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Field Notes

Across North Carolina’s Guilford County, leaders and community members are partnering to ensure that the county’s 37,000 0 to 5-year olds, and the 6,000 children born each year, are on a path to lifelong success when they begin Kindergarten.

Led by Ready for School, Ready for Life and The Duke Endowment, the Get Ready Guilford Initiative (GRGI) aims for population-level outcomes and reduced disparities for young children and their families.

To get there, GRGI is building a county-wide system of care. Root Cause is contributing by helping 13 early childhood programs strengthen their measurement capacity, improve program quality, connect their work, and tackle the big systemic issues affecting Guilford families.

We are striving to shape our work so it matters for Guilford’s children and their families. This is a play-by-play of how we are doing and what we are learning. We’re questioning everything. It’s complex. It might take a while. There’s local energy and commitment to tap into. This is what working toward community-level change looks like in real life.

This post is written by Anand Dholakia, a Principal at Root Cause and member of its Guilford County project team. Anand works with early childhood and county health programs on continuous quality improvement, facilitates a Community of Practice, and contributes to the project’s strategic direction.

Part 12 ⎮ 3

“Let hate and prejudice have no place here. Elevate yourselves. But pull nobody down. Go for the education and progress of mankind without regard to race or color and invite all to come forward and assist in the development of our own common country.”

– Thomas Settle, North Carolina Supreme Court Justice 1868-1871

In consulting and technical assistance industries, time is literally money. Thus, background research and preparation for projects can be narrowly focused, which we still believe is part of a sound approach. So in Guilford we did all the usual background preparation: reviewed GRGI’s theory of change and backing research, grant proposals, lists of program partners, and other materials, interviewed key stakeholders, etc.

This time, however, we also put our own agenda aside to learn what matters for families in raising their children to be ready for school and succeed in life. We set out to immerse ourselves in Guilford County and learn what families experienced.

Immersing Ourselves in a Place

Since we were working in a well-defined place, we first physically mapped the county, paying attention to urban density, neighborhoods, demographics, transportation, and proximity to resources. Our first observation was the obvious variation in density between the largest cities of Greensboro and High Point and the rest of the county. It was also hard not to notice the prominent distinction in household income between neighborhoods, particularly around Greensboro and High Point where this occurs along distinct census tract lines.

 

 

As is often the case, due to the evidence of a long history of policies driving race and class based residential segregation, the above income variation closely overlaps with the race of families.

 

 

Other maps showed that both urban and rural areas with lower household incomes also have higher rates of Medicaid enrollment or no insurance coverage, limited health and early childhood resources (OB-gyns, pediatricians, child care centers, etc.), limited food access, and households with no vehicle, while also having the highest concentration of children ages 0-4.

 

 

Google map directions showed that for a family with young children living in a southwest Greensboro neighborhood without a car or sharing one car, it would take more than one hour to travel about four miles for a pediatrician appointment. This trip would require a fair amount of walking, switching two bus lines, and folding and stowing a stroller (along with stashing the kids somewhere given that open strollers are not allowed on the bus). A trip that would otherwise take 15-20 min by car. 

 

 

Now, did all of this information directly inform our capacity building role? Well, no. Not yet anyway. And that was ok for now.

Research, Research, Research

To complement the mapping, we compiled and examined a range of research evidence, best practice models, and literature in the early childhood field (examples here, here, and here). This review helped us understand the wide spectrum of academic perspectives on what families and children need, challenges, and solutions. While there were many commonalities between them, it was interesting to note the variation based on who developed it. For example, some highlighted interventions to support early brain development, while others highlighted systems and policy change to increase parents’ economic opportunity and reduce family stress.

To us, this variation led us to consider tendencies to narrow our view and even ‘cherry-pick’ research that best corroborates whichever solution we are already bought into. Which research should we pay attention to? Who’s right? Wait, did anyone ever ask families what they think about this research? If a best practice model cites five recommendations, what happens if we only address two or three and skip the rest?

Next, with a stack of demographic maps and GPS as our guides, we used a shiny new rental car – which turned out to be an iconic American sports coupe in lieu of our reserved compact – with the optional collision insurance to explore the cities, towns, villages, and rural areas comprising Guilford County’s 650 square miles. At just slightly above the posted speed limit, allowing us to cover even more ground. 

We witnessed the great variation in transportation availability and service access across the county and within Greensboro and High Point. Physically experiencing the environment for ourselves brought our online recon to life.

Learning From People

Of course our intent was not to just do an isolated drive by, but also to talk to real people (imagine that!). We descended upon community health clinics, the county social service centers, and the offices of an array of program and systems leaders working both within and well beyond the early childhood space. We watched programs in action, observing their work with parents and their children and allowing us to hear their hopes and dreams for their kids, what gets in the way of achieving those, and what could help most.

During our ground recon, one early conversation with Ready Ready alerted us to its massive, painstakingly organized summary of results from the many family listening sessions they had run engaging several hundred people a few years prior when GRGI was getting off the ground. We also organized and ran five sessions of our own with 50 more people, just because.

What we heard  added significant new depth and color to what we had noted in our online research. 

First, we were inspired to hear parents practically rave about many of the programs they were participating in, how much they helped them and their children, and the herculean efforts and passionate commitment by many providers to meet families where they are at and address their needs. We heard that families have trusted sources of information about services, including their pediatricians, preschool teachers, and social service providers that may visit families in their home and play a central role to help assess people’s needs and connect them to services and resources. And we heard that families have service providers that make them feel supported and listened to.

People then described their challenges in working with service providers. Here, we admittedly honed in on those stories that reinforced the need for our for our given capacity-building and coordination role. Stories about negative experiences with some providers, confusion about which services to use when, what worked or not, or what was even available, Great, that’s why we are here! 

And then we also heard the honesty of what I call ‘daily lived experience.’ People’s reality

This included challenges that we had seen evidence of in our research. Challenges like transportation to services faced by families living in the more rural ‘outer-county’ areas, and also living in the more urban areas without a car when resources are located on the other side of town more than a one-hour bus ride away. 

Facing this situation, parents described many resourceful solutions, such as arranging rides to take their children to a public library or park on the other side of town when they could not afford to buy a car, books, or residence in a neighborhood with neither a library nor a park. It is often hard to hear these anecdotes and not celebrate the self-reliance and creativity displayed in them.

However, people also described daily experiences that were beyond the ability of their resourcefulness, self-reliance, or any set of particular services or resources to overcome. 

Now clear themes were starting to emerge, and we were collectively in a better position to answer what matters for families and their young children. But many of these themes did not fit neatly into our role or our hypothesis… 

Imagine you are about to launch a new initiative focused on program quality, data and evidence, organizational capacity, network building, or something along those lines. Let’s say (hypothetically) that you are excited about how it will improve programs and hopefully community outcomes. Now take a skim below.

“When we can’t get services due to programs being full, we aren’t given options or alternatives.”

 

“It’s important that people are mindful of the times that parents are available. Most of us are working, but also working different hours than 9-5pm.”

 

“Services need to be provided at more flexible times. It’s so hard to take time off work to do most of what needs to be done for children, even pediatrician appointments.”

 

“I think the job field in Guilford County is horrible for young mothers—low pay and no flexibility.”

 

“I feel like a hot potato—passed from agency to agency until I either stop or get connected with the resource.”

 

“The eligibility requirements are different for each program so it’s hard to keep track of what programs parents could/should consider.”

 

“I don’t think people understand how difficult it is to get around if you don’t have a car.”

 

“I don’t have a babysitter to be with my child, so I can’t work. I was not eligible for any (child care) voucher because my income is too much. I was later put on the waiting list (for child care subsidy) and am still on it. What do you do?”

 

“As parents, it’s always a struggle to make sure the bills are paid so we don’t have time to go through a packet of work from school. It’s not that I don’t have the desire to do so, it’s just that I don’t have time because I’m also in school myself.”

 

“It was difficult because I didn’t have any food in my house at all. I am pregnant and I struggled traveling from food pantry to food pantry in the heat.”

 

“I’ve been treated with such little respect–it makes me feel less than a human. It doesn’t help to walk out of an office feeling worse about yourself than when you walked in. Just because I don’t have money doesn’t mean that I deserve that.”

 

Agencies aren’t listening to what we want or need. The rules don’t make any sense and people don’t care what we think or feel. The system is set up to make us fail.”

Well… now what? How would knowing the above have you think about your work?

To be sure, none of the above is unique to Guilford County, rather it reflects the experiences of millions of families in countless communities across the country. Some of our team members knew this reality personally, some of us had prior professional positions in which we worked directly with families experiencing this reality, but many of us had not. And of course we would continue learning to inform our work, but with the core of our upfront preparation complete we now faced the obvious question: What should we do with all of this information, given Root Cause’s program quality and network role? 

Well as it turns out, many things. To be continued in our next update from Guilford County

Learn more about CQI for social service providers at our Continuous Quality Improvement Resource Library and subscribe for updates.