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Navigating through the challenge.

At the close of 2008, our newly elected governor, Jack Markell, nominated me to serve as Cabinet secretary of the Delaware Department of Health and Social Services; the largest department in state government. It is an extreme honor to serve in this capacity, since I have embraced the mission of this department throughout my career as an advocate. As an advocate, I have spent 30 plus years attempting to influence the behavior and focus of government, only to find myself now faced with the responsibility from the inside of government. Many from the advocacy community applauded my appointment while those in the field of public service were somewhat skeptical of my ability to transition from so-called activist to public servant. I believe that these characteristics are one in the same. Public servants are indeed advocates and advocates can be viewed as public servants ensuring that those most disenfranchised are not forgotten. So for an advocate, to be given the opportunity to lead the state agency that focuses on enhancing the quality of life for our public, there was no doubt that I would accept the appointment, even in the midst of the most challenging economic times facing my state.

Our mission is indeed a very worthy one:

To improve the quality of life for Delaware's citizens by promoting good health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

The services of the department have an impact on every Delawarean, whether by direct intervention through benefits and support or indirectly by ensuring the public is protected by disease. Our vision is to facilitate and empower individuals and communities to gain healthy outcomes, both in physical wellness and emotional well-being, to gain economic self-sufficiency, which will eliminate or limit long-term reliance on government, and to protect and support those citizens most vulnerable due to advanced age, disability or medical fragility.

Our mission is worthy, but our economic reality is forcing us to constantly re-evaluate the value and the impact of the service. We are challenged by the public's distrust of government and by those of the belief that placing blame will somehow advance the direction for greater good. It will not, in fact; I have found that it only divides us further and energy is spent in the defensive mode, which does not honor our mission. In fact, it may only prolong our ability to truly problem solve. Our government is one of the most liberating of all, we choose our leaders and, we can influence the direction from the outside as well as from the inside. We are free to voice our concerns, to engage in the process, to influence and direct, to respond and partner to better serve those in need of service.

We are in uncharted territory and the demand for services is spiking since more and more individuals are facing job loss, decreased incomes, and need medical care or food on their tables. We are committed to working within our means, while preserving the core services that truly affect the individual's health and well-being. I have never been a promoter of across-the-board reductions, since I believe it may leave one more vulnerable to costlier unintended circumstances. For instance, if the state were to cut community-based support services to seniors and those with disabilities, many of these individuals would be forced back into facility-based care at an increased rate. This is not the preference of that market nor is it fiscally responsible.

The department is navigating through this economic downturn by conducting a thorough review of all programs, capturing if they are a core (basic need) service and if they must be performed or funded by government. These programs are then "tri-aged" based on numbers of individuals affected, along with the negative circumstances that would occur by a reduction and the ability to leverage with others to maintain or enhance the service. We are also vetting this approach with our community-based partners. This enables us to view our decisions from a broader perspective, and increases our ability to problem solve. We are moving from a state government that affects our partners to a state government that involves our partners as part of the community-solving process. This approach is for the greater good and will promote energy to resolve the most pressing issues together.

These challenging times are indeed challenging beyond belief. Personally, I have found that the challenging times are when lessons can be learned, values are embedded and benefits are gained from the guidance and input of others. We have all heard that within every challenge lies an opportunity. Through challenge we are most open to reform, re-direction and collaborating for a common purpose. I am privileged to serve in these most challenging times.

Rita Landgraf is the secretary of the Delaware Department of Health and Social Services.

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Title Annotation:my turn; Delaware Department of Health and Social Services
Author:Landgraf, Rita
Publication:Policy & Practice
Geographic Code:1USA
Date:Feb 1, 2010
Words:802
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