Policy and Practice | December 2022

Policy and Practice | December 2022

The Magazine of the American Public Human Services Association December 2022

Partnering for Impact

Co-Creating Generative Solutions

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Vol. 80, No. 6 December 2022




Realizing the Promise of No Wrong Door Making Health and Human Services More Intuitive to Discover, Easier to Access, and Simpler to Use

Changing the Headlines How Illinois Is Reimagining Public Safety



Interdisciplinary Humanitarian Response Equitably Supporting Refugee and Immigrant Families

Shifting Power to Communities and Addressing Systemic Racism Partnering to Co-Create a New Leadership Framework for Human Services


3 President’s Memo

8 From Our Partners

28 Race Equity Champions Minnesota Department of Human Services Supplemental Nutrition Assistance Program and SNAP-Education Programs

Aspirations for the Future of Human Services—Part One: Shifting the Paradigm

Navigating the Unwinding in Ohio Through Policy, Practice, and Technology

5 APHSA Insights

26 Technology Speaks

30 Association News

Partnering for Families: Reflections on TANF and Child Support

Eight Key Learnings Before Modernizing Your State’s Legacy System

Awards and Recognition from 2022 NSDTA, ISM, and AAHHSA Conferences

6 From Our Partners

27 Technology Speaks

36 Staff Spotlight

Creating a Desired Future State Together: Modernizing TANF to Truly Benefit Families

My Turn: How California Accelerated COVID-19 Vaccine Distribution

Mary Goble, Senior Policy Associate, Knowledge Mobilization

Cover illustration by Chris Campbell


December 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


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, Secretary, Oklahoma Department of Human Services Local Council Representative Dan Makelky , Director, Douglas County (CO) Department of Human Services




Policy&Practice December 2022

president’s memo By Tracy Wareing Evans

Aspirations for the Future of Human Services Part One: Shifting the Paradigm

A s part of APHSA’s ongoing stra tegic work, we held a series of interactive sessions this year with our membership, executive governing board, and partner network, exploring what leaders aspire to for the future of the human services field by the year 2030. Three overarching themes emerged from these conversations: 1. Cultivating service delivery systems that are truly equitable , human centered and community driven 2. Unlocking the potential of the human services workforce (both public sector and community based) to support next generation approaches 3. Partnering with and through community-based organizations (CBOs) and adjacent sectors to align systems and achieve greater impact Not surprisingly, human services leaders seek transformative, systems level change while also acting on the immediate needs of the people and communities they serve. To get there is not an easy road and, if we are to live the value of being community led, the adage “it takes a village” takes on new meaning for our collective work ahead. In Part One of this series, I’m excited to share top takeaways from these con versations. In subsequent posts to our blog, The Catalyst , I’ll dive deeper into the insights shared around the themes above, including where leaders in the

of government—that puts community at the center. To achieve this, we must reckon with the harm our systems, including human services, have done, while demonstrating that systems can and must work for the common good. Leaders must play an intentional role in modeling and fostering radical inclusion of youth and parent leaders—acts like building avenues into daily work for hearing from youth and families who have had experience with or are currently experiencing the human services system, hiring staff at all levels with lived experience, and systematically establishing the means for families to contribute to service design with continuous feedback loops built into them.

field believe we need to spend our collective energies to advance systems level change. KeyTakeaway:To Center Communities, We Need a Fundamental Paradigm Shift in HowWe Work A change in how we work is foun dational to advancing the equitable outcomes we desire for families and communities to thrive. The shift requires new mental models and a new operating paradigm—across all levels

“There is aneed to ‘let go’ of decisions and power that human services leaders have held onto too tightly, often in choices that were never ours tomake.” —STATE HUMAN SERVICES CEO

See Shifting the Paradigm on page 32

Illustration by Chris Campbell


December 2022 Policy&Practice

Vol. 80, No. 6


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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Policy&Practice December 2022

aphsa insights By Mary Nelson

Partnering for Families: Reflections on TANF and Child Support

O ver the past few years, the American Public Human Services Association (APHSA) has invested in a member-driven Temporary Assistance for Needy Families (TANF) modern ization effort to establish a set of core principles and legislative framework 1 making it clear that to help families achieve economic mobility, TANF must shift focus from work compli ance and verification to what families need to thrive. When aligning the TANF program with other key building blocks, we can achieve the outcomes we desire for the future. And yet, this paradigm shift is not unique to TANF within human services. During outreach to child support directors about the frame work, APHSA found a similar, complementary shift in child support agencies from an enforcement focus to a model of support and family services. Recognizing the incredible potential of partnerships and collaboration between child support and TANF, APHSA, the National Council of Child Support Directors (NCCSD), and the National Child Support Enforcement Association (NCSEA) are capitalizing on this momentum. Through a newly established partnership, we will bring together TANF administrators, child support directors, and other key stake holders to advance critical discussions on the interplay between child support and other economic supports in a whole-family approach. As a launching pad for these conver sations, APHSA and NCCSD separately hosted conference sessions this summer that highlighted existing perspectives

Providing a practical example, Karen Hebert, Director of the Division of Economic and Housing Stability at the New Hampshire Department of Health and Human Services, shared that non-custodial parents are assessed to determine if they are receiving or are otherwise eligible for Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and TANF. Not only does this ensure non-custodial parents have access to essential supports that promote their own stability and parental success, but it also could qualify parents for the state’s Work Now program, which provides employment services and funding for education tuition, travel, and child care. During the same session, discussing the impact of Colorado’s child support pass-through policy, Larry Desbien,

on, and efforts to, collaborating and coordinating between TANF and child support agencies. Discussions centered on removing barriers to services and supporting child and family develop ment. These sessions display a strong commitment amongst state leaders to develop and strengthen the ties across programs and agencies in the interest of supporting the whole family. Kicking off the conference season with Spilling the Tea on TANF: An Honest Conversation on Partnerships and Families , at NCCSD’s 2022 Annual Meeting, panelists elaborated on opportunities and challenges to coor dinating policy and practice across programs. They also highlighted the mutual goals of supporting parents as caregivers, promoting economic mobility, access to employment and training services for all parents, and elevating child and family well-being.

See Partnering for Families on page 33

Illustration by Chris Campbell/Shutterstock


December 2022 Policy&Practice

from our partners

By Danielle Barnes

Creating a Desired Future State Together: Modernizing TANF to Truly Benefit Families

I n 2019, while I was the Tennessee Department of Human Services Commissioner, the state legislature called me in for a high-profile briefing, which became a contentious hearing concerning why the department had been unable to spend down its $732 million Temporary Assistance for Needy Families (TANF) reserve. I won’t ever forget the months that followed. The topic garnered a great deal of attention from the public. So much so that the local newspaper ran a series of stories that focused on examining the state’s expenditures. As a department, we found ourselves in a constant defensive posture as we strug gled to explain the complexities and restrictions of the federal program. In each of the news stories, the local newspaper published a picture of me at the budget hearing wearing a white jacket. I often tease, recalling the months of media attention, that I should bury that jacket. Years later, the jacket is long gone. However, the complexities and chal lenges for states to distribute TANF dollars to people who truly need them haven’t changed. The time has come for states to rethink and modernize TANF to ensure that families are ben efiting from the program as it was originally designed. As Commissioner, I faced a situation where restrictive state laws and ambiguous federal guidelines prevented my agency from distributing these dollars quickly and in a way to meet the unique needs our Tennessee families had that might not have aligned perfectly to the guidelines. Families who needed assistance faced onerous restrictions

to access benefits that fell well short of subsistence levels. At the time, the Tennessee monthly cash benefit was $277 for a family of three. 1 To receive this benefit, families had to muddle through overly bureaucratic and some times demeaning processes to puzzle through different and sometimes con tradictory eligibility requirements for multiple assistance programs. As governments concentrate on holistic care of families, we must pause to ask ourselves, are we really

distributing these dollars in a mean ingful way? Are we making solid investments in child care and educa tion, since we know there is a direct correlation between lack of access to quality care and education, and poverty levels? Are there innovative partnerships to help meet the needs of the families who don’t come to our doors? Have we asked our families what they need to grow beyond their current circumstances and enjoy self sustaining lives?

Illustration by Chris Campbell


Policy&Practice December 2022

The Roots of TANF To understand TANF, we have to go back to the program’s inception. TANF became law in 1997, replacing the 1935 grant program Aid to Families with Dependent Children (AFDC). TANF provided block grants that gave individual states more leeway to spend dollars, so long as one of the four purposes of the program was met: 1. Assist needy families so that children can be cared for in their own homes or in the homes of relatives. 2. End the dependence of needy parents on government benefits by promoting job preparation, work, and marriage. 3. Prevent and reduce the incidence of out-of-wedlock pregnancies. 4. Encourage the formation and main tenance of two-parent families. The intent of TANF was to create a program that led families to stable work and off of government assistance. Welfare caseloads dropped across the country almost immediately after enact ment and continued to steadily fall. However, poverty rates remained steady. The concept behind TANF is simple: families in crisis need help to bridge a gap until adults get back to work and the family can get back on its feet. But in practice, this is insufficient to support reentry into the workforce. It also does not recognize the changing structure of families in America, including grandparents who take care of their grandchildren and parents who are unable to work. Due to a variety of factors, such as the changing landscape of families and stringent state and federal regulations, many states find themselves in the same position as Tennessee—they face a large surplus of federal dollars. There is no doubt that these dollars should be spent for the benefit of families in need. Doing so requires a certain amount of strategy, innovation, and understanding of local needs, all while balancing the require ments of federal and state law. Innovating Our Approach toTANF Assess the current state To truly modernize the TANF program, it is critical that we begin

help agencies strategically identify and focus on new areas to invest in without overburdening the staff. The aligned partnerships will also bring an opportunity to collectively adjust the program portfolio to meet even greater and deeper needs. It’s time to stop offering programs that have little value and invest in new programs that are directly unique in providing services to families. Having this defined vision not only allows innova tive services to bloom but it keeps the agency focused on its North Star and forges partnerships at the federal and state levels to meet compliance. Implement and track outcomes Finally, and perhaps most critically, we need to begin tracking outcomes for families, not transactional activi ties. We know how many people are on TANF and how many dollars are spent on TANF participants. But do we know if people are better served because we’ve provided them with funds intended to help them? We need to apply robust data analytics to see which approaches have had the greatest success and build from those actions. We must expect the same from the community partners. Then we can begin to coalesce around the combi nation of data from multiple sources. That leads to better understanding the needs of the families and even tually using that data to inform our decisions, develop the right programs to achieve success, and work toward actual prevention of crisis, as opposed to reaction to it. Together, re-examining our TANF program in this way can help families go from surviving to thriving. In a time where so much has changed, we owe it to our families to rethink our role and make change for good where we can. The views reflected in this article are those of the author and do not necessarily reflect the views of Ernst & Young LLP or other members of the global EY organization.

with a current state assessment. The approach is two-fold. First, garner an understanding of the journey and experience of the TANF participant. Take the time to assess what is going well and what is not going well from the perspective of those with lived experience. Discover the barriers to participation and unveil any unmet needs. Addressing needed policy and process changes for the recipients first is vital to a strategic redress of future success of the program. This may require changes to how services are delivered—meeting customers where they are. The world has changed, and the time is ripe to rethink how people need to be served. This is also a good time to review and reconsider state policy to make sure our programs reach families who need them and are not unduly burdensome. During my tenure, we traveled the state and often spoke directly with our customers. However, talking with them was not enough. We missed the opportunity to take a purposeful approach to systematically evaluate their experience and make changes to improve that experience and impact. Second, garner an understanding of current and prospective partners. There are undoubtedly many programs outside of enrollment in TANF that states are utilizing to bolster communities holistically. Many agencies have come to understand the necessity of com munity partnerships and rely on those programs to be “boots on the ground.” They are neighbors and community allies with our TANF families. Understanding the full array of programs and services that are available to engage and support families beyond a small cash grant, and coordinating those services and partnerships, is essential to a family’s ability to thrive. Future state vision By considering feedback from those who have lived experience with TANF—and input from other key stakeholders, the community, and employees—we can create a desired future state of TANF. Having this consensus and alignment will

Danielle Barnes is EY Americas Government and Public Sector Leader.

Reference Note 1. Graphical Overview of State TANF Policies as of July 2019 (www.hhs.gov)


December 2022 Policy&Practice

from our partners

By Jon Eakins

Navigating the Unwinding in Ohio Through Policy, Practice, and Technology

W e first talked about “the mountain of work that has yet to come” in the August 2020 issue of Policy & Practice . “The unwinding” didn’t have a name yet, but its shadow was already looming. Since then, agencies have been hard at work finding efficiencies, streamlining administrative work, and getting plans in place to make sure no person or case slips through the crack when the time comes. We’ve been fortunate to work with the Ohio Department of Administrative Services on a couple of their initiatives: n Since July, Ohioans can apply for child care assistance through the same form they use to apply for Medicaid, Supplemental Nutritional Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF). That form, regard less of how or where it’s completed, gets stored in Ohio Benefits, the standardized statewide case man agement system. n All workers across child care, Medicaid, SNAP, and TANF can see each client’s verification documents, no matter who collected them, through the shared Ohio Enterprise Document Management System (EDMS). This gives workers across all program areas access to the relevant documents they are autho rized to view regardless of how they come into the state. Bringing child care into the same case management and electronic document management systems as Medicaid, SNAP, and TANF has

were previously siloed in a dif ferent system and couldn’t see when this information already existed. Now, since everything is in one spot, workers can be more efficient. There’s greater awareness around what clients need and what actions have been taken in other program areas. n Focus on high-value work. When workers don’t have to focus their time and energy on collecting information that already exists elsewhere, they can put more effort toward answering questions, communicating with clients, and pri oritizing customer service. n Impact on timeliness. The one touch process for real-time eligibility

many benefits that will help the state navigate the unwinding. “It is very helpful to have things in the same system,” said Diane Sunagel, program administrator at Lorain County Department of Job and Family Services (JFS). “The combined application allows clients to apply for child care more easily and reduces the administrative burden of applying for benefits in general.” Some additional results of the unified system: n Less duplicate work. Even though child care workers often need to collect the same verification documents as their counterparts in Medicaid, SNAP, and TANF (think pay stubs or driver’s licenses), they

Illustration by Chris Campbell


Policy&Practice December 2022

in Ohio. Earlier this year, Public News Service shared poll data from Groundwork Ohio confirming the child care crisis is undermining the stability of many households in the state. 1 Lorain County JFS also noted a year-over-year increase in people applying for child care assistance. Rising costs, limited providers, and staff shortages are well-established causes of the crisis. But administrative roadblocks are also worsening the problem. With broad access to all the docu ments stored in Ohio EDMS, child care workers can spend less time tracking down information and more time on things like finding and licensing new providers that could help mitigate the current provider shortage. Having systems and tech nology in place to make child care workers feel more supported can also help keep them in their jobs longer to lessen staffing issues. Lessons Learned Ohio’s story demonstrates how improving cross-communication between programs through policy,

practice, and technology can help Lorain County JFS and other agencies across the state manage the ripple effects of the unwinding. The system not only helps workers process applica tions faster, but also provides greater awareness of clients’ challenges to ensure quality within each case and facilitate better decisions about allo cating resources. States should be doing everything they can to reduce friction in applica tion processes, boost collaboration between programs, and double down on technology that raises awareness of applications, verifications, changes, and workers’ observations. Doing so will allow workers to focus on helping clients address barriers to their success.

determination through Ohio Benefits and Ohio EDMS results in more con sistent case-processing timelines. Now that workers can see everything clients are applying for at the same time, they can make sure requests for additional verification are sent out to process applications as soon as possible. n Versatility with staffing and training. Many agencies in Ohio leverage case banking or have the same workers handling multiple programs due to staffing shortages. Training can be simplified when workers only have to learn one system and process. This also allows agencies to have more flexibility as needs ebb and flow—for example, SNAP or TANF workers can help process child care applications, and vice versa, when there’s an overload of a certain type of application coming in but not enough workers to handle it. Ohio EDMS and the Child Care Shortage Of course, preparing for the unwinding isn’t the only challenge

Jon Eakins is the Director of Services at Northwoods.

Reference Note 1. https://www.publicnewsservice.org/ 2022-01-26/livable-wages

working-families/childcare-crisis ohio-parents-at-tipping-point/ a77557-1


December 2022 Policy&Practice

Changing Headlines the How Illinois Is Reimagining Public Safety

By Christopher Patterson


he State of Illinois, particularly the City of Chicago, has long been associated with high

rates of community violence, particularly firearm violence. This reputation does not account for the multifaceted nature of the firearm violence epidemic in the United States and the systemic factors that perpetuate cycles of violence in disproportionately impacted communities.


Policy&Practice December 2022


December 2022 Policy&Practice

are just the beginning of this effort to radically improve safety in communi ties across Illinois by reducing gun violence and investing in resources and opportunities for disproportion ally impacted communities. The OFVP has been particularly focused on growing the profession of street outreach, intervention, and conflict mediation within our target communities. Street outreach pro fessionals work block by block in impacted communities to engage individuals who are at immediate and high risk of being either victims or per petrators of violence. Engagement can occur in a variety of settings, including parks, homes, street corners, com munity centers, schools, or hospitals, to name a few. Street outreach staff is focused on building relationships with those at high risk so that they can promote peace and mediate potential and existing conflicts. Street outreach professionals have time and time again proven critical in intervening when violence occurs or is imminent. They connect with commu nity members and help them navigate issues, including housing, mental health, education, and justice—all resources that are essential to ensuring community vitality and safety. Outreach leaders bring lived experi ences to their work—that experience may have been confronting community violence, incarceration, mental health, substance use disorders, or other expe riences resulting in trauma. Assisting someone who carries the weight of the world on their shoulders often takes someone who has also carried it before. And we know street outreach works. Research partners at the Northwestern University Neighborhood and Network Initiative (N3) assert, “with 100 percent cer tainty, that outreach can reach those in harm’s way successfully without relying on the criminal justice system.” For years, community-based orga nizations have been building street outreach capacity in Chicago neighbor hoods. One such organization, Chicago CRED, an anti-gun violence organiza tion founded in 2016, has studied the impact of this lifesaving model. An evaluation of Chicago CRED’s street outreach initiative shows that nearly

After dedicating my life to pro viding street-based intervention and outreach to communities and young people impacted by firearm violence, I am honored to lead Illinois’ Office of Firearm Violence Prevention (OFVP) as Assistant Secretary at the Illinois Department of Human Services (IDHS). In November 2021, Illinois Governor J.B. Pritzker signed the Reimagine Public Safety Act (RPSA) into law, which is designed to prevent and mitigate the harm of gun violence in our communities. At the same time, Governor Pritzker declared gun violence a public health crisis and directed all state agencies to develop holistic solu tions to prevent violence by investing resources to address systemic factors that perpetuate trauma and violence in historically impacted communities. The RPSA is a comprehensive approach to violence prevention in response to the State of Illinois' height ened experience of loss, harm, and trauma at hands of firearm violence, especially during COVID-19. RPSA is investing $250 million over three years among the 42 communities in Illinois that have endured the highest rates of gun violence, providing resources to implement violence prevention and interruption programs, with a specific emphasis on street outreach. This unprecedented investment rec ognizes that law enforcement alone cannot be the sole answer to reducing violence in our communities. We need to support good law enforcement with the resources they need while also increasing our support for neighbor hood organizations that are stepping forward to keep kids safe and de-esca lating violent environments. In one year since establishing the office, the OFVP has issued 14 notices of funding opportunities and initiated grants to more than 115 community organizations, totaling $65.4 million. We have established 16 councils across Illinois to provide local perspectives on community-based solutions to violence in varying regions of Illinois. We have also convened researchers from academic institutions across the state to provide evidence-based insight into firearm violence reduction and methods for evaluating our success. These monumental achievements

Growing up in Chicago’s Cabrini Green Homes, a Chicago Housing Authority (CHA) public housing project on the Near North Side of Chicago, I experienced gun violence, a trauma far too many young people continue to endure. I know first hand the impact of intergenerational trauma stemming from domestic violence, community violence, sub stance use, and poverty. After being shot, leaving my children for a 12-year prison sentence, and burying close friends whose lives were cut short by gun violence, I have been fortunate to break through the devastating conse quences that ongoing violence driven by poverty can inflict. Unfortunately, my experience defies the statistics. Nationwide, Gun violence is the leading cause of death for African American men ages 15 to 34. In Illinois, Black individuals are 32 times more likely than White indi viduals to die by gun homicide, which is triple the national average. Overall, at a rate of 29 firearm homicides per 100,000 residents (2020), the Chicago homicide rate is six times higher than New York City’s and three times higher than in Los Angeles. In 2020 alone, gun homicides increased by 52 percent, resulting in 769 deaths. These are not simply numbers. Behind each shooting are individuals and communities who are perma nently scarred by these incidents. Each shooting inflicts trauma on entire neighborhoods, and this pain shapes the experience of too many young people growing up across Illinois. That is why leaders at the highest levels of Illinois recognize that we have a responsibility to address this trauma and prevent it.

Christopher Patterson is the Assistant Secretary at the Illinois Department of Human Services (IDHS) and Director of the Office of Firearm Violence Prevention (OFVP).


Policy&Practice December 2022

involved with the legal system prior to his participation. He’s currently enrolled in a two-year community college and has signed on to work at UCAN as a youth mentor himself. He described how the mentoring team at UCAN became family, with themmoti vating him every step of the way and helping him envision his future beyond the constraints of his circumstances. As I bear witness to the deep com mitment and coordination of Illinois communities working to prevent violence, I am filled with a sense of hope and purpose. We are collectively reimagining public safety to ensure every child and adult in Illinois can achieve their fullest potential. Let’s build a world where no person is left behind and where people who look like me don't have to learn their hardest lessons after living behind prison walls. We understand the urgency of this moment, and we are harnessing every available resource to prevent even one more gun violence tragedy, one more grieving mother, or one more lost child. If you would like to learn more about efforts to reimagine public safety in the state of Illinois, please visit www.dhs.illinois.gov/rpsa.

reaching those most at risk and con necting them with lifesaving services. I have been fortunate to travel the state, listening to community members and advocates who have seen lives shattered by violence—not just in Chicago but in cities like East St. Louis, Peoria, Urbana, and Rockford. From each of these encounters, I have been inspired by hope as I learn about intentional and collective efforts to bring together community-based orga nizations, community advocates, law enforcement, schools, healthcare insti tutions, housing providers, food banks, and park districts to comprehensively address the myriad needs of communi ties impacted by firearm violence. This summer, I heard from Devion (pictured on page 11), a 20-year-old who has been participating in youth development programming with UCAN, an organization focused on preventing violence and improving outcomes for youth in Chicago’s Englewood neighborhood. Devion described his journey receiving one-on one mentoring, academic coaching and engagement, and case management from the time he was 16—completely disengaged from the school system and

63 percent of participants in Chicago CRED programs who didn’t have a high school diploma received one through the program. Participants also experienced nearly 50 percent reduc tion in firearm victimization rates 18 months after completing the program compared to victimization rates 18 months prior to participation. While these programs have demon strated success over the last decade, these dedicated and groundbreaking street outreach providers have never seen this level of government invest ment in violence prevention activities. In addition, many Illinois communities outside of Chicago are now adopting these practices and identifying pro viders who can do this work. That is why the OFVP strongly believes it is our duty to work hand in hand with communities to help organizations build the capacity to provide these services and expand their impact. We are asking local elected officials, non-profit leaders, and other stakeholders to help us identify where we can cultivate this potential. We must scale up what works and put resources into the hands of community organizations who are the experts in


December 2022 Policy&Practice


Policy&Practice December 2022


Response Humani tarian

Equitably Supporting Refugee and Immigrant Families

By Amaya Alexandra Ramos


ver the past few decades, systems worldwide have been reevaluating mechanisms for responding to complex humanitarian emergencies, with the aim of ensuring that approaches are humane and that the desired outcomes lead to sustainable well-being. An essen tial aspect of this effort has been maintaining beneficiaries and their input central to all aspects of design, in addition to ensuring that the requisite disciplinary expertise is integrated into comprehensive planning. The United States has historically been among the world’s leading recipients of resettled refugees, and criti cally, has been a primary stakeholder in shaping the current global system for the management of displacement crises. 1 Nevertheless, it is not immune to the strains arising from the fallouts of these emergencies. Crises of mass displacement equaling the magnitude of the humanitarian emergency fol lowing the 2021 U.S. military withdrawal from Afghanistan can have political implications for relations between strategic global partners, 2 and furthermore, they can also pose serious infrastructural challenges for the countries receiving persons in flight.


December 2022 Policy&Practice

Savvy local actors, such as local government representatives, caseworkers, and community organizations are often the unsung heroes in cobbling together stopgap remedies for supporting refugee families and needs not covered by existing programming.

groups with a wide array of support needs requires a holistic, systems based perspective. Though the media coverage on the recent humanitarian responses has quieted, national systems continue to work on providing supports in proportion to the needs of popula tions that have experienced events carrying extremely elevated trauma potential, as well as highly atypical and heterogeneous processing. This is a matter that has become exception ally acute for Afghan families, since many households are comprised of members with varying immigration status. 5 Furthermore, operations affecting refugee and immigrant groups require fine-grain operational coordination across a kaleidoscope of stakeholders and funding streams in order to avoid gaps, service duplica tion, and policy contradictions. Not least among these priorities is the coordination of economic and social supports falling outside of the Office of Refugee Resettlement’s framework of programs, 5 such as the Temporary Assistance for Needy Families (TANF) program and the Supplemental Nutrition Assistance Program (SNAP). Conversations of this nature have catalyzed a wide range of new part nerships for engendering meaningful change by leveraging creativity and resources. Interdisciplinarity has proven vital to such efforts, and actors have been jointly addressing the incongruencies that families might otherwise have to navigate. One such example is the collabora tion between Loudoun and Fairfax counties of Virginia who, in collabora tion with Lutheran Social Services of the National Capital Area and Catholic Charities of the Diocese of Arlington,

in this domain, limited means for obtaining participant feedback, and limited actionable data have all rendered this a nebulous and fre quently impractical goal. Systems are now seeking to develop a shared understanding of these crises’ implica tions on various interconnected, yet frequently disjointed systems. In order to identify opportunities for modernization, some overarching narratives must be challenged. As fre quently occurs in other areas of human services, the current difficulties are not simply the consequence of high volume and limited funding, and as such, they cannot be rectified through finances alone. Rather, they reflect fragmented policies attempting to cover a wide breadth of needs. Prior to Operation Allies Welcome and Uniting for Ukraine, many U.S. systems were already struggling with equitable delivery of services to immi grant communities, and as such, were underequipped in terms of staffing and training to manage this groundswell of additional expectations. While the government has released consider able amounts of funding specifically dedicated to serving arrivals from Afghanistan and Ukraine, 4 and while a commendable array of activities has been undertaken by a variety of actors, many of the national, state, and local systems receiving this funding did not have enough time to plan how to best spend down resources in a coherent manner. This vast funding overlaid onto both infrastructural and disciplinary gaps has placed significant strain on administrators trying to effectively deploy resources while building in lasting resiliency. Scrambles of this sort, while inevitable under the presenting conditions, can ultimately be detrimental to progress since the provision of services to

The newest humanitarian responses have several novel dimensions with respect to their interactions with U.S. human services systems, including the volume of beneficiaries, the immediacy of the response, the disciplinary range required, and the variety of immigra tion pathways employed. While the 2015 collapse of Syria had already primed the nation for discourse around matters of capacity, the high number of Afghan and Ukrainian arrivals to the United States has catalyzed a reevalu ation of the refugee sector as a whole, requiring urgent bipartisan attention at every juncture. Compounding this urgency, the uptake of persons fleeing Ukraine, an unexpectedly rapid crescendo in the number of Cuban Haitian entrants, as well as a continuous stream of other border crossings into the United States, 3 have reinvigorated discus sions, with equitable service delivery to refugee and immigrant populations rising once more to the forefront of national discourse. Mapping Disjunctures Effectuating comprehensive reforms in serving refugee and immigrant families has been a long-held goal in human services, but in addition to political challenges, scarce funding

Amaya Alexandra Ramos , MSW, CPH, MA, is the Refugee

and Immigrant Social Services

Policy Associate at the American Public Human Services Association.

helped to establish the Virginia Community Capacity Initiative


Policy&Practice December 2022

… (Instability) imbues systems with a sense of urgency and flexibility. More importantly, it also creates opportunities for introspection and introduces pathways for the strengthening of alliances.

cohesive structural development across all programmatic levels. On the essential nature of such part nerships, Mekibib remarks, “Thanks to the VCCI, and the trusting relation ships we have fostered over the years with all the key actors, we, as Fairfax Department of Family Services, have leveraged the platform to successfully manage the unprecedented emergency repatriation and refugee resettle ment activities under Operation Allies Welcome. The U.S. refugee system will benefit from such strong local partners to ensure that innovative approaches and promising practices are elevated to national, regional, and state elected officials and practitioners.” Capitalizing on Opportunities to Enhance System Alignment The worldwide implications of the 2021 humanitarian emergency cannot be understated, whether philosophical or practical in its conse quences. However, while having the potential to cause disruptions for those who are most susceptible, instability also imbues systems with a sense of urgency and flexibility. More impor tantly, it also creates opportunities for introspection and introduces pathways for the strengthening of alliances. Capitalizing on this renewed energy, the effectiveness, appropriateness, and accessibility of services must be evaluated relative to the high level of heterogeneity within the new arrivals’ countries of origin, including ethno linguistic and religious diversity, as well as educational variances. 6 The broader population of human services providers must also be offered more in-depth resources for understanding how immigration status and socio linguistic variables may interact with

the services provided. Moreover, as interdisciplinarity is at the core of systems modernization, and as it facili tates moving interventions upstream, cross-sector collaboration must be further encouraged to render systems increasingly reflective of the voices of beneficiaries and their providers alike. To this end, continued experimenta tion in cross-system and cross-level collaborations, as well as enjoining the perspectives of those with lived experience, would help systems better understand how to support refugee and immigrant beneficiaries across the breadth of health and human services. Ideally, any emerging part nerships would advance conversations beyond simply rectifying discontinui ties during the immediate post-arrival period toward the establishment of systems able to equitably support refugee and immigrant families well into the future. Reference Notes 1. https://reporting.unhcr.org/ donors-usa; https://reporting.unhcr.org/ donor-profiles?donor=GUSA 2. https://www.npr.org/ 3. https://www.cbsnews.com/news/cuba venezuela-nicaragua-migrants-processed record-us-border-2022/ 4. https://immigrationforum.org/ article/legislative-bulletin-friday september-30-2022/ 5. https://www.acf.hhs.gov/orr/about/ what-we-do 6. Afghanistan Education Equity Profile for Adolescent Girls. United Nations Children’s Fund (UNICEF) December 2019; https://worldpopulationreview. com/countries/afghanistan-population ; 2022/07/27/1113835454/taliban india-pakistan-afghanistan-us-ttp counterterrorism-earthquake-crisis

(VCCI), which unites a range of stakeholders. Daniel Mekibib, Fairfax County’s Assistant Division Director for Workforce Development shares, “The VCCI is a multi-agency platform created to educate local stakeholders on how the U.S. refugee resettlement system works, share crucial informa tion such as projected numbers of arrivals in a given period of time, and coordinate efforts to welcome and resettle them seamlessly. It brings together a wide variety of professionals including human services agencies, public safety, health, education, and others who regularly interact with the is insufficiently celebrated. Savvy local actors, such as local govern ment representatives, caseworkers, and community organizations are often the unsung heroes in cobbling together stopgap remedies for sup porting refugee families and needs not covered by existing programming. Nevertheless, it should not be incum bent upon local actors to compensate for systemic gaps, nor is it possible at the scale currently required. Therefore, promising practices in cross-sector and cross-level responses, such as the VCCI, could be docu mented for future replication. In this manner, and with the input of diverse stakeholders, responses can be made more reflective of the variety of systems with which resettled persons interface throughout all stages of their integration into the new country. Additionally, doing so would enable local knowledge to inform state and federal action, as well as more refugees in our communities.” Similar task forces around the country have either been newly established or reinforced where they already existed, and the extraordinary, combined work of public and private actors performed through these venues

Ukraine International Religious Freedom Report for 2019. United States Department of State, Office of International Religious Freedom


December 2022 Policy&Practice

Making Health and Human Services More Intuitive to Discover, Easier to Access, and Simpler to Use Realizing the Promise of No Wrong Door


Policy&Practice December 2022


magine how frustrated you’d be if you needed to understand the different business units of your bank to deposit or withdraw money. In the health and human services realm, the typical customer doesn’t understand how agencies are organized, which programs are available, and which agencies administer which programs. Nor should they. This complexity creates administrative burdens that make it harder for customers to quickly get the help they need. There is often no single location to find information about all relevant programs. Content about programs is often organized based on how the state is structured, not on customer needs. Many appli cations request the same information from the customer, who must enter those details repeat edly on each application. And some applications can’t be completed online, so once submitted, application status isn’t clear—missed mailed notices can result in unintended benefit lapses or delays in approval.


December 2022 Policy&Practice

Customers aren’t the only ones who suffer from this kind of complexity. Disparate systems, redundant pro cesses, and duplicate and inconsistent data also create undue burdens for staff and inefficiencies for states. Manual processes drive paper, postage, and printing costs and shift staff

effort away from higher touch, more rewarding tasks. Customer confu sion drives up call center volumes and unintended churn increases processing costs. Estimates suggest that the cost of one Medicaid recipient churning one time is as high as $600. 1 Relying on customers to “figure it out” is no longer acceptable. There’s a better way to engage customers as they discover, apply for, and maintain health and human services benefits. This approach focuses not on the orga nizational structure of the state and its agencies, but on customers. Thanks to increased federal funding made avail able through the American Rescue Plan Act of 2021, states have a window of opportunity to make their services more user-friendly and efficient. What Good Design Looks Like Sound, human-centered design can address this complexity head on, with a particular emphasis on three foundational design principles: Make it intuitive, make it easy, and make it clear (see chart 1). Principle 1: Make it intuitive to discover benefits n Create a single, mobile-friendly source for discovering government programs and services. n Allow users to search for benefits in ways that make sense to them based on their personal or family situation, without needing to log in. n Provide proactive recommendations about other programs for which they might be eligible. n Make it obvious what steps are involved in the application process and provide direct links. n Use plain language that doesn’t require a user to understand how the government is organized or what specific programs might be called. Principle 2: Make it easy to enroll in and manage benefits n Create a single, integrated channel for customers to apply for and manage benefits. n Digitize paper application processes. n Share information across agencies to reduce redundant information requests in completing an applica tion or renewal.

n Provide transparency about and control over how data are being used. n Provide users with an easy way to manage their preferences. Principle 3: Make it clear with pro active communication n Supplement official notices with clear, concise reminders delivered across digital touchpoints (web, email, SMS). n Personalize message sequence, content, images, and language to meet user needs. n Provide proactive support to enable self-service and reduce call center volumes. n Allow users to choose preferred com munication channels. n Send messages using automation Several states have put these prin ciples to work to improve the way customers discover, apply for, and receive health and human services. Here are three examples: Partnering with Trusted Community Organizations to Reach Customers Human services agencies are exploring partnerships with trusted community organizations to reach customers about assistance for which they may be eligible. Arkansas, for instance, had $173 million in federal funding for its rent relief program, which provided financial assistance to renters struggling to pay rent and utili ties, and to landlords who lost income due to the COVID-19 pandemic. 2 To promote awareness of the program and distribute its funding equitably, the Arkansas Department of Human Services used an integrated outreach and marketing strategy that targeted customers across all media channels. As part of this effort, the agency equipped more than 600 community-based orga nizations with training, messaging, and social media content. In less than a year, the agency distributed more than $100 million in rent and utility relief. Simplifying Application and Benefit Management Michigan’s self-service benefits delivery portal, MI Bridges, provides and machine learning to reduce manual effort required by staff.

Kate Holman is a Senior Manager in Deloitte’s Government and Public Services Advertising, Marketing, and Commerce practice.

Jordan Schneidman is a Principal in Deloitte Consulting LLP’s Government and Public Services practice.

Phong Khanh Huynh is a Principal with Deloitte Consulting LLP. Phong serves as both the national

asset leader for Deloitte’s

Government and Public Services’ human services practice and the firm’s product owner for its child welfare practice.

Tiffany Dovey Fishman is a Senior Manager with

Deloitte’s Center for Government Insights.

Policy&Practice December 2022 20

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