Human Services Performance Management System

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1 Human Services Performance Management System Human Services Performance Council For more information contact: Human Services Performance Management Team P.O. Box St. Paul, MN (651)

2 This information is available in accessible formats to individuals with disabilities by calling the Human Services Performance Management Team , or by using your preferred relay service. For other information on disability rights and protections, contact the agency s ADA coordinator. Minnesota Statutes, Chapter 3.197, requires the disclosure of the cost to prepare this report. The estimated cost of preparing this report is $ This figure does not include the considerable time that Human Services Performance Council members and workgroup participants spent developing the report s content. Printed with a minimum of 10 percent post-consumer material. Please recycle.

3 Table of Contents I. Executive Summary...4 II. III. Legislation...6 Introduction...7 A. Background...7 IV. Implementing the System...8 A. Outcomes and Measures...8 B. Thresholds...10 C. Technical Assistance and Training...11 D. Remedies Process...11 V. County Performance...12 VI. VII. VIII. Report Recommendations...13 Commissioner Response...14 Appendix A County Performance Data...16 A. Outcome 1: Adults and Children are Safe and Secure...17 B. Outcome 2: Children have Stability in their Living Situation...22 C. Outcome 3: Children Have the Opportunity to Develop to their Fullest Potential...32 D. Outcome 4: People are Economically Secure...42 IX. Appendix B Steering Committee on Performance and Outcome Reforms...62 X. Appendix C Human Services Performance Council...63 XI. XII. Appendix D Vision, Mission, Values, and Strategies Statements...64 Appendix E Steering Committee Remedies Process Recommendations

4 I. Executive Summary In 2013, the state legislature authorized the Department of Human Services (DHS) commissioner to implement a Human Services Performance Management system for essential human services. The mission of the Performance Management system is to improve outcomes for people through creativity, flexibility, accountability, collaboration, and performance management. Initial performance data issued; more measures in development Beginning in April of 2014, the Human Services Performance Council and the Performance Management team identified, implemented, and delivered baseline performance data to counties on an initial set of nine performance measures. Measures do not currently exist for two outcomes, but are in development. The areas in which these measures will apply are adult protective services, adult mental health, and health care. Performance thresholds to be published; accountability begins in 2015 The Council convened thresholds workgroups in the fall of 2014 to clarify and adjust the initial thresholds recommended by the steering committee. The thresholds for the current performance measures will be published in early Counties will be held accountable to those thresholds in The workgroups are also developing methods for identifying and addressing racial and ethnic disparities and situations where small numbers cause significant fluctuation in county data from year to year. Technical assistance and training plan in development; counties will be surveyed In late 2014, the Performance Management team began working with a key group of stakeholders to develop a survey to counties to determine current technical assistance available and county technical assistance needs, and to set priorities for future development in this area. Results of the survey will be published in early 2015, and will be used to develop a structure for providing technical assistance. Remedies process to be implemented in 2015 The Council and the Performance Management team are working to develop a uniform process for implementing Performance Improvement Plans (PIPs), and creating the tools and forms needed to manage the PIP process. The team will issue more information on the remedies process in the first quarter of The 2015 individual county reports will identify the counties that will be subject to a PIP, and will include baseline data for any new system measures. Counties will not be subject to PIPs on any new measures until County performance While performance on the nine measures varied across counties, overall no one county was doing poorly on all measures using the current federal or state standard as a yardstick for good performance. On the other hand, all counties had some room for improvement in at least one area. 4

5 Recommendations The Council is pleased with the development of the system to date. Goals for 2015 include: Pursue legislative changes to clarify the term standard. The Council recommends using the term threshold in place of standard. Identify methods for addressing racial and ethnic disparities. Adopt new measures in the areas of mental health and adult protection, and continue work on health and long-term care measures. Develop a structure for providing technical assistance and training to counties. Implement all components of the remedies process. Because the Performance Management system is still in development, there are no other recommendations other than to continue the development as laid out in other parts of the report. 5

6 II. Legislation This Legislative Report is mandated by Minnesota Statutes, section 402A.16, subdivision 2 (10): MINN. STAT. 402A.16 (2013); Subd. 2. Duties. The Human Services Performance Council shall: (10) submit an annual report to the legislature and the commissioner, which includes a comprehensive report on the performance of individual counties or service delivery authorities as it relates to system measures; a list of counties or service delivery authorities that have been required to create performance improvement plans and the areas identified for improvement as part of the remedies process; a summary of performance improvement training and technical assistance activities offered to the county personnel by the department; recommendations on administrative rules or state statutes that could be repealed in order to improve service delivery; recommendations for system improvements, including updates to system outcomes, measures, and standards; and a response from the commissioner. 6

7 III. Introduction This report was prepared in response to a mandate under Minnesota Statutes, section 402A.16, subdivision 2(10). This report includes background information to familiarize the reader with the Human Services Performance Management system along with information on Performance Management system outcomes, measures, and standards 1 or thresholds. The report also shows the results of the county performance data requested by statute. Because the Performance Management system is still in development, the report will outline progress, plans, and intentions. The Human Services Performance Management team at the (DHS), on behalf of the Human Services Performance Council (Council), submits the report. The 2013 Legislature authorized the Council as part of the establishment of a performance management system for human services. The work of the Council is to advise the DHS commissioner on the implementation and operation of the human services performance management system. A list of current Council membership can be found in Appendix C. A. Background Minnesota s human services delivery system provides programs and services to meet the basic health, welfare, and safety needs of all Minnesotans, particularly the poor, children, people with disabilities, and the elderly. Counties, tribal governments, and lead agencies, deliver these services in partnership with the (DHS). In 2013, the state legislature authorized the DHS commissioner to implement a Human Services Performance Management system for essential human services as described in Minnesota State Statute. This system would include the performance measures and thresholds, which are consistent with the recommendations of the Steering Committee on Performance and Outcome Reforms (Steering Committee) in the December 2012 report to the legislature. 1 To clarify understanding, the Council recommends using the term threshold in place of standard. 7

8 IV. Implementing the System Implementation of the Performance Management system will occur in four key phases: 1) development; 2) growth; 3) expansion; and 4) management. The first phase is the development phase. Activities in the development phase began in 2014; the Performance Management team expects this phase to last one to two years. Year one accomplishments include: Appointment of Council members, hiring Performance Management system staff, and development of Performance Management system mission, vision, values, and strategies for implementation (see Appendix D for more information); Identification, implementation, and delivery of baseline performance data to counties on the initial set of performance measures; Convening of workgroups to set performance thresholds; and Beginning of work to define technical assistance and the remedies process, to develop methods for identifying and addressing racial and ethnic disparities, and to develop additional measures. The second phase is the growth phase. Starting in 2015, activities will include expanding or refining system processes as needed. Work will also begin toward developing the system s long-term strategic plan, which includes defining a comprehensive system of measures. The third phase is the expansion phase. Activities in the expansion phase include updating outcomes, performance measures, and thresholds to reflect the comprehensive system of measures outlined above, using technology to provide regular and timely performance data to counties, and exploring new opportunities, relationships, and connections. This phase is expected to begin as early as The final phase is the management phase, which includes systemic continuous improvement activities. This phase is expected to begin as early as A. Outcomes and Measures The Performance Management system assesses the delivery of human services using performance data. This analysis indicates whether programs and services are reaching their expected goals and outcomes. Initially, the system will focus on six population outcomes and begins its implementation with nine program performance measures. Outcome 1: Adults and children are safe and secure Measure: Percent of children with a maltreatment determination who do not experience a repeat maltreatment determination within six months 8

9 Outcome 2: Children have stability in their living situation Measure: Percent of current child support paid Measure: Percent of children discharged from out-of-home placement to reunification who were reunified in less than 12 months Outcome 3: Children have the opportunity to develop to their fullest potential Measure: Percent of children in family foster care that were placed in a relative home Measure: Percent of child support cases with paternity established Outcome 4: People are economically secure Measure: Percent of expedited Supplemental Nutrition Assistance Program (SNAP) applications processed within one business day Measure: Percent of SNAP and cash assistance applications processed timely Measure: Percent of open child support cases with an order established Measure: MFIP/DWP Self-Support Index Outcome 5: Vulnerable adults experience a quality of life Outcome 6: People have access to health care and receive effective services Measures do not currently exist for outcomes five and six. Although the Steering Committee initially recommended measures for these outcomes, the Council did not move forward with those recommendations because either data were not available or responsibility for service delivery had shifted from the counties to DHS. The next section describes the measures currently under development for these outcomes. Measure development There are three measures currently under development: 1. The adult protective services measure in development is the percent of vulnerable adults with a substantiated or inconclusive maltreatment allegation who do not experience a subsequent substantiated or inconclusive maltreatment allegation of the same type within six months. 2. A measure for adult mental health is currently in development. In October 2014, Performance Management staff and the Council began working with DHS, counties, and community stakeholders to develop new measures. 3. A measure for health care is in the planning and discussion phase. Counties will receive individual county reports in June 2015 with baseline performance data on any new measures. Counties will not be subject to Performance Improvement Plans (PIPs) on those measures until

10 B. Thresholds Terminology To clarify understanding, the Council recommends using the term threshold in place of standard. This is because some system measures already have a state or federally mandated standard, which defines a desired level of performance. The Performance Management system identifies minimally acceptable performance levels, or thresholds, and provides assistance to counties with the goal of improving performance. Initial thresholds The Steering Committee recommended using percentile rankings as an initial method of assessing county performance. The Steering Committee defined excellent performance as at or above the 90 th percentile of counties, and performance triggering the remedies process as the bottom 10 th percentile of counties. Because the Steering Committee did not have the in-depth program knowledge necessary to make specific recommendations on standards or thresholds for each measure, the Steering Committee recommended that the Council convene workgroups to develop more appropriate thresholds. Threshold workgroups The Council convened thresholds workgroups in the fall of 2014 to clarify and adjust the initial thresholds recommended by the steering committee on eight of the nine performance measures. The workgroups were comprised of subject matter experts from the Council, counties, non-profit and provider communities, and DHS. Following approval by the Commissioner, the new thresholds for the current performance measures will be published in Counties will be held accountable to those thresholds in Racial and Ethnic Disparities The DHS commissioner has the authority to determine that a county or service delivery authority does not meet the minimum performance threshold for one or more racial or ethnic subgroup for which, there is a statistically valid population size for three or more measures, even if the county or service delivery authority met the threshold for the overall population. Under direction of the Council, the Performance Management team convened a small group of subject matter experts to develop performance thresholds for racial and ethnic disparities. The Council will finalize a methodology in early Small Numbers A number of counties have denominators too small for a meaningful assessment of performance. The Council has convened a workgroup to develop a methodology to assess performance where numbers are small and causes wide performance fluctuation. The Council will finalize a methodology in early

11 C. Technical Assistance and Training The Performance Management system offers counties and DHS the opportunity to collaborate on strategic and targeted technical assistance and support, which promotes performance and outcome improvement. Technical assistance may include the following: Consultation Providing consultation to DHS program areas, counties, and community partners on improving performance, identifying barriers, and problem solving through organizational analysis methodologies. Best Practices Researching, identifying, and sharing best practices with counties, service delivery systems, and DHS. Best practices are often defined as a set of guidelines, ethics or ideas that represent the most effective or efficient course of action. Training Providing non-programmatic training or referrals to both programmatic and non-programmatic training available through DHS, the State of Minnesota, counties, community organizations and other places as needed. Bridging and Connecting Providing referrals and/or assistance to develop and improve connections between and among counties, DHS business areas, and communities. In late 2014, the Performance Management team began working with a key group of stakeholders to develop a survey to counties to assess current technical assistance and county technical assistance needs, and to set priorities for future development in this area. A report of findings will be published in early 2015, and will be used to develop a structure for providing technical assistance. D. Remedies Process The DHS commissioner can impose remedies if a county or service delivery authority has not achieved the minimum performance threshold for a specific performance measure. While Minnesota State Statute outlines much of the remedies process, the Performance Management team and the Council are working to make the process operational. This work includes developing a uniform process for implementing PIPs, and creating the tools and forms needed to manage the PIP process. The Performance Management team will issue more information on the remedies process in the first quarter of In the second quarter of 2015, counties will receive individual reports, which will include performance data on the current nine measures based on the new thresholds. The 2015 report will identify the counties that will be subject to a PIP and will include baseline data for any new system measures. Counties will not be subject to PIPs on new measures until

12 V. County Performance This section of the report provides information on county performance on the initial Performance Management system measures for Appendix A includes performance data for all counties and Service Delivery Authorities (SDAs) with measure narratives, maps, and data tables. Individual county reports In April and May 2014, the Performance Management team sent each county and service delivery authority a report, which detailed the outcomes and measures and discussed each measure s importance. The reports provided data specific to each county or service delivery authority, including current and past performance and performance compared to other counties in the same Minnesota Association of County Social Service Administrators (MACSSA) region. While performance on the nine measures varied across counties, overall no one county was doing poorly on all measures using the current federal or state standard as a yardstick for good performance. On the other hand, all counties had some room for improvement in at least one area. Performance on the child support measures was generally high, with most counties earning the maximum federal bonus based on their performance. For example, all counties had paternity established for 90 percent of their open Child Support cases and nearly all counties (96 percent) had a child support order established for their open child support cases. Performance was also high for three additional measures. On the MFIP Self-Support Index, only four counties performed below their Expected Range of Performance. Eighty-six percent of the counties met the federal performance standard for the percent of children with a maltreatment determination with a subsequent determination within six months. Eighty-five percent of counties met the federal standard for the percent of children in out-of-home placement reunified within 12 months. Counties tended to struggle more with the percent of expedited SNAP cases processed within one business day, with 14 percent of counties processing at least 80 percent of expedited SNAP applications within one business day. Counties also struggled with the percent of current child support paid where 11 percent of counties had at least 80 percent of their open Child Support cases with current payments made. Many counties, however, were very close to meeting these existing standards, particularly for the percent of current child support paid. With the initial reports, tools were provided to help counties start thinking about how to apply the Performance Management system s outcomes and measures to their current work. The tools were intended to help counties identify areas for improvement, strategies for reaching desired outcomes, technical assistance needs, and potential barriers. The 2015 county reports will include updated data on the current measures, data on the new measures, new thresholds, information on the remedies process, and available technical assistance. 12

13 VI. Report Recommendations The Council is pleased with the development of the system to date. Goals for 2015 include: Pursue legislative changes to clarify the term standard. The Council recommends using the term threshold in place of standard. Identify methods for addressing racial and ethnic disparities. Adopt new measures in the areas of mental health and adult protection, and continue work on health and long-term care measures. Develop a structure for providing technical assistance and training to counties. Implement all components of the remedies process. Because the Performance Management system is still in development, there are no other recommendations other than to continue the development as laid out in other parts of the report. 13

14 December 3, 2014 Co-Chairs Toni Carter and Charles Johnson Human Services Performance Council C/O P.O. Box St. Paul, MN Dear Co-Chairs, Council Members and Human Services Performance Management Team: Thank you so much for the time, effort and commitment you have demonstrated in the development and writing ofthis report. You are to be commended for work that comprehensively fulfills the intent of legislation. More importantly, however, is the fact that your efforts, in collaboration with the work of county partners, will assure that our human services delivery system is truly people centered and guided by measureable outcomes. I agree with the future recommendations cited by the report on pages 5 and 13. I am particularly encouraged by, and will look forward to, the focus on identifying methods for addressing racial and ethnic disparities and the Council's continued commitment to develop and adopt new measures in the areas of mental health, adult protection, health and long-term care measures. I will encourage and support your efforts as you collaborate with groups such as the Council of Community Relations in the development of these methods and measures. As you reference in this Legislative Report, Minnesota Statutes, section 402A. l 6, Subdivision 2 directs that this report addresses five areas. In my review, you have fulfilled this requirement, i.e., Report on individual county or SDA performance: Pages 16 through 60 does an excellent job of summarizing each of the nine measures, including easy-to-read graphical charts and numerical tables depicting county-by-county status on each measure ---Performance-Improvement-Plans: -Based-on-the-data-to-be-gathered-and-analyzed in 2015, l anticipate-that initial- plans will be developed Training and Technical Assistance: Again, based on the activities and fmdings in 2015, I support training and assistance strategies that not only utilize the expertise ofdhs Administrations, but also the expertise of high performing counties who can serve in this capacity as well Waiver of Administrative Rules or State Statutes: As more county groups seek certification as a Service Delivery Authority (SDA), I fully expect that the Human Services Performance Council in coordination with the Redesign Council will review and recommend such changes that will improve service delivery System Improvements and Updates: I fully expect that outcomes, measures and thresholds will change and be modified based on what we learn from our data analysis, resulting in an improved human services delivery system PO Box St. Paul, MN An equal opportunity and veteran-friendly employer

15 Thank you for the opportunity to read and review this report. In my capacity as the Commissioner of Minnesota's Department of Human Services, I will advocate that our elected officials continue to support the mission and objectives of the Human Services Performance Council. Si~c, ~ ~~.Jesson Commissioner PO Box St. Poul, MN An equal opportunity and veteran-friendly employer

16 VIII. Appendix A County Performance Data County performance data are grouped by outcome, and descriptions of the importance and a definition for each measure are provided. Most of these data have been published in various locations, but never in a single document prior to the initial county reports. Tables in Appendix A provide the most recent three years of data for all measures for all counties and SDAs with the most recent year s denominator. Bold fields indicate that a county or SDA met or exceeded an established federal or state standard for the measure. Minnesota gives its counties and political subdivisions broad authority to work cooperatively. Two or more Minnesota governmental units may create a new and distinct governmental entity whenever the existing governing boards determine that a new entity offers a better way to meet a duty or obligation. Faribault and Martin Counties are reported together. Counties in the Southwest Health and Human Services (SWHHS) consortium are reported as a group. As counties joined the consortium, their numbers were included in the group. Past year data where those counties were not members reports those counties separately. Note that Rock County joined the Southwest Health and Human Services (SWHHS) consortium in January 2012 and Pipestone and Redwood Counties joined in January Where measure data precede their membership, data for these counties is provided at the bottom of the table. This varies by measure as some are calculated for calendar year, while Child Support measures are by federal fiscal year and the MFIP/DWP Annualized Self-Support Index is for April to March of each year. Where counties have fewer than 10 people in the denominator, data are not provided in the Appendix tables. However, those counties percentages are represented in the accompanying maps, and are listed in the tables. These data should be interpreted carefully as those counties had very small numbers, which resulted in widely varying percentages. 16

17 A. Outcome 1: Adults and Children are Safe and Secure Measure 1a: Percent of children with a maltreatment determination who do not experience a repeat maltreatment determination within six months What is this measure? This measure is the percentage of all children who were victims of determined maltreatment during the last six months of the prior calendar year who did not have another determined report within six months. Why is this measure important? County social services should increase the likelihood that children are safe from abuse and neglect. When a maltreatment determination is made, there is a heightened responsibility of the county to mitigate the threat of future harm to children. A repeat maltreatment determination indicates that the risk for the child has not been fully mitigated. Due to small denominators, data are combined for three calendar years. Only counties with 10 or more children in the three-year denominator were included. How are counties doing? Statewide in 2012, 96 percent of children were not the subject of a repeat determination within six months. Figure 1 shows statewide performance on this measure for the combined years 2010 to These data should be interpreted carefully as many counties had very small numbers of children with maltreatment determinations, resulting in widely varying percentages. About 70 percent of counties had no children with subsequent maltreatment determinations within six months of the first each year, indicating excellent performance overall. County by county performance data can be found in Table A1. The denominators of counties with less than 10 children in the combined 2010 to 2012 total were not included in Table A1; however, the percentages were included. 17

18 Washington Hubbard Dodge Figure 1. Percent of Children with a Maltreatment Determination Who Do Not Experience a Repeat Maltreatment Determination within Six Months Lake of the Woods Kittson Roseau Marshall Koochiching Pennington Red Lake Beltrami Cook Polk Saint Louis Lake Clearwater Norman Mahnomen Itasca Clay Becker Hubbard Cass Wadena Otter Tail Crow Wing Aitkin Carlton Wilkin Traverse Grant Stevens Douglas Pope Todd Stearns Morrison Benton Mille Lacs Kanabec Isanti Pine Combined % - 75% 76% - 98% Big Stone Lac Qui Parle Lincoln Pipestone Swift Yellow Medicine Kandiyohi Renville Lyon Redwood Brown Murray Chippewa Cottonwood Meeker Watonwan McLeod Sibley Nicollet Sherburne Wright Blue Earth Carver Le Sueur Hennepin Scott Waseca Anoka Rice Steele Dakota Chisago Ramsey Washington Goodhue Wabasha Olmsted Winona 99% - 100% Denominator less than 10 Rock Nobles Jackson Martin Faribault Freeborn Mower Fillmore Houston September 2014 Human Services Performance Management

19 Table A1. Percent of Children with a Maltreatment Determination Who Do Not Experience a Repeat Maltreatment Determination within Six Months Combined Combined Combined County Denominator Statewide 95.0% 95.3% 96.0% 6,475 Aitkin Anoka Becker Beltrami Benton Big Stone Blue Earth Brown Carlton Carver Cass Chippewa Chisago Clay Clearwater Cook Cottonwood Crow Wing Dakota Dodge Douglas Faribault-Martin Fillmore Freeborn Goodhue Grant Hennepin Houston Hubbard Isanti Itasca Jackson Kanabec Kandiyohi Kittson 97.6% 96.5% 97.5% 98.3% 95.8% 92.2% 95.7% 87.5% 95.8% 96.9% 91.6% 95.0% 96.2% 89.3% 91.0% 92.5% 98.4% 93.0% 97.1% 96.6% 97.0% 95.2% 92.7% 98.7% 91.6% 96.4% 92.1% 96.3% 95.4% 90.2% 91.3% 95.4% 92.8% 91.2% 96.3% 96.7% 98.4% 97.3% 97.9% 98.9% 92.5% 94.4% 96.7% 93.3% 90.7% 95.2% 93.8% 92.7%

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