Position Statement on Proposed Iowa Health and Human Services Alignment

Earlier in the year, the State of Iowa announced a planned Alignment between the Iowa Department of Public Health (IDPH) and the Iowa Department of Human Services (DHS). The two primary human services agencies in the state will soon become a single department, Health and Human Services (HHS). The Alignment is expected to officially begin in early 2022, with a gradual implementation of the planned changes in the months and years to come.

On November 15th, the Alignment Project Team and Public Consulting Group released the Preliminary Change Package, a high-level proposal for aligning IDPH and DHS into a single agency. The Preliminary Change Package describes a vision of an efficient and effective Health and Human Services system that coordinates care, responds to need, and reduces burden for stakeholders. The plan organizes the proposed changes into five “impact areas”:

1. Integrated organizational structure
2. Welcoming and efficient “front door”
3. Closed loops and facilitate “warm handoffs”
4. Improve use of data
5. Shared vision, frameworks, and connection with the “big picture”

The Alignment Project Team is currently soliciting stakeholder feedback regarding the potential changes. Prevent Child Abuse Iowa has carefully analyzed and considered the plan and holds the following positions in response to each feedback question. The relevant section of the Change Package is cited in parentheses.

Regarding each Impact Area, which proposed changes do you feel are particularly important to keep as we move toward one, single health and human services structure?

Area 1: Integrated Organizational Structure

PCA Iowa supports the proposal for an integrated HHS structure (B.O.1.) and is hopeful about the opportunities to apply public health practices to child abuse prevention and child welfare (M.3). PCA Iowa supports joint block grant applications to take advantage of the overlap in behavioral health services provided by both agencies. Combining substance abuse and mental health block grant applications allows for a shared vision of prevention and treatment (B.10). PCA Iowa agrees with the recommendation to align contract language, policies, and processes (M.1), and believes that this should be examined for all similar programs to ensure ease of access for Iowans receiving these services and for contractors. The proposal to increase Mobile Crisis access through American Rescue Plan Act funds strengthens our state’s ability to respond to mental health needs (B.11).

Area 2: Welcoming and Efficient Front Door

IDPH and DHS are primary “front doors” for need-based services to Iowans. Prevent Child Abuse Iowa supports the efforts for better screening (B.5) and streamlining intake and eligibility (A.2, H.4) as ways to focus on prevention. This alignment presents an opportunity to reduce information-sharing burden for individuals and providers, so that families can more effectively apply for and receive services without the challenge of two separate service connections (A.1b). The change plan proposes expanding functionality of Your Life Iowa, the state’s behavioral health support hub, to enhance screening and service access for all Iowans (H.7). We support a true “front door” with easy access to live person who can provide needed resources or connect to the right resources, rather than multiple access points requiring multiple handoffs, phone calls, or locations to visit.

Area 3: Closed Loops and Facilitate Warm Handoffs

Families who receive services from IDPH and DHS often have complex needs and may be involved with multiple systems. The Alignment presents an opportunity to streamline the case management system by improving the connection between the individual served and the programs that serve them. Aligning prevention services across departments (S.8), training hospital staff to educate families on services (M.O.1.), and broadening screening strategies are three proposed changes that improve statewide prevention efforts (S.5). The proposed Service Navigator Corps is a high-touch strategy to gather screening and application data from families while facilitating the “warm handoff.” (S.O.2.). We believe the Service Navigator Corps will provide an ally to family members, reduce fear and stigma when interacting with the department, and limit the burden involved in sharing information with multiple people and departments.

Area 4: Improve Use of Data

IDPH and DHS depend on high-quality, accurate data to make decisions. The proposed data-sharing arrangement will make application and verification easier for those receiving services. Privacy and data protection safeguards in the proposal are important requirements for public trust and information security when merging sensitive individual data with aggregated public data.

Area 5: Shared Vision, Frameworks, and Connection with the “Big Picture”

The adoption of one shared vision and strategic framework (B.1) and increased understanding of services internally (A.1a) has the potential to improve accessibility for Iowans. This can lead to earlier access to services, improving outcomes and preventing more expensive future service needs.

Regarding each Impact Area, what are some potential disadvantages of the changes proposed? What programs or practices could be put at risk if we proceed with the changes as proposed?

Area 2: Welcoming and Efficient Front Door

There appears to be multiple recommendations in the initial change package for this structure from the different work groups. A potential disadvantage of a multiple “no-wrong-door” approach is that the individual with multiple needs must call or travel to multiple locations, take more time, and share the same piece of information multiple times. Additionally, there appears to be a crisis orientation to some of these recommendations. Crisis intervention is a crucial service provision, however, PCAI would advocate for a stronger focus on prevention efforts to reduce the need for crisis services.

Area 3: Closed Loops and Facilitate Warm Handoffs

A potential risk in program consolidation is the loss of some program variety. We advocate for continuous review of program service array.

Area 4: Improve Use of Data

While we support strategic sharing of data across services for improved access and for continuous quality improvement, we recognize the difficulty in doing so while maintaining personal privacy and data security. Combining public data systems with sensitive health care data systems will require a sophisticated data management approach.

As we work toward combining the departments of public health (IDPH) and human services (DHS) and into one, single HHS structure, what should we keep in mind as we develop the HHS organizational chart?

Maintain focus on prevention

Prevention saves money, reduces harm, and improves outcomes for families. Each family that reaches out to HHS in crisis is a missed opportunity to prevent harm and trauma. The earlier we can identify and meet the needs of the families in our state, the more we can reduce harmful impacts and costly treatments down the road. We would recommend including responsive and protective services (i.e., Child Welfare) on a continuum of services as part of a public health framework.

Keep families/users at the center of decisions rather than services, divisions, programs

Families are stronger, and our efforts are more effective, when their unique strengths and needs are at the center of decision-making. We support a structure for family services that is family-centered and strengths-based, not focused on process and family deficits.

Importance of community and social supports

Communities are best served by a safe place to gather and build social supports for all community members, where other resources and opportunities are also available. The focus of community supports should be on strengthening relationships and offering access to services in a dignified way that facilitates natural, informal social support networks. Resilient, connected, responsive communities serve as an important and needed protective factor from many negative outcomes.

Maintain focus on ease of access and navigation of families and users

The current plan references multiple different access points, call centers, assessments, and case managers. PCAI recommends a system with one true contact point that could be reached for access to any of the services.

Include family voice for this and future projects

Families across the state at times feel disconnected from the decisions being made in Des Moines. It is critical to authentically involve families at each stage of the change process. Family voice should guide the conversation, and leadership must be willing to make changes in response to community needs, if the alignment is to be effective.

Ensure necessary funding to implement systemic change to reach stated expected outcomes

The vision of a simplified, effective Health and Human Services department cannot become a reality without an investment in Iowa families. Enhanced systems benefit families only when there is a strong network of supports waiting on the other side of the “front door.”

What Can You Do?

Share our one-sheet!

Our one-sheet is a single page version of our statement. Download, read, and share!

Provide Feedback!

We encourage you to provide feedback on the alignment by filling out the survey form, which can be found here. You can learn more about the Alignment, read the change package report, and register for one of the remaining listening sessions at hhsalignment.iowa.gov.

Feedback closes on Friday, December 3rd, 2021