An experiment by Annie E. Casey Foundation staff in children and family services agencies is improving these organization's performance.
It's a perennial public-sector issue: trying to figure out how to move entire organizations in a new and better direction. Regardless of the program or policy area, fear, bureaucracy, laziness, rules and inertia get in the way, and get good people to give up.
This might be particularly true in human services. Given the vulnerable nature of the population served, asking those in the human services business to try new and different ways to do their job always carries with it the inherent risk of some very bad outcome. That is why for decades the most effective way to get a human services agency to change has invariably involved lawsuits.
In fact, child advocacy organizations have gotten really good at suing states based on allegations of inadequate services. Although lawsuits might force some change, they have one significant downside: They tend to focus systems on the wrong "customer." The courts become the focus of and reason for change instead of the basic well-being of children and families. At the same time, lawsuits obviously divert scarce resources toward legal battling rather than fixing problems.
So what if there was a way to move whole bureaucracies in a better direction without the turmoil of having to declare legal war, or without the soul-draining misery of actually trying to shoulder bureaucracies in a new and better direction?
About eight years ago, a small group of Annie E. Casey Foundation staff and consultants decided they wanted to try an experiment: Embed a small group of consultants in children and family services agencies and commit to staying on the job for years as the team worked with staff and other interested players both inside and outside the system to try and leverage change.
Called the Child Welfare Strategy Group (CWSG), the basic approach has shown real promise in states from Maine to Virginia, Indiana to Louisiana. (By way of full disclosure, I have been writing case studies for CWSG.) But figuring out how to move bureaucracies didn't happen right away. It took a considerable amount of hit and miss, including trying traditional approaches, such as pushing new policies, training mid-management and front-line staff, focusing on "evidence-based practice," collecting and analyzing data, and changing practice models.
What the group eventually realized, though, was that they could adapt a concept gaining currency in the private sector called "catalytic mechanisms" to children and family services systems, and use it to achieve the same sort of dramatic results as some businesses have seen.
In essence, a catalytic mechanism is some fundamental change that you can use to lever other internal processes and procedures in a new and better direction. In the case of children and family services systems, that catalytic mechanism is a very simple, single number: the percentage of a state's children under state supervision who were in congregate or institutional care.
It turns out that if state leaders take a hard look at ratcheting down that percentage, they're able to stimulate other fundamental changes in how systems operate (what the Casey crew calls "catalytic combinations"). The essence of the change is this: Systems can no longer make the easy and therapeutically questionable call of just warehousing kids in institutional settings; instead they have to figure out how to either keep them out of the system in the first place or work harder to find an appropriate placement with kin or a foster family.
If systems focus on the former, or prevention, that drives a whole new approach to evaluating risk and to providing in-home services. Does a child really have to be pulled out of his or her home, or can the system bring resources to bear in the name of family preservation? If systems focus on the latter, or better placements, then it means working harder to find relatives who might be able to step in and take a kid, and it means working harder to recruit and support foster families as an alternative to congregate care.
In every state where officials focused on reducing congregate care -- and then committed to making other changes in support of that -- systems saw widespread improvements in key measures like keeping children with their families, shorter stays in state custody, improvements in permanency rates and reduced incidents of repeat abuse or neglect.
It's absolutely vital to note that just working on a reduction in the percentage of children in congregate care in and of itself doesn't magically create change; what it does is get everyone's attention and forces them to refocus, which is where the CWSG's "catalytic combinations" notion comes in. For congregate care reduction to actually result in improving system performance, other internal systems have to realign in support. It doesn't do any good to shoot for a 10 percent reduction in congregate care if a system isn't going to consider significant new practice models that focus on the most therapeutically, least traumatic placements; if systems to recruit and support foster and kinship care aren't beefed up; if community-based "wrap-around" services aren't improved; or if IT systems aren't upgraded in a way that actually allows staff to accurately track kids and outcomes.
But in that significant handful of states where the push on congregate care reduction has been faithfully and sincerely pursued, the data bears out the benefits in a wide and important variety of key success measures. In Virginia, for example, congregate-care placements dropped 50 percent statewide in the wake of reform, community-based care increased 60 percent, caseloads fell 20 percent and child permanency rates increased by 80 percent.
It's also worth noting that such a fundamental shift in strategy has one other very powerful and attention-getting effect: It can actually be less expensive because foster-care placements cost a fraction of what the average institution charges.
A key question begged by CWSG's success is, of course, whether there might be other areas of human services besides foster care where some "catalytic mechanism" or "combination" can be deployed to force broader system change.
We invite you to discuss and comment on this article using social media.
LATEST HEALTH & HUMAN SERVICES HEADLINES
What's the Best Way to Enroll People in Medicaid?1 day ago
How Trump's Health Budget Would Impact States2 days ago
CBO: House Bill Would Leave 23 Million More Uninsured and Destabilize the Market in Some States2 days ago
How States Are Trying to Root Out Welfare Fraud2 days ago
Single-Payer Health Care Would Cost California More Than Triple Its Budget3 days ago
New York Applies Special Pressure to Prescription Drugmakers4 days ago