Policy and Practice April 2019

The Magazine of the American Public Human Services

Association April 2019

Solutions Within Our Reach

Creating a Modern, Responsive Health and Human Services System

TODAY’S EXPERTISE FORTOMORROW’S SOLUTIONS

contents www.aphsa.org

Vol. 77, No. 2 April 2019

features

departments

10

3 President’s Memo

Bridging the Divide: Effectively Translating Evidence-Based Policymaking

5 Association News

Department Names Room in Honor of Nannette Bowler’s Workforce Career Development Vision

6 Book Review

Workaches: The Neuroscience Guide to Surviving and Thriving at Work

Invest in What Works (or the What Works Toolkit) Five Steps to Help Governments Shift to Outcomes-Focused Contracting

8 Locally Speaking

Perry County: Building Well-Being from the Ground Up

22 Legal Notes

New Foster Parents Gain Experience with Incremental Challenges 23 Improving Financial Integrity in Human Services Agencies

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25 From Our Partners

Meeting Individual Social Needs Falls Short of Addressing Social Determinants of Health

28 Technology Speaks

When Humans and Machines Collaborate: Four Lessons from the Fight to Reduce Infant Mortality

Case for a Youth Portal Supporting Adolescents on the Road to Adulthood 18

30 Staff Spotlight

Jenny Hogan, Marketing and Communications Coordinator

36 Our Do’ers Profile

Wanda Rogers, Director of the Hampton Department of Human Services

Child Welfare’s Pipe Problem How Relieving the Pressure Can Ignite the Workforce’s Ability to Do Its Job

Cover illustration by Chris Campbell

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April 2019 Policy&Practice

APHSA Executive Governing Board

Chair Kelly Harder, Director, Dakota County Community Services, West Saint Paul, MN Vice Chair Brenda Donald, Director, DC Child and Family Services Agency, Washington, DC Treasurer Reiko Osaki, President and Founder, Ikaso Consulting, Burlingame, CA Leadership Council Chair (Vacant) Local Council Chair Frank Alexander, Director, Boulder County Housing and Human Services, Boulder, CO Affinity Group Chair Paul Fleissner, Director, Olmsted County Health, Housing and Human Services, Rochester, MN

Elected Director Susan Dreyfus, President and CEO, Alliance for Strong Families and Communities, Milwaukee, WI Elected Director David Hansell, Commissioner, New York City Administration for Children’s Services, NewYork City, NY Elected Director Anne Mosle, Vice President, The Aspen Institute and Executive Director, Ascend at the Aspen Institute, Washington, DC Immediate Past President David Stillman, Assistant Secretary, Economic Services Administration, Washington Department of Social and Health Services, Olympia, WA

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Policy&Practice April 2019

president‘s memo By Tracy Wareing Evans

Bridging the Divide: Effectively Translating Evidence-Based Policymaking

T here is a lot of talk these days about evidence-based policymaking, 1 and with good reason. Grounding health and human services policy in evidence of what works is foundational to fos- tering systems that enable better, faster outcomes for families and communities; provide more targeted interventions; address structural inequities; and ultimately reduce costs. Put another way, all of us want to know that our public investments are working to advance social and economic mobility for all people in all places. And, yet, we know that too often there is a wide discrepancy in how the research field, philanthropy, policymakers, and practi- tioners approach evidence. While I am not researcher, I have the good fortune of working

standard research designs or a resis- tance to anything labeled “evidence based” because of the associated cost and time. This tension is particularly con- cerning when fiscal policy gets tied to funding only those programs or interventions with the RCT label. We risk cutting whole areas of needed services—where there are necessary interventions (e.g., services for sex trafficking victims) 2 for which no iden- tified evidence-based programs exist. Moreover, not all interventions are created equal nor should they be. For example, capturing how light-touch interventions effectively prevent longer term needs is likely to be revealed

alongside seasoned academicians and researchers, in addition to leaders at all levels of government, and the practi- tioners who are closest to the ground in communities. In doing so, I have come to appreciate the discipline of clearly articulated research questions and theories of change; the importance of sample size and integrity of data; and the need to apply appropriate qualita- tive and quantitative methodologies and study designs. At the same time, I have witnessed an overreliance on large, clinical, randomized controlled trials (RCTs) that while certainly of value to the field from a long-term perspective, rarely translate well in the field in real time and often drive experts back into extreme positions— either an insistence on the rigor of gold

See President’s Memo on page 30

Image via Shutterstock

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April 2019 Policy&Practice

Vol. 77, No. 2

www.aphsa.org

Policy & Practice™ (ISSN 1942-6828) is published six times a year by the American Public Human Services Association, 1101Wilson Boulevard, 6th Floor, Arlington, VA 22209. For subscription information, contact APHSA at (202) 682-0100 or visit the website at www.aphsa.org. Copyright © 2019. 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 1101Wilson Boulevard, 6th Floor, Arlington, VA 22209

Advertising Natasha Laforteza ads_exhibits@aphsa.org Subscriptions Donna Jarvis-Miller djarvis-miller@aphsa.org Design & Production Chris Campbell

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Policy&Practice April 2019

association news

Department Names Room in Honor of Nannette Bowler’s Workforce Career Development Vision

O ver the past 10 years, the Fairfax County Department of Family Services (DFS) has come to be known as a county agency that focuses a signifi- cant amount of effort, time, and resources toward workforce career development. This workforce-centric culture was the vision and passion of DFS Director, Nannette M. Bowler. She knew that the successful delivery of services to Fairfax County resi- dents needed to be built upon a few vital building blocks, one of which was professional develop- ment of its workforce. With a staffing complement of more than 2,000 employees, Bowler embarked on a mission to provide all DFS staff with the tools they needed to succeed, not only to deliver the most effective and efficient services possible, but also to develop their own careers, knowledge, skills, and abilities. In an effort to achieve these goals, she began to develop and institute a variety of different internal agency initiatives, projects, and academies all geared toward affording staff with an opportunity to develop their professional skills to the highest level. With the need to offer several simultaneous, on-going training opportunities throughout the year for such a large staff, DFS frequently was starving for adequate conference room and training space where they could conduct these varied programs. After years of making due with limited training space, Bowler embarked upon a two-year effort to consolidate and reconfigure existing

space. This effort led to the devel- opment and construction of a dedicated, 612-square-foot DFS training conference room that could accommodate up to 50 indi- viduals, configured for all audio visual and training requirements. For years DFS staff has appreciated Bowler’s sincere and genuine focus on personal career development and it was deemed appropriate to honor and thank her by dedicating the DFS training room in her name on February 28, 2019. This occasion was marked by placing a plaque in the training room. The plaque and its inscrip- tion symbolize the appreciation and sentiments of current staff (and all those in the past) who have enjoyed working for an agency and a leader who cares.

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April 2019   Policy&Practice

book review

Workaches: The Neuroscience Guide to Surviving and Thriving at Work

I had the privilege of meeting Dr. Cohen a few years ago when she accepted an invita- tion to speak at an event sponsored by my organi- zation, which represents public-sector leaders in the health and human services field. As soon as I heard her speak, I was hooked. Through mastery of her field, the ability to trans- late science into actionable knowledge, and the will- ingness to share her own story with humor and vulnerability, Dr. Cohen helped spark a movement busy executives, including myself, to push the pause button and self-reflect on how we “show up” to work each day. I quickly found myself asking: Am I now underway in our field. Her remarks led

One of the key strategic partners in APHSA’s health and human services workforce initiative (Igniting the Potential), Dr. Beth A. Cohen, and her professional partner, Deborah Winograd, have published a new book entitled Workaches: the Neuroscience Guide to Surviving and Thriving at Work. APHSA’s CEO, Tracy Wareing Evans, received a sneak peak and shared her insights in the book’s foreword reprinted here. W hat keeps you up at night? I have asked that question—of senior executives, department direc- tors, field managers, and frontline staff—countless times over the course of my career in human services. While individual responses inevitably vary, concerns about the workforce—the very people we rely on to make work happen—are consistently top of mind across all organizational levels. In health and human services, senior leaders express this worry in terms of turnover rates and the struggle to recruit and retain the right talent. For field supervisors and staff, it mani- fests as stress and job dissatisfaction due to workload burdens, insufficient resources, and required tasks that detract from the reason he or she was drawn to the job in the first place. Inherent in both vantage points is the recognition that the workforce is critical to accomplishing the goals of any organization, and to excel, all employees from the front line to the board room must be healthy, well, and engaged with their work. Workaches helps all of us dig deeper to understand what underlies

walking my own talk, especially as to self-care? What is it that I need to be my best self at work and with others? Do I know enough about my own inter- actions at work to assess how the rest of the workforce is doing? I realized these were fundamental questions that I had too often overlooked. I became a willing student of Dr. Cohen, and by extension, her long-time professional partner, Dr. Winograd. Fast forward to today. Workaches provides powerful insights into what it takes to enhance organizational cultures and ignite the potential in others, starting with ourselves. In

these enduring challenges. Through clinical expertise, thousands of hours spent with staff at all levels, and a resolute focus on how our lived experiences—as well as our genetic inheritances—shape our interactions in the workplace, Drs. Winograd and Cohen shed light on why so many of us struggle to survive at work, rather than thrive. By connecting the incredible strides in what we now know about the functioning of the human brain (neu- roscience) with an insightful look at the evolving and highly complex world of work today, Workaches illuminates a way forward for all of us.

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Policy&Practice   April 2019

Whether you lead a teamor interact daily on the front line with customers and your community, Workaches will widen your lens on the world of work—unfolding the possibilities it holds to thrive whenwe truly appreciate the full landscape before us, roots and all.

understanding how much of our inter- actions in the workplace are shaped by our own life journeys, we enhance our ability to see and respect the per- spectives of our work colleagues. Each of us can recount stories from our own life experiences that stick with us wherever we go … the boss with a critical eye who was always first to spot the flaw in our new idea, making us hesitant to be innovative at work … or the team that didn’t really work as one, shaping our perspective on group efforts. Importantly, Drs. Cohen and Winograd help us put a label on those experiences—the “workaches” that thrust us into survival mode. By illuminating the complicated interpersonal dynamics at play in workforce relations—both spoken and unspoken, conscious and uncon- scious—they help us gain insights about ourselves and others: why that person reacts that way to an offhand comment, why some people take feedback in stride and others don’t. We learn how deeply embedded early experiences are for each of us and how our individual pasts continue to

or place of business, Drs. Winograd and Cohen are calling us to more fully understand how each of us “shows up” at work, and then do something about it so that we can all feel produc- tive, engaged, and purposeful in what we do. In a time when all of us are increasingly called upon to innovate, problem solve, and adapt to an ever- changing world, I am convinced that collectively, and with a stronger understanding of how our minds work at work, we can help everyone achieve that sweet spot. Workaches: The Neuroscience Guide to Surviving and Thriving at Work will be available on Amazon in May 2019.

play out within our organizational cultures. We gain an appreciation of how some workaches (when under- stood) help shape us into better leaders while others, especially those that cut deep and are left unhealed, not only inhibit our professional growth, but impact our health and well-being. Whether you lead a team or interact daily on the front line with customers and your community, Workaches will widen your lens on the world of work—unfolding the possibilities it holds to thrive when we truly appre- ciate the full landscape before us, roots and all. No matter our position

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April 2019   Policy&Practice

locally speaking By Cheryl Boley

Perry County: Building Well-Being from the Ground Up

Cheryl Boley, Director of Perry County (OH) Job and Family Services (JFS) and Perry County Transit, spoke at an APHSA-NACo joint congressional briefing, “Transforming Policy and Practice at the Local Level: The County Role in Building Well-Being from the Ground Up,” on March 5. These are her edited remarks. I was asked to describe, in a few minutes, the challenges of serving in a rural county, what it looks like, and how we operationalize program and funding opportunities in a setting with limited capacity. When you think about what it means to live in a rural Appalachian area, many things come to mind. At or near the top of the list is usually poverty. Perry County fits that narrative. And Perry County, in a word, is small. We are located in Southeast Ohio with a population of approximately 36,000 and an estimated 8 persons per square mile. Just under one-third of our population is Medicaid eligible and we distribute a little more than $700,000 Supplemental Nutrition Assistance Program benefits each month. Our economic history is steeped in coal mining. Today, the coal mines are shuttered and some 60 percent of our residents drive outside the county to work. The rural location and lack of countywide broadband multiplies the challenges of competing for employers who could offer technology- driven 21st-century jobs. This is also a cruel disadvantage for low-income job seekers and students—only about 66 percent of our residents have access to broadband.

Road leading to the historic single-lane Hopewell Church Covered Bridge, built in 1874, which is still in use today in Perry County, Ohio.

residents accept employment outside the county and leave us. The impact of this “brain drain” exodus, and the local knowledge and education they take with them, creates a void in the rural community that is impossible to replace. The resulting effect is that many of us wear multiple hats. And the number of individuals with expertise in navigating new federal grants and associated rules is like Perry County, small—and the people who do it wear capes. Aside from government entities we have one service provider, a fan- tastic community action agency whose main office is outside our county. With that said, let me tell you what else is not within our county. If you

Public entities face the difficulty of encouraging students to envision earning a college degree or advanced certification. The reality of what it takes to earn a college degree is over- whelming for the average adult. But, for teens, many of whom have had limited experiences and relationships and who would be first-generation college students, the obstacles can seem insurmountable. Less than 12 percent of our popu- lation has a four-year degree. By comparison, in our nearest metro- politan area, Franklin County, 38.7 percent of the residents (about 2 million) hold four-year degrees. Perhaps the most disappointing reality is that after college graduation or other career preparedness activities, our

See Perry County on page 32

Photo by JNix/Shutterstock

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Policy&Practice April 2019

Invest in What Works (or the What Works Toolkit) Five Steps to Help Governments Shift to Outcomes-Focused

Contracting By Jed Herrmann

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Policy&Practice   April 2019

King County, Washington, wanted a game changer.

innovation, increase collaboration with providers, and build the capacity of human services leaders to measure outcomes and steer public investments toward the most effective approaches. With the support of the Kresge Foundation, Results for America gathered examples of how cities, counties, and states across the country have accelerated their governments’ push toward outcomes-focused con- tracting. We bundled these ideas together into the What Works Toolkit, 2 a framework for understanding the policies and practices necessary to move state and local government agencies and human services providers from compliance-focused to outcomes- focused contracting. While the approaches varied, we identified five key recommendations to help human services leaders build a more results-driven culture: Step 1: Gather Feedback and Focus on Outcomes As King County learned, the first step toward a more results-driven approach is to engage with human services providers, service recipients, and com- munity groups to gather feedback, define desired results, and establish outcome goals for each contract. A good start is to identify which con- tracts are approaching a renewal or are central to your local or state govern- ment’s priority goals. Many cities and counties are getting creative about opening new and better channels of communication with service providers and other key stakeholders. In New York City, Mayor Bill de Blasio created the Nonprofit Resiliency Committee, 3 which was comprised of city staff and providers, coalitions, academia, and philanthro- pies. The committee was charged with identifying, designing, and promoting solutions to increase collaboration between the city and the nonprofit

For years, the county’s health and human services contracting had followed a familiar pattern: most gov- ernment-funded services were focused on crisis intervention rather than pre- vention. Funding generally went to larger providers rather than smaller community-based organizations that typically served the county’s historically underrepresented residents. And in many cases, the county lacked data on which services worked best for residents. “We just weren’t achieving the kinds of outcomes we wanted for children in our community,” said Carrie S. Cihak, King County’s Chief of Policy. In 2014, the county reinvented its approach. It started with a broad com- munity engagement strategy that included events like “community cafés,” surveys, and interviews with residents and providers to build alignment around shared goals. “We started with the outcomes we wanted to achieve for children and youth in the county: babies being born healthy, the journey to adulthood being healthy and safe, and building a supportive environment in our community around kids,” Cihak said. When county voters in 2015 passed the Best Starts for Kids initiative—which generates an average of $65 million a year to help achieve these outcomes— County Executive Dow Constantine and his team had already laid the foundations for a new contracting system. 1 It would focus on increasing equity, strengthening partnerships with community-based providers, and gathering rigorous evidence of impact to track whether the county was making progress toward key goals. The What Works Toolkit King County is part of a growing movement of local and state govern- ments that are shaking up decades-old procurement practices, shifting away from a compliance-focused model toward new approaches that incentivize

King County residents in Powell Barnett Park in Seattle's Central District.

human services sector. Through the initiative, the city created the Guide to Collaborative Communications with Human Services Providers 4 with the goal of broadening engagement with nonprofit experts, consistent with the city’s procurement policy for safe- guarding open competition. As the New York City guide illustrates, the best conversations begin well before the issuance of a request for proposal (RFP) for services. By using pre-pro- posal conferences with providers, letters of interest, or requests for information, government agencies can validate community needs, align expectations, and collaboratively develop outcomes. Many of these tools and templates are included in a new report that Results for America produced with Project Evident, An RFI Guide: How Requests for Information Can Improve Government Human Services Contracting . 5 Most important, these early discus- sions help government leaders and service providers develop a shared sense of mission. Some policymakers are taking the next step by building these expectations right into their con- tracts. For example, Washington, DC’s Procurement Practices Reform Act of

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April 2019   Policy&Practice

2010 6 requires each city government contract to include performance standards and expected outcomes of the proposed contract. Step 2: Break Down Government-Funding Silos Even the best efforts by policymakers and providers to shift to a results-driven approach can be undermined by siloed programs and overlapping contracts. But increasingly, local and state human services leaders are experimenting with more flexible approaches, including combining funds frommultiple sources, streamlining reporting requirements, and forging more holistic solutions to entrenched problems. For policymakers, the first step is to review existing funding streams and determine whether government agencies can blend funding streams into one solicitation to allow providers to focus on outcome-oriented services rather than record-keeping for multiple grants. When Seattle was seeking better outcomes from its homeless services contracts, the city began by determining which contracts it could consolidate. Through its participa- tion in Bloomberg Philanthropies’ What Works Cities initiative, 7 the city’s Department of Human Services worked with the Government Performance Lab at the Harvard Kennedy School to merge 26 separate contracts into eight portfolio contracts, giving homeless services providers more flexibility 8 to shift funding between programs as needed to try to achieve the city’s overarching goal: helping homeless residents into permanent housing. When feasible, government agencies can also streamline allowable uses across each contract to minimize the administrative compliance burden on human services providers. Agencies

should also provide incentives for multi- year contracts that enable a focus on

sustainable, long-term change. When Bernalillo County, NM,

was seeking to improve outcomes in behavioral health services, county leaders worked with the Government Performance Lab to issue a new problem- based RFP 9 and used the new contracting process as an oppor- tunity to transform its service delivery system to focus on collaboration, real-time data sharing, evaluation, and program

improvement. This procure- ment approach is now being adopted more broadly throughout county government. Step 3: Issue Clear Requests for Proposals As government agencies develop their RFPs, they should make sure they include clear outcome goals and perfor- mance measures that reflect the input of providers and the broader community. By preferencing programs and practices with evidence of effectiveness—such as those found in evidence-based clear- inghouses—human services leaders can help increase the likelihood of achieving those goals. For example, the Florida Department of Juvenile Justice requires 10 the use of evidence in the RFP process, and then uses real-time data uploaded to its Juvenile Justice Information System to track results—an approach that was featured in Results for America’s Invest in What Works State Standard of Excellence. 11 The Santa Cruz Probation Department, working with the Pew- MacArthur Results First Initiative, has used its RFP process 12 to drive investments toward evidence-based interventions while also collecting the outcomes data needed to help policy- makers determine which approaches are most effective. Simply cutting and pasting the word “evidence based” into RFPs and con- tracts is not enough, because evidence can mean anything from an anecdote to the most rigorous randomized

controlled trials. Policymakers should start by defining what they mean by “evidence based,” and they can find good models in the What Works Toolkit, including links to outcomes- focused RFPs and sample contracts that promote proven solutions. Step 4: Fund Outcomes and Build Evidence Another way government agencies can ensure they are getting the best results is to pay for them. By con- necting the payment of at least part of a contract to the achievement of mea- surable outcomes—whether through Pay for Success, outcome rate cards, or outcome bonus payments—human services leaders can incentivize and reward providers that meet key goals. In Pennsylvania, the state Department of Corrections uses a carrot-and-stick approach 13 to help human services providers assist newly paroled inmates as they transition back to their communities. Providers whose clients attain a better-than-expected recidivism rate earn an increase of 1 percent in the department’s per diem rate, while providers with recidivism rates that are worse than expected for two consecutive contracting periods risk having their contract terminated. Department officials credit this system with an 11.3 percent reduction in recid- ivism rates for 2014–2015.

Jed Herrmann is the Vice President of State and Federal Policy Implementation at Results for America.

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Policy&Practice April 2019

State and local governments can also help providers generate evidence of what works best to address commu- nity challenges. King County is setting aside 5 percent of funding 14 from the Best Starts for Kids initiative for rigorous assessment, data collection, and evaluation, including technical assistance to local nonprofits so they can test innovative solutions and build a base of evidence for new approaches. “In the past, our award of a grant to a partner organization kind of was the outcome,” King County Executive Dow Constantine explained. “Nowwe are drilling down andmaking sure we are focusing on the results we want to see for the people andmeasuring those results.” Step 5: Create Feedback Loops As state and local governments improve their systems for gathering and sharing data, they should harness the power of these new data through regular discussions with providers to determine which strategies work best and which can be improved. When Rhode Island’s Department of Children, Youth, and Families shifted to a results-driven contracting process 15 —structuring services around 15 outcome categories and linking those to specific performance objectives—the agency gave vendors new flexibility to propose the services, supports, and resources that achieved the best outcomes for children and families. To institutionalize performance feedback loops, agency leaders added small per- formance-based payments into all new contracts for family-based and residen- tial services. The agency also increased the sharing of administrative data so that both service providers and agency staff could track what happens with clients after they exit programs. Using these data, and working with experts from the Government Performance Lab, Rhode Island officials piloted an active contract management systemwith four providers, which allowed agency staff and providers to monitor outcomes in real time and quickly intervene if performance starts to drop. The results? The state has reduced the number of children in group care by 32 percent since 2015 (with help from the Annie E. Casey Foundation

(Above) King County residents from the Somali community discuss Best Starts for Kids Health Survey data at a community Café Data Dive. (Left) Mother and daughter at a Best Starts for Kids photo booth at a community event in Seattle's Rainier Beach neighborhood.

in Rhode Island are the ones to benefit,” Buffi said. For more on the What Works Toolkit, go to the website 16 or listen to the recent webinar 17 , co-hosted by the American Public Human Services Association. To see these ideas in action, watch the new video 18 on King County’s Best Starts for Kids initiative. Please send your best examples of state and local government agencies using data and evidence to improve results to info@results4america.org!

and Casey Family Programs), expanded its portfolio of family-based services and supports, and reduced the number of children entering state custody due to the improved performance of preventive services. Deb Buffi, the agency’s Associate Director of Contracts and Compliance, said some of the best learning has come at the regular meetings where different providers join agency staff to review the data in a non-threatening atmo- sphere where all parties can assess what is working, what is not working, and how they can continually improve. “Everyone is willing to come to the table to brainstorm solutions with us and their peers if their monthly data show a slip in outcomes,” Buffi said. “This is not a ‘gotcha’ environment.” As the months went by and results kept improving, the providers and agency staff would erupt in applause when the new statewide performance data were shown at meetings. “We’re all jointly excited that kids and families

Reference Notes 1. See http://bit.ly/2SMlzn2 2. See http://bit.ly/2SMftmz

3. See https://on.nyc.gov/2H3JmgS 4. See https://on.nyc.gov/2tQnJrM 5. See http://bit.ly/2C7mokR 6. See http://bit.ly/2H4STo5 7. See https://bloombg.org/2VzTph0 8. See http://bit.ly/2SL2oKw 9. See http://bit.ly/2H2Zorq 10. See http://bit.ly/2SQhY7q 11. See http://bit.ly/2TyNYS2 12. See http://bit.ly/2ERb6Dh 13. See http://bit.ly/2EJlVWO 14. See http://bit.ly/2J9RPBh 15. See http://bit.ly/2Hgv8sl 16. See www.results4america.org/ what-works-toolkit

17. See http://bit.ly/2Hj5NOl 18. See http://bit.ly/2Tm5CZR

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April 2019 Policy&Practice

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Policy&Practice   April 2019

The Case for a Youth Portal

Supporting Adolescents on the Road to Adulthood

By Tiffany Dovey Fishman, Jamia McDonald, and Suguna Sundar

A

cross the country, foster care caseloads continue to rise. At last count, there were nearly 443,000 children and youth in the U.S. foster care system, with more than 123,000 waiting for adoption. Of those awaiting adoption, nearly 10 percent (13,451) are in the age range of 15–17. These teenagers are adopted at a lower rate than younger children, wait longer to be adopted, and are more likely to age out of the system without a stable place to call home, all of which may adversely impact their life trajectories upon emancipation.

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April 2019   Policy&Practice

Table 1. U.S. Foster Care System Caseloads Year

n Storing important documents and records n Transferring tacit knowledge and guidance to navigate adulthood n Providing moral support through life’s ups and downs Foster youth need and deserve these same supports. Federal legislation mandates transi- tion planning, and many states have made it easier to access resources for youth who are approaching emanci- pation, consolidating those links in a single place. But vulnerable youth need more robust support to help them overcome the significant disad- vantage from which they start their journey to adulthood. A robust youth portal for a foster care system should provide more than a set of links and click-through resources. It should change lives for the better. Such a portal would: n Provide information in a style that is digestible, dynamic, and easy to use n Be relevant and focused on issues facing youth n Provide engaging material that attracts youth to visit n Provide functionality that supports their needs Here we examine the breadth of functionality and ease of use such a portal could include. Virtual Safe for Important Records Before emancipation, states are required to furnish foster care youth with copies of their birth certificates, social security cards, health insur- ance information, medical records, and driver’s licenses or state-issued IDs. The American Bar Association recommends that youth aging out of foster care should receive much more, including a full accounting of their past, plus the documentation they would need if they wished to re-enter care, access their case files, apply for financial aid, and so on. Those docu- ments would include: n Credit report n Proof of citizenship or legal residency n Letter including the dates that they were within jurisdiction of the court

Number in Foster Care Number Waiting To Be Adopted

2013 2014 2015 2016 2017

400,394 414,129 427,328 436,551 442,995

102,808 106,610 109,881 116,608

123,437 Source: AFCARS 2018 report: https://www.acf.hhs.gov/sites/default/ les/cb/afcarsreport25.pdf

Without the benefit of a forever home, young people who age out of foster care face a bleak future. According to iFoster, within four years of aging out of foster care: n 70 percent will be on government assistance n Half will be unemployed n Half will experience homelessness n A quarter will not have completed high school n Fewer than 12 percent will earn a college degree 1 The result is a “$1 million economic burden to society for each young person we fail.” 2 While the vast majority of states have extended eligibility for foster care to age 21, the reality is many young people still opt to leave the system when they turn 18. 3 If states best equip them with the necessary supports to transition successfully? In this article, we lay out our vision for a robust youth portal to support youth currently in care, those transi- tioning, and those who have exited the system. The goal is to support these adolescents during a critical period on the road to adulthood. Reimagining Supports for AdolescentsTransitioning to Adulthood Turning eighteen marks an impor- tant rite of passage into adulthood. For youth outside the foster care system, that passage almost always comes equipped with a lifeline back to a parent or relative who continues to play an important role long after they have left the nest. It is not unusual for parents or relatives to continue to perform various functions to ease the transition to adulthood, including: can’t convince them to stay, the question becomes: How do they

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

Jamia McDonald , J.D., is a senior manager with Deloitte Consulting LLP’s Government and Public Services practice.

Suguna Sundar is a principal in Deloitte Consulting LLP’s Government and Public Services practice.

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Policy&Practice April 2019

A robust youth portal would help to assess the ability to forge and sustain new relationships. It would also connect youth leaving foster care to mentorship programs within their community, to help them develop meaningful relationships with adults outside the system, as well as with peers who have been in their shoes and have successfully navigated life after foster care.

n Letter including a statement that they were in foster care, in compliance with financial aid documentation requirements n Educational records n Documentation of a health power of attorney n Clear and age-appropriate written instructions on filing a petition to re-enter care, including a completed sample petition n The process for accessing their case file n Death certificates for their parents (where applicable) n Termination of parental rights orders (where applicable) 4 Given the well-documented housing challenges that youth contend with when they age out of foster care, a virtual safe for storing these documents would be a tremendous help. A youth portal would, among other things, provide a repository that youth could access while they are in care, in tran- sition, or after they have exited. The virtual safe would also provide an audit trail of the time a young person has spent as a ward of the state, including their placements and relevant contact information. This information would let youth reach out to caseworkers, adults, and mentors with whom they formed connections and meaningful relationships during their years in care. ActuatingTransition Plans The Fostering Connections to Success and Increasing Adoptions Act, P.L. 110-351, requires transition plans for youth exiting foster care. Ninety days before their 18th birthday, a young person is to sit down with their case- worker and designated representative(s) to map out a transition plan. Among other things, this plan addresses housing, education, employment, men- toring, and continued support services. This static plan could be made far more dynamic and actionable with: n A tailored list of resources and supports that map to the transition plan n Behavioral nudges to prompt specific actions by youth and caseworkers n Alerts to tell the young person, for example, about openings for suitable housing and jobs

to adulthood and set themselves up for greater success. Post transition, the portal could continue to guide young people through the ordinary tasks of adult- hood. It could prompt them to take actions such as making annual doctor’s appointments, scheduling routine dental care, attending coun- seling sessions, preparing and filing taxes, monitoring their credit rating, staying up to date on vehicle and voter registrations, creating a budget, saving for retirement, accessing relevant benefits, and so on. Fostering Relationship Development Too many youth exit foster care with underdeveloped relationship- building skills. But we know that the ability to develop lifelong connections and build meaningful relationships is critical for success. A robust youth portal would help to assess the ability to forge and sustain new relationships. It would also connect youth leaving foster care to mentorship programs within their community, to help them develop meaningful relationships with adults outside the system, as well as with peers who have been in their shoes and have successfully navigated life after foster care. This type of matchmaking is already starting to emerge in the child welfare

n A tool for tracking progress against the young person’s own goals and aspirations A well-conceived youth portal would bring transition plans to life for digital natives. It would animate a plan by breaking it down into a set of discrete actions, along a timeline, with prompts to take action and engage with relevant resources that can further the young person’s goals. Youth in foster care could start using the portal at around age 14, well before they are ready to plan for emancipation. At that point, the portal would offer age-appropriate modules in areas such as financial literacy and money management. It could provide supports for tutoring, mentoring, and college prep, and provide strengths and aptitudes testing paired with targeted job placement, helping youth to start building their résumés and think about future careers. It could also provide mental health modules to help them understand the trauma that brought them to child welfare in the first place and connect them to appro- priate counseling resources. These functions would introduce younger teens to the youth portal, getting them accustomed to using it long before they start planning their transitions. It would serve as a “pseudo nagging parent,” getting young people started on activities they should be doing at various stages of adolescence, to ease the transition

See Portal on page 34

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April 2019   Policy&Practice

Child Welfare’s Pipe Problem: How Relieving the Pressure Can Ignite the Workforce’s Ability to Do Its Job

F

or several years now, I have been fortunate to work with a phenom-

enal group of public servants dedicating this portion of their professional lives to the noble work of child welfare. What they’ve taught me is that, nationally, we are living in crisis. In an area where we are making one of the most impor- tant government decisions, our workforce is struggling to keep up. Those are two sentences that should not go together. How can amazing people be working so hard, and still be struggling to complete tasks timely?

By Bill Bott

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April 2019   Policy&Practice

The truth iswe cando a proper assessment that alignswith whatever safetymodel anagency has embraced inabout half the time it takes today.Maybe not for every case, but we have seen cuts of 50 percent for childrenwe knoware safewithin the first fewhours.

I’m talking about people who work countless overtime hours and do not take a family vacation without packing a dozen case files. These are people with the courage to boldly investigate abuse allegations despite the inherent risks. Yet despite the best intentions and efforts, the stories continue to roll in about preventable abuse, children staying in care longer, and an over- whelming influx of children in need of placement. At the core we are dealing with a capacity crisis. There is more work than we have time and resources to do. How much more? Our work with several states has shown that in assessment alone, workers are getting between three and five new cases per week. Each case requires approximately 20 hours to complete. That’s 60–100 hours of incoming work for every 40-hour work week. It’s no wonder things are bad, when we’re getting twice as much work in as we could possibly hope to close out. Imagine the system of child welfare like a pipeline. At one end, new cases—like water—flow into the pipes through assessment and staffing; they flow through ongoing work with the family, and eventually come out one of any number of outlets, including case closure, reunification, or adoption. All of our daily tasks help guide the water through the pipes like a series of valves controlling flow. Now imagine we start pumping two and three times the amount of water than the pipes are engineered to handle. Gauges imme- diately go into the red, water begins to shoot from every connection, and we desperately try to control flow as we pray nothing bursts under the enor- mously building pressure. Child welfare has a pipe problem. Our pipes can’t handle this much pressure.

No one feels this pressure more than the workforce in the field. I’ve often said that child welfare is as much a calling as it is a profession, requiring the right heart as well as the right skills to be successful, and we rely on heart and dedication to work through the pressure. But there’s another way, a way to relieve the pressure and unleash the amazing internal motivation of our people…and it starts with fixing the plumbing. We Must Address the Time that Work Takes Recognizing that new assessments require 20 or more hours to complete and that we have no way to turn down the flow of incoming allega- tions, is critical to understanding our crisis. Workers—who are tasked with managing the “flow”—are forced to self- prioritize their workload and juggle the demands of a new allegation, documen- tation, and working with a child in care. The typical prioritization looks like this: Kids who have not been seen go to the front of the line. Kids we removed are next, as we work to meet the demands of placement, the court, and the hand-off to some family preservation unit. That leaves documentation to sit on the back burner. Of course, all these priorities go right out the window if we go out on a new allegation and find a family in need of intervention and they automatically become the new number one priority. I’m stressed just writing about it. The key to addressing this time imbal- ance is understanding howmuch of the 20 hours is core to accomplishing the mission and howmuch of it non– value-added work. The real work of

assessment is investigating the allega- tion, collecting supporting evidence, and making a safety decision—this work can be accomplished between 10–14 hours, according to our research. So what is happening for the other 6–10 hours?We require workers to document every step and thought process. For children who are deemed to be safe, the only people who actually use the documentation are in the intake unit if a new allega- tion is reported on the same family, and the social worker who gets assigned to the report. When we ask these social workers what they look for when there has been a prior report, it’s usually two sentences buried in the dozens of pages we produce. Why did we go out?Why did we think they were safe? For unsafe children, the consumer of documenta- tion becomes the case manager who will work with that family. What do they need?Why are we involved with this family, and what are the risks we need to mitigate? Despite the very little amount that is used, our documentation remains a barrier to the water flowing through the pipes in a timely manner. The truth is, your workforce can do a proper assessment that aligns with whatever safety model your agency has embraced in about half the time it takes today. Maybe not for every case, but we have seen 50 percent reductions in the work it takes to document clear, safe kids. And huge reductions for those clearly unsafe children, whomwe know are going to be removed before we leave the office. This frees us up to do what we do best, assess the children who are living in the area in between, not clearly safe or unsafe, who need the heart and skills of our workforce.

Bill Bott is the Director of Performance

Improvement at the Change & Innovation Agency.

Policy&Practice April 2019 20

four months and to discuss the family’s progress, we often set a timeframe based on a deadline dictated by the court, and not by the unique timeframes of that particular case. Workflow cares less about due dates, and more about what work needs to be done to move the case forward with purpose. One aspect of managing by caseflow considers the time tasks should take and sets realistic expectations. The second part assures actions drive decisions. Imagine staffing a removal case in the first few days, outlining an immediate path and setting some timeframes for the next staffing, based on the work that needs to be done. The next staff goal would be to make a decision for the long-term well-being of that child, or set the next activi- ties needed to get to that decision and determine the next checkpoint. This process continues throughout the life of the case, until a permanency decision can be made. Managing caseflow, caseloads, and deadlines assures that workers are always moving cases forward with purpose, and this movement results in more timely decisions. More timely decisions move cases through the pipes faster and save workers nearly 20 hours for each month shaved off the time we are engaged with a family. Can we shave off months for every family? Probably not, and that shouldn’t be the goal. The goal remains to make a quality permanency decision for the family. We just want to make sure that throughout the pipeline, water isn’t sitting because of how our pipes are routed. Conclusion This combination of reducing work time and managing caseflow is the key to getting out of our capacity crisis. When used together, these two strate- gies allow us the time to help more kids more thoroughly, and with less stress and anxiety. If we want a responsive modern workforce, it won’t come with a new case management tool or some radical artificial intelligence solution to help us make decisions. It will take finding capacity within the pipes to give our amazing folks the time they need to do the noble work they have been called to do.

This idea of clear and concise docu- mentation is not new, but to get radical results we must pair it with two other concepts. First is case triage, the ability to treat different cases differently. While every case is unique, they seem to fall into three broad categories: clear safe, clear unsafe, and unclear. When we have a clear safe case, we need to build a pipeline that moves that water through extremely fast. For clear unsafe cases, we should have a completely dif- ferent pipe that quickly moves the water to the unit that will be working with that family through service delivery. We need a third, more complex pipeline for unclear cases, as these should demand the most time and effort to make a wise decision. While the safety model should be the same, the things that surround the work should be different. Second, these triaged cases should lead us to what we call “differential documentation.” Instead of requiring the same documentation for every case, we build the documentation based on the triaged type and who will use it. We end up building documentation with purpose and stripping out all of the duplicative and unnecessary language that no one uses. By doing this, we can cut documentation time by hours while maintaining the integrity of the model and telling the story. Cutting documentation time helps the workforce spend more time doing the assessment, but alone that’s not enough. We Must Learn to Control the Flow Shortening the time we spend per case is critical, but by itself it won’t be enough. Our pipes are deadline driven, as water remains stagnant until an arbitrary date when we force it through. While the deadlines were designed to be a failsafe, Parkinson’s Law (that work expands to the time allotted), is demon- strated again and again in child welfare. Remember the last time you extended a deadline—maybe from 30 days to 45— and almost instantly everything took 45 days? No one pays attention to the back burner until the deadline. Controlling caseflow requires us to build pipelines that are driven by tasks and not time. For example, when a case manager meets to review the case of a child who has been in foster care for

April 2019   Policy&Practice 21