Poverty, low education levels, crime rates, teen pregnancy, and a host of health issues are all interrelated. They tend to reinforce and compound each other. Yet, as a society, we don’t treat them as if they’re related.
The public sector consists of a lot of large silos – among them are health, education, social services, workforce development, law enforcement, housing, transportation – that don’t often communicate well, if at all, with each other. There are even silos within the silos that don’t communicate well with each other. Meanwhile, the not-for-profit sector is incredibly fragmented, consisting of hundreds of thousands of mostly small organizations that do good work, but that are typically focused on one problem or one target population or one often tiny geographic area. They have great difficulty aggregating capital or talent to replicate what works and achieve scale.
Neither sector is structured to deal effectively with complex social problems. Perhaps this is a major reason why so many social indicators have worsened over the last forty years, despite massive increases in public spending and a huge proliferation of not-for-profit organizations.
It is unrealistic to think we can remake either sector. And experience indicates that if add another layer of bureaucracy in an attempt to better coordinate the activities of various silos, we will most likely accomplish nothing significant other than to further increase costs.
So what can we do?
A lot of what exists is good. But we can do a much better job of aligning and leveraging the resources and capabilities of various entities in focused ways to improve overall impact and make much more effective use of the total resources. We can do this by creating networks that bring together organizations with common interests and complementary resources to work with each other to accomplish a goal with clear, measurable objectives.
There must be a strong organization at the center of the network; the roles of each participant must be clearly defined; and the participants must trust each other. If all of these ingredients are present, a lot can be accomplished. Here is one example from our own experience.
Recently, our organization has begun operating Nurse-Family Partnership in Indianapolis. This is a highly effective nurse-led home visiting program for first-time parents in low income households that begins during pregnancy and continues until the child turns two. Implementation in other states has proven to have immense long term impact. In our community, Goodwill is the implementing organization. Funding comes from a federal grant and is administered through a contract with the Indiana State Department of Health. Referrals come from an array of sources including hospital systems, other health-related organizations, schools and social services organizations. A community advisory board includes nursing experts in prenatal and early childhood, physicians, hospitals, and social services representatives. An independent continuous quality improvement system established under the direction of the State Department of Health measures and tracks performance.
In addition, Goodwill is connecting parents who are enrolled in the program with education and employment opportunities. Goodwill also provides assistance in solving problems related to housing, transportation, and child care.
Our approach enables families to access education, employment, health-related services, training in good parenting skills, and other services through a long term relationship that we believe can substantially improve the lives of the Nurse-Family Partnership parents and their children and help break a cycle of generational poverty. It is a holistic, whole family approach that leverages existing resources to help accomplish something that otherwise probably would not be accomplished as well, if at all.
This is one example in one community. But it illustrates an approach that could be taken by many organizations in many communities to help improve overall impact and the productivity and effectiveness of both the public and the not-for-profit sectors.