In January 2023, New Hampshire Children’s Health Foundation initiated a multi-year pilot known as Trauma Responsive Communities in four N.H. locations. This update highlights the work of the Coös Coalition for Children and Families whose service area encompasses the entire northern tip of the state.
The objective of the Trauma Responsive Communities pilot is, Families, service providers, and community leaders work together to address the impact of ACEs and reduce the conditions that lead to trauma and toxic stress.
“The Foundation’s Trauma Responsive Communities investments are intended to strengthen an existing community resource, utilizing a policy, system or environment change, to address prevention or early intervention of Adverse Childhood Experiences,” explains Foundation Program Director Patti Baum.
“Our introduction to the Coalition was our support for UNH’s Pediatric Improvement Project screening for ACEs in primary care project with Coös County Family Health Services,” Baum noted. “We then approached the Coös Coalition for Young Children and Families which we were delighted to discover was a natural fit for our Trauma Responsive Communities initiative,” Baum said.
Raising Strong Families
Coös Coalition leadership partners include the Family Resource Center of Northern New Hampshire, Tri-County Community Action’s Head Start, Northern Human Services, Coös County Family Health, DHHS, area school districts and North Country Education Services and other service providers.
These partners have been working together for more than ten years with the support of the Neil and Louise Tillotson Fund and the NH Charitable Foundation and have developed a strong sense of the needs and desires of families and caregivers.
The experience of the Coalition informed a wraparound practice pilot, Raising Strong Families, for the Coös region’s families with the highest needs.
Raising Strong Families seeks improved family access to quality services and basic needs resources and increased coordination among service providers and improved early childhood service delivery systems. It serves children and families from pregnancy through age 8.
Mollie White coordinates the Coalition’s activities. She said, “The reason we came up with Raising Strong Families in our system transformation plan is because several of our leadership team members spoke up and said, ‘You know, we see the same kids or the same families over and over again, and we try to get them connected to all these resources, but yet it’s still not having the impact that we want. What’s going on? We’re not changing lives or family trajectories.’”
“It was really demoralizing for people in the field,” White adds.
That honest self-assessment led to what Coalition members really wanted to do, which was to transform the way they worked together so that it was no longer a piecemeal approach, e.g. we’re going to refer you here and you’re going to go there.
“We took it on as a system’s change transformation,” White says. “It’s about getting organizations to do their services differently.
“Our approach is no longer, ‘Come to our office we can do this for you,’ which puts the onus on the client. Our approach now puts more accountability on the service providers to make things happen instead of on the families, which is the way it is usually done.”
Previously, families would work independently with agencies to meet a variety of needs and supports. This approach often resulted in a lack of coordination and contributed to the breakdown in success.
For example, one agency might assist a family with relocation to another town in order to acquire the stable housing they needed in order to avoid homelessness. But this didn’t take into account the fact that moving out of one town often requires a change in health care providers, maintaining prescription refills in a timely manner or opening an account at a new bank, never mind the need for a child to change schools.
Connecting the Dots and Closing the Loop
Today, from a systemic systems transformation perspective, agencies are communicating and coordinating services to as White puts it, “Connect all those dots.”
The way in which agencies in Coös County work together today is through what White characterizes as a closed-loop referral system.
Agencies are now connected through a common online software platform. So, when a staff member from the Family Resource Center makes a client referral to a human service agency they receive a confirmation that the referral has been accepted (or not) and are able to keep tabs on the progress the client is making (or not) and better coordinate support services that can help the family overcome its challenges.
Family dynamics are changing to include fathers and grandparents as primary caregivers. A single child can have a myriad of needs including housing and transportation, while service providers are only able to address a single need from the perspective of their profession. The common platform improves communication and builds relationships between agencies and helps overcome the service silo barrier.
“We didn’t tear the system down,” White says, “Instead we enhanced it.”
Even Non-traditional Partners Involved
Outreach to a variety of community members makes the Coös Coalition especially responsive and forward thinking in its approach. Coalition members represent child-serving programs including child care, schools, health care, mental health and home visiting.
Non-traditional partners such as an automobile dealer have also joined the Raising Strong Families effort. Transportation is a huge barrier in the North Country. The dealer’s participation means that family members and caregivers have access to transportation via routes the dealership has on its customer service pick up and drop off schedule.
Tweaking the Model
Raising Strong Families’ objective is to improve tertiary support for families experiencing complex stressors. Its effectiveness is measured by:
- Families served by the pilot teams who report they received effective care coordination.
- Parents served by the pilot teams who report they were never frustrated in their efforts to get services for their child.
- Children served by the pilot teams who received needed services and did not have difficulty getting them.
“A key component of New Hampshire Children’s Health Foundation’s three-year investment is to encourage communities to identify a sustainable change by addressing a systematic barrier or gap,” says Foundation Program Director Patti Baum.
“In the case of Raising Strong Families, the partners are changing the system and environment in which families receive and are supported through service referrals and provision,” she notes.
Outcomes reported from early stages of the referral process and relationships include:
- Things went better than expected.
- Inappropriate referrals and challenges have been immediately addressed.
- Pediatric providers have been engaged and are making referrals.
- Understanding about “who gets referred” has changed over time.
Policy, System and Environment Change
How has the Coalition found working with the New Hampshire Children’s Health Foundation?
“When I heard about the Foundation-funded Pediatric Improvement Partnership in local primary care practices I wanted to make sure that I learned about it because they were working with our partners and connecting the doctors to the resources out in the community,” says Mollie White.
“It goes back to that closed loop referral,” she adds. “I thought, ‘I have to get this dot connected.’”
“So I leaned in, started chatting with them, and that led me to Patti Baum. She came several times to meetings that we had and talked with us. We were vocal in a diplomatic way about having a system and being a bit apprehensive about an outside organization coming in to do this project.
“The first thing I would say is they asked questions and they listened. And that’s where I really feel like that made the difference, because they started to understand what we were doing here,” White says.
“The biggest thing is that they got in on the ground and they got very involved. We’ve seen the same thing with the Neil and Louise Tillotson Fund. “They feel like true partners, not just the money people and the icing on the cake is their focus on systems transformation and systems change versus creating more programs.”
All of which have supported a local community which had the will to improve its approach augmented by outside expertise and financial support.
“If I wanted other funders or other people to understand what funders can do to support and empower systems change at the local level, I’d point to this model,” White said.