Fighting Service Delivery Chaos & Building Civic Capacity

File Feb 05, 8 14 27 PM

Me, behind the podium, wildly gesticulating about the elimination of service delivery chaos at the 2017 Ohio Healthy Homes Network Conference.

In the 1980s, a group of parents met each other in the intensive care unit of Johns Hopkins Hospital, united by some terrible circumstances.  Their children were undergoing chelation therapy for acute lead poisoning, which was traced back to their housing.  These parents decided to form an organization called the Coalition to End Childhood Lead Poisoning.

As they worked to find solutions, they encountered a confusing array of organizations that were ostensibly there to help them with their homes. Some were nonprofits, some were government agencies. They each had different sources of funding, and different restrictions. They each operated independently from one another.  Parents encountered many challenges: filling out forms, getting on waiting lists, and having to take time off from work as they waited to meet different agencies and their representatives at their homes or offices.

As the organization matured, it hired an economist as its Executive Director, Ruth Ann Norton, to help make sense of this chaos.  Ruth Ann and her team discovered that the sources of dollars available to address housing for vulnerable people across America look like this:

GHHI

Funds flow through numerous channels at the state, federal and local levels. Federal agencies, such as the U.S. Dept. of Housing and Urban Development, grant resources to communities.  Some dollars are granted to the state and local governments through formulas, while others have to be applied for. Often, federal grants can by applied for by local governments, state governments and nonprofit organizations. Some localities are good at applying for the grants that are competitive, others are not.  Cities themselves may create their own, locally-funded programs to address housing needs. States may do so as well. National and regional foundations may also grant purely private, charitable resources so support these efforts. Nonprofits also actively solicit for individual donations. This all means that the available funding looks very different on the ground in each city you may stand in.

It also means that service delivery is quite complicated.

In my own community, a local nonprofit that rehabs and builds houses asked to meet with me last year. This nonprofit organization operates an effective home repair program. They are able, through the use of volunteers, sweat equity, grants and donations, to complete critical health and safety repairs in our city’s aging housing stock. This might involve repairing a leaking roof for an elderly senior, or repairing a toilet that is not functioning for a low-income mother.  It might involve repairing a staircase or adding a needed railing.   Through this program, they impact hundreds.

This organization was frustrated that there were four different agencies, both government and nonprofit, that were operating roof repair programs. They each had their own waiting lists, their own criteria, their own funding and they were not working with each other.

This tangle of programming has negative effects – on individuals, on institutions and on democracy.

  • Connecting to help is difficult. If you are an aging senior, on a fixed income, becoming overwhelmed by the cost of maintaining your home, must you knock on numerous agency doors? How do you become aware of these doors to begin with? At what point do you become disengaged, losing hope that your community even cares?
  • It hampers civic decision-making. How big is this need in our community? How should we allocate resources to address blighted and unsafe housing? How can “we the people” engage in genuine, deliberative dialogue about the trade-offs that may need to be made?
  • It’s hard to participate in meaningful solutions. Where do you plug in if you are a citizen concerned with these conditions, and want to be part of the solution? Whether through taxes, private charity or volunteerism, growing the resource pie becomes much harder when there is no way for people to figure out what is going on and where they can plug in.
  • Most critically for democracy, taxpayers have no way to make sense of how their contributions have been utilized. There is no real structure for accountability, one of our most fundamental political institutions.

How can we begin to address these conditions? These conditions are known in the literature as “service delivery chaos.”  It’s been written about, most frequently in reference to the field of education, here, here and here.

If we go back to my original story about the parents at Johns Hopkins, we may find one way forward.

The Coalition to End Childhood Lead Poisoning eventually became known as the Green and Healthy Homes Initiative (GHHI), and it spread nationwide. It created a model for how to make sense of this chaos.

First, GHHI sends out its staff to conduct an “Asset and Gap” analysis in the community. It looks at all of the different home repair and weatherization agencies and their programs. It then helps the community map out a strategy to get those programs working better, in a more collaborative way.  Some of the strategies are very simple:

  • Cross-trained local inspectors – Why send out multiple inspectors from multiple programs, when you can just send out one?
  • Bi-monthly meetings – Sit all of the rehab and weatherization organizations around a table with each other and make them bring their case files. If family A was encountered by agency A, and is eligible for agency B’s program, make it happen.
  • A common intake process eliminates the multiple-waiting list problem described above.
  • Metrics. They help your community set up a methodology to track data, so that you can know what is having an impact. How much work is getting done relative to the need? Are ER visits for asthma going down at the local hospital because fewer children are living in moldy conditions? Is the incidence of childhood lead poisoning actually dropping?

With the help of a local hospital system, my foundation made the decision to make a grant to the Green & Healthy Homes Initiative to fund the initial groundwork in Toledo.  The Mayor signed on to support the endeavor.  Still, it can be hard for many to understand why we need initiatives like this.

We held a kick-off event. Before it started, a reporter from our local newspaper walked in and started peppering me with questions.

“Who is funding this initiative? Are city funds being used for this event?”

I said, “No, it’s funded by philanthropy.”

Quizzical look.

“What is the purpose of this initiative?”

I explained that the initiative’s purpose was to use existing community resources in a better way. To do that, it starts with a common understanding of what our resources happen to be.  I explained the Asset & Gap Analysis, and that it would let our nonprofits and government agencies see the programs, grants and resources at 10,000 feet. It would let them develop a strong awareness of each other and work better together.

He said, “So you are telling me that these agencies don’t already know about each other?”

“They may, but they don’t all work together. ”

Another skeptical look.

Yet, these are the conditions in our community – and many communities across the country. The civic landscape has become incredibly complex.  It needs tending.

Forming a common understanding of the current state of affairs is its own challenge. Then, creating the civic infrastructure to contend with it is another.

We must be mindful of the public’s place in all of this – residents, networks, nonprofits, donors, and other institutions can both advocate for what is needed and be a part of the solution.

We need to evolve our civic institutions so that they can contend with these conditions and better facilitate the type of pluralistic, democratic governance we espouse.  We need awareness, through better civic information. We need accountability, through better systems. We need participation, by all segments of the community. We need receptivity, by governmental entities, which may prefer to see the public as passive consumers. We need activation, of all of our assets – through our institutions and in our people.

It’s not impossible. Those parents who got together in that Baltimore hospital were eventually responsible for a 90% reduction in the incidence of childhood lead poisoning in Maryland.

A whole field has emerged around collective impact strategies that attempt to bring structure and process to sectors that are bogged down by service delivery chaos.

I am excited by the work of the Kettering Foundation, which studies how best to improve civic life and build civic capacity through deliberative democracy.

I am encouraged by civic innovations like Community Heart & Soul, created by the Orton Family Foundation, which offers a process that engages all demographic sectors of the community in planning efforts in small towns – giving new meaning to “representation” in the local practice of democracy.

I intend to highlight in coming blogs about what may be some promising solutions. It’s time we set about the task of improving our democracy.  What better place to start, than in our own local communities?

 

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