, a fair proportion of these cases are resolved without any action needing to be taken (e.g., injury due to an accident). But during lockdown when children were not leaving their homes, these types of routine and innocuous reports were not occurring as regularly. That leaves reports of just the most intense and traumatized cases. Reported Child Welfare Cases Have Been More Severe While the pandemic has often

situations themselves have resolved. Add that to the pandemic stress and isolation that we all have been feeling, their own individual and family situa- tions, and a plethora of available jobs in other industries that pay as well or better, and it’s easy to understand why child welfare workers are leaving the field (and why others are reluctant to enter it).

Spending the majority of their time trying to help children and families in the worst situations takes a large mental and emotional toll on child welfare workers. Many have found themselves experiencing secondary trauma, which mirrors the symptoms of post-traumatic stress disorder, and can be character- ized by compassion fatigue, anxiety, isolation, sleep disturbance, and a host of other physical and emotional ailments that may persist long after the

See Trauma on page 22

Photo via Shutterstock

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February 2022 Policy&Practice

The Child Care Workforce and Family Stability

A Model of Resilience During COVID-19 By Choquette Hamilton, Kate Wylde, Natalie Renew, and Meg Dygert

Small Business Child Care Providers Are Critical to Stability for Families As of 2019, more than 1.1 million small business providers (SBPs) were providing care in small centers (25 children or fewer) 1 and in their homes (also known as home-based or family child care) to more than 3 million children from birth to five as of 2019. 2

Why do so many families turn to small child care providers? Three reasons: (1) Accessibility—small business pro- viders are embedded in neighborhoods making them closer to families and easier for those without transporta- tion, (2) Affordability—small business providers typically charge less, and (3) Flexibility—small business providers often offer longer and nontraditional hours. Just as important, parents may prefer a more personal or home-like environment. Small business providers are known for developing strong and trusting relationships with parents and their children by offering care with shared values, culture, language, and child-rearing practices. Systemic Barriers Worsened by COVID-19 Despite their value to the commu- nity, a host of pre-pandemic barriers meant these small business providers had some of the slimmest profit margins in child care with providers personally earning $24,000 per year. 3 The providers behind these essen- tial businesses are predominantly women, half of whom identify as Black, Indigenous, and People of Color. On top of that, an industry built upon systemic racism, based upon free child care provided by enslaved Africans, meant that through the decades, the industry remained underfunded due to the unsubsidized labor from women of color. 4 And, it is women of color like Dr. Choquette Hamilton, founder and CEO of RISE Child Development Center, Inc. who continue to ensure that families have the care they need despite these challenges. RISE is a nonprofit early child care center in central Texas that opened in the midst of the pandemic to help fill the gaps left as other centers closed. As a new provider, RISE was ineligible for some of the original relief funding but has benefited from recent programs such as the Employee Retention Tax Credit, 5 but is hoping for additional support to ensure that RISE continues to meet the needs of the families in their community. When COVID-19 arrived, already under-supported SBPs found themselves in nearly impossible cir- cumstances. However, in the face of all these challenges, home-based child

care providers are the most likely to remain open, despite ongoing strug- gles to achieve full capacity, manage burnout, and make ends meet. Finding Bright Spots of Innovation and Resilience Since the start of the pandemic, Promise Venture Studio has spoken with hundreds of entrepreneurs, public leaders, and early childhood advocates across the country. Through many hardships, they found bright spots of resilience. Below are just a few examples of innovators stepping up to support providers in keeping their businesses sustainable and providing high-quality care to children. Challenge: Providers are struggling to maintain full enrollment. Bright Spot: WeeCare, Jessica Chang, CEO Solution: WeeCare matches parents looking for care and providers with openings and, to ensure that small business providers can thrive, WeeCare goes a step further to help providers relocate to areas with more demand, including securing housing and achieving complete enrollment quickly. WeeCare creates a thriving child care ecosystem—helping families find affordable and convenient care, and helping child care providers earn two to three times more than they would as preschool teachers. Challenge: Providers struggle to access subsidies when only 12 percent of eligible children are enrolled. Bright Spot: Pie for Providers, Chelsea Sprayregen, CEO and Founder Solution: Pie for Providers’ open source software helps child care pro- viders earn more and more predictable revenue from government programs, while creating a more respectful, humane process for claiming and managing this funding. Their software addresses some of providers’ biggest daily challenges, overcoming the most common administrative roadblocks to providers accepting government funds. Find more innovative organizations supporting home-based providers through the Home-Based Child Care Compendium (www.promisestudio. org/hbccn-supports-compendium) co- created by Promise and Home Grown.

Dr. Choquette Hamilton is the Founder and CEO

of RISE Child Development Center, Entrepreneur

in Residence at Promise Venture Studio, and a 2021 Public Voices Fellow of The OpEd Project.

KateWylde is an Associate Partner at Promise Venture Studio.

Natalie Renew is the Executive Director at Home Grown.

Meg Dygert is a Policy Associate for ChildWelfare and Family Well-Being at the American Public Human Services Association.

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Policy&Practice February 2022

toddlers, Black and Latinx families, and those living in homes with low incomes. These caregivers are trusted members of their extended family and commu- nity and are the deliberately chosen child care option for many families. They are also often the caregivers who are available to parents who work non- traditional or unpredictable hours, who want to keep siblings together, and are looking for the most affordable option. During the pandemic, reliance on FFN care increased as schools and child care centers closed. Many FFN caregivers also took on additional responsibilities during the pandemic, caring for more children and for longer periods of time. Many FFN caregivers also supported school- age children in their online schooling while their parents went to work. These added caregiving responsi- bilities, along with increased costs for cleaning, sanitation, and food, placed more strain on these caregivers. Despite being critically important to families during the pandemic, FFN caregivers are struggling and need more support, particularly financial support. FFN caregivers are most likely to be serving low-income and other- wise marginalized families in diverse communities across this country, from deep rural areas to immigrant communities. Vast numbers of FFN caregivers are unpaid. When they are paid, FFN caregivers earn about $8,000 per year for full-time care of one or more children. Those that are paid also struggle to gain predictable, stable funding because the families they serve may also be financially unstable and often unable to pay fully or on time. Because these providers often operate legally but without a child care license, they are disconnected from services that help them thrive, including payment for services, training opportu- nities, and relief measures such as low or no-cost protective equipment. Most FFN caregivers cannot access state or federal child care subsidies. The few who do receive subsidies get pennies on the dollar of what is given to other providers, who are also grossly under- funded. In most places, FFNs cannot participate in the subsidized food

Ways to Support Small Business Providers

for those who are English language learners. LUNA (https://lunalati- nasunidas.com) is one organization working to make licensing (and child care business sustainability) acces- sible for Spanish-speaking providers.

1. Simplify Funding: With no end in sight, many small business providers will not survive the pandemic if additional funding is not made avail- able. However, it is also important to provide funding that is as simple as possible to receive. Due to burnout, many providers will not have the capacity to navigate cumbersome processes. Getting input directly from providers will help to find equi- Services Alliance: Across the nation, we found a promising practice was to reduce overhead costs and make it easier for providers to operate. Through collaboration with pro- viders, administrators can help businesses with critical infrastructure ranging from billing and technical support to mentoring and coaching. Read more about shared services through the work of Opportunities Exchange (www.oppex.org). 3.Establish Partnerships: Working together in public–private partner- ships will ensure that we all emerge from the pandemic stronger and more equipped to address some of the long- standing challenges in the child care system. Wonderschool (www.youtube. com/watch?v=PQb8kDOdz4E), Neighborhood Villages (www.neigh- borhoodvillages.org) , and Let’s Grow Kids (https://letsgrowkids.org) are a few examples of innovators part- nering with local and state leaders. 4.Clarify and Simplify Regulations: Regulations and licensing are typically complicated, especially table and effective solutions. 2.Explore a Statewide Shared

Resilience of Family, Friend, and Neighbor Caregivers

While the pandemic laid bare the many and various challenges facing parents of young children and the child care industry, little has been discussed about the role that family members and close friends played in ensuring our nation’s essential workers could go to work and support their communi- ties during the pandemic. These family members and neighbors, who we call Family, Friend, and Neighbor (FFN) caregivers have been a critical aspect of our child care sector during, and long before, the pandemic. FFN caregivers who encompass a variety of relationships and care arrangements, including providers who offer care to a few children at their home and relatives who come to the home of a child to care for them, are the largest share of nonparental child care of children younger than age five in the United States. In fact, one in five young children is cared for by a grandparent. 6 Based on data from 2019, there are about five million FFN providers caring for about 6 million children from birth to age five. 7 Most FFN caregivers are women and approximately half are people of color. FFN care exists in every U.S. com- munity and is the mainstay of child care for rural communities, babies and

See Child Care on page 21

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February 2022 Policy&Practice

s agencies across the country have been grappling with a new wave of customers seeking help due to the COVID-19 health crisis, they must now prepare for the massive number of existing customers who must be renewed after the public health emergency (PHE) and pandemic waivers come to an end. How Agencies Can Make Room for the Upcoming Wave of Renewals and New Customers A With Medicaid enrollment up 18 percent since February 2020, representing more than 12 million additional individuals nationally, and Supplemental Nutrition Assistance Program (SNAP) enrollment up nearly 15 percent, agencies are simultaneously managing unprecedented enrollment, facing the capacity challenges associated with the end of PHE, and ensuring their service delivery systems align with federal guidelines for conducting renewals, even as those guidelines continue to shift. Medicaid enroll- ment has grown to nearly 84 million individuals nationally, all of whom will need to be reviewed after the end of the PHE. All of this is occurring at a time when labor shortages are making it increasingly difficult to retain and hire staff. By Leo Ribas and Michael Jones EMERGING STRONGER When the Public Health Emergency Ends

Photo Illustration by Chris Campbell

Diagram 1

The Impact of Self- Created Workload Recovering organizational capacity to meet this increased demand requires that agencies clearly understand the practices in service delivery that erode valuable staff time. Our work in 25 state agencies illus- trates the general customer experience that occurs in a capacity-drained agency: a family initiates a request and around 15 to 20 days later the agency decides to either approve and continue services or deny the request. Certainly, some customers get a decision sooner, but others will wait for a decision for perhaps 30 or 45 days. Another common observation that we see in many states is that, on average, from the time the customer submits an initial request until a decision is made, agencies spend about two hours of staff time, collectively, on a single case. What in the process turned two hours of work into a 20-day wait for our customers? This is such an important question because the longer work remains “unfinished” in our systems, the greater the likelihood of the customer interacting with the agency multiple times as they seek to understand the status.

The daunting task of re-engaging customers to ensure those who meet eligibility guidelines continue to maintain services—many of whom may have not updated their contact information for more than two years—will significantly impact and hamper agencies as they work to help families in need. Customers will potentially lose important benefits and agencies’ workload will increase. This workload growth will be larger than the number of customers requiring renewal services. In many states today, for every one customer contacting the agency to access services, four customers are navigating the process— pursuing answers to questions such

as “What is the status of my case? May I reschedule an appointment? I sub- mitted my verification, so when will I get my benefits?” Churn will also be a factor. When customers realize they have lost benefits, agencies will face even more work by responding to calls about the status of benefits, resending requests for information, and pro- cessing new applications for customers who could have remained eligible in the first place. Is it any wonder that human services agencies feel as if they are being tasked with building a plane while it is already in the air? Without a solid plan to increase capacity, this unique set of circumstances will lead to a capacity crisis in all work areas; there simply won’t be sufficient staff bandwidth to handle the increased demand. The influx of customer visits and calls will overwhelm even the best operated service delivery systems in the country.

Leo Ribas is Senior Vice President for Change & Innovation Agency (C!A®), a Vimo® Company.

Michael Jones is Medicaid, SNAP and Safety Net Practice Lead—US for Change & Innovation Agency (C!A®), a Vimo® Company.

Reality Check To get a good indication of the potential opportunity to eliminate self- created workload in your agency, compare the number of applications and renewals in any given month against the volume of calls and office visits your agency receives. Usually, it’s not even close. For every single customer contacting you to initiate a service, four more customers are navigating the process, asking for a status update, rescheduling an appointment, or calling to make sure verification was received.

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Diagram 2

These repeat and often unnecessary interactions with the same cus- tomers are what erodes staff capacity. What we discovered from our work with these states is that the average customer interacted with the state or county agency, in person or virtually, three to five times in the course of a single eligibility event. UK management guru John Seddon calls this “failure demand.” It is the extra work we create when we do not provide decisions at first interaction— whether it is in person, online, or over the phone. Even worse from a capacity standpoint, this self-created workload does not just mean repeat interactions, it causes work that must be managed and tracked. When agencies are dealing with a high volume of unfin- ished work, they create new processes to manage that work, dedicating valuable staff time to manage these processes and respond to unneces- sary customer interactions. Eventually states invest incredible resources for IT solutions to enable their ability to track and provide the status of the unfinished work. Focusing on On-Demand Services and First Contact Resolution When agencies do not have a robust, on-demand, same-day service and First Contact Resolution strategy, the impact on agencies is significant. Here is an example (see diagram 2): We recently worked with one of the largest state- administered agencies in the country; they process 290,000 applications and renewals each month. Initial pro- cessing of each application or renewal resulted in a request of additional information rather than a decision for 6 out of every 10 customers. When we

measured the number of visits and calls, at least those we could quantify, the state recorded 1.2 million customer interactions every month. In addition to the staff working in field offices and processing centers, this state also dedicated millions of dollars annually for a vendor to staff a call center that only provided customers with answers about the status of cases. This back and forth created additional unnecessary handoffs to already overburdened state staff, adding processing delays, and forcing even more customer calls and visits. While well intentioned, these approaches did not deliver the desired outcome because they did not address the underlying problem. The agency would have had a better outcome by focusing on creating an avenue for resolving customer needs with state staff, or better yet, eliminating the reasons that led to customers’ calls. Strategies to Regain Capacity Self-inflicted work created the chal- lenges outlined above. Unwinding process and policy changes imple- mented during the PHE will compound those challenges. Without taking strategic action to prepare for PHE unwinding, human services agencies are at risk of overwhelming their systems and staff, leading to backlogs of work. Not only do backlogs mean that eligible individuals wait longer for services, but they also contribute to agencies continuing to pay for services for ineligible individuals whose cases have not yet been reviewed.

Strategy 1: Make the work visible Planning for needed capacity begins with understanding the inevitable influx of work and ensuring that the workload is visible. States must use current and historical data to under- stand the volume of work that will be received once normal operations are resumed and the types of work that will be represented. For example, based on guidance issued by the Centers for Medicare and Medicaid Services (CMS) in August 2021, Medicaid agencies will be expected to complete pending eligibility and enrollment actions within 12 months after the month in which the PHE ends. This guidance also requires agencies to complete a redetermina- tion after the end of the PHE before terminating coverage for an individual. Considering Medicaid enrollment growth of 20 percent during the pandemic, these requirements mean that states will have to complete 20 percent more renewals in the year following the PHE than they were accustomed to completing prior to the pandemic. This work will be combined with normal applications and changes, and agencies should use their existing data sources and historical information to project workloads based on enroll- ment, historic auto-renewal and return rates, historic volume of applications and changes, and any historical data about application churn resulting from closures. Due to staff attrition during

the PHE and expected upcoming workload, one Medicaid agency

See Workload on page 25

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February 2022 Policy&Practice

research corner By Ariel Kennan

Equity and Access: Ways to Reduce Administrative Burden and Center the User

F rom coast to coast, there are oppor- tunities to begin to address equity in accessing and receiving government benefits. Public benefits administra- tors and delivery organizations, like those in San Jose and New York City, are focusing their efforts on making content about public benefits and programs accessible, easy to under- stand, and informed by the needs of constituent communities. Content about public benefits and programs can be accessible by writing in plain language that people at varying levels of literacy can understand, by translating content into languages other than English, by co-creating and testing messaging with residents and other stakeholders, and by using technology tools to help manage and scale content. The Beeck Center for Social Impact + Innovation at Georgetown University has sought to highlight best practices and the governments and organizations undertaking this work in our January 2022 guidebook, “Accessible Benefits Information: Reducing Administrative Burden and Improving Equitable Access through Clear Communication About Safety Net Benefits.” 1 Centering Stories From Coast to Coast: Replicable Ways to Get Started With Accessible Content Every organization has work they can start doing today to improve the accessibility of their content. Consider starting small with writing in plain language If the task of overhauling all your content seems monumental, it is

possible to pilot the approach and then replicate it at scale. University of Michigan Poverty Solutions 2 started with a guide to one benefit, Coronavirus Stimulus Payments, 3 and replicated the same approach for the Child Tax Credit. 4 They engaged

the nonprofit design firm Civilla 5 to create the initial designs that they were able to test with residents for feedback. Through this plain-lan- guage resource, the team at Poverty Solutions showed how to quickly and effectively provide benefits

Image via Shutterstock

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Policy&Practice February 2022

services, an integrated translation application programing interface (API) for computer-translated content, or using a hybrid approach that combines these methods. The City of San Jose has invested in expanding language inclu- sivity in its 311 service to better support correspondence between city staff and residents by using machine learning to build a custom translation model. This allows residents to write their 311 text descriptions in their preferred language, which is then dynamically translated in near real-time to English for city staff, who can then respond in English and their response is dynami- cally translated back to the resident’s preferred language. The 311 website uses the Google Translate API to trans- late the content on the page, although the website could be transitioned to the custommodel in the future. They used translators for Spanish and Vietnamese to help recruit users who speak those languages in their initial service research and to validate translated content in their eventual implementation. For organizations or governments in the midst of a website or service redesign, it is a great time to consider a new process for creating, managing, and distributing content. When the New York City Mayor’s Office for Economic Opportunity 7 set out to redesign ACCESS NYC, 8 the city’s public benefits information site and eligibility screener, their primary goal was to make it simpler for resi- dents to find which benefits they may be eligible for, and start the applica- tion process. The team also sought to modernize the technology stack to support the improved public-user experience and internal operations. The team reviewed ACCESS NYC usage patterns and connected with residents, benefits navigators, and staff at government agencies to under- stand why people come to ACCESS NYC, the information they seek about benefits, and the challenges they face in accessing that information. The relaunched site includes information about more than 80 Use technology to manage and distribute content

programs, and eligibility screening for more than 40, all in 11 languages. As part of the redesign, the team rei- magined the editorial flow by which content for ACCESS NYC is created, managed, and distributed. All benefits content now follows the same set of steps: once content is drafted and edited, it goes through reviews with plain-language experts and benefits agency liaisons, before getting final approval and undergoing translation. NYC Opportunity has a powerful content management system in place to organize and distribute content to ACCESS NYC, other benefits sites, and as open data using an API. They advise others to start small but consider the scalability and interoper- ability to work with other systems and scale as needed. While information accessibility is just one part of reducing the greater administrative burdens on residents seeking benefits, we hope these examples inspire you to start reviewing and revising content, and as your organization is ready, start to use tech- nology to further improve accessibility and publishing capacity. About the Beeck Center for Social Impact + Innovation at Georgetown University The Beeck Center for Social Impact + Innovation at Georgetown University reimagines systems for public impact using design, data, and technology. Our projects test new ways for public and private institutions to leverage data and analytics, digital technologies, and service design to help more people. Reference Notes 1. https://beeckcenter.georgetown.edu/ report/accessible-benefits-information 2. https://poverty.umich.edu 3. https://poverty.umich.edu/stimulus-checks 4. https://poverty.umich.edu/child-tax-credit 5. https://civilla.org 6. https://www.joinproviders.com 7. NYC Opportunity; https://www1.nyc.gov/ site/opportunity/index.page 8. https://access.nyc.gov Get in touch at beeckcenter@georgetown.edu.

information in a time of crisis that the team has continued to duplicate to support additional languages and fre- quently asked questions. Engage your audience and center their needs Accessible content is written to be used by the greatest number of people. Consider the audiences for your content. If possible, test the content with multiple groups to improve accessibility. Providers 6 is a free smartphone app that lets Supplemental Nutrition Assistance Program participants in any state monitor the real-time arrival and balance of their benefit allocations. Alongside their benefit balances, the Providers app’s Benefits Hub gives its users aggregated, local- ized information about changes to benefits, other benefits users may be eligible for, and links to resources where users can learn more and take action. The team prioritizes getting feedback from the users of the app, both to learn what features its users find most helpful and to learn what additional information its users want. In addition to employing tra- ditional user research methods (like user surveys, interviews, analysis of customer service requests, and rapid feedback mechanisms like asking, “Was this helpful?” with a thumbs up and thumbs down button), the organi- zation hosts a closed Facebook group. In it, a few thousand people who use the app exchange information about changes to benefits and troubleshoot navigating various benefits processes together, and the Providers team uses their feedback to add information and update features. Offer multiple languages Translation greatly increases the accessibility of content for people who do not speak English as their first language. When your content is written in plain language, it also allows better translations. There are many ways to implement transla- tion, including prioritizing the most used materials, creating a glossary of common words and phrases, using a contract for professional translation

Ariel Kennan is a Fellow at the Beeck Center for Social Impact + Innovation at Georgetown University.

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staff spotlight

Name: Antonette E. Russell Title: Human Resources Director Time at APHSA: Seven months

administration of employee benefits. Develop and implement policies and procedures, talent acquisition and management, and oversee payroll administration. Encourage employment engagement and help create a sense of belonging while and ensuring equity, diversity, and inclusiveness at APHSA. What I Can Do for Our Members: Be a resource to APHSA for human capital programs that support and benefit our ongoing effort to align our vision and mission as an organization with business model outcomes. Best Way to Reach Me: I can be reached via email at arussell@aphsa.org When Not Working: I am an AFOL (Adult Fan of LEGO). I build small local businesses out of LEGOs to promote and market their services. Motto to Live By: Give people the tools they need to succeed.

Life Before APHSA: Director of Human Resources (HR) and Operations at Rising Tide Interactive; Director of HR and Administration at Meals on Wheels America; Director of Administration at DC Central Kitchen; Operations Director at DC Vote Priorities at APHSA: To drive the culture of the orga- nization and ensure the values at APHSA are met. Take the lead on all HR functions, create HR strategies, and collabo- rate with other members of the executive team to shape the business requirements of the organization. Serve as a trusted advisor for managers and direct reports, practice process improvement, oversee the full employee life cycle and design. Ensure compliance and direct the development and

D r. Linda A. Kauffman Wolf , former executive deputy director of APHSA, died on January 16, 2022. She retired, after 20 years of service to the association, in 1999. A resident of Cape May, NJ, Linda graduated cum in memoriam

management consulting and executive coaching firm. Linda was a popular lecturer and guest speaker in social policy circles and was called on to testify before Congress and to address national social services and gov- ernmental affairs organizations. In the Policy & Practice issue published at her retirement, Linda stated that the rewards of her job “…all revolve around people—being part of an organiza- tion that serves those who serve others,

laude from Immaculata University and earned graduate degrees from the University of Connecticut and the University of Southern California where she also earned a Doctorate in Public Administration. Linda was a member of the faculty at Virginia Tech and held various teaching assignments at the University of Delaware, the University of Connecticut, and the University of Southern California. She was nationally recognized for her leadership at APHSA in the areas of welfare reform, housing, adolescent pregnancy prevention, and immigration and refugee resettlement. She founded and operated her own

working with the dedicated public servants who run state and local human services agencies, and being the colleague of members of the APWA/APHSA staff. The real challenge in an organization like APHSA is to strike the balance between representing and leading. Too much of either one makes for an ineffective orga- nization. The tension between the two modes keeps a creative edge alive."

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PRESIDENT’S MEMO continued from page 3

reverberating throughout the work- force, with a particular strain on staff directly responsible for working with impacted families. Comprehensive approaches to the health and well-being of the workforce have gained more traction in recent years (see, for example, our “Igniting the Potential” series in 2018), and there have been many examples of agencies increasing staff morale and retention rates as investments are made and staff feel valued as true partners in the work. When COVID-19 struck, many jurisdictions were just undertaking these endeavors—and while the pandemic understandably halted some of those efforts, it rapidly accelerated change in others. Hybrid and remote work environ- ments have become more of a norm, at least for parts of the health and human services workforce, with many agencies vowing to keep those options open for workers post pandemic. We have also seen the rapid deployment of new technology—in some cases accel- erating three-year planned rollouts to a fraction of that time. The experience of the pandemic has also heightened awareness that human services workers are part of the essential workforce, and must be supported accordingly. As we look to the future, one thing remains clear—the issues are complex and multidimensional. Achieving solutions requires our understanding that some issues are rooted in the chronic lack of investment in the workforce, others shaped by the changing dynamics and expectations of the workforce itself, and still others directly impacted by the cumulative stressors that the pandemic has layered onto an already challenging work envi- ronment. Staff at all levels of the public health and human services workforce, and the community partners they work alongside, are experiencing the realities of working under prolonged stress from extreme demand on the human services system, coupled with a growing distrust of government, as well as countless other factors weighing heavily on society.

the community, we can solve problems together.” Today, those words feel truer than ever. The way forward requires ingenuity, intentionality, and adaptability. We have witnessed what’s possible when we come together to share our learn- ings and innovations. To this end, we seek your stories of innovation and impact: What is helping your organization get under- neath the needs of the workforce, and adapt to those needs quickly and effectively? What efforts in continuous quality improvement are making a dif- ference, and how does the workforce itself contribute to continuous learning and growth? What changes spurred from the pandemic are you working to keep? How are you approaching enhancing and embedding those practice and operational changes? What are you seeing as the biggest pressure points for the workforce now and into the next few years? How are you assessing what’s a temporary gap versus a long-term need? What invest- ments are being made through ARPA or other dollars? For our part at APHSA, we are com- mitted to sharing practical resources for leaders that support individual and organizational workforce health and well-being. Our Organizational Effectiveness team has continued to distill lessons from on-the-ground experiences of health and human services agencies and will be sharing new tools (and a new learning man- agement platform) this spring. And, to help increase awareness of the contributions of human services workers worldwide, be on the lookout for shared stories of impact with our partners at the European Social Network (details coming soon). If you have a workforce story to share with your peers across the country, please contact Jessica Garon at jgaron@aphsa.org.

For the human services system to prevent issues before they happen and help advance economic mobility, we must trust and invest in the very people we all rely on to do the work day in and day out. And the time is ripe for doing so. As states and localities make key investment decisions with the American Rescue Plan Act (ARPA) dollars, the human services workforce should be front and center, and include the community-based organizations that are integral to the human services delivery system. In 2018, I wrote the following as part of our “Igniting the Potential” series: “When we see and engage the human services workforce as helping “ unlock and ignite human potential,” we both energize and honor our workforce and we create an important mindset shift about their role in partnership with families and communities. When we can create an authentic sense of con- nectedness between the workforce and cumulative stressors that the pandemic has layered onto analready challengingwork environment. Achieving solutions requires our understanding that some issues are rooted in the chronic lack of investment in theworkforce, others shaped by the changing dynamics and expectations of theworkforce itself, and still others directly impacted by the

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