Due to its size, New York City necessarily serves a significant vulnerable population. There are eight agencies to support two million adults and children, many in grave need. Starting around 2006, commissioners for New York City’s major human service agencies saw a need for change. City officials were beginning to ask themselves, in the words of a senior executive, “How do we develop an integrated case management model, get all the players in the room around a case, and view a client across city agencies?” The result of this effort was HHS-Connect, a comprehensive initiative to use technology in health and human services to better serve New Yorkers. With HHS-Connect, New York City hopes to break down existing information silos and empower caseworkers with better information about their clients’ needs. The ultimate goal is to establish a client-centric approach to human services administration and benefits access.
When the impetus for a new approach emerged last decade, the city launched an initiative called One City, which sought to reduce the bureaucratic demands on families seeking services and to assist city agencies in coordinating service delivery. The One City initiative made progress towards producing an integrated case management model, but fell short of this promise because, in the words of one city executive, administrators “simply couldn’t figure out how to get our workers to know about one another in real time.”
In response, administrators then turned to a new effort: HHS-Connect. The HHS-Connect initiative consists of three primary strands: ACCESS NYC, Worker Connect, and enterprise case management solution development. Originally administered by the Deputy Mayor for Health and Human Services and now reporting to the Mayor’s Office of Operations, HHS-Connect integrates the city’s Administration for Children’s Services, the Department of Homeless Services, the Human Resources Administration, and more. The goal of HHS-Connect is to create a seamless human services delivery experience for clients, caseworkers, and administrators alike.
ACCESS NYC is a benefits and eligibility tool for use by clients and families in New York City. This portal enables users to determine real-time eligibility for 30 local, state, and federal benefits and services, ranging from food assistance to cash support to child care.
Worker Connect is a tool used by frontline staff, managers, and administrators that shares client information in a way that is consistent with privacy and confidentiality laws and regulations. Worker Connect enables human service agency employees to quickly determine which other agencies are assisting a given client and help coordinate care with other caseworkers.
The enterprise case management development component seeks to develop a common software platform across human service agencies. It leverages shared middleware and uses a common data model to ensure that systems can be delivered in a cost-effective and timely manner, and that the information from these systems can be readily shared with other agencies. To date, the program has launched one system for the Department of Homeless Services known as CARES (Client Assistance and Re-housing Enterprise System).
POLITICAL LEADERSHIP PROVIDING SUPPORT
As city administrators took a step back and recognized the need to, in the words of one executive, “solve the information barrier by investing in a system that would tie the agency’s data together,” political leadership gave guidance to the project. A strategic planning exercise laid out the governance framework for HHS-Connect. One result of the exercise was the decision to better coordinate the information technology capabilities under the oversight of the Deputy Mayor. Said a lead administrator on the project, “Up until then, strategy had been coming from City Hall, and we had a citywide IT Department that was doing the project management for implementing our policy vision. We were separated even physically from one another, and had to make sure the policy and technology were in sync.” By bringing together a governance structure—which included agency commissioners and city technologists—under the Deputy Mayor, the initial strategic planning sessions produced a roadmap for the development of HHS-Connect.
The Mayor’s Office provided crucial executive support to the HHS-Connect project from the outset. An executive order institutionalized the initiative’s governance structure, mandating regular meetings among the Deputy Mayor, HHS-Connect senior staff, and agency chiefs. Additionally, the executive order mandated a legal liaison group that brought together counsels from each agency. Importantly, the group was charged with “looking for ways to share information as opposed to looking for obstacles,” as a senior executive within the city’s Human Resources Administration said. The legal team was able to provide an analytical framework that would ease collaboration among agencies through data sharing. A critical output of the legal workgroup was an Inter-Agency Data Sharing Agreement that defined the legal framework, including the terms and conditions under which HHS agencies would share data through HHS-Connect applications.
USER-GUIDED DEVELOPMENT AND DEPLOYMENT
To ensure that the tools were as effective as possible, New York City executives sought feedback on tools as they were developed in order to adjust the software to user response. This has included many focus groups with various end-user groups such as beneficiaries and community organizations as well as city employees. In the words of one city executive, they began the process by “figuring out who are the relevant key stakeholders, including clients [and] community-based organizations.” City personnel worked diligently with these groups to ensure that programs would be as useful as possible for both organization staff and clients. This collaboration also helped to overcome any misgivings from outside staff about the new tools. As one Department of Homeless Services partner noted about the Department’s CARES case management tool, “Once employees know it, they like it.”
City leaders also actively engaged staff in the roll-out of HHS-Connect. Trainings conducted by managers and supervisors who had been caseworkers previously allowed the city to demonstrate concrete gains from tools such as ACCESS NYC and Worker Connect. One city administrator noted that these technical demonstrations and trainings often helped workers realize the potential of these tools to “lessen their workload, sometimes by hundreds of hours.”
BUILDING THE NEXT-GENERATION INFRASTRUCTURE
Managing the massive HHS-Connect infrastructure has been a significant undertaking for New York City. City officials have been planning a virtual client center for ACCESS NYC, and the city Human Resources Administration has been considering process adjustments to provide applicants with enhanced technical tools. Additionally, city officials have been contemplating advanced evaluation measures to assess the initiative’s impact. Current data reports bring together approximately 30 points of information that are “primarily output measures—how many visits, how many applications,” in the words of a senior city administrator. The city hopes to expand its technological capabilities to produce data that more readily captures high-level client outcome measures.
Since the original contractors have moved on from the project, city government now has sole responsibility for maintaining HHS-Connect’s systems and infrastructure. This has been a challenge, particularly due to problems in hiring outside experts to work for the municipal government on city government salaries. Nevertheless, HHS-Connect has successfully maintained and enhanced the systems. A relatively flat hierarchy throughout HHS-Connect encourages free and open communications among all levels of staff, promotes innovative thinking and risk-taking among personnel, and encourages staff to be proactive in raising concerns about the technology tools.
Given the sheer size of New York City and the considerable ambitions of the initiative, the HHS-Connect project remains an ongoing effort. City administrators continue to seek improvements to already-developed tools by incorporating additional data sources and user groups. Meanwhile, the city hopes to draft legislation to ease the data-sharing necessary for the realization of the HHS-Connect vision of client-centric human services in New York.