e' e' ‘American Public Human Servis Association Council of the District of Columbia Joint Public Hearing on Bill 18-356 Jacks-Fogle Family Preservation Case Coordination Authot Thursday, Oct. 8, 2009 Committee on Health Committee on Human Services SUMMARY OF FINDINGS Presented by Robin O'Brien ‘To support the work of the DHS Sponsor Group and Core Continuous Improvement ‘Team for this initiative, APHSA conducted a survey of effective practices in transforming human service systems from program-centric to person-centric. After extensive interviews with states and localities and a survey concerning person-centric practices, APHSA conducted five case studies. The case studies focused on locales and practices that are most likely demonstrate promising practices and lessons learned. A more detailed description of APHSA's work to prepare this report is included in Appendix A. To gather case study data, APHSA staff interviewed agency leaders who spearheaded and implemented major human service system overhauls. The following locales and practices were selected for in-depth interviews: El Paso County (Colo.) Department of Human Services; Miami-Dade County (Fla.) Department of Children and Families; Louisville (Ky.) “Neighborhood Place”; Texas Health and Human Services Commission; and Kenosha County (Wis.) Job Center. The following characteristics of effective system transformation emerged from the case studies: Maintained a client focus with other agencies, community partners and staff Implemented system transformation incrementally Developed and maintained continuous dialogue with partners, staff and clients Actively and sustainably (by senior leaders) monitored plan progress and impact Established relationships of trust and collaboration with community partners. Used technology to work toward agency goals and strengthen communication, including building in data assessment from the beginning of the overhaul * Reallocated financial and staff resources over time to improve customer service while k« overall costs from rising Maintained a client focus with other agencies, community partners and staff ‘The case studies show that maintaining a focus on the client—the individual or family receiving services from the system to help them move out of poverty to self-sufficiency—keeps all partners and agency staff connected to the overarching purpose of system transformation. It reminds them how vital their open and honest participation is to the success of the effort. In several cases, keeping the client as the focus helped bring about breakthroughs in conversations, negotiations and relationshipsthat got bogged down in details. It also helped build relationships with key agency and community partners early in the process, providing a common vision to serve as a foundation, Maintaining a client focus also prevented the systems from becoming static and stale; it injected vitality, flexibility and innovation throughout the organizations and partnerships. Examples of ways that client focus comes through in the case studies are as follows: + Neighborhood Place, Kenosha County, and El Paso County maintain their client focus through team case management and utilizing collocation to coordinate services. + ETPaso County used the client experience as a training tool—the county had staff go through what would happen to clients had they not worked together to provide services. + Miami-Dade maintained the client focus when building relationships and trust with community partners. ‘+ Miami-Dade noted keeping the client at the center wa more community partners on board. a powerful negotiating tool to bring Implemented system transformation incrementally ‘A phased, strategic implementation is a common theme throughout the case studies. Laying a solid foundation and setting up a system of continuous improvement increased the likelihood of sustaining the transformation. Incremental implementation took many forms, including the following: + Florida ACCESS started in Tampa as a pilot before it went statewide. + Neighborhood Place started in one school in 1993; between 1994 and 2002, the seven additional sites and two satellite offices followed in sequence. + Kenosha County hired a consultant early on to develop a step-by-step plan. + In contrast, Texas tried to implement a comprehensive information technology system overhaul rapidly without having individuals on-site to provide technical support when the system launched. Developed and maintained continuous dialogue with partners, staff and clients ‘The case studies show that authentic dialogue with key stakeholders allows plans and designs to be improved continuously. Authentic dialogue has had the added benefit of creating buy-in on the part of people on whom successful implementation depends. Key stakeholders include staff, community partners, advocacy groups and faith-based organizations. Excellent planning and execution are imperative for effective dialogue, with systematic, frequent opportunities to brief stakeholders and capture feedback. It needs to be two-way, with sponsors of the work ready and willing to adjust plans and designs in response to input gained through the dialogue. In the case studies, interviewees identified the need to communicate goals, policies and practices to all levels of staff. Partners + Both El Paso County and Neighborhood Place developed and implemented written, two-way communication plans with community partners. + EPaso County continuously seeks community stakeholder feedback, even after the initial planning/implementation process. + EI Paso County set up a mechanism by which informal and formal community partners can talk to each other, clients and department staff. + Neighborhood Place established a monthly meeting of community partners to problem- solve and make recommendations to leadership; the leadership team is accountable to this group. +E} Paso has interagency agreements to clarify roles and responsibilities and to ensure communication lines remain open; the agency did this with law enforcement and the military liaisons. Staff + In Neighborhood Place and El Paso County, all staff members were included in planning and implementation. An outside contractor conducted focus groups, allowing for “elephants in the room” to be discussed candidly and staff concerns to be addressed up front. 2+ EI Paso County evaluates staff members on their ability to work with other departments. + Both El Paso County and Neighborhood Place set up advisory groups that meet monthly to enable staff to provide continuous feedback, suggestions, successes, ete, Neighborhood Place leaders empowered this group to tackle projects and involve more staff and experts, as necessary. + Neighborhood Place used retreats in the beginning of the process and continues to utilize retreats and annual conferences to share and garner information. + Kenosha County initiated monthly meetings during its change implementation to assure regular communication with staff. Meetings are now bimonthly. Community + Kenosha County surveys clients regularly to inform ongoing planning. + Neighborhood Place has a community group that meets regularly. This group provides feedback to the senior leadership team on a continual basis. +E Paso implemented the Consumer Foundation Group, which meets monthly to problem- solve and make suggestions for improving access and quality of services. Actively and sustainably (by senior leaders) monitor plan progress and impact ‘The importance of active senior sponsorship comes through in several case studies. Neighborhood Place and El Paso County's systems have weathered leadership changes and political swings. Both transformation efforts have been sustained for well over a decade. Keys to successful sponsors include agency leadership remaining committed to partnering, checking their titles and agency prerogatives at the door when meeting as sponsors and partners, and ensuring the client remains the focus of service design and implementation, In both these systems, the senior leadership team: + Meets weekly; + Reviews feedback from agency staff, community partners and clients regularly; + Conducts regular data analysis and reporting along with input from various committees representing different stakeholders; and + Uses feedback to drive continuous system improvement. They ensure the system evolves as clients’ needs evolve. Established relationships of trust and collaboration with community partners The leadership teams successful at sustaining transformation efforts recognized that community partners who provide services to clients can provide insight and financial support for projects. Clients can benefit from a variety of services to help them on the road to self-sufficiency, some provided directly by their local human service agency while others are provided by community partners (often, though not always, under contract with the agency). To assist clients holistically, case study participants found that establishing relationships of trust between their agency and community partners helped them meet their clients’ needs without taking the entire burden of transformation and service delivery on themselves. Examples of ways community partnership come through in the case studies are as follows: + Miami-Dade has more than 400 community partners. It has different levels of partnership, with varying agreements regarding roles and responsibilities. + E1Paso County takes the time to identify and listen to community stakeholders constantly, not just early in the process. Its leadership urged colleagues in other jurisdictions to always ask the question of which stakeholders will be impacted. + Kenosha County partnered with the DHS employee union as well as with private employment services to make one, streamlined system. + Neighborhood Place has a Community Council of 15-21 members at each individual Neighborhood Place that influences the design, guidance and plan for the work at that site. + Neighborhood Place has a System Outcomes Committee that assesses the progress of collaboration regularly and determines future measures and goals for collaboration. + Neighborhood Place leadership has found that collaboration can lead to more investment, since collaboration makes the effort more attractive to public and private funders. 3