Fostering Hope: Integrated Care Treats the Cause, Not the Symptoms
In my last article, I introduced the Fostering Hope Initiative (FHI), a neighborhood-based collective impact initiative in Oregon’s Marion and Polk Counties. Led by Catholic Community Services. FHI seeks to strengthen at-risk families and build more resilient neighborhoods by bringing multiple partners together around a common goal, aligning resources and sharing leadership for planning and results.
It’s an intentional departure from business-as-usual for the healthcare and social service agencies involved. So why are they doing it?
“Because if healthy, resilient families and strong communities are what we want to see, we’ve been going about it all wrong,” says Maureen Casey, Ph.D., director of strategic projects at Catholic Community Services.
In other words, there is a mismatch between the environment in which we work and the systems we use to manage it. And that mismatch creates gaps in care that leave many people – especially the most vulnerable – struggling.
It’s a problem about which I’ve written extensively: our community health delivery systems are rooted in manufacturing management theories that fail to account for individual differences and social determinants of health. As a result, we have a fragmented, prescriptive system. Rather than improving or lowering the cost of care it has created a series of perverse incentives that result in the opposite.
Our current system values procedures over outcomes. It encourages providers to bend the rules to get people some help, even if it’s not the best help available. It operates in a triage-based cycle that encourages clients to present themselves as worse-off than they actually are. And, it incentivizes organizations to focus their resources on advocating for higher rates of pay rather than encouraging innovation.
In an attempt to make community health delivery more holistic, organizations are increasingly looking to alternative structures. The collective impact initiative is one such attempt, says Jill Sorenson, chief operations officer of FHI.
“There is tremendous waste, frustration and missed opportunity in a fragmented system. The collective impact approach is an attempt to remedy this by reintegrating care,” Sorenson says. “By building strong local networks, we are able to adapt and respond to the specific issues keeping individual neighborhoods and families from success. And by working closely together, we avoid wasting resources.”
Sorenson’s comments touch on three important attributes that make collective impact initiatives like FHI successful: it is community-focused, relies on strong multidisciplinary networks and is outcome-driven.
First, FHI is unquestionably place-based. The initiative focuses on neighborhoods that share specific risk factors but treats each neighborhood as a separate system. Serving as a liaison between each neighborhood and FHI is a dedicated community health worker (CHW) who is a member of the neighborhood he or she serves.
The CHW serves as trusted resource in the neighborhood, assisting individual families with anything from translating a letter to appearing with a parent in court to try to establish child support. They also facilitate Community Café’s, neighborhood conversations that focus on building the “Five Factors:” parental resilience; social connections; reliable support in times of need; knowledge of parenting and child development; and social and emotional skills of children.
“The Café’s are important for two big reasons,” says Esme Rios, one of FHI’s community health workers. “They’re one of the main pipelines through which we identify neighborhood issues that we can then build activities, resources and support around. And, they’re how neighborhood social connections are made and strengthened. It gives people who may feel disenfranchised a voice, and helps them build confidence and develop skills that can help them become leaders within the community.”
As an example of this crucial dual role, Rios recalls that during one Community Café, a number of parents with children with special needs discussed the unique difficulties they face. Rios reached out to other CHWs and found that parents in other neighborhoods were facing the same problems. As a result, she formed a topic-specific Community Café for this sub-group to share stories, develop self-care strategies and access targeted resources. The group has grown to include 27 families who meet regularly and have learned skills that have empowered them better advocate for their families’ needs.
Second, FHI relies on a strong, adaptable network of strategic partners to succeed and be financially sustainable. Far from a loose affiliation of agencies that just refer to each other, it has a local infrastructure, staff and processes to keep partners’ focus on specific objectives and facilitate ongoing communication and leveraging of resources. Each partner agency can thus focus on their own area of expertise while avoiding administrative and service overlap or scope creep that could derail cost savings or impact quality of service.
“By having an integrated group of service providers collaborating as one, FHI is able to get services to families in a more integrated and efficient way,” said Casey. “No one partner is required to provide everything. And, paired with the work the CHWs do in building natural, supports within each neighborhood, we’re able to intervene and mitigate the impact of many social determinants earlier – and prevention is always more efficient than treatment!”
Finally, FHI is focused on achieving specific outcomes, not on providing specific services.
In a federally-funded study of FHI’s success in reducing parental stress and preventing child maltreatment, relative to similar families in other neighborhoods, families receiving services through FHI reported statistically significant reductions in stress and none had been the subject of a child maltreatment case.
“We’re in the middle of a metamorphosis in delivery of healthcare and social services,” said Casey. “We aren’t going to change it overnight, but there is increasing recognition that social determinants have a huge impact on individual health, and FHI been successful in improving community health by recognizing that it is inherently place-based.”
In my next article, I will delve deeper into the concept of outcome-based pay and explore how Curandi is helping FHI use technology as a platform to support their networked approach and build a financially sustainable model for community health.
Special thanks to Catholic Community Services and Fostering Hope Initiative staff for their input and feedback for this article series.