Policy & Practice June 2015

The Magazine of the American Public Human Services Association June 2015

We examine how great ideas are turned into real-life success. Building Transformation

TODAY’S EXPERTISE FORTOMORROW’S SOLUTIONS

contents www.aphsa.org

Vol. 73, No. 3 June 2015

departments

features

8

A Job Alone is Not Enough to Get Ahead The second article in a three- part series focusing on economic independence.

3 Director’s Memo

The changing human service landscape

5 WashingtonViewpoint The status of reform

20 Locally Speaking

Cuyahoga County pioneers child welfare Pay for Success project

22 Partnering for Impact

Partnering for social mobility: The U.S. Department of Labor’s YouthBuild program

12

Pathways From Innovation to Transformation A report from Texas on emerging trends in the field.

24 From Our Partners State transformation opportunities for health insurance coverage 25 Part skill. Part science. Part art. Why citizen engagement is essential to human service convergence

26 Budgeting for results: Funding Pay for Success initiatives

28 Technology Speaks

Digital transformation: The promise of greater efficiency and customer service

16

Refocusing the Collaborative How the National Workgroup on Integration transformed for the better.

30 From the Field

Reaching out to new CEOs

31 Association News Updates from California and the 2015 ISM Conference

32 Legal Notes

Sexual assault of minors in rural areas: The role of human service departments

34 Focus on ChildWelfare Small moves yield big results: Federal policy change presents a momentous innovation opportunity

36 Staff Spotlight

Darnell Pinson, database/IT manager

40 Our Do’ers Profile

George Sheldon, acting director of the Illinois Department of Children and Family Services

40 In Memoriam

Jerry W. Friedman

Cover photograph via Shutterstock

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June 2015 Policy&Practice

INDUSTRY PARTNERS Platinum Level

APHSA Board of Directors Officers President Raquel Hatter , Commissioner, Tennessee Department of Human Services, David Stillman, Assistant Secretary, Economic Services Administration, Washington Department of Social and Health Services, Olympia, Wash. Treasurer, Local Council Representative Kelly Harder, Director, Dakota County Community Services, West Saint Paul, Minn. Secretary Tracy Wareing Evans, Executive Director, APHSA Past President Reggie Bicha, Executive Director, Colorado Department of Human Services, Denver, Colo. Director Eric M. Bost, Assistant Director of External Relations, Borlaug Institute, Texas A&M University, College Station, Texas Director Mimi Corcoran, Independent Consultant, Harrison, N.Y. Director Susan Dreyfus, President and Chief Executive Officer, Alliance for Strong Families and Communities, Milwaukee, Wis. Director Reiko Osaki, President and Founder, Ikaso Consulting, Burlingame, Calif. Affiliate Representative, American Association of PublicWelfare Attorneys Ed Watkins, Assistant Deputy Counsel, Bureau of Child Care Law, New York State Office of Children and Family Services, Rensselaer, N.Y. Nashville, Tenn. Vice President

INDUSTRY PARTNERS Platinum Level

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

ToChallengeandEquipOrganizations toTurnGood Intent intoMeasurableChangebyRelatingE orts toOutcomes Silver Level

ToChallengeandEquipOrganizations toTurnGood Intent intoMeasurableChangebyRelatingE orts toOutcomes Silver Level

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Policy&Practice June 2015

director‘s memo By Tracy Wareing Evans

The Changing Human Service Landscape

A s we convene this month with human service leaders from across the country for our annual Policy Forum, I have been reflecting on how the health and human service land- scape has changed in just a few short years as we collectively work to bridge systems of care and create a path to the improved outcomes our members and partners envision for our communities. It is worth stepping back and examining the evolution of system integration at the macro level. Think back to the state environment a few years ago when nearly all the energy was directed—and understandably so—to modernizing Medicaid eligi- bility and enrollment systems, setting up health care exchanges, and the debates and politics surrounding the Affordable Care Act (ACA). At that time, “horizontal integration,” our name for linking the health and human service systems, barely registered as a blip on the radar screen. Fortunately, leaders within our network stood committed to ensuring that the opportunity to better connect health care with the human service system did not fade away. Instead, we embarked on a path to leverage the changes occurring in the health arena by harnessing the expertise of public and private sector leaders to ensure that the tiny blip on that screen came into full view. 1 As we move beyond creating health care exchanges and meeting

innovations across sectors, and break down longstanding service delivery practices organized around specific programs that alone do little to achieve the desired outcomes for children and families. We should not underestimate how deeply embedded and institution- alized these historic practices have become in agencies, legislatures, and even in the best-intentioned commu- nity partnerships. And, second, we must be mindful of the need to bring together health and social service leaders—across all levels of government—including public, non- profit, and private industry providers. Without open dialogue and an under- standing of what is happening in all sectors, we risk building duplicative systems of care that do not recognize how to leverage services or identify opportunities to bend the projected cost curve in both systems. This means that hospital associations, community health organizations, and associated providers and networks must be inten- tionally connected with social service providers and industry leaders in human services. Without a concerted effort to address the bias inherent in our organizational structures, we will miss the opportunity to make the kind of changes we need to sustain integra- tion efforts in the long term. Fortunately, despite these chal- lenges, there is a convergence of

ACA-driven deadlines, more juris- dictions are focusing on health and human service systems interoper- ability, particularly in eligibility and enrollment, and data-sharing efforts across programs. Human service leaders are more often players at the table now, and no longer simply trying to get in the door. Early innovators are setting the stage for a much broader national focus on how to maximize interoperable systems toward reducing costs and producing better outcomes. States and localities have moved the needle on connecting human services to health, not just behind the scenes, but more important, for what it can mean in overall population health and well-being. While many challenges remain, we know much more about the potential obstacles and the underlying causes, which are driving solutions. Two of the bigger challenges have come to light through the work of our National Collaborative for Health and Human Services Integration (formerly known as the National Workgroup on Integration). First, our moderniza- tion of governance lags behind our modernization in technology. As a result, keeping the sequence straight (i.e., ensuring that business is driving technology and not the reverse) con- tinues to challenge even the most innovative states and localities. We must continue to support the system changes required to allow for blended and braided funding, incentivize

See Director’s Memo on page 37

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June 2015 Policy&Practice

Vol. 73, No. 3

www.aphsa.org

Policy & Practice™ (ISSN 1942-6828) is published six times a year by the American Public Human Services Association, 1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036. For subscription information, contact APHSA at (202) 682-0100 or visit the web site at www.aphsa.org. Copyright © 2015. All rights reserved.This magazine may not be reproduced in whole or in part without written permission from the publisher.The viewpoints expressed in contributors’ materials are the authors’ own and do not necessarily reflect the policies or views of APHSA. Postmaster: Send address changes to Policy & Practice 1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036

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Policy&Practice June 2015

washington viewpoint By Ron Smith

The Status of Reform

I t is almost impossible to find articles on the status of most federally funded human service programs without some reference for the need to “reform the system.” That is certainly true at APHSA where a great deal of attention is being paid to our members’ Pathways efforts focused on a future state where the system is person- centered, outcomes-focused, and wisely uses public dollars. This future state envisioned in Pathways calls for accountability that encompasses 21st century technology to embed data analytics into practice models and then uses the power of those ana- lytics to continuously improve service delivery to achieve better outcomes. Pathways also calls for alignment of federal and state financing that allows services to be tailored to the needs of communities and promotes preven- tive services that reduce reliance on government supports. Virtually every “think tank” located in Washington, D.C. that focuses on domestic issues has a position or policy statement on the delivery system for human services and the need for reform. Consider the following statements: Š Š To put welfare spending on a more prudent course, aggregate means-tested welfare spending for the approximately 80 federal programs that provide cash, food, housing, medical care, and social services to poor and lower-income Americans, should be scaled back to pre-recession (FY 2007) levels plus 10 percent, and capped at the rate of inflation going forward (The Heritage Foundation). 1 Š Š America’s low-income working families are struggling to get by, too often forced to make impossible choices among food, housing, and

Maryland Democrat Chris Van Hollen is the ranking member of the House Budget Committee, which is one of many committees sifting through position papers, studies, and policy papers regarding the future funding of human service programs.

health care. Government safety nets were reformed in the mid-1990s with the promise that work would pay. But that promise remains unfulfilled for many families (Urban Institute). 2 Š Š Child poverty in the United States could be substantially reduced. By making work pay more, supporting employment for those who can work, and expanding safety net supports to ensure children’s basic needs are met, the nation could reduce child poverty by 60 percent—lifting 6.6 million children out of poverty immediately (Children’s Defense Fund). 3 Š Š Welfare reform passed a decade and a half ago is in desperate need of its own reform (Daily Kos). 4

advocacy policy positions that argue for reforming the current welfare system in the United States. As these policy statements indicate, many of the studies conducted in recent years try to evaluate the effectiveness of the last major welfare reform bill enacted into law, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) passed in 1996 and signed into law by President Bill Clinton. That law incorporated numerous changes in existing federal welfare programs. It ended the entitle- ment program, Aid to Families with Dependent Children, and created Temporary Assistance for Needy Families (TANF). It also repealed the Food Stamp program and replaced it with the Supplemental Nutritional Assistance Program (SNAP). In

These are just a few of hundreds of position papers, research studies, and

Photograph via Flickr user Campus Progress

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June 2015 Policy&Practice

federal expenditures. In 2012 the Congressional Budget Office con- ducted a study of federal means-tested programs and identified “83 overlap- ping federal welfare programs that together represented the single largest budget item in 2011—more than the nation spends on Social Security, Medicare, or national defense. The total amount spent on these 80-plus federal welfare programs amounts to roughly $1.03 trillion.” 6 In today’s Congress, the leadership of the relevant committees recognizes

addition, it made far-reaching changes to child care, the Child Support Enforcement Program, benefits for legal immigrants, Supplemental Security Income for children, and modified the child nutrition program, as well as reducing the Social Services Block Grant. Much of today’s discussion about PRWORA involves an assessment of whether or not it was “successful.” According to the House Budget Committee’s 1996 report explaining the provisions of the bill: 5

including by developing innovative efforts to improve cooperation between and the performance of TANF, child care, social services and multiple other benefit programs. As part of this process, ensure that programs are rigorously evaluated and held accountable for achieving mea- surable performance goals, including substantive work and activity require- ments for adult recipients, such as the TANF program has applied since 1996 reforms. Also review opportunities to prevent duplication, overlap, and fragmentation, in order to improve

There are signs within Congress that progress toward understanding the need for a delivery system that can better respond to local conditions and demands is taking hold. While giving states more flexibility is not a panacea for what reforms are needed, it is an important and necessary step in the right direction.

that problems exist within the human service system. In both the House and Senate, concurrent budget resolutions are references to the need for some reform measures. As far as reforming human service programs, the House Ways and Means Committee plans seem focused for now on some over- sight hearings, with one exception. For the committee, repealing the Social Services Block Grant remains a high priority. According to the committee: The Social Services Block Grant is an annual payment sent to States without a matching requirement to help achieve a range of social goals, including child care, health services, and employment services. Most of these are also funded by other Federal programs. States are given wide discretion to determine how to spend this money and are not required to demonstrate the outcomes of this spending, so there is no evidence of its effectiveness. 7 The Ways and Means Committee gave further evidence of their “welfare reform” agenda in releasing their over- sight hearing plans for 2016: Welfare Reform. Review proposals designed to better assist low-income families in increasing their work and earnings so they can escape poverty,

the overall effectiveness of efforts to serve low-income individuals. Examine associated barriers to increasing self-suf- ficiency among low-income families with children, and how changes may better address the needs of adult beneficiaries who face barriers to employment. 8 The situation in the Senate is not much different. According to the Senate budget resolution, the Finance Committee’s major interest for this year is “replacing ineffective policies and programs with evidence-based alternative that improves the welfare of vulnerable children.” Because both the House and Senate budget resolutions are designed to balance the federal budget in 9 or 10 years, significant reductions in both discretionary and mandatory funding are envisioned. Both the Ways and Means Committee and the Finance Committee are being asked to reduce the spending in programs they have jurisdiction over by $1 billion in FY 2016. 9 As has been the practice in recent years, welfare reform debates in Congress are focused mainly on reducing spending, ensuring com- pliance on the use of funds, and on requiring people who receive benefits to work if they are able. There is also discussion of the need for evidence- based programs and services, but some

The reform proposal (PRWORA) saves families by promoting work, discour- aging illegitimacy, and strengthening child support enforcement. It converts welfare into a helping hand, rather than a handout, by limiting lifetime welfare benefits. It halts payments to people who should not be on welfare. It grants maximum State flexibility to show true compassion by helping those in need achieve the freedom of self-reliance. Since the law’s implementation, lawmakers and advocates have argued about the success of its provisions. Some point to the fact that today— nearly 20 years later—one out of seven people in America are living in poverty and, therefore, the goals of PRWORA were never accomplished. This viewpoint fails to recognize that the delivery of social services will never (and could never) fully meet every need of every low-income or under- privileged individual or family. The mere fact that there are unmet needs is not sufficient justification for advo- cating that reforms to existing welfare programs are necessary. Others will argue that the federal government continues to have too many means-tested programs and that, as a result, there is far too much duplication, inefficiency, and abuse resulting in unnecessarily high

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Policy&Practice   June 2015

confusion as to what that means. In all, there is little commentary about how to improve the ability of individuals or families to become self-sufficient. This is true not just at the federal level, but at the state level as well, at least as far as state legislatures are concerned. Congressional Quarterly (CQ) recently conducted a study of what issues were receiving the most attention in each state legislature. 10 CQ interviewed journalists who cover their state capitols to see what issues were on the minds of legislators. Not surprisingly, budget issues led the list, named as the single-largest issue in no fewer than 10 states. Education was ranked number one eight times, followed by transportation and taxes, both five times. On the list of issues that were mentioned as somewhere in the top five, social services was mentioned just twice, the same as guns, liquor, gambling, and privacy, among others. This, of course, is not to say that state governments are not concerned about reform in human services, many governors and human service depart- ments are experimenting in various ways to improve and reform human service delivery. 11 Of course, many of these efforts are constrained in their impact because they must be done within the silos established by federal programs and state laws that mirror the federal system. This limits the degree to which reforms can be tested, and consequently, the outcomes of testing new approaches. This is one reason that our members support more opportunities for federally sup- ported innovation demonstrations, where evidence-informed practices can be tested across programs and funding streams. There are signs within Congress that progress toward understanding the need for a delivery system that can better respond to local conditions and demands is taking hold. While giving states more flexibility is not a panacea for what reforms are needed, it is an important and necessary step in the right direction. For example, when the House Budget Committee reported the FY 2016 Concurrent Resolution on the Budget, strong language was added to the committee report stating:

Our budget realigns the relationship the federal government has with states and local communities by respecting and restoring the principle of federalism. It streamlines federal programs and turns the focus of Washington back to its core responsibilities, all the while giving states ownership and flexibility to better serve their constituents. From health care to education, states will be empow- ered to create their own solutions, free of onerous Washington mandates or overregulation. These reforms will save money, but, more importantly, by finding more effective means to address challenges, states and local leaders will have the power to actually solve them, thereby increasing choices and opportu- nities for Americans. 12 It is true that the House Budget proposal is controversial and that many of the policies contained within it are opposed by a number of members of Congress and the President. However, on the narrow issue of giving states a larger role in determining how best to provide struc- ture in the delivery of human services, there hasn’t been open opposition. The Ranking Member of the Budget Committee, Chris Van Hollen (D-MD), while outlining the provisions of the budget he strongly disagreed with, made no mention about the efforts to give states more flexibility. 13 Time will tell if Congress is able to make the kind of alignments and changes in federal law that will empower states to fully make the changes they know are needed to ensure that dollars are being spent in ways that achieve the kind of lasting outcomes for children and families that strengthen communities and ulti- mately reduce reliance on government services. The key is to look for oppor- tunities to showcase the successes occurring in states and localities, and assure that the discussion includes those who are leading these efforts on the ground. At APHSA, we’re com- mitted to doing just that. Reference Notes 1. http://www.heritage.org/research/ reports/2015/03/7-priorities-for-the-2016- congressional-budget-resolution 2. http://www.urban.org/projects/ newsafetynet/index.cfm

3. http://www.childrensdefense.org/library/ PovertyReport/EndingChildPovertyNow. html 4. “Age 16 welfare reform shows that critics were right. The poor, children included, are being hurt.” Meteor Blades (Timothy Lange), Daily Kos, March 14, 2012 5. Committee on the Budget, House Report 104-651, 104th Congress 2nd Session, June 27, 1996. http://www.gpo.gov/ fdsys/pkg/CRPT-104hrpt651/pdf/CRPT- 104hrpt651.pdf 6. Press release by Senator Jeff Sessions, Ranking Member, U.S. Senate Budget Committee . http://www.budget.senate. gov/republican/public/index.cfm/files/ serve/?File_id=34919307-6286-47ab- b114-2fd5bcedfeb5 7. House Report 114-47 to Accompany H. Con. Res. 27, Establishing the Budget for the United States Government for Fiscal Year 2016 and Setting Forth Appropriate Budgetary Levels for Fiscal Years 2017 through 2025. https://www. congress.gov/114/crpt/hrpt47/CRPT- 114hrpt47.pdf 8. Committee on Ways and Means, U.S. House of Representatives letter to Committee on Oversight and Government Affairs and the Committee on House Administration, January 21, 2015. http:// waysandmeans.house.gov/uploadedfiles/ oversight_lettier_114th.pdf 9. S. Con Res 11 . https://www.congress.gov/ bill/114th-congress/senate-concurrent-reso lution/11?q=%7B%22search%22%3A%5B %22concurrent+budget+resolution%22% 5D%7D and H. Con. Res. 31. 10. Congressional Quarterly/CQ-Roll Call, “The 50 State Project: A report on the top state issues of 2015 by the reporters who cover them.” March 2015. http:// info.cqrollcall.com/rs/cqrc/images/50_ StateProject_MAR2015.pdf?mkt_tok=3Rk MMJWWfF9wsRoisq7KZKXonjHpfsX64%2 BokW6K0lMI%2F0ER3fOvrPUfGjI4FTMRr I%2BSLDwEYGJlv6SgFTbbBMbhh2bgPUx M%3D 11. “Lessons Learned from System Reform Efforts: State and Local Examples,” Child Welfare Information Gateway. https://www.childwelfare.gov/topics/ management/reform/lessons/state/ America, House Budget Committee, March 2015. http://budget.house.gov/ uploadedfiles/fy16budget.pdf 13. “Top Reasons to Oppose the House Republican “Work Harder, Get Less” Budget,” Budget Committee Democrats. http://democrats.budget.house.gov/ 12. A Balanced Budget for a Stronger

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June 2015   Policy&Practice

A Job Alone Is Not Enough To Get Ahead

By Kate Griffin, Jeremie Greer, and Alicia Atkinson

Photograph vaia Shutterstock

This is the second article in a three-part series focusing on economic independence.

Millions of working Americans

struggle to manage their finances, often accumulating no savings and high debt. According to the 2015 Assets & Opportunity Scorecard, 44 percent of households are liquid asset poor, meaning they cannot afford to live without income for three months at the poverty level. This vulnerability impacts all household levels; one in five middle-income households—those earning between $56,113 and $91,356 annually—are asset poor. Living on the brink of financial insecurity means these households are much more likely to cycle in and out of various forms of public assistance even if they are employed, creating a strain on govern- ment programs and services. Public social service agencies who engage with clients on workforce, edu- cation, housing, or health outcomes are poised to address financial chal- lenges faced by households in real, meaningful ways. By integrating opportunities to practice financial skills, to gain trusted financial advice, and to access financial products into the delivery of other social services, agencies can create pathways toward longer-term sustainability and decrease reliance on government income supports. This article empha- sizes the opportunity for service providers focused on building career pathways.

>>>

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June 2015   Policy&Practice

Figure 1

The federal government invests approximately $9.1 billion each year into workforce development. While individuals come to these programs to find a job or receive skills training to access higher wage jobs, many also come with multiple financial chal- lenges, such as having little or no access to credit, high debt, low savings, and irregular cash flow. Living in these circumstances makes it much harder to quickly bounce back from a financial emergency, such as a car repair or a child care disruption, and can cause individuals to miss work. Although serious, these kinds of challenges are not uncommon. The Consumer Financial Protection Bureau finds that one in five employees reported they had skipped work in the past year to deal with a financial problem, possibly making it difficult to maintain employment.

WAGES $2,200 increased yearly pay for clients receiving financial counseling at Center for Employment Opportunities .

Higher job placement rates for clients receiving financial JOB PLACEMENT

HOURS WORKED

Participants who opened a checking account secured 12 additional hours of work per week in the Small Business Services program.

counseling at the Capacity Building Initiative .

Source: Building Financial Counseling into Social Service Delivery: Research and Implementation Findings for Social Service Programs (New York: Department of Consumer Affairs, 2014).

All of these barriers start and end with the state of a household’s finances and take a toll on a household’s finan- cial stress and ability to manage finances. Recent research from the field of behavioral economics has shown that low-income households are so overwhelmed by the constant worry about money that their “mental bandwidth” becomes dramatically reduced, 1 creating a tunneling effect that reduces their ability to make good long-term financial decisions. This stress can hinder job performance and retention. Integration of Financial Capability Financial capability services and workforce development programs, like TANF and one-stop centers, share similar goals; both focus on ensuring that individuals have the tools to participate in, contribute to, and benefit from the mainstream economy. These services are strongly interrelated and become more effec- tive when combined. Financial capability services have a track record of increasing employment outcomes while addressing the other dimen- sions of an individual’s financial life. Evaluations have shown that by inte- grating financial capability services into employment services, job place- ment rates, number of hours worked, wages, and job retention all tend to increase (see Figure 1). Services into Workforce Programs Yields Improved Employment Outcomes

Barriers to Employment are Linked to Household Financial Insecurity While finding a job creates a finan- cial challenge in and of itself, there is more going on underneath the surface. Research from the Urban Institute shows that adults entering workforce development programs generally have four or five financial challenges beyond unemployment which, taken together, can create barriers to gaining employ- ment and exacerbate a household’s ability to become financially stable. These barriers can include: Š Š Transportation issues due to lack of savings to purchase a car or repair a car, or lack of affordable public transportation. Additionally, indi- viduals may have low credit scores, making financing a car unaffordable. Š Š Child care issues , including lack of affordable and quality child care, lack of transportation to child care, child care hours that do not match their work schedule, and child care being closed on holidays or weekends. Inevitably, these chal- lenges involve relying on friends and family for informal child care, which can also be unreliable and inconsistent. Š Š Unstable housing can cause commutes and transportation to change frequently and make applying for employment difficult due to the lack of a permanent address. Additionally, budgeting can be especially difficult if housing is unstable and costs can change rapidly.

Kate Griffin is the vice

president of Programs at the Corporation for Enterprise Development (CFED).

Jeremie Greer is the vice president of Policy and Research at CFED.

Alicia Atkinson is a policy analyst on the Policy and Research team at CFED.

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Policy&Practice June 2015

Figure 2

Source: Building Financial Capability: A Planning Guide for Integrated Services (Washington, D.C.: Department of Health and Human Services and CFED, 2015).

workforce counselor, there is immense opportunity to integrate financial conversations and actions that lead to a change in financial behaviors and outlook. Research continually shows the benefit of providing multiple services to boost overall financial outcomes. A 2009 evaluation by Abt Associates showed that clients who received multiple services were three to four times more likely to achieve a major economic outcome, such as a job attainment, increased income, or increased savings, compared to those who only received one service. Workforce Development Programs Have Multiple Options to Deliver Financial Capability Services CFED, a Washington, D.C-based nonprofit dedicated to expanding economic options for low-income com- munities, has identified three models that different community organiza- tions and social service agencies have adopted to integrate financial capa- bility into their core service model. Š Š Refer. This approach involves finding organizations that provide the relevant services and setting up a process for referring clients to these services. Š Š Partner. This approach involves deeper relationships and “shared” clients. These partnerships can extend as far as co-location, where

multiple organizations are hosted at a single site with centralized intake and outcomes, so that many services can be offered in a “one-stop” setting. Co-branding can be included in this approach, despite multiple agencies providing the services. Š Š Do-It-Yourself (or DIY). This approach involves building internal capacity to embed financial capa- bility services into the existing core service model. Each of these options has advantages and disadvantages, depending on how easily clients can access the service and the resources required to implement it. The set of service delivery options that best suits a social service agency’s clients and capacity can vary widely. Implementation strategies can range from “light touch” integration, such as adding financial topics to an existing workshop, to “high-touch” integration, such as a more fully integrated model, in which many service providers organize under one roof to provide a range of financial capability and social services. The U.S. Department of Health and Human Services and CFED recently released an interactive resource, Building Financial Capability: A Planning Guide for Integrated Services, which provides a step-by-step process for service providers interested in

Workforce development programs provide a key leverage point to strengthen a household’s financial stability. Research by the Catholic University of Portugal and the Center for Research on Consumer Financial Decision Making finds that moments when people can use their finan- cial skills and knowledge—such as choosing an auto loan or filling out a direct deposit form—are ideal for con- necting them to the financial services, tools, and resources they need to make sound financial decisions. It is the most important time to create new habits, because the information and resources are relevant to a decision in their lives at that moment. This approach also allows people to put what they have learned into action immediately, as they have the skills, tools, and income to practice what they learn. This hands-on and meaningful skill-building helps boost individuals’ confidence about their ability to handle financial issues in the future, creating long-lasting behavioral change that can help stabilize house- holds into the future. Financial capability services often require providing ongoing support as clients change financial behaviors. While a one-time financial capability service such as pulling a person’s credit report or opening a bank account can be effective, it is not often associated with long-lasting behavioral changes. Rather, when someone has a long-time, trusted relationship, such as with a

See Financial Capability on page 39

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June 2015 Policy&Practice

By Stephanie Muth

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T he American Public Human Services Association (APHSA) works with and through our members to capture inno- vations in practice, programs, and policy that will transform our health and human service system to support meaningful and sustainable outcomes for strong and healthy children, youth, families, and communities. This work is outlined in our members’ vision for a transformed health and human service system in Pathways: The Opportunities Ahead for Human Services. As part of the Pathways initiative, APHSA, in partnership with The Kresge Foundation, has launched a national effort aimed at collecting stories of human service transformation and innovation. Each narrative describes the context or catalyst for the change made, various strategies utilized, and results that occurred. Here is one of the success stories from the Texas Health and Human Services Commission.

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June 2015 Policy&Practice

Scoping Emerging Trends Texas’s population has grown and continues to grow rapidly. The increasing numbers of individuals and families have translated to greater demand for services from the Texas Health and Human Services Commission (HHSC). Between 2007 and 2012, HHSC experienced a 46 percent increase in its caseload. If the population growth continues as expected, by 2020 there will be an additional 20 percent greater need for public human services. Population is just one of the impacts on caseload. Less predictable factors such as unforeseen natural disasters and changes in policy can also place a strain on resources. In order to meet current demands and prepare for the future within the confines of current resources, HHSC has taken a proactive approach to redesigning its system for greater efficiency and effectiveness for both its staff and clients. The reality is that staffing growth does not parallel population growth. Because of this, HHSC leadership has focused its transformation strategies on creating more capacity within existing resources. Workforce Retention. The first strategy is focused on retaining current HHSC employees in order to keep experienced and competent staff on the job. Four primary areas are lever- aged to increase workforce retention: 1. Work-life balance: This is achieved by reducing extensive overtime requirements and ensuring that the eligibility process is as efficient as possible so that caseloads are man- ageable on an individual basis. 2. Development: HHSC demon- strates a commitment to employee growth by providing opportunities

Screenshots of the Your Texas Benefits app.

success. The group established prac- tices to reduce duplication of effort. They mapped the processes, identi- fied efficiencies, looked at how many people touched a case, and measured how long it took to determine eligi- bility. They standardized intake and eliminated unnecessary steps, while retaining legal requirements and only the necessary customer interactions. Management molded the workgroup’s recommendations into a cohesive plan. Incoming work was triaged based on complexity of need. Real- time data and resource management were brought into play to maintain reasonable workloads and support fluid staff assignments. The result is a highly coordinated, customer-friendly system from application start to issuing benefits. A pilot program to test the changes kicked off June 10, 2014, at Houston’s Meadowfern HHSC benefit office, where the workload stress was the highest. Leaders also recognized that for the change to be effective it had to be rolled out incrementally with strong staff support. Since March 2015, the new processes have been tested in a total of 35 pilot sites. Results of lessons learned will be compiled and adjustments made prior to state-wide implementation of the new processes in late 2015. Technology. Technology can also bring large efficiencies to the table. HHSC has had an aggressive approach to deploying digital technology solu- tions over the last five years and

for professional development and advancement for exemplary staff. 3. Active voice: Staff has the ability to offer input and voice an opinion about upcoming changes in pro- cesses. This gives them a feeling of engagement while ensuring that all changes are informed by the front- line employees that are actually conducting eligibility work. 4. Communication: Provide ongoing updates on key initiatives so the entire workforce understands the strategic direction HHSC is taking and why. Process Improvement. Texas leadership examined other states, primarily Florida and Utah, to learn about their best practices and decided to proactively conduct a redesign of the benefit eligibility process. The goals of the redesign are to free up lost capacity by reducing activities that do not add value, and decrease the days it takes to determine eligibility. HHSC knew that the best employees for redesigning the process were those that are con- ducting the current process. Forty field workers and first-line supervisors from HHSC offices across the state were brought together to form a workgroup to redesign the eligibility process from start to finish. The group was provided with a skilled change agent consultant and management support, but they designed the new system themselves and, therefore, were invested in its

Stephanie Muth is the deputy executive commissioner for the Office of Social Services at the Texas Health and Human Services Commission (HHSC).

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as they understand how changes on the horizon personally benefit them and their customers. Leadership also looks to create a culture of fun to help staff and clients embrace the new changes. For example, in 2014 there was a Lobby Computer Championship in which offices competed against each other on increasing client use of lobby computers. The goal of the contest was to educate clients and staff on all of HHSC’s self-service offerings. This created excitement, creativity, and sharing best practices across the state. Offices that excelled went on the road to serve as mentors to others. For example; one clerk started a new approach to helping people in the lobby. Seeing that it was effective, other staff voluntarily followed. This clerk and her manager then went out and worked a day in many of the lobbies across the state, helping other staff get comfortable with increased customer interaction. Private-public partnership. Part of HHSC’s strategy in meeting growing caseload demand is a commitment to Community Partner collaboration and recruitment. Community Partners fall under many different categories such as domestic violence shelters, schools, libraries, or food banks but they all share the common goal of offering clients additional locations to apply for benefits on YourTexasBenefits.com. HHSC has nearly doubled its number of Community Partners in the last 18 months to 1,000+ partners. This reduces the workload for Texas HHSC case management staff and provides more convenient options for clients. Making a Real Impact HHSC leadership credits all of these strategies working together holistically when it comes to the positive results the agency has been experiencing. The improvements have allowed the state to serve more people without an increase in staff

resources. The eligibility caseload has increased 16 percent since FY 2011 while the number of eligibility staff has remained relatively constant. The increase in self-service directly correlates to reduced turnover and decreasing overtime. Average days to disposition are decreasing, and same-day dispositions are increasing. For example, in 2007, only 58 percent of SNAP applications were processed on time, and the state had a 7 percent error rate—well above the national average. In 2014, 97 percent of applica- tions were processed on time, and the SNAP error rate was 0.68 percent—an all-time low for Texas and among the best in the nation. In 2014, the federal Health Insurance Marketplace sent more than 268,000 new applications to Texas. Despite this new influx of work, client applications stayed on track and accurate in eligi- bility determinations. The decrease in overall office visits helps state staff devote more time to those who need extra help. As of December 2014, 70 percent of client applications are now submitted online, up from 14.6 percent in January 2012. The ability to upload required docu- ments, like a paycheck stub, and send it to the state on YourTexasBenefits. com and now, the Your Texas Benefits smartphone app, has led to a decline in vendor payments for document imaging from $7.8 million in 2012–2013 to $6.3 million in 2013–2014. Payments for call centers and document processing fell $12.7 million between FY 2012 and FY 2014 while the monthly caseload increased by more than 600,000 during the same period. Where to Learn More Other stories of agencies from around the country can be found at http://aphsa.org/content/APHSA/en/ pathways/TransformationsinAction. html.

continues to plan ahead for the future. The two technology cornerstones are focused on providing clients with a portfolio of self-service options via the web site, YourTexasBenefits.com, and a Your Texas Benefits smartphone app. YourTexasBenefits.com offers clients the ability to apply, renew, and report changes for their benefits at any time and anywhere. The app is focused primarily on features easily done by smartphone, such as uploading docu- ments and signing up to receive case alerts via e-mail or text message. The increased use of self-service options helps manage workloads by reducing data entry, client traffic, and calls to eligibility offices or call centers. This allows staff to focus on their core function of making accurate and timely eligibility decisions. Vendor costs are also reduced because fewer documents are imaged and call volume is decreased. Short-term plans in 2015 for self- service are the ability to opt-out of mail reminders as well as a newly rede- signed YourTexasBenefits.com based on client input. To ensure high utilization, none of the new technological advances are rolled out without user testing and robust staff training. Communications. Effective com- munications play a key role in adoption of any changes. Every channel of communication—e-mail, videos of staff working together to design the process, newsletters, a robust network of Change Champions (comprised of field staff), and face-to-face meetings with staff— has been used to promote new strategies to every worker in every HHSC office and to other stakeholders as well. Proactive and frequent communica- tion has helped quell any fears among staff that they would be forced out of their jobs or expected to work longer hours at breakneck speed. Workers are more invested in their performance

The increased use of self-service options helps manage workloads by reducing data entry, client traffic, and calls to eligibility offices or call centers. This allows staff to focus on their core function of making accurate and timely eligibility decisions. Vendor costs are also reduced because fewer documents are imaged and call volume is decreased.

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Illustration by Chris Campbell

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Policy&Practice June 2015

How the National Workgroup

on Integration Transformed for the Better

I

In partnership with communities across the nation, our agencies are already creatively generating solutions for the many needs and concerns in human services through dynamic leadership, path-breaking part- nerships, and new answers to old problems. We are excited and opti- mistic about the unprecedented opportunities we have—for innova- tion, alternative funding models, and breakthrough technologies. These new approaches, tools, and relation- ships are converging to transform our work—from a system focused on outputs, rigid categories, and outmoded business techniques to one that creates community-wide change and supports meaningful and sustain- able, person-centered outcomes. These dramatic shifts are lifting individuals and families toward independence, adding value to communities, strength- ening families, and achieving more at less cost—positive changes that bring new value to all of us. APHSA has long recognized that inte- grating the health and human service system is a long-term and complex body of work. For decades, the current operating systems have solidified their siloed administration and regula- tory structure and will not easily be changed. Significant strides toward integration have been made, but our members want and need additional

n April APHSA launched the National Collaborative for Integration of Health

By Anita Light

and Human Services (the National Collaborative) to advance and accel- erate the benefits of horizontal integration of health and human services. The National Collaborative has its genesis in the National Workgroup on Integration (NWI). As a result of that work over the past three years, the Collaborative will now expand its scope and reach by highlighting best prac- tices of integration, providing technical assistance to state and local members who recognize the need to transform their agency. The Collaborative will also expand networks and partnerships of public, nonprofit, business, academic, foundation, and other health and human service stakeholders to advance principles of integration, and promote policies and practices that support an integrated health and human service enterprise. The United States continues to change rapidly in many areas—the economy, social structures, demo- graphics, communication, and other major sectors that bear directly on our collective national success and well- being. These broad changes are also directly affecting health and human services, challenging us to rapidly increase the effectiveness and value of our work.

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June 2015 Policy&Practice