Effective Services for Young Children Report of a Workshop (1991) / Chapter Skim
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Report of the Workshop
Report of the Workshop
Pages 1-20
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Report of the Workshop
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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.
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, 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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?
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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.
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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.
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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.
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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.
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