Policy & Practice | August 2019

The Magazine of the American Public Human Services Association August 2019

Maximizing Modern Tools and Platforms

TODAY’S EXPERTISE FORTOMORROW’S SOLUTIONS

contents www.aphsa.org

Vol. 77, No. 4 August 2019

features

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Overcoming a Culture of Cautiousness The Critical Role of RFPs in Innovation

Unified Vision, Unique Transformation Oklahoma Benefits Illustrate the Power of Modularity

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Beyond Case Management Better Child Welfare Outcomes Through Relationship Management

MD THINK The Future of Maryland’s State IT Landscape

departments

3 Locally Speaking

24 Technology Speaks Five Keys to Intelligently Deploy AI and Automation 26 Eliminate Blind Spots to Improve Safety: More Eyes More Often

29 Staff Spotlight

Leveraging Technology to Strengthen New York City’s Child Welfare System

Max Daniel, Membership Operations Manager

30 Association News

5 From Our Partners Modernizing Technology

NSDTA 2019: Learn, Network, and Grow in Long Beach

28 Legal Notes

Procurements: A Performance- Based Contracting Model

Text Taunting to Suicide: The Role of Child Protective Services

36 Our Do’ers Profile Robert Hobbelman,

Chief Information Officer, Division of Information Systems, Virginia Department of Social Services

Cover illustration by Chris Campbell

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August 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 S. Duke Storen, Commissioner, Virginia Department of Social Services, Richmond, VA 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 Elected Director Jennifer Walthall, Secretary, Indiana Family and Social Services Administration, Indianapolis, IN 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 August 2019

locally speaking By David A. Hansell

Leveraging Technology to Strengthen New York City’s Child Welfare System

W e all know how important tech- nology is. Of course, it’s helpful when you need to access breaking news, order a taxi, or look up direc- tions. But, in the human services industry it’s even more critical—poten- tially life or death. New York City’s Administration for Children’s Services (ACS) is respon- sible for protecting the safety and well-being of the city’s children. Each year, our child protective special- ists (CPS) conduct more than 60,000 investigations of possible child abuse and neglect. As you can imagine, it’s immensely challenging work and our success rests on thousands of com- mitted and courageous staff who carry out this work. It’s of the utmost importance that child protective staff be well-equipped and fully supported. With this in mind, I’ve paid close attention to the ways in which better technology could strengthen their work and make it more efficient. Last year we provided more than 2,000 front-line child protection staff with electronic tablets. These tablets enable our staff to access critical infor- mation while conducting investigations out in the field. The tablets also allow CPS to maintain timely documentation during down time between home visits, waiting for a case to be called in Family Court, or sitting on a subway. This means they don’t have to run back to the office after each visit and can nowwrite their notes on-the-go. Giving CPS the capability to work in real time helps us enhance child safety, reduce overtime hours, and improve morale overall. In addition to their tablets, our CPS now have access to new

investigators’ progress on every case, and monitor key performance indi- cators comparing their teams to the system as a whole. This is a major step toward automating what have previ- ously been manual and burdensome processes, and we will be making this valuable tool available to our provider agencies over the coming months. Both of these new technological enhancements are part of a much larger effort ACS has put forth to strengthen child protection work here in New York City. We’re also using technology to help ensure that CPS can get to families across New York City much more quickly. Many abuse and neglect reports are called in at night, over weekends, or on holidays and they are dispersed across the more than 300 square miles of the city’s five boroughs.

software known as the Safe Measures Dashboard. Technology and other improvements have enabled us to reduce average caseloads, but CPS generally have to interview multiple individuals relating to each child in a family’s case. Imagine: if a family has three children—that’s three different teachers to interview, maybe three dif- ferent doctors to interview, along with friends, cousins, neighbors, and so on. The Safe Measures dashboard, devel- oped by the National Council on Crime and Delinquency, helps staff keep track of next steps and deadlines on all their active investigations and moni- toring cases. The software also means that our front-line workers can dig deeper into the history of ACS involve- ment with the families and children on their caseloads. And it allows supervisors and managers to view each caseworker’s workload, track

See Locally Speaking on page 31

Image via Shutterstock

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August 2019 Policy&Practice

Vol. 77, No. 4

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

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Policy&Practice August 2019

from our partners

By Carole Hussey

Modernizing Technology Procurements: A Performance-Based Contracting Model

T he advent of modern technology solutions offers many advantages to public-sector agencies. These solutions include agile development methods, software-as-a-service (SaaS), and commercial-off-the-shelf (COTS) software. These options are attractive with a value proposition of reduced capital investments and speed to market through rapid con- figuration. Many states are also opting toward smaller, module-based procurements, aimed at reducing risk and increasing competition. As a result of this changing market, however, some organizations are struggling with how to effectively purchase and ultimately manage con- tracts with technology vendors. Traditional approaches to procure- ment and contract management are not typically aligned with modern approaches to solution design and implementation. Deliverable-based (often fixed price) contracts worked (somewhat) for waterfall develop- ment methodologies and custom-built solutions that took years to deliver. Unfortunately, those models don’t work in an agile world or with COTS solutions, where you would not typically produce volumes of project documentation. Those models also do not always yield the desired results. The reality is that a project can be produced on time, on budget, and for the defined scope without adding real business value or resulting in what would be called a “successful” project. While an organization may have a new system, that system may not be any better than the legacy system that they replaced.

using platforms and products that are easier to maintain and support. Sounds simple, right? I’m especially excited about this opportunity and really want to help her make a difference. Performance- based contracting offers opportunities for innovation and encourages com- petition in the market. Shifting from traditional procurement and vendor management methods in public-sector environments will not be easy, but it is necessary to get the most from a technology investment. This shift will not happen overnight. And … it is not just the procurement office that needs to figure this out. Here are some thoughts on how we can all affect this change over time. Here are some tips

At PCG, we often help clients with procurement planning and manage- ment. We are sometimes limited by how creative we can be in our counsel, depending upon the appetite for change. Recently, a client asked us to help her think through a new way of managing technology projects from a performance lens. She had come from the private sector and was shocked to learn how long it takes to procure and implement an information technology (IT) project. She wants to change that. She wants better solutions, imple- mented faster. She wants payment tied to performance. She wants solutions that affect real program- matic improvement. And, she wants to reduce total cost of ownership by

Image via Shutterstock

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August 2019 Policy&Practice

Change is hard, but it isworth it.Wemust continue to challenge the status quo and innovate approaches to technology procurement and contractmanagement for public-service programs.

performance measures as part of their response to your procure- ment. This allows the performance measures to be tailored to a specific approach and solution. The method by which services are delivered in the public space has changed drastically in the last five years. Most governmental programs are focused on self-service, person-cen- tered care, cross-programmatic service delivery, and more. At the same time, the landscape of technology solutions available in the public space has also changed significantly. Change is hard, but it is worth it. We must continue to challenge the status quo and innovate approaches to technology procurement and contract management for public- service programs. By doing so, state government agencies will expand their ability to operate and provide quality service delivery in the most cost- effective manner possible, while also fulfilling their missions to the clients they serve. Carole Hussey is an Associate Manager at Public Consulting Group (PCG). She has spent 20 years working within state government technology consulting, and nearly 10 years of that with PCG. She leads PCG’s Human Services Information Technology business development efforts nationally. Most recently, Hussey has been focused on advising states how best to approach their transitions to Comprehensive Child Welfare Information Systems (CCWIS) in a way that most effectively supports the programs and operations of child welfare agencies.

to help you move the needle in your own organization. n In advance of writing the request for proposal (RFP), clearly define the business results you expect from the investment, and the methods by which you will measure project progress and success. To do this well, you need everyone at the table (e.g., IT, program, procurement, legal, budget/finance). n It is not necessary to tell the vendor how to do the work, only what you want out of it and then measure to that. n Design incentives, not just penalties. Traditional service-level agreements (SLA) increase risk for the vendors, which inflates the price. SLAs are certainly important, but only include those that are most important to your organization. n Develop a collaborative relationship with your procurement team and involve them early and often. Get them engaged so they understand what it is that you are trying to achieve from a business perspective. n Create a performance management tool and process. Document it in your procurement vehicle and make sure the vendors are clear on how they will be managed throughout the project. n Use pre-approved vendor pool or master services agreements (MSA) with multiple awards, from which you can create task orders. This expedites the procurement process. n If you do not have access to MSAs, consider using federal or regional blankets (e.g., reciprocal, cross-state procurement vehicles) that can be shared, sometimes for a fee. n If you are really open to change, invite vendors to propose

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Policy&Practice   August 2019

Overcoming a Culture of Cautiousness The Critical Role of RFPs in Innovation

By Rich Bowlen

he Comprehensive Child Welfare Information System (CCWIS) is changing the way human services and child welfare leaders think about technology and innovation, which is causing a ripple effect across all programs and future initiatives. We’re shifting the focus from monolithic to modular systems, priori- tizing flexibility and human-centered design, and bringing emerging technologies like artificial intelligence and machine learning to the forefront of our conversations. There’s even a certain shift in how we think about managing and supporting a workforce that becomes more mobile and remote, but wants to remain connected, every day. Yet, we’re still living in a culture of cautiousness. T

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technology projects fail. We know from experience failed projects begin with a failed RFP. A failed RFP may be too generic or too specific. A failed RFP may be written as a wish list, rather than something to benefit a specific set of users. A failed RFP may focus too much on policy, and not enough on problems to solve. Or, a failed RFP may not accurately rep- resent the voice of the worker, and by extension, the children and families they serve. Be clear on exactly what you intend to accomplish and use the RFP to drive it. Without a clearly defined purpose you risk over-abun- dant responses that aren’t tailored to your needs and require more work to sort through and determine viability. n Start with why: If you want tech- nology that truly supports your mission-driven work, you need to seek out a mission-driven partner. The RFP process is a great way to find out what motivates a potential vendor beyond meeting require- ments and fulfilling contracts, which is the key to a lasting partnership. Incorporate questions to identify and evaluate the values that drive a company’s approach to building, implementing, and supporting products. What do they believe in? Does their mission align with yours? n Put people and problems in the center: The most innovative, impactful solutions are rooted in solving real problems social workers and caseworkers experience every day when interacting with children and families—not simply checking boxes on a list of requirements. With this in mind, at least one worker and super- visor should be part of the RFP team, RFPs should be as bold and brave asworkers in the field. The realities of their challenging work should serve as the foundation for innovation.

Despite decades of conversations and planning around the demand for access to modern tools and ideas, as an industry we are still restrained by obsolete processes and policies, and in some instances, outdated mindsets. Despite constantly asking for bold, new, innovative ways to protect and strengthen vulnerable children and families, we still tend to fall back on the “same old things” we’ve done for the past 25 years. Stuck in a comfort zone, we’re fully aware we must move forward, yet we’re afraid to take the first step. In many ways, we’re simply paving the proverbial cow path—updating our existing systems and processes to meet new rules and requirements without considering: What do we really need? How do we place true best-of-breed technology in front of the workers who deserve it and the children and families whose lives depend on it? What’s the hold up? We’re afraid to fail. To get blamed if something goes wrong. To move in an unprecedented direction when we might as easily play it safe and simply do what procedures dictate. RFPs: Laying the Foundation for Innovation Technology has evolved consider- ably in the last 20 years. Most of us are likely to be more comfortable using advanced technologies in our personal lives, yet the consideration for such tools in human services, especially child welfare, is slowly catching up.

The perspective shift driven by CCWIS offers an open door to fresh, new ideas and opportunities to act on them. We’re not confined to technology innovation, rather innovation in every sense of our practice. In fact, technology and practice should be joined at the hip as a dynamic duo of sorts as we navigate the possibilities in child welfare. Discovering what’s out there and what can be leveraged in child welfare need not be uncharted waters. Since it kicks off the process of exploring options and researching available tech- nologies, requests for proposal (RFPs) are at the forefront of creating mean- ingful change. Knowing what to ask for is a critical part of constructing the RFP. After all, the best way to gather such information is to pose the question. An RFP—or a request for informa- tion (RFI) for agencies that have the time and resources—is an ideal way to get in front of the latest technology to determine what fits your business needs. When effectively executed, the RFP serves as a tool to solicit the right solutions to maximize invest- ment when dollars and resources are tight. It’s a blueprint for out-of-the-box practice and a map for identifying the tools to make it happen. Employing the same approaches to develop RFPs that were used more than two decades ago doesn’t fit today’s technology and business process needs. Planning from obsolete templates and guidelines won’t suit current and future needs. RFPs should be as bold and brave as workers in the field. The reali- ties of their challenging work should serve as the foundation for innovation. Think about it this way: the RFP begins the formal relationship between agency and vendor. It’s the first step in building a trusted and lasting partner- ship. Asking the right questions and evaluating the right criteria will differ- entiate a true partner in your innovation efforts from vendors offering “cookie cutter,” one-size-fits-all solutions. Developing an RFP that accomplishes this considers common themes and practices. These will guide your entire process—from planning and writing the RFP to evaluating responses and

Rich Bowlen is Vice President/ Evangelist—

ChildWelfare at Northwoods, a national lead and advocate for child welfare and pro- tective services. He’s the connector

between the Northwoods team and child welfare partners, including agencies, advo- cacy groups, policymakers, court systems, state and local legislators, and national industry leaders.

ultimately awarding a contract: n Clearly define your purpose: It’s common knowledge many

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Policy&Practice August 2019

you make more informed, evidence- based decisions. Require them to show how they minimize duplication requiring users to navigate between multiple systems. Flexibility is also critical. Ask about methods for integration in addition to systems a vendor can integrate with. achieve program goals for ensuring safety, improving well-being, and achieving permanency, not simply IT goals like reducing infrastruc- ture or guaranteeing uptime. Use the RFP process to gauge how well a vendor understands and can meet business needs. Use practice examples like family finding or kin connections to demonstrate how the vendor will identify and understand the nature of all the connections in a case—how often and to what extent has each person been involved in the child’s life? Have interactions been positive or n Focus on program outcomes: Human services agencies need vendors and solutions that help

in addition to administrative, IT, and legal representatives. The front line should influence your decisions, as they will be most affected. Seek solutions that are designed and built by and for the people who will ulti- mately use them. Stay laser-focused on specific problems to solve and don’t shy away from providing details about how or why those problems are impacting your agency’s ability to meet its mission. Without a people- centric focus a vendor won’t be able to accurately explain how they can help. n See the whole picture, not just the software: Figuring out technology solutions you need is just one piece of the puzzle. What’s more challenging is figuring out the best way to provide the solution to your workers once it is purchased. The best RFPs go beyond the technical solution and evaluate the full scope of a project: How is it implemented? How will workers receive training? How will it be supported? How is the project managed? Most important, how does all of this sync up to your agency’s goals and objectives?

n Think beyond buzzwords: Most vendors will say they focus on human-centered design but dig deep enough to ensure this is the case. Don’t get drawn in by atten- tion-grabbing keywords and trends. Exercise due diligence to make sure vendors truly practice what they preach. Think back to your problems and ask how the vendor leverages these trending concepts to solve them. Similarly, use the RFP to gauge how they’ll anticipate future needs that haven’t been defined or identified. This is critical in identifying who has the right expertise to meet your state’s or agency’s unique needs. n Emphasize integrations: No vendor can realistically solve all your problems on its own. The right partner will help you under- stand what other systems they can integrate with to provide you a truly best-of-breed solution. Be integration-minded throughout the RFP process and ask vendors to demonstrate how they can exchange critical data and information to help

See Cautiousness on page 34

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VISION unified

By Sarjoo Shah and Anil Sharma TRANSFORMATION unique Oklahoma Benefits Illustrate the Power of Modularity I

magine a family building a new house. Everyone agrees where they want to live, but they don’t agree on many of the specifics inside the new structure. Each person decides to build a home-within-the-home to suit his or her indi- vidual needs and preferences. The result is a house with multiple kitchens, multiple mechanical systems, an excessive number of bathrooms, and highly disjointed décor. It sounds absurd, but that approach is akin to how most of human services departments have operated for decades. Each division in the “family” lives in its own space, with its own people, systems, and processes. What often results is unnec- essary complexity, costly operations, and confusion for the individuals and families these agencies exist to serve. The Oklahoma Department of Human Services (DHS) is a pioneer in moving to a single “home” for programs and services. The department has articulated a unifying vision— and undertaken a unique transformation—to ensure that all parts of the organization are working in harmony and effi- ciency. Known as Oklahoma Benefits, the vision and roadmap take full advantage of modularity—not purely as an approach for developing systems but as a way of thinking and acting.

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delivers benefits and services. When fully implemented, DHS will be able to obtain a 360-degree view of every client to facilitate family-focused, out- come-driven decision-making. Oklahoma Benefits will demon- strate that DHS values people over transactions—with access to the right services at the right time via multiple platforms. In fact, unless they want to, citizens will no longer need to set foot in a brick-and-mortar building. Meanwhile, DHS employees will be empowered with a more complete view of the children and families they are serving—and will feel more inspired by the outcomes they help deliver. Oklahoma Benefits represents the culmination of many years of strategic commitment to enterprise architecture. It has taken time for federal, state, and agency stakeholders, as well as available technologies, to catch up with DHS’s vision. Today that vision is taking shape for three of the 22 divisions within DHS–Adult and Family Services, Child Support Services, and Child Welfare Services—with a detailed roadmap for the transformation. That roadmap reflects a fundamental principle: that modularity can—and should—extend beyond system development. The Modular Mindset Starting with Medicaid Enterprise Systems, the concept of modularity continues to gain traction within gov- ernment. As a development approach, modularity provides a faster, more flexible way to create large, complex systems through a collection of parts that are self-contained yet interoper- able. These modules make it possible to test, enhance, or replace each part without disrupting the entire system. Modules also obviate the need for a massive multiyear program to mod- ernize old systems or build new ones. Oklahoma DHS recognized the value of modularity when developing systems, but the state also saw the need to extend modularity when transforming business functions and procurement processes. Indeed, modularity is taking shape as an entirely new mindset for managing human services programs and deliv- ering support to individuals and families. The modularity mindset

The goal is to enable programs and people to transform human services outcomes by redefining the DHS expe- rience for customers, communities, and staff through comprehensive self- service and holistic case management. Oklahoma Benefits is leveraging tech- nology to increase impact, ensuring that more Oklahomans are safe, healthy, independent, and productive. It’s a large-scale transformation that’s being implemented as a series of smaller initiatives—and it’s demon- strating how modularity can be used to fuel partnership and collaboration, support customer-focused innovation and, ultimately, deliver services more quickly. Oklahoma is up for the chal- lenge with a history as an established leader in human services innovation, becoming the first state in the nation to create a federally approved SACWIS (Statewide Automated Child Welfare Information System). A Bold Vision Oklahoma DHS is not just unifying or simplifying back-end systems. The strategy is focused on transforming virtually every aspect of the way DHS

is reflected in the five “swim lanes” of the Oklahoma Benefits roadmap: Employee Involvement, Customer and Community Involvement, Organizational Change, Refined Data/ Metrics, and Improved Technology. What follows is a glimpse of progress to date, along with advice to other human services departments seeking to get their own “houses” in order. Lesson #1: Establish a “Decision Team” The Oklahoma Benefits transforma- tion involves multiple organizations, including the three divisions within DHS, as well as the Oklahoma Office of Management and Enterprise Services, and other areas. Representative stake- holders from each group serve on a decision team that meets weekly to review progress. To be sure, a trans- formation of this scale and complexity will encounter a host of challenges. This team continually unpacks and works to resolve those challenges. The executive sponsors of Oklahoma Benefits—DHS Director Ed Lake and State CIO James “Bo” Reese—have fully empowered the decision team, an approach that has proven critical to maintaining positive momentum. An enterprise view is the key to every phase and every aspect of the Oklahoma Benefits transforma- tion as DHS works to eliminate the redundancies and inefficiencies of the “homes-within-a-home” model. One of the core building blocks of DHS’s enterprise approach is what it calls the Master Person Index—a single reposi- tory for identifying every person who interacts with DHS. It’s a concept that has received virtually no pushback across DHS stakeholders; the value is universally recognized. With the Master Person Index and the other modules of Oklahoma Benefits, DHS is working to simplify and standardize the way processes are designed, systems are developed, and services are delivered. While there will no doubt be cases where some special- ization is required, those should be rare exceptions. When questions and Lesson #2: Emphasize the Enterprise

Sarjoo Shah is the Chief Information Officer for Health and Human Services and Chief Strategist in the State of Oklahoma, leading a responsive IT organization that consistently delivers

results by aligning technology initiatives with business goals supplemented by strong IT governance and oversight.

Anil Sharma is the Managing Director

for Accenture's Oklahoma City office and also

leads the Accenture effort with the State of Oklahoma work- ing on Oklahoma Benefits.

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Policy&Practice August 2019

modular procurement, Oklahoma is changing business processes to meet that need. The Oklahoma Benefits team is working with the legal depart- ment to create a template that will work for any component in any of “swim lanes” on the transformation roadmap. Oklahoma has also engaged with the federal government to reduce the quantity of reviews required, thereby accelerating the project schedule. Above all, the Oklahoma Benefits team has mastered the art of the streamlined request for proposal that focuses on the desired outcomes. Solution ideas now come from the responding vendors—not from the sponsoring agency. Lesson #5: Take Change Seriously For Oklahoma DHS, an investment in formal, expert change management

needs arise, the goal should be a return to enterprise thinking, and having a dedicated “enterprise evangelist” is invaluable in that effort.

the state’s ability to monitor cross- program indicators and generate family-centered insights. Rather than traversing multiple systems, DHS will have a common platform and shared data elements. A cross-program data point—such as identifying how many children are receiving Temporary Assistance for Needy Families (TANF) benefits, support from a noncustodial parent, and a child care subsidy—will become faster and easier than ever. Lesson #4: Forge New Paths for Contracting Anyone with experience in state government contracting knows this: Breaking a transformation of this size into smaller modules doesn’t make the process easier. Longstanding funding models are designed for big-bang projects, and states are now challenged to make budgeting, procurement, and legal review more agile. With a firm commitment to

Lesson #3: Think Through Functional and Data Governance

Today, each division within DHS has its own dedicated information tech- nology (IT) resources that can assist with requests for updates and enhance- ments. Under Oklahoma Benefits, the goal is to store each data element just once and to maintain a central- ized set of IT skills—requiring silos to be replaced with enterprise gover- nance and resources. To that end, the Oklahoma Benefits team is devoting significant effort to establishing clear functional and data governance so that IT resources receive and execute only approved requests. The anticipated speed and efficiency benefits will be remarkable, as will

See Modularity on page 33

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Beyond Case Management Better Child Welfare Outcomes Through Relationship Management

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Policy&Practice   August 2019

By Tiffany Dovey Fishman, Phong Khanh Huynh, Alex Mezhinsky, and Sunil Pai

C

which agencies use to comply with state and federal reporting require- ments. The case file a CMS produces is hard to navigate and doesn’t put the relationship between agency and client at the center of the system’s design. Moreover, when an agency wants to add new capabilities to a legacy CMS, such as predictive analytics or artificial intelligence (AI), that initiative takes a great deal of work. Any technology solution used to support the critical business processes of child welfare should address these challenges. It should allow agencies to build more effective relationships with the children they serve, while being: n modifiable, to keep pace with changes in policy and business processes; n less costly to own and maintain; n easy to learn and use. For agencies seeking to develop better support for child welfare caseworkers, customer relationship management (CRM) platforms can play a critical role. Enter CRM: Child ProtectionThrough Relationship Management CRM platforms are designed to help organizations manage their relation- ships with new or existing customers. As integrated, data-driven software solutions, CRM platforms can improve the way agencies interact with and manage long-term relationships with the children they serve, from child- hood, through adolescence, and into adulthood. CRM platforms can help tackle some of the longstanding challenges facing caseworkers and child welfare agencies. Caseworker Challenges: n Managing multiple communication channels: A client’s case involves far more communications than simple

hild welfare caseworkers serve on the frontlines of protecting America’s most vulnerable

children. Poverty, neglect, violence, parental substance use, and physical abuse are frequent staples of childhood for children who come into contact with the child welfare system. Ensuring their safety often involves working with fractured families and making difficult decisions—when to remove a child from a home, place a child in foster care, or reunify a child with his or her family— all while minimizing the trauma children experience. It’s a tremendous responsibility carried out under some of the most challenging circumstances. While a caseworker’s job is complex by nature, workplace realities make it even harder. High caseloads con- strain the amount of time a caseworker can spend with any given family. According to the National Child Welfare Workforce Institute, the caseload of the typical child welfare caseworker is often twice the accepted national standard. 1 Moreover, turnover rates for child welfare agencies hover around 30 percent nationally. 2 The result is that cases frequently change hands and are touched by multiple caseworkers over time. In addition, many caseworkers rely on decades-old legacy case manage- ment systems (CMS) to support their day-to-day work. Time spent struggling with the shortcomings of these systems is time not spent with the children and families under their care. One problem with many CMS is that they lack an integrated view of a child’s or family’s engagement with various health and human services programs. That leaves caseworkers to manually piece together data from different sources to develop a holistic view of the children and families they serve. Nor do CMS adequately support decision making. These systems were designed as data collection machines,

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quickly onboard a steady stream of new, inexperienced staff and deploy them to the field. 3 Moreover, as policies change, the agency must update its technology and related training for new and existing staff. CRM platforms provide the ability to “configure” rather than “develop” solutions, enabling swift changes that can keep pace with new require- ments. These platforms let agencies develop different interfaces for dif- ferent users, making it easier to train disparate populations. n Facilitating collaboration: CRM platforms promote collaboration internally, between social workers, built-in mechanisms to capture con- versations, ask questions, chat, and otherwise communicate in a natural social context, as opposed to a form- based, system-heavy experience. States on the Forefront of Change Given these benefits, a number of states have adopted cloud-based CRM platforms for managing their child welfare programs. In 2018, Delaware’s Department of Services for Children, Youth and Their Families (DSCYF) went live with the nation’s first cloud-based CRM system for child welfare caseworkers, FOCUS (For Our Children’s Ultimate Success). FOCUS integrates the department’s four previously siloed divisions within one enterprise-wide solution. To ensure that FOCUS would spur innovations to address the core needs of DSCYF staff, the department conducted human-centered design research with key business stake- holders. The goal of the new solution was improved operational efficiency, reduced time spent in the system, increased ease of use and visibility of information across service providers, and enhanced users’ ability to locate information at every level of the organization. DSCYF staff and providers can now spend more time focused on advancing their core mission, to promote the safety and well-being of the 49,000+ and externally, between social workers and clients. They offer

case notes can capture. A system that creates one big set of notes can cause problems when a case changes hands and a new caseworker must get up to speed quickly. A CRM platform provides a configurable foundation with an intelligent, structured way to ask questions and capture notes, using customer relationship man- agement techniques fine-tuned over years of experience. Lacking this kind of intelligence, traditional CMS rely on caseworkers to know how best to gather data from clients, based on their own experience. n Supporting work that takes place outside the office: Most case- workers split their time between the office and other locations. Agencies that want to let caseworkers access a traditional CMS from mobile devices must have that capability built for them. CRM platforms come with built-in mobile capabilities. n Developing data-driven action within their caseloads, helping them develop strategies to promote better outcomes for the client. While this is a fundamental function of CRM platforms, it has typically been added to CMS solutions only as an afterthought. n Reacting to changes in family structure: As household structures can change over the course of a case, it’s often hard for caseworkers to keep track of the people in a child’s life. CRM platforms automatically monitor changing relationships, helping caseworkers better under- stand how the network surrounding a child evolves over time. budgets: The population of youth and families involved with child welfare agencies continues to grow, requiring agencies to do more with less. Cloud-based CRM platforms are cost efficient. They can also synthesize operational data, which the agency can use to gauge its performance and facilitate ongoing improvements. n Constant training needs: With high staff turnover, an agency must plans: CRM platforms let case- workers analyze data and trends Departmental Challenges: n Growing caseloads, reduced

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

Phong Khanh Huynh is a principal with Deloitte Consulting LLP.

Alex Mezhinsky is a managing director with Deloitte Consulting LLP.

Sunil Pai is a senior manager with Deloitte Consulting LLP.

See Case Management on page 34

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MD THINK I I The Future of Maryland’s State IT Landscape

By Som S. Mukherjee

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MD THINK is an innovative, futuristic, and highly ambitious cloud-based technology platform that will revolutionize health and human services delivery for the residents of Maryland.

The MD THINK program will eventually improve the lives of approx- imately two million Marylanders. The Long-Term Care Program’s electronic application share has already spiked to 67 percent—reducing manual pro- cessing and increasing efficiency for faster eligibility determination. The Back Story In the spring of 2015, violent riots rocked the city of Baltimore after a 25-year-old African American man named Freddie Gray died from injuries sustained while in police custody. His death spurred peaceful protests, but those protests soon turned to unrest, and unrest turned to violence. Thousands of police and Maryland National Guard troops were deployed, but in the end, more than 20 police officers were injured, nearly 250 arrests were made, and hundreds of businesses and building were damaged, looted, or burned. As the state worked to deliver aid to those affected, it became clear that Maryland had no effective system to share or coordinate citizens’ data across state agencies. Coordination and cooperation would more efficiently direct resources to help those who needed it the most. This prompted state leaders to advocate for an integrated

The first program of its kind in the nation, the MD THINK (Maryland Total Human Services Integrated Network) shared services platform will be available to the applications of various state agencies, which will allow them to consolidate and unify common services while continuing to provide the benefits that are unique to each application and agency. This enterprise model of the state-provided Platform as a Service (PaaS) will lead to more efficient service delivery and significant cost avoidance. Currently in the second year of oper- ation, a major application is already live on the platform, as well as the data management service layer. The MD THINK shared services platform allows customers to access all health and human services options via a common portal where they can easily upload supporting documents and enroll in benefits. Customers also enjoy shorter turnaround times for eligibility deter- mination and enrollment, as well as more efficient document handling and reporting. Additionally, MD THINK enables improved system performance and higher data fidelity that substan- tially reduces data fraud, waste, and abuse. Each beneficiary may access the services they truly qualify for using the latest in technology available.

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The Vision The holistic approach of the MD THINK program achieves both cost and performance efficiencies by: 1. Consolidating expensive local on- premise hosting; 2.Reducing duplicate data entry across multiple siloed systems providing high-quality platform and data security to all applications; and 3. Allowing agencies to leverage several other common services in the integrated architecture that would otherwise have to be built separately for each individual application. The Benefits Customers of MD THINK benefit from: 1. One master customer portal: Customers access all health and human services options through a common portal. They can create an application on a web or mobile inter- face, upload supporting documents, have their eligibility determined, and enroll in a service—all in one portal. 2.Shorter turnaround times: Customers experience quicker turn- around times because of streamlined eligibility determination rules. 3.Efficient document handling and reporting: Transmission of

technology system that could host the state’s health and human services applications on a unified platform and utilize common services, security, and infrastructure. Thus, MD THINK’s integrated, cloud-based, technology platform was born. The MD THINK program is breaking down agency silos and data barriers to provide better access and integrated resources. The platform offers a common hosting service where multiple state agencies and their applications come together to leverage shared services, such as enter- prise security, business rules, data management, reporting, forecasting, business analytics, and document storage and retrieval. The MD THINK shared services platform is built on the Amazon Web Services cloud and went live in August 2017.

enrollment and other documents is quicker and more efficient due to automated scan and upload functions where documents are concurrently available to multiple applications. 4.Improved quality of service: The modernized platform and use of shared data enable state agencies to deliver the highest level of service to Maryland customers. In addition to improving the customer experience, MD THINK significantly benefits participating Maryland state agencies and their staff, particularly their caseworkers. Caseworkers are the backbone of Maryland’s health and human services. Caseworkers and the state will benefit from: 1. Reduction in fraud, waste, and abuse: MD THINK’s consolidated cloud technology, its applications, and its shared data repository greatly reduce fraud, waste, and abuse. MD THINK’s metrics track the accuracy, efficiency, and automated checks and balances within the application processing system to con- tinually identify and deploy system improvements.

Som S. Mukherjee is PMO (Project Management Office) Director of MDTHINK at the Maryland Department of Human Services.

See MD Think on page 32

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technology speaks By Kirke Everson

Five Keys to Intelligently Deploy AI and Automation

J ust a few years ago, only a handful of government organizations were truly using artificial intelligence (AI) and automation. Since then, many applications have emerged with dem- onstrated results that display AI and automation in all of its forms, including robotic process automation (RPA), machine learning, natural language processing (NLP), and other cognitive tools. Examples throughout govern- ment include automating repetitive back-office tasks in human resources, finance, and procurement; harnessing AI to gain deeper insights into program data and to identify or predict anoma- lies; and deploying chatbots for better customer service. Within health and human services, recent applications span the front-, middle-, and back-offices. n California’s state health insurance marketplace, Covered California, deployed a virtual assistant during open enrollment to better serve customers, decrease call volume, and reduce seasonal call center workload needs. Utilizing a cloud- based machine learning platform and NLP framework, the virtual assistant named CiCi responded to more than 111,000 user questions within the first four months and con- tinues to evolve its knowledge and responses through training. Through interfacing directly with customers, CiCi collects valuable and actionable data such as customer sentiment and satisfaction, usage trends, as well as frequently asked and unanswered questions. n The Center for Program Integrity at the Centers for Medicare and

large application releases in eligi- bility and child welfare information systems. RPA bots build a large inventory of pre-configured cases allowing human testers to execute cases more efficiently by reducing the average time per case from 21 minutes to 2 minutes. Agency and program leaders are to be congratulated for this progress although there is still much work to be done. While agencies are clearly embracing AI tools, most are only applying them to individual use cases without a strategy to scale them across the enterprise where they would have a greater impact on productivity, cost reduction, and improved workforce morale. Given the difficulty of moving proofs of concept into production at

Medicaid Services launched a tool combining RPA, NLP, machine learning, optical character recogni- tion, and microservices to expedite a time-consuming medical record intake and review process that evaluates payment accuracy. The tool retrieves records as they are submitted by opted-in insurers and providers, then digitizes, extracts, and validates data to identify excep- tions based on pre-defined business rules and coding guidance. Records that cannot be processed with a high degree of confidence as well as prob- lematic records are routed to staff for manual review. Working around the clock, the tool is 95 percent accurate and twelve times faster than the process was before applying intelli- gent automation. n Multiple states are using RPA to support user acceptance testing for

See Automation on page 35

Illustration by Chris Campboell

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technology speaks By Sean Toole

Eliminate Blind Spots to Improve Safety: More Eyes More Often

W hen the press writes about failures in the child welfare system, the tragedies are unique, but the pattern is often all too familiar. A family has been involved with the agency multiple times, signs of risk were missed, and the result is signifi- cant harm or even death. It’s hard to read about a set of facts that seem so clear in hindsight. We could have known, we should have known, we just didn’t connect the dots from the avail- able data and the risk it entailed. Quality assurance reviews following a tragedy often indicate it was prevent- able and, unfortunately, attribute the tragedy to a people problem, further singling out the caseworker or super- visor. In reality, however, the cause of a tragedy is often driven by a capacity problem that is disguised as a people problem. While there is much information gathered about the families we serve, finding and tracking everything presents a monumental challenge to caseworkers. The short list of obstacles includes handoffs, multiple agencies and providers, staff turnover, and overwhelming workloads. We leave this problem to the caseworkers, who have dozens of cases, hundreds of interactions each month, and just minutes to absorb and react to new information on each case. On top of that, we implement new technologies that inundate workers with hundreds of alerts, reminders, and notifications telling them what to remember and what needs to be done now… and be sure to complete it all by Friday. It requires staff to be super human. The dream, of course, is that case- workers can do all those things. We

those families when allegations are raised. These analytical solutions are maturing and show some long-term promise, but they have generated inconsistent results. The algorithms are error prone when applied to his- torical and potentially biased data, the improvements in accuracy have been modest, and the downside when they fail is just as problematic as the problem they are addressing. Fundamentally they just don’t focus on this key issue facing child welfare. The problem is not the judgment of intake workers; rather we need to augment casework with insights. We need to remove the blind

want “eyes” on these kids all the time and we expect staff to notice every detail. Each child deserves the right attention and the right services. It’s up to staff to find a way to get that done. If they just review everything or if the supervisors dig hard enough, they can find the “blind spots” that might be missed. Unfortunately, the dream and the reality are far apart, and there is no safety net when things go wrong. One way we might reduce risk involves predictive analytics, using a model, for example, to determine which children are at greatest risk of harm in the future and “screening in”

Illustration by Chirs Cmapbell

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