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15 minutes with the president of the United States.

If you had 15 minutes with the next president of the United States, what would you say about the state of the nation's most vulnerable families and children and the public systems that serve them?


That is the question we posed to the chief executive officers of the states' public health and human service agencies around the country. In an effort to crystallize a message to the next administration about the state of the nation's safety net for millions of Americans, members of the APHSA Board of Directors and National Policy Council began a two-year effort to identify and reach consensus regarding key challenges and potential solutions to some of our nation's most pressing human service issues today. The goal: deliver to the president-elect a blueprint for a new and uniquely American response to 21st century human service crises and challenges.

At few times in history has the convergence of social fragility, economic crisis and political turnover produced such an opportune moment to reexamine our country's--and our government's--commitment to its most vulnerable citizens. Who better to frame the conversation than the dedicated public servants who meet these citizens at their most vulnerable moment, on the precipice of crisis, where they live, work, play, learn, need medical care or housing, employment, education, food or just a little help to get by? The hundreds of thousands of government employees in states and territories daily witness the human tragedy and heroic acts of hope that play out in government service centers, public hospitals, city streets, rural regions, and tribal reservations. They see, well before the media or politicians, the impact of economic instability, the health care crisis, the costs of food and energy, the collapse of the housing market, and loss of jobs. They feel most acutely the budget-tightening during states' fiscal crises in their inability to help those who need help the most at a time when the help can make the difference between personal independence and long-term government dependency. APHSA represents these hard-working, competent, and compassionate state and local government employees, who are the front-line in the American public human service systems; and they have a lot to say to the next president of the United States and to Congress.

Beginning the Conversation

Perhaps the greatest challenge to the proposed task at hand two years ago was balancing the philosophical differences among the states' human service CEOs, appointed by partisan governors, who were elected based on their approaches to governing, about the role and responsibilities of government in supporting vulnerable families and children and the method by which to achieve the desired outcomes. As a non-partisan national organization representing every major government sector in health and human services, APHSA was uniquely positioned to convene such a conversation and find common ground.

In the end, the common ground transcended political affiliation or partisan philosophy to a unity of purpose: that is, to rekindle the true spirit of partnership between the federal and state governments working together to assure that Americans in need are well served with quality care and maintain their dignity while working toward personal independence from public assistance. This common ground reflects the unity of purpose behind such historic social movements as the implementation of Social Security, Medicare, Medicaid, and welfare reform. Behind the words lies a strong commitment to aligning public will with government ways and the seeds of compassion that lie at the core of the American way. The federal-state partnership, dignity, independence and responsibility are the common threads that weave throughout the tapestry of human services that is the very fabric of the American safety net.

Over the two-year project, members of the APHSA Board, Policy Council, affiliate associations housed under the APHSA umbrella, and individual members have had the opportunity to weigh in on the discussion. From high-level philosophical debates to practical implementation, members voiced their opinions. In between the pages of flip charts and the plethora of e-mails lie the thoughts, hopes and recommendations from the specific to the sublime. The first of several final products released in October highlights the most pressing concerns and more than a dozen specific recommendations for consideration by the next president, along with brief background on each subject.

Answering the Question

So, back to the question. If APHSA members had 15 minutes with the next president of the United States, what would they say about the state of the nation's most vulnerable families and children and the public systems that serve them?

They would say that the new president has the opportunity today to reinvigorate government social services by providing real leadership in affirming the federal responsibility toward its citizens. They would say that the impact of a failing economy is sorely felt in the lives of too many people, including millions of children, and in the revenues of state and local governments that bear the brunt of fiscal support for their citizens in need. They would say that the good intentions and professional competence of public servants at federal, state and local levels must not be compromised or minimized by intergovernmental mistrust or uninformed administrations; that government employees understand and desire to implement evidence-based services, good business practices, operational accountability, and 21st century technology in pursuit of high-quality, efficient and effective service delivery.

The next president needs to know that it is time to fashion a health and human service system for the 21st century. Federal funding participation in health and human service programs has been declining steadily over the past decade, to the detriment of the American public and the unraveling of the public safety net. The "new Federalism" has created a new underclass of middle-class "working poor" who cannot meet the threshold for many government programs but who struggle mightily to simply survive in today's economy. He needs to know that the voices of marginalized Americans are heard day in and day out by the millions of public service workers. And their voices are represented by APHSA, which could be a valuable partner with the new administration in identifying the challenges and the solutions. He should know that many good solutions already exist in states and local jurisdictions around the country as shining examples of government service at its most efficient and effective best. We should maximize that existing knowledge through replication, not penalize innovation with federal withdrawal of funding or worse--fines and penalties.

States have demonstrated significant innovation in Medicaid and SCHIP, child welfare, food stamp programs, and TANF (Temporary Assistance for Needy Families). Allowing more states the flexibility to create innovative strategies that remove barriers to service entry before absolute crisis and enhancing federal financial participation in preventative and early intervention will provide better service to those in need and curtail the exponentially growing costs of human services in this country. Perhaps the most consistent of the common ground relates to the need to change the incentives for federal participation from out-of-home care to home- and community-based care and flexible front-end services that are known to prevent the crises that bring Americans to public human service systems.

The new document that was endorsed by APHSA members and leadership and entitled "A Starting Point: For Those We Serve" sets out six broad categories of service needing urgent attention by the next administration. Federal/State Partnerships, Health Care, Child Welfare, Temporary Assistance for Needy Families (TANF) (including Child Support), the Supplemental Nutrition Assistance Program (food stamps), and Child Care. It is clear that progress in these areas will have the greatest impact on the health and well-being of America's children, those who will bear witness to the laws and policy we make today.

The Great Law of the Iroquois states, "In our every deliberation, we must consider the impact of our decisions on the next seven generations." Indeed, it is time for serious deliberations by the next president, Congress, governors and state legislators, and the American public about the real change we seek, about the country we wish to be, and about our collective responsibility to our fellow citizens, especially our children. This notion of deliberately examining the status quo and beginning the creation of a 21st century public human service system that responds to 21st century challenges in 21st century ways was at the heart of the APHSA Policy Council deliberations begun two years ago, and it is the at the core of the message we wish to share with the next president of the United States.

Cari DeSantis is president of the APHSA Board of Directors and recently joined the Seattle-based foundation Casey Family Programs as executive vice president for public affairs and communications. She previously served two terms as secretary of the Delaware Department of Services for Children, Youth and Their Families.
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Author:DeSantis, Cari
Publication:Policy & Practice
Geographic Code:1USA
Date:Oct 1, 2008
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