Reframing Human Services for Greater Impact

(Illustration by the Alliance for Strong Families and Communities)

What is a “human services community-based organization”?

Giving a definition is easy enough: Human services community-based organizations, or CBOs, are 501(c)(3) organizations that work in collaboration with government and philanthropic funders to build the human services ecosystem that ensures the health and well-being of all Americans. Most people know more familiar terms, like “nonprofit” or “charity,” or the work that CBOs do: providing for public safety and disaster preparedness; mental and behavioral health services; early childhood education and special education programs; family and community development; and job training and employment services. In short, CBOs support the health and well-being of children, families, and seniors enabling them to achieve their fullest potential.

However, when people think about “charity,” or about the work of human services organizations, does it bring to mind negative associations? Do they find themselves thinking about “handouts” for the poor, or imagine that nonprofits don’t operate as effectively as “real” businesses do? Perhaps, when people think about organizations that provide human services, they don’t think of them as being in the business of creating civil society and producing social change at all.

Writing a New Story for Human Services

CBOs are a foundation of national well-being. As illustrated in the groundbreaking 2018 report, “A National Imperative: Strengthening Human Services in America,” they play an irreplaceable role in improving health outcomes and reducing health care costs, in ensuring that children are safe in supporting neighborhoods, that they can succeed in school, in helping older adults maintain a high quality of life, in helping people with disabilities live their lives fully, in building quality, affordable housing, and in providing crucial mental health and substance abuse services.

However, framing is powerful. Many in the human services field are embracing a new lexicon for CBOs and the sector. Public misperceptions about CBOs—as the report concludes—not only “contribute to a lack of trust between government agencies, philanthropic funders, human services CBOs, and the American public” but:

“When CBOs are viewed as inefficient pass-throughs, rather than valuable economic entities and contributors to a healthy and productive society, funding tends to be highly restricted in nature. A human services CBO CEO in Illinois noted that ‘funders are more worried about what money is being spent on than what results the money is producing. They don’t place much trust in us to run our own operations.’”

These perceptions stand in the way of CBOs’ ability to innovate and to invest in new capabilities and infrastructure.

Because human services CBOs are embedded in the communities they serve and have deep knowledge about how to solve the root cause issues that their neighbors experience, they have a far greater responsibility than just to be providers of “services”: They can and should be advocates for systems change. But because traditional funding for CBOs focuses on services delivered—rather than outcomes achieved—it restricts innovative implementation and limits the abilities of CBOs to maximize their impact.

Working to change perceptions can also help us re-think the role and importance of CBOs in national well-being. “Framing science” employs communications strategies to activate the public’s engagement with complex social issues (like climate change, the opioid epidemic, or guns). In 2015, the FrameWorks Institute partnered with the National Human Services Assembly to address how the human services sector frames its work, finding, for example, that tropes such as “safety net” programs and “vulnerable populations” only propagate myths about charity and handouts. But by reframing both the narrative around what human services CBOs do and the funding structures that empower them, we have the opportunity to build greater trust in the transformative power of human services to address root causes, be advocates for systems change, and ultimately see greater societal value as a result.

Shared Values

To more effectively tell the story of human services, framing science encourages us to begin by identifying a shared value. Negative frames like “poverty” and “charity” can overshadow the intended message by dividing people into categories of either “givers” or “takers.” By contrast, utilizing shared values encourages audiences to see themselves in the issue, as when human services are framed as “common sense solutions,” that reflect American pragmatism.

(Illustration by the Alliance for Strong Families and Communities)

When we talk about human services, we want to land in the shared values that enable audiences to see a bigger picture, one in which they can see themselves. Researchers with the FrameWorks Institute found, for example, that using construction metaphors centered on families’ experiences when describing what human services do, helped broaden the public’s perception of how human services CBOs help families and individuals achieve well-being. Foundational building blocks help families achieve well-being and those building blocks, such as health, education, workforce supports, are integral to all families.

The construction metaphor, for example, helped articulate how well-being is composed of many materials:

“Just as a building under construction depends on different people with different skills working together with materials, people’s well-being is not solely of their own making but depends on what others do and on the resources that are available.”

The use of this new frame led to a clear shift in perception and consequently a greater willingness to support human services CBOs and the vital work they do. FrameWorks conducted a survey presented with two focus groups—one that received the framed messages and a control group that did not—asking respondents to describe what human services do. Thirty-six percent in the control group understood a very narrow definition of human services (i.e. services for the poor) while only 13 percent of those who received the framing messages had this narrow view, a 23 percentage-point swing.

Both the Alliance for Strong Families and Communities and the American Public Human Services Association have used this framing for human services in communicating with members and the public. However, to bring this effort to scale will require ongoing efforts to share the framing and impact with others across the sector; changing longstanding negative perceptions that have defined human services for too long will require a broader effort than just changing the language.

A Commitment to Outcomes

In addition to how we talk about human services, we must also reframe how CBOs operate, shifting from a charity model to a business model: outcomes-oriented, able to invest in innovation and new capabilities, and funded to enable those innovations.

Because CBOs traditionally focus on services delivered (i.e. number of foster beds filled) rather than outcomes achieved (i.e. children successfully living with their families or children achieving other lasting permanency), outcomes can be hard to measure. For-profit corporations can point to profit and shareholder value to demonstrate their success, but it is much more difficult to capture and measure outcomes for highly people-oriented services that play out over the long term. But philanthropic funders and government grantors tend to structure grants around what can be measured (services provided) rather than what should be measured (outcomes achieved). This not only restricts funding for CBOs but hobbles their ability to shift strategy to better outcomes.

This shift is already in play. For example, Lutheran Social Services of Illinois (LSSI)’s largest foster care government contract is structured as a “Percentage of Referral Opportunity" (PRO) contract. A PRO contract provides an equitable process for the best performing organizations to proportionately replace cases that exit due to achievement of positive outcomes for children—namely, cases that reach permanency and close due to family reunification or adoption. With contracts paid on a per diem basis, organizations that perform well will perform themselves out of business: As cases close due to children reaching permanency through family reunification or adoption, organizations have no way to regenerate the loss of those cases.

To allow the best performing organizations to proportionately replace cases that exit with positive outcomes, PRO contracts rank providers based on success. After calculating PRO at the regional level, organizations are ranked by permanency performance (percentage of cases that exit to reunification or adoption) and PRO is then calculated based on those permanency rates. (Organizations like LSSI that serve multiple regions, therefore, have multiple PROs—one for each region served). When a new case comes into the system, the state’s central intake unit rotates the case based on the regional PRO targets. If an organization in a region has a high PRO, that organization will get more referrals than a neighboring organization with a lower PRO.

There are still challenges, of course. For example, the onus is still on the organization to accept the case, and if an organization declines the case because they lack staff or foster homes, the referral still counts against the fulfillment of their PRO. Moreover, as more government agencies and funders shift to an outcomes-based model and demand that CBOs demonstrate “return on investment” as a prerequisite for funding, greater investment will be needed to measure outcomes, an investment in enhanced metrics and data collection that may come at the cost of program and staff development. However, over the long term, these shifts will enable CBOs to better measure the true societal value of the services they provide.

Enabling funding flexibility is another way that foundations and government contractors can provide CBOs with the resources and capacities to develop more evidence-based practices, such as rewarding CBOs for innovation by allowing them to retain and reinvest savings if outcomes are achieved. The recent pledge by five of the nation’s top foundation leaders to enable funding for CBOs’ full and essential operating expenses—including technology investments—is a good example.

Moreover, there is an ongoing need for standardization of evidence measurement approaches. Defining success in the delivery of human services is still an elusive goal, since funders utilize different measures that make it difficult to compare “apples to apples.” But a standardized approach to metrics will help CBOs better navigate the shift to an outcomes-based model.

One other important impact of moving away from a focus on outputs to outcomes is the potential for a stronger focus on prevention. For too long, the human services sector has been geared toward addressing problems after they’ve occurred. But the shift to prevention can be seen in promising new legislation like the Family First Prevention Services Act which realigns resources toward prevention and intervention before a child reaches the critical point of being placed into the foster care system.

Conclusion

Realizing the transformative power of the human services system will be a challenge as well as a tremendous opportunity. It will require a shift in framing from the entire ecosystem, both philanthropic and government grantors and CBOs, as well a shift in procurement policies to align with an evidence-based, outcomes-based model.

We must develop and incentivize the human services ecosystem’s capacity for innovation together. If both public and private funders recognize the importance of innovation, and support it through funding and flexibility, it will accelerate the entire ecosystem to higher performance, increased efficiency, and better outcomes. Achieving all of this will pave the way for a broad range of positive outcomes in the lives of the neighbors we serve and ultimately leading to a healthier, equitable, productive, and more prosperous America.

Read more stories by Tracy Wareing Evans & Susan N. Dreyfus.