P&P February 2016

The Magazine of the American Public Human Services Association February 2016

How to identify it, harness it, and use it for positive outcomes Effective Leadership

TODAY’S EXPERTISE FORTOMORROW’S SOLUTIONS

contents www.aphsa.org

Vol. 74, No. 1 February 2016

features

departments

6

3 Director’s Memo

At a Human Services Tipping Point How leaders move from ideas to outcomes

Boldly leading through an ever-changing human service landscape

5 From the Field

Leading change in workforce engagement: the Seattle Jobs Initiative

20 Legal Notes

Mission: Improbable—Getting exonerated from a child sexual abuse conviction

21 Legal Notes

The role of claims adjuster and defense counsel in human service litigation

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Reframing Public Support for Human Services How a new initiative is reengaging the public and building understanding for human service programs

22 Technology Speaks

One and Done: The strategy and measures you need to make your call center work

24 Association News Updates from NDSTA and award presentations

25 Staff Spotlight

Emily Campbell, director of organizational effectiveness

32 Our Do’ers Profile

14

Dan Makelky, director of the Douglas County (Colorado) Department of Human Services

Racing to Achieve Pathways ’ Vision

18

The Key to Unlocking a Stronger Workforce How the National Staff Development and Training Association is providing a resource for the human service field

Cover illustration via Veer

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February 2016   Policy&Practice

INDUSTRY PARTNERS Platinum Level INDUSTRY PARTNERS Platinum Level

APHSA Board of Directors Officers President Raquel Hatter , Commissioner, Tennessee Department of Human Services, David Stillman, Assistant Secretary, Economic Services Administration, Washington Department of Social and Health Services, Olympia, Wash. Treasurer, Local Council Representative Kelly Harder, Director, Dakota County Community Services, West Saint Paul, Minn. Secretary Tracy Wareing Evans, Executive Director, APHSA, Washington, D.C. Past President Reggie Bicha, Executive Director, Colorado Department of Human Services, Denver, Colo. Director Anne Mosle , Vice President, The Aspen Institute and Executive Director, Ascend at the Aspen Institute, Washington, D.C. Director Mimi Corcoran, Vice President, Talent Development, New Visions for Public Schools, Harrison, N.Y. Director Susan Dreyfus, President and Chief Executive Officer, Alliance for Strong Families and Communities, Milwaukee, Wis. Director Reiko Osaki, President and Founder, Ikaso Consulting, Burlingame, Calif. Leadership Council Representative Roderick Bremby, Commissioner, Connecticut Department of Social Services, Hartford, Conn. Affiliate Representative, American Association of Health and Human Services Attorneys Ed Watkins, Assistant Deputy Counsel, Bureau of Child Care Law, New York State Office of Children and Family Services, Rensselaer, N.Y. Nashville, Tenn. Vice President

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Policy&Practice   February 2016

director‘s memo By Tracy Wareing Evans

Boldly Leading Through an Ever-Changing Human Service Landscape

T he theme of this issue is one of my personal favorites because it shines a spotlight on what it takes to lead our field in transformation, and illustrates the complex context within which health and human service leaders operate daily. The issues we face are not linear, simple, or predictable. They do not fit neatly into electoral cycles or grant timelines. They involve many fluc- tuating actors, conditions, and norms. Despite these complexities, health and human service leaders across the nation are boldly leading their agencies through transformative changes. Leaders within our field are asking themselves: „ „ How do we move from managing people to managing networks?

the insights of these leaders at the forefront of our thinking. Below, I’ve highlighted just a few ways in which the talented leaders within this field are steering our collective work: Framing Matters. Framing is critical. As APHSA Board President and Commissioner of the Tennessee Department of Human Services, Dr. Raquel Hatter, has noted: “How we speak about our work matters. We have to speak strategically and artfully, creating a degree of cognitive dissonance that gets people to think differently about something that they have believed in for a long time.”

„ „ How do we move from managing programs to managing resources and systems? „ „ How do we shift focus from program delivery focused on a single pre- senting issue to a prevention and population-based health lens that addresses risks before they lead to problems? At APHSA, I have the honor of working with these transformative leaders every day. I am humbled by the stamina, spirit, and smarts that our members and partners bring to the table. As we enter a pivotal year marked by a presidential election and national debate around the growing income divide, we do well to keep

See Director’s Memo on page 30

Illustration via Shutterstock

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February 2016   Policy&Practice

Vol. 74, No. 1

www.aphsa.org

Policy & Practice™ (ISSN 1942-6828) is published six times a year by the American Public Human Services Association, 1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036. For subscription information, contact APHSA at (202) 682-0100 or visit the web site at www.aphsa.org. Copyright © 2016. All rights reserved.This magazine may not be reproduced in whole or in part without written permission from the publisher.The viewpoints expressed in contributors’ materials are the authors’ own and do not necessarily reflect the policies or views of APHSA. Postmaster: Send address changes to Policy & Practice 1133 Nineteenth Street, NW, Suite 400, Washington, DC 20036

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Policy&Practice   February 2016

from the field

By Mary Brogdon

Leading Change in Workforce Engagement The Seattle Jobs Initiative

I n the December 2015 issue of Policy & Practice , we introduced readers to APHSA’s new initiative, the Center for Workforce Engagement (CWE). The center’s purpose is to advance a system of human services, workforce devel- opment, economic development, and education and training that effectively supports greater capacity and indepen- dence, employment, self-sufficiency, and well-being for low-income indi- viduals and families. In consideration of this purpose, one of the goals of the CWE is to share existing innovations and highlight leaders in the field of workforce engagement. The Seattle Jobs Initiative (SJI) is one such leader driving innovation and transformation. Seattle Jobs Initiative The Seattle Jobs Initiative began in 1997 through a partnership between the city’s Office of Economic Development and the Annie E. Casey Foundation to combine job-skills training, wrap-around services, and local employer involvement to connect low-income and low-skilled adults with employers offering good paying jobs. By 2003, SJI had established itself as an independent 501(c)(3) nonprofit organization. Today, SJI acts as a workforce development intermediary dedicated to improving local workforce systems to benefit low-income people. The Seattle Jobs Initiative is cur- rently focused on increasing the number of low-income adults who obtain one- and two-year college cre- dentials. Through its Career Pathways program, SJI works with community colleges and community-based orga- nizations to increase access to and perseverance in community college

Thomas Turner, left, and Ellen Martinez, above, are among the many success stories coming out of the Seattle Jobs Inititative. Thomas works as a welder while Ellen participated in the office occupations program.

In addition to its direct services program, SJI also conducts innovation, research, and policy work. This work is aimed at identifying and sharing solutions to address the barriers that low-income individuals face in building their education and skills and accessing employment opportunities that lead to upward mobility. To meet this objec- tive, SJI conducts focused labor market research to help ensure that education and training programs are connected to middle-wage employment opportu- nities and meet the workforce needs of local employers. SJI also develops and shares tools, research, and best

among low-income adults. Career Pathways is centered on providing innovative “career navigation” services to the hundreds of individuals they serve each year. Career navigators work with SJI participants to help them negotiate the often complex commu- nity college system, into careers in key sectors of the local labor market, while also connecting themwith needed sup- portive services (e.g., transportation, child care, housing, the Supplemental Nutrition Assistance Program [SNAP], counseling). SJI has also developed and integrates into Career Pathways unique training in “soft”—or “performance”— skills that employers find critical for successful employees.

See Jobs on page 31

Photographs courtesy of Seattle Jobs Initiative

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February 2016   Policy&Practice

At a Human Services Tipping Point How Leaders Move from Ideas to Outcomes

By Debora Morris

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Policy&Practice   February 2016

The 2015 Human Services Summit: Emergent Leadership—Turning Ideas into Outcomes— brought together leaders whose experiences reveal that human service agencies are at a tipping point. 1 To make progress, they must abandon the status quo. This can be ener- gizing, but overwhelming.

This is where adaptive leadership comes in.

Illustration by Chris Campbell/Shuttersotck

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February 2016   Policy&Practice

The Human Services Value Curve

Efficiency in Achieving Outcomes

Regulative Business Model: The focus is on serving constituents who are eligible for particular services while complying with categorical policy and program regulations. Collaborative Business Model: The focus is on supporting constituents in receiving all services for which they’re eligible by working across agency and programmatic borders. Integrative Business Model: The focus is on addressing the root causes of client needs and problems by coordinating and integrating services at an optimum level. Generative Business Model: The focus is on generating healthy communities by co-creating solutions for multi-dimensional family and socioeconomic challenges and opportunities.

Generative Business Model

Integrative Business Model

Collaborative Business Model

Outcome Frontiers

Regulative Business Model

Effectiveness in Achieving Outcomes

© The Human Services Value Curve by Antonio M. Oftelie & Leadership for a Networked World is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Based on a work at lnwprogram.org/hsvc. Permissions beyond the scope of this license may be available at lnwprogram.org.

A DIFFERENT KIND OF LEADERSHIP

processes—building one type of strength from another. She is exploring how regulative indicators can have a generative effect. Take the example of the Supplemental Nutrition Assistance Program (SNAP). “If we’re not timely, how many kids and families are waiting? It’s not the time that is measured, it’s a hungry measure.”

These challenges require adaptive leadership. It is leadership at all levels that fosters learning and experimentation over time, even amid organizational and cultural resistance. ADAPTIVE LEADERSHIP IN ACTION Consider these five fundamentals of adaptive leadership in human services: Honor the positive and build from strength Adaptive leaders acknowledge what works in their organiza- tion, and move forward from there. For Raquel Hatter, commissioner of the Tennessee Department of Human Services, this principle applies to moving up the Human Services Value Curve. 2 With the generative model as the ultimate goal, it is easy for leaders to lose sight of the innate value of the other models. Hatter views the regula- tive state as a necessary foundation, not a lesser pass-through. If organiza- tions get it wrong, they jeopardize everything else. She is thinking about generative capacity while refining regulative 1

Ronald Heifetz, founding director of the Center for Public Leadership at the Harvard Kennedy School, developed the theory and framework of adaptive leadership. As Heifetz explains, human service leaders—all leaders—face technical and adaptive challenges. Technical challenges can be solved in short order with technology, policy, or process changes. Adaptive challenges are more deeply rooted. They require organiza- tions to venture into the unknown. The journey can cut into long-held values.

2

Harness staff power for leadership from within Adaptive leaders excel at the art of bringing differences

together within and outside of their organizations. In Michigan, where Timothy Becker, chief deputy director of the Michigan Department of Health and Human Services, is spearheading the integration of two departments overseeing 140 health and human service programs, staff is involved in planning. Leadership is acting with intention to create a culture where staff members are encouraged to take chances in the service of better ways of working and serving. At the Georgia Division of Family and Children Services, workforce development is a significant part of

Debora Morris is the managing director, Integrated Social Services, State, Provincial and Local Government at Accenture.

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Policy&Practice   February 2016

“The only way to change the lives of families and systems is to be inside them. You have to be in there day in and day out, have to be up to the challenge to do it.”

ongoing transformation. This involves mentoring for supervisors, improved compensation, career path develop- ment, and other initiatives. The agency is conducting staff surveys and road shows for leadership to connect with front-line staff.

3

—VIRGINIA PRYOR, DEPUTY DIRECTOR OF CHILD WELFARE AT THE GEORGIA DIVISION OF FAMILY AND CHILDREN SERVICES

See the silver lining in unexpected places Adaptive leaders need to be optimists to seize on the poten-

4

Developing this model required sig- nificant structural changes—recreating relationships among multiple agencies, vendors, legislators, and the private sector. As Parks explains, a shared, data-backed view helped to build rela- tionships around facts, not assumptions. Experiment, experiment, experiment Leaders in situations without a roadmap must be bolder, embracing experimentation. This is 5

Strengthen partnerships with data The human service commu- nity has long recognized the need to support cross-agency

tial of a good idea. Maria Cancian, deputy assistant secretary for Policy at the Administration for Children and Families (ACF), encourages leaders to find ways through barriers. She works with program directors to integrate across programs, and has faced some resistance. Her initial reaction was to be frustrated by territo- rialism. However, once she considered the intention behind such “tribal” mindsets, everything changed. This shift from pushing back to working through barriers helps adaptive leaders move past pitfalls to progress.

and cross-sector partnerships to improve service delivery. Joseph Parks, director of Missouri HealthNet, offers a fresh perspective. This insight reflects Parks’ experience helping to create the groundbreaking Missouri Health Homes initiative, a unique service delivery program designed to improve care for a targeted population with mental illness or substance abuse and at least one chronic condition.

See Outcomes on page 25

NATIONAL HEALTH & HUMAN SERVICES 2016 SUMMIT

INSPIRE.

MAY 22-25 KEY BRIDGE MARRIOTT ARLINGTON, VA

IMPACT.

www.APHSA.org @APHSA1

INNOVATE.

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February 2016   Policy&Practice

s leaders in the field, you understand the vitally important role that human services plays in How a new initiative is reengaging the public and building understanding for human service programs by ilsa flanagan A

step back and consider a critical question: How can we communi- cate the value and rich potential of human services in a way that reso- nates with the public? With generous support from the Kresge Foundation and the Annie E. Casey Foundation, the Assembly launched the National Reframing Human Services Initiative to help answer that question. The initiative seeks to build public understanding of human services to encourage more vibrant civic participation and deepen support for effec- tive programs. We engaged the FrameWorks Institute (FrameWorks), renowned for their rigorous, evidence-based approach to communications, to take our field through their Strategic Frame Analysis® process. In doing so, FrameWorks uncov- ered the deeply held assumptions that people rely on to think about human services, and identified an effective narrative that the sector can use to elicit deeper engage- ment from the public.

creating a thriving society. You have first-hand knowledge of the prevention programs that build a foundation for long-term success. You understand the breadth and variety of services that people need throughout their lives. You identify and address systemic challenges that contribute to ineq- uities in well-being. And yet, despite all that we know about the value of human services and our best attempts to articulate that value, over the last decade the sector has experienced deep cuts in public and private funding. What we’re seeing is a disconnect between what we as a sector know to be true about human services, and what the public understands. The challenge of engaging the public as allies and supporters of human services prompted the National Human Services Assembly (the Assembly) to

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February 2016   Policy&Practice

Figure 1: What will it take to reframe human services? A FrameWorks Institute analysis of public vs. expert thinking revealed key goals for redefining public perceptions of the sector.

“As a field, we must immerse our- selves in the Frameworks research and begin to apply it if we are to have a more effective narrative for the human service sector. We have a compelling story to tell of how human services supports the building of the well-being of all children and families, and leads to stronger communities. As we get better at sharing why our work matters, our ability to present solutions and impact policy will improve.” —Tracy Wareing Evans, Executive Director, APHSA Understanding the Current Human Service Story As a first step in our reframing initiative, FrameWorks undertook a series of studies to gain a comprehen- sive understanding of how the public currently views human services. Through interviews with leaders in human services and members of the public, researchers identified and dis- tilled key differences between how the field and how the public understand human services. Leaders in the field understand the term “human services” as encom- passing a complex and vibrant set of approaches that ultimately benefit every member of society. We include in our definition services and policies that are designed to promote well- being at every stage of life. We define “well-being” holistically, including physical, emotional, spiritual, social, and financial factors. The general public, on the other hand, has a much more narrow view of the work of the field. To the public, “well-being” is limited to physical

ADVANCE Broader, fuller picture of the sector: research, advocacy, direct services

AVOID

Leaving “human services” for the public to define

Charity work

Skilled, essential profession

Safety net for the vulnerable

Varying supports for all kinds of people

PROBLEM, PROBLEM, PROBLEM solution?

problem SOLUTIONS, SOLUTIONS, SOLUTIONS

Figure 2: Outline of the Building Well-Being Narrative A FrameWorks Institute analysis of public vs. expert thinking revealed key goals for redefining public perceptions of the sector.

I. WHAT IS AT STAKE?

Human Potential Lead with the Human Potential Value to help people recognize that everyone needs support and that human services benefit us all

VALUE

I I. WHAT KIND OF SUPPORT DO PEOPLE NEED? Construction

Use the Construction Explanatory Metaphor to explain what well-being is and how it is shaped

METAPHOR

II I. WHAT THREATENS WELL-BEING? Construction

Use extensions and implications of the metaphor–like spotty construction and unpredictable weather–to explain how context affects outcomes

METAPHOR

IV . HOW DO WE ENSURE WELL-BEING FOR ALL? Construction

Use the Construction Explanatory Metaphor to help people reason about the different ways that human services support well-being Life Cycle Use Life Cycle examples to give people a concrete understanding of the full scope of human services

METAPHOR

EXPLANATORY EXAMPLES

health or financial security and understood to be something that

Source: FrameWorks Institute

adequate substitutes for a robust public human service sector. FrameWorks’ findings, released in July 2013, 1 confirmed what many of us in the field suspected. If we want the public to appreciate the value of human services, our field needs a bold new communications strategy that offers a better definition of our work. Figure 1 summarizes some of the key tasks that any redefinition must accomplish.

individuals are responsible for crafting themselves, through good choices and willpower. Working from these two mental models, people come to a limited range of conclusions. Human services are only “for” a limited set of people who are failing to meet their own needs. Any support should be temporary, lest individual willpower be weakened further through depen- dency. Individual acts of charity are

Ilsa Flanagan is the director of the National Reframing Human Services Initiative, at the National Human Services Assembly.

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Policy&Practice   February 2016

Building Well-Being: A New Narrative for Human Services Armed with the knowledge of the public’s view of human services, the Assembly again partnered with FrameWorks, this time to identify a new narrative for human services that captured and conveyed the rich and complex work of the sector. Between February and July 2015, FrameWorks developed a set of potential reframing strategies and systematically tested them. Researchers conducted qualita- tive and quantitative experiments with close to 5,000 Americans across the country to validate a new frame for human services. Through this rigorous process, FrameWorks identified an overarching story that significantly improved the public’s understanding of what human services are and why they are impor- tant. We call it the Building Well-Being Narrative. According to Strategic Frame Analysis, an effective story on a social problem “widens the lens” beyond indi- viduals. Instead of seeking to merely “put a face on the issue,” a reframing narrative “puts a frame on an issue.” It establishes why an issue matters to society by invoking a widely held value that connects people to the issue in a productive way. It uses explanatory techniques such as metaphors and examples to fill in public thinking on an issue, making expert assumptions accessible to the ordinary person. FrameWorks research has shown definitively that when deciding which value, metaphor, or example to use, the question should not be left to guess- work. Instead, the framing studies sponsored by the Assembly lead us to these strategies and themes: Open with an appeal to the Value of Human Potential , which taps into the belief that communities thrive when all people can realize their full potential. Expand the frame for human services beyond “bare basics for the deserving poor” by using the Explanatory Metaphor of Constructing Well-Being , which identifies well-being as something that is built, drawing on a common understanding of the range of mate- rials, resources, and expertise required

Figure 3: Reframing is Most Effective with a Complete Narrative

Prevention

Remediation

Planning & Research

Importance & Ef cacy

12

Statistical Signi cance p ≤ .05 = *

10.9

10.4

10

8.8

8.2

8

7.6

6.7

6.2

6

5.3

4.7

4.4

4

2.2

2

*

*

* *

*

* * * *

0

Percentage Point Increase in Policy Support vs. Control -0.7

-2

VALUE: Human Potential

EXPLANATORY METAPHOR: Construction

NARRATIVE: Building Well-Being

MESSAGES

Source: FrameWorks Institute

to plan, construct, and maintain a building, dwelling, or community. Reframe the assumption that human services should be temporary by drawing on Explanatory Examples that come from across the Life Cycle. Communicators should use examples life—childhood, adulthood, and older age—to advance the understanding that human services is about fostering healthy human development. Activating the New Frame for Human Services Now that we have a research-based approach to reframing human services, here are some guidelines to help you implement the Building Well-Being Narrative. First, FrameWorks’ research shows that the frame elements should be used together as a complete Narrative in order to see the full benefits of the reframing. “When we keep in mind that we are testing very brief frames in these experi- ments—sometimes the frame that we are testing consists of only 10–15 words— it’s amazing that we see measurable of how human services support people in at least three stages of

differences in how these messages move public opinion. The results from the Building Well-Being Narrative are among the most robust frame effects we’ve seen in our research across social issues over the past 15 years.” —Dr. Nat Kendall-Taylor, CEO of the FrameWorks Institute Second, the order in which we intro- duce various points matters almost as much as the messages we use. In our field, we have been conditioned to state the problem upfront, define the magnitude of the problem, and then shift toward solutions. The framing research tells us that it is more effec- tive to establish two preconditions before introducing the problem at all. First, people must understand why the problem should be understood as a public issue that concerns us all. This is the work that the frame element of Values can do. Second, people must have a productive way to conceptualize an issue that lets them think systemi- cally. This is the work that Explanatory Metaphors and Examples can do. If we do not actively promote a productive

See Reframing on page 31

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February 2016   Policy&Practice

By Megan Lape

O

ver the past five years, the American Public Human Services Association (APHSA) has worked

These included developing a horizontal integration maturity model for health and human service (H/HS) agencies, technical guidance documents on financing and technology, two documents on the use of Big Data—an Analytic Capability Road Map and the Roadmap for Analytic Capacity Building —as well as state and local workforce devel- opment and analytics committees, all of which can be found on APHSA’s National Collaborative web page. In addition, the National Collaborative broadened its strategic partnerships to include all of APHSA’s affiliates, other nonprofit member- ship organizations, university faculty members, and private foundations. Federal involvement with our long-time federal partners— the U.S. Department of Agriculture’s Food and Nutrition Service (FNS), the Administration for Children and Families (ACF), and the Centers for Medicare and Medicaid Services (CMS)—was recently expanded to include the Social Security Administration (SSA) and the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE). to translate its Pathways vision of a proac- tive, client-centric, 21st century health and human service business model into reality by undertaking a number of activi- ties under the banner of the National Collaborative for Integration of Health and Human Services (National Collaborative), previously known as the National Workgroup on Integration (NWI).

Illustration via Shutterstok

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February 2016   Policy&Practice

2015 HHS Integration Self-Assessment During the summer of 2013, and again in 2015, the National Collaborative provided APHSA state and local members with an elec- tronic self-assessment instrument to understand where they were on the road to human service integration and data interoperability, important benchmarks relative to achieving the Pathways vision. Based on earlier discussions with state and local CEOs, we framed our survey questions around the dozen parameters shown in the accompa- nying chart. A brief description of these parameters (aka Key Features) was developed by the advisory group for each of the four levels of integration maturity— Regulative, Collaborative, Integrative, and Generative. The result was a 4 x 12 matrix we have described as our H/HS Horizontal Integration Maturity Model. 1 In developing the self-assessment, we provided four possible responses to each question based on the characteristics in the Maturity Model. A respondent’s answers could then be easily cross- walked to one of the four previously mentioned maturity levels. Over the course of the two surveys in 2013 and 2015, APHSA was provided with a snapshot of its members’ current status and progress toward systems integration. While this was by no means a scientifically based analysis of the highly complex mix of current activities in every state and county, the full report, “On the Road to Horizontal Integration: Results from APHSA’s 2015 National Survey of Health & Human Service Agencies” can be found

12 KEY FEATURES REVIEWED BY APHSA’S SELF-ASSESSMENT IN 2013 AND 2015 • Organization’s Vision/Strategic Focus • Defining Success • Governance/Decision-Making • Adaptive Leadership/Organizational Change • Access to Services by Consumers • Eligibility and Enrollment: Common Processes/Shared Services • Role of Front-Line Worker Relative to Coordinated Service Delivery • Measures • Integrated Infrastructure/Cross-Boundary Communications • Workflows • Use of Data and Front-Line Workers’ Access • Use of Technology

on our web site. 2 Although the report focuses on the results from the 2015 survey, a comparative analysis of the results from both the 2013 and 2015 surveys is also included. 2015 Top Five Key Features Farthest Along the Integration Pathway 1. Adaptive Leadership/ Responsiveness to Change Sixty-three percent (63%) of all responses to our questions on this topic were either Integrative or Generative. Respondents saw the leadership of their organizations as being highly mindful of changing circumstances and prepared to move quickly when necessary. 2. Governance/Decision-Making While some respondents tended to say their key decision-makers were exclusively internal to their organiza- tion, nearly half (46%) indicated they include people from other parts of the enterprise, or even external to it. 3. Vision/Strategic Focus Four out of 10 respondents (42%) believed that their organizations were focused on addressing the root causes of their program participants’ needs, with many of them working with partners outside the H/HS enterprise.

4. Outcomes/Defining Success More than a third (37%) of the responses on these topics was either Integrative or Generative. 5. Consumer Access One out of three respondents, (33%) overall, thought their organization’s infrastructure for enabling program participants to access the services provided was either Integrative or Generative. 2015 Five Key Features Least Far Along on the Road to Integration 1. Use of Technology 3 Of all 12 Key Features, the Use of Technology was viewed by the respon- dents to be the least far along in terms of being fully integrated. Nearly 9 out of 10 respondents provided responses that were either Regulative or Collaborative. We asked such questions as: (a) “How is technology used in your orga- nization?”; (b) “Which technology features most closely characterize your eligibility and enrollment system today?”; (c) “What would you say is the primary purpose for which your systems were designed?”; and (d) “Is data shared with others, and for what purpose?” In response, the answers that came back included: “Technology is

Megan Lape is the director of the National Collaborative for

Integration of Health and Human Services at APHSA.

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Policy&Practice   February 2016

Thosewho responded strongly believe theirH/HS leaders are

across organizational boundaries with data owners’ and program participants’ consent.” (72%—Collaborative) 3. Workflows With both the use of technology and the use of data not well inte- grated, perhaps it is not surprising that respondents felt that their orga- nization’s workflows were not either. Three out of four responses (77%) on this topic were either Regulative or Collaborative. 4. Eligibility and Enrollment (E&E) Common Processes/Shared Services Three out of four respondents (76%) believed their E&E systems were not highly integrated as reflected by the preponderance of Regulative or Collaborative answers we received on this topic. For example, 24 percent of respondents said that “program- specific applications/intake processes are used to determine eligibility and enroll program participants in a given program” (69%—Regulative) as compared to the 7 percent of respon- dents who said, “through the use of a universal client registry and decision- support tools, the staff’s ability to make enrollment decisions is greatly enhanced— enrollment is centralized, based on eligibility determinations established through a common system.” 5. Coordinated Service Delivery/ Role of Front-Line Worker Seven out of 10 responses (73%) reflected a less than well-integrated range of activities. While there appears to be some training about partner organizations, achieving a holistic approach at the level of the front- line worker still currently appears to be a steep hill to climb for nearly all organizations that responded to self- assessment. For example, none of the respondents selected two responses we viewed as Generative; i.e., “Workers ensure that solutions are customized to meet program participants’ needs and that supplementary services are part of the participants’ service plan that also addresses the social determinants of health where appropriate,” or “Workers utilize universal knowledge within and external to the enterprise, including the program participants and community

focused on processing transactions and reducing administrative costs” (41%— Regulative); “Our E&E systems are old and difficult to change without a lot of work” (25%—Regulative); “Some limited communication is possible with our partner organizations due to work- arounds and add-ons but the current system is not integrated with other parts of our organization and partners” (68%—Collaborative), and; “Systems are designed to be transaction driven and focused on the individual division or line of business meeting its goals.” (62%—regulative) higher ranked in terms of integration maturity than the use of technology. Eight out of 10 responses (82%) were either Regulative or Collaborative. When asked about where consumer history currently resides and who has access to it, the responses we received were: “Consumer history resides exclu- sively within individual programs; it is not shared with others except where specifically required to do so by regula- tion or statute” (Regulative—10%), and; “Consumer history resides within individual programs but can be shared 2. Use of Data The Use of Data was only slightly FOUR LEVELS OF H/HS SERVICES INTEGRATION Level 1: Regulative Serve constituents who are eligible for particular services while complying with categorical policy and program regulations. Level 2: Collaborative Support constituents in receiving all the services for which they’re eligible by working across agency and program- matic boundaries. Level 3: Integrative Address the root causes of client needs and problems by coordinating and inte- grating services at an optimum level. Level 4: Generative Generate healthy communities by co-creating solutions for multi- dimensional family and socioeconomic challenges and opportunities.

partners, to anticipate and proactively address participants’ needs.” Conclusion There is much to celebrate in the responses we received this year. Those who responded strongly believe their H/HS leaders are visionary and respon- sive to change, that their organizations are inclusive and governed by people with a broader, more-encompassing view of their mission, and nearly one out of every three respondents thought achieving meaningful outcomes, rather than measuring outputs (such as the numbers of people enrolled) was the true value of their enterprise’s work. At the same time, opportunities still abound in the use of technology, analytics (data), improving workflows, and empowering front-line workers through multiple ways. This includes making improvements to E&E systems, continuing to move up the systems integration continuum and, in so doing, providing even greater value to taxpayers and service to program par- ticipants across the country. We refer you to APHSA’s National Collaborative web site 4 for more details on this study as well as a wide range of additional materials we hope you will find useful in your transfor- mational journey. Reference Notes 1. http://www.aphsa.org/content/APHSA/ en/pathways/NWI/BUSINESS_MODELS/ h-hs-integration-maturity-model.html 2. http://aphsa.org/content/APHSA/en/ pathways/NWI.html 3. Note: The questions focused on the use of technology and the types of technology currently in place in the respondents’ organizations, not on whether technology in general was sufficiently sophisticated enough to handle today’s H/HS environment. 4. http://aphsa.org/content/APHSA/en/ pathways/NWI.html visionaryand responsive to change, that their organizations are inclusive andgovernedbypeoplewitha broader,more-encompassingviewof theirmission.

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Policy&Practice   February 2016

How the National Staff Development and Training Association is providing a resource for the human service field unlocking a STRONGER WORKFORCE I By Freda Bernotavicz Key The to

human service workforce. As a result, human service training and development professionals need expertise in several fields: human service program knowledge, a broad range of skills related to human performance and organizational improvement, and the ability to use a variety of delivery modalities. An increasing body of research is clarifying the relationships among training, organizational develop- ment, workforce issues, and client outcomes suggesting the need for an ecological perspective on workforce development. We need to pay attention to organizational development that goes outside the scope of traditional classroom training to focus on orga- nizational performance improvement and to adopt comprehensive evaluation strategies to increase accountability and provide evidence of the effective- ness of specific approaches. Like the human service field as a whole, the training and develop- ment system is experiencing constant change and is nested in a broader contextual context. Effective programs use a variety of modalities, including e-learning, to overcome time, distance,

n human services our workforce is our greatest asset and also our largest organizational expense. The costs are not just in payroll, but also in recruiting, training, and retaining staff. Within one program in Texas (Family and Protective Services), where turnover is high, the cost to the agency for each staff person that left was $54,000 for a total cost to the program of $72.7 million in 2013 (Sunset Staff Report, June 2014). Creating a competent, stable, well- trained workforce to provide quality services is a priority for all agencies. An effective and efficient training and development program is critical to that endeavor. In turn, these programs need to be staffed by competent indi- viduals with state of the art knowledge and skills. For more than 30 years, the National Staff Development and Training Association (NSDTA), an affiliate of the American Public Human Services Association (APHSA), has filled that role as the primary profes- sional association for human service training and development. Complex social problems, with changing mandates and priorities, require a timely and appropriate response to ensure a well-trained,

Freda Bernotavicz is a senior research associate at the University of Southern Maine’s Muskie School of Public Services.

See NSDTA on page 28

Illustration via Veer

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February 2016   Policy&Practice

legal notes

By Daniel Pollack and Layah Shagalow

Mission: Improbable Getting Exonerated From a Child Sexual Abuse Conviction

E xtensive citation of social science research is unnecessary for us to know that child sexual abuse is one of the most underreported crimes. Likewise, most people would be hard pressed to think of a crime as despi- cable as child sexual abuse, and we have few qualms about strict sentences for such offenders. So when an Orange County, California, Superior Court judge recently sentenced a child rapist to 10 years instead of the manda- tory minimum sentence of 25 years, the community was outraged. Tens of thousands of people called for the judge to resign. 1 It happens—albeit rarely—that people are wrongfully convicted of child sexual abuse and are later exonerated. The National Registry of Exonerations (NRE), 2 a project of the University of Michigan Law School “provides detailed information about every known exoneration in the United States since 1989—cases in which a person was wrongly convicted of a crime and later cleared of all the charges based on new evidence of innocence.” 3 Definition of Exoneration The word “exonerate” comes from the Latin exoneratus, and means to remove a burden, discharge, or unload. The NRE uses the following definition: “In general, an exoneration occurs when a person who has been convicted of a crime is officially cleared based on new evidence of innocence. Exoneration—A person has been exonerated if he or she was convicted of a crime and later was either: (1) declared to be factually innocent by a government official or agency with the

Mapping the Exonerated The National Registry of Exonerations has tracked 1,700 exonerations nationwide since 1989.*

<8 8-16 17-27 28-42 >42

*As of Novermber 2015 Source: National Registry of Exonerations

authority to make that declaration; or (2) relieved of all the consequences of the criminal conviction by a govern- ment official or body with the authority to take that action. The official action may be: (i) a complete pardon by a governor or other competent authority, whether or not the pardon is des- ignated as based on innocence; (ii) an acquittal of all charges factually related to the crime for which the person was originally convicted; or (iii) a dismissal of all charges related to the crime for which the person was originally convicted, by a court or by a

prosecutor with the authority to enter that dismissal. The pardon, acquittal, or dismissal must have been the result, at least in part, of evidence of inno- cence that either (i) was not presented at the trial at which the person was convicted; or (ii) if the person pled guilty, was not known to the defen- dant, the defense attorney and the court at the time the plea was entered. The evidence of innocence need not be an explicit basis for the official action that exonerated the person.

See Exoneration on page 26

Policy&Practice   February 2016 20

legal notes

By Daniel Pollack and Cameron R. Getto

The Role of Claims Adjuster and Defense Counsel in Human Service Litigation

W hen a human service agency is sued, litigation is usually resolved through settlement. Who pays the bill? Very often, it’s an insur- ance company. Claims that involve human service agencies vary widely. Whether dealing with a simple work- place accident, serious injuries and fatalities, or allegations of negligence or professional malpractice, an insur- ance company’s priority is to provide swift, effective resolution of every claim. The company evaluates which claims should be legally defended and which warrant early settlement. The person making these decisions will be an insurance company claims adjuster. Seemingly anonymous, claims adjusters are ultimately responsible for deciding how much money, if any, will be paid out in settlement. The Claims Adjuster The insurance claim process is com- plicated and involves different areas of expertise. Generally, an adjuster must develop a clear understanding of the policyholder’s enterprise. In the event of a claim, the adjuster promptly inves- tigates and forms an assessment of potential liability, damage, and finan- cial exposure. To be an effective adjuster requires a detailed knowledge of the insur- ance industry and an ability to view complex issues in terms of their dollar value. Simultaneously, adjusters appreciate that their company wants to maintain a positive, ongoing long- term interaction with their insured agencies, reinsurers, attorneys, accountants, risk managers, and a number of other professionals, both inside and outside of government.

organizations or individuals. Because these organizations tend to have unique and diverse coverage needs, insurance for human service corpora- tions is considered a specialty area. Only select insurance companies offer products and services designed to meet the specific needs of agencies dealing with child abuse, adult and child day care, residential treatment, housing and shelter, foster care, and so on. Of course, every risk and exposure cannot be underwritten. To maintain profit- ability, insurance companies select only certain risks. This allows the company to offer price stability while remaining competitive.

Far from dry, being an insurance adjuster in the human service area can be intriguing. Successful claims adjusters are quick learners, adapt- able, collaborative, and have a knack for blending good listening skills with the ability to make tough, informed, analytical decisions. They understand that the need for exceptional customer service has never been greater—but remember—the adjuster works for the insurance company, not the policyholder. Human service agencies are often required to carry certain levels and kinds of insurance. These require- ments can arise out of state law, contractual obligations with funding sources, or responsibilities to partner

See Litigation on page 29

Photograph via Shuttersotck

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