5 Trends Driving the Future of Human Services

April 1, 2013 By Tracy Wareing, executive director of the American Public Human Services Association and Howard H. Hendrick, director of Human Services Business Strategy for Accenture and former director of Oklahoma’s Department of Human Services

Henry Ford unveiled the Model T in 1908 in a defining moment that changed travel and manufacturing—and influenced American life for years. Ford’s innovation and others like it—the airplane, the television, the Internet and the mobile phone—shattered the status quo, introducing the next frontier in how people live and work. While it’s not the stuff of history books, human services innovation is equally powerful. It’s happening now, fueled by trends that help agencies deliver outcomes today while preparing for tomorrow. 

Today’s do-more-with-less environment is more the rule than the exception. The political pressure to avoid displaying material reductions in service while costs increase and revenues fall is driving change in human services. Leaders know that processes, technologies and cultures must all be part of the change equation to deliver high-quality, cost-effective services. A recent survey of 2012 Human Services Summit attendees revealed a consensus around the value of progressing along the Human Services Value Curve (a framework developed by Antonio Oftelie at Harvard University), citing it as a high priority. Yet respondents acknowledged that moving their organizations to greater levels of maturity is a significant challenge. 

How can agencies move through the challenges of change? What today’s pragmatic human services leaders understand is that innovation does not have to be an all-or-nothing proposition—and that it is never a one-size-fits-all proposition. Innovation can be about bold moves or subtle shifts, and it can occur all at once at scale or incrementally in pockets and across functional areas.

Whatever the future of human services innovation looks like, the key for organizations lies in making the most of the forces of change in alignment with their unique circumstances. It’s about harnessing burgeoning ideas, trends and innovations that can bring about outcomes and impact in the short term—and hold strong potential for continued progress five or even ten years from now. So what are the most promising trends in human services? And how can organizations take advantage of them to move to greater levels of outcomes and impact for the people they serve? 

Human services organizations sometimes have entrenched ways of working. It is not uncommon for service delivery functions within a single agency to be isolated from one another, despite redundancies that mean higher costs and lower-quality services. Government agencies and nonprofit community-based organizations often work in parallel, but rarely with explicitly common goals and practices. 

Recognizing the need to maximize resource use and offer fresh ideas, some human services organizations are breaking through longstanding barriers and exploring nontraditional partnerships with each other—both nonprofits and the private sector. The result is a new human services ecosystem where organizations forge interactive and interdependent relationships that are mutually beneficial and directed toward a common goal. 

This mix of new people and resources creates important advantages. Working together broadens the discussion around the role of human services with other state and community services. It forces every contributing organization to consider core competencies and determine how the collective can best function for greater, system-wide impact at less cost. It adds a client and community-centered approach to program-centered accountabilities, and creates stronger social services through collaboration. 

The relationship between the Arizona Commerce Authority and the Arizona Department of Economic Security reflects the potential of nontraditional collaboration. Once operating in isolation, the state’s job generation mechanism and its human services system are finding ways to come together to meet their distinct missions while seizing the potential for collaboration where clear intersections exist. 

If this trend continues over the next five years, human services delivery could change dramatically. Broad coalitions of organizations with the right skills and resources led by human services agencies would jointly provide coordinated, cradle-to-grave human services with a shared emphasis on work, higher paying jobs with skill-ready workers and early intervention—minimizing the need for deeper-end government services.

An extension of this partnership climate, pay-for-success contracts are gaining traction as an alternative funding mechanism for human services programs that pays providers of goods or services when outcomes are met. These arrangements take on a variety of forms, and social financing is one of them. The basic principle is to encourage outside investment in preventive social interventions that ultimately benefit the common good—and reduce the need for costly future remediation for which taxpayers will have to pay. 

In social financing, foundations or other non-government entities infuse capital for a specific intervention and, if a predefined social outcome is achieved, funders recoup their investment plus a reasonable rate of return. Prison recidivism programs in the United Kingdom and New York City number among those that have been funded via social financing. Similarly, Dakota County (Minnesota) Community Services, supported by the Bush Foundation, has explored the business case for its Re-entry Assistance Program, developed an outcomes measurement framework, and a re-investment design to support social investment funding. 

Not only do such pay-for-success models align incentives across sectors and promote the wise use of precious taxpayer dollars, they are rooted in a strong outcomes focus. To monetize social outcomes, value must be inherently data-driven and outcomes-based. This drives discussion on measurable impact and emphasizes return on social investment in an entirely new way. Non-government funding opportunities also tend to increase tolerance for the risks that accompany innovation. Continued momentum here could mean that, as soon as five years from now, agencies could regularly pay providers only when social outcomes are met or exceeded. 

The proliferation of data and the sophistication of technology to draw insights from it is a double-edged sword for many human services organizations. While today’s data-rich environment has brought an ability to measure outputs and some outcomes, it can also create a swirl of complex questions without easy answers. What data do we have? What data should we be collecting? How do we protect our data’s integrity? 

Descriptive and predictive analytics are at the heart of the information boon as organizations work to make data insight actionable. Human services agencies using analytics today are most often using descriptive analytics for simple reporting or to detect and correct non-compliance after transactions are completed. The more exciting promise of analytics lies in a more proactive application. Predictive analytics can increase understanding of the relative effectiveness of different programs so that interventions—and resources—can be smartly targeted for better outcomes. As one 2012 Human Services Summit attendee explained: “Analytics is the way we are going to be able to figure out where to target our resources.” 

There is also tremendous potential for organizations to deepen analytics insight to develop preventive interventions that stave off later traumas and future reliance on the social safety net among specific populations. Consider the story of the Hillside Work-Scholarship Connection, a public-private partnership focused on reducing dropout rates among at-risk youth, so they are ready for a productive life after high school. 

Working in the Rochester, New York school district, Hillside used predictive analytics to understand the relationship of specific risk factors—attendance, suspensions and standardized test scores among them—to graduation rates. Hillside understood that some students would graduate without their intervention, and other students would not graduate even with it. The organization developed a data-driven recruitment strategy based on which students would be the most likely to benefit from the program. It’s an approach that improves return on investment for participants and funders alike. 

As the use of analytics matures in the coming years, this success points to a future where key decisions, including resource allocation and service provisioning, are based on known impact and proven results in all aspects of human services delivery.

While public human services delivery is unlike anything in the private sector, this does not mean that agencies have nothing to learn from commercial practices. Even before Henry Ford’s day, the private sector had an R&D model where innovation was valued. 

The opportunity here is for human services leaders to fearlessly challenge “insider” mindsets that see only differences and inconsistencies between private sector and public sector services—and consider the potential of “outsider” innovations. The advantage lies in lower-risk innovation that aligns with consumers’ service delivery expectations. Agencies should consider the example of customer-centered organizations that use multichannel touch points, customer and product segmentation, targeted promotions and self-service options. Translated to the human services environment, such approaches could mean quicker access to jobs, job skill development, eligibility determination and other services, so that people can experience economic recovery faster.

Looking to service delivery innovators in retail, financial services, telecommunications and insurance, the Australia Department of Human Services is reaching people in new ways through service center experiences, self-managed channels and online and mobile options. Targeting students receiving stipends, the Department launched its first mobile app, which allows them to conduct a number of tasks from their smartphones. The Department reports that users are conducting an average of 40,000 transactions per week, which eases pressures on service centers.

As other human services agencies begin to explore such “outsider” practices, what’s business-as-usual in other industries may increasingly define the new face of human services delivery. 

Serving the whole individual, a tenet of human services transformation, is impossible without health and human services integration—from strategic vision through tactical implementation. A 2012 Human Services Summit attendee explained the vision, “The challenge is sustaining a long term strategy to be able to view our customers from eligibility determination through delivery of services and assess health outcomes of the overall populations.”

In recent years, there has been increasing momentum around the connection between these areas, some of it spurred by the requirements of the Affordable Care Act (ACA). Opportunities for coordinated service delivery and holistic planning and economies of scale for infrastructure investments should create positive value where planned vision exists at the start. 

As the mechanisms for paying for and delivering healthcare change post-ACA, it is an optimal time to come together and refocus on measuring the right kind of outcomes. This provides a richer understanding of how overall population health is often an indicator of the effectiveness of specific social programs, revealing “hot spots” for integration. 

Consider the Home and Healthy for Good program in Massachusetts. It provides housing to homeless individuals as a first priority and then focuses on health issues. Data have shown a significant drop in participants’ Medicaid costs, revealing a link between housing and healthcare costs, and highlighting a place where continued and even broader interoperability would likely bring additional value.

As states integrate health and human services, the future vision is one where the distinction between health and human services fades, both in theory and in operation, and wellness is defined holistically as a function of a person’s social, economic, physical and mental state.

Henry Ford’s use of assembly line manufacturing and interchangeable parts helped make the Model T affordable to the common man. While human services organizations share common ground around the need for change, the paths to change are varied. Different organizations will be ripe for different trends. Some jurisdictions are already rich in an entrepreneurial atmosphere, while others may need legislative action as a first step to incubating change. 

Yet for all, success will require adaptive leadership and a pragmatic approach that never lets the perfect be the enemy of the good. The search for improvement is continual, and reaching the next frontier requires the courage to lead. 

This article was published previously in Policy & Practice, the journal of the American Public Human Service Association.

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Oregon Explores Treadmill Desks for State Workers

Anthony Behrens worries that the Affordable Care Act is going to kill him, but not for the usual reasons cited by opponents of the federal health care law.

Behrens is a senior policy analyst in the Oregon Department of Consumer and Business Services Insurance Division. The task of implementing the health law has kept him sitting at his desk 12 hours during the day followed by another few hours at home each night.

Behrens was so alarmed by research pointing to possible long-term health consequences from sitting for extended periods of time that he pitched a solution to his local state legislator: installing treadmill desks that would allow state workers to walk at slow speeds while they are working.

“Even if you get regular exercise at a gym, you’re still going to die sooner if you spend a certain amount of time sitting at a desk,” Behrens said. “I didn’t realize that if you sit for an hour, from that point on your body shuts down and almost goes into hibernation mode.”

A recent study of more than 200,000 adults 45 and older in the Archives of Internal Medicine found that adults who sat 11 or more hours per day had a 40 percent increased risk of dying in the next three years compared with those who sat for fewer than four hours a day.

That conversation resulted in a legislative proposal for a pilot project that would fund treadmill desks for some state workers and study the effects on health and productivity. Treadmill desks range in cost from $400 to $5,000, but the hope is that the state could recoup its expenses through lowered health-care costs over the long run.

At a recent hearing on the bill, Mayo Clinic endocrinologist James Levine testified about the potential health benefits via video-conference call while walking on a treadmill desk. “We’ve had extensive experience in deploying these types of programs and universally have seen either positive responses from employees’ improved health or improved productivity,” said Levine, who is widely credited with popularizing the concept. Legislators in the room could see the technology in action while they mulled its merits.

Levine told lawmakers they should act on mounting scientific evidence about the consequences of being sedentary. In 2012 alone, Levine said, 1,300 peer-reviewed studies were published linking sedentariness with heart disease, obesity, diabetes, high blood pressure and other negative health effects.

“Even if one does go to the gym three times a day, and if you make your (recommended) 10,000 steps at the gym, the long periods of sedentariness that we experience at work are not offset by those intermediary, scattered episodes of gym-going,” he said.

Use of treadmill desks has taken hold in a range of private companies, including BlueCross BlueShield and Marriott (see video), but is not common in the public sector, in part because of concerns about upfront costs.

Republican U.S. Sen. Orrin Hatch criticized the federal Center for Medicare and Medicaid Innovation for its use of treadmills. “In a post-sequester world, where White House tours are being canceled and Easter egg hunts are being threatened, you can imagine why American people would take a very cynical view about federal employees being furnished with thousand-dollar treadmill desks,” he said at a recent hearing.

But to Republican state Rep. Jim Thompson, the Oregon bill’s sponsor, the potential benefits of treadmill desks far outweigh the costs. “It’s not unbearably expensive; one of those units costs less than the desk I have in my office,” he said. Still, Thompson said, the bill will have a better chance of passing if they can find some support from private donors.

“We are not designed to sit,” he said. “We talk about all these things we need to do to get people healthier, but when are we actually going to try some of them?”

This story was originally published by Stateline.org. Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Illinois DHS Digitizes Forms, Leverages Mainframe Technology

To most efficiently realize cost savings with an IT transformation, the Illinois Department of Human Services (DHS) decided against digitizing paper benefit eligibility forms the agency has been accumulating for years. Instead, starting early last year, the department started digitizing all new eligibility forms.

DHS secretary Michelle R.B. Saddler said the agency, which is responsible for providing integrated services through 100 Family and Community Resource Centers, generates 7 million paper forms a year. Given recent leadership changes at the state level, Saddler said the agency began looking for a new way to reduce paper and improve file management while maintaining cost efficiency.

“Part of the initiative led to discussion of needing to digitize file cabinets, but digitizing and imaging for the thousands of file cabinets that we have was really cost prohibitive,” Saddler said.

DHS CIO Doug Kasamis then spearheaded efforts to digitize and store three types of benefit eligibility determination forms, which collectively make up nearly 70 percent of the agency’s total form volume. These forms are currently created on the department’s mainframe technology.

But instead of sending the forms to a print queue for printing, they are now turned into PDFs with their corresponding metadata – like case number and recipient ID – and then stored securely in an IBM content management system. Within four weeks’ time, the content management system was deployed statewide for the DHS’ 200 offices and 2,000 case workers.

Kasamis said that the department determined it was more cost effective for the agency not to scan and digitize forms the department already has stored in file cabinets, and to only digitize forms from present day forward. The department’s records retention policy requires that forms be stored for five years, so as the DHS continues to digitize forms, forms that are currently stored in hard copy will be phased out.

“Rather than trying to figure out a way to scan all that legacy paper, we’re basically getting rid of 20 percent of our problem every year over the next five years,” Kasamis said.

The IBM technology cost the department $325,000 and Kasamis said the DHS saw return on investment within three months of deployment. In the future, the DHS plans to integrate its other 15 form types into the system to be digitized and stored electronically. Currently the electronic data is housed in Illinois’ statewide data center, but there are no immediate plans to migrate the data into a cloud computing environment.

Ken Bisconti, vice president of products and strategy for IBM’s enterprise content management software, said because the content management system is designed to hold large amounts of data, there isn’t a pressing need to delete files from the system after the forms have been stored electronically for their required five years.

“These content management systems are capable of storing hundreds of millions, if not billions, of items and documents,” Bisconti said.

According to Kasamis, the DHS has seen a reduction of 650,000 paper forms each month since the IBM technology was deployed in early 2012. The department has already reduced its paper load by 7.5 million forms.

Saddler said the new system will prevent the DHS from using 40 10-foot-by-10-foot file storage rooms per year for storing paper files.

In October of this year, the DHS will also implement a new system to follow new Affordable Care Act requirements. The agency plans to implement the Medicaid eligibility system and integrate it with its IBM content management system. According to the DHS, some legislative uncertainties remain regarding the Affordable Care Act, so issues surrounding the new system’s compliance requirements are subject to change before its October implementation.

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NYC Targets Teen Pregnancy with Mobile Phone Game

A new campaign launched last week by the New York City Human Resources Administration is making waves thanks to its frank depiction of the harsh realities of unplanned teen pregnancy. 

The Teen Pregnancy Prevention campaign combines ads designed by the city’s Office of Communications and Marketing with social media, video and even an interactive texting game. 

The campaign’s ads, which appear on buses and subway trains, pull no punches. The ads (one of which is shown at left) feature distraught-looking children and provocative messages such as “Dad, you’ll be paying to support me for the next 20 years,” and “I’m twice as likely to not graduate high school because you had me as a teen.” 

In a clever appeal to the target demographic, the campaign also includes a “choose your own adventure” style texting game. By texting NOTNOW to 877877, anyone can play the game, which has you choosing to act on behalf of either Louis or Anaya, two fictitious 16-year-olds who are dating.

The game begins with Anaya’s discovery that she is pregnant. Once a player chooses either Louis or Anaya, the game sends text message scenarios with two choices. Each choice leads to other scenarios, which generally illustrate the difficulties of teen pregnancy. 

The game has been criticized by several media outlets. The New York Daily News deemed the effort a “Shame Campaign,” while an article on The Today Show’s website decried the game for apparently failing to offer abortion as a solution — and claiming that the Louis character demeans Anaya in one scenario, supposedly calling her a “fat loser.”

Government Technology contacted the city to answer questions about the game and for a response to the criticisms, but received no reply by press time. 

So I decided to try the game myself, twice as Louis and once as Anaya.

First, as Louis, I made only what seemed to be the best choices:

NYC: DYK as a teen you can call 311 for sexual health care services and contraception near you? Text “more” to play a game.

ME: More

NYC: Hey my name is Louis – my GF Anaya is pregnant! Prom is coming up and she’s not going, should I stay in with Anaya or go to Prom? Reply “PromYes” or “PromNo”

ME: PromNo

NYC: Can’t believe I missed Prom! I need more time with my boys! Should I go shoot hoops w/ them or go w/ Anaya to the doc? Reply “Doc” or “Hoop”

ME: Doc

NYC: I saw the sonagram and still can’t believe I am going to be a father. I need to provide for the baby, should I get a job? Reply “Yes” or “No”

ME: Yes

NYC: Just failed Math and I might not graduate. Should I try to pass Math or get my GED later? Reply “Math” or “GED”

ME: Math

NYC: I’m doing OK in school, can’t wait till I’m done. But Anaya needs more money for the baby – should I get a job or focus on my future? Text “Job” or “Future”

ME: Job

NYC: Louis graduated H.S., but had to put his life on hold after that. Now, he can’t afford to go to college, and has a lot less free time. Text “Done”

Next I tried the game with Louis making what, to me, were the worst possible choices. 

NYC: Hey my name is Louis – my GF Anaya is pregnant! Prom is coming up and she’s not going, should I stay in with Anaya or go to Prom? Reply “PromYes” or “PromNo”

ME: PromYes

NYC: Prom was great, but Anaya won’t talk to me. She’s even ignoring me in school. Should I get her a gift and say sorry? Text “Gift” or “NoGift”

ME: NoGift

NYC: Anaya and I are over! But I am still going to be a great dad. Should I start buying baby clothes or buy new shoes? Reply “Clothes” or “Shoes”

ME: Shoes

NYC: I’m rocking my new kicks, but I’m behind on child support. Should I work overtime to pay off child support or go out with friends? Text “Child” or “Friends”

ME: Friends

NYC: Got a warning letter from the gov’t. They said there’d be “legal consequences” if I don’t pay my debt. What should I do? Text “Ignore” or “Respond”

ME: Ignore

NYC: Louis had his driver license suspended for not paying child support! Now he has to apply for a work-only permit just to get to his job & school. Text “Done”

Finally, I attempted the game as Anaya, meaning I had to imagine what I would choose were I a pregnant, 16-year-old girl. 

NYC: OMG! My BF Louis and I got pregnant. He was going to take me to prom. Now I will look huge in my dress. Should I go? Text “Yes” or “No”

ME: Yes

NYC: My BFF called me a “loser” at prom. I was devastated. Now she’s texting me. Should I text her back? Reply “TextYes” or “TextNo”

ME: TextYes

NYC: My friend says I should get a job to pay for the baby. Should I be a waitress or a cashier? Text “Wait” or “Cash”

ME: Cash (note: I figured that job has more stability)

NYC: Being a cashier is tough – pregnancy makes me tired. After work, should I finish my math homework or just go to sleep. Text “Math” or “Sleep”

ME: Math

NYC: Got a B in Math! But I’m nervous about how I’ll pay for my baby. My `rents won’t talk to me. Should I call my sis for advice? Text “Call” or “NoCall”

ME: Call

NYC: You finished 8th! (note: no ranking system was ever conveyed). Louis pays child support. In NY, you must pay child support until the kid is 21 or face losing your license & possible jail time. 

The game ended, and I was invited to invite my friends to play. The scenarios I encountered seemed random and illogical, making it appear as if the entire campaign is less about informing teens about what to do should they become pregnant and more about scaring them away from the risky behavior to begin with.

I also did not encounter the “fat loser” insult The Today Show claimed to have discovered; it’s possible the offensive word was removed since it was reported.   

Despite the campaign’s widespread criticism, a reader poll on The Today Show‘s blog post that asked what readers think of the anti-teen pregnancy ads showed that most think the ads are good. Of the nearly 17,500 votes on the morning of March 11, only 14 percent of readers said they did not like them. 

Whether the same can be said for the mobile game is not yet determined. 

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The future of the Semantic Web: cultural heritage and privacy

By Dr. Heather Packer, Research fellow, the University of Southampton.

After attending both the International Semantic Web Conference (ISWC) and the Joint International Semantic Technology Conference (JIST), I considered what this meant for research and development in this exciting area.

Some of the most interesting work presented at ISWC and JIST were in the areas of cultural heritage, such as the recording of personal stories, and integrating historic maps with new timelines. This was highlighted in the opening keynote at JIST, which was given by Eero Hyvönen of Aalto University in Finland, presenting its work on using Semantic Web technologies to preserve Finnish cultural heritage.

These included the preservation of ancient shoemaking methods, through the digitisation and documentation using Semantic Web metadata with multimedia, interviews and written sources. Secondly, the complete transcription of the Finnish national epic, the Kalevala, into a Semantic narrative, and the process by which topics are linked from their own ontology portal, so that topical connections in the Kalevala narrative can be made with other Finnish cultural heritage work.

Aalto University’s work shows that Semantic Web technologies, such as its Cultural Sampo ontology portal, allow cultural heritage artefacts and narratives from multiple sources to be brought together and automatically cross-referenced. Examples were shown where the cross-linking between sources has already benefitted researchers, with technical barriers easily overcome.

In the future, I am aiming to work towards a Semantic Web which will allow narratives to share workflows and stories about companies, as opposed to more traditional methods like statistics calculated from databases. These narratives can be used to explain things based on people’s past experiences and their interests (taken from their actions on the web), to make them both more useful and engaging.

One problem, however, arises from where is it acceptable to gather and use data. Many of the people I have spoken to in academia and industry have said that information taken from their emails is too intrusive and people as a whole are unwilling to use such a system. However, people are more willing to adopt systems that use information from social networks where they can freely censor information about themselves.

Yet in my experience the most useful information is often to be found precisely in private online places such as email and calendars. In the future I would like the Semantic Web to allow me to attend a conference in another country, and automatically (with optional and minimal input) handle my flights, hotels, conference registrations and restaurant recommendations based on preferences that I had made in the past, such as price range and hotel recommendations and amenities.

In addition to academic research, the Semantic Web also has applications for business and handling personal data. The latter, in particular, has recently seen its research spurred on by a number of initiatives, including the midata initiative from the UK government’s Department for Business, Innovation and Skills (BIS). The initiative, which is due to start in 2013, mandates that companies must supply data they hold about a person back to that person in a machine readable format, and under an open licence.

The Semantic Web provides an obvious framework for enabling this at low cost to businesses – there are already numerous examples of marking up personal data under appropriate licenses such as the Open Government license used on data.gov.uk. Semantic Web technologies would therefore enable businesses to comply with new data protection legislation in a cost-effective manner. End-users that receive their data will also benefit, because there are numerous analysis, visualisation and storage mechanisms which already work with Semantic Web data.

The need for storing, managing, using and sharing personal data continues to grow. In response, numerous business startups which focus on providing such services have been launched. Meanwhile groups such as the W3C Read Write Web community group are discussing approaches to using Semantic Web techniques for publishing, receiving and sharing private data. For users this means that it will be easier to make their data work for them, including sites that use your data to help you save money, such as Bill Monitor, which analyses your mobile phone bill to find out how much you can save by getting a new phone contract. It is very likely that similar services will exist in the future for other utilities, such as electricity, gas, and broadband.

The future of the Semantic Web is making it easier to access increasingly richer presentations of our history and heritage, and also publish, and thus increase the amount of cultural heritage material being preserved and made available online. The future of personal data is also one which is expanding rapidly, towards the goal of helping people to make more financially beneficial purchases, and to better manage their private data.

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