[Navy blue CAI "We power the possible" logo appears on screen with white background, with www.cai.io below in black.]
[Title slide. The slide title reads: "Collaborative governance for delivery of successful human services". Above the title in smaller teal text reads: "Webinar". Near the bottom of the slide, two logos are aligned horizontally. On the left under text that reads "CAI is a sponsor of" features the National Association of Counties logo, and on the right features the navy blue CAI logo with tagline "We power the possible".]
[Slide 1. The slide title in bold white font reads: "Collaborative governance for delivery of successful human services" with the CAI "We power the possible" above. To the left of the slide, four photos of talking heads indicate speakers with the following names from top to bottom: "Cathy Arbogast", "Joe Hafer", "Bill Browning", and "Jamey Welty".]
00:00:07 - 00:00:26
Jamey Welty
I am Jamey Welty, behavioral health and child welfare lead and senior consultant for CAI. I'm a retiree of the Commonwealth of Pennsylvania and have nearly 30 years of experience in supporting state and local governments with implementing data systems and strategic planning and implementation of policy programs and outcomes.
00:00:27 - 00:00:52
Jamey
Health and human and social service systems from the federal to state and local levels of government by design through statute regulation, grants, and other funding streams often function independently of one another, resulting in siloed operating structures where services within and across each system can be redundant, confusing, and overwhelming for local governments, service providers, and especially individuals receiving services.
00:00:53 - 00:01:09
Jamey
These structures have created barriers across service systems that inherently do not communicate well with one another, are self-protective, and have duplicative administrative functions, and other inefficiencies that do not allow for maximizing positive outcomes.
00:01:10 - 00:01:29
Jamey
Collaborative governance can be part of the solution to these challenges, but providing a structure to support the coordinated delivery of services, bridging the spectrum of health, and human and social services for individuals with intellectual mental health and/or physical disabilities and children and families involved in the child welfare system.
00:01:30 - 00:01:144
Jamey
During this webinar, our panelists will provide research on the concept of collaborative governance, and share examples of their varied experiences using collaborative governance for improving coordination of care, efficiency, and outcomes.
[Slide 2. The slide title is "Meet the speakers" with smaller teal text above the title that reads: "Collaborative Governance for Delivery of Successful Human Services". Below the title, four sections are lined up horizontally in the middle. The first section includes an image of Jamey Welty with text: "Jamey Welty, Behavioral Health Lead and Senior Consultant, CAI". The second section includes an image of Bill Browning with text: "Bill Browning, Former Health and Human Services Director and Office of Youth and Family Services Director". The third section includes an image of Cathy Arbogast with text: "Cathy Arbogast, Administrator, Centre County Mental Health/Intellectual Disabilities/Early Intervention - Drug and Alcohol Office". And lastly, the fourth section includes Joe Hafer, Assistant Professor, Department of Public and Nonprofit Administration, University of Memphis.]
00:01:45 - 00:01:53
Jamey
Our panelists are Bill Browning, Cathy Arbogast, and Joe Hafer.
00:01:54 - 00:02:28
Jamey
Prior to becoming the Health and Human Services director and Office of Youth and Family Services director for Lackawanna County in Pennsylvania, Bill began his professional career as the caseworker in the Harlem Washington Heights section of New York City, and later investigated child abuse in the New York County District Attorney's office. He also provided consultation to the 5 boroughs districts attorney's offices, and provided prospective analysis and retrospective reviews of child deaths for the Office of Child Medical Examiner, and was an administrator at a diagnostic facility in Staten Island.
00:02:29 - 00:02:49
Jamey
Bill is also a trainer on forensics issues for Pennsylvania's child welfare system. Throughout his career, he has witnessed firsthand the inextricable link between socioeconomic conditions and physical health, leading him to develop the county health department as a component of the human services.
00:02:50 - 00:03:41
Jamey
Kathy is the administrator for Centre County Mental Health/Intellectual Disabilities/Early Intervention & Drug and Alcohol office. She's responsible for contract monitoring and oversight of programs, as well as supporting program development and community education. She also oversees case management services and works closely with her team, who is dedicated to connecting people with treatment and recovery supports, community residential supports, and skill building services that meet their needs. She has been an employee of the county for 35 years and has had a particular interest in helping individuals establish connections in their home communities, provide comprehensive care coordination services, and recovery support for individuals in their early stages of their recovery, and prevention education in all areas to community members of all ages.
00:03:42 - 00:04:32
Jamey
Joe is an assistant professor in the department of Public and Nonprofit Administration, School of Urban Affairs and Public Policy at the University of Memphis. He has over 15 years of public service experience in state and county government and public management consulting. His research focuses broadly on producing public value through public policy and implementation in an era of inter-organizational collaboration and cross-sector governance, particularly in state and local contexts. His research has been published in the Journal of Public Administration Research and Theory and Perspectives on Public Management and Governance among others. We're going to get started with the presentation now, with Joe providing some background and research related to collaborative governance.
[Slide 3. The title of this slide reads: "Defining collaborative governance". The text below reads: "Collaborative governance is a "fuzzy concept" grounded in cooperative federalism". The first bullet of text reads: "1970s/80s - changing face of cooperative federalism:; "A collection of private and semi-public groups and agencies that moved into a full partnership with the national, state, and local governments in administering federal policy "1". The second bullet of text reads: "Wicked" problems (e.g., poverty, public safety, conservation, etc.) cannot be solved in a traditional government-agency silo; Multiple stakeholders, multilateral interactions, multi-dimensional issues". A section on the right side of the slide is titled "Cooperative (Marble Cake)" with an image of a cartoon marble cake below it and the text "Blurred boundaries between national, state, and local governments (i.e., marbled)2" below the image. The footnotes in the bottom left-hand corner read: "1 Kettl, D.F. "The Fourth Face of Federalism." Public Administration Review, 41(3), p.366. 1981" and "2 "The Evolution of Federalism." OER Commons. January 2024." The University of Memphis logo is displayed next to the text: "The University of Memphis Department of Public and Nonprofit Administration".]
00:04:33 - 00:04:58
Joe Hafer
All right. Well, thanks Jamey. Again, my name is Joe Hafer. I'm an assistant professor at the University of Memphis, department of Public and Nonprofit Administration. Also a faculty member in our Center for Local and Regional Governance. And today I'm here to talk to you about collaborative governance. Going to give you sort of a crash course I'm, and excited to talk about it as it's very important for modern public administration, very important for county government as well in terms of where they sit.
00:04:59 - 00:05:47
Joe
Collaborative governance itself is still kind of what we consider a fuzzy concept, but it's important to understand where it came from. It's grounded in this idea of cooperative federalism, which is also kind of referred to marble cake federalism, where you have these blurred boundaries between all different levels of government in terms of funding and service delivery. That was coined back in the 1950s, and then in the 1970s and eighties we see this sort of changing face of cooperative federalism where in addition to government, you have nonprofit private agencies, the civic sector kind of coming into the fold as well. This was accelerated by a shared understanding that today's wicked problems like poverty can't be solved by just a traditional government. So it's really this shift of government from government agency silos to this idea of participatory approaches to address large scale problems.
[Slide 4. The title of the slide reads: "Defining collaborative governance" with three bullet points of text below. The first bullet of text reads: "Joint decision-making across public, private, and civic sectors". The second bullet of text reads: "Tackle complex problems beyond capacity of a single organization". The third bullet of text reads: "Sharing resources and power; mutual respect; collective action". Below are two quotes aligned horizontally in teal text that read: ""A governing arrangement where one or more public agencies directly engage non-state stakeholders in a collective decision-making process that is formal, consensus-oriented, and deliberative and that aims to make or implement public policy or manage public programs or assets."3 and "...the processes and structures of public policy decision-making and management that engage people across the boundaries of public agencies, levels of government, and/or the public, private and civic spheres to carry out a public purpose that could not otherwise be accomplished."4". The footnotes in the bottom left-hand corner read: "3 Ansell, C., Gash, A. "Collaborative Governance in Theory and Practice." Journal of Public Administration Research and Theory, 18(4), p. 544. 2008" and "4 Emerson, K., Nabatchi, T., Balogh, S. "An Integrative Framework for Collaborative Governance." Journal of Public Administration Research and Theory, 22(1), p.2. 2012."]
00:05:48 - 00:06:18
Joe
Today, collaborative governance is pretty ubiquitously used across the wide range of policy areas. At its core, it's really decision-making across different sectors, really tackling those complex public problems that I talked about a little bit earlier. Two of the primary examples or definitions there provided in green. I won't read those, but again, it's really about sharing resources, sharing power, having shared decision-making and problem-solving, and leading to collective action to accomplish what one agency cannot do.
[Slide 5. The title of the slide reads: "Defining collaborative governance". Below the title are two sections, each with text above an image. The first section of text reads, "Sage-Grouse Conservation Partnership (SageCon)5" with an image of birds in a field below it. The second section of text reads, "CoC: Continuum of Care Program 6" with an image of three smiling children and an image of two people hugging below it. The footnotes in the bottom left-hand corner read: "5 "Oregon Solutions." Sage-Grouse Conservation Partnership (SageCon). January 2024. https://orsolutions.org.osproject/sagecon" and "6 "Continuum of Care Program." US Department of Housing and Urban Development. January 2024. https://www.hudexchange.info/programs/coc/".]
00:06:19 - 00:06:56
Joe
A couple of brief examples of collaborative governance in action across different policy areas. So the first is the Sage-Grouse Conservation Partnership, also called SageCon, was developed during the 2000s out in Oregon, and it's really a great example of how all different kinds of partners across all levels of government as well as the civic and the private sector came together to sort of balance partnership interest in terms of both local economic development, but then also conservation. This is in terms of preserving the habitat for the Sage-Grouse and letting them flourish.
00:06:57 - 00:07:31
Joe
The second is the Continuum of Care Program, also called the COC program administered by the US Department of Housing and Urban Development. This is a competitive grant funding program where the policy has basically created hundreds of these collaborative governance in different regions throughout the United States, where the local communities must come together and collaboratively develop an approach to addressing homelessness in the region, and then apply for funding as a collaborative group. Really a good example of multiple service providers, multiple levels of government having to come together to work together.
[Slide 6. The title of the slide reads, "Collaborative governance benefits" with the following text underneath: "Shared decision-making and pooling of resources 7", "Enhanced pubic trust through deliberation 8", "Innovative solutions 9", and "Broader impact and reach 10". The footnotes in the bottom left-hand corner read: "7 Greenwood, S., Singer, L., Willis, W. "Collaborative Governance: Principles, Processes, and Practical tools." Routledge, 2021.", "8 McIvor, D. W. "Toward a Critical Theory of Collaborative Governance." Administrative Theory & Praxis, 42(4), p.501-516. 2020", "9 Torfing, J. "Collaborative Innovation in the Public Sector." Georgetown University Press. 2026", and "10 Emerson, K., Nabatchi, T. "Evaluating the Productivity of Collaborative Governance Regimes: A Performance Matrix." Public Performance & Management Review, 38(4), p. 717-747. 2015." An image of four people in a business meeting setting is located on the right-hand side of the slide.]
00:07:32 - 00:07:48
Joe
Research has shown us that there are several benefits to collaborative governance approach. At its core, like I said, it is a very shared decision-making process and pooling of resources. So when you do this, the idea or the hope, and often happens is you have enhanced public trust through deliberation.
00:07:49 - 00:08:20
Joe
The idea is that this deliberation dialogue must be authentic though, and stakeholders and partners must be involved in every process of the partnership or the collaborative governance endeavor. Given that you're bringing together multiple perspectives, multiple individuals and organizations, that tends to leave to the creation of innovation solutions, things that a single individual or organization wouldn't have been able to come up with. And that often also leads to broader impact and reach of the initiative. So ability to kind of scale these innovative solutions.
[Slide 7. The title of the slide reads, "Collaborative governance benefits" with the following text underneath: "Diverse stakeholder interests and perspective of "success" 11", "Power imbalances across different types of power 12", "Complexity in management, coordination, and communication 13", "Time and resource intensive 14", and "Loose accountability mechanisms 15". The footnotes in the bottom left-hand corner read: "11 McIvor, D.W. "Toward a Critical Theory of Collaborative Governance." Administrative Theory & Praxis, 42(4), p.501-516.2020.", "12 Hafer, J., Ran, B., Hossain, M. S. "Rethinking Perspectives of Power in Collaborative Governance." Journal of Public and Nonprofit Affairs. 8(2), p. 260-280. 2022.", "13 Greenwood, S., Singer, L., Willis, W. "Collaborative Governance: Principles, Processes, and Practical Tools." Routledge. 2021.", "14 Greenwood, S., Singer, L., Willis, W. "Collaborative Governance: Principles, Processes, and Practical Tools." Routledge. 2021.", and "15 Waardenburg, M., Groenleer, M., de Jong, J., Keijser, B. "Paradoxes of Collaborative Governance: Investigating the Real-life Dynamics of Multi-agency Collaborations Using a Quasi-experiemental Action-research Approach." Public Management Review, 22(3), p. 386-407. 2020".]
00:08:21 - 00:08:47
Joe
So while benefits, you could also definitely have challenges. And to reap the benefits, you need to at least acknowledge and address these challenges. Some of the more important ones that we see in the research are those that we see on the screen here. The first being that of course, you're going to have diverse stakeholder interests, some I talked about in this SageCon process. And most importantly, these people are going to come in with different perspectives of what they view success as the collaboration. So there's a need to acknowledge and address that.
00:08:48 - 00:08:59
Joe
Second, you'll have these things called power imbalances where people hold different types of power. Different people in organizations, different across organizations, and this is going to kind of shift throughout the lifespan of the collaboration,.
00:09:00 - 00:09:14
Joe
Given that you have lots of folks and organizations involved from different areas, this is definitely a very complex sort of initiative or endeavor to manage, coordinate, and communicate to ensure everyone is involved and informed throughout the process.
00:09:15 - 00:09:37
Joe
This inherently leads to being a rather typically time and resource intensive process, which can be addressed again, with clear implementation frameworks can help with that. And lastly, it can lead, I should say, lead to loose accountability mechanisms. And what I mean for that, it means not having clear pictures of accountability both within the collaboration but also outside of the collaboration.
00:09:38 - 00:09:56
Joe
So people working in collaborative governance endeavors have day jobs. So it's hard to keep them engaged. It's hard to understand and keep them accountable to working within the collaboration. But then also outside of the collaboration, people want to know, what is this endeavor doing? Who can I hold accountable for the outcomes of this?
[Slide 8. The title of the slide reads: "Collaborative governance model". This is a repeatable model for collaborative governance developed by Ansell and Gash, "Collaborative Governance in Theory and Practice." Journal of Public Administration Research and Theory, 18(4), p. 543-571. 2008. The input variables in the box to the left include the prior history of conflict or cooperation, the incentives for stakeholders to participate, power and resources imbalances, leadership, and institutional design. The center box identifies a series of factors within the collaborative process itself. These factors include face-to-face dialogue, trust building, commitment to the process, shared understanding, and intermediate outcomes. External factors on the top and bottom of the image include Institutional design and facilitative leadership. The box on the far right includes the outcomes achieved when employing this cycle.]
00:09:57 - 00:10:26
Joe
So while this seems like a complicated process, when you're starting or rethinking a collaborative governance endeavor, it's really helpful to put this input process, output model onto your thinking. So in the blue boxes there you see input process output, and then you also have to consider sort of the contextual or external factors. Some of those are in the green box, green boxes there, and this basic model is just applied to a very cited and highly researched collaborative governance model, Ansell and Gash from 2008.
00:10:27 - 00:10:51
Joe
And then in each of these parts of the model, there would be sort of influential variables. So for example, in input, there's that idea of power imbalances or power asymmetries is something that you need to adjust really at the beginning. In that blue process model for example, you have highlights the idea of trust building, creating a shared understanding. So very important things that you'll need to consider when designing that.
00:10:52 - 00:11:10
Joe
Then just for example, some of the external factors that are rather prominent in the research include the context in which the problem is in a regional context, but also those institutional factors that are there, and then how leadership both inside and outside of the actual collaboration will impact the progress.
[Slide 9. The title of the slide reads: "Takeaways/Strategies for effective collaborative governance". There are four sections of text lined vertically like a list, each with a bolded takeaway/strategy and a bullet of text underneath. The first section reads: "Proceed with caution and intention" with the bulleted text underneath, "Benefits can outweigh challenges but with right strategies in the right context 17; 18; 19". The second section reads: "Follow a framework and engage throughout" with the bulleted text underneath, "Assess, design, deliberate, implement, adapt 20". The third section reads: "Balance innovation and progress" with the bulleted text underneath, "Participation can foster innovation but can stifle agreement 21". The fourth section reads: "Learn how to collaborate" with the bulleted text underneath, "Develop collaborative competencies as a participant and leader 22; 23". The footnotes in the bottom left-hand corner read: "17 Emerson, K., Nabatchi, T. "Collaborative Governance Regimes." Georgetown University Press. 2015.", "18 Milard, H. B., Provan, K. G. "A Manager's Guide to Choosing and Using Collaborative Networks." IBM Center for the Business of Government. 2006.", "19 Purdy, J. M. "A Framework for Assessing Power in Collaborative Governance Processes." Public Administration Review. 72(3), p. 409-417. 2012.", "20 Greenwood, S., Singer, L., Willis, W. "Collaborative Governance: Principles, Processes, and Practical Tools." Routledge. 2021.", "21 Page, S. B., Thomas, C., Kern, M., Murphy, A., Page, C. "Producing Agreements and Innovations in Collaborative Governance." Perspectives on Public Management and Governance, 6(4), p. 137-150. 2023.", "22 Greenwood, S., Singer, L., Willis, W. "Collaborative Governance: Principles, Processes, and Practical Tools." Routledge. 2021.", "23 O'Leary, R. Bingham, L. B. "A Manager's Guide to Resolving Conflict in Collaborative Networks." IBM Center for the Business of Government. 2007."]
00:11:11 - 00:11:23
Joe
So while as I noted, there's a lot of contextual things that you need to consider, there are some universal takeaways or strategies that we see in the research that can help foster effective collaborative governance.
00:11:24 - 00:11:38
Joe
The first is to really proceed with caution and intention. So just don't want to throw together some work groups, right? To really reap those benefits, you need to address what are the challenges that we talked about and consider how those challenges can be addressed in the right context.
00:11:39 - 00:12:02
Joe
A helpful way to do this is to really follow a framework and ensure that partners and stakeholders are engaged throughout that process. There are step-by-step frameworks out there that start with assessing the situation, understanding how I can use a collaborative governance approach. And we'll step through all the way from implementing it, designing it, all the way to adapting it to how the collaboration changes over time.
00:12:03 - 00:12:29
Joe
A third thing to consider is how to balance innovation and progress. So how slow or fast does this collaboration need to move? Sometimes that's up to leadership. Sometimes that's up to policy, legislation. Just need to figure out what that sort of goal is. And with more participation, you can foster innovation. However, when you reach a decision point, sometimes it can stifle agreement with more minds and voices in the process.
00:12:30 - 00:12:58
Joe
And lastly, something that is sometimes overlooked, learn how to collaborate. What I mean by this is develop those collaborative competencies that is sometimes called, which are really kind of soft skills. So that interpersonal communication, relationship building, and consider how to use those skills both as a participant but then also as a leader within these collaborative governance endeavors. So while again collaborative governance is a very context-specific endeavor, there are some universal things to consider here.
00:12:59 - 00:13:20
Joe
So I would encourage you to learn more about the concept. There's a lot out there. We provide more resources with sort of a very practice focus in the resources section of this webinar. And I'll wrap that up there and looking forward to hearing from Bill and Cathy about their collaborative governance practices in the field. Thank you.
[Slide 10. The title of the slide reads: "Health and Human Services intervention model". A circular diagram is broken up into four sections, and in between each section reads, "Intervention opportunity", in teal text. The top section's heading reads, "Presenting Event", and includes the following items listed in bullet points: "Arrest", "Child/Elder abuse referral", "Mental health crisis", "Medical crisis - from modifiable behavior e.g. overdose, ketoacidosis from diabetes", and "Housing request/referral". On the right-hand side of the slide, the next section's heading reads, "Biological changes", and includes the following items listed in bullet points: "Changes in the mesolimbic dopamine functioning from various addictions", "Neurotransmitter change/receptor changes from acute and chronic stress", and "Other physical changes to the body". The bottom section's heading reads, "Resultant conditions", and includes the following items listed in bullet points: "Trauma response", "Exacerbation of presenting problem, e.g. Behavioral Changes, motivational issues/gratification issues, depression, etc.", and "Increased morbidity of physical disease". On the left-hand side, the last section's heading reads, "Deprivation", and includes the following items listed in bullet points: "Physical or behavioral health hospitalization", "Incarceration", "Homelessness", "Social isolation", "Poverty - new/sustained/increased", "Unemployment", and "Food insecurity".]
00:13:21 - 00:13:30
Jamey
Thank you, Joe. Next up we have Bill who's going to share information related to county health and human services structures, silos, and the need for collaborative governance. Bill.
00:13:31 - 00:14:12
Bill Browning
This outlines the need based on my experience over time. So let's just look how people come into systems. So in the presenting event, follow up, say, look at overdose. If that's left unattended, they overdose, they're treated, released. Services may be introduced, may not be introduced. They may be compliant, not compliant. But if we miss that opportunity, there are biological changes that occur for a person that's in the throes of addiction. We know that it changes the brain. It requires them to require more of the drug, more intensive drugs, and that's the result and condition.
00:14:13 - 00:14:36
Bill
Again, if that's left, if we don't deal with that or intervene at that level, that just goes into the cycle. We know that people that are addicted to drugs have higher exposure to criminal activities, to health complications, loss of job, homelessness, and all those other things.
00:14:37 - 00:15:07
Bill
The traditional model would be perhaps a referral to a drug and alcohol agency. If there were children, depending on the laws of the state that you're in, there may be a referral to the child abuse hotline. In Pennsylvania, that's not necessarily true because in Pennsylvania, only child abuse is mandated to be reported, not neglect. We actually split out child abuse and neglect in Pennsylvania, and drug use by parent would come under neglect.
00:15:08 - 00:15:35
Bill
But even assuming that a referral is made, if there are children, the traditional model would be a phone call to the drug and alcohol provider. There may be a plan saying, "You must attend drug and alcohol sessions. You must be clean and sober." And if there are meetings, it's situational, it's sporadic, it's not necessarily collaborative. You're just checking in. Did they go to their appointment? Did they not go to their appointment?
00:15:36 - 00:16:21
Bill
That's really not a recipe for success because it's really not changing behaviors. You're not marshaling all the resources around that individual. The downside, obviously, is that you have duplicative services. So drug and alcohol may be looking at their client saying, "Oh, you have a housing issue. Now let's see, I have a special grant for housing," because we're a drug and alcohol agency. Go to the child welfare agency. If they're involved, they're looking at it and saying, "Well, you need to find a house. We'll pay your first month's rent or we'll help you find a home. We'll put you in a hotel, whatever."
00:16:22 - 00:16:48
Bill
And that goes on and on throughout the system. You're not really dealing with the whole person, you're dealing with them as an episode of behavior. So at each level, you're not saying you're bringing and having some collaborative vision on how to treat the whole person. You're really just looking at, how do I fulfill my role in this way? I'm a drug and alcohol worker, I'm a child welfare worker, I'm a housing provider, etc.
00:16:49 - 00:17:06
Bill
And this goes on and on. You see in that cycle that that opportunity for intervention can occur at any point, right? It could occur when they're incarcerated. If you're trying to do a reentry program, if you do it in isolation, again, the same issues that we discussed.
00:17:07 - 00:17:27
Bill
And that's generally I'd say most throughout my entire career, that's how things have been done, right? Everyone has their separate silo. Everyone has their separate department, their separate funding, their separate philosophies. And everyone assumes that the other person is doing their job much worse than they're doing theirs.
[Slide 11. The title of this slide reads: "Ideal HHS department structure". An organizational chart shows three levels. The top level in dark blue has the "Executive Director" and "Behavioral health managed care". Under the "Executive Director" are the following eight positions/departments in blue: "DHHS Chief Administrative Officer", "Child protective services", "Aging services", "Research and development (Role can be fulfilled by a contractor, gov't affiliated 501.c3, etc.", "Behavioral health / intellectual disabilities / early intervention", "Drug and alcohol programs", "Department of Health", and "Housing programs, grants, other human and social supports". Lastly, under the "DHHS Chief Administrative Officer", are the following three positions in teal: "Categorical (departments) fiscal staff contract officers", "DHHS IT", and "DHHS transportation".]
00:17:28 - 00:18:05
Bill
Now, this obviously isn't a panacea. This is just how I set up the structure. And I would say to follow up with Joe as far as time and resource intensive, getting there was. Maintaining it, not necessarily so. But getting there was very intensive. Turf battles, assuming, what are you trying to take over of mine? So when we started developing this whole structure, that was the fear that you're going to be taking something away, not necessarily adding something to.
00:18:06 - 00:18:39
Bill
Once after numerous meetings, looking at the data, looking at the money that was involved, in Pennsylvania, we have a block grant for human services that you could opt in, opt out. We opt in, and so we're allowed to use dollars for certain things in behavioral health, housing, and other systems, aging, etc. Drug and alcohol. Child welfare is not included in that. It was initially, but we're so successful at managing costs, that the governments offered to pull it up.
00:18:40 - 00:18:55
Bill
But we do get a block grant, and what that means is we sit down as a group and look at what our commonalities are in terms of need. We look at, if you remember back in school the Venn diagram, where are those overlaps?
00:18:56 - 00:19:29
Bill
Some of the low hanging fruit would be housing. Every system has housing needs, drug and alcohol has housing needs, behavioral health has, child welfare, etc. And so we start looking at, what does that look like from a department of health? That seems out there, right? But it's not because we now know that housing is a public health concern. Without housing, you're not getting adequate treatment, you're not getting adequate screening, etc. You may be living in a food desert. So all those things intersect.
00:19:30 - 00:19:59
Bill
So then we start looking at, well, drug and alcohol does have grants for housing and it covers this population. But I may have a child welfare family that's drug involved, but I could use my dollars then to find housing for that drug and alcohol client because there's family members. That then frees up dollars in drug and alcohol to treat more people. And that goes on and on. We see that throughout numerous levels.
00:20:00 - 00:20:58
Bill
One of the important things that Joe brought up was the accountability piece, and that's why one of the first things we started was doing a research wing. So we did have an office of research and development right now because of staffing issues throughout the county and the nation and social services, that's somewhat depleted, but we did find a 501(c)(3) that's willing to take up the slack to do the research for us and partner with us. And they are a government affiliated 501(c)(3) made up of area professors from the colleges, including the medical college. We have medical providers. We have consumers that are part of the panel and all the department heads within human services. And that's our collective where we sit down and look at the actual numbers.
00:20:59 - 00:21:11
Bill
And it seems daunting. It does seem daunting. How do you take all this? You're developing research, you're doing all this. It doesn't have to be. It's really just looking at find one project to start with.
00:21:12 - 00:21:42
Bill
And I mentioned housing because that's universal. And I think if we look at that and then start doing baby steps as far as research, we don't have to do a whole outcome analysis, etc. Let's just talk about, what data do we have? It could be descriptive data to start. It could be just output. Who and how many are involved in the system? Are we serving more? Are we serving less with this model? That's the lowest level of statistics, right? You could really get into.
00:21:43 - 00:22:09
Bill
And it's something that is measurable over time. Then you say, "Okay, well how long, does the provision of housing lead to better outcomes in drug and alcohol or child welfare?" Defining those outcomes. And that's where that collaboration becomes so important. Not just in the delivery of service, but also measuring the outcomes and maintaining that.
00:22:10 - 00:22:51
Bill
For example, I could tell you that when we started this model, there were dollars that would just be given, were given a status quo. So even though we had a block grant, the money was given. "Okay, well this is your pot behavioral health. This is your pot drug and alcohol. This is your pot for housing." And why was that? Well, that's because last year, this was your pot in drug and alcohol. It sounds absurd, but that's a bureaucracy. And I always say bureaucracy is not conducive to innovation.
00:22:52 - 00:23:36
Bill
So we started looking at those universal needs. And since then, we've provided over time millions of dollars in collaborative governance through housing projects, through dealing... Now, we've expanded to the courts as well. So the courts trying to get people out of jail sooner and have them have housing plans that wouldn't have been able before. It would've been in isolation with very limited resource. We're using the opioid settlement dollars now as part of a whole vision of housing. And I'm talking about housing because that's something that's very tangible, but this does apply through other service, whether it's home-based care, aging services, etc.
00:23:37 - 00:24:56
Bill
And again, there are some issues as far as, you still do need to have that overarching kind of administration. So as the executive director in my team, we did the monitoring, we looked at the money, but we also respected the individual expertise of the partners. And I think that's important, that we could all be blended and homogenous, and is not realistic. We have to look at the expertise. And also there are legislative, right? There's laws with some of the funding that's discreet. But really leveraging that individual expertise in all those departments, but having a collective vision. And that's done through hiring. It's done through meetings. And this may seem slight, but what I found what was most successful is even co-location. We brought our 501(c)(3) to the same location, aging in the same location, all of human services so we can have those real time interactions that our boots on the ground people have those real time interactions with people going to offices and departments that they would've normally just waited for a phone call or maybe a report somewhere in the life of their case.
00:24:57 - 00:25:42
Bill
It is a successful model. Obviously, there has to be expansion. And by expansion, I mean releasing some of the strings in government at each successive level, right? At the state level, the federal government, there has to be recognition of the importance of doing this collaborative governance, because that probably is the single biggest issue that I've seen in developing this, is running up against a regulation that doesn't allow us to provide something that makes sense, but provide something that meets some bureaucratic construct. And so I think with that, I'll turn over to Jamey.
[Slide 12. At the top of the slide is the Behavioral Health Alliance of Rural Pennsylvania logo with large blue text that reads, "BHARP" and "Behavioral Health Alliance of Rural Pennsylvania" to the right of the logo. An image of the state of Pennsylvania and all of its counties is in the middle of the slide. The following counties are highlighted in blue: Warren, McKean, Potter, Tioga, Bradford, Wayne, Forest, Elk, Cameron, Clarion, Jefferson, Clearfield, Centre, Union, Mifflin, Huntingdon, Junita, Snyder, Sullivan, CoumbiaMontour, Northumberland, Schuylkill, and Green. Under the image, at the bottom of the slide reads, "The Rural Difference", highlighted in green.]
00:25:43 - 00:25:55
Jamey
Thank you, Bill. Much appreciated. Next up we have Kathy who's going to share some information about her experiences with The Behavioral Health Alliance of Rural Pennsylvania and also Centre County. Kathy.
00:25:56 - 00:26:35
Cathy Arbogast
Thank you Jamey. Again, my name is Cathy Arbogast and I'm with the Centre County Mental Health/Intellectual Disabilities/Early Intervention & Drug and Alcohol Office. But today, I'd like to talk about our role as a partner in the behavioral health Alliance of rural Pennsylvania. BHARP was established in the fall of 2006 and is comprised of county mental health and intellectual disabilities administrators, human services directors, and drug and alcohol offices, also known as the single county authorities, from 24 counties in rural Pennsylvania.
00:26:36 - 00:27:40
Cathy
BHARP is charged to act as the primary contractor for the 24 counties in the central region for the HealthChoices behavioral health program. Now, when BHARP originated in the fall of 2026, it was again, excuse me, it was an unincorporated association of the county MHID administrators, human services directors, and single county authorities from 23 counties in rural Pennsylvania. The administrators from those 23 counties developed a board structure and bylaws, which BHARP would then operate under. The structure recognized the importance of each county and joiner, but also each mental health and drug and alcohol organization, and made sure that each organization had a voice in how the HealthChoices program would be implemented and operated across those rural counties.
00:27:41 - 00:28:23
Cathy
The individuals representing the agencies signed a memorandum of understanding that addressed each signatory agency's role in BHARP. It provided staff for BHARP, and the BHARP board entered into an, excuse me, administrative services agreement with a non-profit human services organization. And it was through that non-profit that BHARP could hire staff and that BHARP could provide the duties that we asked of them so that we could operate as an organization.
00:28:24 - 00:28:43
Cathy
So BHARP then had a staff, and the counties could serve as a collaborative partner to both OMHSAS and to the MCO in the operation of the HealthChoices contract for the 23 counties.
00:28:44 - 00:29:04
Cathy
Over the following 11 years, BHARP then established itself as the collaborative partner in the contract, as well as creating a reputation for assuring cost-effective quality-driven services for individuals residing in rural Pennsylvania.
00:29:05 - 00:29:35
Cathy
BHARP was instrumental in developing innovative services to meet the needs of special populations, including those individuals with mental health and intellectual disabilities, individuals with co-occurring mental health and substance use disorders. Drawing on the years of experience of its member counties, we were quick to establish ourselves for training and technical assistance for providers that are practicing in the North Central region.
00:29:36 - 00:29:55
Cathy
In addition, BHARP has had numerous initiatives that focus on the implementation of community-based services such as medication-assisted therapy for opiate use disorders, and this allowed individuals in rural communities to receive services locally where they live.
00:29:56 - 00:30:33
Cathy
As BHARP grew, the BHARP board realized it was time to become an independent organization. And in the fall of 2017, the board started to work on applying for a non-profit corporation status, which would allow us to become more independent as an organization. So over the following months, BHARP board and BHARP staff, with the support of OMHSAS and Community Care, our MCO started to develop and implement an infrastructure for BHARP that would allow them to operate as a standalone entity.
00:30:34 - 00:31:29
Cathy
Using subcommittees, the board was able to develop policy, review, and execute the necessary contracts and began operating as a Pennsylvania non-profit corporation effective July 1st, 2018. So you can see as a collaborative governance, under collaborative governance, these 23 counties not only worked independently for the betterment of their own individuals living in their counties, but were able to work together to build themselves from an unincorporated association to building a Pennsylvania non-profit corporation that could work together to operate for the betterment of the whole of those 23 counties.
00:31:30 - 00:32:12
Cathy
Once we were established as a non-profit corporation in 2018, the executive committee and board of directors felt confident with this new structure that they could provide a conflict-free organization, and was ready to assist OMHSAS and Community Care in managing the North Central contract for years to come. And with this new structure in place, the BHARP member counties began to explore the possibility of accepting the right of first opportunity and designating BHARP as the single entity to act as the primary contractor for those 23 counties.
00:32:13 - 00:32:39
Cathy
We called on our collaborative partners to discuss how this arrangement might work. And for several months, BHARP member counties worked with their boards of commissioners to highlight the importance of and the advantages of moving control of the North Central contract from the state-run contract to the counties running the contract via BHARP.
00:32:40 - 00:32:59
Cathy
With assistance from legal counsel, board members worked with their commissioners to introduce and adopt ordinances that would authorize them to enter into an intergovernmental cooperative agreement, outlining their acceptance of the right of first opportunity, and designating BHARP as the primary contractor.
00:33:00 - 00:34:11
Cathy
This involved 23 times 3 commissioners coming into agreement, passing the ordinance, signing the intergovernmental cooperative agreement, and all coming into agreement and going forward as the primary contractor for the North Central contract. As members completed this task, they proceeded with issuing an RFP to determine who would be subcontracted as the behavioral health managed care organization. With [inaudible 00:33:37] partner, We completed the final steps necessary to enter into an agreement with the Department of Human Services, becoming the primary contractor for the HealthChoices behavioral health program. In addition, BHARP was approached by Greene County regarding their interest in also moving from a state-held contract to one with more local control. Because of its relatively small population base, Greene County could not move forward as a standalone program, and they were interested in exploring joining the BHARP group.
00:34:12 - 00:34:30
Cathy
After several weeks of discussion, the BHARP board unanimously agreed that Greene County could join as the 24th member county. And on January 1st, 2022, the North Central HealthChoices contract went from 23 counties to 24 counties.
00:34:31 - 00:35:16
Cathy
So in reviewing all of the steps that Joe spoke about, the positives and the negatives, the things that have to occur in this process, BHARP is an excellent example of how that process has to occur, not only in identifying the needs of the individual county, but the collaborative governance that has to occur in looking at the whole and prioritizing the needs of the many, while assuring the needs of the individual counties are occurring at the same time.
00:35:17 - 00:35:43
Cathy
It's been a wonderful process. It's had its bumps along the road without a doubt. But we've come a long way and are doing incredibly well as a collaborative partnership together. And with that, I will pass it back to Jamey.
[Slide 13. The title of this slide reads: "Panel discussion". Under the title is a question that reads: "1) A key element of collaborative governance is the inclusion and participation of stakeholders that represent multi-dimensional issues. What do you believe are the most important strategies for keeping stakeholders continuously engaged in collaborative governance?". On the right-hand side of the slide is an image of four people having a meeting in a business setting.]
00:35:44 - 00:36:13
Jamey
Thank you, Kathy. That's quite an accomplishment really, if you think about it. 24 counties representing the unique individual needs, while at the same time pulling resources together as a single group. It's really a story. Next slide we have a panel discussion, and we'll start with the first question. And I'm going to ask Bill if he wouldn't mind responding to the first question after I read it.
00:36:14 - 00:36:29
Jamey
A key element of collaborative governance is the inclusion and participation of stakeholders that represent multidimensional issues. What do you believe are the most important strategies for keeping stakeholders continuously engaged in collaborative governance?
00:36:30 - 00:37:10
Bill
I think the most important thing is that if you're lucky enough to have the consumers or stakeholders involved in the process, to ensure that they have voice. And that sounds cliche, but it's not, because I've been a part of numerous boards where you've ticked off boxes, okay? Well, we have somebody in recovery, we have a provider, and they're all ticked off. But they just continue kind of bulldozing through whatever it is that you want. They'll learn that very quickly and they won't participate. And I've seen that happen. I think keeping them engaged by showing that their voice means something.
00:37:11 - 00:37:57
Bill
I think the best example I saw was when I had a large forum when we were kicking this off in 2012, whenever that was. And a lot of discussion was around confidentiality, the various providers and government entities complaining about that, saying, "Well, they didn't think it would work." It's going to take until a consumer said, "I don't want to keep on telling my story all over again. Every one of you keep on telling me you're protecting my confidentiality, but I have to go down to the street to UNC and fill out an application there. Then I have to tell my life story over at drug and alcohol. Then children, youth, they want to know every element of my life since birth. So I don't want that."
00:37:58 - 00:38:28
Bill
And I think that to me was the turning point for a lot of people in that room saying that we're so stuck in the process, that we're not even looking at the outcome. The outcome is to try to make that person's life better. And I think that that's probably the key element, is not to just take off the box that you have somebody there, that they're active participants, you're listening to them, and you're adapting your program accordingly.
00:38:29 - 00:38:36
Jamey
Thank you, Bill. Kathy, Joe, is there anything that you'd like to add to Bill's response from your experiences?
00:38:37 - 00:39:01
Joe
Just want to highlight that the feedback loop to the people involved is extremely important. That's kind of what I was saying in terms of authentic deliberation and dialogue, you have to show them that what they're saying actually means something. So it could be a small win or even a big thing, but to keep people involved and let them know that what they're talking about, what they're contributing is actually being heard is vastly important.
00:39:02 - 00:39:34
Cathy
I think it's important to remember that people that are quiet, doesn't mean they don't necessarily have something to say. And that people who are talkative, that doesn't necessarily mean they're telling you what they really want to say. And sometimes, it's important to continue to ask in different ways and in different forums to be sure that people are really having the opportunity to tell you what they want.
00:39:35 - 00:40:16
Cathy
We've changed our forums for sharing and gathering stakeholders' input in different ways. To be sure, people will tell you things in a smaller group that they won't necessarily tell you in a large group. They'll tell you things in a survey that they won't tell you in an open dialogue. They'll tell you things in an open dialogue that they won't tell you in a survey. So we want to do things in different ways to give people the opportunity to share in ways that are comfortable for them.
[Slide 13. A second question transitions into the slide underneath the first question and reads: "How can the success of collaborative governance structures be measured in both intended outcomes and cost effectiveness?".]
00:40:17 - 00:41:05
Jamey
Thank you, Kathy. That really ties back to a key element of one of Joe's slides where he talks about the facilitation of collaborative governance, and having the ability to engage with various stakeholders who have different levels of involvement and different personalities. And in experience, especially with family members and individuals receiving services. There's oftentimes where prepping them prior to meetings, curving the agenda, helping them with their comfort level, and then circling back and making time to ensure that they have the opportunity to speak. Because sometimes in these environments, they can feel somewhat intimidated. And so providing that level of facilitation is critically important. So thank you all for your responses to that question.
00:41:06 - 00:41:17
Jamey
Let's go to question number 2. How can the success of collaborative governance structures be measured in both intended outcomes and cost-effectiveness? And Joe, would you mind kicking this one off?
00:41:18 - 00:41:54
Joe
Sure. So there's lots of ways to do that. To what Bill had said, going back to in terms of his restructuring of the departments and getting folks to work together, he had said, "We started off with some small but important data." So making those small wins, and again, making that known and demonstrate that either shifting around resources, shifting around our process has contributed to a reduction in X or an improvement in X. But ultimately, we're trying to help improve someone's life, right? As Bill said.
00:41:55 - 00:42:37
Joe
But to put that in figures is a little hard, particularly if you're involving a lot of different groups. I just would encourage people to start small, really try and just pull together some sort of basic data. And it's hard to sometimes link that to specific outcomes, but think through it. Be, I would like to say strategic in terms of if we're going to start this now, what do we hope to see in a year or 2 years? And also think if we change these processes and things, how long is that going to really take to make an impact? Right? Sometimes that can take years before that will even be visible.
00:42:38 - 00:42:42
Jamey
Thank you. Joe. Bill and Kathy?
00:42:43 - 00:43:48
Bill
I would just say as far as starting small, we talked about having a research wing and reaching out to 501(c)(3), but that was the end point. The beginning point was really just coordinating all of our fiscal operations and have it monitored by one CAO that was able to take in all the data, and all of the financial data, and then start doing financial action reports and performance reports, and then providing them to the individual departments. And that was our start saying, "We see that you didn't have enough dollars to provide this. But we can reorganize this fund and give you more to treat more consumers at this level." So just those tiny things. We're not talking about outcomes, quality of service. But I think that was a good starting point for us to start showing that we are able to effectively move funds as well as do joint planning.
00:43:49 - 00:44:17
Cathy
I think for us, the most important outcome was to learn more about each other, and learn about the projects and what the actual needs were. Not just for ourselves, but for other counties. And to kind of take ownership not only of what our own needs were, but what the needs were across the region.
00:44:18 - 00:44:45
Cathy
It was surprising how quickly in partnership we all wanted for each other and not just for ourselves. We thought our first intended outcome would be to not kill each other in the first 6 months. And it never became a problem. That was never an issue. Maybe it was the social worker in all of us that wanted to take care of everybody instantly.
00:44:46 - 00:45:53
Cathy
But there was a sense of collaboration from the very beginning, which was a wonderful thing. Even after all these years, we still continue to prioritize where the greatest needs are, and how we measure that, and figuring out how we measure that, and prioritizing the importance of quality, the importance of cost-effectiveness are still discussions that we have to this day. Whether there's a little money or a lot of money, those are still priorities that we set as intended outcomes. Which is impressive, because it's easy to kind of let those things take a back burner when there's lots of money, and to zero in on those things when there's not a lot of money.
00:45:54 - 00:46:08
Cathy
And it's important that you maintain a standard at all times, regardless of how big the project is, how small the project is, and where you are in terms of other criteria.
[Slide 13. A third question transitions into the slide underneath the second question that reads: "3) When creating a new collaborative governance structure, whether for a single initiative or a permanent standing governance body, what are your recommendations for getting started?".]
00:46:09 - 00:46:35
Jamey
Final question here that we have, is when creating a new collaborative governance structure, whether for a single initiative or permanent standing governance body, what are your recommendations for getting started? I know we covered this in a number of ways, so if you could just give some key bullet point areas of where viewers, if they're interested in starting a new collaborative governance structure, where they would be at, where would they start? And Kathy, could we start with you?
00:46:36 - 00:47:27
Cathy
Start slow. Take your time. There's lots to learn about all the partners at the table. There's lots to the planning and the intent for the group. And I think everyone has to be willing to participate. Forced to be collaborative is not a good sign. And I think there has to be at least some willingness to see the value in what this collaborative can bring to the work that you're doing in order for it to be successful.
00:47:28 - 00:47:31
Jamey
Bill and Joe?
00:47:32 - 00:47:58
Bill
The way I started it, I tried to identify which would be the most challenging partner. And so at that time, it was aging. When I spoke to the provider or state provider organization, I talked about integration and collaboration. I said, "Well, you don't want to do that," because then all the money is going to go from aging to all the other categoricals. And that was somewhat reflected all the way down.
00:47:59 - 00:48:24
Bill
So I targeted aging first to show that, "Here's the result, you have a waiting list." And because we're able to look at the funding in our human service block grant and looking at some other efficiencies throughout the system, not just in aging, that here now we could get people off the waiting list. We could provide more personal care now. And so that was the low hanging fruit.
00:48:25 - 00:48:44
Bill
So once we engaged, in Pennsylvania, aging is outside of human services. It's a separate entity. And so that's why you had that very siloed approach. But I think by showing good faith and showing how it works practically, we're able then to reach out even to the other groups.
00:48:45 - 00:49:03
Bill
So that would be my advice. Find where the biggest benefit, or not necessarily even the biggest, the most visible benefit is to show the small success with somebody that you've, I guess converted and then build upon that.
00:49:04 - 00:49:35
Joe
Yeah, I'll just add, I totally agree with both those. It's very people process endeavor, right? Or a thing. It's all based on relationships, at least at the core. So really need to figure out, what are you trying to accomplish? Be very clear with that. Sort of scan the field in terms of who's involved and individual people, but then also organizations. And really, the thing that I've seen or also seen at research that these endeavors trying to fall apart, I guess you could say, is people leave.
00:49:36 - 00:49:53
Joe
So while it is a very people person, person to person kind of relationship, you really should sort of structure a collaboration in terms that you could plug somebody new in. What were they doing? How were they involved? How will this new person be brought into the fold?
00:49:54 - 00:50:19
Joe
So while it is again, sort of this, I hate to say informal, but one-to-one relationships or one to many, I guess you could say, if you're leading this. Also consider that people will leave. They just move on from different positions, and there'll be certain key people that are involved, and all of a sudden you're like, "Well, Steve's gone now. Who do I talk to at that organization?" So try to prevent that from happening by having some more formal agreements or things in place.
[Slide 14. This slide is divided vertically into two sections. The left section features the "CAI" logo and tagline "We power the possible™" in white text. Below reads, "Thanks for joining us!", followed by contact information: "www.cai.io," "inquire@cai.io," "+1 (888) 824 - 8111," "@CAI," and "@CAI_Insights," each with respective icons. The right section contains an image of two business people smiling and shaking hands.]
00:50:20 - 00:51:12
Jamey
Okay. Well, thank you so much for your participation and the information that you shared today. And we talked a good bit about structure as far as a larger overarching structure with how collaborative governance is used. But keep in mind, you do have the ability to implement collaborative governance in a single initiative, such as the many initiatives that counties are facing today. And that's whether advancing whole person care, addressing the opioid epidemic, building a unified crisis response system, or eliminating maternal and infant morbidity and mortality, and disparity in health outcomes. There's opportunity in all of those in building a collaborative governance structure around each of those initiatives individually.
00:51:13 - 00:51:27
Jamey
So thank you everyone for joining us today, and please reach out if you would like to have more information in supporting you and getting started with collaborative governance. And our next slide, if we could move that next slide.
[Slide 15. The title of the slide reads: "Additional reading". Underneath the title, additional readings are listed vertically with the titles in bold, and the author bulleted underneath each title. The additional readings are listed as follows: "Introductory Reading on Collaborative Governance; School of Government & Public Policy - The University of Arizona", "UNCG Guide to collaborative Competiencies; Kitchen Table Democracy", "Building a Collaborative Governance Framework: A Five Step Process; National Policy Consensus Center - Portland State University", and "Collaborative Governance: Principles, Processes, & Practical Tools; National Policy Consensus Center - Portland State University".]
00:51:28 - 00:51:36
Jamey
It provides additional resources that may be of interest to you in your journey to beginning collaborative governance. Have a great day.
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Watch this 45-minute NACo on-demand health and human services webinar where you will discover what collaborative governance is and how it unites stakeholders across departments and external organizations, creating lasting outcomes and cost efficiencies. Collaborative governance provides a structure to support the coordinated delivery of services, bridging the spectrum of health, human and social services, for individuals with intellectual, behavioral health and/or physical disabilities and children and families involved in the child welfare system. Learn practical government use cases and hear the latest academic perspectives. If your organization is interested in working with CAI Health and Human Services experts, contact us today.
