Annie E. Casey Foundation

The Annie E. Casey Foundation sponsored a series of cases that examine a variety of attempts at reform of children and family services, using state, county, and city level examples, and involving the relationships between governmental institutions, non-profits, business groups, and community activities. In addition to examining social service issues, the cases in this series generate lessons about organizational and policy change, policy analysis and development, creating politically realistic strategies, and about reforming complex service delivery systems.

These cases have been successfully used in executive and masters level programs.


Improving Services to Missouri's Children and Reforming the System

In the mid-1980’s, many of Missouri's children were in trouble—for a whole host of complex social, economic, educational, and health-related reasons. One of every four high school students was dropping out before graduation. Missouri ranked in the lowest third of all states in measures such as infant mortality, child death rates, single parent families, and children living in poverty. It was clear to officials and child welfare advocates alike that drastic changes in the scope and structure of children and family services were needed.

Like many other states, Missouri sought in the 90's to reform children and family services, seeking more family-centered services and a greater level of public-private partnership. The case traces the development of several pilot projects, in the four large state agencies serving children and their families, designed to provide services necessary to improve the health of families and keep them intact. It describes interagency collaboration in the provision of these services and the failure of an attempt at systems reform via a consolidation of the state agencies providing the services. This allows students to examine several stages of the attempt to decentralize and integrate children and family services and triggers a discussion of how best to reform a major social service system, where you can look for major resistance points, and strategies that seem to work better than others.

The case is especially illustrative when taught in conjunction with a companion case on social services system reform, Improving Children and Family Services in Iowa. The Iowa reforms adopted a different approach and got different results; Iowa was able to successfully integrate responsibilities and services to a large degree and make use of de-categorized funding as one of the important tools. For students interested in social service reform, or in learning about strategies for service delivery systems reform of other kinds in a state-local delivery network, a comparison of the two cases makes for a powerful set of lessons. They can be taught in either order in two class sessions of 1.5 hours, or in a 3 hour time block.


Improving Children and Family Services in Iowa

This three part case chronicles a philosophical and practical shift in services to children and families at the Iowa Department of Human Services (DHS), and the resulting collaborative process for change across distinct human service jurisdictions. Instructors may use the Iowa experience to present a broad overview of service delivery reform, and to evaluate the policy behind the shift.

The case examines the policy and funding changes that were made to accomplish the state’s goal. It traces the development of the decategorization of state funding and devolution of decision-making authority to the county level of government. Although the new policy and funding changes yielded many positive outcomes, the number of children in group care continued to grow. The decision point in this case is a response to a directive from the governor to control the costs of child and family services in a way that would continue to promote the use of in-home, placement prevention services. Students may use the Iowa experience to draw inferences about legislative, political and individual role players' discretion in comprehensive systemic change. In addition the case affords the opportunity for detailed exploration of the power and problems of flexible funding, the role of foundations in leveraging change, and strategies in collaborative systems change. 

The case will be especially illustrative when taught in conjunction with a companion case on social services system reform, Improving Services to Missouri's Children and Reforming the System. For students interested in social service reform, or in learning about strategies for service delivery systems reform of other kinds in a state-local delivery network, a comparison of the two cases makes for a powerful set of lessons. They can be taught in either order in two class sessions of 1.5 hours, or in a 3 hour time block.


Implementing a New Drug and Alcohol Treatment Model in Sacramento County

This is an excellent case to illustrate the use of training as a leverage point to reform a service delivery system. Students also learn that training is a tool to change a service delivery system, not necessarily a catalyst for change. Training can support, but does not often drive, reform, so it would also be useful to address the bigger picture of what other leverage points might be available to achieve new service delivery goals.

In this case, Robert Caulk, the director of a County Department of Health and Human Services, hires Toni Moore as the new program manager who is faced with the task of convincing her department's staff and managers of the importance of a new program (Alcohol Drug and Treatment Initiative). She must take this idea from the developmental stage to an actual program, and make it an integral part of employees' daily work lives. In doing so, she is forced to overcome objections based on concerns ranging from lack of funding and funding conflicts to employee fear of increased work time and bringing people with limited training and experience into treatment work.

This case will help students learn to:

  • Scan the environment (internal and external) in which a program operates, and identify the key players whose support or opposition can help or hinder program implementation;
  • Recognize some common obstacles in translating a policy decision into a successful program; and
  • Think about the use of training as one leverage point in changing a service delivery system

The case is intended for use in classes that teach service delivery, health administration, and human services, in addition to negotiation and consensus building.


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