The Struggle Over Community Level Indicators

Anne had a meeting a few weeks ago with a United Way exec to orient him to our firm’s services.  During the conversation, she asked about the challenges he was facing and he shared that his United Way was struggling with connecting the programs that they fund to community level indicators.  He thinks he ought to be able to demonstrate that a gift to United Way contributes to a specific positive change in the community.  As I have had some involvement with similar processes, she suggested that he chat with me and so we did have a conversation. I hope I was helpful; I certainly intended to be.  The issues that arose in the conversation do make me want to bang my head against a brick wall, however. Let me explain.   

I completely understand that donors are tired of giving money to solve community problems, only to be told, year after year, that the problems are getting worse, not better.  As another UW exec explained to me awhile ago, “When I took this job, I was told by my corporate donors that I had better fix something.  Didn’t matter what it was...just so something got better and not worse!”   

The UW exec I spoke to this week expressed surprise that he was unable to find many examples of other United Ways who had succeeded in linking their funding to changes in community level indicators.  He has staff members working with groups of community volunteers who are trying to figure this out and was hoping that they could draw upon the successes of other communities.   He assured me that his volunteers are very well educated and very sincere and he is confident that they will come up with something terrific.  I am less confident and not at all surprised that he is struggling to find success stories.

There is a set of interconnected problems that have to be taken into consideration that, in my view, are mostly ignored in this effort to tie funding to changes in community indicators.  Let’s take some things we all know about…like immunization.  We know beyond a shadow of a doubt that if kids are immunized, their health outcomes, over the course of childhood, are better than if they are not immunized.  We also know that participation in quality early childhood education is a solid predictor of success in school…at least through the 4th grade.  If we want to improve community indicators that these interventions address, we are on fairly solid ground.   But those instances of near certainty are more the exception than the rule.  Let’s look at high risk behaviors by adolescents.   This has become an attractive target for community indicator projects because of the availability of normed surveys to measure risky behaviors that are undertaken in many states.   But when we look at the stage of development of the field of risky behavior prevention, we see that we don’t have certainty about how to intervene.  We may have a wide array of programs that are being tried; we may have some that have been evaluated; some that are labeled promising, but we really don’t have a large body of knowledge that tells us that there is evidence based practice to support the use of this intervention rather than that. 

Another area that seems popular is elimination of pockets of extreme poverty in our cities.  Here we can measure the existence of these pockets at least every ten years by the census but that measurement is confounded by the fact that people move.  If we are successful in helping some families out of poverty, they will probably move from their poverty stricken neighborhood (wouldn’t you?), and will be replaced by others who are drawn by the low rents typical of these areas.  In this arena, we may have some confidence that job training, placement assistance and job retention supports can help families move out of poverty but using community level indicators to track success is very challenging.

And then there are the issues of scope and intensity.   If a United Way or foundation is responsible for an area that is as large as a city or perhaps a county, what level of intervention at what level of intensity is required to move a community level indicator?  Mostly, we don’t know. 

So, what are we to do?  Quit trying to improve community indicators?  No, not at all.  I do think though that we have to say where we really are on this issue.  If I were a funder in this position, I would make sure that my process of choosing community indicators included: (1) the identification of indicators where good measurement is possible; and then, from among that list, (2) identification of indicators where interventions are solidly based on evidence based practice; and then, from among those remaining, (3) identification of indicators that my organization can afford to address in sufficient scope and intensity to make a difference.  And if I found that we didn’t have enough money to address any of the remaining indicators?  Well, I would seek funding partners among other funders in the area. 

So, does that mean we should never tackle an indicator where we don’t have known knowledge?  No, but if we are going to do that, we should be honest with our stakeholders, our donors, our Board, our staff, that we are experimenting.  And, if we are going to experiment, then we have to accept the obligation to evaluate what we are doing so that we can add to the knowledge base….even if we only tell the story of something that fails to prevent others from failing in similar ways.   And I can’t tell you how many times when I reach this point in the conversation, someone says, “Oh we don’t have either the money or expertise to evaluate what we are doing.”   And that is when my head banging begins anew.

Photo provided by tanakawho

What data do you look at?

We have recently taken on a project that promises to answer questions I have had for a very long time.  We are working in partnership with a capacity building entity that is interested in encouraging systemic approaches to community problems.  Over the work of the last of couple of years, we have realized that these kinds of solutions to community problems emerge only where there is a strong culture of data and evidence and we now have a small grant to explore some of the organizational antecedents that have to be in place for such a culture to materialize. 

We are recruiting agencies to participate so I have been having conversations with CEO’s of mid to large nonprofits about how data and evidence inform decision making in their organizations.  Across the group of interviews, I would have to say that I see a disturbing pattern.   The most often mentioned arena of closely examined data by CEOs is financial.  The least often mentioned and the arena where the least amount of data is routinely available is program quality data. 

If you read the literature on organizational learning, you quickly discover that one of the most powerful facilitating factors in organizations that learn from their practice is the presence and leadership of the CEO in examining what the organization does well and what the organization does poorly.  It is the CEO that has to make addressing quality measurement important and it is the CEO that ultimately determines whether the rest of the organization values quality measurement. 

As a CEO, what do you look at routinely?   

Photo provided by interrupt via Flickr

The Value of A Good Mirror

Scott, one of the contract consultants who works with us, is home from New Orleans.  He was there to do an assessment of lessons learned in a project we have helped to support for the last three years.  It is a Success by 6 initiative of the Greater New Orleans United Way that began three years ago to track the process of achieving NAECY accreditation by three day care centers.   At the time, New Orleans had very few accredited centers.  Increasing the quality of child care was chosen as a
that would reach a large number of children with an intervention that is well supported by evidence to increase the likelihood that children will succeed in school.   The intervention with the three child care centers consisted of two parts:  (1) helping them work directly on the children care accreditation standards; and (2) participating in an assessment of organizational development stage and identification of a strategy to build each organization’s internal infrastructure.    The idea was to make sure that these centers were as strong from a business and organizational perspective as they were programmatically and to observe the process in three organizations at very different developmental stages.

We were just about 9 months into the project when Katrina hit.  We were handling the organizational development piece, of course, had completed the assessment process and conducted one round of counseling based on the assessment.  Katrina flooded all three of the day care centers with 8 feet of water.  One was hit so hard by the rushing floodwaters that it shifted off its foundation.  But this is a Katrina story with a happy ending.  In each case, the Directors of these centers tackled the rebuilding of their centers with amazing energy and commitment and used this tragedy as an opportunity to rebuild better than before.  In fact, all three had had significant barriers in terms of the configuration of classrooms and other physical plant challenges that would have impeded their chances of being accredited.   They used the devastation and its aftermath to address these issues as they rebuilt.  All three are open and currently serving children.  All three still intend to pursue accreditation.  I was only able to meet with each of them again once before the three year grant ended. With all they had to do (rebuilding their buildings, hiring and training all new staff,  identifying an entirely new census of children) there was not enough time left in the grant to deliver the supports around organizational development that were planned.

So what surprised me most when I read Scott’s report?   All three Directors report that our initial assessment and tiny bit of support was a truly valuable part of the project and expressed real disappointment that they hadn’t been able to follow through on the OD aspects of the work.  With all that had happened, I am astonished they even remember what we discussed!   It reminds me of the value of true mirrors.  The assessment process did no more than showing them where they are developmentally and laid out where they could go.  Here you are, here is what is possible.  This is a way to think about it.  It changed the way they thought about their organizations; it changed how they want to grow them.

If you would like to see what they found so valuable, you can download the first phase of the assessment process for free from our website.

Photo provided by: Eda Strauch via Flickr

Do we need a fourth leg on the old three legged stool?

When I was In Calgary last week, a client handed me an article on nonprofits in Canada that was actually written in 1998, indicating as she did that its main points about a funding crisis for the Canadian nonprofit sector continue to this day. The crisis is largely made up of the dependence of Canadian nonprofits on government contracting and the actions of Canadian provinces to reduce these ties.  As I have more and more conversations with RI agencies who are struggling with the prospect of massive government budget cuts and the potential for bankruptcy, the parallels are obvious. So I have been thinking about what might make a sustainable revenue strategy for a nonprofit organization these days.

Last year, a client asked me to do some research and create a brief history of the sector and an overview of “nonprofit economics.” As a result of that exercise, I saw some connections that I hadn’t noticed before. (I am going to oversimplify a bit.) Over the course of its history, the nonprofit sectors in the US and Canada, as a whole, have known only growth, as remarkable as that may seem. The sector has an uncanny ability to reinvent itself. When individual donors were insufficient, the sector learned to partner with, first, foundations, and then, corporations. When philanthropy was insufficient, the sector learned to contract with government. In the 1970’s and 1980’s, we used to say that a healthy nonprofit’s budget was like a three-legged stool: funds from donors whether individuals or corporations, foundation grants, and government contracts.

Of late, however, there appear to be increasing doubts about that government contracting piece. Since the 1980’s the forms of support from the federal government have changed in several ways: (a) government program managers have been encouraged to promote for profit involvement in government contracting, causing significant entry of for profit entities into traditional nonprofit markets including, home health care, nursing, hospice, substance abuse, and day care; (b) the ascendancy of conservative forces has favored forms of assistance that maximize consumer choice, leading to the proliferation of vouchers to consumers rather than grants and contracts to providers. Nonprofit providers have been forced to compete in the private market for these consumers, and, as a result, must master complex billing and reimbursement systems as well as learning to market directly to consumers. Managed care, involving capitated rates, has become more of the norm in health care and has increasingly invaded the fields of drug treatment, rehabilitation, and mental health.

The Social Enterprise Alliance says on its website that: “Social Enterprise is the next thing.” (www.se-alliance.org).  They define social enterprise as: An organization or venture that advances its social mission through entrepreneurial, earned income strategies. This is an international movement that seems to be furthest along in the UK, the Netherlands and Australia. The movement recognizes a very wide range of investments in the common good and acknowledges these investments as made by government, nonprofits and for profits. The social enterprise movement is less concerned about the source of revenue or the type of sponsoring entity and more concerned about the intended impact and the choice making inherent in achieving the organization’s objectives.

I recently had a fascinating discussion with a network of disability providers who were able in about ten minutes to identify an array of possible social enterprise ventures that could be undertaken collaboratively and that could employ their disabled clients and/or generate income to support the work of their agencies.  What was interesting and different about this discussion was the obvious fact that these opportunities would only work if pursued collaboratively. So my last email from Michael Gilbert wanted to know if we were working at all on “financial structures that facilitate network centric funding?” Yes, we are working on those models, and, for many in health and human services, they may well be the replacement leg on a new four legged stool: funds from donors, foundation grants, government contracts, and income from social enterprise.

Marketing challenges as systems change

In the last week, I have worked with several agencies serving the developmentally disabled community in both Rhode Island and Calgary. One of these engagements was with a group of organizations seeking to use their existing trade association as a base for deeper collaboration in order to deal with the major changes in how services in this field are funded. Another was a board retreat to help an organization choose a planning model that would suit their field and a third was an ongoing process of strategic assessment, reporting out the results of our internal review of climate and management systems in an effort to prepare this organization for the significant challenges ahead. So what’s going on?

This work is among the most interesting aspects of our practice right now. The Developmental Disability Field is facing a significant change in consumer expectations as the generation of children raised in community environments reaches adulthood. Many of these children bring complex medical and behavioral challenges due to the sources of their developmental delays as well as expectations that they will live in community. At the same time, people with developmental disabilities who were raised in institutions, and then moved to group homes when those institutions closed, are aging, reaching life spans that were unheard of just 25 years ago. The system, then, must meet the needs of an ever larger group of consumers. In fact, the field of developmental disabilities is struggling to meet these challenges in every country of the developed world. The challenge is to take the community based residential system that was built as a result of closing major institutions and allow it to evolve into a system of supports for people who live in their own homes. The current residential system is, in almost everyone’s estimation, not sustainable through another generation and perhaps not sustainable for the current population that is aging in place.

The issue of sustainability is made more pressing for the Rhode Island system due to the budget problems of state government and is exacerbated in Calgary by a shortage of direct care employees. Care must be taken, however, not to define the problem as either the need to absorb significant cuts in funding from the state or as the need to secure a stable workforce. To do so will result in less than thoughtful solutions to what will be long term challenges. The problem is how to create a system that will provide a wide array of services efficiently and effectively to all who need them while generating sufficient funds to pay for those services.

One means of getting to efficiency by government is this service system’s experiments with voucher systems. What were once contracts for groups of consumers became individually funded plans. These individual plans have now become Family Administered Funds in Calgary and are about to become vouchers in Rhode Island. Essentially funds are placed directly in the hands of family or guardians who then make the choice of services and the choice of providers. This means that organizations whose primary customer has always been offices of government must market directly to consumers and their families.

There was an article in this morning’s Providence Journal about a partner at Continuum in Boston who spoke at a local college. Gianfranco Zaccai talked about how this innovative company designs products (think the Reebok pump and the Swiffer). He spoke of the need to think about the emotional response to products and services in design. As DD agencies consider how to adjust to this new reality, this will be a central concept…thinking through the journey of choice for a family or guardian, anticipating the “touch points” of first contact through contracting. This transition will require far greater understanding of managing customer relationships through the purchasing process.

We will write more about how agencies are meeting this challenge as the various strategies emerge.

And so we begin…

This is the inaugural entry of the FIO Partners Blog…FIO Perspectives.

My hope is to share what will become a “journal from our practice”…a place to record what we are learning from our firm’s work with nonprofit organizations, foundations, and government in the US and Canada. Let me start by giving you a sense of three places where our firm has worked with several organizations in a single community. Each has its own distinct and quite exceptional set of challenges and the nonprofit, foundation and government managers in these places do so in particularly demanding contexts.

Rhode Island is our home base and its state government is facing the worst deficit in its history. The recently published “Governor’s Budget”; offers nothing but draconian cuts to social service spending and threatens to de-stabilize several components of the civic sector. The Legislature will have more to say about how this deficit will be dealt with but the battle is on to pit one group of vulnerable people against another in a resource war like no other…the elderly in nursing homes, the developmentally disabled, the mentally ill, the children of illegal immigrants, etc. The agencies that serve these constituents are facing losses of 30% due to the increased cost of energy and health insurance coupled with revenue cuts of  20%...all of which will come due in the next 18 month period. I suspect our Rhode Island work will be about consolidation and alliances, about retrenchment, about influencing public policy and about managing in a crisis environment.

We have worked in New Orleans for over seven years, watching with horror when much of what was accomplished before Katrina seemed to wash away over night and have also watched with awe at what has returned. Here it can be clearly said that among the unsung heroes of the recovery of New Orleans are the nonprofit managers, both service providers and foundations, who have effectively restructured their services and investments to assist in the reconstruction of an entire city, of an entire society. However, a new challenge has now arisen: the withdrawal of national funds that flowed into the city since Katrina has begun. The sector will need to continue its reinvention to adjust to a new city with different demographics in an economy that is affected by the housing crisis and pending national recession. It continues to be our privilege to help in any way we can.

Calgary, has, in the words of some, experienced its own kind of Katrina…not overnight but in the last few years since oil was discovered in northern Alberta and this small western City best known for its annual rodeo has taken on many of the characteristics of a gold rush boom town. The challenge for nonprofit managers here is keeping a hold on its workforce. Signing bonuses for pizza delivery persons are not unheard of. The price of housing has skyrocketed, if it can be found at all, despite a building boom that is astonishing to those of us who arrive every few months to find a city with a larger footprint, extending further and further into the surrounding hills. It is almost impossible to find an apartment, condo, or house that is affordable for someone who works in a group home for the developmentally disabled or supports someone with mental health problems. There is funding but services need to be redesigned to adjust to far fewer available workers.

These are the contexts for much of our work. There is a reason that the Chinese say that “May you live in interesting times” is a kind of curse. Clearly the sector’s managers in each of these locations understand the truth in that.  From our vantage point, though, we see the coping strategies, the tenacity, the passion, the conviction to continue the work. It is my hope we can bring to our readers that understanding and share what we are learning about managing in this swiftly changing world.