Too large DHHS, too little focus on families

With all the attention given to the Department of Health and Human Services this past year, it seemed inevitable that someone in a high-level policy role would ask the questions that Gov. Pat McCrory posed recently during a media conference:

Is DHHS too large? Are its “management problems” the result of human resource challenges, organizational structure or program requirements that are too complex for one entity? What other issues make it so difficult to deliver high-quality services without all the problems?

Most North Carolinians have little idea just how much DHHS oversees. Over the years many in state government have questioned the wisdom of constantly adding programs, divisions and tasks to what once was an agency established primarily to be a safety net for the neediest. DHHS indeed has many complicated and sometimes competing roles. It interfaces with federal agencies, other North Carolina Cabinet and regulatory entities, local (county agencies) and others. Its customers range from pre-birth to the eldest among us.

It isn’t coincidence that other states have considered these questions over the years and reacted by solving at least one piece of the puzzle: When it comes to children and families, consolidating and integrating family-centered services that focus on prevention, early childhood, assisting vulnerable families and effectively responding to crises makes great sense. In other words, a Children’s Cabinet (or Cabinet on Children and Families).

Creating a structure that mirrors the lifecycle of families – pre-natal, birth, post-natal, early childhood, adolescence through adulthood – seems logical. And not inclusive of just health care-related services. If one were to ask, “What does it take to build strong families and teach children to be self-sufficient and ready to succeed in adulthood?” one might decide that a governmental entity should focus on policies and services that “build” healthy families, not just respond only when problems arise.

A family-centered Children’s Cabinet might include medical/physical (and public) health, mental health, substance abuse, developmental disability, early childhood education, youth employment and advocacy services, consumer advocacy, juvenile justice, child protection.

In 2004 the National Governors Association published a guide called A Governor’s Guide to Children’s Cabinets through its Center for Best Practices. The NGA notes, “A strong and effective Children’s Cabinet can improve coordination and efficiency across state departments and local levels of government; mobilize resources around the governor’s priorities for children; facilitate a holistic approach to serving children; and strengthen partnerships with the non-profit and private sectors”

If McCrory is all about seeking effective solutions, this is an excellent place to start. North Carolina needs strong policy leadership when it comes to children and families. Housing many of the critical services that children and families depend on within the DHHS behemoth should be rethought. State and federal budget resources have seriously eroded over the past decade, and children and families have been caught in the crossfire. Virtually every system or program attempting to strengthen vulnerable families has been negatively affected.

We must encourage our state policy leaders to adopt a well-crafted strategic vision in North Carolina that is proactive and responds effectively when problems involving children or families occur. No such vision is in place today. A Cabinet on Children and Families that has the political backing of the Governor’s Office and the legislature could not only help reduce and resolve some of the massive management challenges facing DHHS, but also more effectively align with the needs confronting North Carolina’s residents.

We need to create a North Carolina that fosters resilient and healthy families – not just be there when problems surface.