The newly installed Biden Administration has a real opportunity to dramatically shift the paradigm of federal agencies and programs to make human services yield improved and more equitable outcomes for people they serve. Whether housing, food assistance, workforce development, health, education or any number of other services, the Biden Administration will be able to make progress on its agenda to build back better our health, economy and safety net systems while addressing systemic racism IF it embraces and, more importantly, disseminates to state and local levels, this paradigm shift towards outcomes focused government (OFG). The President’s recent executive order on racial equity and underserved communities imparts new urgency to the need for government to focus on outcomes, since it is only by assessing and addressing disparate outcomes that the federal government can achieve success in eradicating systemic racism in human service delivery.
Backdrop for an OFG Paradigm
The concept of focusing on outcomes and measurable results is not new in the federal space. Multiple initiatives including GPRA (1993), the GPRA Modernization Act (2010), and more recently the Evidence Act (2018) have sought to drive a shift in focus from delivering services to delivering measurable results (See Box 1). Despite good intentions, these initiatives have fallen short of their potential in three ways:
Implemented in silos: Current responsibilities to re-focus outcomes are almost always divided between offices within and between agencies. The responsibilities to research and evaluate; manage and support program implementation, innovate and learn; and capture and report on data are all led by different offices with separate goals, objectives and practices. To the extent that interagency councils and initiatives exist, they include some (but not all) of the people from each agency responsible for these functions and often lack people with front-line expertise and experience working at state and local levels.
Concentrated at the federal level: Current efforts have been primarily concentrated at the federal level with federal agencies working independently or with each other to re-orient policies and data towards outcomes. Federal agencies have not yet made the necessary capacity and resource investments to fully articulate (with state and local input) and disseminate these approaches to the state and local levels. Because program impact happens at state and local level where money meets the people , the federal government will only be effective in achieving population-level impact goals if it engages in ongoing 2-way conversations with state and local leaders and adopts a comprehensive TA platform that helps states design, implement and evaluate human service programs in a way that consistently achieves desired outcomes.
Insufficient and fragmented support: Assistance that is provided to state and local agencies often lacks a cohesive framework that would support consistently achieving improved and more equitable outcomes over time. For example, requirements for use of evidence-based practices, training on the content of these practices and findings from robust evaluations, are rarely coupled with necessary technical assistance to support application, adaptation, implementation, scaling and continuous improvement.
Theory of Change for an OFG Paradigm
The case for an OFG paradigm boils down to a systems-level theory of change where changes to the regulatory, financial and management systems at the federal level directly affect how well services can meet the complex, compounded and evolving needs of people. This, in turn, will affect the ability of services to achieve the desired impact in terms of peoples’ social and economic mobility, health and housing stability, and personal and family stability.
Components of the OFG Paradigm
In order to consistently achieve improved and more equitable outcomes, a government agency at the state or local level needs to re-orient governance levers related to data, policy, funding, service delivery, external relationships and internal culture in direct support of those outcomes. The OFG paradigm encompasses the eight components necessary to achieve this reorientation. The paradigm starts by establishing a clear goal for a given population, and the nature and magnitude of this goal will track with the nature and magnitude of the other components. The goal can be as small as improving kindergarten readiness for pre-k children in a given county and as big as improving economic mobility for all racial minority youth in an entire state. Outcomes Focused Technical Assistance (OFTA) is a ninth and central element as it makes it possible to systemically and sustainably work through and facilitate change management with the other components. Addressing one component without the others runs a high risk of perpetuating silos or making a narrow adjustment to a single process or program that doesn’t last over time.
- SET GOALS: Build consensus among key stakeholders on the most important outcomes to be improved for a given population with explicitly focus on equity for underserved communities.
- USE DATA: Analyze existing quantitative data from administrative sources and qualitative data from stakeholders in order to understand current outcomes, uncover inequities, and establish key outcome metrics
- PARTNER: Develop and implement strategies to overcome barriers caused by program silos through partnerships and collaboration around funding, enrollment, service delivery and data
- INCENTIVIZE: Create meaningful incentives for the achievement of both near- and longer-term outcome goals, including the use of outcomes-based funding
- IMPLEMENT: Identify and implement a set of evidence-informed, cross-cutting practices that have the greatest potential to drive better outcomes and address inequities
- ASSESS: Develop and implement an assessment strategy to determine the impact of system change against the stated goals and metrics of success
- LEARN: Create a robust continuous improvement process to regularly review data and adapt as needed to keep improving results.
- SYSTEMATIZE: Devise strategies to sustain and scale revised management policies, practices and behaviors once feasibility and impact is established
- OFTA: Utilize outcomes focused technical assistance at adequate dose and frequency to support implementation and change management of all of the above components.
The OFG Paradigm in Practice
Virginia workforce: In Northern Virginia, a workforce development board sought to increase enrollment and improve services to underserved, mostly LatinX youth who had experience with the justice and foster care systems. An OFTA provider helped work through the OFG Paradigm. Based on insights from a data review and root cause analysis, the workforce board determined they would need to be more proactive when enrolling and serving these youth. In partnership with workforce training providers, mentoring groups, the probation department and child welfare case managers, they set up a reverse referral structure, ensured sufficient wrap-around support during training, adopted a pay-for-performance funding model and instituted a continuous improvement structure. This resulted in a 200% increase in youth served and achieving longer term employment and living wage outcomes.
California health and wellbeing: In Santa Clara county, the cost of crisis services (shelters, hospital ER visits) for the chronically homeless was costing millions so the County worked with an OFTA provider to move through the OFG Paradigm with the goal of cutting some of these costs. By using qualitative and quantitative data, the County determined that permanent supportive housing coupled with comprehensive wrap-around support would address many of the factors that drove this population to the crisis services. They established strong relationships with housing and support providers which included regular data-sharing and collaborative improvement discussions. An outcomes contract ensured that implementation and oversight remained focused on the desired outcomes. Through these efforts, Santa Clara County significantly reduced the need for crisis visits for 200 notoriously underserved individuals, ultimately saving the county $1.11 million.
Recommended Steps to Adopt the OFG Paradigm
To break down federal silos and better disseminate the OFG paradigm to state and local agencies, we recommend six concrete actions that the Biden administration should take. Under the leadership of OMB and the DPC, Together, these actions will improve the government-wide regulatory, financial and management systems (run by OMB, GSA, and OMB) so that human service agencies (HHS, USDA, HUD, DOL, Dept of Ed, DOJ and CNCS) have the authority, capacity and resources to streamline and disseminate the OFG Paradigm.
1. Set a vision and strategy for the US human services system
Since individuals accessing services have a myriad of complex, evolving and compounded needs, government agencies responsible for meeting those needs should work together to develop, manage, oversee and evaluate human service programs. In order to work as a coherent system with each agency supporting a piece of a whole, the DPC should lead a collaborative effort with human service agencies to develop a vision, mission and a strategic plan for the entire US human service system. Once developed, DPC will work with the Interagency OFG Council (see 5 below) and human service agencies to develop and implement action plans in support of this vision.
2. Conduct and outcomes review and update regulatory guidance
While OMB has taken some modest steps to re-orient its guidance for discretionary grants (CFR.200) towards outcomes (by for example requiring grant solicitations to establish clear outcome goals, considering an applicant’s ability to achieve outcomes when selecting awardees, and enabling “alternate methods of reporting” to support innovation in data), these actions don’t go nearly far enough. To ensure that the regulations that govern human service delivery are in support of outcomes (rather than barriers to overcome), we recommend the following four approaches:
- Conduct an outcomes review: OMB and DPC should work with the human service agencies to conduct a comprehensive outcomes review to fully understand the extent to which and the reasons for why various programs are able to achieve measurable outcomes for people
- Analyze barriers: Once the review complete, OMB should work with agencies to analyze its findings with a particular focus on examining which barriers are program-specific versus systemic and whether the barriers are statutory, regulatory, administrative, technological, or cultural
- Update regulatory, legislative and executive guidance: The findings of the outcomes and barriers review will uncover ways in which the financial, regulatory and management systems at federal level are supporting or impeding state and local governments from themselves focusing on outcomes. Areas that are likely to be addressed include reorienting audits to focus more on outcomes than financial expenses, establishing uniform data-sharing agreements, streamlining reporting requirements across programs and agencies, expanding use of waivers that allow grantees greater flexibility if they can demonstrate progress in improving outcomes; and encouraging grantees to braid and blend funding from multiple programs for improved service delivery, integrated data systems, analytics, evaluation, and staff training.
- Reframe existing guidance to clarify what’s permissible: Even for flexibilities in program design, delivery, management and reporting that already exist,, service administrators at state and local level are often not aware of these and even when they are, they don’t know HOW to take advantage of them. For example, few state and local program administrators are aware of the “Exceptions” provision in 2CFR Section 200.102 of OMB government-wide grant rules that allow waivers of standard reporting requirements for innovative program designs OMB should therefore work with agencies to develop clear guidance, tools and templates clarifying permissible innovations and flexibilities and should provide OFTA (see 1 above) to help states take advantage of the flexibilities.
3. Increase outcomes focused TA (OFTA)
Technical Assistance (TA) is widely used by federal agencies to assist states, localities, non-profits and other grantees in implementing their programs. Consequently, TA has the potential to be one of the most powerful tools available for human service agencies to help state and local agencies adopt the OFG. While there are some examples of federal TA programs that have been purposefully designed to facilitate the use of data and evidence to guide program implementation and improvement, only a small portion of the vast resources for federal TA are deployed to further outcomes achievement using elements of OFG Paradigm. To expand the use of federal TA for outcome (rather than compliance) purposes, OMB and the DPC should lead an effort to provide human service agencies with guidance and support on how to engage OFTA for itself while also making it more readily available to state and local governments.
4. Assign federal responsibilities for state and local outcomes
To elevate the need for state and local engagement and focus, we recommend appointing a senior official at OMB who is charged with coordinating government-wide process improvements involving OMB’s management, regulatory, and budget functions and who can serve as a liaison with state and local governments. The ideal candidate would enter the job with knowledge from prior experience at the federal and state or local level about how to overcome bureaucratic barriers that impede achievement of better outcomes. Each human service agency should similarly designate a State and Local Outcomes Offices who reports directly to the Departmental PIO/PMIO. These State and Local Outcomes Officers are responsible for executing agency-specific aspects of the broad human service strategy (described in 1) and for ensuring that their agencies’ State and local grant programs and processes are structured in line with the OFG Paradigm This means that the State and Local Outcomes Officers should be influential players in agency policy discussions, rule-making, program funding, data, TA and evaluations.
5. Create interagency OFG Council
The DPC or OMB should create an interagency Council of State and Local Outcomes Officers with three purposes: 1) implement relevant aspects of the human service strategy 2) serve as a learning community to identify and promote best practices developed in enhancing State and Local outcomes, and 3) develop cross-agency strategies to meet emerging issues and challenges. The Council should create various working groups that bring together key performance leaders in agencies with overlapping missions, as well as performance leaders at the State and Local level who are demonstrating leadership in confronting silos and improving equity and outcomes in their programs. Council working groups should conduct listening sessions with State and Local leaders to aid in developing their recommendations to OMB and their agencies.
6. Build federal capacity for outcomes management
Recognizing that managing towards improved and more equitable outcomes (rather than regulatory, financial and other requirements) is a new and different way of operating for most federal human service staff, we recommend two strategies to build experience and expertise in “outcomes management”
- Expand “outcomes management” training and coaching for federal staff: Senior federal program managers, contracting officers, data analysts, legal counsel, auditors and other staff need training and coaching on how to use their positions to drive improved and more equitable outcomes for the programs they oversee. A competency model for “outcomes management” should therefore be offered through both OPM’s Federal Executive Institute and university programs. Once developed, these programs should be opened up to participation by state and local officials who oversee the same programs or related programs with similar goals (e.g., TANF/WIOA). These professional development programs would provide a critical opportunity for federal program managers to strategize collaboratively with their State and Local counterparts and identify opportunities to improve the effectiveness of their programs. Several states/graduate schools are already in the process of designing Outcomes Fellows Programs, which could provide a relevant model.
- Take advantage of the Intergovernmental Personnel Act (IPA): To accelerate the implementation of the OFG paradigm, the Administration should bring in expertise and capacity from the outside via the IPA. There are several non-profits, universities, and selected state/local officials who have deep experience implementing OFG reforms. For example, an IPA could help the OMB and DPC develop the human service vision, mission and strategic goals or help OMB and DPC conduct the outcome review and barrier analysis. Individual agencies could also employ IPAs to help implement agency-specific changes as staff complete the outcomes management curricula. The cost of IPAs can be underwritten by foundations so it could come at minimal cost to the federal government.
For additional information, or to further discuss the OFG Paradigm, please contact Maria Posey, Director of Federal Business at firstname.lastname@example.org