American Public Human Services Association’s (APHSA) Policy Forum

American Public Human Services Association’s (APHSA) Policy Forum
June 16, 2014
Acting Assistant Secretary Mark Greenberg

Thanks, everybody, I’m very glad to be with you all today. As you know, I’m currently Acting Assistant Secretary at ACF and am speaking with you in that capacity, but my connection with and appreciation of the work of APHSA goes back much further. Before joining the Administration, I was often a regular participant at APHSA conferences and activities, and my first engagement was when, as a young legal services lawyer, I enrolled with an individual membership in the then-APWA.

It’s also great to have been able to see and hear Cindy, and to share the panel with Kevin and Jennifer. Kevin and I have known and worked together for many years when he was in Oregon, and Maine and Iowa, and Jennifer and I and our HUD and ACF colleagues work closely together in support of the Administration’s efforts to end family and youth homelessness. Those of you who come to DC regularly know that we often talk about how strongly inter-agency collaboration is emphasized in this Administration, but I hope everybody can see that it’s not just a talking point, it’s a fundamental principle guiding our work.

We were asked to talk this afternoon about the relationship between our agencies’ work and the APHSA vision of transformation, including issues relating to program integration and interoperability, cross-departmental initiatives, evidence-based results; a focus on outcomes rather than process; and how we take a holistic view of our work. So, I’ll start with some quick overview, talk about how our work relates to this vision, and then flag what I think are some key challenges we face in advancing the vision.

First, ACF has responsibility at the federal level for a wide range of programs and activities that provide help principally to low income children, families, and communities. The list includes Head Start and child care, child support, child welfare and adoption assistance, TANF, LIHEAP, the Social Services Block Grant, the Community Services Block Grant, refugee resettlement, the unaccompanied alien children program, marriage and fatherhood programming, runaway and homeless youth programs, domestic violence, asset-building, and more. So, we understand the importance of breaking down silos between programs.

Overall, we’re guided by the vision of “children, youth, families, individuals, and communities who are resilient, safe, healthy, and economically secure” and we seek to bring together our research, technical assistance, discretionary grants and policy guidance in support of this vision. And, we’ve made major efforts throughout this Administration to have programs work together toward common goals. To list just a few examples:

  • Our Offices of Head Start and Child Care work closely together on a comprehensive, cross-program early childhood strategy, with coordinated research, technical assistance, policy development, and now, through the Early Head Start-Child Care Partnerships, funding announcements for integrated work.
  • Our Offices of Child Support Enforcement and Family Assistance and other ACF offices work closely together on issues relating to fatherhood.
  • Our Office of Refugee Resettlement has forged partnerships across ACF to promote greater attention to the needs of refugees entering the United States.
  • We’ve got cross-ACF initiatives concerning asset building, addressing homelessness, addressing human trafficking, and in support of Affordable Care implementation.

Our efforts directly support the President’s commitment to promote and advance economic mobility and opportunity. A strategy to do this needs to broaden opportunities across the life cycle ---expanding access to high quality early childhood settings, promoting success in elementary and secondary school, ensuring effective transitions to work and postsecondary education, providing career pathways to labor market progress for adults, and helping families build assets. The strategy must also support and promote labor market participation and the engagement of parents in the lives of their children, and it must strengthen the communities in which children reside. And, we work across ACF programs in support of these efforts, including our early childhood efforts; marriage, fatherhood and teen pregnancy prevention efforts; and work to help less skilled adults succeed and move up in the labor force.

Addressing economic mobility and addressing poverty aren’t identical, but they’re closely related. Cross-national research suggests that a principal reason why economic mobility is not as strong in the US as in a number of other developed nations is because the bottom fifth here is less likely to move up. Research tells us that over forty percent of children growing up in the bottom quintile will remain there as adults. On the one hand, that tells us that birth isn’t destiny, that most children growing up in poverty don’t remain there as adults, and that most poor adults didn’t grow up in poverty. But, it also tells us that children growing up in poverty are more likely to be poor adults than any other group, and most children growing up poor remain in the bottom half. All this suggests that any strategy for improving mobility in the United States must addressing sustained and persistent poverty and its impacts on children.

We’ve also got a broadly shared ACF priority to address and prevent early adverse experiences for children. Advances in neuroscience are demonstrating the adverse effects of childhood poverty on the brains of developing children. We are also mindful of the emerging findings about the impacts of trauma, adverse childhood experiences, and toxic stress -- the body of work indicating that when a child experiences strong, frequent, or prolonged adversity without adequate adult support, the prolonged stress can disrupt the development of brain architecture and other organ systems, and increase the risk of disease and cognitive impairment well into the adult years. As many of you know, we’ve placed a major emphasis in addressing trauma cutting across our work in child welfare, family violence, runaway and homeless youth programs, trafficking, unaccompanied children, and others. We are committed to building the research base and drawing from that research to guide policy and practice, with goals of reducing the stressors facing poor and high-risk children and the communities in which they reside, and with advancing two generational efforts that helping parents and caretakers succeed in employment and build skills to strengthen parenting and better manage the stressors they may also face.

So, we share the goal of looking across programs so that they’re working together toward common goals. And, we share the commitment to ensure that our approaches are grounded in research and evidence, and that we are building the evidence base while seeking to spur innovation and speed the process of learning from research. Our efforts include the rigorous experimental evaluations of career pathways strategies through the Innovative Strategies to Increase Self-Sufficiency Project and of health care sectoral strategies through the Health Professions Opportunity Grants initiatives, evaluating applications of behavioral economics in human services through the BIAS Project, the Buffering Toxic Stress Consortium testing interventions in Early Head Start, and Head Start University Partnerships focusing on two-generation strategies, as well as our continuing research relating to home visiting, pregnancy prevention, and marriage and fatherhood.

We appreciate the fundamental role of technology in advancing human services efforts. ACF’s Interoperability Initiative has developed and promoted the National Human Services Interoperability Architecture reference model for the design of next generation, fully integrated health and human services enterprises; worked to enhance existing legacy systems with improved data sharing through data exchange standards; and promoted close collaboration and coordination between human and health services through use of the A-87 exception. We’ve published several interoperability toolkits for states and localities, explaining opportunities of integrating health systems with our human service programs' systems, including the availability of Medicaid's enhanced 90 percent funding and the A-87 exception. We awarded seven, one-year long Systems Interoperability and Integration grants to explore improved interoperability across states' health and human service programs. These grants were used to develop programs that aggregated child welfare program data with multiple human services programs, improved eligibility determinations, built innovative calculators that can measure benefits, and more. And, we really are quite close to releasing our long-awaited confidentiality toolkit.

I want to close with some quick observations about the effort to move from process to outcome and the challenge it presents. I think all of us likely agree that that the ideal state would be one in which states or other grantees had broad flexibility as to process and were accountable for outcomes, or even more appropriately, impacts. But, I think the principal reason why that often doesn’t happen is that as one seeks to specify broader outcomes of concern, it becomes difficult to determine what was the role of the human services agency in attaining, or failing to attain, the outcome and what’s the degree of responsibility that should fairly be ascribed or the consequences that should flow from it I appreciate one might respond that if we get a good outcome, who cares which agency contributed what, but that’s actually a pretty fundamental question if the framework is flexibility with accountability. And, the more global the outcome, the more difficult this is to do. For example we might have goals of raising graduation rates, or ensuring successful transitions to adulthood by 25, or having all children arrive at school ready to learn, or ensuring that all families entering a public assistance system are able to enter and sustain stable employment, or reducing child poverty. But, the reason we often rely on output measures --- how quickly is a case processed, what’s the participation rate, what’s the payment accuracy or error rates --- is because they are measures for which there’s shared agreement that a state can and should be held accountable.

So, I think the ultimate challenge we all face in moving the discussion forward is to be able to articulate and operationalize broader outcomes for which states and other grantees can reasonably and fairly be accountable, and to then be able to articulate both what flexibility needs to look like, and what accountability needs to look like in such a structure. It’s a crucial discussion to have, and we welcome having it with you.

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