Human Service Agencies Research Articles

Why Won't Anyone Talk? Challenges Naming and Addressing Tokenism Within Health and Human Service Agencies Serving the LGBTQ+ Community.

Workplace tokenism, the use of superficial efforts to appear equitable, which often leads to burnout of marginalized groups, is pervasive, even in health and human service organizations dedicated to improving their community's health and well-being. An original research project to identify interventions addressing tokenism within Lesbian, Gay, Bisexual, Transgender, Queer plus serving health and human service agencies in New York was unable to engage staff in focus groups. A follow-up survey with 41 potential participants reported burnout as the main reason for nonparticipation. Qualitative data revealed desired aftercare for the retraumatizing nature of sharing individual experiences. Utilizing a community-based participatory research approach with an antiracism lens may mitigate challenges addressing tokenism, thereby increasing workplace inclusion of our Lesbian, Gay, Bisexual, Transgender, Queer plus community.

Adaptive Governance: Empowering Data Sharing for Public Health Impact - Insights from North Carolina Department of Health and Human Services

Objective and ApproachAt the 2022 IPDLN Conference, we presented work led by the North Carolina Department of Health and Human Services (NCDHSS), in partnership with university-based researchers, to build legal and ethical processes for routine data sharing. This session provides significant updates on the methods, results, and implications of these efforts–namely, that NCDHHS implemented an enterprise-wide data governance process and a legal framework that has enabled timely, impactful use of cross-sector data. We relied on Participatory Action Research and Deliberative Dialogue methods to engage a diverse range of partners in a data landscape overview and the co-creation of new data sharing processes that better enables the enterprise to adapt to a changing world. ResultsFour key actions were taken as a result of the participatory research process: NCDHHS developed a data strategy, created a data sharing guidebook, staffed their Data Office, and implemented a new legal framework. In addition to describing how these actions support data use across a large US state health and human services agency, we provide three use cases demonstrating the impact of this work. ConclusionsEstablishing routine data sharing presents legal, technical, and cultural challenges, particularly in large agencies. Through a collaborative, participatory approach, the NCDHHS successfully established enterprise-wide data governance and a legal framework to support data-driven policymaking and, ultimately, improve health outcomes for residents. ImplicationsThis research presents a successful, actionable, and replicable framework for developing and implementing processes to support intradepartmental data access, linkage, and use.

An Applied Research Partnership to Improve The Children’s Behavioral Health System Of Care

Objective and ApproachThis session describes a doctoral student-led process to align research, policy, and practice partners around the use of integrated data to address a policy priority—the mounting youth mental health crisis. The project partners engaged in a five-year governance process to leverage integrated administrative data from a large health and human service agency in one U.S. state. Qualitative field notes—collected while conducting quantitative analyses and engaging partners—were analyzed to document a realistic timeline and process for ethical, actionable research using cross-sector data. ResultsFive key lessons for partnership-engaged research emerged, emphasizing the importance of adapting to changes in project themes, leveraging strong partnership to address data quality concerns, nurturing existing and new relationships, balancing data access and data privacy, and supplementing administrative data with contextual data. ConclusionsThough engaging deeply with partners takes substantial time and energy, there are benefits to researchers, policymakers, practitioners, and most importantly, residents whose data are represented. Furthermore, building pathways to legally and ethically access integrated data can promote the efficient, strategic use of data for social policy research, and ultimately, be leveraged to support evidence-based policymaking in an ever-changing world. ImplicationsThis session underscores the value of forming applied research partnerships and building legal and ethical pathways to access integrated data when tackling complex social policy issues.

TAKING IT TO THE STREET: A CONCEPTUAL MODEL PROMOTING THE ESSENTIALITY OF TRUST IN COMMUNITY-FOCUSED QUALITATIVE RESEARCH

Introduction/Frame: Trust is foundational to qualitative research and program evaluation to ensure that data collection, data analysis, and actionable recommendations improve programs and produce effective outcomes. Concomitantly, building trust between the university and community sectors offers a rich opportunity to join efforts to address public health issues including substance use, homelessness, criminal justice involvement, and mental illness. Research suggests cross-sector collaboration among human services organizations produces effective outcomes when stakeholders are engaged, trust one another, and have shared goals. Developing qualitative program evaluation partnerships between university researchers and human service organizations offers a valuable application of cross-sector collaboration, including the transferability of qualitative research and program evaluation findings. Objective: This conceptual paper aims to highlight the essentiality of trust, summarize the facilitators and barriers of collaboration, and share a case example of a partnership. Additionally, it offers implications for researchers and community partners while outlining the benefits of university/community collaboration. Finally, we will offer a conceptual model of the iterative relationship between trustworthiness, trust, and impact in our evaluation approach. Theoretical Framework: Our approach to community-focused qualitative program evaluation is anchored in an action research paradigm, a use evaluation approach, coupled with trust as the key factor in developing and maintaining effective evaluative relationships. The Impact of Trust: Three areas in which trust is most beneficial to qualitative program evaluation are relationships, data collection, and transferability of results. Conceptual Model: Our model is grounded in three seminal works focusing on trust in business-business relationships, organizational trustworthiness as a mediator to both cognitive and affective trust, and relationship stability in inter-organizational reliance. Final Considerations: We found that using this model allowed quicker research-to-practice implementation of evaluation recommendations, solidified community/university collaborative relationships, and facilitated strategies to address workforce shortages in community human services agencies.

A Retrospective Study of Cat Hoarding Cases and Their Management Through Voluntary Spay/Neuter and Relinquishment In New York City

Introduction: Animal hoarding cases are complex sources of shelter intake. Cases require significant planning, collaboration, and resources, often from multiple responding organizations. Study objectives included description of cat hoarding cases in New York City not criminally pursued, case outcomes when managed by a spay/neuter and relinquishment program utilizing a collaborative approach with caregivers, and characteristics or interventions leading to better outcomes. Methods: Data were extracted from the American Society for the Prevention of Cruelty to Animal’s Community Engagement (CE) case files. Eligible cases were retrieved using a keyword search and screened for inclusion criteria. Client demographics, case factors, and outcomes were described with descriptive statistics. Data were further analyzed using adjusted logistic regression models to investigate variables predictive of outcomes. Results: The study population included 79 cases with a median population size of 22 cats. The majority of clients were female, lived alone, and had high levels of social vulnerability. Object hoarding was reported in 29.1% of cases and unsanitary conditions in 68.4% of cases. Almost one-third (30.4%) identified as rescuers or community cat caregivers. At the time of the first interaction with CE, 88.6% of clients were interested in spay/neuter and 76.0% in surrender services. Social service agencies were involved in the initial CE intervention in 26.4% of cases. Successful outcomes were defined as cases in which clients were left with a manageable population of cats, or all cats were removed. Successful outcomes were achieved in 67.1% of cases after the first CE intervention. Recidivism occurred in 41.5% of these cases. Clients who showed an initial interest in surrender were 10 times more likely (OR 10.0, P = 0.014) to experience a successful outcome than clients not interested in surrender. Significant predictors of re-collection included clients identifying as rescuers (OR 4.8, P = 0.039) and the involvement of human service agencies during or after the CE intervention (OR 6.1, P = 0.041). Conclusion: Results demonstrate animal hoarding cases involving cooperative caregivers and rescuers can be successfully managed by programs using a collaborative approach with clients. The high rates of initial interest in spay/neuter and surrender in caregivers suggest a need to expand access to veterinary care and strategically manage case intake into shelters. Further interdisciplinary research is needed on how mental health, social service, and animal service providers can attain successful outcomes long-term and reduce recidivism in animal hoarding cases.

Assessing Local Public Health Governance in North Carolina Across Organizational and Governance Configurations.

Every county in North Carolina must include a board of health (BOH) with specific prescribed duties and powers. It is unclear how BOHs in North Carolina are currently exercising their governance ability. In 2012, the North Carolina General Assembly provided coun-ties with additional flexibility to select among different configurations for their local health department (LHD). The impact of this flexibility on the governance and service delivery of LHDs is yet to be explored. We conducted semi-structured interviews with LHD directors and BOH members to assess the strengths and weaknesses of BOHs within different local public health configurations across North Carolina. We employed conventional content analysis to derive themes from the interview transcripts. BOHs were largely described as an underutilized institution, with few BOHs noted to be active beyond satisfying their required legal duties. Strong BOHs were noted to fulfill three identities on behalf of the LHD: an advocate, a bridge, and an advisor. The majority of interviewees desired to work in a standalone county health department (as opposed to a consolidated human services agency) with an appointed (versus elected) board of health. This configuration was preferred because, according to participants, it is more likely to enable a structural focus on public health initiatives. Our sample frame did not control for the length of time an interviewee had been in the office nor the professional background of each BOH member. Wide variations exist in the exercise of BOHs across the state, partially due to how different LHD configurations structurally focus resources and attention on public health.

High stress, high demand and high pressure: Experiences of social work and human services agencies during Melbourne's COVID‐19 lockdowns

AbstractThe COVID‐19 pandemic has created major challenges globally. The social work and human services profession has been required to rapidly respond to policy and social changes. This research aimed to understand how the pandemic has affected social work and human services staff within Melbourne, Victoria. In this paper, we analyse the practice and policy implications of these responses, and outline learning for the human services sector. We draw on interviews with social work and human services practitioners, exploring their experiences during the pandemic, including social and economic impacts on service users and agencies, and organisational and practice changes. Participants highlight compliance requirements, digitalisation of services, loss of social connection for service users and service impacts. In addition, participants highlight how people from low socioeconomic backgrounds were immensely affected throughout COVID‐19 lockdowns. However, this research also identifies service benefits, resulting from the rapid adjustments made by agencies that need further exploration for future practice. This article highlights how, despite the challenges posed by COVID‐19, agencies and workers developed innovative responses to this crisis. Drawing on these insights can help to understand how such initiatives can be implemented in the future. This article contributes to knowledge about innovation in a time of crisis.

Radiation and Chemical Program Research for Multi-Utility and Repurposed Countermeasures: A US Department of Health and Human Services Agencies Perspective.

Although chemical and radiological agents cause toxicity through different mechanisms, the multiorgan injuries caused by these threats share similarities that convene on the level of basic biological responses. This publication will discuss these areas of convergence and explore "multi-utility" approaches that could be leveraged to address common injury mechanisms underlying actions of chemical and radiological agents in a threat-agnostic manner. In addition, we will provide an overview of the current state of radiological and chemical threat research, discuss the US Government's efforts toward medical preparedness, and identify potential areas for collaboration geared toward enhancing preparedness and response against radiological and chemical threats. We also will discuss previous regulatory experience to provide insight on how to navigate regulatory paths for US Food and Drug Administration (FDA) approval/licensure/clearance for products addressing chemical or radiological/nuclear threats. This publication follows a 2022 trans-agency meeting titled, "Overlapping Science in Radiation and Sulfur Mustard Exposures of Skin and Lung: Consideration of Models, Mechanisms, Organ Systems, and Medical Countermeasures," sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), a part of the National Institutes of Health (NIH). Discussions from this meeting explored the overlapping nature of radiation and chemical injury and spurred increased interest in how preparedness for one threat leads to preparedness for the other. Herein, subject matter experts from the NIAID and the Biomedical Advanced Research and Development Authority (BARDA), a part of the Administration for Strategic Preparedness and Response (ASPR), summarize the knowledge gained from recently funded biomedical research, as well as insights from the 2022 meeting. These topics include identification of common areas for collaboration, potential use of biomarkers of injury to identify injuries caused by both hazards, and common and widely available treatments that could treat damage caused by radiological or chemical threats.

SAN ANTONIO TRANSPORTATION PLANNING SYSTEM: MAPPING INFRASTRUCTURE CAPACITY AND COORDINATION

Abstract Ride Connect Texas and its partnering agencies seek to develop an expanded senior mobility management system supported by a One Call One Click transportation planning system. Its purpose is to enhance on-demand transportation system coordination and the application of technology, providing consumers, service providers, and mobility managers with direct access to comprehensive transportation information. GIS mapping is used to help develop a spatial awareness of the transportation challenges among older people and individuals with a disability and the current system capacity. Interviews with transit, non-transit, and health and human service agencies will reveal factors that influence coordination among providers and opportunities for capacity expansion. Surveys and focus groups of older adults and individuals with disability will show differentiating characteristics of riders and transportation needs and challenges. GIS mapping will allow us to geocode these findings relative to the user’s street address and zip code, illustrating variations in specialized client needs, service availability, travel behavior, and available amenities for basic daily living. Mapping will identify gaps in transportation services, hot zones revealing high user demand and low system capacity, and the ability to reduce fragmentation of service through seamless technology-based coordination. The mapping element informs the measurement of a community’s transportation system capacity for this user group. The value proposition of this tool is its ability to help any community measure its readiness toward developing a comprehensive implementation strategy for coordinated demand response transportation, including resource mobilization strategies, capacity augmentation, phasing of the system, and implementation timeline.

Shigellosis outbreak among persons experiencing homelessness-San Diego County, California, October-December 2021.

During October 2021, the County of San Diego Health and Human Services Agency identified five cases of shigellosis among persons experiencing homelessness (PEH). We conducted an outbreak investigation and developed interventions to respond to shigellosis outbreaks among PEH. Confirmed cases occurred among PEH with stool-cultured Shigella sonnei; probable cases were among PEH with Shigella-positive culture-independent diagnostic testing. Patients were interviewed to determine infectious sources and risk factors. Fifty-three patients were identified (47 confirmed, 6 probable); 34 (64%) were hospitalised. None died. No point source was identified. Patients reported inadequate access to clean water and sanitation facilities, including public restrooms closed because of the COVID-19 pandemic. After implementing interventions, including handwashing stations, more frequent public restroom cleaning, sanitation kit distribution, and isolation housing for ill persons, S. sonnei cases decreased to preoutbreak frequencies. Improving public sanitation access was associated with decreased cases and should be considered to prevent outbreaks among PEH.

An Exploratory Study of Employee Engagement in Human Service Agencies

Given research suggesting that engaged employees demonstrate greater workplace performance, employee engagement has been one of the highest trending topics in the management and human resource literature over the past 20 years; yet there is minimal empirical research focused specifically on employee engagement in nonprofit organizations. The purpose of this study was to explore antecedent factors that contribute to employee engagement in the human services sector, using a convenience sample of staff in human service agencies in the New York City region. Organizational trust, satisfaction with supervisor, and coworker support were significant predictors of employee engagement.

Social Needs in the Prehospital Setting (SNIPS): EMS Attitudes Toward Addressing Patient Social Needs.

There has been interest in utilizing EMS to address patients' social determinants of health, which are thought to be the cause of many unnecessary transports, particularly for "super-utilizing" patients. However, existing research is limited regarding EMS clinicians' understanding of social determinants of health and attitudes toward potential interventions. This cross-sectional study was conducted using an internet-based survey of EMS clinicians across the United States with multiple methods of recruitment. Descriptive statistics and Chi Square Tests analyzed the data. A total of 1,112 EMTs and paramedics completed the survey with 43.4% reporting familiarity with the term, "social determinants of health," and 87.7% screening positive for burnout. Greater than 60% reported willingness to use proposed interventions to address patient social needs. Those who reported familiarity with the term, "social determinants of health," were more likely to indicate willingness to utilize interventions and to believe they were responsible for addressing their patients' social needs. Burnout had no effect on clinicians' willingness to use resources. Respondents showed substantial interest in using the proposed resources to address patient social needs, suggesting that EMS clinicians may be receptive to expanding their scope of responsibility to include socioeconomic interventions. EMS clinicians familiar with the term "social determinants of health" were more likely to believe they were responsible for addressing patient social needs and more willing to use interventions, suggesting a potential benefit to more education on the topic. Burnout among EMS clinicians may not be a barrier to implementing such interventions. Our survey suggests that EMS clinicians may be interested in helping to address their patients' social needs. EMS clinicians should be offered education on social determinants of health in their initial training and through continuing education. Partnerships with human services agencies will be important to ensure the effectiveness of prehospital interventions.

Actualising power sharing in community-led initiatives: Insights from community-based organisation leaders in Chicago, USA.

There is an increasing call for a governmental organisations such as local health departments and federal health and human service agencies to partner with community based organisations (CBOs) for health promotion. There is a large body of literature suggesting that CBOs need capacity building or empowerment to do this work, but less literature about the necessary culture shift at governmental organisations who fund public health work. This study aimed to examine the knowledge, attitudes, and beliefs of CBO leadership who do not want to partner with state funders, and understand which structures and practices demonstrate power-sharing in a community-led approach. We conducted six interviews with community-based organisation leaders and conducted a thematic analysis and a secondary, inductive discourse analysis of the transcripts to analyse why organisations chose not to apply for a government funded initiative and how they talked about power-sharing for community-led public health. Themes about the decision for CBOs to apply to the public health funding initiative: how it related to the CBO's scope of work, meeting the needs of the community, having the technical capacity, and cross-cutting themes of putting the community first and having a long-term positive impact. Organisations rejected the opportunity for this funding due to poor fit, even if they could fulfil the scope of work. A community-led approach was described as one that includes the government giving up control, creating spaces for meaningful participation and power-sharing, and systems demonstrating trust in CBOs. These findings reiterate that in order for public health to be community-led, there needs to be system-wide transformation and intentional investment that supports an infrastructure for community-led public health. State funders can learn from practices in trust-based philanthropy, such as flexible funding and reporting requirements. The results of this study can support the wider participation of CBOs in collaboration with state actors, maximising the transformative potential of collaboration, ultimately transforming power structures and advancing health equity.

Precarious Professionals: The Impact of Neoliberalism on the Workforce of the Nonprofit Human Service Sector

Abstract Forty years of neoliberal policies and protocols, such as privatization, austerity measures, and managerialism, has pushed the U.S. human service sector to the brink of collapse. This commentary delineates the impact of neoliberalism on nonprofit human service agencies. Specific attention is paid to the untenable working conditions of professional frontline staff, who are tasked with providing much needed programs and services to often vulnerable populations. Worker strategies for coping with and fighting against neoliberalism, both individual and collective, are delineated. This piece concludes with some suggestions for more systemic responses to ameliorate and challenge neoliberalism’s impact on the human service sector workforce, although additional strategies are also needed.

“If Another Person Says, ‘You’re So Articulate,’ So Help Me”

Few studies have examined the nature of microaggressions experienced by employees of human service agencies. This exploratory study identified the types of microaggressions that women and non-binary people of color experience within their agency settings. Narrative data were collected using a web survey. The survey consisted of two instruments, both developed by the researcher--a non-categorical demographic questionnaire and a survey that asked participants about their experiences of four types of workplace microaggressions. The sample consisted of 52 self-identified women and non-binary people of color employed by non-profit agencies or governmental departments providing human services in the United States. Data were analyzed by applying interpretive phenomenological analysis (IPA) and a constant comparative approach, generating three overarching themes: (a) misperceptions of identity or circumstances, (b) navigating racial stereotypes, and (c) racialized objectification. Findings stress the importance of addressing microaggressions among employees to foster inclusive workplaces and the salience of race/ethnicity as a targeted identity in the human service professions. Recommendations include the development of workplace policies that create clear and effective avenues for addressing subtle discrimination. Individual social workers can effectively implement these policies by acknowledging, validating, and ultimately reducing unintended harm to colleagues.

Supporting Children and Families Through Trauma: A Qualitative Exploration of the Change Promotion Aspects of the Co-Creating Well-Being Initiative

ABSTRACT This study investigated a regional foundation’s Co-Creating Well-Being initiative, a multi-year effort to increase human service agencies’ capacity in trauma-informed care, human-centered design, and diversity, equity, and inclusion. This research examined the change promotion process inspired by an innovative grantmaking model and the barriers and facilitators for organizational change. A stratified sampling approach was applied to recruit representatives from N = 33 agencies. Thematic analysis was used to develop a change promotion model featuring four main themes: pre-existing conditions, receptivity to opportunities for change, adoption to change, and early outcomes. Macro-level influences of COVID-19 and calls for racial justice accountability are discussed.

Predictors of service integration by community based providers in New York State offering maternal and infant services

Perinatal maternal depression, interpersonal violence, (IPV) substance use and poor sexual health are critical public health concerns with significant negative impacts on child development. Despite widespread calls for service integration at the systems/organizational level and well-documented benefits to children and families, predictors to service integration are not well understood. Using cross-sectional data from 159 community-based providers (CBPs) who identify as community health workers (CHWs) or home visitors (HVs) in New York State, United States, our study aims to examine organizational and individual level predictors to service integration. Service integration in this study is defined as the screening, delivery and referral-making of two or more services over the course of six months. Services of interest in this study include mental health, IPV, sexual health, mental health, and substance abuse services. Descriptive statistics were performed to characterize our sample and show the distribution of service types. Multivariable logistic regression was used to identify salient organizational (job satisfaction: communication, contingent rewards, fringe benefits, operating conditions, and coworker; and training helpfulness) and individual characteristics (self-efficacy) that are associated with service integration, while controlling for demographic characteristics. Forty-four percent of participants (n = 70) integrated all four of the services: mental health, IPV, sexual health and mental health services. Training helpfulness (b = −2.48, p = 0.01), self-efficacy (b = 0.07, p < 0.01), and job satisfaction (b = −0.04, p = 0.01) were significantly associated with provision of integrated services. Specifically, elements of job satisfaction that were associated with integrated service provision included satisfaction with communication (b = −0.28, p < 0.01), coworkers (b = −0.29, p < 0.01), and pay (b = −015, p = 0.02). Findings elucidate areas for future investment for human services agency administrators and point to future areas of intervention that can bolster integrated service provision, thereby improve efficiency, cost effectiveness, and optimal maternal and child health care outcomes for at-risk populations.

Learning to Be a Leader Worth Following

ABSTRACT Leading human service agencies has always been challenging, but recent political, financial, public health, and racial tensions in the U.S. have added further turbulence and complexity to those in CEO and Executive Director positions tasked with providing steady leadership of agencies serving the most vulnerable in our society. Though numerous books and journal articles examining leadership are published every year, there is something valuable about learning from experiences of leaders in the field. This article shares the perspective of one such leader, whose leadership approach is grounded on the principles of The Sanctuary Model, an evidence-supported, trauma-informed, organizational change intervention.

Self-harm and suicidal ideation among young people is more often recorded by child protection than health services in an Australian population cohort.

We investigated patterns of service contact for self-harm and suicidal ideation recorded by a range of human service agencies - including health, police and child protection - with specific focus on overlap and sequences of contacts, age of first contact and demographic and intergenerational characteristics associated with different service responses to self-harm. Participants were 91,597 adolescents for whom multi-agency linked data were available in a longitudinal study of a population cohort in New South Wales, Australia. Self-harm and suicide-related incidents from birth to 18 years of age were derived from emergency department, inpatient hospital admission, mental health ambulatory, child protection and police administrative records. Descriptive statistics and binomial logistic regression were used to examine patterns of service contacts. Child protection services recorded the largest proportion of youth with reported self-harm and suicidal ideation, in which the age of first contact for self-harm was younger relative to other incidents of self-harm recorded by other agencies. Nearly 40% of youth with a health service contact for self-harm also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm than boys, but not child protection or police services. Suicide prevention is not solely the responsibility of health services; police and child protection services also respond to a significant proportion of self-harm and suicide-related incidents. High rates of overlap among different services responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people.

The Lived Experiences of Women of Color Leaders in Human Services: Professional Challenges and Implications for the Field

The purpose of this study was to explore the lived experiences of women of color leaders in the field of human services. This study used phenomenology as a methodological approach to understand women of color leaders’ lived experiences. Sixteen women of color participated in semi-structured interviews about professional challenges that they experienced as leaders in human services agencies and organizations. Most of the study participants identified as Black or African American. Six themes emerged from the data including being treated with disrespect because of race, being one of a few, constantly policing oneself, feelings of isolation, intersectionality, and not being privy to networks. Implications for human service professionals and organizations are discussed.