Disrupting poverty: How systems approaches to social issues can lead to lasting stability

A sunny day in New Wellington brings the sounds of hammering, sawing and the beeping of construction trucks backing up. All of these sounds mean progress for a core neighborhood that a few years ago, was in deep crisis.

The issues with Wellington Heights - the New Wellington as it's now called - are played out in neighborhoods all across the country; aging homes divided into apartments, increased density, rising crime and stressed neighborhoods. There is also an underlying issue that can't be seen as easily as a decaying rooftop or broken window. It is the often hidden strengths and complicated realities of families living behind the doors of some homes.

Each year, more than 100,000 Iowa kids live in poverty, 15,000 are victims of abuse or neglect and nearly 3,000 young women ages 15-19 become mothers. That means there are many children in Iowa with complex needs that go beyond mental and physical health challenges. When these children come to Four Oaks and complete a program, they have reached short-term stability in one area of their life. But how long does that stability last if the daily context within which a child and their family lives their lives aren't addressed? How do we make sure they are on a solid foundation to succeed as adults?

Children and families benefit when our many, often disconnected, interventions produce long-term results in the future anchored in the common sense approaches that are making stronger families, safer neighborhoods and asking communities to work together to get it done. Think about a successful child you know. They have a roof over their heads, food in the refrigerator and feel safe at home. They have a family who cares about them and a parent who is employed. They live in a safe neighborhood and have reliable transportation. And finally, their education results in academic achievement, good character and applicable life and work skills. In other words, every day, they experience emotional and physical safety and stability in their lives and relationships.

All across the nation, child welfare advocates, educators and policymakers look for solutions to help families raise resilient children who are well positioned to become successful adults. Lawmakers and taxpayers would like sustainable results and cost-effective solutions. But the current funding streams continue to appropriate dollars to programs and not integrated community-based strategies that reach across sectors and systems.

A NEW APPROACH TO STABILITY

Four Oaks recently finished a multiyear TotalChild pilot, demonstrating that when we come together as a community, put our children first, strengthen their families and provide for a safer and more supportive community, we truly can help all children succeed. The 'secret sauce” looks something like this: work together to address a child's emerging issues, widen supports to address the family's basic needs and follow up at regular intervals until the child is 18. This strategy can be applied through child welfare, health care, education and juvenile justice.

After 40 months of applying this truly generative strategy, TotalChild now has 800 children enrolled and more than 90 percent of the kids reached stability in a year. Stability means their lives aren't in chaos and they've achieved success in a checklist of areas which include basic needs, education, employment, housing and family supports. The goal is to keep going. In the next three years, TotalChild has a goal to enroll 1,400 children in Linn County.

To date, 26 TotalChild teenagers have reached 18 and are doing well. Four Oaks reached this level of success because of the community. TotalChild works because of collaboration with more than 200 agencies and caring people. Just last year, fundraising campaign leaders Chris and Suzy DeWolf and Kyle and Susan Skogman asked the community to contribute $6 million to TotalChild. Those private dollars have supported this important work.

So how does the hammering and construction in New Wellington fit into the TotalChild picture? During the pilot, the numbers of children enrolled in TotalChild and living in Wellington Heights began to grow. As city leaders turned to help other core neighborhoods affected by the 2008 flood, Wellington Heights continued to falter. Over the last 25 years, stately old single-family homes had been purchased and subdivided into apartments.

In May 2012, the Wellington Heights neighborhood Association, the Affordable Housing Network, Inc., Jane Boyd Community House and the City of Cedar Rapids joined forces to revitalize Wellington Heights and turn it from 42 percent single-family homes to 62 percent; a number that changes the neighborhood's tipping point. Now 90 properties in an 18-block core area of the New Wellington have been purchased, 67 renovated so far as single-family homes. Four new homes have been built and sold, to date, in this neighborhood for the first time in 50 years - helping to attract new homeowners and increased property values. This has also spurred permanency for TotalChild families by providing a basic childhood need: safe and affordable housing.

What's important to keep in mind is that this approach to working with children and their families who experience complex needs, including housing, is more than just a program. Programs come and go, as funding and state policy changes over time. Unfortunately we've come to expect that it has to be that way - and aren't looking at what's needed to help the next generation of all Linn County youth, achieve and sustain personal and economic success.

PRACTICE, POLICY, REGULATION AND FUNDING

The answers about what to do are already known in our own personal experiences, and most of the 'ingredients” are already available in our communities and state - or about to be so very soon. The four ingredients which lead to comprehensive and lasting results include more integrated and effective practices across sectors and systems that are supported through aligned policies, regulations and funding. These four things are woven together to create the conditions necessary for bigger and more lasting success, including affordable housing, policies that help spur creative solutions in core neighborhoods, regulations with intent to strengthen families such as Cedar Rapids' landlord-tenant ordinance and finally, funding that includes public and private sources.

Sometimes these lasting results for children and families are gained by disruption; an interruption or unexpected break in a normal process that drives us to think and act bigger then we have before. At the 2013 Human Services Summit at Harvard University, participants focused on leadership in an era of disruption that was necessary to truly reduce the number of people living in poverty, increase the number of people living safe and healthy lives and put more people onto pathways for educational and employment success. To do so requires us to move from program thinking to systems change thinking and realize none of us can get there alone. A report from the summit said leaders who can adapt to this disruption, respond with innovative ideas, involve a broad coalition of stakeholders, reframe long standing issues and use disruption to generate resources will create the more innovative models for the future that yield the best and longer lasting results. TotalChild is one of a number of innovative strategies across the U.S. that is doing just that.

This summit of leaders in human services across America created something called the 'Human Services Value Curve”. The curve is a framework that reminds us it is not enough to help the individual child with their malady, but increasingly the family and community must be included in the efforts for sustained and long-lasting change. A lot of this work involves empowering families, coming up with innovative solutions that cost less and do more, achieve goals and do it in new ways that create healthier and more vibrant communities that are equipped to make sure all children can succeed.

SUBSTANTIAL, EFFECTIVE CHANGES

The efforts necessary to design and implement these generative system changes are substantial and essential. You may have read about a change in the way Iowa will deliver and pay for the care of all 500,000 Iowans in the state's $4.2 billion Medicaid program, beginning January 2016. The Iowa Department of Human Services has received bids from 11 Managed Care Organizations (MCO). Of the three to four chosen, those MCOs will ' … establish utilization guidelines to assure appropriate services are provided the right way, in the right time and in the right setting. This will shift the focus from volume to per member, per month capitated payments and patient outcomes.” The National Conference of State Legislatures reports that comprehensive Medicaid managed care models have been established in 39 states.

Approximately 43 percent of Four Oaks children are supported by Medicaid, some being helped by the TotalChild model. MCOs will be establishing a performance and incentive method to providers that are creating value through an integrated delivery system. This results-oriented approach puts TotalChild clients in a good position to become successful and supports the work in which some 200-plus community partners have invested.

In his 2013 State of the City address, Cedar Rapids Mayor Ron Corbett cited TotalChild and the Wellington Heights initiative as examples of how the city is beginning its 'second wind.” He said, 'as their efforts progress, it will result in remarkable improvements for the Wellington Heights neighborhood and its residents. As that neighborhood is transformed, other neighborhoods will be addressed and also transformed in ways that we can't even imagine right now. This effort will have great rewards well into the future for not just members of those neighborhoods, but for the whole city of Cedar Rapids. I am looking forward to witnessing their progress.”

Some two years after the mayor made that statement TotalChild has made enormous strides and will continue to evolve. But there still is so much more to do. It's not enough to help children achieve stability and maintain those gains until age 18. They need to gain the hard and soft skills necessary to find and succeed at a job with a living wage. And our core neighborhoods must, once again, support small businesses and have common spaces to gather and play safely.

Now that the initial goals of helping so many youth in Linn County reach stability, and progress toward achieving the 'tipping point” in Wellington Heights is within our reach - it's time to outline the 'upgrades” needed to address our community and workforce needs. We know that Cedar Rapids was named an All-American City in 2014 because of our resilience and proven capacity to work together to make our community stronger. Together - public, private and non-profit organizations in Cedar Rapids and Linn County- are showing the country that we dream big for children and families, and in the end, our community is better off.

' Anne Gruenewald is President & CEO of Four Oaks, one of the state's largest non-profit child welfare and juvenile justice agencies in Iowa. She is the strategist who created the TotalChild concept and is now leading the challenge to reverse family crisis and help build stronger communities. Susan Dreyfus is President and CEO of the Alliance for Strong Families and Communities, a national non-profit organization dedicated to achieving a vision of a healthy society and strong communities for all children, adults, and families. It has a member network of more than 450 local, non-profit organizations. Comments: agruenewald@fouroaks.org; sndreyfus@alliance1.org