Family Pathways to Care is a multi-year collaboration between the Public Policy Lab, the NYC Administration for Children’s Services (ACS), and the NYC Department of Health & Mental Hygiene (DOHMH). Funding was provided by a Collaborative Innovations Initiative grant awarded to ACS by the NYC Mayor’s Office for Economic Opportunity (NYCO).
ACS’ Division of Prevention Services and DOHMH’s Bureau of Children, Youth, and Families each contract with nonprofit providers for services that support children’s development and well- being. These therapeutic and prevention programs serve a similar population, using the same or similar approaches, but provider staff have differing service coordination processes, inconsistent access to available program information, and limited means by which to make cross-agency referrals.
We conducted over 200 hours of qualitative research and co-design remotely due to the COVID-19 pandemic.
Hours of qualitative research
Caregivers, frontline staff, and subject matter experts engaged
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, visualizing learnings about the service landscape and family and staff experiences.
In analyzing issues of service delivery and family experience, PPL learned that the limitations of service coordination left families feeling mistrustful and cognitively burdened by disruptions in their care. Families felt more trust and agency when providers clearly and regularly invited them to reflect on their experience.
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—tended to refer families to the programs and providers they already knew. Additionally, the lack of an integrated system for coordination between provider agencies undermined frontline staff’s ability to provide proactive, uninterrupted, wraparound care.
This diagram represents the common referral sources into public mental-health and prevention programs, based on qualitative research with NYC service providers and families.
Family needs and backgrounds influence how family members interact with services. This journey map illustrates the service phases, touchpoints, and tools NYC service providers and families interact with, highlighting pain points and bright spots by phase.
We built on learnings from qualitative research to develop design concepts that responded to the needs and pain points in families’ journeys interacting with ACS and DOHMH services.
The project team used a sorting framework to organize the concepts according to perceived impact on the system and executional feasibility. Through this prioritization exercise, we identified a subset of feasible high-impact concepts with which to begin co-design with potential users.
Through iterative cycles of collaborative design and field testing with families and provider staff, the project team explored speculative new policies, tools, and materials to shift behaviors in the system. 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 were clustered into one of three service objectives.
Following co-design, PPL launched a four-month, hands-off pilot in which 10 program teams across six provider organizations field tested the prototypes in real service environments.
Prior to the launch, PPL trained and equipped 16 pilot leader representatives—one or 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 evaluated qualitative and quantitative survey data about the three sets of tools and used the synthesized pilot learnings to make improvements.
The project resulted in a set of three guides—one for each phase of the service journey—that build on the highest-impact tools co-designed with families and tested by provider staff 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.
The feedback tools appealed both to staff looking to augment their existing feedback processes and to families who felt that the commitments format created an intuitive invitation to share.
The Intake Guide helps staff to lead transparent, family-centered intake conversations and build trust with caregivers during initial conversations by ensuring they receive accessible program information.
It includes a checklist with talking points for staff to prepare for intake and a family- facing one-pager which serves as an agenda, FAQ sheet, and conversation tool.
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.
The Feedback Guide helps staff operationalize feedback processes and set clear expectations with families about how their feedback will be addressed.
It includes a user-centered framework for responding to feedback which can be adapted and implemented incrementally by provider organizations, as well as a family- facing illustration of the “five commitments” that providers will make to their clients.
The Referral Guide helps staff facilitate referral conversations, collect the information they need to search for appropriate programs, and ensure successful referrals are made and sustained.
It includes a three-step process for making referrals drawn from best practices across the system; a tip sheet to help staff better leverage existing resource directories like NYC Well and NowPow, an independent and highly searchable directory of community-based organizations and local support services; and a family-facing worksheet to ensure youth and family service preferences are accounted for.
The referral tools produced the highest positive change in staff satisfaction during the pilot.
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.
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.
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.”