A Summary of the Meeting of May 30-June 1, 2001. The Factors and Contexts that Influence How Indicators Get Used in States, With a Reflection on How to Survive Changes in Leadership

05/30/2001

The first speaker was Cornelius D. Hogan, Senior Consultant with the Annie E. Casey Foundation of Baltimore and former Secretary of the Vermont Agency of Human Services. He was introduced by Harold Richman of Chapin Hall.

Hogan was followed by Gwendoline Angelet of Delaware, Christine Johnson of Florida, and Michael Lahti of Maine. Most sessions from these meetings are summarized. In this case and a few others, we offer a transcript of remarks by the speakers.

Con Hogan

When we think of indicators and outcomes, we have to think about neighborhoods. We have to remember we are working on the behalf of neighborhoods and communities. That is what this work is all about. It is at the neighborhood level, at the community level that indicators have a context. And indicators have to have a context. An indicator without a context is like a great meal without ambiance. It is like a politician without an audience or a sailboat without wind. It is the ambiance, the audience, the wind that brings them to life. Context brings an indicator to life.

Indicators are not worth much unless they are put in a strong context. Another word for that context is a common purpose. Without a strong articulated common purpose, indicators don't have resonance. In fact, it is very hard to talk about indicators without talking about the common purpose. One way to guarantee a powerful context is to formulate indicators that describe cross-programmatic, cross-organizational, cross-sector outcomes. Similarly, contexts that are cross-programmatic, cross-organizational, cross-sector will bring indicators to life in a powerful way.

When we discuss indicators it is important that we not become involved in the discussion of specific programs and indicators for the success of that program. The idea of measuring accountability for a specific program mires us in a discussion of the details of those specific programs--often this is a negative discussion of specific programs--and it doesn't allow us to discuss indicators at a higher level. It also prevents us from placing those indicators in context.

To have a broad impact, the outcomes must resonate. There are a number of ways to obtain outcome resonance:

  1. Use short, simple, declarative sentences--a noun, a verb, and an object. Language is essential for developing a context for indicators. For example, the following indicator is short and sweet: All children are ready for school.
  2. Use language that engages people at an emotional level. Language that brings forth emotions is language that connects with people. Example: All babies are born healthy. This is an outcome that tugs at the heart. Everybody can relate to that. Indicators are more powerful when they are stated in the context of a strong, declarative, emotional, from-the-heart statement.
  3. Use developmental language, where possible. Indicators become more powerful when the language you use to describe them connects with the stories of all our lives. They compel attention, touch people in the heart, and bring more technical indicators to life. If your language relates to the life cycle of human beings--from birth to death--you give your indicators and outcomes a rich context.
  4. Don't threaten other models or other people's work. All professions and disciplines have important contributions to make to this work. Don't write or speak in a way that threatens other people, disciplines, or other specialties. There has to be room in your language for everybody. It is important that the language you use doesn't exclude.
  5. Don't slip into jargon or the specific language of a discipline. Don't clutter up your language with obscure language and jargon. I know this is part of our make up, but this kind of language is foreign to the rest of the world. No language about Medicaid, Title XX, PRWORA (Personal Responsibility and Work Opportunity Reconciliation Act).
  6. Use words that any of us can understand. This is essential if communities are to become key players in this work.

Here are some examples of indicators and outcomes written with the above suggestions in mind:

  • Pregnant women and newborns thrive
  • Infants and children thrive
  • Children are ready for school
  • Children succeed in school
  • Children live in caring and supportive families
  • Youth choose healthy behaviors
  • Youth become successful adults
  • People live in safe and supporting communities
  • Elders and people with disabilities are resources in their communities and live with dignity and independence in settings they prefer

These outcomes are stated in positive terms. If the outcomes are positive statements, they motivate. Whenever you can restate a negative outcome in positive terms, you have unlocked another level of motivation. Here are some examples of powerful outcome statements that have made a difference:

  • Win the war
  • All children have a human relationship they can depend on
  • All babies are born healthy
  • No taxation without representation
  • Better lives through living and learning
  • Covering kids
  • Youth choose healthy behaviors
  • Put a man on the moon
  • All children can
  • Caring communities
  • End welfare as we know it

Win the war. One of the most powerful outcome statements this country has ever been touched by was "win the war." I am old enough to remember my mom collecting tinfoil during the war, collecting her nylons. Everybody knew they had something to contribute. They weren't told what to do.

Here is a case study in the Trondheim region of Norway, which has about 120,000 people, about half the population of Vermont. Their bureaucracies are fascinating. They are much more vertical than the ones here, there are more steps from top to bottom. These bureaucracies are also much more specialized. They will take our child welfare function and break that up into three bureaucracies. By the time you get to the top of their bureaucracies you really can't see what the other guys are doing.

What is the common purpose they could organize themselves around, no matter what bureaucracy they were part of, no matter what organization they belong to? This is the language they came up with: "All children have a human relationship they can depend on." Think about the power of this indicator. The stronger, more powerful, more understandable the common purpose is, the more the context brings indicators to life.

Powerful outcomes and their indicators:

  • Are clear and declarative statements of fundamental well-being.
  • Are bigger than any program or organization.
  • Connect to us emotionally. Ideally they provide a developmental view of our lives.
  • Are stated in positive terms where possible.
  • Are measurable, by and large.
  • Are presented over time.
  • Extend beyond political cycles.
  • Are presented nationally, statewide, and locally.
  • Are interactive.
  • Are accumulative over time.

Preserve the culture. This is a raging issue for native Hawaiians and what role they are going to play in the future. Preserve the culture. That language meant something to them. They understand it. They can measure it. It is a very powerful idea.

As we listen to the reactions in the different states we ought to have a red flag that goes up every time we inadvertently bring up an indicator that relates to a specific program. If you really want to keep this powerful, make sure you talk about cross-sector indicators. Indicators that touch more than one program, more than one organizational unit, more than one personality, more than one leader, have much more resonance.

Another thing I've seen states do that you should watch out for is put together indicators for only two or three years. You are laying a trap for yourself if you put together indicators for only two or three years. You really have to collect indicator data for a decade or so. A few years of indicators can get connected to a single administration. You really should be looking at this stuff over the course of a decade to really cross sectors and work out all of the political things. Otherwise, it can really grab you by the neck.

If indicators are used as part of a positive challenge, they communicate volumes. Example: What can you do in your organization to improve teen pregnancy rates? Being able to ask a question and get answers is part of what makes the indicator process an actual process. You have to be able to convert indicators into a personal and interpersonal challenge. When I was Secretary of Vermont's Agency of Human Services I worked with 12 different departments. I always asked the commissioner of each department the same evaluation question every year: What did you do, or can you do, to improve the well-being of the people we serve as described by our agreed upon outcomes? You would be amazed, when you personalize it that way, how the indicators take on importance and become key to the work we all do.

When you have your indicator data, map it out. Part of the indicator challenge is not just talking about indicators, but mapping your data out, putting it into graphs, or some other format, that can easily be used by the press to get word of your program out. It is essential that you find a format that makes it easy for the press to "steal" and place on the news.

Don't focus on just one indicator. There are indicator herds. In conceptualizing indicators, there are always leading indicators which the other indicators follow. If you can find one or two that are going in the right direction, you can be guaranteed you will have 4 or 5 going in the right direction. It is all connected. For example, examining lowering infant mortality leads to considering lowering smoking rates for pregnant women. That in turn leads to thinking about higher education levels, because women who drop out of school are more likely to become pregnant which leads to lower teen pregnancy rates. Lowering teen pregnancy rates leads us to lower child abuse rates. And so it goes.

Everything is connected. Anywhere leads to everywhere. The more you think about your indicators in a connected way, the more you get an integrated view of your work. And the more integrated your view is, the more you can see how it all fits in context, the more your work will resonate with others, and more satisfying and effective your work becomes.

Another way to work with your indicators is to connect changes in indicators with costs. If you do this, you may be able to open up a whole new realm of discussions with a range of people you never thought possible before. You may also be able to bring new arguments to your political process.

If you are able to compute the correlation between indicators and cost you will be able to build relationships with businesses and businesspeople. You will, in a sense, be meeting them on their turf because this is how they think: in profits and loss, benefits and costs. Businesspeople may not know the technical side of teen pregnancies, for example, but they do know that if you have fewer teen pregnancies it costs the state less. Having these numbers available can be very powerful politically. Once again, map these numbers, put them into a graph that states your message simply and strongly. If you describe the movement of your indicators in this way, you have provided a context that will speak to more people and will inspire a sense of pride in your accomplishments.

To survive leadership changes you have to get to the point where your indicators and outcomes are embedded in the culture. One way to do this is to connect the concepts and language of your initiatives to those of other sectors and initiatives. You can, for example, connect with businesspeople in your community by using a modified balance sheet to show the equivalence of positive equity and positive well-being for children, families, and communities. One way to look at indicators is as something akin to a business balance sheet. Our equivalent to the items on a balance sheet is the well-being of our people. The classical balance sheet has been around for a couple thousand years. It can easily be adapted for your purposes. How do the ideas of a balance sheet map across to key indicators? If you have improved indicators, that's a positive cash flow. Improved indicators are short-term assets. Long-term assets include outcomes and indicator structures.

Businesspeople understand balance sheets. They especially appreciate methods of measuring intangible assets. For a business, intangible assets include good will, the capacity and experience of the workforce, customer value, and leadership. Our intangible assets include common purpose, political credibility, community engagement, community assets, and leadership. If you put your indicators and outcomes into this context you will see businesspeople light up. They will trust you and believe you know what you are doing. If you can connect your indicators language to other sectors, you know you have got something that is universal.

I'll end with this fundamental thought about outcomes. The more complicated the organization, the more dangerous the situation, the longer the time line, the larger the area, the more people involved, the more complex the information, the more intense the politics, the more compelling the common purpose must be.

Gwendoline B. Angalet, Acting Director of Child Mental Health Services, Department of Services for Children, Youth, and Their Families, State of Delaware

What I'd like to talk to you about for the next few minutes is the practical side of transition and the practice of trying to survive changes in leadership within a state as it relates to social indicators of children's health and well being. In 1998, Delaware published its first Families Count/Kids Count fact books through collaboration with the Kids Count Project administered by the University of Delaware. We have a wonderful relationship with our Kids Count project in Delaware. I think it will be the entity that helps us maintain the momentum as we go forward promoting the use of indicators in Delaware. They have been our strong partner in this effort over the past couple of years. The indicators we use are broad-based indicators that cut across organizational lines, sector lines, geographic lines, that try to paint a complete picture of what is happening with children and families in the context of their communities. What is important to remember here is that we started in 1998.

With the support of the federal grant from U.S. DHHS on using social indicators to promote children's' health and well-being, we broadened the engagement with communities. To this end, we developed a video. We have just completed the video and we are just now distributing it across the state for community groups to use. We have a guide that goes along with the video about ways you can get involved with your community to advocate on behalf of children--one child at a time, or in a group setting. We also have an evaluation form for those people who want to give us feedback about how the video is being received and some action steps they've taken as a result. We'll be able to compile this information and use it to inform our process as we go forward.

These products were done during the administration of our former governor, Governor Thomas Carper. He was a strong believer in what gets measured, gets done. That tone emanated from the top and through our agencies in state government. It resonated with our partner, the University of Delaware, and through our community. He created the Family Services Cabinet Council, which was an important vehicle for bringing together, twice a month, the state agencies concerned with children and family issues.

The Governor personally chaired the council. We had an active agenda and made much progress on children's' issues during those 8 years.

What's Happening Now in Transition from Governor Carper to Governor Minner?

One of the things I am finding out--and I've been through four transitions (I've been in state government a long time)--is that this transition is very different from any that we have gone through. You don't think when you transition from one governor to another from the same party that you are going to go through a complete turnover in the leadership of organizations. We really haven't in the past. But we did this time. That effect is being felt as we try to maintain momentum around those things we thought were working in the prior administration.

Transitions take a long time. They don't happen in just the first 100 days. Because your secretaries get appointed, then they appoint division directors or agency heads, who appoint others, and you have a series of changes, a trickle down effect. So it takes a long time to put it all in place. The learning curve that the new team had takes a while. It's funny, I understood this before, but I understand it now in a very practical way, as we try to maintain the continuity in our work on the indicators.

The new administration is really trying to figure out very basic things like making sure all our computers work, making sure that day-to-day operations are going on. At the same time they are trying to appoint their agency heads. In this case, our Governor is very organized. She had a list of every thing she wanted to get done. She hit the ground running.

Her list of things to get done was very much related to what her campaign platform had been. She didn't hear a lot about social indicators of children's health and well-being on the campaign trail. So that was not at the top of her list of items she wanted to take action on. Then, the 2000 fact book for Families Count/Kids Count came out in January. We invited the Governor to come for the initial press conference.

Some of the indicators in the book were not going in the right direction. Her new team didn't feel comfortable with her coming because they thought she might be put on the spot and they weren't prepared to deal quickly with a response.

We thought we'd done our homework. We met with key advisors before the new team took office. We had the support of new cabinet members. We thought we were doing all the right things. But we came to realize we weren't. We thought what the governor could do is say she was going to continue the work of the cabinet council and give them the charge to work on the indicators that were not going in the right direction and come up with some comprehensive strategies that could address those. However, we pushed a little too hard and as a result, were unable to make much progress.

By the time Kids Count was having its first annual conference in March--and we were actively participating in that--the Governor felt a little more comfortable. She had a little more time to look at the information. Her immediate staff felt more comfortable and that was important. So, she was able to come. She talked about supporting, in concept, the indicators and how she wanted to continue to work around collaboration. She announced that she would appoint an interagency group for bringing the different sectors together to do this.

What Did We Learn From This?

One of the things that really hit home with me was the idea that, if I had it to do over again, I would have produced the video within the first few months of our grant project and gotten it out there. And we would have put the community engagement piece into high gear quickly, really quickly. Because if the governor had heard, while she was campaigning last fall, that citizens were concerned about this indicator or that indicator, it would have resonated with her and her team. I think the other thing that we would have done is spend more time with the governor's team--even during those campaign days--and built those relationships. We would have had an easier time with the top level, so that when we invited the governor to the press conference in January, they would have said, "Oh, it's okay. We know this is what is happening here and we can work through it."

I think the other thing we would have done--and we are trying to do this now--is talk to the legislators about this book. I think when we start to break the data down and make it more personal for individual legislators, personalize it for their individual senatorial or representative districts, then it is going to be more meaningful for them. And they're not going to think about this as a big book with lots of data. They're going to start to think about this in more real terms, in terms of the impact this is going to have on their constituents. So the degree to which we can personalize this information for the legislators, I think that's going to help us reach out.

Another thing we learned from this is that, at the 35,000-foot level, everyone says the indicators are good. But when it comes time to translate the indicators into very practical usage, whether it's advocacy in the community or whether it's policy making and allocation of resources at a state agency, that's a whole different ballgame. I think we have to work to help people make those translations. For example, consider children's readiness for school, and all the indicators that fit into it. We have to help people break this down into a usable factoid, that they can make sense of and really act on.

So where do we go from here? University of Delaware is the entity that is helping us take the important next steps for maintaining the use of the Kids Count, Families Count indicators and the use of the video. We're going to promote the video more. We're going to use these as tools to strengthen our relationships. And one of the things I am very much assured by is that the money that's in the state budget to support Kids Count, which includes production of the Families Count indicators, is still there. Nobody has redlined it. That is a very good start for us because we are really crunching for resources in our state.

The last thing we are going to have to do is continue to have our partners rally around a common purpose. My new boss is a planner and a marketer. What she came up with--which is really helping us--is "Think of the child first." That's become our motto. But I think it is the kind of motto that resonates with a lot of people in terms of looking for that central purpose, that common ground. So, as we go forward, we are going to think of the child first and hopefully that will give us that rallying flag for us to keep things moving forward to survive this change of leadership.