MOLLY TIERNEY: North Carolina launched these changes during the pandemic, when many people across the country were noticing that children were out of school, adults were out of work, and suicides were on the rise. Other states have been working to address the pandemic’s impacts on systems—education, health care, and social services.
But in North Carolina, you’ve flipped the equation. Instead, you’re focusing on families, how they’ve been affected and how you can help them recover.
What prompted this approach?
SUSAN GALE PERRY: North Carolina had been moving in this direction even before the pandemic. As we transitioned to managed care for Medicaid, our state made a major commitment to focus on social determinants of health like food security, stable housing, transportation access and interpersonal safety.
For example, our Healthy Opportunities initiative will test the impact of providing evidence-based, nonmedical interventions to Medicaid enrollees. That could mean paying to replace carpet with flooring in the home of a child with severe asthma or targeted services to help address interpersonal violence, such as helping a woman transition out of her traumatic condition by securing safe housing and establishing a new phone number.
Because we were already thinking in terms of whole-person and whole-family health and well-being, we were primed to take a similar approach to post-pandemic recovery. We want to build back better and have a heightened sense of urgency as we have seen how children, families and especially historically marginalized communities have been disproportionately impacted by the pandemic. We’ve also learned a lot about the power of shared goals to drive cross-team collaboration that we will bring to this reorganization.
MT: How is that translating into action on the ground?
SGP: NCDHHS is a large organization with 17,000 people and responsibility for the full suite of health and human services. Rethinking how we’re structured was the first step.
Since we announced the reorganization in April, we’ve begun the hard work of bringing teams, programs, policies, funding streams and operations together. WIC, SNAP and CACFP are great examples. In most states they’re operated separately with little to no overlap. We’re thinking about how we can bring those three programs together to help people access the full complement of nutrition programs. That’s just one example of how we’re looking across the system to meet the needs of the child and the family.
MT: Breaking down silos and enabling family-centered service delivery are no small tasks. Recognizing that you’re still at the beginning stages, what lessons have you learned so far?
SGP: First, you need the commitment from the very highest level of leadership as well as the staff who make these programs happen. That’s critical, and we have that.
Second, we’re using data to hold ourselves accountable to outcomes and inform our work. This has been a core strategy of our pandemic response beginning with our commitment to look at data from an equity perspective. North Carolina was one of the first states to publicly provide data on COVID cases, testing and vaccinations by race and age and has been nationally recognized for the quality of its data. We’re focused on making more of our data transparent and using it to inform our practice.
Finally, while we’ve received strong support from within and outside NCDHHS for this reorganization, we know it can be a significant challenge to bring a vision like this to life.
We’re investing significant time and resources in operationalizing this work. And we’re focusing on very intentional change management and communication efforts with our people. So far, I’ve observed that there isn’t so much “resistance to change” as “fear of the unknown.” That’s something we can address through ongoing engagement and shared work.
MT: When you look back in three years, what results do you hope to have accomplished?
SGP: I come to this work with lived experience. My family used food stamps. We experienced periods without a home when we stayed with people or even in a tent for a short time. My mother was severely and persistently mentally ill, and in and out of the hospital. I’ve experienced what it’s like to live under adverse conditions, but I’ve also experienced what it’s like to have protective factors around me—like a community of people who supported my family with things like food, credit, a job for my dad, a scholarship to summer camp for me, and lots of kindness, love and respect.
In the next three years, we will be able to articulate more clearly what it looks like for us to have shared responsibility for children and families across the state of North Carolina and begin to operationalize that with our partners at the state level and in local communities.
We will have better clarity on what each person’s role is in achieving a community of resilience. As a result, more children and families will be able to experience the protective factors that helped me as a young person—and NCDHHS will support better outcomes for the people we serve.
