Voices of HHS

Michael Caputo: Hello and welcome to Learning Curve. This is Assistant Secretary Michael Caputo. I'm in charge of the public affairs here at the Department of Health and Human Services, a big place, a very, very big place. And I think I've told you this every time I've open this podcast so far. Eventually, I'll be able to stop talking about it. But right now, I will one more time at least. We call this a learning curve, because I came to this agency now two months ago and I lacked direct health care experience, not unusual for a public affairs assistant secretary at a United States Cabinet Department.

Our job is to get the experts in front of you, to get the information to reporters, so that the public can be informed at important of important issues. And this, of course, is a pandemic. And the United States Department of Health and Human Services is dead center on it. We've been talking a lot about Coronavirus and the pandemic and how it intersects with the different departments here. And the great thing about me having this job is I learned, like you did, from my couch watching the Coronavirus Task Force press conferences and watching my governor, Andrew Cuomo's press conferences. And my county executive in Erie County. I live -- I'm from outside of Buffalo, and our county executives press conferences just like everybody else in the country. And it's been interesting to go the round robin to the people that we've seen on television. After I arrived here, I got to meet all these folks. And it was -- it's been a really interesting ride for me. It's like learning science from Albert Einstein. And you know, it to me, it's a humbling experience.

I'm very honored to be here, and I thought I'd bring you along. So, we started this podcast called Learning Curve, so you can join me as I learn. And we've been talking about the pandemic across the ways here in the last several weeks. And I thought for a minute that we would try to step away from that for just a minute. Actually, for 30 minutes. And I'm leaving this week to go home to be with my children for Father's Day. I have a 5-year-old, soon to be six. I have a 7-year-old and an 18-year-old and -- all girls. That is a real pleasure for me. They say girls never leave their father alone. And boys, they grow up and get married and leave their dad and I if the if my family's any indication, I will never, ever be alone.

It's a real pleasure to introduce Assistant Secretary Lynn Johnson. She is in charge of the Administration for Children and Families here at the Department of Health and Human Services. The Administration for Children and Families, we talk through acronyms in the government. So, we'll just call it ACF for now. It's a huge part of Human Services that work that we're doing here at HHS. In fact, it's the second H in HHS, isn't it Secretary Johnson? But it's the bigger H, isn't it?

Lynn Johnson: It is a big H and a big job.

MC: And that means a majority of our funding, right?

LJ: Exactly.

MC: And, you know, once you what I found very interesting that the people who work here for the Trump administration at HHS is their background. I found some of the things that your colleagues, your peers here at the agency have done on their way to here with some of them were straight paths, some of them were winding paths. What brought you to the administration? What's your background?

LJ: I have been married for 35 years. I have three children and an incredible daughter in law. And my professional life started by me working in a prison. I then moved to be a parole officer. I joked that I was paroled and then moved to the United States Probation and Parole Office, where I worked for the United States courts. With that said, so often I would hear from offenders that they were trying to get services, so they wouldn't go back to prison. And they struggled with the human services systems. So, I began working on what is wrong with the human services systems that offenders cannot get the help they need so they don't recidivate Ultimately, that let me into 20 years in the human services system. And I've been working on changing that system ever since.

MC: So, you went from working with prisoners in that kind of parole arena. What kind of human services do those folks who have served their time in prison? What are human services do they interact with?

LJ: So often, they would come back into the community, not have a relationship with their children. They would have huge arrears in child support because they didn't stop while they were serving their time. They would not have a place to live. They wouldn't have a job yet. So, they needed work force, employment, child support, a poverty assistance, and mental health. Many times, when you are in a prison, you make one decision. That is when you close your eyes and go to sleep because the guards tell you everything else to do. You come back out, so many of my offenders -- there was one can of beans on a shelf when they were going into prison. They came out, and there's 30 choices. And making choices was the most hardest thing that they had ever done. So, we had to help them through that. And that is what so often would send someone back. One gentleman asked me to do a urine test on him. When I asked him why, he said he'd been working with social services for the last three weeks, he needed to go back to prison to clear his head. That's what makes you realize that we have complicated our systems too much.

MC: Oh, my God, he wanted to go back to prison?

LJ: Just for a break.

MC: Oh, my God. So that's really amazing now. Now, can you tell us a little bit more about ACF and what the organization does? You said you've got 60 programs you run, six zero?

LJ: Six zero programs, and they are programs that help serve the neediest of people, the people that are afraid, scared, abused, neglected, domestic violence, hunger, poverty, everything. And so, we wrap around those individuals by using nonprofits, for-profits, community-based government entities to serve a family to strengthen that family. And that is what this president has wanted very much. The very first thing he did was an executive order to end poverty. And that was before I had come on board. My confirmation took quite a long time. And I looked at that poverty executive order and said, this is a man that wants to get action. This is a man that is going to let me serve the people toward success and help change the culture. And so, with a president that is saying, do this, there's nothing we shouldn't be able to do to help people.

MC: And, you know, we've only spoken a couple of times in meetings. And I know one aspect of HCF that you're really, really passionate about is adoption. And that's what made me think perhaps we should invite you this week, because, you know, I have my little village of East [unintelligible], where I'm from. I'm you know, we have all these -- it's like you're living in It's a Wonderful Life. It's where they actually have filmed three Hallmark Christmas movies in my village. No Wal-Mart. We have a Five and Dime literally that's been there since 1850. And no Starbucks we have, but we have plenty of coffee shops. It's really a wonderful place. And next door to me is this family, a man and woman a little younger than myself and my -- and he's a very professional manufacturing executive. And his wife is a pharmaceutical executive.

And they decided to adopt. And now, fast forward a couple of years, they've got a couple of kids and they you know, I watch him over there teaching his son, who's I think eight, how to change tires and how to, you know, how to change the oil. And the kid is just up to his elbows in it.

I see one of the happiest families I've ever seen. And the process they went through to get there was really trying. In fact, they came to me for help a couple of times because I happen to know a few people in the government, and it was really challenging. But the joy in that family is just tremendous. And I think they celebrated three father's days. Nobody celebrates it like they do. It must be really interesting to get involved in this.

LJ: It is the best part of my job is meeting the kids who have gone through our foster care system. Not a great thing hearing the stories and the trauma that they went through. But then as they move to success, when they do get an adoption, I am talking to a young man right now who absolutely did not want to be adopted. He thought he was being disloyal to his parents. He was angry at the system and he is 22. And next month, should the courts be able to be open, he will be adopted and have a forever family. And so, he is guiding me and has introduced me to hundreds and hundreds of kids, so that I can do with the young adults and the kids in foster care, not for them. And they are leading the charge on helping us to change our system, which is to get kids into forever permanent homes.

MC: And it's amazing to watch. I mean, you know, I can't tell you how many people I know who were adopted and feel like they were just saved. You know, I mean, a lot of people know I spent the better part of a decade in Russia. And I lived in Moscow. One of the things I did, I tried to do volunteer work, because I volunteered for an orphanage in my neighborhood. And that system there is so broken, it's so broken. When these kids are 18, they're kicked out the door, and they're on the street. It's awful. I remember we were bringing Christmas gifts to them on Christmas. And they had nothing. They didn't even have a tree. I mean, this is not the way we do this in the United States. And nobody adopts really in Russia. They just don't. And their system is so broken. And then I came home after seven and a half years. And I'm seeing how it actually, in comparison, works so well here. There are still some problems, of course. And I know that your focused on this, and you've done this All-In Adoption Challenge, which you've told me about upstairs on the sixth floor once. Can you tell me about the All-In Adoption Challenge? What are you hoping to accomplish with this? And it's really one of your main priorities, isn't it?

LJ: It is absolutely our main --

MC: Six zero programs.

LJ: Exactly. And there's a reason for that. Part of the adoption challenge is addressing primary prevention. The Congress had, in their wisdom, changed the laws around child welfare. Passed a law called the Family First Prevention Services Act. And that has changed how you serve. And there is prevention money for families, so children can be kept in the homes with their parents when it can be done safely. Well, that's great. Absolutely, one of the best things that's happened, however, you have to be abused, neglected or removed from your families before you get into our system to get that help. So, we decided to look at our child welfare system. I told you it took me a long time to get here through the confirmation process. So, I had a little over two years in our first term.

MC: Oh, my. It was a long confirmation process. A month.

LJ: It was very long.

MC: That's a whole other podcast though.

LJ: That is another whole podcast. But it is what I was I was doing the same thing that you did. I was sitting on my couch waiting and watching to see what was happening in the human service world. So, with that, I came in and said, I cannot solve all of these problems in two plus years. What can I focus on that would really make a difference in the United States? So, working knowing where the president's heart was around foster care and adoption, talking to the vice president and Secretary Azar, I looked at the number of kids in our foster care system. There are currently 480,000 children in foster care system. There are 125,000 who have already had parental rights terminated and an adoption plan of which half are sitting in the home that wants to adopt them, and they're not moving. And so, I said we can take on the 125,000 because that would be a huge impact to the system. It would reduce workload. It would reduce the maximum time that caseworkers can work with kids. So, let's do this. And the first thing we decided was all 50 governors needed to be on board.

>> So, we called all governors offices. And then fast and furious, we went and visited them in person. And we have had --.

MC: All 50 governors?

LJ: Not yet. COVID put us on to a dead stop. We were on track to have all 50 visited. And then all travel, as you know, has stopped. So we'd started making phone calls. We have had every governor from Cape Brown and Oregon to Governors DeSantis in Florida, to Governor Kemp in Georgia, Governor Deucy in Arizona. I can just go on and on and on where they are all saying, yes, we're in, we'll do it. Let's get these kids adopted. During the worst of the COVID, I called Arizona to see how they were doing. Governor Deucy's team had 200 plus children adopted while we were in the middle of the pandemic through virtual adoptions. That's unheard of. We don't get 200 adoptions done in two months when we're not in a pandemic. So, then I called Governor Sununu just yesterday from New Hampshire. He is down to only 43 children left that need to find permanent loving homes. If we can focus on something, we can get it done. And especially, with all of the governors, all of the country, these are America's kids. And we can take care of America's kids. And that's what we're doing. We are using every tool that we have.

MC: How do you assist states in this process of adoption?

LJ: We have done many different. We have many different avenues to assist the states. We have talked to --

MC: I'm curious as to how it actually touches the parents and the kids.

LJ:

Absolutely.

MC: How you actually reached down through the states to help them along.

LJ: So, we are talking to the faith-based groups. Think about this. There's far more than 125,000 churches in America. If every church would find one loving, safe family that wants to adopt and then wrap around that family to give them the tools when things get tough to help them with meals and transportation and loving up on kids, we could have this done in a week. But while we look at this, we know we've got the faith-based groups on board. We have nonprofits on board. And just last week, 80 philanthropic groups signed on to say we will help make this happen. So, if I get to a state that needs some funding or some assistance or technical assistance, not only does the government step in and help, but we're sending in the philanthropic groups to say, what can you do to help with this situation. And is there a match and what your mission is and what the state's doing. They have all agreed to be all in on this challenge. So, with that said, everybody we talked to, we are asking if they would be all in, and then what's their commitment? And everyone is stepping up. No one has said no to us yet.

MC: Nobody?

LJ: Nobody has said no. No one has thought of it as a political issue. They know that President Trump is leading the charge on this. They love it. They're stepping up. They know that America's kids deserve this.

MC: That's amazing.

LJ: And our first governors that I talked to was Rhode Island governor, Kansas, and Oregon, which are governors, Democratic governors, who have said we will not help on this. And they even put some things in their state of the state. And our Republican governors have also been just as fantastic. And the fun thing about the governors is they are somewhat competitive. And so, when I share what one state is doing, the other one says, I can do that.

And then they're talking to each other. And we've worked with National Governors Association, Western Governors Association. So far, everyone has stepped up their games because these kids deserve to be loved. These are the kids that are harder to place. These are the older kids. These are the kids that might have some disabilities. And these are the kids that have siblings. And we want to keep them together. So, we're not asking someone to take a baby. We're asking someone to take someone who might have been in the system for 18 years. And the bigger, most important impact of this is about 20,000 of that 125,000 age out of our system every year to nothing. If we get this permanency done, we won't have kids aging out and moving into other systems, becoming pregnant, using drugs, being scared. During COVID, we saw that. We saw kids calling us. They were scared. They didn't have parents to talk to. They couldn't even couch surf because people were afraid to let them in their homes because of covered. So, we were doing webinars and we were had 1,000 people on each webinar, mostly our kids who had aged out. And they were asking us questions.

MC: Where were they calling from? Where were they checking it?

LJ: Wherever they could find libraries, their cell phones, whatever they could do. Groups that were pulling together with advocacy groups, and they were being pulled together by these kids who said we want to help lead the charge on this. And so, we have an army of foster -- kids with lived experience is the best way to say it, who are helping make this happen. And one of the groups, they talked to the Indiana governor to ask him not to let any kids age out of the system during the pandemic. He did an executive order because of the request of the kids. We are seeing fantastic governors step up for these kids.

MC: So still, some are aging out and having and leaving the care during a pandemic?

LJ: Exactly. And so many most of the governors have done something to stop that. But the other half are not. And the kids are still aging out. So, we're trying to catch them. And we're asking states, call your kids even if they're out of your system, spend the 10 minutes to say, are you okay? Do you need medical care? Where are you sleeping? Often many of our kids have also lost their jobs, and they lost their housing because they lost their jobs. And so, they're calling now saying now what do I do? I thought I was going to be okay. So, we have had to step up our game.

MC: What do you do for a kid who ages out of the system or did recently during the pandemic? They lose their job; they lose their living situation. What does ACF do?

LJ: Well, first thing is, once a child ages out of the system, we have no legal authority to work with them. And so -- but during the pandemic, as we waived our rules and our regulations and had flexibilities to serve in a bigger way, we wrapped around those kids, called the states and said, you've got a homeless child that was in foster care. We called our faith based groups. Lucky thing is, having had all these conversations with people throughout the country. We had created a network, so we could pick up the phone and say, hey, in Oregon, we have a young lady who's sleeping in her car. Can you check on her and see if there's anything you can do? No one has said no. People are caring for people. I have seen the best of humanity during this pandemic, in spite of some of the really horrible things that were happening.

MC: I find it really hard to even fathom, being released out into a community from a from foster care in the middle of a pandemic that scares the living daylights out of people who are in forever homes already. I mean, I was, you know, I've --I'm not a guy without knowledge or resources. You know, we're living in a nice little village, and I was scared, you know. And, you know, I I'm the head of the household. I couldn't show it to my kids that I was frightened, but I was frightened. I can't -- have any kids told you what that was like? Also, to be outside the door and nobody's on the street and nobody in all everything's closed. And there's not even a place to that you can walk to the -- what's that like? I can't even imagine.

LJ: So many of the kids that have lived experience have called and said, we've got to do more, we've got to go find these kids. They are fighting for those that have also been through the same systems they have been in. And so, they put together networks, but these kids did fall through the cracks. We know that was a gap in our system. We know we did not have the ability to find all of the kids that had aged out, especially because they were finished with our system.

And the call is what woke us up. They were calling back in. They were telling us, I've been out of the system for six years. I lost my job. And that network has been very, very helpful, I think, to the kids.

MC: So, aren't a lot of these regulations, county regulations? Like, for example, you're 18, you got to go. You're are done with the system. Isn't that a county thing, not a state thing?

LJ: It's state. It's often state, it's legislated. And so, we give a lot of flexibility through our block grants to the states. And then the states establish the timelines. That's why the executive orders from the governors were so good, because they waived those legislative mandates to release a child during the pandemic.

MC: But you still have to work through the states, don't you? To the county level at times. That's a massive job. A massive job.

LJ: Yes.

MC: It's -- I can't even imagine. Did you have actually additional funding from Congress to deal with the pandemic? And as, you know, in regards to not just adoption in children and in the system, but other aspects of ACF?

LJ: Every part of ACF received additional CARES Act's money and supplementals, over $6 billion coming to us that helped us serve in a bigger and better way. Getting the money out and getting it to states and reminding them that they can flexibly use this. They are not used to the federal government giving out funding and saying use it flexibly. And so, we have worked very hard to help states, especially around childcare. But the money that was given for adoptions, permanency prevention, strengthening families during these hard times, hopefully we're catching substance use disorders and mental health challenges, so that we are not starting from ground zero in the health and safety areas when we start getting back to a new way of human service delivery. I don't want to say normal; I say I want it better. I think we've learned from this and we can serve much, much better for these families.

MC: Have you seen indications? We've heard, like, you know, suicide is up. Substance abuse is up. Alcoholism among those. But also, you know, abuse in the home. Have you seen an uptick in the things that are under your purview? The negative behaviors that can happen when you're under pressure, like a lockdown during a pandemic?

LJ: We do work closely with SAMHSA. And so, we have gotten data --.

MC: Can you tell the listeners what SAMHSA is?

LJ: Substance Abuse and Mental Health Agency.

MC: Lots of acronyms here.

LJ: Lots of acronyms. And it's still I don't know them all myself, having only been here 21 months. But the agencies that address mental health and substance abuse have joined with us to help us work with the families. Primary prevention and strengthening those families will keep kids out of the foster care system. It will help those families be okay during a pandemic. So, we are continuing to do that work on the front end using a public health approach, using mental health approaches, using subs -- everything that's in the community, we're wrapping around families now instead of siloing services. So, with that, we have seen domestic violence has gone up. We know that the shelters are full. And there -- we're getting reports from law enforcement on that. We have been told there has been a reduced number of abuse and neglect calls to our child hotlines. Now, that doesn't mean that that means 50 percent of those kids are being abused. It's just we don't know. And so --.

MC: Not getting calls from teachers.

LJ: We're not getting those calls. Exactly. So, I look at that. We don't know, maybe because families are home together and having to spend time together, which they don't usually get to do. Maybe it's better. We don't know. So, I don't want --.

MC: How are you going to find that out because a lot of people -- I mean, there's going to be -- people say there's going to be an uptick in divorces. You know, there's also going to be an uptick marriages and an uptick in pregnancies.

LJ: Exactly.

MC: I mean, when are we going to know the results of the impact on families?

LJ: So, I'm the glass half full person all the time. So, I am looking at --.

MC: I get that.

LJ: I can't wait to see the data. I am hoping that I am pleasantly surprised based on what I'm hearing through the media. But I think that the increases will become obvious once people start opening back up. Teachers are back with children; we'll be able to see if things are happening. But the more we're in the home strengthening the family, we also have extra sets of eyes on that family. So, we might know earlier, but the data comes into us once a year and we'll have that documentation.

MC: I keep hearing the words primary prevention whenever I hear -- because I get briefings on what your organization is doing. What is primary prevention and why is that so important?

LJ: I think it's an area we have missed for 200 years of human services practice. When we look at it's like the medical if you have a heart condition, you don't wait until you have your heart attack before you go to a hospital and get care. So the same thing in the human service world. If we know that someone had to drop out of school at age 14, and they were in a gang and they had substance abuse issues, but now they have nine kids. What is -- what is a way to work with that woman and her children before she abuses someone? There's a domestic violence issue. They are hungry, homeless, scared, any of the human service negative issues that we could run into.

So, we look at, now, asking all of our federal partners to work with us on getting to people before the crisis happens. And we're all coming up with ways. This is completely new. We are asking states to be innovative. Tell us what you could do. We're also telling them it's okay to get out of your silo. Child protection, you can work with mental health. It's okay. Go in the home together, talk to people together. So that's primary because we start prevention once people get it, get in a system. If we can keep kids from needing to be in a system and spend 10 years in a foster care system, which also adds trauma, they don't see their parents, they don't understand what's going on. Just the mental health piece of that trauma prevention could make a healthier nation, a healthier community, healthier people. So, the primary pieces getting in there early, looking people in the eyes, asking someone, what do you need? And responding to their needs. Not handing them, here's the government package.

Sometimes you need nonprofits because the government package doesn't provide the new tires, so someone can go to work, or mentoring and tutoring. This young lady, and I actually was mentioning that was in a gang at age 14. By the age of 40, she wanted her life changed. So, we gave her a tutor every day of the week because she wanted to get a college degree. She has since graduated. She has now a livable wage job. Her kids saw what their mom did, and they are back in school. So, we stopped the generational poverty issue right there by not saying, here's food stamps, here's TANF, here's Medicaid. But by saying, what do you need? She needed a tutor. And there is nothing in my government world that pays for a tutor.

So, we've got nonprofit funding. And she has graduated because she graduated another young lady who is African American, living in a van with her husband in a wheelchair, another six kids. She said if she can do it, I can do it. So, she's back in school and she has since written a book. So, when you see these stories of looking at uniqueness and prevention, we know people can stand on their own two feet, have the dignity they deserve because we're getting there earlier and saying, hey, you're okay. We can get this done, and it works. We've seen it. We know it can work. And we know that people don't all want to be taking money from the government system. They want to stand on their own two feet. Our safety net, just like it does with fish, keeps people caught sometimes. And our goal is to get them unstuck and help them move to success.

MC: You mentioned earlier about how in order to keep kids in foster care during the pandemic, you had to change some rules, regulations, to help states do that. Is it pivotal to simplify and right size rules and regulations in your world?

LJ: That is one of the --

MC: When I see your world, I mean, human services.

LJ: I understand it, yes. I -- this is one of the reasons I was so honored to work for President Trump because he did an executive order on rules and regulations and that was aimed at businesses, streets, roads, transportation, all of government. I don't think he had any idea truly how many how much overregulation is in the human services and health world. So, when we look at rules and regulations, one person who comes in to get services from a multiple different group of programs fills out a 27-page form or whatever it is. And each state goes to the next program, has to fill the same form out, goes to the next program, probably a different form. And they all do different forms. They all fill things out. They all ask questions. Then they make that person prove they're worthy to get it. They might require urine tests. So, someone might, for each of those programs, have to drop a urine sample in a day, four different times. Those are the kind of things that is just illogical. And they don't get us to an outcome.

It may get us to compliance, but compliance doesn't move us to success. So, this president issued his executive order, and we are given permission to remove unnecessary, burdensome rules and regulations. My staff work 70 percent of their time on paper rules and regs and 30 percent of their time looking in the eyes of people they're serving. We have to flip that. And the only way to do it is to have smart accountability. No one doesn't want accountability, but we don't have to pile on to people who are already scared, hungry, homeless, beaten. We can move people with dignity, and we can get them to success. If they are moving to a job and taking care of themselves and needing very limited government assistance, that's an outcome. If it's true that a family of four costs $1 million over a lifetime, if they stay in government assistance, if they're generational poverty. Think of the numbers. If we move 10,000 people into success with the way the president had done our economy and how people were working, we know we're going to be back there. Let's get everybody there, because that saves millions of tax dollars, not to mention the dignity of human life.

MC: And I know that the administration and this president is committed to helping Americans move out of poverty. How is ACF and the work that you do there making that easier for people?

LJ: We are reviewing all of our rules and regulations. We are also integrating, and I think this is the first time every one of our programs is talking to each other. So, that if we can do it at the federal level, we will expect it at the state level, and then at the county level. And I ran a large county human service department and it's easier to integrate at that level. But once we talk to each other, mental health with human trafficking, human trafficking with childcare, childcare with Head Start, we are able to -- we're all serving the same people. And then, we make it easier for those we serve. Plus, we're not duplicating all of our efforts. And ACF has been doing that for the last two years. We're on it and we're not done. We will continue to look for ways to simplify and streamline our systems.

MC: As we approach Father's Day and the work that you've done with adoption to create more families, to create more fathers. I just think about, you know, in our neighborhood, we have, like I mentioned earlier, it's all these old houses and we have the old porches in front with the swinging benches. And when the pandemic started right next door, Tyrus, as I said, is this family of adopted children. Great parents. And my kids just love them. They're in with them all the time. But they couldn't play with them. Right? They played from porch to porch. They sat on their porch. My kids sat on our porch. And they had things like the Lego challenge. You build it. Then you hold it up and show each other. And this developed across the space of weeks. And if you look down our street, you see all these kids playing on their porches and interacting with to the point where our neighbor with their two kids, they actually -- when I was home two weekends ago for the weekend, they cut back the bush on the side of their house to share their adopted kids with us, so that they could actually see each other. And they didn't have to hold their Legos up so high. You know, what you do with adoption, it impacts all those porches, every single one of them. And I just wanted to thank you.

LJ: Well, thank you.

MC: Assistant Secretary Lynn Johnson from the Administration for Children and Families. This is Michael could put on assistant secretary of public affairs here at the Department of Health and Human Services. What the ACF does is very, very important. And it's so big. It's the other H in HHS. We think only about the H for health right now because of the pandemic. But don't forget, a lot of these kids are caught up in the pandemic. And when you see some kid alone on the street during this pandemic, think to yourself, maybe the system is failing them. Check with them. We'll catch you next week.

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