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 is 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 will aim to make the prevention services referral process more accessible, family-friendly, and scalable across the H+H systems.

This project is 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're Researching

Research Approach

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

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 including plotting our insights to understand commonality (how many stakeholder groups feel this insight) versus intensity (how intensely do stakeholders feel this insight ) and having our partners at ACS and H+H plot the insights based on their curiosity versus 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're Designing

After printing and plotting, immersing ourselves deep in the experiences of our participants, we narrowed in on 5 concept areas ripe for intervention: Service Snapshot, Quick Connections, Family Choice, Referral Roadmap, and Trust-Building Care.

Next up, we’re heading into our co-design phase where we will begin to develop prototypes alongside families, H+H staff, providers, and ACS Prevention. By the end of co-design, we’ll begin piloting our prototypes.

Design Concepts

Service Snapshot

Accessible and adaptable overviews of service offerings for frontline staff, families, and providers.

Family Choice

Collaborative practices that empower families to make decisions about their service experience.

Trust-Building Care

Peer-led communication channels that foster trust with families.

Quick Connections

Tools for frontline staff to make efficient referrals to well-matched services.

Referral Roadmap

Tools to keep track of families’ progress in the referral journey and guide them toward the next steps

What We’ll Implement

By 2025, PPL plans to develop an improved referral pathway program, making the process more accessible, family-friendly, and scalable across the city system.

Projects

Partners & Funders

The Project

The Outcome

Prevention Pathways

Partners & Funders

The Project

The Outcome