by Tom Corbett
From the 1960s on, the federal government tried to stimulate collaboration across the different programs serving similar populations. Sometimes the feds focused on related income transfer systems, other times on related service programs. They pushed states to create super agencies like the one I was first hired into as a young state policy wonk. These centralized bureaucracies did not always (perhaps never) resulted in much coordination where it mattered, at the operational level; but they seemed like good ideas at the time. The feds also developed pilot program initiatives that supported collaborative efforts at the state-local level as a way of inspiring others to follow suit. But the anticipated spread of the new model programs never happened as expected. The feds continued to push and prod with only small, and too often temporary, successes.
When Jennifer and I realized that a liberal and a conservative could work with one another (assuming I obeyed her every command), we earnestly dove into the Super Waiver controversy. Of course, blind obedience comes easily to me since I had been married forever. I likely jumped into this debate in response to arguments from the WELPAN network and she probably more from a general conviction about the preference of local control over policy decisions. No matter, we found one another to be on the same team.
As we looked around, we hit upon one insight. There was a lot of service integration and programmatic collaboration taking place around the country. It was happening all the time and in many different service contexts. Most were spontaneously generated efforts borne out of the desperation to do a better job of serving families. Yet, too many of these efforts were struggling to thrive, and too many did not survive over the long haul. They were bucking many headwinds such as counterproductive federal and/or state regulations and funding streams, bureaucratic inertia, union or civil service inflexibility, and many other such impediments. Somewhat to our surprise, we noticed that some places were making it work quite well despite the presumed impediments. It occurred to us that there might be fewer insurmountable barriers to breaking down the silos between programs and agencies than was thought. Perhaps the conventional wisdom needed a deeper look.
With support from the Annie E. Casey Foundation and later the Joyce Foundation, the two of us embarked on an effort to first try to diffuse the animus surrounding the Super Waiver proposal and then seek to find out more about what makes local innovations work or not work. The first effort probably was doomed from the start, but we immersed ourselves in it with the old “what the hell” attitude that all good policy wonks must possess. A bit of insanity is quite necessary to tackle some of these issues. We set up several meetings in D.C. with many of the key actors to facilitate a rational discussion of that issue. Yes, I was still naïve, even optimistic, despite having been around the track many, many times.
A few days before one of these meetings, I received a call from Robert Greenstein, the head of the Center for Budget and Policy Priorities (CBPP) in D.C. I had met him on several occasions and was always impressed with his command of facts and his personal gravitas. Though he often came across as if he had just consulted with God, I knew he was not always right…none of us are. It was just that he always seemed to be right. He was a force majeure in Washington and could stare down the toughest insiders. I saw him come close to intimidating David Ellwood during my Washington stay, not an easy thing to do given David’s sound ego. I broke out in a cold sweat just realizing that he had tracked me down in Madison. He gave me the “what are you thinking?” routine that was followed by the “I know you mean well, Tom (you total doofus), but don’t you realize you have fallen into the arms of Satan” speech. In the end, we agreed to disagree.
Jennifer and I also spoke at several forums on the matter. I recall one put on by the National Governor’s Association. Jennifer and I were on a panel with assorted welfare experts. At some point, a paper was distributed to everyone. It was a statement denouncing the Super Waiver provision as the worst policy idea since the Dred Scott decision that affirmed the constitutionality of slavery. It was signed by every liberal and left of center group and individual that I could imagine.
So, I am sitting there thinking, have I really fallen into the arms of Satan? But no, I concluded perhaps in a moment of self-delusion, too much of what goes for policy debate is really scripted beforehand. Once handed their lines, the actors carry out their assigned roles without thought or imagination. In the policy arena, there is nothing more deadening than seeing the same play, and hearing the identical lines, for the thirty-third time. Sometimes you simply must walk your own walk. You might walk right into the quicksand, but hey, you did it on your own.
On that note, I remember another time when I spoke before a Wisconsin legislative committee on some issue regarding the famous Wisconsin Works (W-2) program. It was before I started working closely with Jennifer, but we knew each other and she and Jennifer Alexander (the secretary of the State Welfare Department at the time) were in the audience. I had briefed legislative committees many times in the past but this, it would turn out, would be my last trip up there.
As I sat waiting my turn, I listened to the speakers who preceded me. I was appalled, though I had been through this drill numerous times before. Perhaps I was simply getting grumpy in my old age. Each speaker struck me as coming straight out of central casting, saying exactly what you would expect, given the organization they represented. There were no surprises and no new information, just rehashed scripts from years past. I remember thinking, how do the legislators do it? How do they listen to verbiage that is so predictable? Had I endured this with any regularity, they would soon notice my lifeless body slowly swinging from a nearby rafter. It was almost as bad as being in a faculty meeting.
I can no longer recall much of what I said that day. However, I do recall pointing out that W-2 could not be faulted for not ending poverty in Wisconsin. The program it replaced, the AFDC welfare program, did a miserable job in that regard as well. Welfare, by its structure, is not an anti-poverty strategy, at least as poverty is conventionally measured, which strikingly ignores noncash benefits. Any assistance provided tends to replace and not supplement earnings and the guarantees (the amount given absent other income) must be kept rather low to avoid an uprising from the general populace. On finishing, committee members mentioned how refreshing it was for a speaker to provide objective evidence and a balanced point of view. I did sympathize with them if they had to rely on me for that! I was tempted to mention that the former governor saw me as the Devil incarnate who surely could trace his genealogy directly back to Karl Marx.
Back now to the main story! Jennifer and I spent most of our time working with what we called “lighthouse sites.” We selected places that seemed to be doing exemplary work on program or systems collaboration and then did site visits. We engaged in what I now call institutional ethnographic analysis, which is not an official line of inquiry. Still, I find that those words roll off the tongue. Put plainly, we used our experience and smarts to get inside these organizations to figure out what is going on. Now, if I had been halfway smart as a young man, I would have pimped this term as a new methodology through which we might unravel the deep secrets of institutional dysfunction and make them whole again. I could have done those 2:00 AM infomercials alongside the guys hawking Ginza knives, and made millions, okay hundreds, of dollars as an expert on such matters. There could have been book and CD to sell, along with the movie rights. If not that, perhaps I could have palmed it off on my Social Work colleagues to save my tragic excuse for an academic career. Seriously, though, good intentions flounder on the shoals of institutional dysfunction all the time. We need to develop the diagnostic and theoretical tools to better manage the doing of extant policies as opposed to the creating of new policies.
Our collaborative work on these issues stretched over a decade and could fill a book on its own. In fact, we have published several articles in Focus and written several reports. We also developed a manuscript ready to go on the topic, but I was never sure that the worl
d was ready for it. Rather, I excised significant portions of that work to include in another book of mine titled The Boat Captain’s Conundrum. Absent the handful of readers of this present blockbuster running out to get a copy, I will just give a thumbnail sketch here. You can wait for the movie to get the full story.
We organized a group called SINNET, the Service Integration Network. It included people like Susan Golonka, Courtney Smith, Jim Dimas, Mark Ragan, and James Fong among others. All had been doing work in this area; we compared notes to brainstorm about how to advance the integration agenda. We spent much time comparing our experiences and understanding of the underlying issues before convening several venues to explore key issues with stakeholders and those doing integration in the real world.
Susan Golonka and Courtney Smith also pulled us into the work of NGA (National Governors Association). This trade organization periodically polls governors regarding what issues are high on their interest list. The issue of cross-systems integration, as it came to be called by NGA, typically made its way to the top of these interest lists year after year. They convened an “academy” where a small number of states are selected to participate in workshops designed to facilitate the planning and execution of model programs. Top officials were invited to a kickoff session. They then go back home to start their projects and subsequently gather together once again to share lessons learned and for motivational booster shots. Jennifer and I served as staff for the sessions.
I recall sitting on the initial planning sessions for Wisconsin and Pennsylvania. In the Wisconsin session, the secretaries for the State’s Labor Department and Services Department were struggling to get the discussion off the ground. It was too abstract, more like a cheering session to do good things rather than a substantive discussion. I gently suggested that they focus on some actual target populations and specific issues that both organizations served. What might they accomplish if they worked together on these real families and actual problems rather than in isolation? One of them jumped up with data on the number of child welfare cases which fell under the purview of both departments but from distinct therapeutic perspectives. Soon, they were off and running. Dealing in the concrete is a better path to progress than abstract discussions of intent.
Wisconsin later launched a series of six pilot projects in counties around the state. We assisted as much as time allowed, writing a report for the state on what was going right and what was going wrong. As with so many other similar projects, the people at the top were smart and motivated. But they were also overextended. Doing service integration requires a lot of hands on attention and that was not forthcoming. I recall that we asked for a meeting with the top people in both departments and it took months to arrange. When you are engaged in systems change, oversight must be continuous; and a clear vision and message from the top must be reinforced repeatedly.
Jennifer then worked with the Center for Law and Social Policy to identify any federal impediments to doing integration at the state level. This was a shotgun marriage of the left and right perspectives, but it worked well. Their joint work explored whether the presumed federal impediments observed at the state level were as important as people said. Were these presumed barriers overblown? In either case, what might be done about them?
I, on the other hand, started to work with Barbara Blum, a grand old lady who had run human services in New York State, had been the CEO of the prestigious Manpower Development Research Corporation (MDRC), and had headed the Foundation on Child Development (FCD). She and I began to look at how we could better evaluate and learn from the extensive experimentation on service integration that was going on around us. We were convinced that existing methods were inadequate for the task and convened the best and brightest from academia and the evaluation firms to explore the question. The assembled expertise was able to document why existing evaluation methods fell short, but never really came up with an answer to the shortcomings. Alan Werner from ABT Associates and Sandra Danziger from the University of Michigan worked hard on a proposal to systematically explore methods suitable for these complex questions, but funding never materialized. Besides, I was approaching the stage in life where another major initiative did not have great appeal. The question remains, how do we rigorously evaluate interventions so broad in scope that they transform the very culture in which the services are delivered?
Jennifer and I also convened several workshops in which we brought together some of our pilot sites, our “lighthouses.” At these sessions, we vetted what they were doing, what was going right, what was going wrong, and what might help them advance the integration agenda. One was a joint SINNET/WELPAN meeting held in St. Paul Minnesota in 2003. The synergy and connection between the lighthouse sites and the top state welfare officials was great to observe. There seemed to be such great promise and hope for the future in that room. As someone who contributed nothing to the world through his own efforts, it was wonderful to bring together those making actual contributions.
We found such sessions stimulating, as did the participants. Too often, they were out there struggling to overcome so many obstacles in seeming isolation. They felt alone and often frustrated. I recall we met with top state officials in Utah, a state that was quite active in doing systems integration work. I asked at the beginning of the session how they were doing. After a pause, one of them said, “We are exhausted.” In truth, they looked rather spent. As they began to discuss what they were involved in, however, their animation and spirit returned. If nothing else, these sessions were welcome therapy to them. I wished we had obtained sufficient resources to do more of them.
The greatest fun was going out to the lighthouse sites around the country and Canada. I won’t bore you with a list of names that won’t mean much to the average reader. Let us just say we made many site visits either singly or together. Poor Jennifer, she got to hear about the rest of my fascinating life. How she maintained her sanity is yet a matter of wonder. Sometimes we went as learners, sometimes as consultants. The role did not matter, we learned much from those doing the work. The reality is that the real experts are the ones working in the trenches. It was from their sweat and inspiration and effort that we drew some wonderful insights and lessons.
I do recall one visit to a local office in the state of Oregon. They had developed a team approach to dealing with difficult family situations. The members of the team tapped into several types of expertise—mental health, child protection, substance abuse, family dynamics, income support, workforce development, and so forth. The lead worker, or case manager, would be selected according to the primary issue that needed to be addressed though all members of the family would be incorporated into a comprehensive treatment plan.
It all sounded ideal, and I became a bit suspicious that we were getting the county’s public relations pitch. I probed whether they all worked together as well as they claimed. After a moment’s pause, a young man spoke up, “It was hard for me at first. I admit that. I had been in the Marines earlier in my career. I was used to always following orders, obeying the rules set out in a manual. When I started here, I was lost. I went to my supervisor and asked for the manual, I needed to know the rules I was to obey. My supervisor looked at me, paused, and then reached inside his desk for a book. But it wasn’t a manual. It was a self-help work that laid out the seven habits of highly effective people. Eventually I got it. There would be no hard and fast rules. We were to use our professional judgment and work as a team to do the best we could. I had to learn what the others could do and how I could fit in. It took me a while, but now I am totally convinced that this is the best way to work with these families.”
From dozens of such insightful moments, we learned that doing integration is both simple and hard. Most people approach the task as a conventional planning effort. They spend enormous amounts of time on organizational charts, on innovative automated case management tools, on new training protocols and procedures manuals. They change forms and they change buildings and they
change the places where people sit and do their work. Such innovations often are fine. Sometimes they are essential to what you are trying to achieve. In the end, however, they may not be enough. The heart and soul of doing integration lies elsewhere, and the secret is finding where that elsewhere is.
While the details of doing integration are many and exhaustive, the essentials are few and fundamental. First, know what the problem is you want to fix. Second, identify what population needs attention. Third, articulate what you want to achieve at the end of the day and make sure you focus on customer changes, not bureaucratic changes (the latter are only interim markers toward what you really want to see). Fourth, figure out what it is you do now that doesn’t get you there. Fifth, think through, very carefully, what you need to do to get from where you are now to where you want to be. Sixth, walk in the customers’ shoes…envision how the new system would look from their perspective. Seventh, be honest! Why in God’s name would what you are proposing result in the realization of the changes you are seeking (i.e., what is your theory of change)? Eighth, think through what resources and structural changes are needed to facilitate the new customer experience in your reformed system. Ninth, think hard about what kind of people you need for the new system, the ones you have now might not fit. And tenth, how will you know you are on the right path, what markers will you pay attention to as a signal that you have transformed the customers’ experience in a way that just might possibly create the outcomes you seek?