Projects

Family Pathways to Care

How might we refine referral pathways and coordinate public mental health services to support healthy child development and well-being?

Partners & Funders

The Project

A variety of therapeutic and prevention services are available to low-income New Yorkers, however, these systems aren’t coordinated for full efficiency. PPL partnered with New York City’s child-welfare agency and health department to improve their inter-agency referral pathways and better understand what families need for comprehensive care.

The Outcome

Alongside caregivers and a cohort of contracted, service-provider agencies, we co-created and piloted a series of service delivery and operational tools designed to improve trust and coordination across three critical service touchpoints: intake, feedback, and referrals.

Family Pathways to Care

How might we refine referral pathways and coordinate public mental health services to support healthy child development and well-being?

Partners & Funders

The Project

A variety of therapeutic and prevention services are available to low-income New Yorkers, however, these systems aren’t coordinated for full efficiency. PPL partnered with New York City’s child-welfare agency and health department to improve their inter-agency referral pathways and better understand what families need for comprehensive care.

The Outcome

Alongside caregivers and a cohort of contracted, service-provider agencies, we co-created and piloted a series of service delivery and operational tools designed to improve trust and coordination across three critical service touchpoints: intake, feedback, and referrals.

Project Background

Family Pathways to Care is a multi-year collaboration between the Public Policy Lab (PPL) and the NYC Administration for Children’s Services (ACS) Division of Prevention Services and the NYC Department of Health and Mental Hygiene (DOHMH) Bureau of Children, Youth, and Families, funded by a Collaborative Innovations Initiative grant awarded to ACS by the NYC Mayor’s Office for Economic Opportunity (NYCO). 

ACS- and DOHMH-contracted children’s mental health and family support services both promote positive child outcomes by strengthening the family unit and parents’ ability to support their children’s development and well-being. These therapeutic and prevention programs serve similar populations, using the same or similar approaches, but their staff have differing intake, referral, and feedback processes, inconsistent access to available program information, and few means by which to support cross-system referral coordination.

We conducted over 200 hours of qualitative research and co-design remotely due to the COVID-19 pandemic.

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Hours of qualitative research

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Caregivers, frontline staff, and subject matter experts engaged

What We Found

Over the course of two years, we worked closely with an interagency project team made up of ACS and DOHMH staff to conduct over 200 hours of human-centered research and co-design with caregivers and providers, continuously visualizing learnings about the service landscape and family and staff experiences.

In analyzing issues of service delivery and family experience, PPL learned that the challenges and limitations of service coordination that providers experience left families feeling mistrustful and cognitively burdened by the disruptions in their care. Furthermore, families want to know that they are being heard, acknowledging that they feel more trust and agency when providers clearly and regularly invite them to reflect on their experience.

We synthesized qualitative research findings into four core needs shared by all stakeholders in the system to propel the team from learning to making.

In analyzing issues of referral and service coordination, PPL learned that providers—unable to check the real-time availability of program slots or compare similar programs across the system—tend to refer families to the programs and providers they already know and trust. Additionally, the lack of any integrated or standardized system for coordination between provider agencies undermines frontline staff’s ability to provide proactive, uninterrupted, wraparound care.

Referral Pathways

The diagram represents the common referral sources and pathways into public mental health and prevention programs drawn from qualitative research with NYC service providers and families.

Journey Map

Family needs, backgrounds, and perspectives influence how they interact with services. The full journey map illustrates the service phases, touchpoints, and tools NYC service providers and families interact with, highlighting pain points and bright spots by phase.

What We Designed

We built on the learnings from qualitative research to develop recommendations and design concepts which responded to the shared needs and major pain points in families’ journeys interacting with ACS and DOHMH mental health and family support services. 

The project team then used a sorting framework to organize the concepts according to perceived impact on the system and executional feasibility. Through this prioritization exercise, PPL was able to identify a subset of feasible high-impact recommendations for which to begin co-design with potential users.  

Through iterative cycles of collaborative design and observed field testing with caregivers and provider staff, the project team explored speculative new policies, tools, and materials to shift behaviors in the system and better respond to felt needs. PPL began co-design with low-fidelity renderings of ideas which respondents could view on their phones and ultimately refined a set of eight pilot-ready prototypes validated and improved by over 30 families and staff.

The prototype tools and processes were encapsulated within a service-delivery model based around three universal and critical service touchpoints: intake, feedback, and referrals. Using a consistent color-coded framework to visualize the major phases of families’ service experiences, PPL ensured the prototypes worked together to support both staff and families no matter where they were on their service journey.

The prototypes clustered into one of three service touchpoint objectives.

Trust-Building Intake

Tools/processes to ensure transparency and accessibility when starting services.

Responsive Service Delivery

Tools/processes to ensure that family/youth voices are heard and accounted for.

Collaborative Referrals

Tools/processes to support holistic and effective cross-agency referrals.

Following co-design, PPL prepared to run a four-month, hands-off pilot in which 10 program teams across six provider organizations would field test the prototypes in real service environments.

Prior to the launch, PPL trained and equipped 16 pilot leader representatives—one-to-two from each of the 10 program teams—to be the champions of the tools internally for the duration of the pilot. Pilot leaders then onboarded 80+ additional frontline staff on their teams to use the prototypes in their normal engagements with clients, resulting in 270+ pilot service interactions with families.

Over the course of the pilot, PPL held monthly check-ins with pilot leaders and ACS and DOHMH partners, supported pilot leaders in one-on-one troubleshooting sessions, and conducted evaluation interviews with staff and caregivers.

At the conclusion of the pilot, PPL assembled all qualitative and quantitative survey data about the three sets of tools and collaboratively synthesized the pilot learnings, ideating potential improvements.

The project resulted in a set of three guides—one for each phase of the service journey—which build on the highest-impact tools co-designed with families and tested by provider staff during the pilot.

For each touchpoint in the universal service-delivery model, PPL developed a brief and practical guide that built on the highest-impact tools tested during the pilot. Each guide begins with a set of journey-based instructions and contains both a staff-facing and a family-facing tool designed to build trust and improve service coordination in each phase of families’ experiences.

Feedback Guide

The feedback tools appealed to both staff looking to augment their existing feedback processes and to families who felt that the commitments format created an intuitive invitation to share.

Intake Guide

The Intake Guide is a behind-the-scenes checklist with talking points for staff to prepare to conduct intake with a new family and a corresponding family-facing one-pager which serves as an intake agenda and visual conversation tool. The staff checklist includes prompts to fill-in talking points so that staff with varying levels of experience have a reliable playbook for conducting comprehensive, transparent, and family-centered intake sessions. The family-facing one-sheet is meant to be printed out and shared with caregivers so that even if they are unsure what to ask, there are cues about what they should know and reminders about commonly-asked questions.

Intake Guide for CPS Cases

A secondary version of the Intake Guide was developed in close collaboration with ACS’ Division of Child Protection (DCP) to specifically address the questions and concerns of families transitioning to prevention services from a Child Protective Services (CPS) investigation for child abuse or neglect. This guide is currently being piloted by two prevention provider teams who participated in the main pilot.

Feedback Guide

The Feedback Guide offers a standardized user-centered framework for collecting and responding to family feedback about their program or assigned provider with operational guidance for how organizations can tailor the framework to meet the needs. Additionally, it provides clear expectations for families about how their feedback will be collected and addressed in the form of an illustrated one-pager titled “The Five Commitments.” The Five Commitments Framework for provider organizations to establish or improve their own feedback processes can be downloaded separately and include operational checklists for both frontline staff and provider leadership according to each of the commitments they will make to their clients.

Referral Guide

The Referral Guide is a recommended three-step process for making referrals drawn from best practices across the system, a tip sheet to help staff better leverage existing resource directories, and a family-facing worksheet to ensure youth and family service preferences are accounted for. The staff tip sheet describes how and when to use NYC Well, New York City’s free and confidential crisis intervention and referral support service for mental health programs, and NowPow, an independent and highly searchable directory of community-based organizations and local support services. The services preferences worksheet is best used to facilitate referral conversations with the youth or family being referred and to collect a few important pieces of information to support a successful search for available programs.

Referral Guide

The referral tools produced the highest positive change in staff satisfaction during the pilot.

Service-Delivery Model

Synthesis of project research findings revealed that all families – regardless of their path of entry into the system – experience three critical service touchpoints where they can exert agency and where the system can support their participation: during intake, during service delivery when given the opportunity to provide feedback, and during the referral process when being connected to a subsequent provider. PPL used this simplified universal model to visualize the opportunities for holistic cross-system intervention and developed an interaction model detailing how each of the guides are used to drive behavior change across existing interactions in the service journey.

To enable easy onboarding of provider staff to the Family Pathways to Care guides, we additionally prepared a freestanding and easy-to-navigate training tool, in the form of a slide presentation. The slides are broken into two visually-distinct sections: first, a facilitator guide which would allow anyone without deep knowledge of the project to onboard others, and second, a brief set of training slides which give details about how to use each tool alongside insights from research which emphasize its utility.

Interaction Model

The interaction model depicts how, when, and by whom each prototype is used to clarify the function of each in the service journey and to reinforce the cumulative effect of the tools on system behaviors when used together.

Project Implementation

Beginning in July 2022, PPL transitioned to supporting ACS and DOHMH with scaled implementation. Following the tasks identified in the implementation plan, PPL is providing strategic guidance to ACS and DOHMH project partners in planning for provider engagement, developing roll-out communications, establishing content management and maintenance processes, and in convening and seeking qualitative improvement recommendations from providers.

In addition to supporting scaled implementation, PPL is helping ACS and DOHMH maintain collaboration by forming an ongoing cross-agency working group to continue discussing cross-system referral coordination issues and opportunities. Building on two years of collaboration, the working group will seek long-term, systemic opportunities for greater integration and efficiency between ACS and DOHMH systems—like NYC Well—to better support providers in delivering appropriate and timely treatment. PPL will continue to facilitate these sessions, but transition to the role of strategic advisor providing guidance, supporting resources, and accountability.

Having clarity is really important in how you experience services.”

—Caregiver

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