HUMAN SERVICES RESTRUCTURING TASK FORCE

October 27-28, 1997 -- Second and Third Meeting of Five

MEMBERS PRESENT

MEETING IN BRIEF

Minutes prepared by Richard Nelson, Legal Counsel
Organizational staffing by Patty Funaro, Senior Legal Counsel

1. Administrative Business.
2. Overview and Opening Remarks.
3. Issue Identification and Prioritization.
4. Results and Strategies.
5. Missouri's Caring Communities.
6. A Results-Based Framework for Planning, Budgeting, and Establishing Accountability.
7. Devolving Human Services -- Local Investment Commission (LINC).
8. Devolving Human Services -- Maryland's County-Based Model.
9. Action Plan.
10. Additional Meetings.
11. Materials Distributed to the Task Force and Filed With the Legislative Service Bureau.

TASK FORCE BUSINESS

1. Administrative Business.

Convening and Adjournment. The meeting was held at Willow Creek Conference Center located at the intersection of Army Post Road and 63rd Street in Des Moines. On Monday, October 27, the meeting convened at 9:55 a.m., continued through a working lunch, and recessed at 4:40 p.m. Members dined together informally at Christopher's restaurant in Des Moines. The meeting reconvened on October 28 at Willow Creek at 9:15 a.m., continued with a working lunch, and adjourned at 4:10 p.m.

2. Overview and Opening Remarks.

Overview. The members of the Task Force and its subcommittees participated in the two-day planning meeting, which focused on approaches used in Iowa and in other states for improving the overall human services system and for strengthening local, grassroots involvement in human services delivery. The meeting was coordinated and sponsored by the National Conference of State Legislatures with support from the Annie E. Casey Foundation, a national foundation dedicated to helping build better futures for children in the U.S. During the planning meeting, the Task Force members discussed and were presented with many ideas, concerns, strategies, and issues associated with improving the human services system and strengthening local, grassroots involvement in human services. The meeting format was designed to organize members and legislative staff into subgroups for discussion and reaction to presentations.

Meeting Order-of-Business. The results and strategies sessions and the presentation concerning Missouri's Caring Communities program took place on October 27 and the remainder of the business meeting described in these minutes took place on October 28.

Opening Remarks. Co-chairperson Houser opened the meeting with preliminary remarks, stressing the importance of reengaging the families and communities of Iowa. He indicated that the traditional rural values of the state are fundamental qualities which can assist in reengagement.

Co-chairperson Tinsman noted that traditional values are found throughout the state, in urban as well as rural areas, and emphasized that local input and control are key aspects of solving problems in the human services arena. She stated that local communities can and should be at the forefront of nurturing community members and families in need of assistance, and that Iowa is poised to become a leading state in this regard.

3. Issue Identification and Prioritization.

Subgroups. Mr. Ira Barbell, Senior Associate, Annie E. Casey Foundation, stated that the Task Force has a fairly broad charge, falling into the four basic areas of devolution, elimination of program duplication, reduction of red tape and bureacracy, and evaluation of the mission statement of the Department of Human Services. In an effort to provide focus to the work of the Task Force over the two-day period, he suggested that members form three subgroups and identify the top issues or priorities for which they consider themselves personally responsible. The groups were cautioned not to attempt to develop solutions at this point, but rather to identify, as concretely as possible, the primary issues which need to be addressed with the current system.

Issues Identified. Issues and remarks identified in the subgroups included the following:

• Devolution, outcomes, accountability, and the need for a consumer focus.
• Flexibility is an important ingredient of the devolution process. The public interest, which state regulation is designed to protect, must be preserved through accountability.
• Funding, as currently structured, fails to provide the appropriate incentives for devolution.
• Achieving funding and service equity, rather than equality, should be the goal.
• Broad philosophical decisions regarding devolution need to be made, because there may be some aspects of human services which should be performed at the state level.
• A fundamental question involves what the appropriate role of government should be in the lives of citizens. What is the responsibility of government at the local, state, and federal levels? Accountability can be viewed as a common thread between the state and local levels as being similar to the fundamental role and nature of parents as accountable for their children.
• The funding of administrative overhead to provide protection through governmental regulation must be balanced against the reduction of funding for necessary programs and services.
• The distinction between local government and local governance is a significant issue.

Key Issues. Based on the small group discussions, Mr. Barbell identified devolution and the determination of state vs. local roles; funding incentives; accountability of a family, local governing entity and state governing entity; and the appropriate role of government as key issues to be further examined for the remainder of the meeting.

Other Issues. Mr. Barbell expanded on some of the additional issues facing the Task Force, relaying the results of surveys of the general public which indicate that public dissatisfaction with government at every level appears relatively high. He noted that consumers express a high degree of skepticism in the motivations and effectiveness of government, coupled with the conviction that the public is not getting its money's worth through government expenditures. While a majority of those surveyed feel government has a responsibility in meeting the needs of families, and there has been a slight increase in public confidence in government, the issues of an increased need for accountability, a results-focus, better management at all levels of government, and local-level citizen involvement are consistently cited as concerns.

Mr. Barbell also identified personnel issues as potential obstacles to devolution efforts. The job classification system inherent throughout most levels of government may be an obstacle to any meaningful attempt to reclassify or redesign the provision of services from a state to local level. The current system does not generally support the flexibility needed to achieve meaningful change.

4. Results and Strategies.

Task Force members resumed small group work to identify results which they would like to see achieved and feel could reasonably be accomplished and strategies for achieving those results. The groups were instructed to utilize a "two years out" framework - results and strategies for development and implementation two years from being initially put into action.

Results. Results identified by the subgroups included the following:

• Maintaining quality family life within the state by placing core services, standards identification, and responsibility for implementation of federal regulations at the state level, and providing local governments with more authority and accountability through pooled funding streams and expansion of functions that are a part of the decategorization process.
• Maintaining preventive services at the local level, with local administrators having more flexibility than their state counterparts.
• Achieving a means of overcoming obstacles presented by the national accreditation and regulation of services providers.
• Moving additional funding sources to the local area through devolution and pooled funding streams and simplifying training requirements and the rules applying to human services caseworkers to arrive at a less complex system.
• Allowing local level entities to identify and define their own needs and methods of linking their needs to the goals set at the state level. Developing a method of measuring results. Employing various incentives at the state level, to assist and reward local level involvement -- perhaps financial -- by providing enhanced flexibility, etc.

Strategies. Strategies proposed by the subgroups for accomplishing the identified results included the following:

• Using an incremental approach, combining a portion of appropriations from each agency into a decategorization funding stream.
• Revamping the legislative subcommittee appropriations process to appropriate funds in a more meaningful fashion -- perhaps by age classification or geographical region -- instead of by subject or program area.
• Simplifying the procedure for suspending an administrative rule which does not have practical application at the local level.
• Pooling funding streams between the Department of Human Services, Iowa Department of Public Health, Department of Education, the Judicial Department and any other department by way of an appropriations bill, which requires integrated planning and budgeting and local level community/stakeholder identification of potential barriers to pooling of funds.
• Building on the effort of the Program Duplication and Resource Utilization Subcommittee by requesting that department heads join together to reduce duplication wherever possible.
• Examining goals identified by the Council on Human Investment (CHI) and submitting recommendations regarding the goals to the General Assembly for action.

5. Missouri's Caring Communities.

Mr. Steve Renne, Deputy Director, Missouri Department of Social Services and CEO of the Family Investment Trust, described the development and operation of the Missouri's Caring Communities Program. The program was created by Executive Order in 1993, based on a perception that the state-level categorical funding stream structure was not operating to the benefit of the children and families for which funding was appropriated. The Order called for five agencies to work together in an interagency manner to pool resources and integrate services. A Family Investment Trust entity was created and charged with making the system more responsive to families. The Trust is a private/public sector partnership, with technical assistance, funding, and support provided by "Foundation Partners" -- foundations representing private industry or individuals. Seven state agency directors and five private sector board members comprise the Trust.

Fundamental to the operation of the Trust is the understanding that to achieve the state's vision for children and families, all agencies involved must accept mutual responsibility for achieving identified core results. The program strives for shared decision making and community engagement, with the community and the state jointly sharing in goal setting and responsibility for results. The objective is to arrive at a consensus between state agencies, community partnerships, and various site councils which bring together stakeholders within the community partnerships. The program defines "community" loosely -- essentially a community defines itself. In 1995, the agencies involved received an interagency appropriation of $22.4 million. To date, $12.4 million has been expended and has been matched, to a significant extent, with local and other state fund investments outside the budgeting process. No funds were requested or required for additional administrative overhead expenses, and few regulatory changes were needed to implement the program.

6. A Results-Based Framework for Planning, Budgeting, and Establishing Accountability.

Mr. Mark Friedman, Executive Director, Fiscal Policy Studies Institute, Baltimore, Maryland, discussed how the development of a results-based framework can be achieved and how this framework facilitates in the planning and budgeting process, and leads to establishing accountability.

Definitions. Mr. Friedman began his presentation by setting out definitions of terms such as "results" or "outcomes", "indicators" or "benchmarks", and "performance measures" which require a common understanding of meaning to be usefully applied in achieving a results-based approach. Mr. Friedman presented a list of representative outcomes for children, families, and communities which are fairly representative across state programs, and examples of indicators and criteria for selecting them. Indicators may be viewed as a "report card" on state progress with respect to a particular outcome or series of outcomes, capturing what results mean in measurable terms. Mr. Friedman indicated that a majority of state programs tend to end the process after identifying results and indicators, thereby missing an important next step -- the evaluation of "what works" through indicator baseline graphs, cost-of-bad-outcomes baseline graphs, and cost benefit analyses. These types of graphics and analyses can provide an audit trail from a budget decision back to the identified results sought.

Mr. Friedman stressed the importance of describing desired results in simple, everyday language. He suggested the use of a "town square" test by which desired results should be framed so as to be readily understood by the general public hearing them explained in a town square setting.

7. Devolving Human Services -- Local Investment Commission (LINC).

Overview. Mr. Tim Decker, Executive Director, described the evolution of the Local Investment Commission of Greater Kansas City, Inc. (LINC). The organization was established in 1992 as a citizen-based board composed of civic and neighborhood leaders jointly assuming responsibility for improving the outcomes of local children and families. Goals of the organization include improved coordination of human services systems at the neighborhood level, promoting economic development, revitalizing neighborhoods, improving access to health care, and ensuring neighborhood safety.

LINC is also the local administrator of the Caring Communities initiative at 16 schools throughout the Kansas City area. In structuring LINC, the participants determined that a new form of neighborhood governance system could be achieved by expanding and working with existing structures and by utilizing professional and systems development efforts. The program developed core results to achieve and determined that a "neighborhood" would comprise an 8-10-square-block geographic area.

Foundation Beliefs. Underscoring the initiative was the identification of "foundation beliefs" such as accessibility of services close to where a child attends school, that residents best understand their own immediate living environment, that professionals are most effective in working with a neighborhood rather than in place of it, that neighborhoods will be strengthened most effectively through residents' attitude of ownership of the area, and that there are hidden assets in most neighborhoods which can be harnessed effectively to improve conditions there. Site councils are key decision groups within a neighborhood which are composed of local residents and organizations. Site councils are funded and empowered to choose service providers and negotiate contracts. Services for LINC stem from a $3.8 million appropriation across seven state departments as described in the Missouri Caring Communities presentation, matched by approximately $4 million in additional support.

8. Devolving Human Services -- Maryland's County-Based Model.

Mr. Chuck Short, Director, Montgomery County Department of Health and Human Services, Montgomery County, Maryland, discussed devolution efforts in his county. The county has been the subject of a recent initiative in which the state provides a block grant to the government of the county, involving the delegation to the county from the state of the responsibility and funding for administering many types of health and human services. This has involved a shift of state employees to a county employee status and a reorganization of the administrative system, including consolidation of health and human services into a single county agency. The combined system developed out of a resolution in 1994 identifying what state government ought to consider in writing block grants and legislation in 1996 moving responsibility for health services within that county to the local level and combining state and county functions. Legislation also expressly allowed for a less restrictive level of confidentiality between groups and functions, thus facilitating the collective process. Budgeting was changed to a program basis, rather than a department basis, procurement laws regarding contracting were eased, middle-manager job classification grades were reduced or eliminated, and vendors were viewed as private partners. The experience of the county has been that the devolution effort allows much more flexibility and autonomy, but also creates a heightened moral obligation and responsibility.

9. Action Plan.

The Task Force resumed small group work for consideration of the top priority issues, results, and strategies, based upon their previous small group meetings and the presentations. Follow-up strategies ultimately determined, which will be utilized by Task Force members during future meetings and during local forums to be held to gain local input and reaction, include the following:

a. Utilize a results-based framework for human services, which emphasizes accountability and flexibility.

• Identify Desired Results. Develop a system for the state to obtain grassroots input in identifying desired results for citizens. These identified results should be used by the Governor, state agencies and communities, and the Legislature in the planning and budget processes.
• Examine Existing Efforts. The Council on Human Investment (CHI), a state-level council, has extensively solicited community input in identifying a set of desired results for the state. However, the Legislature has not formally considered them. The Task Force and the Legislature should consider the work performed by CHI and formally modify, accept, reject, or endorse the identified results.
• Increase State-Level Interagency Coordination and Integration of Human Services. The human services system at the state level should be comprehensive, less categorical, and more integrated across agencies, programs, and services. Agencies should do more formalized, results-focused, interagency planning, programming, and budgeting.
• Local Implementation. Balance the needs for accountability and flexibility by developing a process in which the state, with the input of local communities, identifies a set of desired results for Iowans, provides communities with flexibility to address these results, and requires accountability based on achieving the desired results.
• Core Services. The state should identify those core services which should be available throughout the state supported by state funding. Communities could supplement the core services, as appropriate, for their particular needs.
• Simplify State Regulation. Ensure that regulation is consistent with achieving the desired results. Eliminate duplication in regulation and certification. For example, accept a certification from a recognized accrediting body in lieu of a state requirement.

b. Pool Funding and Resources.

• Beyond Decategorization. Expand the state and local involvement in existing decategorization projects and innovation zones to incorporate other public funding streams such as education, welfare, work and training, and health. In addition, incorporate charitable efforts and develop local resources to a greater extent.
• Revise the Appropriations Process. Revise the appropriations process used by the Governor and Legislature so that budgets are no longer state department- oriented. Consider pooling moneys for decision making based on other factors such as age group, geographic area, desired results, or service need. Consider appropriating funds on a multiyear basis.
• Shared Appropriations. Designate a certain portion of current departmental budget streams to be jointly considered by the related legislative appropriations subcommittees. For example, Human Services, Education, Justice System, and Health and Human Rights could have money pooled to be directed to common populations. The departments could develop a joint recommendation.
• Block Grants. Establish a pilot project of block granting human services to be operated at the county or other appropriate level, similar to the approach being implemented in Montgomery County, Maryland.

c. Enhance local governance.

• Grassroots Involvement. Link grassroots citizen involvement with local governance. Engage citizens, community leaders, and business leaders. For example, require a local effort to include citizens who represent a specific population within the community. Citizens should be "owners", not just consumers of the system. Perhaps provide a model to be used in negotiating a local governance structure.
• Provide Technical Assistance. Engaging local resources requires training and staffing. It may be an appropriate state role to provide this type of technical assistance to local efforts. Some community groups may require involvement together for a significant period of time to become effective.
• Assist in System Change. Public employees and employees of service providers know how the current system works. Their skills and knowledge are just as vital to a changed system. To obtain committed involvement in a changed system, the state could invest in training these employees.
• Technology. In addition to the Iowa Communications Network fiber optic system which has engaged the education community, other projects are reviewing enhancements in information sharing. These and other state efforts to engage local involvement in developing useful technology tools administered by the state should continue.
• Review Boundaries. There is an array of different zones, districts, and areas established by different governments and agencies as a means to effectively provide services at the local level. Can some of the state-established areas be combined?

d. Eliminate Barriers.

• Data. Collect data based upon the results identified. Do not forego a desired result based upon not having the supporting data to measure performance.
• Training. Retool personnel to adapt to the new system.
• Culture. Change the organizational culture. Eliminate "turf" disagreements.
• Employees. If employees are displaced, how can they can be retrained? If the system is changed, what is the appropriate administrative structure? Would the administrator be the state, county, or other entity?
• Requirements. The only strings on funding should be minimal and for the purpose of accountability.
• Federal Requirements. Identify and address federal regulations, waivers, and legal barriers.
• Local Focus. Address obstacles to expanding decategorization or other local programs.
• Work at All Levels. Eliminate barriers between programs, services, and departments.
• Invest Resources. Any change in the structure of the system must be accompanied by an investment of resources, time, and personnel in change management. Personnel of affected departments, service providers, and other "owners" of the system should be retrained/reeducated in the results-based, service-linked orientation. Retooling must be accomplished in the state, public, and private sectors.

10. Additional Meetings.

The next meeting of the Task Force will be held on Tuesday, November 25, 1997, and the final meeting will be held on Thursday, December 18, 1997. The final meeting will involve formulating full Task Force and subcommittee recommendations.

11. Materials Distributed to the Task Force and Filed With the Legislative Service Bureau.

Iowa Human Services Restructuring Task Force Presentation Materials Binder:

1. Materials from Fiscal Policy Studies Institute:
   • Choosing a Common Language.
   • Results-Based Decision-Making and Budgeting Accountability.
   • Trading Outcome Accountability for Fund Flexibility.
   • Program Performance Accountability Within an Outcomes Framework.
   • Moving Toward Results: An Emerging Approach to Community Accountability for Child and Family Well-Being.
2. Missouri's Caring Communities.
3. Local Investment Commission of Kansas City.
4. Reinventing Human Services: Issues and Challenges for State Legislatures.

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