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For foster teens, the path to adulthood is uniquely challenging. As thousands of young adults age out of the foster care system each year, many child welfare agencies are searching for ways to better support them through this transition. According to Dr. Elizabeth Wynter, child welfare advocate and author of Follow the Love: Permanent Connections Scaffolding, the key is to build strong youth-adult partnerships. In a recent episode of BerryDunn’s Fresh Perspectives in Social Work podcast, Dr. Wynter and I discussed the need for a “connection scaffold” and offered insights on improving outcomes for foster youth. Here are five take-aways from our conversation.

Fostering relationships with youth 

The most important element in a young person’s life is having a supportive adult connection. This “connection scaffolding” is essential if we want young people to be able to form long-term, healthy attachments and make a successful transition to adulthood. Every interaction with a young person is an opportunity to build trust—too often, we make decisions based on liability, rather than the best interests of our youth. So, as child welfare people, we have to ask ourselves: Are we just being transactional or are we being relational in our interactions? Well-being is built on relationships.

Integrate youth voice in the child welfare system

Child welfare advocates recognize the importance of actively involving and empowering young people in the system to ensure their voices are heard and considered when making decisions that impact their lives. But integrating youth voices can be a challenge that requires a change in attitudes, values, and beliefs. We need to be ready to have young people at the table, but we haven’t yet changed our training or approach. This requires a shift in thinking: to perceive youth not as service recipients but as organizational assets. By creating youth-adult partnerships, we can learn from young people what leads to success.

Value all existing connections with foster children

There’s no greater loss for a young person than losing their primary caregiver. Being pulled away from one’s family to live with strangers is very frightening. They are dealing with loss and grief, and often we don’t give them enough time to process the loss before they can open up to a new relationship. Research shows that more than half of youth will end up living with a relative when they age out of care. So, instead of severing those family connections, we can work to scaffold them. We can teach young people about healthy boundaries so when they re-enter those connections, they will be better prepared. All connections can be of value.

Focus on social-emotional needs

Becoming an adult is a challenging transition for all young people, but foster youth have a steeper climb than their peers because they lack adequate support and guidance. During COVID, foster youth fell even further behind academically, emotionally, and socially. If our goal is to help young people become interdependent, as opposed to independent, it’s important to teach them interpersonal communication, socialization, and help-seeking skills. Focusing on social-emotional needs is essential if we are to prepare our young people for the journey ahead.

Follow the data for improved child welfare outcomes

What is success? Unless we begin tracking the outcomes for youth in the foster care system, we don’t know what works. How many of our young people at any given time have graduated college? How many have jobs? When we cut off their stipends, are they going to be homeless? By doing a self-sufficiency matrix that identifies how youth are moving toward self-sufficiency, child welfare agencies can begin to deliver more targeted, need-based services rather than one-size-fits-all. It takes time, but we need numbers to really understand whether or not our services are of value.

BerryDunn’s child welfare consulting team works with agencies to develop sustainable programs that support the safety and well-being of your children and families while supporting child welfare professionals. We work with agencies to leverage data and drive effective decision-making for interested parties to create more stable environments that support the reduction in child vulnerability. Learn more about our child welfare team and services.

In today's data-driven world, the ability to share information between Medicaid and Public Health Agencies (PHAs) is crucial for efficiently using limited resources to serve both individual patient and population health goals and priorities. Often, states already have the needed technology, but they don’t have the partnerships or workforce infrastructure to leverage existing investments across different agencies.

At BerryDunn, we bring together experts from different disciplines to take on current challenges. Our experience offers states and territories realistic and proven strategies that maximize existing investments to make the broadest impact on a population’s health and well-being.

The following are some planning considerations for uniting Medicaid and public health in accomplishing unique goals with shared resources, and bringing much-needed, sustainable resources to modernize public health systems.

Understand existing data systems

It is essential to understand the context of Medicaid and public health data systems and build solutions based on current realities. For instance, the Medicaid Enterprise System (MES) is a portfolio of systems that support various functions such as beneficiary eligibility, care management, provider enrollment, and often, data analytics to enable value-based care models. In many places, Medicaid is also funding, or has a great stake in, the Health Information Exchange (HIE) system(s), which centralizes clinical health information for access across disparate care settings. Alternatively, PHAs have information systems to support their responsibility to be the source of truth for tracking birth/death records, surveillance, prevention, disease prevalence, and outbreaks. This information collectively informs prevention efforts and helps to monitor and respond to public health threats.

Understand the funding drivers

Medicaid IT systems are funded through a combination of federal and state resources; the federal government provides matching funds from the Centers for Medicare & Medicaid Services (CMS). Federal investments vary by state, but CMS often invests in systems that enable effective Medicaid operations. Some of these CMS-supported systems are typical to Medicaid, such as claims management systems, while others are typical to public health departments, such as immunization registries. Public health information systems receive funding from various federal sources to support efforts like vital records reporting, disease registries, and syndromic surveillance. After decades of underfunding, the Centers for Disease Control and Prevention (CDC) released the Public Health Infrastructure Grant (PHIG), which allocates funding to health departments to support upgrades to technology, training, and staffing for modernized disease detection, prevention, and response. The PHIG-supported infrastructure may include some of the same systems in the Medicaid Enterprise.

Promote data interoperability

One of the main challenges in health information sharing is ensuring that different data systems can communicate with each other. This means adopting standardized data formats and protocols that enable different systems to share and interpret data accurately. Both clinical and public health data sets are defined by clear data standards; however, that does not mean the healthcare community is adhering to these standards consistently. Matters of equity, technical and workforce enhancements, and policy enforcements and incentives all require local collaboration, expert support, and partnerships with leaders aiming for interoperability.

Establish clear governance and policies

Effective health information sharing requires clear governance structures and policies that outline how data will be shared, who will have access, and how privacy will be maintained. Developing a framework that addresses these aspects can help build trust between Medicaid and PHAs, ensuring that data is used responsibly, ethically, and in line with federal and state law.

Draw on proven case studies

Look for proven examples that information sharing can provide valuable insights. Across the nation, MES and PHAs are working together to leverage IT infrastructure to support wide-reaching population health goals. Whether it's ensuring that health records contain accurate death data or public health has real-time laboratory results on disease outbreaks, there is a lot to learn from what is working in the field.

The COVID-19 pandemic proved that health information system infrastructure was not sufficient, and that existing systems were not being used to their capacity. One prevalent example is the lack of use of HIEs to support both Medicaid and PHA data aggregation and sharing needs. HIEs can serve as a clearing house for real-time clinical data directly from the sources of Electronic Health Records (EHRs), laboratory information systems (LIMs), and other community information systems. By identifying shared data needs, Medicaid and PHAs can analyze current information for a variety of foundational use cases that align directly with their strategic goals. Many states and territories have made progress in this area.

Take the first step

Building strong relationships between Medicaid and PHAs is essential if states/territories want to leverage existing IT investments to bolster programs focused on improving health and well-being. Start with finding a champion who is willing to understand the mutual benefits of working together and is a trusted voice with agency leadership. Meet your partners where they are, beginning with what drives them (e.g., environmental pressure, funding sources, existing IT, the mission of their organization). Be consistent and expect that building partnerships that catalyze such transformative impact will take time and energy.

By leveraging existing data systems and fostering a collaborative environment, states/territories can achieve broad information-sharing goals that enhance health outcomes. What do you think about these strategies? Do you have any specific goals or challenges that your state/territory needs help with? Let’s connect!

At BerryDunn, we have hands-on experience working with both Medicaid and PHAs. We can help with strategic planning and coordinating efforts to draft and submit funding requests like APDs, launching projects that benefit both agencies through shared goals and activities. Learn more about our services and contact the Public Health team.

Public health is at a crossroads. With the lessons learned from COVID-19 and a workforce on the brink of burnout, now is the time for transformative action. By reimagining operations, infrastructure, and health equity, we can shape a system that’s responsive to future challenges.

Applying lessons learned during the COVID-19 response, our post-pandemic world requires public health to embrace a culture of change and discover new ways to offer services and improve health outcomes. Fostering an educated and resilient workforce, operationalizing health equity, strengthening partnerships and funding, enhancing organizational change management, and improving data collection and sharing efforts are key considerations for public health leaders navigating the transformation process. 

Through transformation, public health agencies can build a system that is more engaged with partners and responsive to future community health challenges. When agencies are more capable of meeting the needs of communities, they essentially increase their abilities to enhance health outcomes across the country. 

Since 2014, the Public Health Workforce Interest and Needs Survey (PH WINS) has assessed the governmental public health workforce in the United States. The survey, conducted by the de Beaumont Foundation and the Association of State and Territorial Health Officials (ASTHO), identifies the public health workforce’s opportunities and challenges including demographics, job characteristics, employee engagement, and training needs within public health agencies. The 2021 survey was conducted during the COVID-19 response and provided meaningful insights that public health leaders could use to make decisions about the current workforce and set priorities for the future workforce with the goals of improving the employee experience and increasing the effectiveness of public health efforts across communities.  

Key survey findings 

The 2021 PH WINS identified a diverse public health workforce in terms of age, educational background, and experience but also recognized challenges posed by an aging workforce. The survey found a significant proportion of public health professionals nearing retirement, which presents a potential problem for sustainability and a critical need for succession planning within public health agencies. 

Taking a deeper look into the demographic gaps identified by survey respondents, most public health professionals identified as white (54%), female (79%), and aged 40 or older (63%). Nearly half of the nation’s public health workforce reported being between the ages of 31 and 50 years, and nearly half of the professionals had served in public health agencies for five years or less while 13% had served for 21 or more years.  

To safeguard communities, promote health equity, and prevent disease, public health professionals are essential. Understanding the workforce’s reasons for leaving the field is crucial for succession planning, recruitment, and retention. The top reasons identified by survey respondents for leaving include work overload, burnout, and stress. More than 25% of public health staff stated they are considering leaving their organization within the next year, and 24% reported that the COVID-19 pandemic had an impact on the decision.  

According to the survey, job satisfaction and morale should be areas of concern for public health leaders even though many public health professionals reported they are dedicated to their work. Over 50% of the respondents reported feeling burnt out, with the COVID-19 pandemic increasing these feelings. The results also acknowledge the importance of addressing and offering mental health services for public health professionals to work toward improving employee morale. 

The PH WINS highlights several important opportunities and challenges required to strengthen the public health workforce. Public health agencies must begin addressing burnout, offering mental health support, and guaranteeing access to professional development opportunities. The survey revealed a substantial proportion of the workforce identified gaps in professional growth and training with public health professionals saying they need more training in areas such as leadership, health equity, and data analysis.  

According to the 2021 survey, the top five areas for training identified nationally by public health professionals across all supervisory levels include: 

• Budget and financial management   
• Systems and strategic thinking   
• Community engagement   
• Change management   
• Policy engagement  

Opportunities for improvement through public health transformation

By addressing and closing gaps, the public health system will be more responsive, skilled, and versatile. Opportunities for improvement through public health transformation include identifying and addressing concerns within communities served by infusing a health equity lens throughout all areas of public health programs and implementing a data modernization strategy. The results of the PH WINS emphasize how important it is to plan and invest in the public health workforce to achieve goals to help ensure the safety and well-being of communities across the country.  

The 2024 PH WINS, set to be released this summer, will give us a timelier temperature check on how the public health workforce is faring and if the opportunities and challenges identified in 2021 remain relevant, have changed, or have been adequately addressed. As the public health landscape evolves, leaders must act decisively to strengthen the workforce, embed health equity into programs, and modernize data systems. By doing so, we can safeguard communities and ensure lasting positive health outcomes. 

This is the first in a series of articles delving into opportunities for public health transformation. Learn more about our public health team and services. 

Read this if your organization is considering replacing or implementing a new EHR system. 

Have you ever been on a vacation with a group of friends or relatives, whether it was a camp outing at the nearest lake, a trip to an amusement park, or a visit to another country? There's one thing that can make or break a trip: communication. If you had good sound communication with your travel companions, it probably enhanced the enjoyment of the vacation. Nonexistent, poor communication more than likely contributed to an experience you won't want to repeat. The same dynamic is present in any workplace project involving other humans.  

According to research by Salesforce, which included employees, corporate executives, and educators, 86% felt that ineffective communication was the underlying reason for workplace failure. A study performed by the Economist Intelligence Unit identified that poor communication results in 25% of missed goals and 44% of failure to complete projects. By contrast a poll by Expert Market showed that when employees are offered better communication, productivity can increase by up to 30%.  

If your organization is in the process of a large-scale project, such as replacing or implementing an electronic health record (EHR) system in the near future, success will depend on having a sound communication plan in effect before, during, and after the implementation. Fortunately, effective communication is not a difficult task to achieve. Based on our experience helping organizations implement EHR systems nationwide, our team has developed five simple communication steps for successful implementations. 

 1. Reach the right audience 

Determine who will be affected by an EHR system. Remember, it is not just providers and caregivers. Make certain that all affected staff (e.g., IT, schedulers, administrative) and providers are discovered, and determine how the daily workflow will be changed.  

2. Develop a thoughtful communication plan

A communication plan is essentially a well-thought-out guidebook for the implementation team to follow, to spread the message of change. A proper communication plan sets forth the process of updating and educating on the coming changes, requests for needs, reporting of issues, training, and delivering the right messages to the masses that change is happening. (e.g., A provider would not need to know the billing and accounts receivable data, nor would a scheduler need to know the nursing data). 

3. Have a dedicated resource for communication

It is essential to know who will be communicating the change and how that communication should be spread throughout your organization. An organization may have a dedicated change manager who orchestrates the progression of all communications, or this task could be dedicated to a group with shared duties. Regardless, the task remains the same: effectively communicate the changes coming.  

4. Frequently re-evaluate and restructure the communications 

Not all communications work the same. Know your staff and their preferences for receiving their communications. Providers may need a messaging system of notification, nurses may prefer an email, but finance may need a memo. It is also important to re-evaluate frequently how well the communications are getting to the target audience. What may have worked before may not be working now, and the organization needs to consistently re-invent their communications to make sure the message of change is being heard and understood.  

5. Hold periodic implementation discussions 

The dedicated change manager(s) should be given an opportunity to briefly discuss changes coming with members of the organization who may be impacted by the change. This may mean one-on-one discussions, group meetings, or during an operations or full staff meeting. A two-way approach to communication will help to disseminate important information and ensure transparency by inviting feedback and questions.  

BerryDunn’s team of consultants is happy to assist you with creating a Request for Proposal, selecting the right EHR vendor for your organization, and developing communication, change management, and project management for system implementation projects. Learn more about our team and services.  

Most nonprofits rely on federal and state government funds to fulfill their missions. With a federal funding freeze in the headlines, many clients are asking us how they can best prepare for a freeze and protect their organizations if funding is cut. Here are three steps you can take today to stay ahead. 

Analyze cash flow and reserves 

The first step an organization should do is understand their cash flow situation and how dependent the organization is on its funding streams. Consider upcoming planned expenditures that could strain cash flow and be sure to track key metrics such as days cash on hand, current ratio, and accounts payable turnover.  

Understand your grant agreements 

Review your organization’s existing grant agreements. Consider whether there are any stop-work clauses and stay in close contact with the grant officers who handle the funds. These factors may give you advanced notice of a possible shutdown, giving your organization more time to plan.  

Develop contingency plans 

Having a contingency plan to implement quickly after a funding freeze is announced is crucial. Maintaining sufficient short-term cash reserves in the face of a funding freeze will allow your organization to adopt a long-term plan. Understand your options to cover short-term cash needs, such as lines of credit and private foundations. Also, prioritize essential services and temporarily scale back the non-essential services as needed. Analyze your variable costs associated with the services and be ready to discontinue them if they are no longer necessary. Lastly, understand the workforce implications that a funding freeze would have. Funding freezes may result in hiring freezes or temporary furloughs. 

Being prepared and staying prepared is step one. If you do lose access to your federal funding, stay calm and implement your contingency plan. If you continue to run a program through alternative funding sources or utilize your cash reserves, make sure that you are maintaining the level of compliance necessary so there will not be issues when funding is restored. If your control structure changes due to a funding freeze, make sure you are adjusting it appropriately to maintain compliance and proper segregation of duties. Continue to stay in contact with your granting agencies so you can stay abreast of the changing landscape of federal and state funding.  

BerryDunn’s nonprofit team brings a clear understanding of nonprofit funding, in-depth knowledge of complex compliance requirements, and the industry-specific knowledge necessary for accurate, complete financial reporting. That knowledge informs our work—and enhances your performance by addressing your most important operational challenges. Learn more about our team and services.