New York Times bestselling author
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President and CEO, StriveTogether
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Senior manager of policy and partnerships, StriveTogether
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Christian Motley, senior manager of policy and partnerships, StriveTogether
[00:17] Hi, I’m Christian Motley, from StriveTogether®, your host of Together for Change, where we explore what’s possible when people work together for an equitable recovery.
Today we’re going to explore what it means to move from reacting to problems to preventing them by going upstream with StriveTogether President and CEO Jennifer Blatz and Dan Heath, author of Upstream: The Quest to Solve Problems Before They Happen. Dan is the co-author of four New York Times bestsellers and a senior fellow at Duke University’s Case Center, which supports social entrepreneurs. Dan, how are you?
Dan Heath, author of Upstream: The Quest to Solve Problems Before They Happen
[00:49] Hey, Christian, how are you?
[00:50] Doing well. Jennifer has designed, developed and implemented strategies that drive large-scale community improvement through partnership with local leaders and organizations that make up the StriveTogether Cradle to Career Network™. Jennifer, always glad to join here.
Jennifer Blatz, president and CEO, StriveTogether
[01:05] Thanks for having me, Christian.
[01:07] Well, let’s jump in. Dan, you published your book about upstream thinking well before we found ourselves in the midst of these dual pandemics, this global health crisis of COVID-19 and the pandemic of persistent systematic racism. In your book, you name three barriers to upstream thinking. And I’m wondering if we can start by just having you give us an overview of what these barriers are, and how you see them playing out in this current crisis.
[01:32] For the listeners who are unfamiliar with this upstream terminology, I first learned about this word used in this way in a parable that’s prominent in public health, and it’s often attributed to Irving Zola. So, I can tell this parable in 45 seconds and come back to your question.
So, the parable goes like this: You and a friend are having a picnic beside a river. You’ve just laid out your picnic blanket. You’re about to have a feast when you hear a shout from the direction of the river, and you look back. There’s a child thrashing around in the water, apparently drowning. And so both of you instinctively dive in, you fish out the child, you bring them to shore. And just as your own adrenaline is starting to recede a bit, you hear a second shout, you look back, it’s another child also apparently drowning. And so, you go right back in, you rescue that child, you bring them to shore, and then it’s two more children. And so in and out, you go and you’re saving kids, you’re also starting to get tired and right about then you notice your friend swimming to shore and stepping out and then walking away as though to leave you alone.
And you say, “Hey, where are you going? I can’t do all this work by myself.” And your friend says, “I’m going upstream to tackle the guy who’s throwing all these kids in the river.”
And that in a nutshell is what I’ll talk about when I use the word upstream in this interview.
[02:56] It’s this notion that so often in life, we find ourselves unwittingly trapped in a cycle of reaction. We’re putting out fires every day or responding to emergencies. It’s react, react, react every day. And we never seem to have the wherewithal or the time or the bandwidth or the money to get upstream to solve these problems at the root.
Now to get back to your question, you were asking, you know, what is it that pushes us downstream so reliably? Because I think we can all attest that life tends to push us downstream. And I identified three things. One is problem blindness, which says, we can’t solve a problem if we can’t see it. And there are a couple of different forms of problem blindness. One type of problem blindness says that when we’re surrounded by a problem for an awful long time, we can kind of just forget it’s a problem. You know, if you think about factory farming, I think the insane way that animals are treated for our food supply is one of my picks for what people 50 years from now will look back and say, “What in the hell were you people thinking? How did you not see this was a big deal?”
[04:05] Another form of problem blindness is a little more insidious. And that’s, we may notice something is a bad thing. But we may just assume, well, that’s just the way the world works, you know. And that’s where I think the George Floyd case came in. For so long, we’ve been witnessing these incidents where often black men were killed by police, and it felt like there was just a kind of societal shrug, you know. It’s like we were outraged by the video for a few minutes. And then, you know, we shrug our shoulders and say, “Well, you know, bad things happen. It’s a complex world. And policing is tough.” And it felt like this was the first time, this incident, where a lot of people collectively awoke from problem blindness.
So, the second barrier is tunneling, and this is a very simple one to explain. This is just, you know, the feeling that you’re playing whack-a-mole every day, you know, that you knock down one problem, another one pops up. You got to put out that fire. You get to the end of the day and all you feel like you’ve done is really just put out fires all day. And that tunneling mindset, if you just picture the visual metaphor of the tunnel, it’s just forward, forward, forward. I’ve just got to survive this day. And that mentality really crowds out the other mentality of systemic thinking, of not working around problems, but ending them. And so, tunneling can be our enemy.
[05:30] Then the third is maybe the most subtle, and that’s a lack of ownership. Where for downstream issues, often the owners of problems are very clear. If your house catches on fire, the fire department is going to put it out, they own that. They’re going to do a great job at it. But if you flip around the issue and you say, whose job is it to prevent your house from catching on fire, that’s a surprisingly hard question. I mean, the homeowner is certainly first on the list, but they’re not alone. We’d have to also look at the builder and the way they built the house and the materials they use and the way those materials were manufactured and the behavior of your neighbors and the building codes in the area.
The point I’m making here is when you have a diffusion of ownership, like what I just described, what often happens is nothing. You know, if someone doesn’t own a problem, tangibly, then often there’s no progress made. And so I think what we’re all living through now is just we can see these barriers everywhere, that even something as eminently predictable as a pandemic, which, you know, smart public health people have been telling us about for decades, still kind of catches us unaware and unprepared. And so those are the forces that are arrayed against us in our hope to go upstream.
[06:48] Dan, thank you for that. And Jennifer, I know at StriveTogether our work is about helping communities think more upstream and work at the systems change level. How do you see this work playing out for the communities in our network?
[07:01] I’ll start with the piece of lack of ownership. One of the first steps that we work with our cross-sector partnerships who we support, one of the first steps that we take with them is to think about shared accountability and shared vision and shared ownership for the really complex, gnarly problems of wicked disparities in education and mobility. Because our work is really about how we can support communities in ensuring that every child regardless of their race, ethnicity, zip code or circumstance has every opportunity to achieve their potential.
The way we see it playing out now, it’s interesting because of COVID-19 and the pandemic of systemic racism, the inequities that we knew persisted and existed in communities. For our partnerships, who are really thinking at the systems level and thinking about the shared ownership and how to use data for learning to drive decision making, what we’ve advised and coached our partnerships through as we address these crises is to rely on the tools that you have in your toolbox.
[08:14] So, these partnerships are really looking at how they’re using data to dig deep into what are the root causes of inequities. We track our outcomes through education data, most of which is not readily available for this year given that most kids were out of school starting in March, and no testing was happening. That wasn’t the best data that we had anyway. That was the data that was available. So, we’re thinking with our network members about what other data is available, how can you capture data to get to sort of the root of the problem. It’s really enabling our network members to really focus on community voice, youth voice and the qualitative data in listening to young people and families to really understand why the system is producing the results it’s producing and how we really see these crises as an opportunity to transform those systems.
That’s how we’re focused on working with our partnerships. It certainly isn’t easy in this virtual world right now. But we’re seeing great, great progress when communities rely on the tools that they have and focus at the systems level.
[09:23] Thanks. I’m thinking about problem blindness that you mentioned, Dan. And Jennifer, the work that leaders in our communities are doing to think about not just sort of the problem that’s in front of them, but how do you reach up to the systems level. And the parable, Dan, that you shared, is so useful. I wonder if you could talk a little bit about what upstream thinking looks like in practice, and maybe one or two examples of just what it looks like in communities.
[09:52] Well, I think one of the most powerful stories that I researched was from Chicago Public Schools. And I’ll tell you where the story started, which is back in 1998 — the graduation rate at CPS was 52.4%. I mean, just shocking, right, that you have a coin flip’s chance of graduating from high school if you’re a teenager in Chicago at that time. And just empathize, if you would for a moment, with a teacher or an administrator, someone within that system that just finds it intolerable. And yet, you’re one person in a district with 300,000 students. I mean, CPS alone would be one of the top 50 cities in the U.S. and its budget of $6 billion is about the same as the whole city of Seattle. This is an enormous enterprise. How do you change something like that?
And the progress that they made, which I’ll tell you about, was really driven by a couple of factors that I think we can all learn from, even in other environments. The first was, they paid attention to early detection. You know, when you’ve got a recurring problem you see again and again, if you can buy yourself some time, some runway to intervene, you can often change the course.
[11:08] And so the first ray of hope came when some academics, including Elaine Allensworth, figured out that you could predict with 80% accuracy in the freshman year, ninth grade, that with, I think I said 80% accuracy, which students were going to drop out and which were going to graduate. And so that gave them for the first time a kind of smoke detector for students dropping out and gave them the promise that if they could change course in the ninth grade, they might see a dramatic uptick in graduation.
But of course, a predictive metric like that doesn’t fix the problem. It just tells you, hey, these particular students may be in trouble. And so, CPS had to figure out, what do you do when you know a student is in trouble? How do you get them back on track?
[11:57] I want to highlight two things that they did that were incredibly powerful. One had to do with looking themselves in the mirror. There’s a quote in the book from the health care expert Paul Batalden, who said, “Every system is perfectly designed to get the results it gets.” And that quote will just stick with you. “Every system is perfectly designed to get the results it gets.”
In the context of something like CPS, what it tells you is, you have unwittingly built a system designed — and I mean that literally — designed to fail half of its students. So, if you want the outcome to change, you have to change the system. And so, they found things like this. This is my favorite example. This is the era of zero tolerance. You know, they wanted to be tough on discipline. And so, in those days, a couple of kids would shove each other in the hallway, and they’d get slapped with two-week suspensions. That was thought to be, you know, zero tolerance.
[12:53] But what we know now from the research is if you take a kid who is kind of on the border, and you kick them out of school for two weeks, what happens when they come back? They never catch up, they’re lost. They fail classes, which is one of the best predictors of dropping out of school, is if you fail more than one course as a freshman. And so you ask yourself, did those assistant principals who doled out the suspensions, do they have any idea that they may well have doomed a child not to graduate from high school? I mean, of course not. They didn’t know that. But that may, in fact, have been the truth. Big complex systems tend to make it opaque. We can’t always see what the effects of our actions are. So that’s the first point is we’ve got to learn to interrogate systems.
And then the second point is something that really shocked me and fascinated me, and that was that the engine of their success turned out to be something very micro, not macro. So, at every school, every high school, they formed what they called the freshmen success team, which constituted faculty members from all departments — biology, English, math, history — along with counselors. They would all get together in the same room. And they were armed with week-by-week, student-by-student data, which, we could do a whole another podcast episode on the horror of trying to assemble that data in a district as big as CPS. But anyway, we’ll leave that for another episode and just take it for granted. This team would meet maybe once or twice a month. And when they met, what they were talking about was not, you know, the disappointment of a high dropout rate or aspirations for a different future. What they were talking about is individual students. So, they would go you know, student by student.
[14:42] Michael, okay, last time we met, Michael was failing math. And we all know failing a core course like math is a classic predictor of being off track. We’re going to get Michael some more tutoring. Did that work? The math teacher says, “Yeah, actually Michael got up to a C on his last exam. So, he’s doing much better.” Okay, good. Well, who’s next? Keesha? Okay, we found out that Keesha has to take her little sister to elementary school every morning. And so, she’s showing up late to first period almost every day. And so, she’s in danger of failing first period. Hey, if we’re smart, we’re going to get her out of English first period and into P.E. Because if she fails a course, you know, we want it to be P.E. and not English. Because, you know, according to the metrics we’ve got, failing a core course like math or English counts a lot more against a student than an elective. And so, that was the texture of progress.
It was student by student, meeting by meeting, you know, one hand extended after another. But the point is that that kind of micro work can snowball into macro results. And you fast forward to the last couple of years. I mean, granted, 15, 20 years into the work, but listen to these numbers — the graduation rate is now 78 to 79%. I mean, I can’t overstate the magnitude of that achievement. That is just mind blowing in a district this size. We’re talking about 30,000-plus students over the years who have graduated, who, in an alternate reality where this work was never done, would have dropped out of school. And every one of those students, by virtue of getting their diploma, will earn between $300- to $400,000 more in lifetime income. That’s just a starting place, not to count the secondary ripples — the effects on their relationships and on their children and on their communities and on the tax dollars they pay and on and on. And that to me is the epitome of an upstream story, that it’s hard, it’s complex. It requires a lot of people. It takes a lot of time. But man, when you get it right, the ripple effects are absolutely stunning.
[16:58] And Dan, at the base of that, there seems to be a strategy around just like understanding the human needs and the experience of students. As a young person who spent quite a bit of time in the assistant principal’s office, I will always appreciate educators who are taking those strategies, and as you said, you know, they work. And it worked in in Chicago.
[17:18] You can’t help 1,000 people or a million until you really understand how to help one. And that sounds like the simplest statement in the world but I can’t tell you how many social entrepreneurs I’ve met over the years, who have, you know, grandiose plans for helping big segments of society but they’ve never really, they’ve never really understood the life and three dimensions of the people that they’re ultimately trying to help. You know, until you understand the Keesha situation and the Michael situation and 100 other students, you really don’t understand how to make change. And often even the macro changes, like the policy changes that affect the whole system, often those bubble up out of your knowledge of individual cases.
[18:05] Our work at StriveTogether is really about shifting from reactive downstream to upstream and thinking about these preventative approaches. Can you share examples from what it looks like, again, in the StriveTogether Network?
[18:18] Yes, definitely. Just building on the Chicago Public Schools example, which is just an incredible story. What CPS is doing really looking at changing outcomes for one student and 20 students and then really scaling and looking at what’s going on in the system that can really take that to scale is the work that most of our partnerships are really trying to do.
We’ve been increasingly supporting this type of district continuous improvement. So, using data, where teachers and students together are looking at data daily and weekly and really engaging in a process together to understand what improvement could look like.
[19:59] So, I’m going to share a quick story from Spartanburg, the Spartanburg Academic Movement. They have an example called the Four Schools Project, where they identified schools where students are experiencing poverty and disparate outcomes. The Spartanburg Academic Movement worked with BMW. BMW headquarters of USA is located in Spartanburg, and they have a tremendous amount of continuous quality improvement experience and expertise. So that helped to build some capacity for the partnership. And then together with some of our StriveTogether team members who are experts in continuous quality improvement. And they work to build the capability of the teachers to use data in a different way, to use data regularly, to try some things ,to do PDSA cycles — so, plan, do, study, act —and identify strategies that could increase third-grade reading proficiency and look at some of the disparate discipline challenges in the schools, and they saw great results, incredible results. Third-grade reading proficiency increased more than 60% in 2019. And then one of the four schools saw a decrease in discipline referrals from 600 to 700 per year to fewer than 450. I mean, there’s still a lot of work to do. And so, it may feel incremental, as Dan was saying, but getting to sort of what is at the root of some of these challenges, and really uncovering those systemic barriers is so critical. And so, having that capacity to do continuous improvement work is an important strategy that we’re working to scale across the Network with partnerships and seeing really great results from that.
[20:40] I think just to add to that point, I think the focus on continuous improvement in all of its guise — and people use different language for this in different industries — but just the focus on getting a little bit better on a set of metrics that everybody has agreed are important. In many ways, it’s the heart of upstream work.
And I want to draw a distinction that I talk about in the book between the scoreboard mindset of change and the pill mindset. The pill mindset, you know, as you might infer from the name, is kind of derived from the pharmaceutical industry where we formulate a pill for some kind of ailment. And we test it rigorously, you know, we use a randomized controlled trial. And, you know, we go through a series of populations over a series of years. And once we figure out, hey, pill A is very helpful in managing ailment x, then we feel like, we just got to scale it, you know, we’ve proven this thing works, we got to scale it.
[21:45] And I’ll be honest, that was my mental model of social entrepreneurship when I first got involved in this work maybe 10 or 15 years ago. I thought about it the way you think about a business startup, you know that if Starbucks works in 20 communities, there’s no reason to think it won’t work in 200 or 2,000. You know, you just get the model right at the local level, and then you scale it up. That’s what you do. And there are lots and lots of social enterprises that look like that. You know, a classic example might be, well, you’ve got to get students to play in a certain way, we have a program for teaching students how to play, or we have a program for teaching phonics that is masterful. And usually the way it works is you go in and you do a pilot, and you know, enthusiasm being what it is, often the pilot is successful. And then you do it at 10 more places, and maybe you get a weakly positive effect. And then you try to 50 places and it doesn’t work. And then everybody points fingers at each other and says, “Well, you didn’t do it right, or you didn’t honor the standards.”
[22:52] And I think that’s just fundamentally a mistaken model of how social change happens. What you need to scale social outcomes is just fundamentally a different thing than what you need to scale lattes and fried chicken around the world.
And that brings up the second model, which is the scoreboard model, which is much more a continuous improvement mindset, which is to say what you really need is a team of people who have agreed that certain outcomes are worth fighting for, you know, a lower dropout rate or, you know, a reduction in the homeless population or reduction in child poverty. And yes, they may be armed — in fact, I think it’s good if they’re armed with certain interventions that have seemed to be successful in other places. You know, maybe the play procedure does make sense. Maybe the phonics procedure does make sense. But here’s the trick: What they’re doing is not trying to honor with perfect fidelity what was done elsewhere. It’s not an RCT thing. It’s a continuous improvement thing, which is to say, six months, in if they figure out the play thing works, great, let’s do more of it. Six months in, if they find out the play thing doesn’t work, they abandon it like a dirty set of clothes and move on, right? Because your loyalty is to the improvement, not to the program.
[24:13] And I think that’s critical and I think StriveTogether is a great example of an organization that’s fighting for that shift in mental model. I’ll tell you, it’s not that common right now. I mean, I think we went through a big wave, a big revolution in the social sector where we tried to “science-ify” everything. And we discovered a love of RCTs and a rigorous use of data. And I think largely, that’s been a positive development, but it’s kind of gone overboard, and we’ve lost sight of the fact that rigor is not a substitute for outcomes, you know, no one’s going to win a prize for fidelity if you’re not ultimately moving moving the needle on the kinds of things that you set out to do. Jennifer, I’d be curious your reaction to all that. My soapbox moment.
[25:04] You know I agree. My hope is that there is a shift away from the RCT. It’s time consuming. By the time we have the data and the evidence, it doesn’t translate contextually. We’re actually seeing more investors interested in continuous quality improvement in this sector. But it’s definitely still not the norm.
And one thing that I’ve worried about is because of the investment, so what we talked about the idea of getting incremental change, and then being able to scale that to get to population-level change, takes time and patience. And so, making sure that we have the patient capital to be able to build the capability of social sector organizations to do this type of work is what is needed right now.
[25:55] I think we have some funders who are who are interested in doing that, and I hope that there will be more. I worry a bit about this moment and the opportunity. I mean, certainly there are many safety net supports that need to be put in place to address the crisis at hand. But it seems to be an incredible opportunity to transform systems, to really change these systems. We cannot be okay with the results that our systems are getting right now. So do we have the patient capital to be able to invest in the capability building that needs to happen to enable teachers, to enable nonprofit leaders, those working in the social sector to be able to get access to the data that they need for learning and to be able to use that learning for continuous improvement, and invest there instead of really expensive studies that just don’t produce this population-level change that we need to see.
[26:51] Yeah, amen. If you’re a funder listening to this, I hope you take that message to heart, that the timeline of these things — any meaningful social change on a reasonable scale — you got to be thinking in decades, and funders don’t want to hear that. They want to think about a two-year cycle where you run a pilot and you get some results that you can trump it. But the pilots are not the thing. You know, the steady, incremental change is the thing. And it starts slow, and it’s hard to get everybody on the same page. And it’s hard to get the data flow right. It’s hard to figure out who’s going to be on the team. But boy, once you build that engine, I mean, that’s everything. If you look at any major social change that’s happened in the last 30 years — I don’t want to get too declarative about this and not every, I’m sure there are exceptions — but virtually every one that I can call to mind has been slow and incremental and ultimately successful as a result of the steady pace of improvement. I’m thinking of everything from reduction in drunk driving to reduction in smoking rates, to, you know, things like the CPS story. So, we need the engine of improvement, not the magic pill.
[28:13] And I love the scoreboard versus the pill frame. And I just want to say one more time for you know, folks who, you know, if they’re standing in another room listening or if they kind of checked out a little bit, I want to make sure they hear that the loyalty is to the improvement and not the program. I think that was just really important and I’m glad you framed it in that way, Dan.
I think it leads to the next question. I think this conversation about continuous improvement, because another step that you talk about for going upstream, Dan, is using data for learning. And you have an example with, again, one of our favorite national organizations, Community Solutions, who has this Built For Zero initiative. Community Solutions ended veteran homelessness in Rockford, Illinois. How did partners use their data differently to solve this problem?
[29:08] They did. And this is another amazing story. And actually, I’m glad I told the CPS story first, because you’re going to notice a lot of common factors here. So, the situation in Rockford, which is the second-biggest city in Illinois, behind Chicago, is they were one of these classic, you know, former manufacturing towns where all the factories shut down. And so, they had a lot of economic headwinds that they were facing, and that had yielded a long-standing homeless problem. And the mayor, Larry Morrissey, he was in his third term, his ninth year of office. And when he had come into office, he had this grand 10-year plan to end homelessness. And in year nine, he said, if anything, they taken a moderate step backward.
And so his colleagues come to him with this idea to join up with a movement called Built For Zero, which is run by Community Solutions, as you said, and they have a kind of radically new approach to homelessness. And Larry Morris, he said when he heard about this, he had to admit being a bit cynical after nine years of not getting anywhere, with what’s going to change. And so he reluctantly signed on for this, they went through some of the training, and within one year, they had become the first city in the U.S. to eliminate veteran and chronic homelessness in their town. And it’s kind of just a breathtaking story. So, the obvious question here was, what in the hell changed in that year to go from nowhere to being a role model.
[30:39] And there’s a couple of examples. One is, number one, they use a strategy that’s called Housing First, which I can only explain by virtue of explaining its opposite, which is for a long time, the idea was that you combated homelessness by putting homeless people through a gauntlet of change. The idea was, they often have mental health problems or substance abuse problems. And so you kind of tick these off one at a time. You put them through a drug rehab center, and then you get them mental health, and then you get them some job training, and then eventually, maybe they’ll earn their way into housing. And Housing First just flips that on its head, and it says the presenting problem with a homeless person is that they are a human being that lacks a home. Like, let’s start there.
And so, once we get this person into a home, then perhaps we can move on to some of the other issues they have. And so that became their strategy in Rockford as they began to think about their homeless population as people without homes, how quickly can we get them into homes. And they began to triage the population by vulnerability, meaning whoever was at the highest risk of dying on the streets was put into housing first. So that was point one, a strategy shift.
[31:58] Point two was they begin to unite the various stakeholders in Rockford in a new way. Remember earlier I was talking about how, you know, problems often have diffused ownership when they’re upstream. So, it’s like whenever homeless people cause a problem, the owner was clear. You know, if they were loitering in some area, the police would get called, if they had a heatstroke, the ambulance would get called. But when you ask whose job is it to get a homeless person off the street and into housing? Surprisingly complicated answer. Well, what they did was they got together all the people who had some piece of that question and they begin to unite together. In the same way, remember, those freshmen success teams at CPS operated. And that brings me to the third point, also like CPS, which was they changed the nature of those meetings to focus on individuals.
[32:52] So just as at CPS, they had gone student by student, in Rockford they went homeless person by homeless person. They created what they called a By Name List, which was a real-time census of every homeless person in Rockford. Now, to appreciate just how far fetched and magnificent this idea was, consider that before they started this work, the data that you kept on your homeless population was gathered one day a year. So, it was an annual census required by HUD. And so, you would go out and kind of make a half-baked effort one night in April to go around and see how many homeless people you could count. One of the women involved, Angie Walker, told me they didn’t even bother going into places like under the bridge or you know, places where homeless people might seek some privacy, they just kind of went to the obvious places like the shelters. And so even that one data point a year was almost by definition inaccurate. And they turn that on its head and they begin to say, if we’re going to do something about this, we have to understand it so well that we have to know at any given hour in the day, who’s out there, you know, who are we trying to help?
[34:07] And they would go down that list in order of priority and talk about, you know, name by name. What are we going to do about Steven, you know, we have housing ready for him, who’s seen him last, where’s he hanging out? Who’s in the best position to make the approach to Steven to get into housing, that was the way it worked. And then one year, they went from nowhere on homelessness to being, you know, the national example.
And I think you’re seeing those same themes that we just talked about reflected there. You know, the focus on fresh, real-time data, the focus on improvement at the human level, you know, programs be damned. They didn’t care what program would allow them to succeed, they just wanted to succeed, because the motivation here is just to get your fellow citizens off the street. You know, who cares whose brew manages to make that possible. The important thing is Steven’s got a place to live now. And that became the engine of success.
[35:07] Can I ask — I want to ask you both the question, because I think Jennifer said something earlier about you know, the capacity that’s necessary to do this well, and given the story that you just shared, even examples from before, it just makes me think, is it possible to — I’m going to use the phrase scale up upstream thinking or maybe better put is about sort of institutionalizing that into systems. And I wonder if you believe that’s possible. And if so, you know, what are the questions that a system should ask or, you know, how best should they approach this
So, once you once you figure it out, you’re in Rockford. It’s not about the one time, you know that one year where they seem to have figured it out. But how do you build that into the just the way you do your work?
[35:59] Well, just to answer that question for Rockford, they have done that. They’ve systematized all of these things and they continue to have what’s called a functional zero level of homelessness, which is which is not some kind of, you know, loophole, but just a way of acknowledging that people come in and out of the homeless state frequently and they’ve managed to keep it at functional zero for years. And they’re moving on to other populations, like youth homeless, which is a thornier problem for a variety of reasons.
But I think that at least in in the examples that I’ve researched, that these the systems and processes you have to build to succeed become habits, you know, so it becomes a habit of mind and becomes a habit of practice in a way that gives them longevity. You know, once you’ve been doing these meetings and this sort of work for 10 years, it kind of becomes the new norm in a way that I think is really positive because it helps to build resistance against some of the social sector’s other, you know, well-known obstacles, like having a charismatic founder leave or that sort of thing.
You know, if Jennifer Jaeger and Angie Walker in Rockford, who are in many ways the twin engines of this incredible work, if they were to leave, I think they would tell you at this point, it’s okay. That the norms have been rebuilt in a way that that allows this to continue. Jennifer, what do you think?
[37:34] I absolutely agree. Community Solutions is one of our favorite national organizations. When we were introduced to Community Solutions, we found so many similarities, and we’ve just become really incredible thought partners in terms of how we do the work.
Community Solutions has a set of developmental milestones for getting to their By Name List and all of the capability building that they do. And there’s a core process and methodology through the Built For Zero and different communities. It has been replicated in other communities and certainly they’re working to take it to scale. And those principles and sort of the developmental milestones are very similar to how we think of our Theory of Action at StriveTogether. And then when we get to work with the Institute for Healthcare Improvement, we find that they also have very similar core principles in the work.
[28:27] So I think there is an ability to take this work to scale, but it will require investment, it’s going to require not only philanthropic investment, which, you know, I want to name that there are key investors out there who are who are bought into this type of work and are really making large investments so that we can try and scale this work, but it will require policymakers at the local, state and federal level to invest in this type of approach to invest in a process instead of a program, which is not typically the way that policy is made. And so, you know, that’s the shift that needs to happen, but I believe in it, and I, you know, we’re partnering with Community Solutions and other national organizations to take this type of approach to sort of lift up these core principles and demonstrate where it works. And there are a number of examples of how it’s led to population-level change. And we just keep having to tell those stories. And Dan needs to keep writing books and doing podcasts about these types of things, because the storytelling that you’re doing about this approach, Dan, is helping to advance, it’s definitely helping to advance this field.
[39:39] 2020 is a really big year for a number of reasons. You know, it’s a year where again, we are facing these twin pandemics that, you know, if we think about it have caused so many other challenges down the road, down the line for families, for youth, for families alike, and it also happens to be a presence financial year, and a year where other important elections will occur at the state and local level. So you have this crisis going on, and also an opportunity for policymakers to sort of submit proposals for how they will adjust these things, and also for citizens and voters to be able to make their choice on how we will move forward. If you were to give policymakers advice on how to use the core principles of upstream thinking to shape policy, you know, what would that look like? Let’s start with you, Jennifer. What would that look like?
[40:35] It is holding equity at the center of this work, really centering racial equity, because what we’re seeing across the global health crisis, the social unrest that’s happening because of the killings of Black men and women in the United States, the economic crisis that we’re facing as a result of these pandemics, we have to, in the policy change that is made, center racial equity and to do that you have to really dig into the data and use upstream thinking, the kind of getting underneath the root cause of what we’re seeing in the way that systems were designed. And you’re going to find that it is racism. How do we really name that and who owns this problem? The lack of ownership, who owns this problem? We all do. And so how do you engage those who are most impacted by systems in the transformation of systems. So, lifting up the voices of young people, of community members and particularly voices of color and Black voices in the recovery efforts, we’re going to have to slow down in some ways in how we make policy.
[41:50] I mean, there’s immediate need, but so often what we see is policy and programs are funded and created very quickly, overly bureaucratic, and it’s going to require the funding of process. Process is truly the new program. And in being comfortable with the process of using data for learning and data for improvement is, we’ve seen that that works, that we can cut the data so many different ways to get at the root cause and really being able to expand that and do it at scale is going to require public resources. So, my hope is that policymakers will consider this as they are making policy to help us move through and outside of this crisis into equitable recovery.
[42:35] And I want to highlight that point, Jennifer, that you make about using data that just says, you know, it’s not just the data, I’s not just the numbers, but also the narrative of and the lived experience of folks who are directly impacted. I think that’s critically important. Dan, final word, what would you say?
[42:54] Yeah, I just want to echo what Jennifer said, I thought she had a great answer. And I would just echo that by saying, you know, policymakers at all levels, I think their two greatest powers are the ability to set the rules and the ability to direct the flows of what can be enormous sums of money. And so if you wield both of those powers with prevention in mind rather than reaction, I think it leads you in really promising directions. It leads you to look at, you know, in criminal justice, everything from tearing down, you know, kind of arbitrary mandatory sentencing to bail reform to, you know, leading a revolution in community policing versus, you know, the more aggressive forms that have sprung up and that we’re all getting to know now.
[43:48] On the economic flow side, I think it can be tremendously difficult to get mechanisms in place to fund prevention, for a variety of reasons, probably too laborious to get into right now. But there are exceptions like in Obamacare, everybody’s focus was on what Obamacare did for the uninsured, but a really important part of that legislation was trying to reconfigure incentives at various levels of the health care system to get people to prevent problems. You know, structures like a HCO’s, accountable care organizations, that give physicians and, in some cases, hospitals and health systems incentives to keep patients from getting in trouble, keeping them out of the hospital and so forth and sharing in the benefit if that is successful.
And those kinds of incentives are just fundamental. If we could think in terms of deflecting 10% or 20% or 30% of what we spend just trying to correct harms that have already happened into preventing those harms, what a profound shift that would be. And I don’t think there’s many areas of life where that would be unattainable, you know, it’s just a matter of, of getting the plumbing right and I think that maybe this is an environment where people are ready to listen to that message.
[45:12] I think that’s an amazing point to stop. Thank you, Jennifer. Thank you, Dan. I’m really grateful. I’m just thinking about the phrases I’ll leave here thinking about: Loyalty to improvement, not the program. Jennifer’s point on racial equity in numbers and narrative. And Dan, your point for policymakers, about the way they set the rules and manage the flow of money. I just think that it’s a good frame not just for policymakers to be thinking about in their role, but for folks who are in communities, you know, thinking about how this stuff will be applied. Again, just an amazing conversation. Thank you both for joining us today.
For folks who are listening, listen, stay connected by visiting us at StriveTogether.org. You can find the transcripts of Together for Change and learn more about upcoming events like our annual Cradle to Career Convening. Thank you, everybody.