Human Services Policy Advisors Institute

Speakers

*Sheila Smith, Co-Director of National Center for Children in Poverty: minutes 9:30 – 27:00

*Sheri Dawson, Director of the Division of Behavioral Health for Nebraska’s Department of Health and Human Services: minutes 27:00 – 49:00

Background

In the wake of the pandemic, Governors across the country are grappling with an ongoing youth mental health crisis exacerbated by the Pandemic. States are searching for solutions to provide quality mental health services for complex child welfare cases, address new student stressors due to the pandemic and school violence, and reach children in rural communities. Compounding these issues, the country faces a nationwide mental health provider workforce shortage that has created a barrier for high-risk populations to access services. According to the American Academy of Child and Adolescent and Psychiatry, nearly 1 in 5 children face a mental health issue but only about 20% receive care.

Key Takeaways

Preventive services and trauma-informed care delivered through specialized providers can mitigate the long-term impacts of complex conditions:

• Children involved in child welfare are more vulnerable to mental and behavioral health issues that can lead to long-term struggles with education, relationships, and overall well-being.
• Child mental health providers need specialized knowledge and training, including an understanding of early development, parent/child relationship stressors, and an awareness of treatments and diagnoses.  

States can utilize flexible ARPA funds to advance mental health policies and resources and equip providers with the specialized skills and training they need to provide quality care to children. 

• Georgia is using ARPA ESSER funds to increase the number of school mental health providers and establish school-based health clinics
• Massachusetts is using ARPA funds to invest over $100 million in strengthening and stabling Home Community Based Services provider workforce in response to COVID-19
• New York is investing $21 million in ARPA funds to recruit and retain, cover education expenses, and provide career development and training to mental health providers.

Investments in career pipelines and apprenticeship programs can address workforce shortage and capacity challenges through early recruitment efforts. Pipeline programs like Nebraska’s Ambassador Program and F.A.R.M C.A.M.P have allowed expedited recruitment to combat the dire shortage in the state’s most rural areas.

Spotlight on States

Arkansas:

• Increased existing clinician capacity by offering subsidized training for evidenced-based IECMH treatments.
• Offered a 10% higher Medicaid reimbursement rate for trained clinicians.
• Recruited and supported providers from underserved areas of the state with mentorship programs and subsidized Infant early childhood mental health (IECMH) training.

Colorado:

• Increased existing clinician capacity by offering subsidized training on evidenced-based IECMH treatments through the state’s Right from the Start program. Offered IECMH training to home visitors, early childhood education providers, clinicians, and nurses.

Washington:

• Used IECMH consultants to support direct service professionals (home visitors, caseworkers) through the state Best Starts for Kids Workforce Development Program.
• Recruited diverse leaders for a yearlong IECMH community of learning cohort to increase clinical skills and training.

Nebraska Spotlight Programs

• Frontier Area Rural Mental Health Camp and Ambassador Program (slide 10): High school exposure/training provides an opportunity for interested high school students to learn about behavioral health professions and support a pipeline from high school to the workforce.
• Virtual Mentor Network (slide 6): Connects interested high school students to behavioral health professionals to ask questions, discuss behavioral health topics, and connect with professionals who are in psychiatry or psychology.
• Community Crisis Consortium (slide 11): A collaboration of mental health providers to share the burden of “being on-call” by expanding technology, training, and designating responsibilities.
• Primary Care Training (slide 13 & 15): Expanded the capacity of local primary care physicians to handle child mental health concerns in their communities by offering free or low-cost IECMH training

Speaker Summaries

Sheri Dawson, Director of the Nebraska Division of Behavioral Health under the Department of Health and Human Services: Nebraska has taken cross-agency collaborative steps to combat the mental health provider shortage, including the innovation of the Behavioral Health Education Center and the development of partnerships with the Division of Family Services. Nebraska has launched several pipeline programs, like the state Ambassador Program and F.A.R.M C.A.M.P, to connect high school students interested in a career in behavioral health with skills and training opportunities. The state has also expanded provider capacity by offering subsidized mental health training to primary care physicians. Nebraska’s philosophy is that there is no one strategy to tackle the provider shortage – a whole-system approach is necessary to break bureaucratic silos and collectively address a multi-faceted issue.

Sheila Smith, Co-Director of National Center for Children in Poverty: Sheila is a subject matter expert focusing on supports for infant and early childhood mental health (IECMH), including the need to support specialized IECMH training for clinicians. Clinicians must consider and factor in impact of childhood events and parent/child relationships on early development. Dr. Smith discussed successful state models and emphasized the importance of mental and behavioral health support for children involved in the welfare system. Dr. Smith gave several examples of states building the capacity of existing providers to support IECMH treatments, including from Arkansas, Colorado, and Washington.

Resources

• National Center for Children in Poverty Slide Deck
• Nebraska Slide Deck
• Session Summary

Speaker

Lisa Cauley – Senior Director of Child, Family, and Adult Services for the North Carolina Department of Human Services, Division of Social Services

• Slide Deck

Background

Title IV-B of the Social Security Act is scheduled for reauthorization in Congress this year. This funding stream supports children in the child welfare system or at risk of entering care, designed around prevention and early intervention.  These discretionary grant programs have allowed states to develop complementary programs and supportive services that cater specifically to states’ priority populations and initiatives. Reauthorization presents opportunities to strengthen IV-B so governors can better utilize this funding stream to support children and families working with child protection services.

Key Takeaways

• Child and adolescent mental health, community-based services to reduce and prevent child maltreatment, and reunification supportive services for children in foster care remain priority areas w/in human services for Governors and policy advisors.
• Burdensome federal rules and regulations create barriers to states’ ability to utilize funding in an efficient and effective manner
• Flexibility in utilizing IV-B funds would assist states’ ability to provide critical individualized resources that layer on top of other child welfare services (like title IV-B) to keep families together when possible

State Discussions

The greatest barriers states experience when utilizing IV-B funds include:

• Inability to braid and blend funding allocations creates barriers to spending smaller amounts of money allocated from IV-B
• Limitations on using funds for children’s medical services when Medicaid is unavailable
• Strict regulations on funding sources prohibit states from customizing services and programs to meet families’ individual needs
• Cumbersome short grant cycles for Kinship Navigators strain administrative resources (I.e. cost, time) that are already limited

State perspectives on improving the use and coordination of IV-B funds include:

•  Raise the limitation on administrative costs from 10% to 20% to meet need for additional staff capacity and equipment
• Allow states to use IV-B funds on concrete supports and legal services for family reunification, as allowed under IV-E
• Promote and encourage collaboration with sister agencies providing medical, mental health, and workforce supports to explore pilot programs for innovative service delivery
• Increase flexibility for uses of funds to include purchasing necessary technologies for child protective services visits, including tech and devices are compatible with remote visits and monitoring.

Governors’ greatest priorities around prevention, reunification, and adoption include:

• Improving child and adolescent mental health and education
• Providing access to community-based and home-visiting programs
• Addressing parents with substance use issues through targeted Parent Partners program
• Preventing the maltreatment of children through prevention services
• Prioritizing the family reunification of children in care

Speakers

• Thea Ramirez, Founder and CEO, Adoption Share—A technology nonprofit helping states to reduce barriers to adoption through their Family-Match application, which predictive analytics to match children with their forever families.
• Jamia McDonald, Public Sector Strategy and Operations at Deloitte—Expert consultants assisting states in building predictive models to monitor workload efficiency, understanding staffing needs, analyzing bottlenecks, and automation for improved delivery of social services programs.

Summary

Adoption Share

• Family-Match utilizes technology to identify appropriate connections between child and adoptive families. By bridging technology and the agency worker’s clinical skills, scientific attributes provide predictive pairings between the child and family.
• Technology is the driving force of innovation and reform in health and human services; by employing efficient and cost-effective data and methodologies, enhanced outcomes for individuals and families can be realized faster and on a larger scale.

Deloitte

• In preparation for the unwinding PHE, Deloitte has assisted states in building predictive models to monitor workload efficiency, understanding staffing needs, analyzing bottlenecks, and automation.
• The unwinding PHE has the potential to create service and support disruptions for individuals; predictive analytics are helping states bridge and prevent the service gap by creating warm hand offs for clients that will be impacted by the decrease in FMAP.
• ARPA funds allow states to explore improvements to program integrity through enhanced oversight and program analytics:
• Opportunities to leverage ARP funds include technology investments, evaluating complex policies to support staff, implementation of automation to lower error rates in benefits applications, and streamline processes.

Key Takeaways

Adoption Share

• There are children in US foster care systems who are eligible for adoption and do not have a family identified to adopt them. Prospective adoptive families outnumber children who are waiting to be adopted by a ratio of 5:1. It’s not scarcity and lack of families, it’s a breakdown in connection between children and eligible families. “It’s a connection problem”.
• In July 2018 Adoption Share matched 700+ children, placed 450+ children in pre-adoptive homes, and finalized 310+ adoptions. Florida forecasts potential savings of $38million over a span of 8 years.
• 3 Core Principles for Program Success:
  • Inverse the Outreach: Focus on finding the best family for a child’s needs.
  • Visibility is Key: Build out a centralized repository of families to allow workers to access a broader pool of candidates quickly.
  • Leverage the Data: We gather data from families and children and use to make the best possible matches beyond the family’s preference.

Deloitte

• Administrative dollars in SNAP are where states have been innovating the most to drive change. States have focused on addressing structural issues through Self-Serve portals, expanding capacity, automation, training for service delivery, and outreach to vulnerable populations.
• In Pennsylvania – DHS caseworkers received a high volume of calls regarding Pandemic EBT eligibility, creating a significant backlog for processing eligibility.
  • Office of Income Maintenance (OIM) developed a call center to triage the volume of calls.
• OIM also developed a robotic process automation (RPA) bot to compliment the caseworker’s intake capacity, which cleared the backlog and reallocated 2 dozen FTEs. In Kentucky– Kentucky “KyNet Benefits” consolidates existing communication tools increasing resident engagement and program efficiency.

Resources

• Session Presentations
• Family Match: Slidedeck | Info Sheet

Speakers

Wyoming:

• Jen Davis, Policy Advisor for Governor Gordon
• Katie Hogarty, CEO of CLIMB Wyoming

Michigan:

• Algeria Wilson, Policy Advisor for Governor Whitmer
• Joe Billig, Division Administrator, MI Department of Labor and Economic Opportunity

Summary

CLIMB Wyoming:

• A nonprofit organization partnering with the state’s TANF program, with a specific mission to serve low-income, single mothers so they can achieve self-sufficiency through career training and placement.
  • State TANF dollars are used to provide career training and placement supports to extremely low-income moms that are within 30%-40% of the federal poverty level
• Utilizes a trauma-informed approach to meet the needs of their mothers and ensure that they have the tools they need to obtain and retain a good job and transition into industries that offer family-sustaining wages, including plumbing, pipefitting, trucking, and professional office careers
• 80% of CLIMB Wyoming graduates double or triple their monthly wages just two years after graduating the program

Michigan:

• SNAP E&T program is a critical part of Governor Whitmer’s 2022 $2.1 billion New Economy plan that aims to lift individuals out of poverty and back into the workforce
• Michigan’s model is a volunteer SNAP E&T program that links together MI Department of Health and Human Services and MI’s Workforce Development Agency, and leverages both 100% and 50/50 SNAP E&T reimbursement funds

Key Takeaways

Proactive employer and business engagement is critical to ensuring that program participants obtain promising jobs that meet community needs—dedicated staff that manage relationships with local businesses are essential to the success of both these programs.  

CLIMB Wyoming:

• Intentionally keeping training programs short (~8-10 weeks) can minimize the financial cost incurred by moms when they take time away from the workforce to invest in reskilling and workforce training
• CLIMB Wyoming provides participating mothers with options for their career development by connecting them with 5-6 potential employers to determine the best fit, and keep participants engaged
• Focus on Soft-skills development: training in problem-solving, communications, and executive functioning are critical to success in the workplace but are often left out of traditional workforce training programs

Michigan SNAP E&T:

• Michigan engages community partners to mitigate real local workforce shortages while bridging the transition from participant training to employment
• Program Promotion of is a critical part of recruitment: Michigan created a toolkit containing templates for partners to use in various scenarios, including social media marketing, job fair collateral, or at American Job Centers specifically
• Michigan’s SNAP 50/50 program drew down more than $1.7 million dollars this year, offering targeted services to hard-to-reach populations, like the homeless or TANF-ineligible families
• External partnerships with FNS and the Seattle Jobs Initiative for technical assistance has been key to expanding 50/50 services and providing more support for participants entering the workforce

Resources

Session Presentations

Speakers

• Kentucky: Lesa Dennis, Deputy Commissioner, Kentucky Department of Community Based Services
• Iowa: Liesl Seabert, Rural Community Revitalization Program Manager, Iowa Economic Development Authority

Summary

Kentucky:

79 of Kentucky’s 120 counties (66%) are considered  child care deserts, where there are more than 3 children per available child care slot

In response, KY’s Department of Community Based Services, Division of Child Care (DCC) established grant programs to improve supply in rural areas and child care deserts:

• Child Care Desert Areas Matching Funds Grant – Provides matching funds up to 100%, to increase supply in rural areas (11 active grantees)
  • DCC is utilizing ARPA for start-up grants in counties experiencing child care deserts, and anticipates ~30 awards or until funds run out
• Family Child Care Startup Grant: One-time grants available up to $2500 to assist in covering start-up licensing fees and purchases of items needed to establish a family regulated child care home (14 active grantees)
• Business Partnership Grant Opportunities: helps support employers to provide their own child care services to their workforce (3 active grantees)

Iowa:

The Rural Child Care Market Study Grant program (RCCMSGP) supports rural communities in determining the specific child care needs, and provides resources for planning

• Iowa set specific thresholds for community eligibility to disqualify suburbs and focus on rural populations with the most need.  
• 7 grant recipients during FY22 totaled $70,000 in funding.

This genesis of this program represents a multi-agency approach: first conceived through conversations with Governor Reynolds’ staff, the Iowa Department of Management, Department of Human Services, Iowa State University, & a private sector partner, First Children’s Finance

• Collaboratively brainstormed how the program would continue on after initial funding ends so that grantees (city governments and nonprofits) are better positioned to embark and build on next steps with their own investments

Iowa modeled the RCCMSGP after another successful program (grants for renovation/construction for child care facilities) and housed the program within the Center for Rural Revitalization, in the Iowa Economic Development Authority

Key Takeaways

Sustainability is top of mind:

• In Iowa, communities found that current state resources and grant offerings weren’t actually addressing their underlying child care challenges, so market survey were employed to empower communities to investigate, instead of applying band-aid fixes
• No ARPA $$ support the RCCMSGP—Gov. Reynolds lobbied the legislature for state funds so that this funding can continue even after time-limited federal funds sunsets
• Kentucky prioritized bringing new providers on-line in child care deserts, without sacrificing current child care providers:
  • KY has been piloting programs to perform research on capacity of current providers, and receives constant feedback from stakeholders to ensure constant improvement

Tailoring solutions to specific communities helps to address the unique needs of different economic landscapes:

• Grant applications in Kentucky require prospective grantees to submit a business plan, including an environmental scan, so that the state can receive input from current providers on the child care landscape from the provider prospective
• In Iowa, market studies not only provided analysis of the economic landscape in communities, but also proved valuable as leverage with the business community to earn buy-in.
  • Small committees performed the market study, shared results with local private businesses, who were more willing to partner on investments which could be leveraged for more grant funding from the state.
  • Iowa has also started to layer in a business incentive grant program, to encourage private businesses to offer more child care services to their employees.