August 7, 2012 - National Conference of State Legislatures

August 7, 2012

Chicago, Illinois

National Conference of State Legislatures - Human Services and Welfare Standing Committee

It is a real pleasure to see so many friends from Florida in the audience today and so many other legislators and legislative staff who are committed to child welfare and human services.

It’s great to be in Chicago and to once again work with the wonderful folks at NCSL.

While there is more work that remains to be done, the employment report released late last week provides further evidence that the U.S. economy continues its recovery from the worst downturn since the Great Depression.

The report from the Bureau of Labor Statistics (BLS) shows that private sector establishments added 172,000 jobs last month, and overall non-farm payroll employment rose by 163,000. The economy has now added private sector jobs for 29 straight months, for a total of 4.5 million jobs during that period.

That’s encouraging and the states are where the economic innovation is occurring. Your leadership and efforts are integral to the recovery.

Your president continues to work toward an economy that’s built, not from the top down, but from a growing middle class.  We must make the investments we need to grow and become a magnet for middle-class jobs. 

The President believes this economy grows best when everyone gets a fair shot, and everyone does their fair share, and everyone plays by the same set of rules.

One of the many things he has done and is doing to accomplish this is to expand the administrative flexibilities he outlined in one of his very first executive orders.

He knows that the issues that need addressing are in Miami and Houston, Chicago and Salt Lake City, LA and and Philadelphia.

And, well, maybe there’s even a few in DC.

But he knows, and I’m sure most of you would agree, that DC is no match for the states when it comes to serving as the incubators for innovation.

Because of this, he wants to give you as much flexibility as is allowed by law because he understands that Washington is 69 square miles surrounded by reality.

Your reality, where many parents are still struggling in this economy and need help not just finding a good job, but making sure they’re ready and qualified to take it when it comes along.

With just that thought in mind last month, the Administration for Children and Families took action to strengthen the TANF welfare-to-work programs that help out-of-work or underemployed Americans find and keep good jobs.

We alerted human services commissioners that we would be issuing waivers of TANF requirements to allow states to test new approaches that they believe can be more effective ways of getting more people to work.

Ever since then, there’s been a lot of talk in the media about this being an attempt to gut welfare reform, in particular relaxing the welfare-to-work requirements that were the cornerstone of the landmark 1996 Welfare Reform Act.

Nothing could be further from the truth. In fact, it is quite the opposite. 

The new steps we have taken will give states more flexibility in how they operate their TANF programs so that states can test ways to increase employment among needy families.

Administrators from states led by Governors from both parties have repeatedly told us the current regulations focus too much on verification and compliance efforts than on actually getting people into employment. These waivers do just that.

When the TANF program was established as part of welfare reform in the 1990s, it was intended to give states flexibility to design effective programs to help parents move from welfare to work.

Today, however, federal rules dictate mind-numbing details about how to run a welfare-to-work program.

Most States and experts agree that these aren’t helpful.

Effective social welfare programs should be about jobs, not about jumping through bureaucratic hoops. About outcomes, not process.

And we think states have insights about how to achieve the desired outcomes, and they know which processes get in the way.

I think we can all agree that state employees should be spending less time filling out data reports and more time helping parents find employment.

The new policy we announced will allow states to test new, more effective ways to help parents successfully prepare for, find, and retain employment. 

This new flexibility will strengthen welfare reform rules and the effectiveness of state efforts to connect families with work.

Waiver requests that weaken or undercut welfare reform will not be approved. Waiver requests that seek to avoid time limits or other federal restrictions on when assistance may be provided will not be approved. Waiver requests that do not include defined, measureable goals, will not be approved.

State waiver proposals must include a federally-approved evaluation process as well as interim performance targets that ensure an immediate focus on measurable outcomes. These waivers are also about more, not less, accountability.

In keeping with the spirit of innovation flourishes where there is flexibility, we will consider a wide range of models to increase employment and put more people back to work. 

For example, states could align and better coordinate employment programs for low-income parents funded by Department of Health and Human Services with workforce training programs funded by the U.S. Department of Labor. No state has to do this.

If they are happy with the current welfare system as initially established under 1996 welfare reform, they can continue to operate that way.

But if they think they have a better idea that will achieve better results, this opens the door to those innovations.

This outcome-focused approach will allow states to shift time and resources from a process-oriented and bureaucratic reporting structure to one that requires real results for parents and families.

Their performance in meeting these benchmarks will be publicly available, so everyone can evaluate how states are doing. 

If states are not meeting their performance targets, their authority to test new ideas will be terminated.

We are adopting this policy after we received requests for more flexibility in the TANF program from a number of states, and received inquiries about waivers from Utah, Nevada, California, Connecticut, and Minnesota. We expect that these efforts will help more parents find jobs and provide for their children.

So, I hope you will take this opportunity to engage the leadership of your state’s human services and workforce development agencies in a discussion of how they can use these waivers to get those Americans who most need it back to work in meaningful, well-paying jobs.

Another, more broadband, system-wide initiative that will provide the states a great amount of funding and flexibility is the HHS’s Interoperability Initiative.

Even if you haven’t heard that phrase before, which, quite frankly isn’t very intuitive, you are familiar with the concept. It is, essentially, about creating the one-stop shop for families in need. You may have heard it called service integration or common eligibility before. This is the same thing. Except now, it’s real and coming your way.

For state governments this is platform for reducing costs, eliminating fraud, increasing efficiency and ultimately it’s about providing the most complete set of services a family is qualified for.

In doing so, these families will receive all the benefits for which they are qualified. Instead a of piecemeal approach that can sometimes a person in the system, when you ensure they are enrolled in and receiving all applicable services in wraparound fashion you will move that person to economic and social self-sufficiency much more quickly and effectively.

If you agree with this concept, and it’s difficult to imagine a state that wouldn’t want to move its citizens to viable self-sufficiency sooner rather than later, then all you have to do is allow all of your human and social service systems and databases to talk to one another and to those of the federal government.

Again, all you have to do is agree. We will provide all of the technological assistance and technology transfer necessary to help you make this happen. Where you need financial assistance, we will provide that too. And that deal is one that every state should accept.

The federal government will provide 90 percent of all funds necessary for you to build out your social service systems. You provide the other 10 percent. Normally the going rate is more like 50 percent federal match. Even better, you have until Dec. 31, 2015 to draw this money down to help you build and perfect your system.

So, picture a system that allows states to root out fraud more easily because all of your systems are linked with all of the federal databases. You will be able to identify who’s receiving assistance but shouldn’t be easier than ever before. Moreover, you’ll be able to qualify folks for services that before went unused due to lack of system coordination.

You are not compelled to make your systems interoperable with one another or the federal government’s, it is not the law, but it is the right thing to do…for states and for your citizens.

There is real value here no matter your political persuasion. So, again, we may be providing some guidance and asking you to join us to make human services more efficient and effective, but we are not compelling you as states.

Another area where the Obama Administration is exploring ways to spark state level innovation is in the area of child welfare. The IV-E waiver is the vehicle and has for years states have used it create foster care and adoption services to greatly reduce the number of children in out-of-home care, while increasing the number achieving permanency within the federal time standards.

That’s good for states, but it’s been great for kids. When it comes to safely reducing the number of children in foster care and reuniting them with their parents or finding permanent loving homes through adoption, we have seen profound improvements brought about by granting states more control over how they spend money.

Where states took full advantage of the flexibility that came with the IV-E waivers, we saw innovative approaches in family safety services that led to dramatic reductions in the numbers of children in out-of-home care.

Since those states were allowed maximum spending flexibility, they also saw corresponding increases in children achieving permanency within the federal time standards.

So, from the first, extremely successful, round of IV-E waivers, we learned many things about getting children out of foster care and into permanent living arrangements through reunification, adoption and guardianship.

In Florida, perhaps the largest single IV-E waiver experiment, the innovation concept included local communities as well. We asked communities to step up and lead the effort to create a new system of care there. The community based care model was so radical at the time; many didn’t give it a chance to succeed. Now, it’s a model to be emulated.

It worked and it worked well, because it approached foster care as a local issue involving local families and local children. But now it’s time for the next round. And, just like in the first round, this round is about making the entire system better…..one child, and one family, at a time.

In the first round of waivers, we were looking for responses to address an unprecedented and sustained surge in the number of children entering the system.

Nationwide, between 1988 and 1999, the number of children entering the system doubled. Many factors contributed to the increase. Not the least of which was the crack cocaine epidemic and an unfounded fear that society was producing legions of uncontrollable children.

This near hysteria led to an unprecedented, and ultimately unsustainable, rate of removals. The Adoption and Safe Families Act of 1997, which created the first IV-E waivers, focused on child safety, well-being and permanency. There were just too many children coming into the system and they were staying far too long.

The policies and regulations that flowed from ASFA and what we learned from the state’s experimenting with the IV-E waivers, led to a 30 percent reduction in the number of kids in care.

Many of you in this room are to be commended for the work your states did to move the needle in the right direction on this issue.

We know that if you allow states to spend federal dollars in the way they see fit to meet a host of guidelines, they will meet and exceed your expectations. Now, it’s time to move the next phase in the evolution of the child welfare system….the quality of care for every child and his or her family receives while they are the responsibility of the state.

In other words, we’ve figured out the best strategies and evidence-based approaches to making and keeping the system smaller. It’s time to make the system and the care it delivers better.

We have more data, we have the science; we will soon have better family interventions, better treatments protocols, and undoubtedly better outcomes for kids and their families.

When the newest round of waivers were announced there were many who were skeptical. They thought we had perhaps set the bar too high.

People wondered if we’d actually get enough applications for the 10 potential waivers we could award. I am happy to announce that we have received proposals from 13 states and still others have expressed an interest. I ask, when it comes to providing care for broken, battered and traumatized children, can we really set the bar too high? If you want mediocrity, you get it. If you expect greatness, you will get it.

In the name of children, I would rather set the bar high, driving innovation toward the best of what is possible, knowing that children and families will benefit from your innovations. The alternative is unacceptable.

We have learned so much in the past 15 years, and we are now in position to leverage that knowledge so you can push your systems further. I appreciate the difficulties you face, but we now have the confidence that this is ultimately doable. So, what are we asking this round?

We asked for proposals that are looking to put in place new, but tested services that increase behavioral and social functioning of the children who come into the system.

We are encouraging a greater alignment between mental health diagnosis, assessment and treatment planning, as well as partnering with the state’s Medicaid office.

In the end, we will be awarding grants to those states who demonstrate the ability to:

• Increase child and family functioning
• Improve mental health outcomes
• Mitigate trauma symptoms
• Decrease rates of psychiatric hospitalization
• Decrease use of psychotropic medications
• Increase parenting skills and capacities
• Improve child functioning at home, school and community

I think a lot of states have begun to really focus on the quality of care they are providing. One of the most significant developments of the past 5 years has been the focus on trauma and how that affects every child entering the system and how it manifests itself acutely and long-term.

Trauma-informed care has revolutionized how we assess abused, neglected and abandoned children, and it informs the entire case management plan for that child.

So, in this round of waivers, the reason we asked states to get creative in how they would partner with Medicaid was simple.

We wanted to make sure the proper mechanisms are created to ensure children exhibiting trauma related symptoms gets the full level of correct treatment they require.

We’ve asked states to submit proposals that go beyond the already required assessments and screenings at intake and remember that trauma is repressed in some cases at the early stages and then manifests itself later in some children and vice versa.

So, without adding too much to the cost of care and by asking states to develop new funding streams through their Medicaid partner, we wanted proposals that understood screenings should occur periodically throughout a child’s time in care.

This, by the way, is already the law. The IV-E waivers do not introduce any new requirements. We are saying, though, if you want a waiver, you must commit to these periodic screenings.

With the additional, in-depth screenings it will become easier and easier to address the broad range of mental health issues children in care experience. This is important because many, if not most, kids who enter the system do not come in with, nor do they receive upon initial screening, a mental health diagnosis.

That said, most, if not all will exhibit troubling behaviors from acting out to non-clinical depression.

Part of what we expect long-term is significant scientific data that we can present to the Substance Abuse and Mental Health Services Administration, for analysis and guidance for future diagnostic screenings.

As we already know from the screenings we do, the better and more accurate assessment we have of a child at intake, the better his chances are of receiving meaningful and appropriate care and interventions.

Ensuring that each child receives periodic updates of those initial screenings will allow case managers across all child-serving agencies to adjust diagnoses, interventions and treatments as needed throughout that child’s time in care.

There have been some very exciting proposals submitted so far. Many are focusing on how to assess and measure the functioning trauma symptoms so that caregivers can compare apples to apples from intake through placement and ultimately to permanency.

Sure, there are cost implications, but there are cost implications for not doing this as well.

Better assessments mean better treatment. Better treatment means lower recidivism. Lower recidivism means reduced costs in the long term.

By keeping kids from coming back into the system, we’ve reduced the likelihood they will crossover into the juvenile justice system--creating even more cost savings.

So, please watch this next round of innovation closely with us. We will only approve the most rigorously evaluated interventions…those that focus on parent and child interaction therapy, child-parent psychotherapy and trauma-focused cognitive behavioral therapy, among others.

As a spur to innovation, the IV-E waiver works and I look forward to learning from what you learn and sharing it with your colleagues from other states.

That was a lot of ground to cover, but it is important that you know your president and his administration are committed to working with you to address the long-term issues facing our country.

I look forward to working with you. Thank you.