Blog Archives

Podcast: Giving Young People the Chance — and the Budget — to Improve Their Community

 

Since its inception in 1999, the Greater Worcester Community Foundation’s Youth for Community Improvement project has engaged more than 180 teens in direct philanthropy. Together, these youth have made more than $285,000 in grants to over 70 nonprofit organizations in Worcester County, MA. How does YCI work? What are the benefits to the community and to the young people who participate? We caught up with six YCI team members on the University of Massachusetts/Amherst campus in June 2017 to talk about it.

They brainstorm their priorities, write their own RFPs, and make their own awards. How does it all work? Click to listen.

 

We interviewed (from left to right): Caitlyn Nguyen; Laura Giordano; Lauren Walsh (front left); Dorean Asuako; Diane Khong (front right); and Sarah Riley. Sarah Shugrue, YCI Staff, is at far right.

The full YCI team, 2017. YCI makes grants to organizations in the Greater Worcester (MA) area.

Posted in funding, motivational, organizational development, promising practices, uncategorized

Pregnancy Prevention for Youth in Special Circumstances: What It Takes to Do It Right

 

wymancoverWe’re excited to share a resource for teen pregnancy prevention programs that we developed for Wyman, based on our and others’ experiences implementing the Teen Outreach Program® with young people in foster care and juvenile justice settings (or who have other characteristics that make them special). Biggest takeaway? Working with young people in special situations requires a whole new set of tools and approaches, some adapted to the young people themelves and some to the larger systems that serve them.

We loved all the inteviews, connections and new learning, and look forward to helping other agencies learn from our and our colleagues’ experiences!

See Implementing the Teen Outreach Program® with Special Populations: Lessons Learned from Seven Youth-Serving Agencies

Posted in evaluation, news, organizational development, promising practices, uncategorized

What’s the Future of ‘Pay for Success’?

PFS-Mass.WASHINGTON DC — Utah’s just-completed Pay for Success pilot is the talk of the town in DC, at least among a certain subset of policy researchers.

Not familiar with it? The Salt Lake County, Utah, High-Quality Preschool Program sought to increase the number of low-income children in the county who started kindergarten on track and ready to learn. Based on predictive assessments, the county estimated that, absent of some special effort, 110 of the 600 low-income children in its study cohort would need special education in kindergarten. Their pilot, funded through an outcome-focused public-private investment mechanism called Pay for Success (PFS), determined to change those numbers, and it did. After a year of the PFS-sponsored program, only one – yes, one – child was found to need special education. The win for the children was also a win for the taxpayers. The county says it has saved $281,000 in education expenses; presumably those savings will rise if children stay in mainstream classes over the long run.

Under the PFS financing model, social service providers sit down with public funders, private investors, and a project intermediary. Together they look at the evidence that the provider’s approach works, set numerical targets for success, hash out the cost of running and evaluating the program, and then make a deal. The private investors front the full cost of the program; the provider rigorously tracks outcomes, with the help of outside experts; and a third-party evaluator determines if, after a pre-established period of time, the program has indeed succeeded. If it has, the government steps in and pays the investors back, with interest, sometimes over an extended period as more and more savings are realized.

As a model for funding nonprofit services, Pay for Success is in its infancy in the United States, and the first few projects – those just completed and those still underway– are under intense scrutiny.

A panel at the Urban Institute this week spoke to a standing-room-only crowd (a crowd which, several speakers noted, could have fit into a supply closet just a few years ago) about the future of the model. The panel included Shaun Donovan, director of the OMB (a PFS enthusiast); the Salt Lake County mayor Ben McAdams; Antony Bugg-Levine, of the Nonprofit Finance Fund; and other policy experts and bureaucrats working with the model. Together, they made an impressive case that Pay for Success can demolish funding silos and create powerful new relationships capable of driving dramatic improvement in services. There’s also a lot that it can’t do, or probably can’t do. In other words, much remains unknown about the true potential of PFS.

The Upside

The PFS approach is highly appealing, at least for some types of projects. It can lead to:

  • More effective services. While government may tolerate mediocre results, private investors will not. Private money focuses attention on results and better aligns incentives and expectations. Service providers are no longer paid to provide a service. They’re paid to produce success. For their part, city, county, state and federal funders get to do more than expand, contract or defund programs and ensure grantee compliance; they get to truly change the lives of the people in their communities.
  • The vigorous use of independent evaluators. This is a very good thing, since programs that conduct or contract out their own evaluations can’t be expected (though surprisingly often, they are) to reach conclusions that are truly objective.
  • More honest conversations between providers and funders. Instead of writing grants that promise the moon, PFS-based discussions focus on what’s actually achievable. The three parties at the table – government, the provider, and the investors – are interested only in what’s concrete and realistic. If outcomes are in fact better than anticipated, as in the Salt Lake County project, that’s great, and everybody has learned something about what is possible. But PFS is an opportunity for government and the private sector to peek behind the curtain of social programs, and they can’t help but gain a more nuanced appreciation of the challenges that make progress difficult.
  • Full funding for programs. It goes without saying that most nonprofits are underfunded, and that public funding rarely pays the full cost of any particular set of services. That means that providers must divert a significant share of their energy and money to fundraising. Anyone who’s ever, say, dived into Boston Harbor in January to raise funds for some program or other knows this all too well. (Yes, that was me. I did that.) Under the PFS approach, providers can get full financial support for a program, eliminating the burden of chasing additional grants or gifts.
  • PFS has bipartisan political support. To liberals, PFS provides evidence that difficult social problems actually can be solved; to conservatives, it shifts both risk and reward to the private sector. PFS can also reduce public cynicism by promoting the expenditure of taxpayer dollars only on programs that demonstrably work.
  • Providers can do their work as they see fit. In PFS projects, service providers aren’t told what to provide or how to provide it. If something isn’t working, they can change it in mid-course. There’s no going back to a program officer hoping for a thumbs-up; the provider is the expert and they decide.

The Downside

Yet if PFS continues to expand, either as a discrete funding mechanism or as a general philosophy that shapes funding for social services, there are obvious reasons for concern.

  • A self-defeating focus on data. Just as a pervasive, laser-beam focus on outcomes could be a game-changer for the social service sector, it could also undermine the validity of services whose impacts are important but unmeasurable. Everyone in human services knows that proving success can be phenomenally difficult, and not just for the obvious reasons. A program may produce fabulous success, but not necessarily of the type, or on the scale, it intended to. Or it may indeed produce the success it desired, but the success may go undocumented because the provider didn’t apply the right tools and protocols. Or – a much worse scenario, and a common one – because the right tools and protocols haven’t been developed. Human beings are uniquely complicated, after all, and the outcomes of any particular intervention could be long distant and linked to a set of experiences and services that are interconnected. Benefits to clients can be real without being documentable, and ignoring that fact won’t help anyone in the end.
  • Fairly narrow ‘suitability’ criteria. PFS is one financial tool of several, and it only makes sense under particular conditions. Despite the almost palpable excitement about the model among providers and policy wonks alike, it may well be the case that only a minority of social service providers should even consider it. For one thing, by its very nature PFS can only support prevention programs, because those are the programs that, if done right, can produce large cost savings down the line. PFS-funded programs must be replicable and scalable, and capable ultimately of reaching large numbers of people. Most important of all, providers interested in PFS should already have clear and compelling evidence that their approach works. While investors vary in their motives and their tolerance of risk, none will happily lose their money, which is what will happen if program outcomes aren’t met. Proving to investors that your program will be successful isn’t a small thing, and you can’t do it on the fly. An intense orientation toward evaluation must already be ingrained in organizational culture; playing catch-up in hopes of attracting PFS investors won’t work.
  • Conducting PFS-funded projects can be difficult in ways that providers don’t anticipate. PFS projects can be taxing for social service providers, who under this financial scheme must focus single-mindedly on outcomes and the various processes and software packages that document them, sometimes to the exclusion of the more human work they’d rather be doing. Not all providers will find the trade-off worth it.
  • PFS involves risks to providers as well as to investors. Many social service providers are happy with the current system. Being paid a certain amount per client to provide a certain service is good enough. They feel their service works for their clients, and perhaps even know it works, anecdotally and through whatever data they’re already required to collect. Their public funders are satisfied, their clients seem satisfied, so why risk their program by developing intense numerical goals that perhaps they don’t end up meeting?
  • Government complacence. For that matter, many government bureaucrats are satisfied with the current compliance regime as well, or at least used to it. Pay for Success can feel enormously complicated, not least because the funding silo that pays for a prevention program may not be the same one that reaps savings down the road. And, as we all know, programs are often funded regardless of the evidence for them. That is to say, evidence matters, but politics usually matters more, making the whole evidence-based enterprise feel a little creaky. Which services require the intense focus of PFS, and which ones are protected from intense focus? This question would become particularly important if PFS moves beyond discretionary public spending (a relatively small slice of the budget pie) and into entitlement spending.
  • Perverse incentives. No one on the panel mentioned it, but I wonder if, with so much money on the line, clients may get pushed to the finish line too soon or be deemed “successful” too hastily. As one Utah resident skeptically noted in a newspaper article on that state’s early education PFS project, gains made by children in pre-K enrichment programs often disappear after a year or two. Is “success” a single-point-in-time determination, or up for reconsideration as time goes on?

Future Directions

Dozens of additional PFS projects are in some stage of development, and policy folks are watching them closely for new lessons. They’re developing toolkits, sponsoring webinars, and fielding questions from interested nonprofits. As they themselves point out, much will go right, but much may go wrong as well, as PFS grows and evolves. There is a great deal of work to be done in making PFS more than a boutique funding approach. The Urban Institute panel identified two important tasks:

  • Search for new ways to produce evidence of outcomes. Randomized controlled trials are expensive and time-consuming. Building knowledge about outcomes must necessarily fold in other kinds of less-expensive data, such as data automatically collected when former clients use public services or enroll in entitlement programs down the line. But there are inevitable privacy issues in mining this kind of data, and no one’s figured out a way past them quite yet.
  • Develop a tiered-evidence PFS project paradigm, so that incubator projects that are promising but lack solid evidence still have a chance at being funded. A second tier might involve projects that have been highly successful with a particular subpopulation and or in a single place but that must be proven with larger groups or in different locations.

There’s a lot to learn about Pay for Success and its suitability for any given provider and project. Read more at the Nonprofit Finance Fund and the Urban Institute. The Urban Institute is hosting a free webinar to potential PFS applicants on Oct. 27.

~ Melanie Reisinger Wilson, YC Research Director

Posted in evaluation, funding, news, organizational development, uncategorized

Cultural Humility in Hawaii

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A Youth Thrive group exercise, Honolulu, 2015.

In July, I went to Honolulu to lead a Youth Thrive training for 14 youth-service providers under the auspices of the Hawaii Youth Services Network. The providers were an amazingly diverse group. They worked with young people between the ages of 7 and 24 in middle and high schools; in reproductive health programs; and in programs for runaway and homeless youth. Among the group was someone from every Hawaiian island and three from Saipan, the largest island of the Northern Marianas.

If you’ve ever brushed up against the US Census, you know that these folks are collectively known as “Pacific Islanders.” So they’re one race, ethnicity, and culture, right? Wrong. Well, they’re essentially the same, right? Wrong.

What this training really drove home for me was how many subcultures exist within our large demographic constructs. And that’s just what demographic umbrellas are: a construct, something we make up for our own convenience. (Anybody want to weigh in on what “the white community” thinks about Donald Trump? Or what “the American community” thinks about the current refugee crisis in Eastern Europe? If you’re white or American, you know those very questions are nonsensical.) Which is why, in Hawaii, without doubt the most ethnically diverse of all American states, social service providers talk about the importance of being “culturally humble.”

Making genuine connections with young people is the basis for doing any successful work with them — as a teacher in a school, as a nurse in a health clinic, as a youthworker on the street. And no genuine connection can happen if you assume, consciously or otherwise, that your culture makes more sense than theirs.

In Youth Thrive, we combine the most recent findings of adolescent neuroscience with four decades of accrued knowledge about approaches that work — really work — to help young people realize their full potential. Youth Thrive teaches us that it’s not about changing them;  it’s about changing ourselves so that we can truly, finally “meet them where they’re at.”

Cultural humility is part of that, a change we impose on ourselves so that we can see the young people in our lives without judgment.

At the end of the three days, Claudia ‘Lala’ Fernandez (who is Director of Programs  Boys & Girls Club of Hawaii-Leeward), helped us close by arranging us in a circle. Circles, she explained to me later, symbolize the equal respect we shared and the bonds we had created during three days of work. She asked each of us to share the makana (gift) that we would take back home with us, and to offer our ko’okupu–our intention to nurture the gift back home, so it takes root and grows.

Finally, she thanked each one of us in Hawaiian, ending with this benediction: ‘Olelo no’eau, a’ohe pau ka ‘ike i ka halau ho’okahi,’ which means that not all knowledge is taught in one school or place. Another reminder of what we gain when we are humble and assume others may know something we don’t.

 ~ Cindy Carraway-Wilson, Youth Catalytics Director of Training

 

Posted in news, organizational development, promising practices, trainings, uncategorized

The Huge Youth Thrive Surprise

Over the last 30 years, we’ve conducted hundreds of trainings for professionals who work with young people. We’ve seen every trend come and go at least twice, and we’re pretty good at predicting how the field will respond to each one. In short, not much can surprise us. But something just has. Meet Youth Thrive™, the one training that has us so busy that it’s been hard to keep up. Why?  Because Youth Thrive is PYD 2.0, the new, improved version that includes the latest information on adolescent neuroscience, trauma and resilience, plus practical help in applying what you learn to your particular setting.  Simply put, it’s the new frontier of youth development.  Want to know more? We think you need to know more. Below is one of our upcoming trainings in Maine. Join us, and find out what all the buzz is about.

Lighting the Bumpy Path to Adulthood: A Youth Thrive™ Overview

2015 Positive Youth Development Institute
& Summer Training Academy
July 20-22
University of New England
Biddeford, Maine

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Research conducted by The Center for Social Policy Study has identified a set of key competencies that have been shown to help young people increase protective and promotive factors while reducing risk factors. Research shows that these supports help young people move beyond trauma and under resourced environments to become more resilient in addressing their developmental needs.

This workshop will present the key components of the Youth Thrive™ Framework including adolescent brain development and the impact of trauma on young peoples’ brain development, youth resilience, the importance of social connections, helping young people better understand their own development, concrete supports in times of need, and cognitive & social-emotional competence in youth.

Participant Outcomes:

  • Become familiar with a set of guiding premises that support key practices with an application of the Youth Thrive™ Framework
  • Explore the Youth Thrive™ Protective and Promotive Framework and key research behind each of its five components
  • Learn how these promotive and protective factors, important for all youth, work together to increase the likelihood that youth develop characteristics associated with healthy adolescent development and well-being
  • Consider important connections or overlaps with other important frameworks such as the Search Institutes 40 Developmental Assets

Trainers

Cindy Carraway-Wilson, MA, CYC-P
Director of Training, Youth Catalytics
Vermont

Hector Sapien, LCSW, CYC-P
Independent Practitioner
Maine

Register here.

Learn more about Youth Thrive™. Interested in bringing this transformative training to your city or state? Contact Cindy Carraway-Wilson at 207 319-6009

Posted in adolescent biology, news, organizational development, promising practices, trainings, uncategorized

So You Want Your Indirect Costs Covered? Done.

graphic overhead
It’s about time.

Nonprofit leaders, grant writers, and program managers are high-fiving in response to a new rule governing ‘pass-through’ funding—states, local governments and other entities that use federal funds to hire nonprofits for service delivery are now required to reimburse nonprofit indirect costs. Although some government contracts have allowed for indirect cost rates in the past, rates vary widely by state, and most were set at less than 10 percent of the actual costs nonprofits incur.

The change to OMB’s Uniform Guidance rules reflects growing recognition that failing to fund the true indirect costs of service provision leaves a big (and unfair) gap for nonprofits. In fact, over half of organizations participating in Urban Institute’s 2013 survey about nonprofit work under government contracts said that uncovered administrative costs were a significant problem for them. Further, 24 percent of respondents reported operating under contracts that provided no funds at all for indirect expenses.

What’s left for nonprofits to do?

The National Council of Nonprofits gives several recommendations, including accurately tracking your nonprofit’s indirect costs, advocating at the state level for any changes needed to comply with new requirements, reporting back your experiences, and holding pass-through entities accountable for following through. (Note: the interim final rule says the right to indirect cost reimbursement cannot be waived. So, if a pass-through entity asks you to sign off on a waiver, stand up for your rights.)

Learn more by checking out this guide that helps assure nonprofits understand their rights and know how to benefit from these changes. To comment on the interim final rule that covers Uniform Guidance modifications, submit remarks online by February 17.

 

 

Posted in funding, news, organizational development

Risky is the New Safe in Social Marketing, via the Amazing David Newman

DavidNewman_board

Think people are tired of hearing from you via Facebook, Twitter and email blasts? Not sure how to break through to potential supporters and partners? Wondering if you should even try, given that social media is such a young person’s game?

This high-powered Quick Take interview with marketing guru David Newman is for anyone involved with nonprofit promotion and development – from directors and fundraisers tweeting about their cause to youth workers promoting the next big event at the drop-in. Newman gives practical tips on how to jump in the pool so that your entrance gets people’s attention – in the right kind of way. He talks about how to build confidence in yourself and your unique offerings, and how to develop habits that will build your base of supporters, one day at a time. Trust us, this Quick Take is for you!

David Newman is a Youth Catalytics advisor and CEO of Do It! Marketing. Our interviewer is Jen Smith, Research Associate at Youth Catalytics.

Click here or on the audio icon below, and fasten your seatbelts. David Newman is quite a ride.

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Posted in motivational, organizational development, uncategorized

The Mitten Paradox: When the Culture of Accountability Produces Only Failure

 

oddmitensYouth Catalytics specializes in organizational and board development, strategic planning, staff supervision, fund development, data management – areas central to the healthy functioning of social service agencies. When problems occurs, we know how they look to people in the organizations themselves. In this essay Youth Catalytics Research Director Melanie Wilson describes how organizational problems look to consumers of services – in this case, herself and family.

Last March I went home to Indiana to visit my mother in the hospital and sort out some issues that had fallen by the wayside when she got sick. It was the typical story, in a way. We move into middle age, our parents move into old age, and their responsibilities devolve to us. In feeling our way through them, we gain insight into their struggles, and sometimes feel a bit of frustration that they’ve struggled at all, when the solutions appear, at least on the surface, to be pretty simple. Or at least that’s how I was thinking of it on this last trip home.

My sister lives in a supported living residence—a group home for adults with cognitive and physical disabilities. After 30 years in a conventional nursing home, and many years of failed attempts and behind-the-scenes machinations by my parents, she finally won a coveted slot in a new apartment program. It was literally brand new, with just-built apartments on wooded land beside a pretty lake. My sister’s new place wasn’t home, of course, but it was a lot more like home than her sprawling nursing facility ever had been. She’d have just two roommates, her own bedroom filled with her own furniture, and 24-hour awake staff to take care of everything—to cook meals, get everyone dressed and where they needed to go, even take them out for dinner occasionally.

It all seemed perfect. Though this particular program was new, the agency running it was long-established, and in fact my sister had participated in its sheltered workshop for years, ever since she was a teenager. They’d been very good to her. Even when her condition worsened and she could no longer do anything productive, not even sort big and little screws into different boxes, they welcomed her anyway, just so she could be with her friends.

Yet after less than a year in the apartment, there were problems. My mother kept emailing me about them. Increasingly those emails arrived in all capital letters, with exclamation marks. “I AM SO FURIOUS!!!” one started.

Increasingly my mother’s emails began arriving in all capital letters, with exclamation marks.

My mother, a no-nonsense retired nurse, seemed to be coming apart. I wasn’t sure if the problem was actually with the apartment program itself, or just with my mother’s ability to cope, after so many grueling years, with the routine issues of my sister’s care.

But after talking to the families of my sister’s roommates, it was clear that they were troubled as well. There weren’t enough groceries in the apartment (one week, my mother had to dispatch my brother to buy some); one of the bedrooms was 64 degrees; the roommates were dressed in each other’s clothes because staff couldn’t sort the laundry properly. Several times after her sheltered workshop, my sister was left in other apartments because her own caregiver was late showing up. The handicapped-accessible van wasn’t available anymore, so after one or two social trips out into the greater world, the roommates just stayed put.

But what really pushed my mother over the edge was the medication issue. My sister has frequent seizures; left uninterrupted, they can become life-threatening. When a caregiver sees one, there’s a two-step protocol. The protocol isn’t complicated, but implementing it presupposes several things: that staff know about it, understand it, and are capable (in a legal and technical sense) of actually carrying it out. But in spot-checking with staff during regular visits to the apartment, my mother found out that many of them didn’t know about the protocol. One caregiver knew there were two drugs involved but didn’t know which was which; one couldn’t legally give drugs at all; another said she didn’t know that two of the residents (my sister and one of her roommates) even had seizures.

At this supposedly perfect place, how could everything be going so wrong?

The answer was obvious to the families: inconsistent, poorly trained caregivers who rotated through the apartment without ever staying for very long. Just when my parents and the other families got comfortable with a caregiver, she (and it was always a she) disappeared. Sometimes the families would hear she had been fired, though they usually never knew why. Other times they heard rumors about why, and were incensed. Almost without exception, the reasons sounded so piddling. A favorite caregiver was fired for taking a nap, when a blizzard had closed down the roads and kept her on duty for more than 40 hours straight? Seriously? And then she was replaced by someone whom the families viewed as completely incompetent? What was going on, and was it going to get any better?

The agency had recently hired a new CEO, a self-described “money guy” from Chicago whom my mother suspected had been brought in either to raise funds or cut spending, or both. After going through all the usual steps, my mother and the other families met with him to express their concerns. According to my mother, he expressed the opinion that many of the agency’s direct-service workers were too poorly educated to be effective, and he vowed to bring in better-quality people. My mother was dubious. To her, this attitude was the very problem:  if you think direct-care workers are as disposable as Kleenex, you’ll never understand what true gems they can be, how very critical they are to their clients’ quality of life. Some caregivers had worked with my sister for years and my mother loved and trusted them. To her, it’s not about what workers don’t know coming into the job; it’s about what they still don’t know two months later, when they have sole responsibility for vulnerable clients.

The CEO asked the families to be patient while he made improvements, and, having little choice, they were. But things didn’t improve; they only got worse. Both direct service staff and administrative staff kept vanishing, and my mother was hearing from an inside informant that morale had hit rock bottom. (Yes, this is a story that has inside informants.)

The chair called me back the same night, horrified. She’d never read a letter like it in eight years, she said.

Before getting on the plane to Indiana, I had written a long email to the chairwoman of the agency’s board, documenting the problems the families were seeing. To me, this was the nuclear option—a potentially destructive last resort, but one that was sure to work. The board, after all, had hired the CEO, and was legally responsible for the way the agency functioned. If the board couldn’t fix it, who could? And at first, I congratulated myself on my prowess. The chair called me back the same night, horrified. She’d never read a letter like it in eight years, she said. As it so happened, she was meeting with the CEO the next morning, and she promised she would get this straightened out. In the meantime, I was to assure my sick mother that everything would be fine.

In two days she called me back. This time her tone was less sympathetic. She assured me, darkly, that staff were fired for very good reasons—reasons I would fully support, if only I knew. She furthermore told me that my mother had made matters worse by talking to my sister’s state caseworker about the problems—now the agency would be obliged to fire even more staff, making the turnover problem worse. It was obvious that the CEO considered the families (and my mother and me, in particular) to be the real problem, and the board chair, having no other source of information, had believed him.

The families had scheduled a joint meeting with supervisory staff, and on the appointed day we all met. I pressed for answers about why trusted caregivers were being fired. After insisting that they couldn’t be transparent about the reasons that staff were terminated, they finally described the agency’s four-strikes policy. Any worker who accrued more than three disciplinary actions was out. And since direct-care staff tend to work in many settings, not just one, any given family may not see the problems that led to a dismissal. But we should be assured that they were real.

What were these problems? I asked, but I already knew, because even though she had been reluctant to spit it out, the board chair had finally told me over phone: abuse and neglect.

Abuse and neglect. It’s a potent phrase. According to agency policy, when an allegation is made, the worker is immediately suspended, an investigation is conducted, and the complaint is substantiated or not. The state is informed from the beginning.

What is abuse and neglect? We all know what it could be, and shudder to even think about it. But my parents and the other families were skeptical. They’d observed caregivers with their relatives for years, and thought they knew the good ones from the bad. One or another visited the apartment nearly every day, and they had ample opportunity to observe and assess staff.

At the meeting, a supervisor acknowledged that many incidents labeled abuse or neglect in an agency setting wouldn’t raise an eyebrow anywhere else. But given state regulations, even minor issues were important. I wanted to disagree,  but I couldn’t. My sister needed to be safe, after all. The meeting ended with a list of actions the agency said it would make, including the purchase of a new, dedicated van for my sister’s apartment program, the creation of a new quality-assurance position, and monthly meetings for family and staff at the apartment. Veteran staff would be pulled from other apartments and posted in my sister’s, and for the foreseeable future, a supervisor would check the apartment daily. All good (at least for my sister’s apartment, if not for those newly deprived of experienced staff).

She let me know that our family would be getting paperwork from the state about an incident involving my sister.

On the way out, the head of social services waved me into her office. Speaking of abuse and neglect … she wanted to let me know that our family would be getting paperwork from the state about an incident involving my sister. It concerned a pair of mittens.

It was cold in Indiana last winter; I can attest to that. One recent morning, as my sister sat in her wheelchair, waiting for the van to pick her up and carry her half a mile to the workshop, someone noticed that she was bare-headed and without mittens. The social services director had embarked on the usual investigation, interviewing witnesses and staff to see if the story was true. After some legwork, she found that it was. Now her job was to interview the relevant caregiver to find out why. Together she and I talked about the possibilities. Maybe the mittens got left behind at the workshop the day before, and thus were missing the next morning. Maybe the caregiver was running late and didn’t bother to fish out the mittens, or maybe the caregiver didn’t realize how cold it was outside. In any case, since the mitten incident had undeniably happened, the caregiver would be suspended for a day. Whether it was her first, second, or third strike, I don’t know.

When I told my mother the mitten story, she got furious all over again. Wasn’t this exactly the problem? The caregiver who got suspended for the mittens could have been the only one to actually know the seizure protocol. And it was the seizure protocol that was truly important. Yes, mittens are an undeniably good thing; we all want my sister to wear mittens in the winter. But were mittens worth further destabilizing an already unstable staff?

It’s easy to understand that small problems, if let slide, can grow into big ones, can day by day create a culture of carelessness that ends up putting both client and caregiver at risk. It’s hard to fault an agency for relentlessly investigating even minor-sounding allegations, since for every one incident that gets reported, several almost certainly never surface. Caregivers have to know they’re being monitored.

But vigilance of this type creates its own conundrum. In trying to hew to the letter of the law—and frankly, what choice does it have?—the agency is unwittingly creating new and potentially far more serious problems. Furthermore, it makes the collateral damage of normal turnover exponentially worse by constantly hiring, training, and firing staff in an endless cycle. An organization that accepts that practice as a way of life is always on the verge of disaster, because direct-care staff who never get to know their very complicated clients are dangerous by definition.

The board chair assured me that the agency had been working to decrease staff turnover “for years,” though it apparently had never occurred to her that there’s something deeply amiss in an organization that works so long on any problem without result. You may assume that money is the real issue. The agency can’t afford to hire better workers, or supervise them meaningfully. Not so. The agency is running well in the black and is a phenomenal local fundraiser. And salary, as everyone who works in social services knows, is at best only part of the picture when it comes to hiring and retaining good direct-service workers.

And that is where things stand. After three months, not much has improved.  At the only monthly meeting to be held so far—which the families had to organize themselves—my mother heard that new caregivers were being trained for my sister’s apartment. More new staff? Her emails are spitting fire again. And I’ve put aside my notion that I can help my mother fix this. When the problem is systemic, after all, the solution doesn’t come from outside, but from inside.


Youth Catalytics has produced several practical resources on  hiring and retaining direct-service staff. In 2009, we conducted a study of children’s behavioral health workers in New Hampshire, the findings of which are also relevant to organizations seeking to hire and nurture quality staff.

Posted in organizational development, uncategorized