At last fall's Health and Human Services Summit hosted by Harvard University’s Technology and Entrepreneurship Center, five key areas were illuminated for health and human service agency leaders — leaders who are striving for integrated, outcome-focused revitalization of programs to address increasingly complex social service challenges.
If HHS leaders focus on these five key areas — data, ecosystems, service design, organization and innovation — they will fuel better interventions faster, place people at the center, shift ingrained mindsets and more, all of which will lead to enhanced HHS services for constituents.
There is a push to move beyond using data insight solely for reporting or operational purposes and use it to proactively shape programs. Contrary to common belief, agencies do not need data warehouses, a full-time staff of data scientists, or years and years to get results.
Predictive analytics allow agencies to pinpoint high-need service areas or populations and quickly use data to develop insight-driven practice models to solve problems. This is how the Allegheny County, Pa., Department of Human Services is improving child welfare decision-making. It is driven by the reality that caseworkers have limited information when they receive a call about child abuse or neglect, and child welfare agencies cannot respond to every case. A risk-based scoring system developed through predictive risk modeling helps caseworkers decide whether to screen calls in or out at the vital first decision point.
Rapid-cycle evaluation is another technique that agencies are exploring to act on data insight. With rapid-cycle techniques, agencies can assess the effectiveness of specific interventions faster. They can do pulse checks on what's working, make the business case to funders and drive continuous improvements.
Working with Virginia Tech, the Commonwealth of Virginia is in the early stages of an initiative to determine the effectiveness of programs for disadvantaged children in Roanoke. Rather than use a randomized controlled trial, the program will use rapid-cycle analytics techniques.
“What we’re trying to do is build an analytics model that helps bridge that research and practice area to allow our research to be much more relevant on a much more timely basis,” explained Accenture’s Gary Glickman.
Ecosystems are the future of health and human services. Leadership for a Networked World’s Executive Director Antonio Oftelie explains an ecosystem as “a set of interconnected organizations, machines and services that can collaborate across boundaries, across silos and design new solutions that address and solve root causes of individual, family and community health and human services challenges.”
Data insight binds ecosystems, making for even deeper connections that exist in cross-agency or cross-sector partnerships. Ecosystems create a “multiplier effect” of scale and impact. Each member has something unique and complementary to contribute to the others, and to the people they serve.
This multiplier effect is alive in Los Angeles, thanks to the Los Angeles Police Department’s (LAPD) Project HOPE. As homelessness grew beyond Skid Row, the LAPD realized that it could not solve the problem alone. Police officers had their role. Social services providers had their role. They had to come together.
LAPD’s ecosystem partners include the Los Angeles Housing Services Authority and other homeless service providers, the Department of Sanitation, the Office of the City Attorney, the Office of the Mayor, and the Department of Mental Health. Members participate in a quarterly “Compstat” where they are held accountable for their commitments.
More homeless individuals are getting appropriate services now.
“It happened because we were able to break through a lot of barriers to get a lot of other people that usually aren’t at the table with us to have the trust and the faith that we’re going to try to do our best to solve the problem that is really and truly impacting individuals, neighborhoods and the entire city,” said Todd Chamberlain, commander and assistant commanding officer of the LAPD's Operations-Central Bureau.
As organizations share data insights and develop ecosystems to provide more evidence-based services, they are making it a priority to place people at the center of it all, the hub on the hub-and-spoke model.
This is happening in at the JeffCo Prosperity Project (JPP) in Jefferson County, Colo. The program is focused on innovative service delivery models to break the cycle of generational poverty. JPP is the convener of school, county government and business partners.
According to Director Joyce Johnson, this work is not done in a vacuum. JPP asks families what they need, and how.
“It really was coming to them and saying, 'What is it that you want and how can we serve you? Not, 'Here’s the box that we’ve decided you need to fit into,'" Johnson said. "And that seems like a small shift maybe in some ways, but it’s massive if you’re really going to make that change.”
Organizations like JPP are threading empathy into program development more intentionally than in the past. Service design principles provide a concrete way to do this from the idea generation stage. This iterative, collaborative approach to program design is gaining momentum in the social services sector. For example, when the Michigan Department of Health and Human Services reinvented its child support calculator, parents and caseworkers were involved in the process.
Learning from the “outside in” to align with people’s unique experiences is essential. However, moving to a more generative state requires organizations to look inward as well to change the hearts, minds and habits of the people doing the work. Organizational norms and cultures must change.
The federal government is challenging existing organizational practice in the health and human services space. Rafael López, former commissioner for the Administration on Children, Youth and Families with in the U.S. Department of Health and Human Services, explained that his vision is to “drive innovation in a very different way at the federal level using the federal levers to both, one, fund interesting and innovative ideas on the ground in collaboration with partners. And, second, try to take those lessons learned and scale them.”
The first-ever White House Foster Care and Technology Hackathon is an example of an organizational and cultural shift to different ways of working. The 48-hour event invited a diverse group including technologists, hackers, app developers and child welfare leaders to develop apps to address foster care issues. This agile way of working developed seven prototypes in two days with few resources.
Two-generation services represent another “counter-culture” way of working in this sector. They are an answer to stovepiped service delivery that is a significant barrier to more personalized care. Lessons from the two-generation initiative in the state of Colorado, and Jefferson County in particular, show what can happen when agencies stop looking at people through a one-dimensional program focus.
While technology innovation will continue to shape the future of health and human services, innovation is not solely about technology. It is a mindset shift. Led by adaptive leaders, innovative organizations pursue fresh thinking that disrupts how things have always been done. This can involve breaking new ground with systemic change or making changes to “the big little things” that can have a surprisingly positive impact on an organization’s effectiveness.
Innovation is a strong theme in the state of Ohio’s transformation story. Five years ago, Ohio created the Office of Health Transformation (OHT) to reinvent health and human services operations statewide. OHT’s push for “practical innovation” has delivered impressive outcomes. The creation of this office in itself is a great example of structural innovation. The implementation of an integrated eligibility system for Medicaid, SNAP and TANF, which now includes a self-service portal for citizens, exemplifies technology innovation. OHT is pursuing payments innovation too, using enterprise data to shift from a fee-for-service to a pay-for-value model.
Although it is miles away from Ohio in distance, Finland’s Apotti program shares a focus on integrating health and human services to improve quality, coordinate approaches and enable more preventive services. Modernizing IT systems will allow for innovations in the customer and services provider experiences, supporting a significant shift toward data-driven and evidence-based care models.
Evidence-based client services are the future of health and human services. The approach is putting data insight at the heart of program delivery to achieve meaningful and sustained outcomes for people and communities. It runs through these five big keys. The goal is to define a generative future where leadership, operations, technologies and processes are adaptive and innovation is continuous. Bold leaders are already seizing the possibilities, and getting results.
Debora Morris and Ryan Oakes are both managing directors with Accenture. An earlier version of this article was published in Policy & Practice, the journal of the American Public Human Services Association.