Prevention Pathways

Project Background

New York City offers free, voluntary services for families struggling with economic scarcity, parenting, mental health concerns, substance misuse, family conflict, and domestic violence. Year after year, families that participate in prevention services continue to have strong results–among families with the greatest level of need, children were far less likely to experience maltreatment or a foster care placement if they participated in prevention services. These services seem to be particularly impactful when families access them, early and voluntarily, through referrals from staff at hospitals, schools, and community-based organizations.

Prevention Pathways was a multi-year project aimed at improving referral pathways to prevention services, with the goal of increasing the number of families receiving community-based services and reducing the number of unnecessary reports to the State’s child abuse hotline.

Building on past initiatives to encourage H+H staff to connect families to prevention services directly, PPL created tools to make the prevention services referral process more accessible, family-friendly, and scalable across the H+H systems.

This project was a partnership between the Public Policy Lab (PPL), the New York City Administration for Children’s Services Division of Prevention Services (ACS Prevention), and NYC Health+Hospitals (H+H), with generous support from Casey Family Programs and Youth and Families Forward.

Interviews

Data points

What We Found

During research, we dove deep into questions like:

What are families’ experiences being referred to prevention services?
When a child’s safety is not at risk, how are H+H staff currently connecting families to supportive services?

We conducted over forty interviews at hospitals and community-based organizations across New York City, speaking with eleven families and twenty seven frontline staff who support them.

In-Person Research

Through guided exercises with interactive materials, frontline staff mapped out common and preferred referral pathways, while families drew out the information sources and formats they prefer when learning about services.

Findings

After hearing from families and staff, and collecting 2,500+ data points, we returned to ACS headquarters to bring these stories directly to leadership. We immersed our partners from ACS and Health + Hospitals in participant stories by playing audio clips and quotes from participants and sharing our takeaways from each phase of the service journey. Our partners engaged with these stories through a series of interactive activities, indicating the details that were new to them, and noting areas they wanted to learn more about.

Some of our takeaways include:

Many H+H staff and families lack basic information about what preventive services are and the types of services available.
When H+H staff encounter a family that needs support, they go through a convoluted process of piecing together information on available services from different sources.
When some families are introduced to preventive services, they have an initial fear of an ACS investigation.
To make a decision about whether to accept a referral to preventive services, some families look for opinions from trusted sources.

What We Heard

Here are a few highlights from the stories we heard:

"We answer questions every day on just, ‘what is Prevention?’ I've already answered two emails on that today.”

“When I'm not sure about a case and don't know where I want to go with it, I'll speak to [a social worker] because she'll ask, 'Okay, does it involve this? Is there a danger? Is there this?’ And then explains, 'Okay, this can be called in, this can be prevented.’"

"It scared me. Like, I hope I don't get a case, I didn't do anything! That's the perception I got."

"[Community referral sources] don't know the basic information to make these referrals. First of all, they don't know that we exist. Second of all, they're not familiar with the process in order to get the services for the families."

"[My friend] said, 'Look what Prevention did for me," and she started saying all these things. I didn't know they could do that! I thought 'let me see what this is about.' And it worked!"

"I connected a family to preventive services and no one got in touch with them. I didn't find out until a month later, and I was like, 'but I connected them!’”

Synthesis Process

Our synthesis process included many rounds of printing, clustering, and re-organizing to identify an initial set of themes. From there, we performed a variety of matrix activities and had ACS and H+H partners plot insights based on how important they felt each issue was.

Commonality vs. Intensity Matrix

During synthesis, we plotted our insights on a matrix of commonality (how many stakeholder groups feel this insight) versus intensity (how intensely do stakeholders feel this insight).

What We Designed

Through synthesis and additional co-design sessions with families, H+H staff, providers, and ACS Prevention, we worked together to create a suite of tools clustered into one of three service objectives: Family Support Training, Family-Staff Interaction, Referral Pathways.

Tool Areas

The prototypes were clustered into one of three service objectives.

Family Support Training

Training materials that seek to help H+H staff gain a better understanding of how preventive services can support families, train staff in effectively using the new referral pathways, and build confidence in talking to families about programs.

Referral Pathways

Tools to simplify and expedite the referral process by directly connecting prevention-service providers with H+H staff. Communication is streamlined through findhelp, a social service directory that facilitates referrals and provides referral status updates.

Family-Staff Interaction

Materials to facilitate conversations between families and H+H staff about program offerings and referral steps, including a take-home brochure, and an in-office guide for social workers.

In May 2024, we launched a four-month pilot with NYC Health + Hospitals staff and ACS-contracted CBO staff across New York City. We marked the launch of the pilot with a Prevention Pathways launch event at Lincoln Hospital.

Leading up to the pilot, pediatric and OB-GYN social workers across three NYC Health + Hospitals locations were led through trainings on the new tools. Medical staff also used Family Support Training tools, disseminating materials amongst their staff to ensure that medical providers across departments participating in the pilot were aware of these services.

Prevention Pathways Pilot Launch

We celebrated the pilot launch with an official launch event at Lincoln Hospital, attended by the full Prevention Pathways team: Public Policy Lab staff, ACS staff, and H+H partners.

At the conclusion of the pilot, we conducted interviews with 31 participants, including H+H staff members, CBO staff, and families referred through the initiative. Our interviews found that H+H social workers’ knowledge about Family Support programs increased as a result of the Family Support Training, and they found the Family-Staff Interaction Tools to be helpful resources when matching families to programs. We were pleased to learn that, using the new referral process, staff felt more empowered to offer families supportive services when they saw a family in need of support and a report to the Statewide Central Register of Child Abuse and Maltreatment (SCR) was not legally required.

Outside of the pilot, we worked with families to co-create a “Prevention Parent Advisor” role at ACS Division of Prevention Services to elevate family voice in the referral process. This leadership position for a parent with lived experience will help advise ACS Prevention teams, strengthen collaboration with families, and build community trust. While not part of our pilot, ACS is moving forward with hiring.

After evaluating pilot insights, we used the learnings to make tool improvements. The project resulted in six tools focused on improving staff training, family-staff interactions, and referral pathways.

Family Support Brochure

This brochure gives families a friendly introduction to services, lets them know what to expect in the referral process, and gives them contact information to follow up for a referral with their social worker.

Family Support Training Tools

These training tools give an overview of what Family Support programs are and who is eligible. It also introduces staff to the program areas to show what each program offers and how to identify families that are a good fit.

Staff Guide to Family Support A comprehensive booklet that assists staff at referral-source agencies in learning about programs and making appropriate referrals. Designed for social workers and other staff who support families, it outlines program models, summarizes referral process information, and provides an online directory of programs.

Staff Quick Reference Card to Family Support A one-page “cheat sheet” for staff summarizing the Guide to Family Support. This tool provides on-the-go referral information for staff that don’t have their complete binders—for instance, when meeting with families in the ER or on other floors of the hospital.

Family Support Referral Decision Tree A flowchart for referral sources, like hospital social workers, that outlines the decision-making process to make a Family Support referral. This tool supports staff in directing cases to appropriate programs.

Findhelp Recruiting Materials Flyers and training materials to recruit and onboard CBO staff and program directors to begin using findhelp.org, a user-friendly digital social service directory and referral system.

Family Support Training Tools Training materials geared towards referral source staff, like staff at NYC Health+Hospitals, that provide clarity on Family Support programs and their value. These trainings teach staff how to effectively use the new referral pathways, and build their confidence in talking to families about programs.

Family Support Brochures A client-facing brochure that provides families with an overview of programs and allows them to note what they need support with. This tool can facilitate collaboration between families and staff to choose the program that best meets the families’ needs.

Guide to Family Support and Quick Reference Card

Staff can use the guide for their own learning or alongside families. Staff often don’t bring their full binders when meeting with families in the ER or on other floors of the hospital, so we also created a portable one-pager that staff can grab in a pinch.

FindHelp Recruiting Materials

We created flyers and training materials for different staff types to encourage and teach them how to use findhelp.org, a user-friendly digital social service directory and referral system.

What We Implemented

In February 2025, we launched the Prevention Pathways tools at an in-person event in Harlem attended by the PPL team, ACS leadership, Health+Hospitals partners, and Family Support provider staff from ACS-contracted community-based organizations.

During the launch event, ACS leadership and providers interacted with the new tools in a science-fair style, moving from station to station to learn about and engage with the materials. Providers also had an opportunity to speak with each other and the project team members from PPL, H+H, and ACS, sharing feedback and strengthening relationships. We received overwhelmingly positive feedback from staff, who expressed excitement about the tools for families and referral sources that can hopefully lead to more accurate referrals.

In the coming months, ACS and H+H will roll out the tools across their systems, borough-by-borough, with guidance from our scaled implementation plan and change management strategies. We can’t wait for our tools to be used with the 15,000 families who benefit from Prevention Services every year, in pursuit of connecting these families with the help they need earlier and more efficiently.

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Prevention Pathways

Partners & Funders

The Project

The Outcome