Policy & Practice June 2018

The Magazine of the American Public Human Services Association June 2018

HUMAN CENTERED DESIGN Reimagining Service Delivery Through the Eyes of the Family

TODAY’S EXPERTISE FORTOMORROW’S SOLUTIONS

contents www.aphsa.org

Vol. 76, No. 3 June 2018

features

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Igniting the Potential Part 3: Move to the Front: A Strategy for Becoming a Stronger Self

Moving Beyond Compliance Accelerated Outcomes in Child Welfare

Improving Citizen Engagement Through Human-Centered Design Our Partnership with the New York City Department of Social Services

departments

3 President’s Memo Putting Family and

20 Legislative Update

25 Association News

Innovations in Using Guardianship to Preserve Families: A National Scan of Policy and Practice

2018 APHSA Member Award Recipients, 2018 ISM Awards and Fellowships Deadline Approaching

Community at the Center: What Does It Really Take?

5 From Our Partners CCWIS–A Call to Action to Increase Capacity

22 Legal Notes

26 Staff Spotlight

Distant Memories, Fresh Wounds: Litigation Strategies for Sexual Abuse Lawsuits 24 Collaborative Law and Public Human Services Agencies

Romuald L. Tassigne, Research Associate, Center for Employment and Economic Well-Being (CEEWB)

6 Locally Speaking

36 Our Do’ers Profile

John Doe Is Not the Father: How a Practice Change Helped Families in Denver

Ron Clewer, Chief Operating Officer, Alliance for Strong Families and Communities

Cover Illustration by Chris Campbell

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June 2018 Policy&Practice

APHSA Executive Governing Board

Elected Director Brenda Donald, Director, DC Child and Family Services Agency,

Chair David Stillman, Assistant Secretary, Economic Services Administration, Washington Department of Social and Health Services, Olympia, WA Vice Chair and Local Council Chair Kelly Harder, Director, Dakota County Community Services, West Saint Reiko Osaki, President and Founder, Ikaso Consulting, Burlingame, CA Leadership Council Chair Roderick Bremby, Commissioner, Connecticut Department of Social Paul, MN Treasurer

Washington, DC Elected Director

Susan Dreyfus, President and CEO, Alliance for Strong Families and Communities, Milwaukee, WI Elected Director David Hansell, Commissioner, NewYork 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

Services, Hartford, CT Affinity Group Chair

Paul Fleissner, Director, Olmsted County Community Services, Rochester, MN

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Policy&Practice June 2018

president‘s memo By Tracy Wareing Evans

Putting Family and Community at the Center: What Does It Really Take?

C onsider this: what if each one of us—in the work we do every day no matter our role, vantage point, or experience, were relentless in our pursuit of the limitless possibilities of human potential? What if we were truly committed to having all indi- viduals and families be intimately involved in planning for and acting on their own economic and social success? What if we not only understood parents as caregivers and breadwin- ners in theory, but actually enacted policies and practices that addressed both the wealth and wellness of families at the same time? These kinds of paradigm shifts are at the heart of placing family and com- munity at the center of our work. We must find authentic and meaningful ways to honor the lived experiences of families—understanding the full context of where we all live, work, play, and age. To do so requires us to disrupt long-held mindsets and highly entrenched ways of doing business. Consider the lived experience of Chef Jeff Henderson, a keynote speaker at our recent National Health and Human Services Summit, who described generational poverty as a “mindset”—one that is formed by the expectations and values experienced while growing up in poverty, and by the “otherness” we create when as a society we describe poverty as hap- pening elsewhere and to others. Several leaders in our field have noted that, through our systems and processes, “we make families prove just how poor they really are.” We also consistently “subcategorize people,” as I heard recently described, into

willingness to seek help? What might we believe about ourselves and our own capabilities, let alone about the community in which we live? At a recent meeting sponsored by Casey Family Programs, I was struck by a story shared by a woman who cared for her grandchildren when her daughter became involved with the child protective system. She told us at the very moment her daughter most needed her, she was forced to make a decision about who she was going to help—her child or her grandchildren—a false dichotomy and untenable position for any family, and yet one that our system perpetuates daily.

“artificial parts” through the transac- tional, administrative-based delivery of discrete programs, most of which do not consider the family as a whole or the context in which they live. We then wonder why we don’t get the results we want. As human services leaders, we must recognize that our operating systems constantly reinforce deficit- based thinking—whether from the perspective of the people receiving services, the frontline staff, or the public at large. To flip our mental models, we must ask ourselves what kind of impact does such a system and structure have on people? What might our own mindset be if we were “seen” only from the answers to the paperwork we must complete? How might it affect our

See President’s Memo on page 27

Photo via Shutterstock

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June 2018 Policy&Practice

Vol. 76, No. 3

www.aphsa.org

Policy & Practice™ (ISSN 1942-6828) is published six times a year by the American Public Human Services Association, 1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036. For subscription information, contact APHSA at (202) 682-0100 or visit the website at www.aphsa.org. Copyright © 2018. All rights reserved.This magazine may not be reproduced in whole or in part without written permission from the publisher.The viewpoints expressed in contributors’ materials are the authors’ own and do not necessarily reflect the policies or views of APHSA. Postmaster: Send address changes to Policy & Practice 1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036

Advertising Natasha Laforteza ads_exhibits@aphsa.org

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Policy&Practice June 2018

from our partners By Sean Toole

CCWIS–A Call to Action to Increase Capacity

M any states are in the process of developing plans for imple- menting a Comprehensive Child Welfare Information System (CCWIS). These next-generation systems offer improved integration, connectivity, and reporting capabilities. However, too many of the plans for implemen- tation of these systems fail to put emphasis on the improvements in process and management systems that can dramatically increase capacity to serve. The requirements are instead focused on automating what is; pro- viding expanded access to the same process, the same structures, and the same reports. You know the story. We put technology before workflow redesign, and we get a sophisticated system that tells us, in a better way, what we already know: We have massive caseloads and our clients are stuck in piles on caseworker’s desks. When we get the process right, we have seen improvements such as 40 percent more clients served and 70 percent efficiency improvements for specific processes, and we know the same opportunities exist for states consid- ering CCWIS. There are several key opportunities that should be included in a complete plan for CCWIS implementation. The discussions in the market regarding modularity and agile develop- ment approaches have drowned out the critical focus on dramatically improving process outcomes. There seems to be a hope that by shifting from a waterfall to an agile method- ology we will naturally generate a better outcome, but that almost never Overlooked CCWIS Opportunities

streamlining identifies capacity oppor- tunities focused on reducing the effort to produce quality work. If your project starts with system design, the oppor- tunity for significant improvement has been missed. 2. Manage case flow over caseloads. Effective management of child welfare processes is often lacking in CCWIS project planning. Dashboards of caseloads, activities, and trends are all discussed and included in the pro- curement requirements, but the status of the work, what hinders progress, and who is needed to close out a task are rarely considered. Managing case flow across an agency requires careful assessment and planning of the sup- porting processes. With the right design you can track where the work is, identify bottlenecks, shift staff to where it will be needed, and make better hiring decisions. CCWIS can then

happens. You get the results you plan for. These recommendations put the focus back on generating the capacity to improve outcomes: 1. Focus on process design first. CCWIS programs risk being tech- nology-first efforts. At the outset, it is essential to take the time to recon- sider how the work gets done, who completes it, how long it takes, the outcome, and, most important, how it is tracked. Too often there is a rush to move into screen configuration and design. But to be effective, two things should come first: human- centered process design and an effort to streamline processes. The use of human-centered design techniques, led by staff who understand the practice, is critical to ensure that capacity-driven innovation takes place. This approach challenges the casework process and identifies new ways to manage outcomes efficiently by considering all participants in the experience. Process

See CCWIS on page 29

Photo via Shutterstock

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June 2018 Policy&Practice

locally speaking By Katie Smith

John Doe Is Not the Father: How a Practice Change Helped Families in Denver

A t Denver Human Services (DHS), our mission is to protect those in harm's way and help all people in need. A large part of living out that mission involves protecting children from abuse and neglect. Keeping kids safe can be a challenge, however, when both parents are not identified, as it limits the number of kin available to form a support system for the child. A recent practice shift has helped us do a better job of engaging the whole family. Until 2016, unidentified fathers in dependency and neglect cases were listed as “John Doe,” and caseworkers worked with the mother and her family on safety goals for the child. However, listing “John Doe” doesn't create any more legal freedom for the child in those instances where the depart- ment needs to take custody and it restricts the available number of family members who can provide support for the child. As the Colorado Guided Reference in Dependency states, “Not only do relatives and kin serve as potential placements for children in need of out-of-home placement, but they also serve as a potential support for a child in need and a critical con- nection to that child’s identity, past, and future.” In mid-2016, DHS stopped listing “John Doe” on dependency or neglect petitions and began asking that an Affidavit of Parentage be completed in each case. The Affidavit of Parentage is a legal document that requires a parent to provide as much informa- tion as possible to help identify, and eventually locate, the noncustodial parent, which is, in most cases, the child’s father. Identifying fathers and

establishing paternity is of paramount importance for children, because it provides children with the opportunity to know who their parents are, to have additional extended family members who can lend support when necessary, and to allow children an under- standing of their culture and heritage, which can lead to a sense of belonging. This new process also has systemic advantages, such as eliminating dupli- cate efforts to establish paternity for child support purposes. Since implementing these new prac- tices, DHS has collected data regarding paternity adjudications and perma- nency outcomes. The DHS averages 600 open dependency and neglect cases in any given month. In 2017:

� 75 percent of children were in their permanent home within 12 months of removal � 65 percent of cases had a paternity determination � 86 percent achieved permanency at home or with kin “Our goal is to identify the father in 100 percent of open cases to provide as many opportunities for safe family con- nections for the child as possible,” said Jenn Collins, Assistant Director of the Human Services Section of the Denver City Attorney’s Office. “This new policy helps us get closer to that goal.”

See Denver on page 26

Photo Illustration by Chris Campbell

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Policy&Practice June 2018

The Health and Human Services Workforce

Move to the Front: A Strategy for Becoming a Stronger Self PART 3

onsider this: You wake up late on a Monday morning, and then your car has a flat tire on the way to work. Later, you discover the leftover chicken tikka masala you were going to eat for lunch sits forgotten on the kitchen counter. At three o’clock, when you need to give a big presentation to a prospective client, you receive an email to reschedule—for next month. When you finally get home for the evening (later than normal), your signifi- cant other asks the inevitable: “How was your day?”

By Randall Kratz and Michael McCafferty

And you will respond: “It was bad.”

Moving forward from the brain- stem, we have the midbrain (which also fuels our reactive impulses); the limbic system, housing our emotional core; the cortex; and finally, the frontal cortex. Radically complex, our brains constantly assess situations while the different parts vie for control over the best response. However, we as human beings can assert control over our instincts, emotions, and reactions, and this is where moving to the front draws its influence. It takes time and com- mitment, as well as a knowledge of resilience practices, but we’re com- pletely capable of taking negative experiences—our bad days—and transforming them into positions of strength and happiness. The Role of Stress One of the biggest contributors to the “bad day” narrative is stress. In fact, surveys show we’re currently experi- encing higher levels of stress due to unique factors like the outcome of the 2016 presidential election and fluctu- ating uncertainty surrounding health care. 1 Stress contributes to an esti- mated $300 billion in health care costs for employers. 2 The role of stress in well-being, both for organizations and their employees, cannot be ignored. We’re all familiar with common signs of stress: Long hours at work,

But what if you were told there are no bad days? That there are simply unfor- tunate events—flat tires, forgotten lunches, cancelled meetings—and that the difference between “good” and “bad” is your personal resilience? Would you believe it? Events that cause negative emotional responses are going to happen and are often beyond our control. FEI has built a framework based on how our brains influence our reactions, especially in response to the “bad” events in our lives, with the goal of helping employees overcome adverse experiences, priori- tize happiness, and ultimately guiding them to their best selves. It sounds idealistic, but it can be done. We just have to move to the front. What is Moving to the Front? When we talk about moving to the front, we’re referencing the different parts of the brain. The back of the brain, where the brainstem is, stores biological imperatives focused on the survival of self and body (think fight or flight responses). The back of the brain is reactive. As we move to the front—in this case, the frontal cortex—we move from base reactions to sophisticated, rational thought. There are parts of the brain in- between, of course, and they inform our reactions as well.

Igniting the Potential is a recurring theme for 2018. In each article, we introduce our readers to various efforts underway in the H/HS workforce. If your organization has a compelling story to share about how you are supporting and advancing the H/HS workforce, we would love to hear from you. Contact Jessica Garon at jgaron@aphsa.org. Igniting the Potential

Randall Kratz, MS, LCSW, LPC, is a Senior Account Manager at FEI.

Michael McCafferty, MSW, PHR, SHRM-CP, is a Senior Account Manager at FEI.

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Policy&Practice June 2018

Let’s apply this idea to our introduc- tion: The car has a flat tire. Do you panic, or do you call a tow truck and patiently wait? Someone cancels an important meeting at the last minute. Do you get angry and frustrated, or do you acknowl- edge that meetings can be rescheduled and adjust your time and assignments accordingly? Inmost cases, there is an opportunity to move to the front. When Stress Sticks Problems occur when stress is so persistent we become stuck in harmful behavioral patterns. This can happen for numerous reasons: Financial concerns, relationship problems, falling behind at work— challenges that occur over time and feel constant, even unavoid- able. Areas of the brain accustomed to tackling these challenges on an intermittent level are now in overdrive, sticking in place and overwhelming us. The long-term effects of too much stress are well documented, but short-term periods of being “stuck” in a stressful state can be just as damaging. When stress sticks, it complicates how we react to normal situations. Let’s use the limbic system as an example, the “emotional core” of the brain linked to feelings of alarm. If we feel alarmed over a prolonged period of time—there’s an extended problem with student loan repay- ments, say, or massive cutbacks at work have everyone on edge—then we’ll

situation (“This is potentially dan- gerous. Who is this person?”). If, however, a new co-worker walks up to our desk in the middle of the day, our understanding of the environment and additional cues will trigger our brains to reconsider reacting in an instinctual way (“This is okay. This person must have a question or need something.”).

unhealthy habits, a general feeling of being overwhelmed, etc. Unmitigated stress can lead to fatigue, irregular behaviors, and a dis- interest in the activities and hobbies we once enjoyed, among other influential outcomes. How our minds and bodies deal with stress depends on even more nuanced criteria, ranging from learned responses and past experiences to our very DNA. Yet, recent studies also have begun documenting the benefits of stress when constructively applied in our lives. Stress can be emotionally draining and physically tiring, yes, but it can also drive productivity, bolster accomplish- ment and instill a sense of engagement. Displaying an extraordinary ability for stimulating different parts of the brain, stress exercises the mind’s dexterity when navigating behavioral responses to various situations. We learn how to react in specific circumstances based on previous experiences, the stress we felt, and the actions we took in response. If a stranger approaches us in a parking lot late at night, our brains will instruct us to prepare for fight or flight until we have a sense of the

See Igniting the Potential on page 31

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June 2018 Policy&Practice

Beyond MOVING COMPLIANCE Accelerated Outcomes in Child Welfare

by Molly Tierney and Valerie Armbrust

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he spirit of child welfare is safeguarding children and families. When the rubber meets the road, however, service delivery is predominantly driven by compliance. The obligation to comply with federal funding rules, state regulations, and court orders has become a central focus of the work,

eclipsing other actionable conversations about the safety and well-being of children. Compliance will always be important and essential. The challenge is that meeting the letter of the regulation has too often become an end in and of itself. The consequences of this phenomenon can be serious for the children we are all dedicated to safeguarding. The focus on compliance preoccupies caseworkers with back office func- tions instead of providing direct service. Caseworkers who are exhausting themselves completing administrative tasks often spend less time with children and their families, and when they do get to direct services, they are faced with making child safety decisions with limited information and time.

Compliance is important and will continue to be. Our call to action is to maintain compliance as a baseline, to devote substantial energy and resources to freeing up caseworkers, and equipping them with the knowl- edge and tools to offer the best direct service possible. The pathway to better child welfare results requires posi- tioning and enabling the caseworker with the right insights and tools to make thoughtful and informed deci- sions about the children and families they serve. On this pathway, we can all feel more confident in the decisions made about the safety of children. Furthermore, with insight-driven decision-making, we will then begin to realize the improved outcomes in child welfare for which we all strive. Right at our fingertips, there is tech- nology innovation waiting to be used. With a new mindset in place, we can rethink how new and existing tools can better enable our caseworkers. Using data insights, artificial intelli- gence (AI), robotic process automation (RPA), and extended reality (XR), we can create a new service ecosystem by weaving technology and casework into an approach that puts the child and

family at the center of the provided services. Specifically, we can focus on how technology can and should be used to return front-line staff’s full attention to the direct service of children and families—something only humans can do. Data Insights In the “microchip millennium,” data systems are standard tools of the trade in child welfare. Good tools allow juris- dictions to end the years of manually reporting IV-E eligibility, NCANDS (National Child Abuse and Neglect Data System) data, and AFCARS (Adoption and Foster Care Analysis and Reporting System) data, but it is rare that these systems also help efficiently manage day-to-day opera- tions. More robust systems equipped with data insights can provide the worker with a global view of a child and the family, as well as a clear sense of actions to keep a child safe. These systems change the user experience by delivering relevant and child-centric content with the necessary immediacy. Data insights can also provide sequen- tial workflows, recommending actions in an order that can improve both effi- ciency and effectiveness. When data systems are both com- pliant and insightful, meaning they manage administrative reports and provide information to the caseworker, agencies are positioned to be far more accurate in safety assessments and are able to move with agility when pro- tecting a child from harm. Artificial Intelligence A collection of advanced tech- nologies, AI allows machines to sense, comprehend, act, and learn while also maximizing the likelihood of a successful outcome in a particular venture. While it can never take the place of a caseworker, AI is an under- utilized technology in the child welfare field, particularly as it relates to safety decisions for children. The most precarious moment for any child welfare agency is the one in which a caseworker must decide if it is safe enough to leave a child at home with the parents after receiving a report of abuse or neglect. The consequences

of making the wrong decision are tre- mendous and we risk either bringing children into foster care unnecessarily or leaving them home at their peril. No child welfare agency wants errors on either side of the margin. Imagine a single mom of a very young child struggling with heroin addiction. Through AI and data mining, a case- worker could quickly access information from a suggested portfolio of services that will make the greatest impact on a family of this profile. AI might suggest that the most effective treatment for the mom is in-patient substance abuse treatment where she can bring her child with her. AI could even provide contact information of locally available resources, including the phone number and address of a nearby treatment center. The caseworker’s administra- tive labor is reduced from hours down to minutes and may enable children to remain safely with their family. Robotic Process Automation Also known as virtual assistants, RPA and chatbots are complementary technologies that can interact with users, perform automated tasks, and assist workers with time-consuming, low-value tasks that keep them from service delivery. Potential use for RPA in child welfare settings is vast, decisions about the children and families they serve . The pathway to better child welfare results requires positioning and enabling the caseworker with the right insights and tools to make thoughtful and informed

MollyTierney is a Senior Manager of Health and Public Services at Accenture.

Valerie Armbrust is a Managing Director of Health and Public Services at Accenture.

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Policy&Practice June 2018

including more efficient IV-E deter- minations, more comprehensive court documents, and easier ways for providers to reports changes in house- holds—all of which free up workers from back office administration. RPA and virtual assistants have special implications for child protec- tion services. A fundamental challenge every child welfare jurisdiction faces is getting people to report the possible mistreatment of a child. The field depends on citizens to inform child welfare, but in reality, many people hesitate to call for fear they may be identified as the reporting individual. Those who do report mistreatment often do so through email, letters, or voicemail, leaving the agency in the awkward position of not having enough information to respond to a report. Imagine if we could add a virtual assistant to the many ways that people report abuse. A virtual assistant could be smart enough to listen to reporters and guide them through additional questions that provide critical informa- tion to the agency. This makes it easier for individuals to submit reports and ensures the agency can act quickly to protect a child when needed. Extended Reality Extended Reality (XR), which includes Virtual Reality (VR) and Augmented Reality (AR), are computer or film-generated scenarios that simulate a realistic environment. XR technology is changing the way people

Artfully and strategically orchestrating technological and human capacities together in this way can accelerate the outcomes for children and families that the caring members of our field so deeply crave .

in a safe environment. With accompa- nying coaching, this technology can rapidly increase the speed with which a worker is confident and knowledge- able when entering a home. Using this technology in this way could go far in reducing unintended errors in decision-making that might lead to cat- astrophic consequences for children. Technology is not a silver bullet, and the use of a single technology alone is not a game changer. As a portfolio, these innovations in technology can be used to free up caseworkers from administrative tasks and accelerate insight-driven decision-making. By doing so, we leverage the dedication of an army of caseworkers who want nothing more than to spend their time providing direct service that protects our most vulnerable citizens. And that may be the most important tool we have at our disposal. Artfully and stra- tegically orchestrating technological and human capacities together in this way can accelerate the outcomes for children and families that the caring members of our field so deeply crave.

connect with information, experi- ences, and each other. While popular in the gaming community, XR has now emerged as a leading training meth- odology with an enormous amount of untapped potential for child welfare. One significant challenge that child welfare agencies continually face is maintaining a workforce of seasoned caseworkers. Putting recruiting and hiring aside, the fact is that even after onboarding a newworker, for better or worse, it takes years to master case management. The only way to truly learn the craft is through experi- ence with families—watching their dynamics and observing and inter- preting verbal and nonverbal behaviors. Imagine if we could accelerate the speed by which new workers become seasoned by using XR training sce- narios. XR can create experiences that replicate the intense nature of entering a home to assess the safety of a child. Through XR, workers can be virtually exposed to high-stress, intense sce- narios that allow them to hone their observation and decision-making skills

Improving Citizen Engagement Through Human- Centered Design Our Partnership with the New York City Department of Social Services

By Claire McLoughlin

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he New York City Department of Social Services (DSS) serves three million vulnerable New Yorkers. The agency has a workforce of close to 18,000 and delivers Like many social services agencies, the New York City DSS wanted to improve its citizen engagement process in a way that would reduce the burden on its staff while simultaneously enhancing the customer experience. T a wide range of services from public assistance and employment services to a large homeless shelter system. In the Supplemental Nutrition Assistance Program (SNAP) alone, caseworkers process close to 70,000 applications and re-certifications per month.

have to usher tired and hungry children with them to the service center. However, despite their diver- sity, their needs are common and relatively simple: � They need an easy, clear path to help. � They need the ability to choose the channel they used to interact with the agency, including smartphone, desktop, in person, or on paper. � They need to know upfront what was involved in the application process and get answers to questions such as, “How long is this going to take?” and, “Can I save and resume this process later, or should I not start at all if I can’t stay for the duration?” � When they are finished with the online application, they need to know what comes next in the overall path to help. Understanding these needs, which become obvious only through firsthand observation with the users, helped the GHHS team discern the kind of user experience the product designers needed to create to meet these needs. “ Hosting the designers in our centers was eye opening for them. Feedback that we had provided over the years that lived on lists, teed up as possible enhancements, became real as they watched clients struggle through the application. Simple things like the size of the clickable space inside a radio button or the need to reduce text through better use of ico- nography became very real. For instance, we learned that close to 100 percent of the time a client will ask a facili- tator if their submission is successful, until you add a giant green check mark and an exclamation point! ” —Lauren Aaronson

Over the last three years, faced with rising caseloads and static resources in the SNAP program, the agency decided to invest in a new service delivery model. The goal was to shift the client interaction from a heavily bricks and mortar, in-person experience to a more self-directed service model using new digital channels, including an online portal that uses IBM Curam Universal Access. Called ACCESS HRA, the portal is designed to provide an improved client experience and to reduce foot traffic at their service centers. In addition to online applications for SNAP, the portal allows a client to view more than 100 real-time case-related “ The efforts at DSS have been very successful. Seventy-five percent of SNAP applications are submitted online and foot traffic in the offices has been reduced by 30 percent. Throughout this process, we gained some valuable insights and became acutely aware that in order to fully achieve our goals, we needed to increase the usability of our digital tools and needed to address the fact that the web portal . . . did not work well on a mobile device. ” —Lauren Aaronson, Deputy Commissioner, Office of Business Process Innovation, DSS

data points, including case status, account balances, and e-notices. IBMWatson Health™ was well suited to partner with the city to address these needs, with 42 design studios around the world and 1,600 formally trained designers. The Watson Health Government Health and Human Services (GHHS) team is tackling the most difficult chal- lenges facing our customers, applying human-centered design and agile development practices across our products and services, to enable us to greatly enhance the value we provide to our customers and their clients. Universal Access is a social enter- prise management platform that is used to connect people to social services across five countries in eight different languages. Government services accessed with Universal Access run the gamut from disability benefits to income support to food assistance to health insurance. The GHHS team engaged in a partnership with DSS to help solve the depart- ment’s pain points—and do so in a scalable way that would maximize the value delivered across the entire GHHS customer base. In order to achieve this mission, the team agreed on three core values that would enable them to push the bound- aries in terms of user research, product design, and software development: � Observe, listen, understand � Build, measure, learn � Influence over control Observe, Listen, Understand The DSS invited the GHHS team to use their PC banks, available at 15 service centers, as user-feedback labs to help gain a better understanding of people’s needs as they interact with the government online. A multidisciplinary team comprised of a product manager, designers, and architects traveled to New York to spend time with people as they went through the process of applying for benefits at these service centers. The team observed, listened, and very clearly understood their needs as a result. So, what did they learn? That all kinds of people find themselves asking for help. Some don’t speak English, some have low literacy levels, others

Claire McLoughlin is the Principal Offering Manager at IBMWatson Health, Government Health and Human Services.

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Policy&Practice June 2018

“ The fact that we deliver a product that is then customized by customers and partners is a compli- cating factor for us as a product organization. For our customers, customization is king and flexibility within that customization process is the key to a successful solution. So, we needed to ensure that the customization capabilities were flexible, modern, and easy, while at the same time, ensuring that the well-researched design of the product flowed through to the custom solution. How could we influence but not control that custom experience? ” —Claire McLoughlin, Offering Manager for Watson Health Social Programs

Build, Measure, Learn These insights led to the creation of a prototype of a transformed citizen engagement experience, accessible from any device. The prototype was brought to New York for feedback. The team then iterated that prototype to tweak and adjust the user experience as the solution progressed. The DSS team (a mix of public- and private-sector business and tech experts) also traveled to an IBM design studio where, together with the GHHS team, they co-designed elements of the new experience. Taking this approach resulted in a very tight collaboration, with public and private teams working shoulder to shoulder throughout the process. Influence Over Control The solution was to build a design system that incorporated govern- ment-specific design principles and guidelines as well as templates, examples, and a set of components that could be assembled to build the custom experience. And, unlike many other design systems used mainly for in-house development, the team delivered that design system along with the product for customers and partners to use, achieving that influ- ence over control.

Looking Forward Investing in good design practices and taking a lean, agile approach to development within the context of a public–private partnership meant that just months after defining the first pro- totype of these ideas, the GHHS team has designed the next generation of Universal Access. This next-generation product has already been validated by its users, and later this year, a simple, modern responsive version of ACCESS HRA will be released to New Yorkers. “ Critical programs like SNAP serve people facing very difficult times, so it’s vital that those programs be easy to access. We’re very proud to work with Watson Health Government to bring accessible online service to New Yorkers in need with ACCESS HRA. ” —Steven Banks, Department of Social Services Commissioner

For more information on this partnership: https://www.youtube.com/watch?v=mY0Xa0Wf9Yo

For more information on IBM Design Thinking: https://www.ibm.com/design/thinking/

For more information on IBMWatson Health Social ProgramManagement: https://www.ibm.com/watson/health/government/social-program-management/

legislative update By William Vesneski and Peter J. Pecora

Innovations in Using Guardianship to Preserve Families: A National Scan of Policy and Practice

C hildren in relative adoptions and foster care experience better outcomes than do children placed in non-kinship foster care. 1 These outcomes include greater place- ment stability, fewer school changes, higher levels of permanency, and better behavioral and mental health outcomes. While the existing research on relative guardianship has limita- tions, guardianship remans a crucial permanency option. In fact, many state and county child welfare agencies are building on federal law to help children achieve legal permanency through guardianship with relatives and fictive kin. To better understand state policies guiding guardianship, this article presents trends in state statutes and administrative codes for guardianship across all 50 states. Figure 1 provides an overview of the diversity of guard- ianship programs in the United States. In the summer of 2016, we analyzed legislation pertaining to guardianship assistance along with the federal Title IV-E Guardian Assistance Program (GAP). In addition, we conducted a survey of state experts in guardian- ship (or child welfare administrators in the states without a guardianship program), later that year. This study, developed in collaboration with the Chapin Hall Center for Children, was guided by a desire to clearly under- stand how states are, or are not, supporting guardianship placements in the law and in practice. We found that states fund their guardianship assistance programs with state or TANF dollars, and they fund federal GAP programs with Title IV-E funds. States may choose to draw down Title IV-E funds to subsidize

Figure 1: 35 States, D.C., and 8Tribes (as of Feb. 1, 2018)

Port Gamble S’Klallam Tribe

Confederated Salish and KootenaiTribe

Keweenaw Bay Indian Community

South Puget Intertribal Planning Agency

Tolowa Dee-Ni’ Nation of Smith River

DC

Navajo Nation

Eastern band of Cherokee Indians

Pascua Yaqui Tribe

GAP and no prior program

GAP and prior subsidized guardianship program No final approval for GAP

Source: www.grandfamilies.org

Oklahoma, and West Virginia) have program effective dates of 2013 or earlier but have not placed any children into subsidized guardian- ships. The remaining three states (Nevada, New Mexico, and North Carolina) have recent program effec- tive dates and are expected to begin showing GAP caseloads in FY 2017. 2 States choosing to draw down Title IV-E GAP money for guardianship subsidies must follow the parameters of federal law. However, many states using Title IV-E GAP funds to support guardianship either narrow or expand

state guardianship payments in which children and their adult guardians meet Title IV-E qualifications. They may also use additional state funds to subsidize guardianship cases in which the child or the adult guardian does not meet federal qualifications for the Title IV-E GAP program (see Figure 2). As of September 2017, 36 states and the District of Columbia, as well as eight Indian tribes, had approved GAP plans. However, challenges remain: six states with approved GAP plans reported no GAP caseload in FY 2016. Three of these states (Arkansas,

Policy&Practice June 2018 20

Figure 2: Guardianship Funding Sources

their federal guardianship assistance programs in the following ways: 3 � Eligibility criteria for guardianship, including the child’s maximum eligible age; the child’s age of input into the guardianship decision; and whether the state will allow fictive kin to serve as guardians � Amount and types of financial support to families, including the maximum allowable monthly subsidy � Post-guardianship management, including periodic guardianship eli- gibility reviews � Parental rights and responsibilities, including whether parental rights are explicitly noted; whether child support requirements are stated; and whether family reunification is explicitly noted in state statutes and administrative codes States vary widely in their monthly subsidy of guardianship programs, with the maximum rate reaching as high as $1,360 per month (the rates are informed by the states’ basic foster care rate). States that choose to draw down Title IV-E GAP funds for their guard- ianship assistance programs report that they do so because: (a) it is the best option for children who cannot be adopted or reunified with their parents; (b) federal funding supports state programs; or, (c) federally subsi- dized guardianship allows additional funding to be used to help move identified populations of children to permanency more quickly.

DC

Mostly TANF Funds No Funded Guardianship Program Missing Data

State Funds IV-E GAP Funds

IV-E GAP Funds and State Funds

Factors that Hinder Guardianship Program Implementation States that decline to draw down Title IV-E GAP to support guardian- ship assistance, and instead use state or TANF funds, or do not have a guardianship assistance program, report several reasons for doing so. These include: (a) guardians

and children in the state will not meet Title IV-E eligibility criteria, particularly foster care licensure requirements of Title IV-E GAP; (b) funding and resources to implement Title IV-E GAP are lacking; and/or (c) guardianship is not considered a per- manent placement option for children.

See Guardianship on page 30

legal notes

By Daniel Pollack

Distant Memories, Fresh Wounds: Litigation Strategies for Sexual Abuse Lawsuits

I n most claims for personal injury there are time limits by which the claim must be brought. There are various exceptions, including sexual abuse that took place many years ago when the claimant was a minor. In all lawsuits, the credibility of facts and witnesses is crucial. Abuse allega- tions, by their nature, are infrequently able to be independently, conclusively verified. Further, litigation is inher- ently an endeavor in which witnesses may have a stake in a particular expla- nation of past events. Assuming there is no statute of limi- tations concern, what are some of the unique challenges and “tricks of the trade” of filing or defending against this type of civil lawsuit? We asked a number of experienced attorneys to share their insights about handling a sexual abuse case when the alleged abuse happened many years ago. The following are their observations. 1. Cameron R. Getto, Michigan It is important to remain objective and avoid over-identifying with the client. Most injury lawsuits are signifi- cantly simpler to litigate than sexual abuse cases. This is because even if a physical injury is fully healed, there is almost always an abundance of physical evidence fromwhich the attorneys can independently evaluate the magnitude of the harm as well as the possible or likely cause(s). Discrepancies among witness accounts of what may have happened almost always take a back seat to the objective, verifiable evidence, because juries tend to understand that witness accounts involve a certain amount of subjectivity.

In contrast, sexual abuse cases, particularly those remote in time, fre- quently involve circumstances in which no objective evidence of wrongdoing exists. Often, there are only two wit- nesses, both of whom present versions of the facts that contain key, dispositive

differences. Additionally, we all know that truthful, honest people sometimes tell lies, and that liars sometimes tell the truth. In remote cases, the passage of time raises questions of motive that ordinarily are not at play when a recent physical or visible injury is evident.

Photo Illustration via Shutterstock

Policy&Practice June 2018 22

able to advance the significant litiga- tion expenses. These issues make the possibility of successfully litigating a case less likely. Although settlement is always a possibility, clients may face a moral dilemma when asked to settle a case that frequently includes a require- ment of absolute confidentiality. It is often difficult for victims to balance their idea of “justice” with the value of the case from a legal perspective and what the offender or institution is willing to pay. Just because a statute of limita- tions is extended or eliminated does not mean a plaintiff wins. Statutes of limitation only prevent access to the courthouse door. Once inside, a plaintiff must still present, prove, and actually win the case. “Access” does not always mean “justice” and careful client counseling is necessary to give victims perspective on exactly what the court process can and cannot provide. Fortunately, most victims gain strength and vindication from the process itself. Win or lose, having their day in court is truly cathartic for many victims. Holding individuals and institutions accountable is perhaps the best definition of justice attorneys and advocates can provide for their clients. 3. Karen Steinhauser, Colorado Sexual abuse of children cases, whether they are brought days, weeks, months, years, or decades after the

Because these dynamics shift the focus away from verifiable facts and instead place enormous importance on who to believe, an effective advocate must endeavor to remain objective. He or she must remain relentlessly focused on supporting the credibility of the client, even if the attorney believes every claim or account of events the client advances. 2. Katie Shipp, Pennsylvania When the statute of limitations is not an issue, cases involving sexual abuse that happened long ago can still raise significant barriers for victims. Locating evidence is often challenging. Witnesses, or people the victim told about the abuse, can be difficult to track down and often their memories may be unclear, espe- cially about critical dates and times. Further, documentary evidence may have been destroyed or buried in a long-forgotten archive. In cases of abuse within an institution, it may be necessary to rely on the institu- tion, which is at risk of being sued, to gather and share evidence. This can be a battle since the institution will unlikely willfully share incriminating information without civil discovery or a court-ordered subpoena. Without this evidence or a clear understanding of exactly what kind of evidence might still be locatable, an attorney may be unwilling to pursue the case on contin- gency alone and the client may not be

abuse occurred, continue to be the most difficult cases to prove either in a criminal court or civil lawsuit. Even if no statute of limitations issue exists, the same type of investigation should be done no matter how recent the abuse occurred or how distant. The most common defense in these cases is one of motive. Arguments are made that the child was angry at the perpetrator, or the child’s family was angry at the perpetrator and this was a way to get even. Arguments are made that the family or child is after money. It is important to look for all evidence that can dispel the motive argument. Most of the time corroboration is not physical evidence, but can start with whom, if anyone, the child told about the abuse, even another childhood friend. Even if a child didn’t tell anyone, there may have been behavioral signs that often family, friends, teachers, and coun- selors have noticed—for example, a change in grades, reverting back to bedwetting or other “potty” accidents in young children who were toilet trained. There may have been other signs such as anger and not wanting to be social, or not wanting to spend time anymore for no apparent reason at the time, with the person who was the per- petrator. Just as important, trying to establish lack of motive to make a false accusation is critical. When jurors are asked to try to imagine why a person

See Litigation Strategies on page 28