It has been approximately one year since leaving my position as the Waupaca County Health and Human Services director, reminding me how quickly times passes. So much has happened over the past year… good, bad and indifferent. The world has changed, and we’ve changed with it — we’ve learned so much about doing things differently, and that sometimes different is better.
It is hard to believe that we can go back to what we knew as ‘normal’. In fact, I would say it is our moral obligation to not go back to what was ‘normal’ — maybe there are parts of normal that weren’t exactly great. As we hopefully round the corner on this pandemic, I believe that leaders have an opportunity to be bold and relentless in changing the status quo.
In the same breath I would also say that leaders should be ready for pushback and barriers. I’d like to share an article I wrote for the December 2020 issue of the Children’s Bureau Express. It describes the inherent risk that change makers and trailblazers are subject to…that I was subject to.
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The shift toward prevention within child welfare practice is under way. It is real, not just lip service by people who say they want change, but don’t change anything. The vision and transformation efforts demonstrated by the Children’s Bureau has been crucial to changemakers at the local level. The support and assurance of knowing that the federal agency is sharing the sentiments and heading in the same direction has allowed leaders like myself to become even more relentless and courageous with our own systems transformation.
For the past eight years as a director of a county health and human services department in rural Wisconsin, I led the implementation and integration of a trauma-informed approach to health and human services. There was a heavy concentration on improving, changing, transforming child welfare practice. Concepts included ‘No child will be placed with a stranger’ and alternative response models for initial assessments that moved from a ‘Gotcha!’ system of punishment to building relationships with families to help them be healthy. The current system continues to use words like ‘investigate’, ‘investigation’, ‘substantiation’ — it’s a system of shame and blame.
We were committed to a compassionate, empathetic and healing-based system. Knowing that you cannot change one system without changing the whole department, we educated all of our staff — from receptionist, to myself as director — about trauma-informed care (TIC) and the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study). 100% of employees were trained. The training was built into our onboarding and orientation for all new staff as well. We developed TIC-based principles and vision/value statements. We used these pieces for internal decision making, and for recruiting staff dedicated to these ideals.
The results were marked improvement in recruitment and retention of staff — a healthy and dedicated staff ready to change the whole system. We did just that and we were gaining recognition for our successes, such as 13 months with zero children in residential placement. We are a medium-sized county, so on average we would have 10+ children in residential treatment at any given time prior to our trauma-informed approach. That costs the county close to $1 million annually. Overall, there was a 17% decrease in the number of children in out-of-home care.
There were successes beyond child welfare as well. There were significant decreases in the use of secure detention for youth in the youth justice system. The use of a 72-hour hold dropped by approximately 75%. In behavioral health, specifically crisis response, there were also impressive decreases in the use of mental health hospitalizations (for children and adults). Prior to the trauma informed shift, more than 40% of people having contact with the behavioral health crisis system were hospitalized. With the combination of a trauma-informed shift along with supportive supervision, this number dropped to less than 20%. Even just a quick glance at the decreases in these deep end and costly services, should signal a great deal of savings. As a result, we were able to shift these savings, 25% of the out-of-home budget, to prevention-based services and approaches.
The changes we were making, along with a trauma-informed lens securely in place across the department, put us on a path to bigger and bolder goals: We wanted to change the child welfare system. Why change the child welfare system? In most cases, when we intervene with families the current system invokes more harm than good. The data suggests that we would be better off not responding at all! Knowing that a prevention-based, relationship-based, compassion-based model would be more effective, we sought every opportunity to find and learn from changemakers.
What we learned is that people are comfortable hearing about what you want to do. This support is always on a surface level and, in some cases, with thoughts that true change to support families would never happen. For example, when you pitch your ideas, people reply: “That sounds great! Good luck to you.” As you begin your change process, I urge you to pay attention to those same people as you start to really evoke change. The system would much prefer status quo, staying comfortable.
But when we stay comfortable, families lose. How could this possibly be? I mean people keep saying ‘the system is broken’, right? Would not everyone, then, want the system to change? To help children and families, to support them and prevent deep end system intervention? I certainly thought so.
Here’s the thing though: The system isn’t broken. The system is doing exactly what it was designed to do. We have set up programming — such as residential treatment centers, group homes, treatment foster homes, foster care in general — that have all now become an industry. The industry needs to eat, right? The industry relies on the exact processes that are in place, removing children from their families. So, the radical transformation needed is the dismantling of an enormous industry that has been in place for decades.
When the changes move from talk to action and begin to impact other systems, be ready. Because they will come for you. This is advice close colleagues and mentors gave me as our momentum was growing. Who is ‘they’? It might be different depending on your situation and relationships. The ‘they’ could be your county board of supervisors, your city council, your human resource department, your local sheriff, your local police chiefs, your local school administrators, your district attorney — anyone who sees and feels that you are creeping out of your lane and affecting theirs. That is who is going to come for you.
These are people and systems who will not be concerned about successful outcomes. Or those that may have a different philosophy on what defines successful outcomes for children and families, such as inflicting blame, shame and punishment instead of policies and practice that understand, nurture and heal. Or what defines safety for children and families or the community. Be ready for ‘secret’ meetings to take place about you, be ready for closed session meetings, be ready to be outnumbered in these meetings. Be ready for the full effects of the oppression of the system. The system does not want to change its ways, it just wants you to fall into line.
Families need us to be strong, unwavering, relentless. They need us to challenge the system. The child welfare system, as it stands currently, is designed to be punitive in nature. It is designed to investigate, to make decisions and then ‘do things’ to families. It is not designed for authentic engagement that allows for true partnership.
In the end it may have been my peril, but I was not going to compromise with systems. I was not willing to place children unnecessarily out of their homes, I was not willing to bend rules/laws for system partners to get the results they were looking for. Essentially give up on a family or a child to make the other systems feel better. That was not going to happen. Which family/kiddo gets to experience the status quo system? Which gets the full benefit of a relationship-based system?
There is inherent risk in this change work — it can come with great personal cost. I urge you to think about what it is costing families, costing generations and the health of our communities. Do not be afraid to step into the arena and stand for what is right. They will come for you. Be relentless anyway.
Chuck Price is now founder/owner of Blue Collar Consulting in Wisconsin Rapids, Wisconsin.
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