Every few months Harvard now asks me to speak to a class or participate in some type of seminar. Recently, I was invited to present alongside Bruce Kamradt of Wraparound Milwaukee. Wraparound won the Innovations award the year after we did for its comprehensive, child-centric system for youth with serious behavioral health challenges that seamlessly integrates local justice, welfare and Medicaid efforts.
The topic of the webinar, part of their Power of Social Innovation series, was to be about "igniting change" in the juvenile justice system. Neither of us thought it was a good idea.
What really makes both our innovations stand out is their combination of innovation and evolution over time. We are of course passionate about youth and glad to talk about our models. But there are lots of great new ideas out there. What we think we can really teach social innovators, no matter what sector they work in, is how to sustain real change in tradition-rich and entrenched systems like juvenile justice.
Through Missouri's approach, youth are assigned to the least restrictive care environment, from diversion programs in the neighborhood to 10-bed group homes, to moderate care campuses or secured facilities. The innovation is best characterized by its youth development approach focused on humane and safe environments; a group system approach to healing, self-awareness and skill development; emphasis on education; universal case management offering continuity for the youth; and family and community engagement.
Wraparound Milwaukee provides mental health and supportive services to children with serious emotional, behavioral and mental health needs and their families. Each child has an individualized plan and a single care management team that includes family. Teams can choose from among 80 different services from a network of 200 agencies based on what is best for each child. This single plan is possible because it pools $45 million in funds from across agencies and programs that include child welfare, juvenile justice, mental health and Medicaid. Wraparound also created a single IT system which allows for measuring and reporting outcomes for the 1,400 youth we serve annually. Of that number, 40 percent are adjudicated delinquents with mental illness.
When first implementing these ideas, both programs faced a number of barriers. Across the system there were entrenched organizational cultures. We protected both turf and the status quo instead of shared values and communication. Misperceptions related to the service offerings and strengths of others in the system were common. Both efforts faced a prevalent status quo bias and little faith in the possibility of a different approach to serving the youth. What did it take to overcome these initial barriers and then to sustain innovation and improve outcomes over time?
Reframe your vision. Leadership must change its vision of what the organization is doing. In our cases, this meant a new approach to helping our youth and a new view on what they themselves were capable of. At Wraparound we created a shared vision based on the common value that care should be strength-based, individualized, family-directed and community-based. Missouri Division of Youth Services created a set of beliefs and principles that fundamentally reshaped how the system viewed youth, families and the rehabilitative process.
Show it works. When people can't fathom that a different path might exist, show them. A pilot program can also take away some of the political risk you're asking your sponsors to take. In a Milwaukee County pilot, within ninety days 17 of 25 children in residential treatment returned home. Within a year we had sent all the children but one back to their families. The results went a long way toward convincing Medicaid, juvenile justice and child welfare officials to sign on. Missouri gradually opened smaller programs across the state, prior to closing its large institutions, to show policymakers and frontline workers, among others, that the new approach would work.
Look across systems. True innovators think systemically. This includes an appreciation of how change in one part of the agency has effects elsewhere in the agency; the role of the environment in which youth are living; and the political dynamics and power. In Milwaukee, considerable effort was invested into understanding the strengths, resources and needs of the Milwaukee community and into understanding the rules of the major funding streams.
Be strategic about change. Often we try to adopt new program ideas like evidence-based therapy without paying attention to the underlying but requisite change in culture. Effective change in organizational culture requires a strategic mindset of how to change the status quo. Cultural change, for example, is often driven by having the right people who share a set of beliefs and philosophies. In Missouri, we now operate on the belief that all youth desire to do well and succeed. Sounds simple, but it reflects a significant change from the old model.
Mobilize a constituency. Sustainability and growth require constituency building. In Milwaukee, they began with a well-defined focus on the population they would serve, and these families became their most important supporters. They also tied proposed reform to other initiatives at the state and federal levels. In Missouri, we recruited a statewide advisory board comprised of respected citizens and civic leaders, but we also have community liaison councils and rely heavily on parents and families as allies. Maintaining transparency, showing empathy, building relationships and keeping the stories and messages positive are keys to mobilizing the support needed.
Quick hits and immediate results are no doubt attractive, especially with short political cycles for elected and appointed officials alike. But a longer-term view of innovation and change, in our experience, produces more powerful impact. Just remember there's no better time to get started than today.
This column is based in part on a recent webinar featuring Decker and Bruce Kamradt, the administrator of Children's Mental Health Services for Milwaukee County and director of Wraparound Milwaukee. Both are recent winners of Harvard's Innovations in American Government Award program. Find more information here on the Power of Social Innovation webinar series.
