Opinion / FIXES
Jan. 24, 2019 [Second of two articles, read part one here]
The Art of Humanizing Social Systems
A number of government agencies in Missouri and Massachusetts are exploring ways to address social problems holistically, through a framework that focuses on clients’ long-term needs.
By David Bornstein
When a filmmaker pulls back the camera lens to capture the widest possible image, it’s called a full frame. Can social service agencies adopt a similar frame? Can they shift from a focus on isolated needs — safety, housing, health or employment — in favor of a broad view that supports human well-being?
Last week, I explored the kinds of problems that are created when services try to tackle individual needs in isolation. I looked at how an organization called the Full Frame Initiative had developed a framework based on five domains of well-being: safety, mastery, stability, social connectedness and meaningful access to relevant resources.
This article looks at how the Full Frame Initiative is partnering with government agencies in Missouri and Massachusetts to integrate this well-being orientation at the system level. The goal is to demonstrate possibilities for system change that could improve social services across the country.
In Missouri, the Full Frame Initiative has been working with state agencies since 2010. Since 2011, one of its partners, the Division of Youth Services, which is responsible for the care and treatment of youths committed to its custody by juvenile courts, has seen improvements in the academic progress, educational completion and law-abiding rates of youths served.
More recently, the Full Frame Initiative has been working with St. Louis’ family courts since 2016. “I found its approach very restorative,” said Ben Burkemper, the family court administrator for St. Louis County. “It addresses the whole person, not just the offense that the juvenile committed.”
“All humans strive to have meaningful gas in all five domains,” Burkemper said. “The key is not to force unsustainable trade-offs.” He offered the example of a juvenile who is placed on probation and ordered by the court to attend group counseling two evenings a week, while unbeknown to the court, his mother, a single parent, is working two jobs and needs to have her son take care of his siblings on those evenings or risk losing one of her jobs.
“Instead of just saying, ‘You have to make it work,’” Mr. Burkemper said, “the court looks at the youth and his family holistically. ‘OK, you can’t make the sessions on these evenings. We’ll try to find something for you during the day through another agency.’”
This approach seems sensible. How does it benefit society to force a youth to comply with a court order that imperils his family’s economic security — even if he has committed a crime?
But it takes a culture change to make the system work this way. For family court to avoid forcing trade-offs like these, the front-line staff must understand the family’s situations in significant detail, Burkemper said. And they must be supported by managers and supervisors who prioritize long-term well-being over short-term responses.
So when Burkemper began advancing this framework in the family court, he recruited the Full Frame Initiative to train high-level staff members, while enlisting deputy juvenile officers to develop new assessment forms and procedures in line with the five-domains approach. They were the ones who would be dealing with cases every day, so it was essential that they felt they owned the new processes — even if it took a year and a half to roll it all out.
The changes initially met with some resistance, he said, but now staff members say the new approach humanizes families and also saves time. “We’re seeing more clearly how hard it can be for families to comply with court-ordered conditions, not because they are unmotivated or resistant but because of poverty, safety and other considerations,” Michelle Frank, a deputy juvenile officer in the investigations unit of the St. Louis County Family Court, said.
The new assessment process begins by focusing on strengths, Frank said. An officer might start by asking, “What are you proud of about your child?” rather than jumping into the problems. “When a kid and his family walk into our office, they’re guarded,” she added. “The first few moments of that interview are so important to get their buy-in. If it’s done right, you get to more of the depth of what’s going on.”
More depth makes it more likely that court orders will work. For instance, some juveniles fail to attend their court-mandated counseling sessions because it means traveling on bus lines that pass through areas that are dangerous for them. A suspicious youth may be reluctant to share that information. Now court officers are more likely to discover this concern during their assessments — and they can respond by trying to bring programs into neighborhoods where youths live.
If a juvenile’s offense involves drugs, it’s common for the court to require participation in a drug program. But an assessment may reveal that a youth’s ambition is to get a job. “Instead, we’ll have them start with a job program,” Frank said. “This gives them more of a sense of control. And when they get the job, they realize they have to be clean.”
The five-domains approach can reveal the logic behind behaviors that may look like nothing more than teenage recklessness or delinquency. “All behavior meets a need,” Linda Snyder, a deputy juvenile officer in the family services unit of the St. Louis County Family Court, said. “So whether that behavior is adaptive or maladaptive, you have to understand the need it is filling.”
A juvenile, she said, may persist with behaviors that keep her in detention because it meets her need for safety better than being at home. Or a student may continue cursing out a teacher because getting kicked out of class serves to avoid the embarrassment of having to read in front of his peers. Or a youth who uses drugs may do so mainly to satisfy the need for social connectedness.
“At the end of the day, negative consequences don’t change behavior,” Snyder said. “Change comes through teaching competencies, and incentivizing and celebrating accomplishments. What the Full Frame does is teaches a process for developing interventions that are going to create competencies that will decrease the likelihood that kids will continue to be system involved.”
The officers in the family court can act with confidence on their insights because they are working in a system where everyone shares a common language, Burkemper said.
In Massachusetts, the Full Frame Initiative has been working for eight years with five state agencies, with the goal of preventing survivors of domestic and sexual violence from becoming, or remaining, homeless. “Often for victims of domestic violence, there’s a forced trade-off,” said Tammy Mello, the former executive director of the Governor’s Council to Address Sexual and Domestic Violence in Massachusetts.
Several years ago, Mello and other department heads who focused on children and families, transitional assistance, housing and homelessness, public health and victims’ assistance began meeting periodically to figure out how their systems could become better aligned. In particular, they wanted to stop making things harder for people who were trying to stabilize their lives.
For example, if a mother experiencing domestic violence lost temporary custody of her children because the child welfare department determined that they had to be removed for safety, it would automatically trigger her loss of housing benefits. “It was crazy,” Mello said. “Then you couldn’t return the kids to the mom because she’d lost her housing. And the mother would say, ‘I can’t get housing assistance unless I have my kids back.’”
“That’s where the five domains came in,” Mello added. “We embraced the idea that although we work in systems with different mandates, we could rally around this framework that’s intended to look at what every human being needs to have overall well-being.”
In Massachusetts, getting alignment on the well-being framework has required a different approach than in Missouri. For the Full Frame Initiative, it has meant working with an array of state agencies that set standards and policies, as well as with numerous nonprofit agencies that actually provide services for people facing domestic violence or homelessness.
But the well-being orientation is gaining ground. “Two years ago, the state re-procured all of its sexual and domestic violence services — $40 million per year for 11 years — explicitly focusing on well-being and equity, not just on short-term safety,” said Katya Smyth, the Full Frame Initiative’s founder. “This has allowed nonprofits for whom this approach makes sense to really lean in and operationalize it — because the incentives and expectations of the government are aligned with what makes sense to them.”
Now five state agencies have come together to pilot an approach to supporting survivors of violence in need of housing that is based on the well-being framework, Linn Torto, the executive director of the Interagency Council on Housing and Homelessness in Massachusetts, said via email. The same crosscutting focus on well-being, she added, is being applied in the development of a new $200 million procurement for the family shelter system.
“What’s revolutionary about this,” Smyth said, “is that it is setting up structures that enable the agencies to focus on what is best for the families rather than on their own individual mandates.”
In addition to its demonstration projects with government systems, the Full Frame Initiative is also developing an institute to work with community activists to bring a well-being orientation to their work solving local problems. The organization has also begun exploring the implications for medicine.
“For older adults, we’re seeing an epidemic of depression, which we’re treating medically as depression,” said Dr. Rachel Broudy, who recently joined the Full Frame Initiative as director of health care transformation after practicing geriatric medicine for 13 years. “Is some of this loneliness a lack of purpose? Or not having a place to give back to society? Or a loss of stability? For older adults, the big thing we focus on is safety. But what does that mean in terms of loss of agency, stability or community? In medicine, we take away so many routines from people. If all we did was try to create equitable access to well-being and do no harm, it would change medicine dramatically.”
“This work isn’t just about better outcomes for individuals,” Smyth said. “It’s about removing systemic barriers that are holding inequities in place. So much in our society is built on what we think makes us different from one another. This work is about what’s possible when we actually build on, and hold our attention on, what is universal: our needs for well-being.”