Course – Lesson 1: VI. Models Guiding Us
LESSON 1:VI – Q+A with authors Katherine Ortega Courtney, PhD and Dominic Cappello
How does the research focused on the social determinants of health guide the 100% New Mexico initiative?
Dominic Cappello responds:
The social determinants of health are the conditions in the environments in which people are born, live, learn, work, and play that affect health, safety, resilience and risks. These are social, economic and physical conditions. Resources such as a health center, behavioral health care agency or early childhood learning program (the ten vital service sectors we focus on with our innovations) can create resilient community conditions and improve the quality of family life. Access to quality education, mentoring, stable food and housing have a significant influence on the health outcomes of children and parents.
Examples of resources that impact social determinants include health care, education, and a variety of user-friendly supports for children, youth and adults. Our entire initiative is focused on such vital services and include what we call the “survival services” which include: safe, affordable housing, local food markets, food programs and food pantries to reduce food insecurity, behavioral health care services, health care services including medical and dental care and transportation to vital services, education and work.
Still listed among services that determine one’s heath would be the five services we call the “thriving services.” They include: parent support programs like home visitation, quality child care and parent education, and early childhood learning programs.
A key service that can serve as the hub to most of our surviving and thriving services are Fully-resourced community schools where parents are welcomed and behavioral health, medical and dental care exists. Add to the list youth mentor programs and job training programs that are in alignment with local current and future job markets.
The social determinants of health also include social norms and attitudes (e.g., sexism, racism, and barriers to success based on low household incomes). Health disparities, concentrated poverty and the disempowering conditions that accompany it also impact the conditions in which families raise their children.
We believe that if we improve the conditions our families live in, we can decrease the causes and rates of childhood adversity, trauma and maltreatment.
Our 100% Community course is strongly influenced by our understanding of the social determinants of health and our local innovations are designed to address lack of services for families. Visit our research page to explore more on the social determinants of health.
What is the collective impact model and how does it inform 100% New Mexico initiative?
Katherine Ortega Courtney, PhD responds:
Developers of the Collective Impact model John Kania and Mark Kramer discuss, in the Stanford Social Innovation Review, how large-scale social change requires broad cross-sector coordination and the importance of social sector focusing collaboration instead of the isolated intervention of individual organizations. They describe how successful collective impact initiatives typically have five conditions that together produce true alignment and lead to powerful results.
The first condition, or components, would be a common agenda with shared vision and goals. Our 100% New Mexico initiative requires this first and foremost. We are taking on a huge challenge with a thousand moving parts, so the shared vision holds it all together.
A key component of collective impact is a shared measurement system which guides how data are collected, protected and shared. In our county initiative we start with our parent and youth survey, but many more assessments will follow in order to understand both the challenge ahead and the capacity to solve those challenges on the county level.
Mutually reinforcing activities, which include what our course projects call local innovations, are another vital component of the initiative. Collective impact works because all the activities are connected in some way, as though a county is building a system.
And, of course, that is what the 100% New Mexico initiative is, one system that is made up of at least ten systems that represent our ten surviving and thriving sectors. Put another way, we are one countywide coalition made up of ten coalitions. This is where the cross-sector nature of our initiative is important as what the action team on food discovers might very well impact what the action team on parent supports is working on. With so many participants working in ten action teams across a county, the third component of collective impact comes into play. This is continuous communication using social media and advances in technology.
And of course, any initiative that is going to be long term is going to need backbone support organizations to provide stability, funding and a physical meeting place. 100% Community requires a well-respected and well-run organization to serve as the sponsor.
Our 100% New Mexico initiative is strongly influenced by collective impact. Collective impact is used for systems change as it takes multiple people from multiple organizations coming together to make the kind of changes needed to ensure that 100% of county residents have access to ten vital services.
What is continuous quality improvement (CQI) and how does it guide our work?
Dominic Cappello responds:
CQI is described in more detail in the next online lesson, but for an overview it is helpful to know that the CQI framework exists in a variety of forms to guide projects in both the public and private sectors. For 100% New Mexico initiative we use the following four steps: assess, plan, act and evaluate. Another CQI framework uses the steps of Plan, Do, Study, and Act.
What’s most important to understand about CQI is that it is a data-driven process, one that asks us to carefully design an innovation that is backed by data every step of the way. Each of our four steps comes with a series of questions. These questions are asked in the following four web-based lessons. Your instructor and coaches can help you answer the questions that provide the foundation for your course project.
Our 100% Community course and entire initiative is built around the assess, plan, act, evaluate CQI framework.
What can you tell us about the adaptive leadership model?
Katherine Ortega Courtney, PhD responds:
The Practice of Adaptive Leadership by Heifetz, Grashow and Linsky is a required textbook for many reasons. We are huge fans of the adaptive leadership process, having been introduced to it while working with management in the child welfare system. When we were writing 100% Community, we could just imagine readers getting to the chapter on adaptive leadership and rolling their eyes when being told, “You need to read another book to implement the 100% New Mexico initiative successfully.” The truth is that the book and insights within are invaluable as we work to improve entire county systems. Initiative participants will have lots of technical challenges to address and while these are tough, they are doable.
Technical challenges are things like how to build a school-based health center, as in the actual nuts and bolts and construction issues. The adaptive challenge can be truly difficult and time-consuming. If we stick to the example of a school-based health center, the politics around it can be volatile. Some board members and parents may feel strongly that such an addition to a school is totally unnecessary. Others may suspect that a behavioral health care component to the center might bring up all kinds of issues, especially if ACEs are addressed. On the other side might be those eager to have a school-based wellness center and one stop shop for families, all in a place kids are already at. Bottom line, the adaptive challenge in this instance is listening really all to all voices, especially those who control whether or not a project like a school-based health center moves forward. The book, Adaptive Leadership, prepares us all for push back to change.
What I found very helpful is the authors’ take on change and how it has a lot to do with leaders or power-brokers feeling a sense of loss. I do not enter into any controversial community project without opening up Adaptive Leadership for a refresher on push back to change and getting on the balcony to take an objective look at a project where there may be division. At the beginning of our work in counties we were hitting one adaptive challenge after another. I kept my cool and optimism because of the lessons from Adaptive Leadership’s chapters.
How many frameworks and models guide the 100% New Mexico initiative?
Dominic Cappello responds:
To guide our 100% Community work, there are hundreds of helpful frameworks and models from the fields of public health, education, child welfare, youth development and early childhood education. We have chosen three to start with.
When it comes to developing an innovation, regardless of what the framework is called, you will need the skills of assessing, planning, action and evaluation.
As you develop an innovation, you may find yourself introduced to new models and frameworks. For example, if you were to work in the arena of early childhood education you would be introduced to the Reggio Emilio model, a very well-respected model for designing and implementing a specific type of learning program developed in Italy and used in the US. As you explore different service sectors, we encourage you to share with your program associates all models and the research guiding them. We will add them to our research page for all future 100% Community participants to access.
Is there a model for focusing on the positive, rather than just trying to fix what doesn't work?
Katherine Ortega Courtney, PhD responds:
Yes, there are many models and one we encourage you to explore is called appreciative inquiry. It is often called a strength-based approach and was developed by David Cooperrider at Case Western University and focuses on asking questions in order to foster positive relationships, which lead to envisioning a future that works better for all involved in a project.
The model uses a process that includes: discover, dream, design and destiny. When we looked at the article, “A Positive Revolution in Change: Appreciative Inquiry” by Cooperrider & Whitney, D. (Taos, NM: Corporation for Positive Change, 1999), we saw some summary statements about the model that we found inspiring: “Words create worlds. Inquiry creates change. We can choose what we study. Images inspire action. Positive questions lead to positive change.”
We might not spend a lot of time discussing appreciative inquiry but it’s a helpful model to know about as we move into communities to listen, learn, imagine and collaborate.
What are the goals of the course and benefits to participants and their agency staff?
Dominic Cappello responds:
The goals of the course are increasing participants’ skills in:
- Data mining and analysis in order to identify challenges in providing quality services agencies and create ways to address those challenges using a data-informed decision-making process
- Journal research and analysis to learn how other states and countries have addressed health and safety challenges
- Communicating, facilitating, brainstorming, developing questions, creating an hypothesis, and testing assumptions in order to launch local innovations
The benefits of the course are:
- Workforce and community, skilled in using CQI, to strengthen agencies to serve families and children
- A community of agency leaders empowered to facilitate change using a collaborative and data-driven process
Improved services for families leading to better health and safety outcomes for children and parents in the community
