1. Creating a Context for Successful Programs to Succeed Recognizing the Collective Need for Change Deborah Daro

2. 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.

3. 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.

4. An Integrated Vision: Elevate the Mission and Plan for Systemic Change

5. Integrated Data Systems/ Common Measures Shared Activities And Functions Common Vision/Shared Outcomes Multi-Agency Collaborative Chapin Hall

6. 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.

7. 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.

8. 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

9. Create Robust Operational Systems: Building Community Capacity

10. Alter Normative Context Build Service Referrals And Linkages Establish Universal Assessment Of Need Evidence- Based Models Chapin Hall

11. 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.

12. 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.

13. 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.

14. Expanding Prevention’s Capacity for Change Community Residents When faced with a family/child at risk, residents can take personal action by… Referring to Child Protective Services Differential response systems Family preservation services Foster care Adoption Transitional Care Offering direct assistance Provide respite care Offer emotional support Problem-solve Referring family to local resources Family Resource Centers Home visitation options Secure health care Advocating for change Advocate for a given family Lobby policy makers Advocate with neighbors Moves Toward Interconnection Sustains Individualism

15. Moving Forward: Factors Shaping the Next Generation of Innovation

16. 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.

17. 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.

18. “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

19. Pathways to Transformative Change Use of modern medicine /genetic research to determine what we can biologically address Consumer cultur e – 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

20. 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

21. 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