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May 8

Social Policy Action is in the Cities and the States

For all the attention that is going to the turbulence in Washington, it is easy to overlook some exciting and reasonably large-scale social policy innovations happening in cities and states. These initiatives involve significant scale and commitments of resources, and if fully implemented could produce a statistical bump in life opportunities for low-income and vulnerable populations.

Los Angeles has elevated homelessness to the Mayor’s top priority and has begun implementing a series of significant policy and program steps to respond to an estimated 21,000 people on the street. The Comprehensive Homelessness Strategy Report, released in January, has provided the framework for the City’s approach. This has been followed up by a series of public hearings, the passage of Proposition HHH, and budget commitments.  In all of these efforts, Los Angeles has conveyed real seriousness-of-purpose about addressing housing, social service, and health needs of the homeless population. Highlights of the proposal include a “housing first” approach, a coordinated social service (“no wrong door”) system, and targeted services for veterans. The plan estimates a commitment of $1.8 billion over ten years. Proposition HHH itself supports $1.2 billion in bonds for housing options for the homeless.

Mayor Garcetti has proclaimed homelessness “the moral issue of our time” and argues it is eminently solvable in the foreseeable future.

In New York City, Mayor Bill De Blasio is moving to provide free universal preschool for 3-year olds. This initiative follows on the success of De Blasio’s program to provide universal pre-kindergarten for all 4-year olds in the City. De Blasio has invoked the research of James Heckman and others in making this case. The additional budget commitment for the program is about $36 million; fully implemented it is estimated that the program would cost an additional $177 million over what the City already spends on preschool.

At the other end of the School pipeline, Governor Andrew Cuomo has implemented a program to provide free college tuition in New York state, city, and community colleges for students with family incomes less than $125,000.

The federal government is in retreat, and the leadership of HHS, HUD, Justice, and Education is backpedaling federal initiatives as fast as possible. For so many areas of social policy – aging, child welfare, community development, education, housing, mental health, poverty, public health, and substance abuse treatment – the action will be local, regional, and state.

A number of organizations, sites, and blogs keep track of these social policy innovations in cities and states. To follow this work, monitor the Stanford Social Innovation Review, Fixes at the New York Times, Next City,  the Center for the Study of Social Policy, Policy and Practice, and Governing for States and Localities.

Look at what is happening in cities and states if you want to feel some optimism at the moment.

 

 

 

 

Mar 17

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Meals on Wheels Doesn’t Work? Really?

In defending the administration’s budget proposals, OMB Director Mick Mulvaney singled out Meals on Wheels and after-school programs as programs that “don’t show results” and are thus deserving of significant cuts in funding. Later, Mulvaney described these cuts as “about as compassionate as you can get.” (More on his comments about after-school programs in another post.)

In the interest of full disclosure:

  • I have delivered meals-on-wheels (as a volunteer).
  • I have had the life privilege of knowing one of the creators of Meals on Wheels (and have come to believe it is one of the most interesting social program innovations of our time).
  • I have a relative who is a leader in an interesting extension of the meals on wheels concept: customized home delivered nutritious meals for individuals with medical and chronic conditions (such as HIV).

 

The choice of Meals on Wheels as Mulvaney’s example is remarkable, because in so many ways it is the model for a social program designed and operated using conservative principles: voluntarism, public-private funding, state and local block grant discretion, and high levels of efficiency. Funding for the program comes through Older American’s Act support; Community Development Block Grants; state, county and city funds; and private philanthropy.

It is also a remarkable choice because unlike so many social programs, there is a corpus of evaluation literature demonstrating program effectiveness, cost effectiveness, and indirect benefits to recipients and communities.[i] The evaluation literature shows improved nutrition, socialization, health status (e.g., reductions in falls), and diversion from nursing homes that otherwise would have been paid for by Medicaid. Costs per meal, costs per year, and cost offsets that would be necessary from other health and social service programs are extremely impressive.

The United States has had less consciousness of social isolation than many other countries, especially the U.K. From personal experience though, I can say that Meals on Wheels is one of the only, and certainly one of the most effective, interventions for older people and disabled persons who are isolated and homebound. Often, the person who delivers the meal – and has a regular conversation – will be the only human contact a home-bound person will have.

Over the past decade, funding for Meals on Wheels has dropped precipitously, especially under the Sequestration limits. Meals on Wheels America reports that 23 million fewer meals are being served now than in 2015. Waiting lists for services are reported across the country.

In an earlier post, I worried that Mulvaney and the administration would use claims for evidence-based budgeting as a stick for rampant budget cuts, irrespective of what the actual evidence shows.

Identifying Meals on Wheels as the exemplar of an ineffective program is not only wrong-headed, it is also extremely stone-hearted. Targeting a cheap and effective program that serves socially isolated older and disabled persons? Really?

You have to wonder if Mulvaney’s use of Meals on Wheels as an example is calculated, a declaration of a budgetary war where there will be no sacred cows. Even some of the most fiscally conservative members of Congress had an immediate allergic reaction to this announcement. The response from the media, advocacy groups, and social media has been scathing.

When the dust settles, it is likely that Meals on Wheels will fare well in the budget process. Nonetheless, it is an early and telling example of how evidence based budgeting will be used to justify some very draconian funding proposals.

[i] See for example, Kali S. Thomas and Vincent Mor, “Providing More Home-Delivered Meals Is One Way To Keep Older Adults With Low Care Needs Out Of Nursing Homes,” Health Affairs (October 2013), pp. 1796-1802; “The Relationship between Older Americans Act Title III State Expenditures and Prevalence of Low-Care Nursing Home Residents,” Health Services Research 49:3 (June 2013), pp. 1215-1226; and Huichen Zhu and Ruopeng An,  “Impact Of Home-Delivered Meal Programs On Diet And Nutrition Among Older Adults: A Review,” Nutrition and Health 22:2 (June 2014), pp. 89-103.

 

 

Feb 28

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What is PART and why should you care?

Mick Mulvaney, the new Director of the Office of Management and Budget (OMB) will have major fingerprints on the President’s budget presentation tomorrow night in his address to Congress.

While the press has been focused on Mulvaney’s Congressional record on military spending, Social Security, Medicare, and “entitlements”, a subtler impact on social policy needs to be appreciated. (Mulvaney is well-known for his role in the Tea Party, the Freedom Caucus, and the Republican Study Committee — all fiscally ultra-conservative groups.)

Director Mulvaney has indicated he will revive a Bush Administration budget management tool, the Program Assessment Rating Tool (PART), as the basis for evaluating future program funding requests.

The rhetoric of this proposal is that he will re-institute an evidence-based approach to budgeting and resource allocation.

Historically, PART follows a long tradition of budget and program management systems, starting with the Planning, Programming, Budgeting System (PPBS), implemented by Robert McNamara and others in the Pentagon. PPBS was followed by Management by Objectives (MBO) in the Nixon Administration, and Zero-Based Budgeting (ZBB) in the Carter Administration. The passage of the Government Performance Accountability Act in 1993, reauthorized in 2010, led to numerous improvements and expansion of government information and evidence  in budget planning for federal programs.

The Obama Administration implemented a “performance and analysis” program that lodged considerable responsibility for accountability and decision-making in the agencies. However, for all of this history, most observers of the budget process see little linkage between evidence of program performance and fiscal decisions.

The Bush Administration’s PART system produced scores or ratings of federal programs based on assessments of program purpose and design, strategic planning, program management, and program results. The particular questions that guided the scoring was based on a schema of different program types, such as competitive grant programs or regulatory programs. Program results or outcomes accounted for half of the weight of the total score. Once programs were scored they were sorted into five categories of performance: effective, moderately effective, adequate, ineffective, or results not demonstrated.

There were numerous areas of controversy in the design and implementation of Bush’s PART:

  • What constitutes evidence of program performance and who gets to decide?
  • What happens to the results of this budgeting process, especially when it goes into the legislative and appropriations machinery?

The overall critique of the Bush Administration’s PART system was that it did not ultimately lead to changes in programs and appropriations because the budget guidance was nearly always swamped by advocacy and Congressional politics.

Despite this history, implementation of some version of PART appears to be a priority for Mulvaney and the new administration.

Analysts at both the Brookings Institution and the Heritage Foundation have advocated adoption of a revised version of this approach, as well as other reforms to budgeting and public management. [i]

Why might we expect PART 2.0 – or whatever new name performance budgeting receives – to be more influential than past attempts? First, in order to reach the ambitious needs for budget savings to finance other expensive priorities of the President (e.g., defense, border security, infrastructure, etc.) the administration will need a big stick to justify cuts in social programs. Performance-based budgeting systems like PART provide the aura and possibly the reality of a rational and objective basis for those cuts.

Second, Mick Mulvaney will likely exert outsized influence in the new administration, especially given the weakness of many of the other domestic policy secretaries.

Third, the alignment of this approach with the goals and values of many of the budget hawks in the Congress – including Speaker Ryan – means that there is less likelihood that the Congress will undermine or sabotage the budget analysis coming out of the administration than has happened in recent history.

For proponents of evidence-based policy making, systematic attention to program outcomes and alignment of program performance should be seen as a good thing. However, (as my colleague Larry Lynn taught me), it is less the case that the budget “system is the solution” than how it is implemented and used. If a performance based budgeting system is merely a fig-leaf for rationalizing and covering decisions that otherwise are driven by ideology, it will not necessarily lead to more rational and principled resource allocation in programs; just “cover” for making significant budget cuts.

As in most policy management, performance-based budgeting is complex and riddled with important details. Many program areas simply do not have a sufficient evidence base for this kind of decision-making. Interpretation of evidence is a contact sport (as the long history of argument over Headstart evaluations demonstrates). The analytic capacity that is needed in the administration, the agencies, and the Congress to legitimately weigh evidence on program performance is tremendous, and the system will only be as good as the quality of the input it receives.

[i] Andrew Feldman, Strengthening Results-Focused Government: Strategies to Build on Bipartisan Progress in Evidence-Based Policy (January 2017);

https://www.brookings.edu/wp-content/uploads/2017/01/es_20170130_evidencebasedpolicy.pdf;

and David Muhlhausen, Evidence-Based Fiscal Discipline: The Case for PART 2.0 (September 2016)

http://www.heritage.org/budget-and-spending/report/evidence-based-fiscal-discipline-the-case-part-20

 

 

 

Feb 1

Social Policy Reader (and listener)

I know, it is hard to stay motivated to keep up with serious social policy analysis in the current political environment. So here is a mix of current great reading and podcasts that will mostly take you to another place. Read more

Jan 9

2 Comments

Nudging Social Policy

Imagine you can reduce obesity, homelessness, smoking, child neglect, or other social challenges or health risks without spending new public money or coercing people. This would be a kind of public policy nirvana.[i] Read more

Jan 2

1 Comment

Social Policy in the Aftermath

For policy analysts, social scientists, human services professionals, and journalists, the recent presidential election was an existential smackdown.

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Nov 4

1 Comment

Where is the outrage?

We know and acknowledge that our Presidential campaign has been nationally embarrassing, distracting, and virtually policy-silent. The tenor and substance of the campaign, especially post-Bernie, have conveyed virtually no empathy or awareness of the realities of our most vulnerable individuals, groups, and communities. The growing disparities in our economy and the extreme hardship faced by many in our society have fallen out of public eye and certainly out of the public policy discussion. There is quite another reality on the streets and in the front lines of call centers and social service organizations.

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Oct 31

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Social Policy Reader

This week: Human Trafficking, Criminal Justice Fines and the Poor, A Universal Child Benefit, MediCaring Communities, and Settling Refugees in communities.

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Oct 17

The Social Policy Reader

Here is your weekly prompt of social policy books and articles that will open your mind (click on links for sources)

The Poverty Industry: The Exploitation of America’s Most Vulnerable Citizens

Daniel Hatcher describes the triangle of federal-state-agency collaborations that take money and exploit vulnerable populations. The analysis is polemic and eye-opening. Readers interested in child welfare, long term care, TANF programs, juvenile justice, and Medicaid will learn a great deal about the conversion of mission in these programs to revenue streams for non-profit and for-profit organizations. Hatcher pulls back the veil on an important set of financial and organizational changes occurring in human services. Read more

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