Creating a Context for Successful Programs to SucceedRecognizing the Collective Need for Change

Deborah Daro

Main Points

• Expanding and sustaining an effective level of support for all families within the current fiscal climate requires thinking “beyond the model”.

• Maximizing our “collective impact” will require the active engagement of multiple parties in cooperative planning.

• Robust public administrative systems and community collaborations are both essential for improving programs quality and expanding impacts.

Home Visiting as an “Agent of Change”• Technical solutions for strengthening prevention –

doing more– Expand and diversify funding for home visiting programs.– Build partnerships among key stakeholders.– Mobilize residents to better support service expansion.

• Adaptive solutions for transforming prevention –doing better– Create an integrated mission to produce collective impact.– Focus on infrastructure development and create robust

community service delivery systems.– Invest in innovation and continuous learning.

An Integrated Vision:Elevate the Mission and Plan for

Systemic Change

IntegratedData Systems/CommonMeasures

Shared Activities

AndFunctions

CommonVision/Shared

Outcomes

Multi-AgencyCollaborative

Chapin Hall

Building “Collective Impact”• Establish a common agenda that moves the mission

outside any specific agency “silo”.• Obtain agreement among partners on:– Time horizon – when do you want to see change.– Risk – tolerance for innovation and new practice.– Scope – size of the target population/geographic area.

• Agree on a shared definition of “success”– Establish benchmarks and develop a system to monitor progress

toward objectives across all investments.– Use data to understand the present and plan for the future.

Kania & Kramer, 2011. Collective impact. Stanford Social Innovation Review, (Winter), 36-41.

Building “Collective Impact”• Identify mutually reinforcing activities (positive “spill-over”

effects)– Determine appropriate balance between infrastructure and

programmatic investments– Encourage ownership of a new idea or reform through active

participation in decision making– Understand the value in collective action and shared resources

and act in ways that build interdependence

• Foster continuous communication and feedback loops• Create a new, independent “backbone” organization or

common service

Kania & Kramer, 2011. Collective impact. Stanford Social Innovation Review, (Winter), 36-41.

Redefining Your Benchmarks for Success• Set benchmarks for direct services at the population level

not simply for those receiving services– Improving child and maternal health– Preventing injury, maltreatment and violence– Improve school readiness– Improve family self-sufficiency

• Establish specific benchmarks to track system change– Document efficiencies in agency operations– Document interagency activities– Track shifts in investments

Create Robust Operational Systems:

Building Community Capacity

AlterNormativeContext

Build ServiceReferrals

AndLinkages

EstablishUniversal

AssessmentOf Need

Evidence-BasedModels

Chapin Hall

Create, Implement and Evaluate Innovations • Develop and evaluate augmentations to existing

models to reach underserved populations.• Create a centralized, universal assessment that

determines the needs of all new parents and refers families to the appropriate level of assistance.

• Identify leverage points for systemic change and evaluate their efficacy in improving program performance.– Cross-model, cross-agency “professional” training – Quality rating systems to elevate all practice– Blending funding streams across agencies/problem silos.

Create Context to Sustain Quality Programs• Create local “learning networks” among providers.– Share innovations around engagement, retention, skill

building with participants– Share management knowledge

• Create sufficient “choice” at the community level to allow for local ownership and meaningful governance.

• Assess impacts of community partnerships and collaborations on resource capacity, normative change and public engagement.

Create Norms to Foster Public Ownership

• Challenge our perceptions of the problem and how to resolve it.

• Nurture community values and institutions that foster mutual support and collaboration.

• Isolate and address normative values that restrict families from seeking help or offering assistance.

• Create common expectations for “all” children and empower residents to accept responsibility for change.

Expanding Prevention’s Capacity for Change

Community ResidentsWhen faced with a family/child

at risk, residents can takepersonal action by…

Referring to Child Protective ServicesDifferential response systemsFamily preservation services

Foster careAdoption

Transitional Care

Offering direct assistanceProvide respite care

Offer emotional supportProblem-solve

Referring family to local resourcesFamily Resource CentersHome visitation options

Secure health care

Advocating for changeAdvocate for a given family

Lobby policy makersAdvocate with neighbors

Moves Toward Interconnection

Sustains Individualism

Moving Forward:Factors Shaping the

Next Generation of Innovation

Impact of Broad Socio-Economic Trends• Growing income inequality and absence of sustained

upward mobility across subsequent generations.• Economic uncertainty– Less stable job markets/prolonged unemployment.– Greater stress associated with instability in income and public

investments.

• Increased number of single parents across all income strata.

• Acts of violence in increasingly diverse settings.

MIECHV’s Successes Stories• Common outcomes/set of performance indicators

covering all HV models operating in a state/tribe. • Initial implementation of interagency collaborations

that plan and monitor program implementation.• A place-based focus to encourage comprehensive

coverage in areas of highest need including tribes.• An emphasis on promoting the efficient use of local

services and supports through service referrals.• A commitment to using data to guide improvements

and reassess investments.

“Infecting” the System With New Thinking• Invest in programs with evidence of effectiveness.• Identify and address barriers that limit the capacity of an

agency to adopt innovation or alter its practice.• Invest in initiatives that foster interagency dependency and

shared responsibility for achieving change.• Create structures that allow direct service providers and

supervisors to share concerns with colleagues in other agencies and institutions.

• Create an integrated framework of universal and targeted interventions – a preventive system of care building on a core set of universal needs

Pathways to Transformative Change • Use of modern medicine/genetic research to determine what

we can biologically address• Consumer culture – teach families to demand what they need• Work ethic – commitment to continuous learning; parents need

to work at the job of raising their children and service providers to change their practice when necessary

• Scientific revolution – use data to improve practice and seek greater efficiency in what you deliver

• Competition – allow local variation and don’t guarantee funding without outcomes

• Rule of law/justice – make good on our promise of equal opportunity by provide all children a fair start

The Importance of Universality

“As a bridge between the young family and health services, the utilization of visiting nurses or, more often in most places, indigenous health visitors who are successful, supportive, mature mothers acceptable to their communities, is in my mind, the most inexpensive, least threatening, and most efficient approach for giving the child the greatest possible chance to reach his potential”.

Henry Kempe, 1976

Extending the Prevention System“It is shocking that so many have chosen to focus one year or two when the child was a preschooler and have disregarded the many subsequent years of development, exalted a single experience over myriad others, and are now putting their hopes and money on early childhood programs as the solution--not part of a solution -- to pervasive social problems.”

Edward Zigler, 1993