Report of the Workshop



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Effective Services for Young Children: Report of a Workshop Report of the Workshop

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Effective Services for Young Children: Report of a Workshop This page in the original is blank.

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Effective Services for Young Children: Report of a Workshop Effective Services for Young Children The Workshop on Effective Services for Young Children was based on the premise that a great deal is now known about how to make early education, health programs, and social services more effective, especially for the populations most dependent on good public services, who have not been well served in the past. A second assumption was that local communities are having a hard time improving services within the context of existing institutional and bureaucratic structures. The hope was that a group of thoughtful and well-informed individuals, representing both the public and private sectors, could identify strategies to improve the effectiveness of programs and policies for young children and families. The workshop began with a review of the attributes of programs that had improved outcomes for disadvantaged children and discussion of the implications for making systems more hospitable to effective programs. Lessons from past attempts to accomplish similar goals were then considered. Following this discussion, participants considered promising strategies to modify how services are organized and financed, how practitioners and program managers are trained, how programs are held accountable, and how services are coordinated. The need for expanded public understanding of the nature of both problems and solutions was emphasized. One question participants struggled with throughout the workshop was the extent to which various groups of the population could be expected to benefit from similar strategies. Participants seemed to concur that different interventions were needed for different populations. Three overlapping populations were identified: (1) all children who live in poverty at some time during their childhood (comprising about 30 percent of all children); (2) all children who come to the attention of public agencies as requiring special

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Effective Services for Young Children: Report of a Workshop help (7-10 percent of all children); and (3) all those who live in geographic areas of concentrated poverty and social dislocation (comprising about 10 percent of poor children). Although there certainly is overlap, the strategies that would improve outcomes among the three groups are not identical. All poor children could benefit from more accessible and higher-quality health care, expanded and improved child care, and more effective schools and social services. Improved income support programs, including expanded earned income tax credits, and job training and placement should also benefit these children and their families. Most participants recognized a need for economic policies and other measures to increase incomes of poor families in addition to services, and they opposed the idea of supporting one approach (i.e., benefits versus services) over the other. Most participants agreed that the most pressing problems seemed to be among children with multiple needs, including children in families who are unlikely to be lifted out of poverty and disadvantage solely by income supports or improvements in the general economy. Services for these children, and for the children and families who fall into the population of what has been called the truly disadvantaged, were the primary focus of most of the workshop discussion. A second recurrent contextual theme concerned the weaknesses of current services. There was broad agreement that most services tend to be fragmented, categorical, inaccessible, episodic, arbitrary, and unresponsive to family needs. Services are generally late, too narrow, too shallow, and too impersonal and give too little attention to families, neighborhoods, and communities. Observations and anecdotes were offered to confirm the ineffectiveness of services for children and families. ATTRIBUTES OF EFFECTIVE SERVICES The past 25 years have yielded substantial information about what makes services for children and families successful. The background paper by Lisbeth Schorr draws on the book, Within Our Reach: Breaking the Cycle of Disadvantage (Schorr, 1988), which described and analyzed the operation of some 17 programs in the fields of family planning, prenatal care, child health, child welfare/family support, child care and preschool education, and elementary school education, all of which had shown evidence of reducing rates of damaging outcomes or their antecedent risk factors among disadvantaged children. The nature of the evidence Schorr employed for determining what programs were effective combined relevant quantitative data with other kinds of information from theory, research, and experience. This meta-analytic approach, which includes but is not confined to quantitative data, makes it possible to make rigorous and informed judgments about what has worked

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Effective Services for Young Children: Report of a Workshop in the past and what is likely to work in the future, even among complex, multifaceted and interactive interventions. The workshop discussion suggested considerable agreement that the following attributes, identified in the paper, account for the effectiveness of successful programs. Successful programs are comprehensive, flexible, and responsive. They take responsibility for providing easy and coherent access to services that are sufficiently extensive and intensive to meet the major needs of those they work with. They overcome fragmentation through staff versatility, flexibility, and active collaboration across bureaucratic and professional boundaries. Successful programs deal with the child as an individual and as part of a family, and with the family as part of a neighborhood and a community. Most successful programs have deep roots in the community and respond to needs perceived and identified by the community. They tend to work with two, and often three, generations, collaborating with parents and local communities to create programs and institutions that respond to unique needs of different individuals and populations. Staff in successful programs have the time, training, skills, and institutional support necessary to create an accepting environment and to build relationships of trust and respect with children and families. They work in settings that allow them to develop meaningful one-to-one relationships, and to provide services respectfully, ungrudgingly, and collaboratively. Moreover, front-line workers in these programs are given the same respect, nurturing, and support by program managers that they are expected to extend to those they serve. Programs that are successful with the most disadvantaged populations persevere in their efforts to reach the hardest-to-reach and tailor their services to respond to the distinctive needs of those at greatest risk. Many of the programs providing health, education, and social services to multiply disadvantaged children and families find it essential to combine these services with the supports traditionally provided by families. Successful programs are well managed, usually by highly competent, energetic, committed and responsible individuals with clearly identifiable skills and attitudes. Contrary to the common belief that great charisma is essential for running a successful program, managers of effective programs have identifiable attributes that can be learned and systematically encouraged, such as a willingness to experiment and take risks, to tolerate ambiguity, and to allow staff to make flexible, individualized decisions. Successful programs have common theoretical foundations that undergird their client-centered and preventive orientation. Staff of these programs believe in what they are doing. Effective programs seek to replace the

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Effective Services for Young Children: Report of a Workshop prevailing preoccupation with failure and episodic intervention with an orientation that is long-term, preventive, and empowering. Some observers have concluded that programs that incorporate these attributes will never become available to large numbers of low-income families because such programs typically exist outside or at the margins of large human service systems and are therefore difficult to replicate. The Schorr paper suggested an alternate conclusion: that if these attributes are what it takes for success, systematic exploration is required of how prevailing policies and practices could be changed to support and encourage the adoption of these attributes in all programs and systems serving poor and otherwise disadvantaged children and families. Before examining the strategies that could create the needed systems change, the workshop participants considered what might be learned from earlier large-scale reform efforts. LESSONS OF THE PAST AND STRATEGIES FOR THE FUTURE Efforts of the last three decades to restructure human service systems and the lessons that emerge were presented by Peter Edelman and Beryl Radin. In their paper on this topic, they described the Community Action Programs (CAP) of the Office of Economic Opportunity and the Model Cities Program of the Department of Housing and Urban Development, which were developed in the 1960s to create mechanisms to deliver services to the underserved more effectively than existing institutions. Some of the CAP agencies, including Head Start, thrived and survived; other parallel, federally funded, ''untethered'' agencies did not survive but succeeded temporarily as yardsticks against which the performance of existing programs could be measured and as goals to push old-line agencies to do better. The CAP legacy also included a group of people "who were nurtured, learned to use the system, and went on to community leadership." The Model Cities Program was designed to pull together existing categorical programs at the local level to make them more responsive to the needs of the poor. The model cities concept of combining education, health, and social services with housing and physical renewal was crushed almost before the program was launched as a result of dissipated authority and radically reduced funds. When the inadequate resources were spread over 66 cities rather than the 4 to 6 originally intended, the potential for making a difference was destroyed. Nonetheless, the efforts of the 1960s, when divested of the caricatures and rhetoric with which they have been surrounded, carry some clear lessons for the 1990s:

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Effective Services for Young Children: Report of a Workshop Government at all levels has a role, but cannot do its job without the participation of other institutions, agencies, and individuals. The federal government exercises its greatest influence by how it pays for services. Local and perhaps state governments have important roles in the coordination of services. One important but neglected government role is "to help rediscover and rebuild the sense of community that we have lost in too many places." Major problems cannot be solved without money, but money won't do the job unless deeper structural failings are confronted. "Measures to make services comprehensive, accessible, and better coordinated . . . will miss their mark unless they are accompanied by adequate funding, . . . better education and training, . . . and changes in personnel policies . . . ." Basic institutions that make up a community must be restored. New program designs require "a balancing of professional and community involvement that eluded reformers in the 1960s." There are interventions that work, but they must be coordinated and combined, even though it is difficult to get the political decision making system to act in comprehensive terms, since decision making responsibility is fragmented. Furthermore, there are few multiservice interest groups, and fragmentation and inaccessibility serve the function of rationing utilization. Mechanisms that overcome fragmentation include multiservice centers, service centers attached to schools, reinvented settlement houses, and offices or bureaus that coordinate services for children and youth. Place-specific models could play a fundamental role in rebuilding a feeling of neighborhood and community, especially in areas of intense poverty. "A fully funded, highly targeted, comprehensive approach in an area of great poverty has never really been tried." A coordinated effort, according to Edelman and Radin, should not only include comprehensive and responsive services and schools, but should also attend to housing, public safety, and economic development, allowing these interventions to build on one another to achieve a visible level of effectiveness. They conclude by calling for "a few demonstrations that are comprehensive on a synergistic scale never before attempted." This last proposal elicited considerable discussion. Participants emphasized that if such demonstrations were undertaken, it would be important from the beginning to set up financing arrangements as parts of existing systems, so that successful demonstrations could be readily expanded to additional communities. The chances of success could also be enhanced by establishing a center that would provide the respected auspices and the insulation from outside pressure to put coherence and discipline into related sets of demonstration programs, e.g., an entity such as the Manpower Demonstration and Research Corporation, which bridges politics, policy making, and the social sciences.

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Effective Services for Young Children: Report of a Workshop Whether such projects should be funded through a political jurisdiction, such as a county or city, or through a local institution (e.g., a school, a community development corporation, a community health center, or a public/private intermediary organization) was the subject of debate. In any case, it was emphasized that the public bureaucracies, as well as the private sector, must be included from the outset. It was also suggested that the difficulties such a complex, multifaceted program would encounter in maintaining a clear sense of mission would have to be taken into account. Participants acknowledged that such a saturation strategy would be a formidable task, with a significant risk of failing in at least some of the sites. The chance of success would be increased if the target communities had an existing base of strong local institutions, networks, and leadership, along with a degree of commitment from the business community. Political realities were also brought into the discussion. The fact that areas of concentrated poverty are not spread evenly throughout the states creates a political obstacle for any strategy that focuses on problems affecting only a few states. It was pointed out that seven states have 50 percent of this country's children, and the most serious problems of children and families are even more concentrated; for instance, one out of three foster children lives in New York or California. This does not mean that geographically targeted strategies should not be attempted; it simply means that garnering the necessary political support, especially at the federal level, will not be easy. STRATEGIES TO ENCOURAGE SYSTEMS CHANGE Considerable agreement emerged around the contention that successful programs could not be made available to all who need them without substantial change occurring in large systems and institutions. The challenge is to make these institutions and systems hospitable to and supportive of the essential attributes of effective programs. Most participants also seemed to believe that in most circumstances the time for launching additional small-scale, program-specific demonstrations may be past, and that among the most critical tasks ahead was to take successful programs to scale. Consideration of how this might be done occupied most of the workshop participants' energies. Several strategies aimed at institutional and systems change to improve programs for disadvantaged children and their families were discussed, including changes in financing, training and technical assistance, coordination and collaboration, the use of outcome measures, and efforts to create greater public understanding. Although each of these strategies was considered at separate sessions, participants in each session made

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Effective Services for Young Children: Report of a Workshop it clear that these strategies had to be combined so their impact would be interactive, for none would be effective in isolation. For example, the discussion of financing strategies made clear that the best innovations in financing methods could not make up for insufficient funds. However, additional funds are unlikely to be obtained without better evidence that programs achieve socially desired outcomes and without more effective public education. Participants in the session on training agreed that traditional professional training may contribute to but does not cause fragmented, discontinuous, and ineffective services. Both improved financing arrangements and a shift to outcome accountability could do much to support new skills and new attitudes on the part of practitioners. The session on collaboration emphasized the contribution that flexible funding, staffing, and cross-disciplinary training could make to successful collaboration and coordination. In this summary and in the seven background papers, the various strategies are considered individually; the reader should keep their interdependence in mind. New Financing Strategies The background papers on financing, written by Frank Farrow and Drew Altman, emphasized that methods of financing services directly affect the nature and outcomes of services by shaping priorities and incentives and by influencing how useful services are to families. More flexible and more permanent funding arrangements could do much to make services more effective and to reinforce new and improved policy directions. However, both authors agreed that without sufficient levels of funding, no financing methods can ensure adequate services. The Farrow paper points out that most effective programs incorporate multiple funding sources and cut across traditionally separate service domains. The paper describes funding innovations of several kinds that are beginning to occur at the state level. The most basic approach involves joint funding of services across agency lines in order to achieve common goals. Agencies share the costs of services that they would otherwise provide independently, thus reinforcing a common policy direction and increasing the likelihood of more coordinated service delivery at the local level. Cross-agency financing of this type is a modest step, but it has real benefits at the local level and represents a step toward more flexible, less categorical financing. States have also evolved new ways of using federal entitlement programs to expand the funding base available for children and families. They use federal entitlements, such as Medicaid dollars, to cover as broad a range of

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Effective Services for Young Children: Report of a Workshop services as federal law will allow and as state budgets can accommodate. As an example of how entitlement sources could be tapped in new ways, the Altman paper proposed that states designate school-based services programs as participating Medicaid providers, since the large majority of young people using school-based health and human services programs are Medicaid-eligible. These funds could make a significant contribution to stabilizing school-based projects and reaching more of the underserved. States are also claiming federal entitlements more aggressively for costs previously paid entirely by state and local funds, thus freeing those state and local funds for reinvestments in service system improvements. For instance, by expanding Title IV-E claims to the maximum extent allowed under federal law, states can dramatically increase available funds. Yet another strategy being used by a growing number of states is front-line service financing through use of flexible dollars. In this approach, funds are allocated to meet families' individual needs at the actual point of delivery; practitioners have discretion in the use of a specified sum of money to purchase goods or services to help accomplish a family's goals. A fourth strategy aims at greater flexibility in the use of state-appropriated funds to meet family needs, with authority over those funds delegated to local entities. This strategy is a more fundamental shift from centralized, usually categorical state decision making toward more flexible local control over funding decisions. Iowa's broad decategorization initiative in two demonstration counties is an example of this strategy. In considering strategies to overcome the perceived ill effects of categorical funding—such as that it tends to undercut efforts to provide comprehensive, coordinated services, workshop participants identified certain risks and limitations attached to the decategorization of funding streams. As the Altman paper points out, decategorization can do little to add dollars to an underfunded system and may not save as much money as is often claimed. Moreover, categorical programs have traditionally been better able to rally the political support necessary to obtain greater funding and to resist the budget ax. Despite these concerns, many participants viewed decategorization as a useful step in improving services for families and children and proposed several specific actions to encourage decategorization. The Altman paper also suggested federal action to promote integrated funding streams and services integration through a little-known entity called the Low-Income Opportunity Advisory Board (LIOAB). The LIOAB, established by President Reagan, brings together in the White House all the federal agencies responsible for the major social programs. According to Altman, "the LIOAB has the authority not just to tinker with categorical programs, but to help effect the thoroughgoing changes necessary to enable states and communities to pool financing, to reorganize services, and, generally, to change the rules and try out new approaches."

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Effective Services for Young Children: Report of a Workshop Using the LIOAB, the President could launch a national integrated services initiative, establishing guidelines, soliciting proposals from states and communities, and providing necessary waivers and pooled funding. If the White House chose not to take that role, the Department of Health and Human Services could take the lead. Other proposals to encourage decategorization were also considered, including provision for the evaluation of demonstration efforts and the funds to support them. New Emphasis on Practice-Based Training for Practitioners and Managers The paper by Douglas Nelson on the role of training and technical assistance suggests that, if provider-client interactions are to become more collaborative and family-centered, with greater flexibility and discretion, practitioners and managers must acquire new perspectives and new skills. New forms of preservice education and in-service training are needed, which emphasize: (1) the family context in assessing and addressing problems and providing support; (2) the communication and interaction skills that encourage trust and mutuality between provider and client; and (3) the diagnostic skill and knowledge about resources that enable practitioners to take broader responsibility for identifying and addressing the diverse range of problems that families experience. These areas must be addressed more effectively in the curricula of professional schools as well as in practice-based training; they must also be central to the ongoing supervision and evaluation that serve as an important form of continuing training to workers on the job. Training practitioners to be comfortable and skilled in situational, collaborative, interactions is a different enterprise than teaching people how to follow certain set procedures. The skills needed to deal with clients effectively situation-by-situation are difficult to reduce to textbooks or practice manuals; rather, they are more effectively taught through case illustrations, observation of actual practice by experienced workers, and constructive criticism of work in actual service settings. The Nelson paper proposes that, in the provision of such training, exemplary service settings and programs clearly have a key role to play as learning centers. Although participants differed on the particulars of this role, no one questioned the importance of practice-based training. The use of exemplary programs as training sites was appealing for three major reasons. First, practice-based and experiential learning is pedagogically sound, especially for learning the kinds of skills and attitudes in question. Second, programs identified as learning centers because of their exemplary practice would get the kind of visibility and recognition that would encourage them

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Effective Services for Young Children: Report of a Workshop and expand their influence. Third, initially it is probably easier to change the content and orientation of training programs in practice sites than in academic institutions. A serious practical issue for practice-based training is whether there would be enough field opportunities in exemplary programs to provide the training that is seen as desirable. At the present time, according to participants, not even the minimal quantity and quality of practice-based training sites are available. Training large numbers of front-line service providers in exemplary programs requires public- and private-sector investment to greatly expand practice-based training. Participants urged that colleges and universities be encouraged to undertake much more cross-disciplinary training. Some participants were quite skeptical about the possibility of making changes in academic institutions of the breadth and depth that are needed. Others were more optimistic, arguing that even academic institutions are market-driven. It was acknowledged, however, that such change will take time and will require a gradual shift in perceptions of acceptable training by students, practitioners, and the institutions in which they work. Perhaps the greatest risk is "pseudo-change" within the academic institutions and other organizations who do training. Because of categorical funding, turf issues, and inertia, institutions might simply co-opt the new perspective and claim to be teaching new skills without actually making major changes in the content of their curricula. Expanded Technical Assistance Capacity Participants agreed that a greatly expanded technical assistance capacity is needed, both nationally and regionally, to provide state and local administrators and managers with the requisite level of fiscal, organizational, and political expertise to change organizational cultures and institutional environments. Today most administrators of human service programs lack familiarity with the interplay and intricacies of the funding streams that shape the amount and kind of services available. They are seldom prepared to develop or adopt a shift toward the use of outcome measures in accountability systems and evaluation. And most policy makers and administrators have too little training and skill in the arts of public and political education that are critical to changing services for children and families. These crucial skills, abilities, and interest could be brought more fully into the efforts to improve services by increasing the cadre of national consultants who can provide technical assistance in support of state and local efforts. A start has been made in such initiatives as the Clark Foundation's Technical Assistance Forum, but a far larger and broader technical capacity is critically needed.

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Effective Services for Young Children: Report of a Workshop The long-run objective is to build at state and community levels a greater level of knowledge and experience in affecting the larger environments in which services are delivered. One relatively untapped resource to help reshape the capacity of institutional and policy environments is individuals with administrative and policy-level positions who have many of the requisite abilities, but lack the conventional credentials. For example, hospitals and nursing homes recruit retiring Medicaid directors for their experience and skill in manipulating state organization and fiscal environments. Given the urgent need, it was judged important not to overlook those who already have the ability and experience to make significant change in institutional and policy environments. One proposal that generated considerable interest among participants was to encourage the creation of regional centers or other intermediaries to provide technical assistance to state and local governments and to groups of providers. These centers or intermediaries would offer assistance related to the changing of the organizational culture and provide expertise in financing, management information systems, collaborative strategies, leadership development, and the use of outcomes-based approaches. Intermediaries like the Ounce of Prevention in Illinois and Florida, and Friends of the Family in Maryland, seem to be successful in nurturing local programs, buffering them from bureaucratic and political pressures, interpreting the needs of the programs to state officials, providing training and technical assistance, and furnishing program managers and policy makers with information that can lead to more responsive programs and policies. Participants emphasized the need to be specific and detailed in the objectives of technical assistance, as well as in the training of workers. Otherwise, the frequent vagueness of training goals for workers ("Let's get someone to talk about counseling") will also pervade technical assistance efforts ("Let's get someone to talk about financing"). This level of detail, it was emphasized, is far from sufficient for equipping individuals to move large systems and institutions through extensive and dramatic changes. From the discussion emerged a sense that the capacity and the incentives to develop new thinking about the provision of effective services are missing. New mechanisms and institutions are needed to promote more systematic, more strategic, and less random approaches to encouraging, supporting, evaluating, and learning from current and future efforts to improve services for disadvantaged children and families. Active Collaboration and Coordination Across Professional Bureaucratic Boundaries At the workshop, the working definition of collaboration was simply "people of different organizations working together." Collaboration is not

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Effective Services for Young Children: Report of a Workshop an end in itself, participants stressed; it is only worthwhile as a means to an end. A major reason for collaboration is that no single system can effectively help the children and families in greatest need of services, because they are likely to have multiple and interrelated problems that spill over traditional bureaucratic boundaries. Despite increasing recognition of the need for collaboration and coordination, these attributes are not widely achieved or, for that matter, attempted. The obstacles to collaboration are numerous and complex. Rigid bureaucracies, past practices, and categorical funding streams head the list of barriers. In addition, teachers, social workers, medical personnel, mental health clinicians, and other professionals and service providers have different educational backgrounds, speak different languages, and look to their own professions for recognition, respect, and promotion. Furthermore, when several programs with different missions begin to collaborate, outside observers may fear that each of the participating programs is neglecting its core mission. In addition, many of the present mechanisms for accountability operate against collaboration. Services to children and families in the United States exist in multiple governmental jurisdictions, and thus multiple lines of accountability. Accountability is defined narrowly in most cases, since measuring the goals of narrow missions is far easier than measuring the goals of integrated missions. Finally, organizational change is particularly hard for large organizations and systems when they are operating in tight fiscal environments and having great difficulty performing their respective missions. Most people in service systems today do not even have the time and resources to perform their core functions, much less to invest in the process of change and a broad consideration of their mission. At present, the major systems serving children and families are, as one participant put it, "persistently failing organizations." Nonetheless, across the nation there are examples of organizations that have surmounted these obstacles. Based on an analysis of successful collaborations, the following characteristics appear to be important (for greater detail see the paper by Olivia Golden): Redefined and overlapping missions. Collaborating organizations have succeeded in developing overlapping conceptions of mission and in enlarging agency missions beyond conventional limits. Conflict resolution. In effective collaborations, people recognize that conflict between the organizations will not disappear and develop ongoing mechanisms for resolving conflict. Commitment of administration time. Managers and administrators in successful collaborations devote considerable time and attention to collaboration, spending time looking out from their organizations rather than simply up or down within them.

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Effective Services for Young Children: Report of a Workshop Importance of personal relationships. Collaboration seems to thrive when managers and front-line staff cultivate personal relationships as a basis for collaboration. Exchange relationships. Collaborating agencies have some basis for exchange, something they can do for each other. Involvement of those served and a broad spectrum of the community. Such involvement at all stages of the collaboration appears to be key to success. Participants noted that in promoting collaboration, there is an underlying tension between restructuring systems or focusing on creating viable linkages and joint projects between systems as they exist currently. In the successful collaborations to date, there is activity on both levels. Participants suggested it is probably not necessary to choose one route or the other. Several participants observed that collaboration and coordination among health and social services, welfare departments, and schools are unlikely to progress far in the absence of financial and other incentives from all levels of government. Participants voiced support for actions encouraging states and cities to experiment with partnerships in which the city takes responsibility for services to children and the state agrees to support that responsibility. To begin, a mayor might convene and get involved in a community-wide process of assessing needs. The New Beginnings effort in San Diego is an example of such an approach. One participant suggested the creation of a cabinet-level position (e.g., Secretary of Children's Services) and similar positions at the state, county, and city government levels. Funds and programs dealing with children (particularly poor children from birth to six), now housed in various other government agencies, would be redirected into this department. Alternatively, a variety of federal funding streams would pass through a Children's Services Office, where they would be blended into services and programs that deal with children and their families in a more holistic way. Participants' views differed on what it meant to make reforms from the top down or from the bottom up, but there seemed to be agreement that efforts that go in both directions simultaneously are most effective. Greater Emphasis on Using Outcome Measures to Ensure Accountability Within public education and human services, the primary question asked of practitioners is: "Did you do what you were told to do?" This question is reflected in the nature of performance evaluation, in the forms that personnel at all levels are asked to fill out, and in the defense offered to account for failure: ("I taught them, but they didn't learn!")

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Effective Services for Young Children: Report of a Workshop The paper by David Hornbeck on outcome measures argues that results must control practice. The right question is ''Did it work?'' Trying hard and following a set of prescribed procedures are no longer enough. In the view of workshop participants, outcomes measurement is an important tool of systems change and improved performance of providers. It may also become a precondition for obtaining additional funds and more flexible funding arrangements. Signs of growing outcomes orientation are emerging in public education and, to a lesser extent, in other sectors. The national education goals and objectives for the year 2000, established by the President and the governors, reflect this orientation. The National Education Goals Panel will issue an annual report card on the states, and Congress is considering a bill to establish a similar report card panel. An outcomes-based strategy is central to the Business Roundtable's 10-year commitment to join each of the states in changing the process and product of education. An aggressive outcome strategy has been legislated in Kentucky and is being considered in other states. Outcomes approaches are emerging outside education, as in the Public Health Service's Year 2000 health objectives for the nation. Certain features essential to an outcomes based approach are outlined in the Hornbeck paper. First, it is important to examine the underlying assumptions that "provide the lens through which one will identify the outcomes to be achieved." For instance, in education, a critical assumption is that all children can learn at significantly higher levels. Next, it is essential to identify the outcomes that the program or system is expected to produce with children and families. The expectation level of outcomes defines the results: if little is expected, little will be accomplished; if expected outcomes are high, much can be achieved. For each outcome area, measurable indicators must be defined. Third, assessment strategies must be as rich as the outcomes one wishes to achieve. Outcomes that are not measured will soon become irrelevant. For instance, the educational outcome of students' acquiring strong writing skills probably will not be achieved if assessment is done only through multiple choice testing. The fourth essential feature of an outcomes-based approach, and the most controversial, is attaching consequences to success or failure in achieving results. Incentives for success and disincentives for failure must be a routine part of the system. And those held accountable, particularly those closest to the clients, pupils, patients, or families, must have the power to decide what strategies are used to accomplish the objectives. It is not sufficient simply to define high-expectation outcomes and attach consequences to success or failure in achieving them. Those who are accountable for achieving the outcomes must have the capacity to do so, which means substantial changes in preservice and in-service training. A

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Effective Services for Young Children: Report of a Workshop number of other enabling conditions also will be necessary for success. For instance, Kentucky considers the following conditions necessary for desired educational outcomes: prekindergarten for all disadvantaged children, a family resource center in every elementary school with 20 percent or more poor children, and a youth service center in every secondary school with 20 percent or more poor students. Although community-wide commitment to defining and achieving outcomes for children and families was seen as important, workshop participants stressed that particular institutions—not just the community in general—must be held accountable for results. The operation of these institutions and the results they achieve will be powerfully changed by an outcomes-based approach. Complementary Functions of Outcomes Assessment and Evaluation Participants distinguished between outcomes assessment, which documents results (i.e., we got from Point A to Point B), and evaluation, which tells us how the program results were achieved. Evaluation also illuminates what elements of an intervention actually made a difference. For instance, outcome assessment for a prenatal care program, which might include rates of infant mortality, low birthweight, and other measures of infant and maternal well-being, would be intended to answer the basic question of whether the prenatal care worked. An evaluation design would attempt to determine the effectiveness of certain specific components of the program, such as childbirth classes or smoking cessation intervention. However, it was noted that it is important to keep in mind that many interventions seem to be effective because their multiple components work interactively. In these instances, a detailed, "thick" description may be the best guide to how the intervention produced desired outcomes. Well-designed evaluations can make use of the new interest in face-valid outcome measures and provide contextual information that helps in interpreting outcome data. For instance, outcome measures may indicate that, after a two-year initiative to reduce adolescent pregnancy, the teenage pregnancy rate had risen. Evaluation data may reveal that the percentage of low-income families in the area rose over the two-year period, that pregnancies increased at a greater rate among comparison groups not targeted by the program, or other factors that help to explain the rising rates. Clearly, an outcomes approach carries political risks as well as benefits. On the positive side, centering political debates around outcomes can be a good way of mobilizing support. But political support may be eroded when outcomes are less favorable than expected, even when exogenous factors are the cause. The shift toward wider and more appropriate use of outcome

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Effective Services for Young Children: Report of a Workshop measures would be helped along, one participant suggested, by an "honest politician's guide to outcome measures and evaluation." Such a guide would include warnings that an unthinking application of outcome measures, such as undue reliance on standardized tests or a misunderstanding of the impact of such exogenous factors as the changing population of a community, could have unfortunate results. Some participants warned of the danger of relying on outcomes assessment unless the shift to emphasizing outcomes is also embedded in an overall approach that shapes all key components. According to Hornbeck, these components include: substantial control by those held accountable; appropriately rich assessment measures; staff development; and the enabling conditions needed to realize the specified outcomes. With this caveat, participants were enthusiastic about the potential of an outcomes approach improving systems toward more effective services. New and Expanded Efforts to Educate the Public and Policy Makers A panel of participants (James Comer, Richard Wehling, Kati Haycock, and Ann Rosewater) presented remarks on the need for better public understanding of these important, complex issues and how it might be brought about. Survey data from the Advertising Council's campaign on Breaking the Cycle of Disadvantage indicate that a large proportion of the public does not have a fundamental understanding about the current conditions or urgent needs of America's children and families, particularly those who are poor. Even when there is awareness of the issues and concern, people often feel immobilized by the magnitude of the problem and by the belief that outcomes are fully under individual control, with no need for a supportive environment. Public education efforts will be more effective, the panelists suggested, if these efforts articulate a vision of what might be, describe obstacles to achieving the vision, include evidence of strategies and programs that work, and document that the costs of inaction exceed the costs of appropriate action. More people need to understand that changes in the economy require a higher level of education and social skills today than in previous generations and, furthermore, that systematic social action, including governmental action, can make a difference. These messages must be accompanied by the recognition that there are no quick, cheap fixes or solutions. Patience and the adoption of a long-term perspective are essential components of any public education effort, since the real impact of effective services must be viewed intergenerationally.

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Effective Services for Young Children: Report of a Workshop CONCLUSION Today there is a ferment of activity and experimentation in states and local communities to improve the circumstances of children and families, especially the disadvantaged. Reform is under way in each of the systems serving children and families—health, education, social services, and family support. Consensus is emerging, as this workshop illustrated, on many of the directions in which the nation could move to provide more effective services to children and families. Workshop participants identified some options and strategies for creating the changes needed to make services effective—not just here and there, for children and families served by a few exemplary programs, but for large numbers of families served by mainstream service systems. Innovative ideas in the areas of training and technical assistance, financing, collaboration, outcomes measurement, and public education were debated individually and in the context of systems change. A clear theme was the need for multiple interactive approaches to improving services for children and families. Participants considered it unwise to prescribe a single approach to improving services for young children. The overwhelming sentiment seemed to be that changing circumstances should guide choices between major systemic reforms and incremental change within existing systems; between improving and expanding programs operating within the mainstream of public systems and those operating under "protective bubbles"; and between measures to benefit the majority of poor children and families and the subset of the population whose future is most dependent on improved services. Similarly, participants were wary of prescribing a single local institution as the one around which more effective services should be organized. At the same time, participants agreed on the major attributes of effective programs and favored more concerted efforts to bring about needed changes in major institutions and systems. They also concluded that the workshop deliberations should become part of continuing systematic endeavors to encourage the kind of changes in policies and practices that could result in vastly improved outcomes for the nation's children.

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