May 23, 2013

The day began with a news conference at the National Press Club, at which Clarence H. Carter, director of Arizona’s Department of Economic Security, presented the state’s vision for transforming the social safety net. The gist was similar to that of DES’ Arizona launch announcement May 10 in Phoenix – but tailored slightly for a national audience.

 

Academic Panel Poses Hard Queries About DES Pilot Project

By Stuart J. Robinson

WASHINGTON (May 23, 2013) — Arizona officials say they are aware of the huge challenge they face in transforming the state’s social safety net. But if any had their doubts, those were put to rest during a meeting Thursday with their own Academic Advisory Board.

Arizona’s Department of Economic Security (DES) hopes a demonstration project starting in September will point the way to a more holistic model for providing social services – transforming the safety net from a system that focuses solely on delivering benefits to one that emphasizes meeting consumers’ needs and growing their capacity to make their own way.

“What doesn’t exist right now in the safety net is this capacity-building model,” Director Clarence H. Carter told the advisers. “We need your heads in this to make sure we design this properly.”

The experts had plenty of thoughts – so many, in fact, that the discussion barely made it out of Square One as the advisers debated how DES should identify which consumers to study.

Molly Bright, DES’ strategic partnership director and the leader of Thursday’s discussion, said that was okay.

“I think I’d hoped to get through more areas,” she said, “but the insights and comments that were offered were things that were helpful. … This group is a very diverse group and an extraordinarily intelligent group, and they’re well versed in their areas of expertise and their research. They’re certainly not a shy group, which is not what we want.”

Richard B Chase, a service-management professor at the University of Southern California, noted that the plan was to cull from online applications and wondered how people in need of economic assistance would be able to get online. Sharon Sergent, DES’ director of programs, said he would be surprised.

“What we have found out is that because of access to computers at libraries and through stakeholder groups, there is significant access,” she said. “We have a lot of people who are first-time users who have online access,” Sergent added, some because the younger generation is accustomed to doing business online and some because folks whose fortunes fell during the recent economic downturn already had access.

Carter said DES already has 40 percent of applications coming in online.

Robert P. Strauss, a professor of economics, public policy and management at Carnegie Mellon University, wondered how the intake rate might be affected by seasonal differences, or by economic cycle.

“You want a sample from this intake process,” he said. “The question becomes: How are you going to stratify? Family units? Age of kids? Age of beneficiary? Each of those is a value judgment.”

“Do we want to say something specific about particular areas?” asked Chris Herbst, a professor of public affairs and social work at Arizona State University. He noted, for example, that one could factor for geography (which DES office the applicant visited) or demography (whether the applicant was single, married or had kids).

“You’re going to need more people,” Strauss warned. “And that’s expensive.”

Herbst said DES would have to do some slicing and dicing: “The findings are going to be in the subgroups.”

“What subset of 1.6 million DES consumers does this model need to serve,” Carter asked rhetorically. “Everybody in that population is not a candidate. What we have to learn is: ‘Who is?’”

At one point, discussion turned to how DES employees could affect the study.

“If you’re going to have lots of workers doing this, it’s important to have a structured [process],” said Aurora P. Jackson, a professor of social welfare at UCLA, “because a lot of people say a lot of different things.”

John Fowler, a professor of supply-chain management at Arizona State’s W.P. Carey School of Business, agreed that the demonstration must follow the same process with each consumer. But even then, he said, the parity would have to extend into the next stage: the treatments.

“What triggers engagement with who at what point? That’s what we’re trying to figure out,” Bright said.

Following the session, Bright said the extra attention to the demonstration’s basis was necessary.

“You have to be thinking about what questions at the end of the day you want to be able to answer,” she said. “If we construct it [the wrong] way, we might end up in a year and a half not being able to answer what we intended.

Chicken or Egg?

Both Thursday’s meeting with the advisory board and Tuesday’s meeting with federal agency officials seemed to present a paradox: DES wants to conduct the demonstration project to determine what questions it needs to answer; at the same time, its advisers and partners are saying certain questions must be answered before the testing can begin.

“There is a paradox between chicken and egg, and how do we do this and this simultaneously, and how do we hypothesize,” Bright said. “I think some of what we’re doing is: ‘Here is our preliminary thinking. Let’s go a little further down this path and check it. Is it valid; is it reliable?’”

Healthy Atmosphere

The academic advisors also recommended a strategic communications plan to foster cultural change within DES.

Herbst said it would be important to introduce new staff for the demonstration in a way that wouldn’t make legacy staffers resentful. Gary E. Roberts, a professor of public administration at Regent University, agreed, saying care should be taken not to bash incumbent employees.

“It’s important to preserve the dignity of all folks involved,” Roberts said.

To the extent that outside agencies would be involved, Strauss said, there would have to be agreements about implementation and accountability.

“Having some metrics in mind across agencies is going to be very important,” he said. “At least have a process to agree on metrics. … Control the conversation; get buy-in.”

This was the second meeting for the advisory board. It met for the first time Jan. 17.

Earlier Thursday, Carter presented Arizona’s vision for transforming the social safety net during a news conference at the National Press Club. The gist was similar to that of DES’ Arizona launch announcement May 10 in Phoenix – but tailored slightly for a national audience.

For more on DES’ initiative to transform the safety net, visit www.azdes.gov/transformation.

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Freelance writer Stuart J. Robinson of Lightbulb Communications is embedded with the DES delegation in Washington this week.

May 22, 2013

“It’s not the heat; it’s the humidity.”

In Talks on Safety Net, Consensus Forms on Value of IT

By Stuart J. Robinson

WASHINGTON (May 22, 2013) — State officials on Wednesday presented Arizona’s vision for transforming the social safety net to so-called national stakeholders – organizations such as National Conference of State Legislatures, the Coalition on Human Needs, the National Head Start Association and the National Coalition for the Homeless.

Most of the questions were specific and parochial in nature, but one topic that carried over from Tuesday’s meeting with federal agencies was the importance of information technology in bringing together data to guide individual cases.

Arizona would like to try a more holistic approach to providing social services – transforming the safety net from a system that focuses solely on delivering benefits to one that emphasizes meeting consumers’ needs and reducing their dependencies. The state Department of Economic Security (DES) administers many single-service programs – dealing with food, employment and other issues – on behalf of the federal government. Each program lies within its own silo, with its own rules and objectives, and is evaluated on how well it delivers its own services. The state would like to try a consumer-centered approach in which a single “case coordinator” would get to know a client, make a comprehensive needs assessment and tailor a personalized approach to the person’s circumstances that would include all the necessary services.

DES Director Clarence H. Carter said better technology is vital to transforming the safety net.

“Right now, the IT infrastructure is built up around the silos of the system,” he said. “So there has to be a technological underpinning to this work that supports the shared vision. It is absolutely essential to the system moving forward.”

Bonita M. Turner, a consultant working with DES, is looking at how the safety net can leverage IT to advance human services.

“One of the things that we’re demonstrating is how we can use technology to create a single view of the client across these disparate silos,” Turner said. “The technology is already there to do it; we just have to deploy it. We’re going to be taking the demonstration clients and creating a single view of them by pulling the legacy systems together … so that we have that single view.”

According to Turner, that will improve efficiency and foster better decision-making:

“Once we have a single view, we can mine that data to say: ‘What does this collective data tell us about the client?’ We’re really going to have the ability to make better decisions because we’ll have better information in front of the case coordinators. The case coordinators won’t have to spend time looking for the data; it’s going to come to their desks.”

From a management perspective, Turner said the approach would improve the handling of caseloads.

“We’ll know what the caseworker is really doing,” she said. “It helps managers to manage case coordinators. It helps case coordinators to manage clients. Because now the data is all in one place.”

Turner said clients could take advantage of new technology as well. Looking forward, she sees airport-style kiosks at DES information centers, which would “cut down on the duplication of process and the waiting time. People could get bar codes on a form and move more quickly through the system.”

Beyond issues of data and technology, stakeholders at Wednesday’s meeting questioned Carter and his DES team on a variety of topics, such as:

• whether progress by clients would cause them to lose some benefits;
• engaging consumers whose benefits come with work requirements to follow through;
• jobs programs for men who are delinquent in child support or getting out of prison so they can acquire the means to meet their responsibilities;
• the role of education programs in growing consumers’ capacity to make their own way;
• whether the transformation has the support of Arizona lawmakers; and
• details about DES’ demonstration project.

Carter said the variety of topics reflected the stakeholders’ differing perspectives.

“It’s the nature of the way these organizations view the world,” he said. “It’s the very specific function of their silos; not the big intention. That, quite frankly, is part of the challenge. Because these are people and organizations that are in the operating weeds … so their questions are very specific to ‘What does this mean for them?’”

Still, Carter was pleased with the dialogue: “We had folks who are engaged and, I think, want to understand what our intentions are, and how they can be part of this and what it means for consumers that we jointly serve.”

DES officials will hold a news conference Thursday morning at the National Press Club. They will spend the Thursday afternoon and Friday morning sharing ideas with a new, seven-member Academic Advisory Board – a sort-of “think tank” studying the safety net.

For more on DES’ initiative to transform the safety net, visit www.azdes.gov/transformation.

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Freelance writer Stuart J. Robinson of Lightbulb Communications is embedded with the DES delegation in Washington this week.

May 21, 2013

Today was extremely busy. Morning and afternoon meetings (below), plus breakfast, lunch and dinner with three different friends I haven’t seen in years. The highlight probably came during lunch at Union Station’s Center Café, when a very orderly bunch of demonstrators filed through the Main Hall. Led by security, they chanted and banged drums while following a prescribed path through the building. They came, made themselves heard and then let us go back to our lunches. Very polite; very D.C. Not at all like those amateurs who block the Memorial Bridge during rush hour.

Feds Buy Into Arizona’s Vision for Safety Net

By Stuart J. Robinson

WASHINGTON (May 21, 2013) — Arizona’s vision for transforming the social safety net earned qualified support Tuesday from a representative panel of federal agency officials.

“The top takeaway was that our federal partners are truly engaged in helping us,” said Clarence H. Carter, director of the state’s Department of Economic Security (DES). “They showed here today an aggressive willingness to help us think this thing through.”

Arizona would like to test a more holistic approach – a first step toward transforming the safety net from a system that focuses solely on delivering benefits to one that emphasizes meeting consumers’ needs and reducing their dependencies. DES administers many single-service programs – dealing with food, employment and other issues – on behalf of the federal government. Each program lies within its own silo, with its own rules and objectives, and is evaluated on how well it delivers its own service.

The state would like to try a consumer-centered approach in which a single “case coordinator” would get to know a client, make a comprehensive needs assessment and tailor a personalized approach to the person’s circumstances that would include all the necessary services.

Jessica Shahin, an associate administer within the federal Supplemental Nutrition Assistance Program (SNAP), said Arizona’s vision sounded a lot like the old case-management model the government used before moving to the current enrollment model. But that isn’t necessarily a bad thing, she said.

“Case coordination is a concept that can benefit from technology that wasn’t around before,” Shahin said. “The timing is good.”

That was seconded by Curt Coy, a deputy undersecretary of Veterans Affairs who was the highest-ranking official at Tuesday’s meeting.

“If you begin the process without IT to do case management, you’re never going to get there,” he advised. “It’s critically important that you look at the incentives and disincentives in each program.” He said that individual case coordinators can’t be expected to know the myriad assistance options out there. As a result, many states leave available federal dollars on the table.

“We have a model of how this could work, but we have to demonstrate and test it,” Carter told the agency officials. “There is no way we can do this without your help.”

He asked for guidance on what is permissible under federal rules, and for help in getting over any hurdles. “We are going to need waivers and other workarounds to showcase the type of system we want.”

To which Shahin said, in effect: Not so fast, my friend.

“If you’re thinking you’re going to identify problems along the way and then come to us for solutions, we may not be able to do that,” she said, suggesting that DES identify potential hurdles in the demonstration’s design phase.

Carter said he was extremely pleased at the level of dialogue.

“I thought it illuminated what we are trying to do, and it showed that they truly were engaged,” he said

Onaje Salim, a division director within the Department of Health and Human Services, asked what level of support the transformation project had from Gov. Jan Brewer, and whether DES planners had taken into account what’s happening with the nation’s health-care overhaul.

Carter said the project was an adopted priority of the governor. Per changes in health care, he said state officials would have to leverage opportunities that become available. He also said the initiative was about policy, not politics.

“Arizona has a reputation for conservatism, so some might think this is about getting rid of the safety net,” he said. “It is not. We are fervent believers in the safety net and all of its benefits, goods and services.” His argument to the governor and state lawmakers, he said, “is that we simply don’t have an efficiently designed safety net.”

The agency representatives urged Arizona to take into account as broad a range of services as possible – and to include outside stakeholders in the design process. For example, Coy pointed out how the military uses the “hire and train” model, while the private sector prefers to hire folks that already are trained. It’s important to include the Labor Department and the business community in creating jobs programs, he said. “If there is an incentive for them to hire and then train using state dollars or federal dollars, you change the equation.”

Among other issues raised by the federal officials were:

• the potential impact of Arizona politics;
• accounting for the communities in which safety-net consumers live; and
• how DES would identify participants for the demonstration program.

“It was a little bit all over the board,” said Jennifer Snow, a senior policy adviser at the Center for Medicare and Medicaid Services, “but I think there was a general appreciation of being involved at this early stage in the game.”

Carter called Tuesday’s session an important mile marker and said the agencies are ready to be a part of the transformation process. “This is no longer just an Arizona pet project,” he said. “It is beginning to take on national significance.”

Later in the week, the DES officials plan to share ideas with a new, seven-member Academic Advisory Board – a sort-of “think tank” studying the safety net – as well as a National Stakeholders Group representing clients, the business community, faith and community organizations, educators and philanthropists, as well as policymakers and staff from federal, state and local government.

For more on DES’ initiative to transform the safety net, visit www.azdes.gov/transformation.

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Freelance writer Stuart J. Robinson of Lightbulb Communications is embedded with the DES delegation in Washington this week.

May 20, 2013

On Monday the Arizona Department of Economic Security delegation held internal meetings to prepare for tomorrow’s powwow with the feds. (See below.)

On a lighter note, a colleague and I checked out the Newseum this morning. I’d been to the old one in Rosslyn, but this was my first visit to the colossus on Pennsylvania Avenue.

Arizona Seeks Dialogue with Feds on Transforming Safety Net

By Stuart J. Robinson

WASHINGTON (May 20, 2013) — Officials from the Arizona Department of Economic Security (DES) will meet with federal agency representatives Tuesday to discuss flexibility the state might need to test a new vision for delivering social services.

Arizona would like to explore a more holistic approach – a first step toward transforming the safety net from a system that focuses solely on delivering benefits to one that emphasizes meeting consumers’ needs and reducing their dependencies.

“We have a model of how this could work, but we have to demonstrate and test it,” says DES Director Clarence H. Carter. “We are going to need waivers and other workarounds to showcase the type of system we want.”

The state administers many single-service programs – food, housing and employment, for example – on behalf of the federal government. Each program lies within its own silo, with its own rules and objectives, and is evaluated on how well it delivers its own service.

“Conflicting rules don’t let us work together to help that consumer move forward,” Carter says. In fact, the system places little-to-no emphasis on helping clients move beyond the condition or inter-related circumstances that qualified them for aid.

Arizona would like to test a holistic, consumer-centered approach in which a single “case coordinator” would get to know a client, make a comprehensive needs assessment and tailor a personalized approach to the person’s circumstances that would include all the necessary services. This approach – “Growing Arizona by Growing Arizonans” – would focus on enabling clients to emerge from the system prepared to stand on their own two feet.

“We should focus on whether the individual gets better through our efforts,” Carter says. “The safety net should be a trampoline. It should be able to launch the consumer.”

Carter and his team will meet Tuesday with senior policy leaders from relevant federal agencies to discuss collaboration.

“We have a concept that looks wonderful from 30,000 feet,” Carter says. “The challenge is to bring that smoothly to the ground level.”

Later in the week, the DES officials plan to share ideas with a new, seven-member Academic Advisory Board – a sort-of “think tank” studying the safety net – as well as a National Stakeholders Group representing clients, the business community, faith and community organizations, educators and philanthropists, as well as policymakers and staff from federal, state and local government. All of those parties will play a role in transforming Arizona’s safety net and, perhaps, providing a template for other states.

“The path to this is not clear,” Carter says. “We are going to be cutting down brush at every turn.”

He says getting the transformation right is imperative because 20 percent of Arizonans depend upon some aspect of the safety net.

For more on the initiative, visit www.azdes.gov/transformation.

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Freelance writer Stuart J. Robinson of Lightbulb Communications is embedded with the DES delegation in Washington this week.

Tags: Arizona Department of Economic Security, Bonita M. Turner, Clarence H. Carter, DES, information technology, IT, Jan Brewer, Molly Bright, SNAP, Supplemental Nutrition Assistance Program