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Second in a Multipart Series on the Past Decade's Health and Human Services Journey.

In my last column, I shared reflections on where we were as a field nearly 10 years ago--and the call to action that brought so many leaders together to shape a new course for human services and the nation. We looked back at the environmental conditions that set the stage for our collective work, and how the imperative for better outcomes drove our thinking. In this second part of the series, I reflect on how a convening of dedicated health and human services leaders on Harvard's beautiful campus a decade ago first seeded the development of what would become a robust peer-learning community of generative leaders (the Value Curve Community).

In October of this year, we celebrated 10 years of the Harvard-related events, including the APHSA Leadership Retreat held the Friday before the annual Health and Human Services Summit. The themes from the Retreat themselves tell a story--from the first gathering of mostly state-level commissioners in year one to the early design work of what would become a multiyear focus on driving transformation through our Pathways framework--shared learning as the Human Services Value Curve gained traction to development of a strategic playbook for the field to major paradigm shifts in policy and practice as leaders at all levels apply the generative lens to their daily work.

APHSA Leadership Retreat Theme by Year

2010: Retreat of state leaders held in conjunction with the first Harvard Health and Human Services Summit

2011: Design work on what came to be known as Pathways

2012: Pathways: The Opportunities Ahead for Human Services

2013: Driving Systems Transformation

2014: Promoting Innovations and Demonstrations

2015: The Human Services Value Curve: Turning Ideas into Outcomes

2016: Leading in Uncertain Times: The Power of Generative Thinking

2017: Leading with Purpose--Charting a Collective Course Toward a Human-Serving Ecosystem

2018: Leadership Through a Generative Lens: Building Well-Being from the Ground Up

2019: Building Thriving Communities: Achieving Our Vision Together

One of my most memorable moments from the early years was when then-Connecticut Commissioner Rod Bremby, during a peer review of the Pathways initiative--which was shaped at the time around program-specific themes--opened his reflections with a simple statement: "We need to be BOLDER." In those few words, he was inspiring us to disrupt our long-standing mindsets and often highly entrenched ways of doing business, push ourselves out of our comfort zone, and collectively take steps as leaders to shift from program-to systems-thinking.

In further reflection today, I realize that Rod was also challenging us to "stand up" to our friends. Harry Potter fans will recall Professor Dumbledore's now infamous line: "It takes a great deal of bravery to stand up to our enemies, but just as much to stand up our friends," uttered when he awarded 10 points to Gryffindor to Neville Longbottom, sealing their win of the annual house cup. For our field, former Commissioner Bremby was challenging the oft-repeated mantra of "too few resources" and "too little flexibility." Together we leaders in the sector had to craft our own future state--by taking a deep look at what roadblocks we, ourselves, were perpetuating within the existing system and simultaneously creating space for innovation and making room for what is possible.

At APHSA, we began to apply "zoom in, zoom out" tactics--understanding that as a national organization we needed to be both close to the ground to better understand the possibilities and pain points and then widen the lens to see the full national landscape in order to identify the ripe levers of system change. We also took to heart the teachings of Harvard Professor Ron Heifetz who, in his presentation at the Summit, introduced adaptive leadership principles to the growing Value Curve Community:

Leadership is a special sort of educating in which the teacher raises problems, questions, options, interpretations, and perspectives, often without answers, gauging all the while when to push through and when to hold steady.

Being comfortable with ambiguity is central to leading within an adaptive lens. Professor Heifetz helped us understand that as leaders in a transforming field we need to keep the level of distress within a tolerable range for adaptive work to happen. Heifetz calls this the zone of productive disequilibrium. To be adaptive leaders in a highly complex and ever-changing world, we had to understand that leading through an adaptive challenge meant helping a team find its learning zone, through which new ideas and solutions emerge.

To help capture the shared learning across the Value Curve Community, we began to craft a strategic playbook, designed to guide our work as an Association. During one strategic planning session, I recall Phil Basso, Director of Organizational Effectiveness, suggesting that we look to other fields for successful transformation models; we focused in on work that had been done in the education sector and found a relevant model, which noted that successful transformations have four phases important to creating the buy-in, proof, scaling, and continuous learning required to drive systems level change:

* First, we must open up the current system to the possibilities of innovation/evolution.

* Second, we must demonstrate related innovations to practice and foundational supports that have the desired impact toward our desired future state.

* Third, we must scale and embed these innovations through policy/fiscal levers; supporting infrastructure (including IT and workforce) and new terminology, theories, and standards.

* Fourth, we must continue these phases as an upward spiral of monitoring, learning, and renewal.

In coming together annually at Harvard to push our thinking on the art of the possible, the Value Curve Community has exemplified this transformation model--first introducing ideas, including those from other fields and sectors; then sharing lessons from demonstrations in the field; and then taking those lessons beyond the classroom at Harvard and considering what is needed in policy and practice to drive systems level change, all the while fostering continuous learning cycles. We have learned, together, what it means to be a generative leader and have coalesced around the imperative of work--the well-being of all people in all places.

Over time, I have come to appreciate how much focus is needed in the opening up and demonstration phases to spark shifts in mental models, and why constantly zooming in and out is crucial to understanding what is ripe for broader action. Only then can we truly SHOW what's within our reach. You can see how these phases came to life in the pages of Policy & Practice from 2012-2014 in the charts that accompany this column. And, we've also added the timeline starting in 2010 to our website history page, and will continue with the next years of our shared journey in the next issue.
P&P Issue  Director's Memo

February   Introduction to Pathways: The Opportunities
2012       Ahead for Human Services
April      APHSA's Innovation Center--a Pathway to
2012       Breakthrough Practices
June       Today's Expertise for Tomorrow's
2012       Solutions--Leading Us Down New Paths
August     Technology--What's in Store for Us in
2012       2022?
October    Recap on Pathways Progress and Next
2012       Steps
December   Focus on Getting to Impact Through
2012       Collective Efforts
February   A Model for Transformation
April      In Pursuit of Adaptive Leaders at All Levels
June       Organizational Effectiveness
August     Policy Forum Energizes Members with New
2013       Insights and Innovative Solutions
October    APHSA to Unveil New Website and Social
2013       Media Platforms
December   Our Path: A Catalyst for Transformation
April      A Top Priority--Human Services Innovations
June       Organizational Effectiveness--Paves the
2014       Way for Agency Innovation and Improvement
August     Policy Forum Highlights Innovation in the
2014       Field and Research-Based Insights
October    APHSA's Partnership Demonstrates Power
2014       of Public-Private Collaborations

P&P Issue  Excerpt

February   Most people know us through the administration of specific
2012       programs that have been traditionally structured to answer
           particular needs--including child protection, job
           preparation, child support, food assistance, and care for
           the elderly, among others. These discrete benefits and
           services are critically important, yet they are tools we
           employ toward a much broader and more holistic mission:
           investments that enable children, families, and adults to
           achieve meaningful and lasting positive outcomes in their
April      The role of the [APHSA Innovation] Center is to provide a
2012       place to introduce cutting-edge ideas and support members
           and other leaders in thoughtful, focused experimentation
           and discussion that helps create a new national narrative
           and position our membership on the leading edge of system
June       The economic times have placed a greater demand on services
2012       while budgets at all levels of government continue to be
           slashed ... community resources and services have been
           severely impacted too, affecting the ability of us all to
           meet the needs... While the strain is real, leaders in the
           field see opportunity in this difficult time, and agree
           on the need for change.
August     I cannot help but be curious about what we'll be saying
2012       about IT in 2022: Will IT be supporting an efficient,
           seamless delivery of services through a customer-focused
           marketplace at the right time for maximum impact? Will the
           policy debates of the day still echo the debates of today
           or will they transcend to issues we cannot fathom? How will
           social media (or whatever we may call its descendant) fit
           into the picture? What kind of news tools will be available
           to the workforce? To our customers?
October    One of our explicit goals in Pathways is to change the
2012       language used to talk about health and human services from
           a tendency to describe our work in ways that are
           crisis-response-, dependency-, program- and output-oriented
           to descriptors that are person-centered and focused on
           prevention, capacity-building, integration, and outcomes.
           We are working to more accurately describe the current
           system, and through a well-articulated "future state," help
           steer national policy so that federal law, regulations, and
           guidance accurately reflect that vision.
December   While the concepts of collective impact and co-creation are
2012       new ones for our field... they offer significant promise
           for bringing about the next generation of human services in
           the country. At APHSA, we are committed to working with
           sister organizations to explore these ideas further,
           focusing on how we can leverage the incredible passion and
           expertise that leaders from both sectors bring to the table.
February   Transformational efforts should be informed by an
2013       environmental scan that helps us understand our context,
           including when to move opportunistically for quick wins and
           when to be patient. Transformation takes years (sometimes
           decades) to achieve, requiring many tactical steps along
           the way.
April      Introduced APHSA's reflective thinking questions to help
2013       members focus on adaptive leadership development.
June       Creating space in our world for innovation to happen is
2013       challenging, Our organizational structures,
           compliance-driven business models, and deep-seated agency
           cultures don't necessarily promote environment where
           innovation is embraced, let alone more "transformative" ways
           of doing business.... A focused approach on organization
           development and effectiveness is one way ... APHSA can
           assist members in their transformation efforts.
August     [At the Forum} we explored alternative ways of financing
2013       human services, what a social return on investment strategy
           can do for our industry, the changing dynamics of the
           federal-state-local relationships, and practical approaches
           to leadership through an adaptive lens.
October    Our goal is to build an even stronger network that
2013       functions both deliberatively and organically to drive
           smart policy decisions, connect members, and spread
December   Announced the APHSA Human Services Roundtable, supported by
2013       the Kresge Foundation, and designed to bring national
           partners together to support development of a modern frame
           for human services and arm us all with a new narrative.
April      To make systematic and broad-scale demonstrations and
2014       adoption of innovation the norm in our work, not the
           exception, we are calling for a continuous series of
           demonstrations covering multiple approaches to funding,
           policy and customer engagement, and partnerships that will
           both support new ideas and scale up existing innovations.
June       Shared the promising results of the third-party evaluation
2014       of APHSA's organizational effectiveness process.
August     True to the conference theme, Transformation in Action,
2014       shared innovative ideas and numerous examples of what is
           working and why, including use of rapid-cycle evaluation,
           application of brain science to understand the extreme
           stress experienced by families, and introducing framing
October    Announced the partnership of APHSA, the Alliance for Strong
2014       Families and Communities, and the National Organization of
           State Associations for Children (NOSAC) to collectively
           influence the policy changes necessary to align an outdated
           federal financing system with proven practices.

P&P Issue  Theme, Key Content

February   Driving Transformation-An Integrated Policy
2012       Agenda
           * Introduced foundational elements of Pathways:
           The Opportunities Ahead for Human Services
           * Role of Children's Cabinets
           * OMB Partnership Fund on Program Integrity
April      Breakthrough Practices
2012       * Title IV-E waivers
           * Public-private partnerships
           * Education training programs
           * Access/benefit coordination for nutrition programs
June       Managing Change
2012       * APHSAs National Workgroup on Integration
           (NWI)--release of Governance guidance
           * Adaptive leadership
           * Change management
           * Path ways TAN F and SNAP papers
August     Technology Issue
2012       * APHSAs NWI guidance on integrated human
           services and utilizing the A-87 cost allocation
           * Supreme Court ruling on ACA
           * New data on child care subsidy programs
           * IT improvement for the workforce
October    The Health and Human Service Marketplace
2012       * APHSAs Pathways--Alternative financing
           * Global lessons in systems integration
           * Money follows the person: promoting independence for
           people with disabilities
December   Decision 2012 Is Over: Now What?
2012       * Congressional outlook in 2013
           * APHSAs NWI 21st Century Business Model Guidance
           * Data standardization
           * Lessons from abroad
February   Driving Transformation
2013       * Trends in human services
           * Values-driven leaders
           * Local innovation in practice (from APHSA's Raise the Local
           * Transforming workforce capacity
           * Live Well San Diego profile
April      America's Changing Demographics
2013       * Healthy aging
           * Supporting employment opportunities for older workers
           * Immigration reform
           * Senior poverty
June       Shared Governance--Creating Effective
2013       Collaborations
           * Tracking Supreme Court trends
           * Role of government in the 21st century
           * Financial empowerment
           * Pathways paper on Gainful Employment
           * Employment for people with disabilities
August     Prevention--Getting Ahead of the Spiral
2013       * Understanding root causes
           * Career pathways
           * Teen pregnancy prevention
           * Pathways papers on Social Return on
           Investment (SROI) and Behavioral Health
October    Technology--Integrating Systems to
2013       Improve Human Service Delivery
           * Impact of social media on Congress
           * Health care reform
           * Systems integration
December   Impacts and Outcomes--Tracking and
2013       Evaluating Strategies for Better Human
           Services Delivery
           * Evidence-based practices
           * First mobile apps in social services
           * Simplifying access to improve outcomes
           * Improving employment for people with disabilities
           * Social impact bonds
April      Authentic Voices
2014       * "Treating" poverty
           * Constituent feedback to inform programmatic decision-making
           * Restorative staffing
           * Empowering youth
June       Transformation in Action--Making
2014       Connections to Make a Difference
           * Leading transformation
           * Federal IV-E waivers
           * NWI Analytics Capacity Roadmap
           * Blended/braided funds
           * Service integration in Dakota County
           * CalWorks program in San Diego
August     The Modern Marketplace--How Tech is Forever
2014       Changing Human Services Delivery
           * Pathways visioning paper
           * Introducing framing science
           * Mobile IT apps in the field
           * Roots of burnout
           * Integrated service delivery
           * IT and health care reform
October    Healthy Families, Strong Communities
2014       * Hawaii's business process reengineering
           * Financial capability services
           * Health and human services convergence
           * Predictive analytics in child welfare
           * Child obesity

P&P Issue  Commentary from Field Leaders and Experts

February   From our members' Pathways Open Letter to Policymakers
2012       and Stakeholders: "Our solutions will require changing
           health and human services programs and funding streams so
           that they become integrated, outcomes-focused, and centered
           on the needs of people rather than compliance with
           bureaucratic outputs."
April      On building stronger communities through public and nonprofit
2012       human services partnerships: "We must continue to move
           beyond program outcomes to partner and leverage resources
           across sectors and within communities for impact."
June       Harvard's Antonio Oftelie and Accenture's Julie Booth, along
2012       with APHSA's Executive Director Tracy Wareing, headlined
           how adaptive leadership principles were shaping field
           transformation, noting that: "Today's environment is
           cultivating a new breed of adaptive leaders who favor
           possibility over pessimism, fearlessly go against the
           grain, and feel energized where others are paralyzed."
August     On leveraging the opportunity for cross-system
2012       interoperability: "The health and human services field is
           at a critical, squarely on the threshold of what promises
           to be a very different future than the world today.
           Although modern technology can deliver whatever system
           design is envisioned, it is up to the nation's health and
           human services leaders to see the vision, think
           strategically, and pan for the future today."
October    On thinking globally and acting locally, a long- time
2012       leader in the field shared that "the many demographic and
           economic forces that shape our human services challenges
           are common to our peers in other nations" and "the better
           we understand the broader world in which we live, the
           better equipped we are to act within our own sphere of
December   From NWI's guidance on the need to integrate health and
2012       human services: "The new business model for health and
           human services calls for an integrated sector seamlessly
           exchanging information and sharing core infrastructure,
           integrating and coordinating public benefits and services
           around the consumer's need ... all the while driving toward
           the realization of outcomes that will sustain the consumer
           long into the future, thereby benefiting the individual,
           the community, and the state over time."
February   On the future of human services: "Recognizing the need to
2013       maximize resources and offer fresh ideas some human services
           organizations are breaking through long-standing barriers and
           exploring nontraditional partnerships with each other--both
           nonprofits and the private sector. The result in a new human
           services ecosystem where organizations forge interactive and
           interdependent relationships that are mutually beneficial and
           directed toward a common goal."
April      From a national partner on bridging the divide regarding
2013       immigration reform: "lost in the political debate ... are
           facts about the immigrants who are already here, their role
           in the workforce, and their impact on states."
June       From then-Delaware Governor Jack Markell, "employers must be
2013       comfortable employing people with disabilities in order to
           harness the talents of the next generation. Savvy business
           leaders already get it."
August     Under our Pathways' policy initiative, we noted: "that our
2013       current policy and funding environment is creating greater
           need for an investment in human services ... land] within
           this context, Social Return on Investment offers human
           services agencies an opportunity to ensure the community
           impact and social value of their services and programs."
October    From APHSA's NWI about the pathway for integration of
2013       health and human services: "Fortunately, there has never
           been a better time to leverage federal financial support,
           analytical support systems, technology, and advances in
           business process re-engineering to connect the widely held,
           positive vision for where organizations need to be, and the
           challenges and opportunities state and localities
           currently face."
December   On solving social problems through evidence-based practices:
2013       "to rectify the lack of proven policy solutions, we must
           formulate working solutions and scale levidence-based]
           solutions nationwide ... government social spending should
           incorporate far more experimentation, perform more rigorous
           evaluations of ideas, and reallocate fund from less
           effective programs to more effective ones."
April      On supporting the well-being of the workforce: "Bottom
2014       line--business and motivational research and lessons from
           working with health and human services programs yield this
           pointed advice. Listen to staff, involve them in change,
           equip and free then to do good work, hold them accountable,
           and recognize and assure them."
June       On transformation work Harvard's Antonio Oftelie shared:
2014       "It is equally important to know what transformation isn't.
           You can't buy it from a vendor, or proclaim it from a
           podium. It's also not a fancy word for innovation. While
           innovation is an important tool to help organizations become
           more effective and efficient... it's incremental and short
           term in nature. Transformation builds on innovation by not
           only shifting the mission of an enterprise, but also the
           capabilities deployed in order to achieve heightened impact
           and an entirely new value proposition over time."
August     On technology's role under health care reform: "By investing
2014       in IT upgrades that enhance data sharing across programs and
           make reporting more efficient, both health care and benefit
           providers will have an unprecedented holistic view of their
           clients, improving individual and overall population
October    On addressing the social determinants of health: "Health and
2014       human services convergence is wholly coordinated and
           data-driven service delivery that empowers individuals and
           occurs across health, social services, and community-based
           providers in both public and private sectors. This
           coordinated, agile, and common sense approach contributes
           to healthier residents, healthier communities--and at
           scale--a healthier nation. The impacts are profound: system
           changing, policy changing, and life changing."

Reference Note

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By Tracy Wareing Evans
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Title Annotation:president's memo
Author:Evans, Tracy Wareing
Publication:Policy & Practice
Date:Dec 1, 2019
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