Embracing change: Become a better functioning organization

Many organizations have become aware of the importance of focusing on Diversity, Equity, and Inclusion (DEI) in their workplaces and communities. But where to start? Discovering what DEI means for your organization and creating an environment of openness and trust are two good places to start, according to our guests on the first episode of BerryDunn’s Fresh Perspectives in Social Work podcast. Host Andrea Richardson spoke with Dr. Christine Moses, CEO of Buffalo Cloud Consulting, and BerryDunn’s Melinda Kirrane about things organizations can be thinking about as they embark on their DEI journeys. Here are some highlights from the conversation.

Discover what DEI means for your organization

DEI is not one-size-fits-all. How you define it should be based on your organization and those you serve. A good place to start is to recognize past harm that has been done. Have there been complaints or criticism? Do they have a common theme? Perhaps you need to address access to multi-lingual materials or the lack of diversity in your C-suite. Acknowledge, own, and fix the problems you’re already aware of. Once you start to do that, you start to build a culture of trust and openness that will encourage others to speak up. Whatever dialogue that follows should be encouraged and acted on.

Start where you’re at and don’t be afraid to fail forward

DEI is a journey that can bring up uncomfortable feelings. Understand that everyone has room to grow. Start by listening and spending time with others who have different backgrounds than you and start to understand your own biases – we all have them. This work can bring up feelings of guilt, shame, and blame. Allow yourself and others to be vulnerable and do work to create safe spaces for conversations to happen.

Normalize conversations about race in the workplace

Many of us try to avoid any controversial topics in the workplace because it might seem unprofessional or we’re afraid to start a conflict. But in order to make a workplace truly equitable, you must create a space where people can talk about race openly. If possible, have an independent third party facilitate equity workshops with groups, such as your board, your leadership team, and other cohorts, so employees have safe spaces to explore their biases and provide constructive criticism. For leaders, being humble and listening are your biggest assets. By listening, you not only identify areas for improvement, but often will get viable solutions that you may not have thought of.

Understand that the work benefits everyone

If your organization is undertaking DEI work because it’s something you feel like you should do, it’s probably not going to work. Be in it for the right reasons and understand that this work has the potential to make the workplace better for everyone. DEI can be the first step on a journey to creating an inclusive culture where everyone feels open to expressing themselves and can bring their best selves to work–resulting in greater creativity and innovation across the organization.

Commit to long-term change

DEI work is not a project that you complete and check off your list. To be successful, it’s ongoing, evolving work that never ends. Systemic change takes years to accomplish, so setting milestone goals can help keep you on track. It won’t happen overnight. If you commit to it for the long term, you will create an environment where people can reach their full potential.

Listen to the full two-part conversation on BerryDunn’s Fresh Perspectives in Social Work podcast, with host Andrea Richardson, Senior Consultant for state government at BerryDunn, Dr. Christine Moses, CEO of Buffalo Cloud Consulting, a DEI and belonging coaching, education, and management consulting firm, and BerryDunn’s Mindy Kirrane, Senior Consultant and co-lead of BerryDunn’s internal Diversity, Equity, Inclusion, Belonging, and Access committee. 

Part 1: Achieving equity in human services systems

Part 2: A commitment to DEI

More DEI resources

• Race Forward 
• The Government Alliance on Race and Equity 
• The Racial Healing Handbook 

Read this if you are a state health officer or leader in public health.

On November 29, 2022, the Centers for Disease Control and Prevention (CDC) allocated $3.14 billion to state, local, and territorial public health departments across the nation through the Strengthening US Public Health Infrastructure, Workforce, and Data Systems Grant. This investment in the nation’s public health infrastructure comes in response to chronic underfunding of critical public health systems, a deficiency that became overwhelmingly evident during the COVID-19 pandemic, and highlighted concerns that the systems could not adequately address health security needs, emerging threats, or continuing health inequities.¹  

The CDC established this grant, supported in part by the American Rescue Plan Act (ARPA), “to ensure that every US community has the people, services, and systems needed to promote and protect health.”² To accomplish this, the grant aims to support state and local public health agencies in addressing three key areas critical to public health infrastructure over a five-year period: strengthening the public health workforce, reinforcing foundational public health capabilities, and modernizing public health data systems. Here are several areas to explore when looking to optimize the funding.

Strengthening the public health workforce

Funding for the public health workforce intends to increase the recruitment, retention, and training of qualified staff. You can enhance your workforce by enacting organizational and workforce development initiatives including:  

• Enhancing and planning organizational structures
  Having a clear, up-to-date organizational structure can help inform decision-making pathways, align functional areas, and enable employees to experience success and improve performance. Review and/or revise organizational structures to create more effective daily and agency-wide operations. 
• Leading workforce planning initiatives
  Some organizational goals can benefit from engaging in workforce planning to coordinate shifting or additional roles, functions, and even departments. You can achieve this by clarifying and defining roles and reporting structures, identifying and prioritizing hiring for essential positions, and developing communication plans to share essential information about changing environments within the wider organizational structure. 
• Developing a workforce development plan
  A workforce development plan identifies and aligns the critical knowledge, skills, and abilities (KSAs) of staff to current and anticipated future workforce needs. Establishing and formalizing partnerships with local academic institutions can help you strengthen internship programs and fill recruiting pipelines. 
• Implementing professional development opportunities
  After identifying gaps in workforce knowledge, skills, and abilities, agencies must implement, track, and assess progress on plans for professional development. 

Reinforcing foundational public health capabilities

Foundational public health capabilities provide a framework for state and local public health agencies to establish more efficient and effective organizational systems and processes to yield improved public health outcomes. To bolster your agency’s capabilities, you can:

• Conduct Public Health Accreditation Board (PHAB) readiness assessments
  PHAB accreditation is an evidence-based approach to aligning state and local health departments with best practices. In addition to prioritizing health equity and aligning with the 10 essential public health services, accreditation serves as a framework for a “minimum package of services” for foundational public health capabilities.³ Achieving initial or renewed accreditation helps assure a strong foundation for public health policy development and service delivery. 
• Review existing policies and perform gap analyses 
  For staff to align their day-to-day processes and procedures with those established by the public health agency, it is essential for policies to be accurate, up-to-date, and easily available to staff. Analyze, update, and draft new policies to support and guide your public health staff to enable them to effectively work toward your organization’s goals.
• Develop and execute strategic plans
  A clear vision, goals, and objectives are essential for providing direction and clarity across a public health agency. Developing, executing, and updating strategic plans are one of the most important and impactful ways a public health agency can establish or strengthen foundational capabilities. 
• Modernize public health data systems
  Modernized public health data systems allow state and local health agencies to conduct surveillance, track, monitor, deliver, and improve public health services. Antiquated data systems often lack integration with other essential public health informatics systems and external systems, such as Health Information Exchanges and federal reporting platforms. By modernizing your data systems, you can help ensure more coordinated and efficient service delivery while protecting your agency from potential system failures, which could significantly impact your ability to operate successfully and serve your population. Steps to take:
  • Conduct needs and/or gap assessments
    A structured needs and/or gap assessment helps public health agencies evaluate processes, systems, and resources to better understand data and program service needs. By pinpointing areas of improvement and developing actionable recommendations, you can promote better health outcomes and more equitable access to care. 
  • Deliver data system planning and procurement services
    Working on large-scale IT systems planning and procurement is crucial to your agency’s success. Defining current (as-is) and future (to-be) state IT solution requirements, developing RFP/RFQs, and managing systems implementation are all integral to building efficient processes. 
  • Evaluate business processes for greater efficacy and efficiency
    Accurately capturing the current (as-is) state for priority business processes helps organizations identify existing pain points and opportunities for improvement. Additionally, by having discussions about the desired future (to-be) state of an ideal data system, you can guide staff to recognize potential efficiencies and enhanced capabilities. 

Our Public Health consulting team has a wealth of experience and expertise supporting state and local health agencies in each of these areas essential to advancing public health and improving population health outcomes. We can help your health department maximize the impact of this funding by providing additional, expert resources to make measurable progress on each of the grant’s objectives. Contact our public health consulting team to learn more about how BerryDunn can help. 
 

 ¹ https://www.tfah.org/report-details/funding-report-2022/
 ² Infrastructure Grant Program Overview | CDC
 ³ https://phnci.org/transformation/fphs 

Read this if you are at a public health agency.

As public health workforce challenges worsen through retirements, burnout, and added need for public health workers highlighted by the COVID-19 pandemic, funding levels for public health remain increased for the time being. This provides opportunities for states to leverage federal programs and funding streams to help ensure a strong and capable public health workforce to meet the needs of all communities. An important consideration for states is the level of cultural competence among their public health workforce.

Cultural competence: Definition and benefits

Cultural competence refers to the capacity to function effectively, both as an individual and an organization, in relation to community members’ cultural beliefs, behaviors, and needs. It allows public health professionals to provide more effective public health services to individuals and communities with cultures different from their own—through awareness, respect, and willingness to learn about cultural differences. The necessity of cultural competence in public health is especially timely due to new and existing disparities that have been highlighted by COVID-19 outcomes and the ripple effects of the pandemic.

Benefits of a culturally competent public health workforce include greater public trust in the public health system, more equitable and effective public health services, improved understanding of existing barriers and community health status, and the potential to reduce disparities and improve both healthcare access and health outcomes in historically marginalized communities.

As many states face significant workforce gaps and challenges in recruiting, training, and retaining staff, it is important to leverage best practices and key indicators of success to inform a sustainable and effective approach for workforce development. States may benefit from assessing gaps in cultural competence and related skills, and by identifying specific cultural competency areas and abilities they aim to achieve in the workforce. A strategic approach is necessary for maximizing the sustainability and long-term benefit of federal funding opportunities, such as those for public health workforce development in rural areas. 

Strategies and best practices for developing a culturally competent public health workforce 

There are many steps you can take toward building cultural competence in your agency. Some of them include:

• Develop and implement a periodic assessment of workforce cultural competence, and training to measure improvement and incorporate up-to-date best practices
• Recruit diverse staff to reflect the culture and demographics of communities, including the provision of linguistic support
• Create and improve pipeline training programs by collaborating with local colleges, universities, and schools of public health and identifying existing gaps in the workforce and in public health educational opportunities 
• Support inter-professional education and teams for community-based interventions, to foster collaboration between public health and healthcare professionals in the community to better meet needs 

Important first steps to improve and foster cultural competence in the public health workforce include setting goals related to building community partnerships and what those partnerships will achieve. 

Other steps for building cultural competence 

Additionally, collecting diversity data and demographic characteristics of the public health workforce, measuring and evaluating performance of the public health workforce and public health services, and reflecting community diversity within the workforce are necessary for developing a workforce that supports community cohesion and trust of community members. These steps can help you assess where you can strengthen services and how communities can be better reflected in the public health services they receive. Effective communication and language access are also critical steps to improve and foster cultural competence in the public health workforce.

BerryDunn can provide state public health and human services agencies with strategic policy and programmatic guidance and management support to maximize the benefits of federal programs to facilitate public health workforce development. 

If you have any questions about your specific situation, or would like more information, please contact our Public Health Consulting team. We’re here to help.

Is your Women, Infants, and Children (WIC) agency struggling with Maintenance and Enhancement (M&E) vendor management? Here are some approaches to help improve your situation: 

• Product Management Office (PdMO): Product management can help you manage your WIC system by coordinating and planning releases with the M&E vendor, prioritizing enhancements, reviewing workflows, and providing overall vendor management.
• Project Management Office (PMO): Project management can help with budgeting, resource management, risk management, and organization. 
• A blend of product and project management is a great partnership that can relieve some of the responsibilities of WIC agency staff and allows a third party to provide support in all areas of product and project management.

Whether you are an independent WIC State Agency (SA) or a multi-state consortium (MSC), having a PMO and/or PdMO can help alleviate some of the challenges facing WIC today. While an MSC may present significant cost savings, managing an M&E contract for multiple states can be overwhelming. Independent state agencies (SAs) may not have multiple states to coordinate with, but having the staff resources for vendor facilitation and implementing federal changes can be challenging. A PMO/PdMO can aid in improving business and technology outcomes for SAs and MSCs by bringing a level of coordination and consistency that otherwise might not happen. 

As federal changes grow in complexity, evidenced by the many changes to WIC stemming from the American Rescue Plan Act, coupled with workforce challenges in government, the importance of a PMO/PdMO has never been greater. Here are six ways a PMO/PdMO can help you:

1. Facilitate the vendor relationship
   A PMO/PdMO not only holds the vendor accountable but also takes some of the workload off the SA by facilitating meetings, providing meeting notes, and tracking action items and decisions.
2. Manage centrally located data
   A PMO/PdMO keeps all documents and data in a centralized location, fostering a collaborative environment and ease of access to needed information. A centralized location of data allows SAs to be on the same page for consistency, quality control, and to support the state’s need for clean, reliable information that is current and accurate.
3. Track and mitigate risks 
   Effective risk management requires a substantial commitment of time and resources. The PMO/PdMO identifies, tracks, and assesses the severity of risks and suggests approaches to manage those risks. Some PMO/PdMOs assess all risks based on a severity index to help clients determine which risks need immediate action and which need monitoring.
4.  Assist in the creation of Implementation Advanced Planning Document Updates (IAPDUs) 
   Creating and implementing an IAPDU can be time-consuming, confusing, and requires attention to detail. A PMO/PdMO alleviates time and pressure on SAs by helping to ensure that an IAPDU or funding request clearly outlines a plan of action to accomplish the activities necessary to reach an organization’s goal. PMO/PdMOs can draft IAPDUs to determine the need, feasibility, and projected costs and benefits for service. 
5. Provide an unbiased, third-party opinion 
   A PMO/PdMO will offer an unbiased, third-party opinion to help avoid misunderstanding and frustration, decision stalemates, inadequate solutions, and unpleasant relationships between WIC agencies and M&E vendors. 
6. Provide the right combination of business and technical expertise
   Staffing challenges (exacerbated by COVID-19), difficulties finding expertise managing software change management for WIC, and a retiring workforce knowledgeable in WIC system implementation have in some cases left SAs without critical resources. Having the right combination of skills from a third party can resolve some of these challenges.

Independent SAs or MSCs would benefit from having a PMO/PdMO to help meet the challenges WIC agencies face today, whether it is an unplanned funding change or updates to the risk codes. With the help of a PMO/PdMO developing standard practices and methodologies, SAs and MSCs can deliver and implement high-quality services more consistently and efficiently. The role of the PMO/PdMO is far-reaching and positively impacts WIC by providing backbone support for WIC’s overarching goal, to “safeguard the health of low-income women, infants, and children who are at nutrition risk.”

If you have questions about PMOs or PdMOs and the impact they can have on your agency, please contact us. We're here to help.

Read this if you are a behavioral health agency leader looking for solutions to manage mental health, substance misuse, and overdose crises.

As state health departments across the country continue to grapple with rising COVID-19 cases, stalling vaccination rates, and public heath workforce burnout, other crises in behavioral health may be looming. Diverted resources, disruption in treatment, and the mental stress of the COVID-19 pandemic have exacerbated mental health disorders, substance use, and drug overdoses.

State agencies need behavioral health solutions perhaps now more than ever. BerryDunn works with state agencies to mitigate the challenges of managing behavioral health and implement innovative strategies and solutions to better serve beneficiaries. Read on to understand how conducting a needs assessment, redesigning processes, and/or establishing a strategic plan can amplify the impact of your programs. 

Behavioral health in crisis

The prevalence of mental illness and substance use disorders has steadily increased over the past decade, and the pandemic has exacerbated these trends. A number of recently released studies show increases in symptoms of anxiety, depression, and suicidal ideation. One CDC study indicates that in June 2020 over 40% of adults reported an adverse mental or behavioral health condition, which includes about 13% who have started or increased substance use to cope with stress or emotions related to COVID-19.¹ 

The toll on behavioral health outcomes is compounded by the pandemic’s disruption to behavioral health services. According to the National Council for Behavioral Health, 65% of behavioral health organizations have had to cancel, reschedule, or turn away patients, even as organizations see a dramatic increase in the demand for services.^2,3 Moreover, treatment facilities and harm reduction programs across the country have scaled back services or closed entirely due to social distancing requirements, insufficient personal protective equipment, budget shortfalls, and other challenges.⁴ These disruptions in access to care and service delivery are having a severe impact.

Several studies indicate that patients report new barriers to care or changes in treatment and support services after the onset of the pandemic.^{5, 6} Barriers to care are particularly disruptive for people with substance use disorders. Social isolation and mental illness, coupled with limited treatment options and harm reduction services, creates a higher risk of suicide ideation, substance misuse, and overdose deaths.

For example, the opioid epidemic was still surging when the pandemic began, and rates of overdose have since spiked or elevated in every state across the country.⁷ After a decline of overdose deaths in 2018 for the first time in two decades, the CDC reported 81,230 overdose deaths from June 2019 to May 2020, the highest number of overdose deaths ever recorded in a 12-month period.⁸ 

These trends do not appear to be improving. On October 3, the CDC reported that from March 2020 to March 2021, overdose deaths have increased 29.6% compared to the previous year, and that number will only continue to climb as more data comes in.⁹  

As the country continues to experience an increase in mental illness, suicide, and substance use disorders, states are in need of capacity and support to identify and/or implement strategies to mitigate these challenges. 

Solutions for state agencies

Behavioral health has been recognized as a priority issue and service area that will require significant resources and innovation. In May, the US Department of Health and Human Services' (HHS) Secretary Xavier Becerra reestablished the Behavioral Health Coordinating Council to facilitate collaborative, innovative, transparent, equitable, and action-oriented approaches to address the HHS behavioral health agenda. The 2022 budget allocates $1.6 billion to the Community Mental Health Services Block Grant, which is more than double the Fiscal Year (FY) 2021 funding and $3.9 billion more than in FY 2020, to address the opioid epidemic in addition to other substance use disorders.¹⁰ 

As COVID-19 continues to exacerbate behavioral health issues, states need innovative solutions to take on these challenges and leverage additional federal funding. COVID-19 is still consuming the time of many state leaders and staff, so states have a limited capacity to plan, implement, and manage the new initiatives to adequately address these issues. Here are three ways health departments can capitalize on the additional funding.

Conduct a needs assessment to identify opportunities to improve use of data and program outcomes

Despite meeting baseline reporting requirements, state agencies often lack sufficient quality data to assess program outcomes, identify underserved populations, and obtain a holistic view of the comprehensive system of care for behavioral health services. Although state agencies may be able to recognize challenges in the delivery or administration of behavioral health services, it can be difficult to identify solutions that result in sustained improvements.

By performing a structured needs assessment, health departments can evaluate their processes, systems, and resources to better understand how they are using data, and how to optimize programs to tailor behavioral health services and promote better health outcomes and a more equitable distribution of care. This analysis provides the insight for agencies to understand not only the strengths and challenges of the current environment, but also the desires and opportunities for a future solution that takes into account stakeholder needs, best practice, and emerging technologies. 

Some of the benefits we have seen our clients enjoy as a result of performing a needs assessment include: 

• Discovering and validating strengths and challenges of current state operations through independent evaluation
• Establishing a clear roadmap for future business and technological improvements
• Determining costs and benefits of new, alternative, or enhanced systems and/or processes
• Identifying the specific business and technical requirements to achieve and improve performance outcomes 

Timely, accurate, and comprehensive data is critical to improving behavioral health outcomes, and the information gathered during a needs assessment can inform further activities that support programmatic improvements. Further activities might include conducting a fit-gap analysis, performing business process redesign, establishing a prioritization matrix, and more. By identifying the greatest needs and implementing plans to address them, state agencies can better handle the impact on behavioral health services resulting from the COVID-19 pandemic and serve individuals with mental health or substance use disorders more efficiently and effectively.

Redesign processes to improve how individuals access treatment and services

Despite the availability of behavioral health services, inefficient business and technical processes can delay and frustrate individuals seeking care and in some cases, make them stop seeking care altogether. With limited resources and increasing demands, behavioral health agencies should analyze and redesign work flows to maximize efficiency, security, and efficacy. Here are a few examples of process improvements states can achieve through process redesign:

• Streamlined data processes to reduce duplicative data entry 
• Automated and aligned manual data collection processes 
• Integrated siloed health information systems
• Focused activities to maximize staff strengths
• Increased process transparency to improve communication and collaboration 

By placing the consumer experience at the core of all services, state health departments can redesign business and technical processes to optimize the continuum of care. A comprehensive approach takes into account all aspects that contribute to the delivery of behavioral health services, including both administrative and financial processes. This helps ensure interconnected activities continue to be performed efficiently and effectively. Such improvements help consumers with co-occurring disorders (mental illness and substance use disorder) and/or developmental disorders find “no wrong door” when seeking care. 

Establish a strategic plan of action to address the impact of the COVID-19 pandemic

With the influx of available dollars resulting from the American Recovery Plan Act and other state and federal investments, health departments have a unique opportunity to fund specific initiatives to enhance the delivery and administration of behavioral health services. Understanding how to allocate the millions of newly awarded dollars in an impactful and sustainable way can be challenging. Furthermore, the additional reporting and compliance requirements linked to the funding can be difficult to navigate in addition to current monitoring obligations. 

The best way to begin using the available funding is to develop and implement strategic plans that optimize funds for behavioral health programs and services. You can establish priorities and identify sustainable solutions that build capacity, streamline operations, and promote the equitable distribution of care across populations. A few of the activities state health departments have undertaken resulting from the strategic planning initiatives include: 

• Modernizing IT systems, including data management solutions and Electronic Health Records systems to support inpatient, outpatient, and community mental health and substance use programs 
• Promoting organizational change management 
• Establishing grant programs for community-driven solutions to promote health equity for the underserved population
• Organizing, managing, and/or supporting stakeholder engagement efforts to effectively collaborate with internal and external stakeholders for a strong and comprehensive approach

The prevalence of mental illness and substance use disorder were areas of concern prior to COVID-19, and the pandemic has only made these issues worse, while adding more administrative challenges. State health departments have had to redirect their existing staff to work to address COVID-19, leaving a limited capacity to manage existing state-level programs and little to no capacity to plan and implement new initiatives. 

The federal administration and HHS are working to provide financial support to states to work to address these exacerbated health concerns; however, with the limited state capacity, states need additional support to plan, implement, and/or manage new initiatives. BerryDunn has a wide breadth of knowledge and experience in conducting needs assessments, redesigning processes, and establishing strategic plans that are aimed at amplifying the impact of state programs. Contact our behavioral health consulting team to learn more about how we can help. 

^{Sources:
1 Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic, CDC.gov
2 COVID-19 Pandemic Impact on Harm Reduction Services: An Environmental Scan, thenationalcouncil.org
3 National Council for Behavioral Health Polling Presentation, thenationalcouncil.org
4 The Impact of COVID-19 on Syringe Services Programs in the United States, nih.gov
5 COVID-19 Pandemic Impact on Harm Reduction Services: An Environmental Scan, thenationalcouncil.org
6 COVID-19-Related Treatment Service Disruptions Among People with Single- and Polysubstance Use Concerns, Journal of Substance Abuse Treatment
7 Issue Brief: Nation’s Drug-Related Overdose and Death Epidemic Continues to Worsen, American Medical Association
8 Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic, CDC.gov
9 Provisional Drug Overdose Death Counts, CDC.gov
10 Fiscal Year 2022 Budget in Brief: Strengthening Health and Opportunity for All Americans, HHS.gov}

Read this if you are a director or manager at a Health and Human Services agency in charge of modernizing your state's Health and Human Services systems. 

When states start to look at outdated Health and Human Services systems like Eligibility Systems or Medicaid Enterprise Systems, they spend a lot of time on strategic planning efforts and addressing technology deficiencies that set the direction for their agencies. While they pay a lot of attention to the technology aspects of the work, they often overlook others. Here are three to pay attention to: 

1. Business process improvement
2. Organization development
3. Organizational change management

Including these important steps in strategic planning often improves the likelihood of an implementation of Health and Human Service systems that provide the fully intended value or benefit to the citizen they help serve. When planning major system improvements, agencies need to have the courage to ask other critical questions that, when answered, will help guarantee greater success upon implementation of modernized system.

Don’t forget, it’s not only about new technology—it’s about gaining efficiencies in your business processes, structuring your organization in a manner that supports business process improvements, and helping the people in your organization and external stakeholders accept change.  

Business process improvement 

When thinking about improving business processes, a major consideration is to identify what processes can be improved to save time and money, and deliver services to those in need faster. When organizations experience inefficiencies in their business processes, more often than not the underlying processes and systems are at fault, not the people. Determining which processes require improvement can be challenging. However, analyzing your business processes is a key factor in strategic planning, understanding the challenges in existing processes and their underlying causes, and developing solutions to eliminate or mitigate those causes are essential to business process improvement.

Once you pinpoint areas of process improvement, you can move forward with reviewing your organization, classifying needs for potential organization development, and begin developing requirements for the change your organization needs.

Organization development

An ideal organizational structure fully aligns with the mission, vision, values, goals, and strategy of an organization. One question to ask when considering the need for organization development is, “What does your organization need to look like to support your state’s to-be vision?” Answering this question can provide a roadmap that helps you achieve:

1. Improved outcomes for vulnerable populations, such as those receiving Medicaid, TANF, SNAP, or other Health and Human Services benefits 
2. Positive impacts on social determinants of health in the state
3. Significant cost savings through a more leveraged workforce and consolidated offices with related fixed expenses—and turning focus to organizational change management

Organization development does not stop at reviewing an organization’s structure. It should include reviewing job design, cultural changes, training systems, team design, and human resource systems. Organizational change is inherent in organization development, which involves integration of a change management strategy. When working through organization development, consideration of the need for organizational change should be included in both resource development and as part of the cultural shift.

Organizational change management

Diverging from the norm can be an intimidating prospect for many people. Within your organization, you likely have diverse team members who have different perspectives about change. Some team members will be willing to accept change easily, some will see the positive outcomes from change, but have reservations about learning a new way of approaching their jobs, and there will be others who are completely resistant to change. 

Successful organizational change management happens by allowing team members to understand why the organization needs to change. Leaders can help staff gain this understanding by explaining the urgency for change that might include:

• Aging technology: Outdated systems sometimes have difficulty transmitting data or completing simple automated tasks.
• Outdated processes: “Because we’ve always done it this way” is a red flag, and a good reason to examine processes and possibly help alleviate stressors created by day-to-day tasks. It might also allow your organization to take care of some vital projects that had been neglected because before there wasn’t time to address them as a result of outdated processes taking longer than necessary.
• Barriers to efficiency: Duplicative processes caused by lack of communication between departments within the organization, refusal to change, or lack of training can all lead to less efficiency.

To help remove stakeholder resistance to change and increase excitement (and adoption) around new initiatives, you must make constant communication and training an integral component of your strategic plan. 

Investing in business process improvement, organization development, and organizational change management will help your state obtain the intended value and benefits from technology investments and most importantly, better serve citizens in need. 

Does your organization have interest in learning more about how to help obtain the fully intended value and benefits from your technology investments? Contact our Health and Human Services consulting team to talk about how you can incorporate business process improvement, organization development, and organizational change management activities into your strategic planning efforts.

The American Public Health Association annual conference’s thematic focus on preventing violence provided an illustration of the extent of the overwhelming demands on state public health agencies right now. Not only do you need to face the daily challenges of responding to the COVID-19 pandemic, you also need to address ongoing, complex issues like violence prevention.

The sheer breadth of sessions available at APHA shows the broad scope of public health’s reach and the need for multi-level, multi-sector interventions, all with a shrinking public health workforce. The conference’s sessions painted clear pictures of the critical public health issues our country currently faces, but did not showcase many solutions, perhaps leaving state health agency leaders wondering how to tackle these taxing demands coming from every direction with no end in sight.

BerryDunn has a suggestion: practice organizational self-care! It might seem antithetical to focus maxed-out resources on strengthening systems and infrastructure right now, but state public health agencies have little choice. You have to be healthy yourself in order to effectively protect the public’s health. Organizational health is driven by high-functioning systems, from disease surveillance and case investigation to performance management, and quality improvement to data-informed decision-making.  

State health agencies can use COVID-19 funding to support organizational self-care, prioritizing three areas: workforce, technology, and processes. Leveraging this funding to build organizational capacity can increase human resources, replace legacy data systems, and purchase equipment and supplies. 

1. Funding new positions with COVID sources can create upward paths for existing staff as well as expanding the workforce. 
2. Assessing the current functioning of public health data systems identifies and clarifies gaps that can be addressed by adopting new technology platforms, which can also be done with COVID funding.
3. Examining the processes used for major functions like surveillance or case investigation can eliminate unproductive steps and introduce efficiencies. 

So what now? Where to start? BerryDunn brings expertise in process analysis and redesign, an accreditation readiness tool, and an approach to data systems planning and procurement―all of which are paths forward toward organizational self-care. 

1. Process analysis and redesign can be applied to data systems or other areas of focus to prioritize incremental changes. Conduct process redesign on a broad or narrow scale to improve efficiency and effectiveness of your projects. 

2. Accreditation readiness provides a lens to examine state health agency operations against best practices to focus development in areas with the most significant gaps. Evaluate gaps in your agency’s readiness for Public Health Accreditation Board (PHAB) review and track every piece of documentation needed to meet PHAB standards.
3. Data system planning and procurement assistance incorporates process analysis to assess your current system functioning, define your desired future state, and address the gaps, and then find, source, and implement faster, more effective systems. 

Pursuing any of these three paths allows state health agency leaders to engage in organizational self-care in a realistic, productive manner so that the agency can meet the seemingly unceasing demands for public health action now and into the future.

There are a variety of programs that can be used to fund SUD services. This article discusses funding SUD services under the Family First Prevention Services Act. In a separate article, more information is available about funding SUD services under additional federal funding sources.

In the midst of the opioid crisis, child welfare agencies are seeing more children and families with SUD. Most children in out-of-home care are Medicaid-eligible, with SUD services covered for children in care. However, Medicaid will also pay for SUD services for children who remain with their families, but many of the children and families that child welfare agencies serve are not Medicaid-eligible. 

Family First Prevention Services Act
The Family First Prevention Services Act (Family First) is a new funding source for SUD services for children, relative caregivers, and parents who are not Medicaid-eligible. Under Family First, states can use Title IV-E funds for prevention services for eligible children at risk of foster care placement and their families. States can use Family First funds to pay for services for:

• Children who are “candidates” for foster care
• Children in foster care who are pregnant or parenting
• Parents or kin caregivers of candidates for foster care where services are needed to prevent the child’s entry into care or directly relate to the child’s safety, permanence or well-being

Title IV-E funds can only be used to provide services for a maximum of 12 months. Children and families can receive these services more than once if they are later identified as a candidate for foster care. Children, youth, parents, and kin caregivers are eligible for prevention services and programs regardless of whether they meet Title IV-E income-eligibility requirements. Family First will pay for mental health and substance abuse prevention and treatment services provided by a qualified clinician to eligible children and families.

The services and programs must meet evidence-based requirements that follow promising, supported, or well-supported practices. The services must also be modeled under an approved clearinghouse – e.g., the California Evidence-Based Clearinghouse for Child Welfare. At least 50% of the expenditures reimbursed by Family First funds must be for prevention services and programs that meet the requirements for well-supported practices.

States can get Title IV-E reimbursement for up to 12 months for a child who has been placed with a parent in a licensed residential family-based SUD treatment facility. The child does not have to meet the Title IV-E income-eligibility requirement. Additional requirements are that:

• The child’s case plan has to recommend the placement
• The SUD treatment facility must provide parenting skills training, parent education, and individual and family counseling
• The treatment and related services must be trauma-informed

BerryDunn’s child welfare experts can help you identify ways to use Family First to fund and expand SUD services that are desperately needed to address the opioid and SUD crisis that are affecting so many families.