University of Vermont

James M. Jeffords Center for Policy Research

Transforming the way children and families are served through Interprofessional Workforce Development

Recommendations from the People Helping People Forum

 
September 30, 2013

Dear Friends and Colleagues,

Because of your interest in workforce development, we are pleased to send you this letter outining the recommendations from participants of the People Helping People: Interprofessional Workforce Development Forum held at UVM on August 15, 2013. The purpose of this letter is to ask you to consider four recommendations that if adopted by state government and human service organizations can help to transform the ways children and families are served.  These recommendations are:    

  1. Integrate funding for all services that families receive from state and private sources

  2. Remove all barriers to collaboration and interprofessional workforce development that may exist between and among agencies, workforce providers and families 

  3. Use the mechanism of Interprofessional Workforce Development and Training to establish common ground and procedures for collaboration

  4. Support accountability to the Governor, Vermont Legislature and the people of Vermont for the successful implementation of Interprofessional Workforce Development across Health, Human Services and Education, with families as partners.

 

On August 15, 2013, the Interprofessional Workforce Development Forum was held at UVM.  More than one-hundred and fifty people attended, including:

  • Family members served by health, human services and education professionals,
  • Professionals representing the Agencies of Human Services and Education,
  • Private health and social services providers,
  • Legislators and legislative staff members and,
  • Workforce development providers. 

 

The day-long meeting was designed to examine

  1. Experiences and needs of children and families,
  2. Various methods and organizations who provide services and
  3. Barriers to service integration.  

 

Why is this integrated approach necessary to obtain positive and lasting outcomes of self-sufficiency and well-being for all Vermonters now? 

Ten-year projections for the growing costs of health care, human services and education portend that without a concerted effort to integrate these areas for the prevention of illness and injury, and the support of self-sufficiency the costs of care and maintenance will outpace economic resources.

“..We have to learn how to do things differently…We heard about efficiency…It doesn’t always work.. but, it does mean that cooperation, avoidance of duplication and avoidance of turf battles will become even more important..” 
Governor Madeleine M. Kunin, August 15, 2013.

 

What steps are already underway to achieve integration of purpose and resources? 

There are several signature efforts underway to achieve family responsive care and development.  Some of these developments have a very long history of actions taken by advocates, legislators and leadership in the agencies.  Since the formation of the Agency of Human Services in the early 1970’s Vermont’s health, human services and education workforce has continuously searched for ways to collaborate in the service of children and families.  For example, a recent Jeffords Center Report reviewed more than twenty reports over the past quarter-century that examined the problems of working together to provide more responsive efforts at reasonable costs.  Many of these reports resulted directly or indirectly in the following, partial list of efforts:

  • Vermont’s Blueprint for Health  http://hcr.vermont.gov/blueprint
  • Vermont’s Health Care  Reform http://hcr.vermont.gov/home
  • Vermont’s AHS Integrated Family Services Initiative  http://humanservices.vermont.gov/integrated-family-services
  • The Governor’s Early Childhood Summit  http://governor.vermont.gov/blog-governors-early-childhood-summit
  • Building Bright Futures  http://buildingbrightfutures.org/
  • Vermont’s Parent Child Centers  http://www.humanservices.vermont.gov/community-partners/cp-parent-child
  • Vermont Interdisciplinary Leadership Education for Health Professionals (VT-ILEHP)  http://www.uvm.edu/~vtilehp/

 

Partners in developmental efforts to achieve a more integrated system of support also include various public higher education efforts to provide training, evaluation and assistance.  Independent training and service providers also provide the network of skilled and caring individuals who possess the knowledge and expertise needed by other partners who are engaged in helping children, youth, adults and families.

Forum Recommendations related to Workforce Development.
Specific recommendations to policy makers, agency staff, workforce development providers and advocates for children, youth, adults and families have been drawn from the discussion and reporting from Forum participants.  There are four major areas that Forum participants identified as critical to the future development of responsive and effective health, human services and education collaborative efforts.  All of these areas and the more specific criteria that follow are rich sources of specifications for the design of new workforce development programs through the Request for Proposal (RFP) process.  All of Vermont’s agencies that are involved in workforce development should use the following four recommendations to structure the funding of proposals to support integrated education programs that balance participation from all the partners, including families. These areas include: 

  1. Family Partnerships/Family Responsive.  The design and delivery of responsive and effective workforce development must result from the guidance of families who receive services. Forum participants (both families and professionals) clearly stated that community/family perceptions of needs and strengths should guide professionals in designing health, human services and education systems that are integrated in ways that establish parity of influence in the selection of content and practice.  Responsive and effective workforce development will be best achieved when guided by family expressions of value, need and acceptance.

  2. Community Based.  Workforce development may include simulation and remote access content, but the process of workforce development delivery must be community based.  Vermont communities are unique expressions of their histories, social and cultural backgrounds, size and proximity.  They present as cities, towns and neighborhoods that have many characteristics in common but they also have unique differences that must be accounted for in the design of the systems of care. When professionals and volunteers are assembled to learn how to become collaborative and skilled on an ongoing basis (workforce development is a process, not an event), in addition to being guided by families, they need to understand the complexity of the community they serve.

  3. Collaboratively Developed.  All of the partners who will collaborate in tomorrow’s health, human services and education workforce must participate fully in the design of the content and process of training with family partners.  For too long, the traditions of medicine, social services and teaching have concentrated heavily on the skills and knowledge of the separate professional fields so that they tend to build barriers rather than bridges of language and culture among professionals.  In a sense, the professions have been suffering from a “hardening of the categories.”  Collaboratively developed workforce development programs will enable professionals to share responsibilities while respecting the unique skill and knowledge that each brings to the team approach to service integration. The fields of study that are blended in workforce development should be considered co-equal and afforded the respect and value that will enable each professional to contribute fully to the whole of team planning and service.  Families need to be a co-equal part of the team that identifies the content and practice and works to implement a collaborative model of service delivery.

  4. Culturally Competent.  Workforce development programs, in addition to being collaboratively developed, community based and family driven, must also reflect deep understanding of the norms, values and cultural traditions of all Vermonters. Vermont is often perceived as a homogenous state with a few minority communities.  Increasingly diverse, however, the communities that represent diversity of gender, language, income and education have provided a challenge for the design and operation of responsive health, social services and education systems.  In order to be effective supports for arriving at practice which is culturally responsive, each member of the team needs a common understanding of the meaning of community complexity.  One team member cannot act effectively as the spokesperson for diversity in a community.  All members of teams need deep understanding of language, culture, norms and values of the people they are attempting to help.

 

These areas of training emphasis are not unusual or revolutionary.  But the combination of them will change the cultures of all the partners in ways that make integrated services, interprofessional and interagency collaboration possible.


Forum recommendations related to funding for an integrated service delivery system.


Problem:  “Silos” of funding create barriers that prevent creative solutions to very complex social, medical and educational problems.


“One of the greatest barriers was the historical lock down of money in very targeted silos, and that now is opened up to a major degree.  The global commitment is one example of that, but now we have Medicare, which never was this flexible, now stimulating innovative models.  Medicaid not only through global commitment, but through the medical home model is allowing the testing of new team based services. One of the greatest barriers (to collaboration) has been (re)moved.”
And,
..“The limitation now isn’t the funding  - it is us – what is our willingness to challenge the silos?  The silos have developed some wonderful expertise, services, and thoughts and practices over the years. They are locked down because of the way they have been paid.  They don’t need to be locked down.”
Dr. Craig Jones, August 15, 2013

 

Specific Recommendations: 

  1. Combine funds across agencies, service programs and sources wherever and whenever possible in order to integrate and fully fund needed services.  A constant theme across the reports of attempts to integrate services over the past twenty-five or more years has been the theme of breaking down the barriers to collaboration or the “Silos”.  Funding streams for both service delivery and workforce development have been driven by the legislation that established the sources of support and the structure of the agencies and grant programs that administer the legislation.  What is needed is the will to coordinate the various sources of funding through a workforce development, interagency governance panel with sufficient authority to support the design of interagency workforce development.  A plan for demonstrating the efficacy of combining sources of support for team based, family responsive services is identified in the recently funded AHS/CMS grant application.  It is recommended that this approach form the model and basis for service integration across health, human services and education.

    “To establish an integrated approach to care, payments, incentives, quality oversight and program integrity practices must transition from fee-for-service, volume based incentives and promote provider alignment, seamless and integrated prevention and earlier intervention.” (AHS/CMS grant proposal, 2013)

  2. Identify and remove all barriers to collaboration and interprofessional workforce development that may exist between and among agencies, workforce providers and families.

  3. Use the mechanism of Interprofessional Workforce Development and Training to establish common ground and procedures for collaboration. Research on organizational change has shown us that education   involving workforces across the boundaries of organizations is an effective way to change the culture of organizations and enable people to work together.
     
  4. Support accountability to the Governor, Vermont Legislature and the people of Vermont for the successful implementation of Interprofessional Workforce Development across Health, Human Services and Education, with families as partners.  For the first time in Vermont’s recent history all of the state partner agencies health, human services and education report to the Governor.  It is now possible for agency heads and staff across state government to provide an integrated analysis of the results of all investments on behalf of family well-being.

 

On behalf of all of the participants of the Interprofessional Workforce Development Forum we hope that you will consider these recommendations as health care delivery systems continue to evolve and the need for integrated health, human services and education delivery continues to grow in Vermont.
 Yours truly,

H. Bud Meyers, Director

 

 

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