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Summary

To control costs, healthcare providers and insurers need to focus on achieving population health outcomes rather than simply treating the symptoms of individual patients. Improving population health requires investment in a coordinated, multi-disciplinary approach involving healthcare professionals, social service providers, and legal service providers. The Medical-Legal-Community Partnership (MLCP) integrates legal professionals into healthcare teams to detect, address and prevent the health-harming legal needs of patients. The MLCP improves health outcomes by helping patients obtain health insurance and income supports while decreasing their stress and increasing their confidence and ability to take control.

The Medical-Legal-Community Partnership (MLCP) integrates legal professionals into healthcare teams to detect, address and prevent the health-harming legal needs of patients. Volunteer lawyers and law students collaborate on-site with medical and social service staff to address legal needs like Medicaid eligibility, protection from abuse, utility shut-offs, and food stamp denials. The MLCP is a partnership between Philadelphia Legal Assistance (PLA) and the Philadelphia Department of Public Health (PDPH) to provide legal services to PDPH Health Center patients. We have operated at Health Center 3 since 2013 and Health Center 4 since 2015.

Why Put Lawyers into Health Centers?

To control costs, healthcare providers and insurers need to focus on achieving population health outcomes rather than simply treating the symptoms of individual patients. Recent research estimates that 60 percent of an individual’s health is determined by environmental and social determinants, while only 40 percent of health is influenced by medical care and genetics.1

Many of the social determinants of health are legal problems: apartments with code violations, domestic violence, and lack of adequate income for food. The American Bar Association reports that every low-income individual in the United States currently faces 2-3 health-harming legal needs. However, only 20 percent of low-income people with such legal problems obtain the assistance they need.2

This suggests that improving population health requires investment in a coordinated, multi-disciplinary approach involving healthcare professionals, social service providers, and legal service providers.

Integration of Legal Care

By connecting the patients of Health Centers 3 and 4 with legal services, the MLCP seeks to ameliorate health-harming legal needs and empower clients to live healthier, less stressful lives.

When healthcare providers at Health Centers 3 and 4 identify a patient’s legal need, they refer them to the MLCP legal advocate on site. The legal advocate meets with the new client to determine the appropriate course for addressing the issue, which involves offering legal advice, opening a case, or referring the client to an external civil legal aid organization that offers specialized legal services, such as in divorce or immigration cases. Once a case is opened, a team of MLCP legal advocates work together to pursue the legal issue and keep in frequent contact with both the client and the healthcare provider who made the referral. Teams consist of pro bono lawyers and law students, who collaborate on casework to ensure that the highest quality of legal services is provided to clients. When the legal advocates finish their legal work, they report back to the referring provider about the outcome of the referral.

This is a departure from the traditional ways that healthcare and legal services have been delivered. Instead of providing legal services from a downtown office, lawyers are embedded into health centers located in communities where low-income people live. Traditionally, healthcare experts and legal services experts have worked in separate silos. The MLCP brings these areas of expertise together. Legal advocates teach healthcare providers about the law so that they can better spot legal issues.

Over one-third of cases handled by the MLCP in 2015 were related to access to health insurance. MLCP advocates helped clients apply for Medicaid and Medicare, enroll in the Affordable Care Act’s insurance exchange, and challenge improper insurance rejections. When appropriate, advocates also helped clients to access public benefits such as Social Security, disability, food stamps (SNAP), and utilities assistance (LIHEAP) in order to increase low incomes and reduce the health impacts of poverty. The remaining 30 percent of cases were related to employment, wills and estates, housing, and family stability. The majority of patient referrals came from physicians and benefits counselors, who help patients apply for insurance and thus are well-positioned to identify complex cases and improper denials.

The MLCP measures the effect of its work on patients, healthcare partners, and its own volunteers. In 2015, legal advocacy by the MLCP helped clients obtain $320,176 in ongoing annual benefits, such as healthcare coverage and public benefits, as well as $206,242 in one-time benefits, such as the elimination of medical debt. Of patients surveyed, 88 percent said that they felt less stressed as a result of the legal care they received from the MLCP. Three-quarters of healthcare staff surveyed agreed (and 30 percent strongly agreed) that as a result of the legal services they received, patients appeared to be “better able to cope with or manage challenges in their life” (the remaining 25 percent said they did not know). One hundred percent of law student volunteers surveyed said that they would recommend the MLCP as a volunteer opportunity to their fellow law students.

The Business Case for Medical-Legal Partnership

Currently, the MLCP is funded by a combination of government and foundation grants, which support one full-time attorney. The MLCP leverages resources of volunteer lawyers, law student volunteers, and fellowships in order to maximize the quantity of legal services provided per dollar of funding. On average, we spend $700 per case. We achieve $1,050 in average one-time financial benefits per case, as well as an average of $1,460 in annual on-going benefits.

We think our model is cost-effective and scalable. In five years, we would like to have a presence at all eight health centers operated by the Philadelphia Department of Public Health. In order to expand, however, we will need to find a stable source of funding.

Our strategy for growth and long-term sustainability is to demonstrate to government, healthcare providers, and insurers that the MLCP provides a social and financial return on investment. For example, if we successfully appeal a Medicaid denial, the healthcare provider will be paid for services that it might otherwise have to write off. Hospitals benefit because patients have options for care that are less expensive than going to the emergency room. If we assist a “super-utilizer” of health insurance with ameliorating the social determinants that keep them coming back to the hospital, then we can help the insurance company reduce costs.

If healthcare stakeholders can realize the alignment between the MLCP’s mission and their goals, they may provide funding to grow and sustain the MLCP. The MLCP now has a three-year track record and has assisted over 400 patients. We have started conversations with a variety of stakeholders in the healthcare industry about sharing data in order to measure the cost-savings and long-term health outcomes attributable to the MLCP’s work.

There are challenges to funding legal interventions in this way. We have noticed that when our cases result in healthcare cost-savings, these benefits are usually are distributed across many institutions. Until the industry is more coordinated, individual stakeholders may be reluctant to bear the cost of services like the MLCP when the benefits of the service may accrue to non-contributing competitors.

In this environment, the most logical funders are central payers who can fund medical-legal partnerships on a regional or national level and realize the aggregate cost-savings. There are signs that the federal government is moving in this direction. For example, the Health Resources and Services Administration recently clarified that a portion of the Health Center Expanded Services Supplemental Funding could be used to fund medical legal partnerships. 

Conclusion

The MLCP improves health outcomes by helping patients obtain health insurance and income supports while decreasing their stress and increasing their confidence and ability to take control. It is one of many interventions that, when widely adopted, will help the healthcare industry achieve lasting health outcomes and ultimately reduce the cost of care.

References

1. Steven A. Schroeder, “We Can Do Better—Improving the Health of the American People,” New England Journal of Medicine 357 (2007): 1221-28, doi: 10.1056/NEJMsa073350.

2. Helaine M. Barnett, “Documenting the Justice Gap in America: The Current Unmet Civil Legal Needs of Low-Income Americans,” Legal Services Corporation (2009), Accessed October 16, 2016, http://www.lsc.gov/sites/default/files/LSC/pdfs/documenting_the_justice_gap_in_america_2009.pdf.

Author Biographies
Caitlin Weiss is a Philly Fellow and AmeriCorps VISTA member serving at Philadelphia Legal Assistance, where she is the Director of Community Outreach for the Medical-Legal-Community Partnership. She earned her Bachelor of Arts degree from the University of Pennsylvania.
Jonathan Pyle is the Contract Performance Officer at Philadelphia Legal Assistance (PLA), where he is responsible for compliance, reporting, and implementing new uses of technology to analyze, streamline, and expand service delivery.

“You don’t just take from the society, you have to give back.” Those are the words Wesley R. Payne IV, board chair at Bethesda Project, emphasized as a theme throughout the conversation I had the privilege of having with him about Bethesda Project, how he got into the nonprofit sector and his leadership style. For more than thirty-six years, Bethesda Project has been working to end homelessness one life at a time. Bethesda Project’s mission is to find and care for the abandoned poor, and to them, the people that they serve are not nameless numbers, they’re members of the Bethesda Project family. The core values of service and family that the Bethesda Project represent are consistent with Wesley Payne’s background and ideals, making both a great fit for each other.

Before assuming his role as board chair at the Bethesda Project, Wes was a board member for more than six years. In addition to his work there, he also serves on the board at the Homeless Advocacy Project, and sits on several pro bono and civil boards while active in many legal organizations. Apart from all of this, Wes is a partner at White and Williams LLP, a law firm with over 240 lawyers in ten offices. Based in Philadelphia, Wes has over twenty-six years of experience representing insurance carriers and insurers in first- and third-party litigation matters. He also serves as a Judge Pro Tem for the Philadelphia Court of Common Pleas. Wes obtained his BA from Washington and Lee University and his JD from the University of Maryland, School of Law.

The duty to serve others and give back to society has been instilled in Wes’ mind throughout his life. When he was in seventh grade at The Boys’ Latin School in Baltimore, Maryland, Wes had the opportunity to be involved in a community giving program where he worked with kids who were on the verge of being homeless. As a result, the mindset to serve others and give back to society followed him through his years at Washington and Lee University and to the army. To this day, as an attorney, he still believes that you have to do something for others, not just for yourself.

Wes’ attraction to Bethesda Project (“Bethesda”) came about through many sporadic exposures. One of his earliest interactions with Bethesda’s work was when his eldest daughter prepared meals for residents at one of Bethesda’s locations as her high school service project. Another exposure was through the legal clinic that Wes ran at Our Brothers Place (one of Bethesda’s locations) where he got to know many of Bethesda’s residents. The final draw that led to Wes’ deeper involvement with the organization was when he met Bethesda’s founder, Father Domenic Rossi. Wes was moved by Father Domenic’s passion and vision to end homelessness by becoming a family to Philadelphia’s most vulnerable citizens, the chronically homeless. Wes recognized this as a great concept to end homelessness in the city and he ultimately joined the board of directors. 

Wes said what makes Bethesda unique is that many organizations believe that “the way to address [homelessness] is to start at the top of the ranks and work your way down. Bethesda does the exact opposite; it is the most affected chronic homeless that we target to help. So the people at the very bottom, the people who are literally falling through the cracks, [they] are not on most organizations’ radars. If we can save one life, one year or winter, then it was worthwhile.”

When asked about how Bethesda measures impact, Wes admitted that it is an area that Bethesda is working on improving. Because of the qualitative nature of their mission, Wes said that the best examples of impact are the individual stories of the residents who have gone from rock bottom, to a daybed, to a bed of their own, to almost living self-sufficiently because of their experience with Bethesda Project. Wes emphasized that “it is great to be able to say everybody [we serve] progressed, but that is just not true, people hit rock bottom, they try, they fail, go back to rock bottom, they keep going and trying, but what Bethesda is there for is to be that family that says ‘it’s ok to fail as long as you keep trying and you will eventually succeed.’”

Speaking about socioeconomic impact and how Bethesda’s work benefits the city of Philadelphia, Wes understands that it’s important to obtain grants or corporate sponsorships. However, Wes’ focus is not on how businesses can specifically benefit from Bethesda. At the end of the day, Bethesda values getting people out of the cycle of homelessness and getting them back to the society, thereby society is stronger and businesses profit from a strong society. When asked what Bethesda’s greatest funding needs are, Wes quickly said “unrestricted gifts for operating costs.”

Additionally, Bethesda hopes to secure funding for the Bethesda Project Beacon. The Bethesda Project Beacon fulfills Bethesda’s vision of creating a one stop shop for all needs relating to homelessness. According to Wes, raising seed money for a redevelopment project such as Bethesda Project Beacon is as challenging as raising operating funds. Not many donors are excited to give seed money, as they want their money to directly help the individuals. Though challenging, Wes is optimistic about the project and the many individuals it will benefit.

Bethesda Project has had its share of setbacks, one of which, according to Wes, has been a failure to plan ahead. The founding concept of the organization “has always been every nickel that we can put forth to getting people off the streets, do it. Even our board meetings are run with that thought process in mind. If donations or grants come in, we automatically look to whoever is next in line to help now and not really who we can help three to five years from now.” However, the Board has started to embrace the idea that it’s good to have more reserves for the future to prepare for a rainy day. 

Guiding and implementing this slightly new financial concept is one of the challenges Wes faces as board chair. But what Wes loves about the Bethesda board is that it is run through consensus and everything is voted upon. “The first thing about leadership is knowing who you are and not who you want people to see you as.” Wes was a commissioned officer in the army and everyone always assumes that when you give orders, the orders get followed, but that’s not how Wes was taught to lead. Wes is a great believer in listening, “not just listen, but really listen and appreciate.” This is advice that he would share with anyone at any stage in life and profession. Wes believes that an effective leader is one that utilizes the people and the team around them, “you don’t have all the ideas, sometimes the best ideas come from those around you and it’s the leader’s job to select and implement those best ideas.”

When I asked Wes whom he admires as a leader, Wes responded with a very historical choice, Abraham Lincoln, which surprised me. Wes probably sensed that I was slightly shocked and went on to explain that he admires Abraham Lincoln because he was an individual placed in an impossible situation and he had never been trained to lead a country through a civil war, having to make some very tough decisions while getting consensus. “And somehow, through self-confidence and not thinking too greatly of his own importance, he was able to cobble together not only a way to eventually win the civil war, but to do it in a way to not allow the country to be split.”

When I asked Wes what inspires hime every day, he answered that it is his family. Everything he does, he does so that his family can be proud. Wes never wants to feel ashamed to tell his family what he did that day. From our conversation, it was clear that Wes and Bethesda Project have the same core values, which are family and helping those in need. It is evident that Wes is part of the Bethesda Project family and is extremely passionate about Bethesda’s mission. Even when we talked about the challenges and setbacks of Bethesda, he committed to the ‘glass half full’ perspective that everything will be ok in the end as long as Bethesda Project continues its goal to end homelessness one life at a time.

The READ! by 4th Campaign is an ambitious attempt to help increase literacy rates among young Philadelphia students and thereby improve education in the city.

With the May 19 mayoral primary fast approaching, the Notebook asked each of the announced candidates -- Democrats Lynne Abraham, Nelson Diaz, Doug Oliver, Milton Street, and Anthony Hardy Williams -- to say, in 300 words or less, how they plan to support this early literacy campaign’s efforts, and what obstacles they thought might hinder its success. Here is what they had to say. The comments of Diaz and Street were edited for length.

Lynne Abraham

Nothing is more important to the future of this city, and the nation, than a well-educated population. Reading is the single biggest component of childhood and lifelong education. Reading is the gateway to entry into the knowledge-based economy and the most meaningful jobs in the modern world, in science, technology, engineering, art, and math (STEAM).

The investment of the Annie E. Casey Foundation and the Philadelphia Free Library system are welcome gifts to our children’s future. Teacher training is key, and our branch libraries provide an excellent community venue for children all over the city.

While programs like READ! by 4th require sustainable funding and coordination among agencies, a mayor can help support the program by keeping literacy at the top of her agenda.

As mayor, I will do everything in my power to support childhood literacy in our schools and throughout the branch library system.

Nelson Diaz

Improving education will be my number one priority as mayor. For every $1 spent now on a child’s [high-quality preschool] education, more than $7 is saved later on. I fully support the literacy efforts undertaken by PCCY, the Urban Affairs Coalition, and the more than 50 public and private partners committed to the READ! by 4th Campaign.

First, we need to get the parents involved. As mayor, I would explore ways in which we can improve the collaboration between the District and community organizations like Springboard Collaborative that are training teachers to effectively work with low-income families on literacy education. I would work to ensure that universal pre-K is available for all Philadelphia’s children and that our most vulnerable children get the community services they require.

I would identify reading education services for children who are monolingual in their native language so that they can then transition those literacy tools to English. I believe that effective literacy tools need to be learned at a young age before they can be prescribed to English in our schools.

I would work with the District to bring back school libraries and hire certified librarians. I would find ways to keep class sizes down, particularly from pre-K to 3rd grade when kids need individualized attention as they are learning to read.

I would continue to address “summer slide” and expand the city’s program to use the recreation centers to provide literacy education in the summer. I would also explore the use of educational programs that use technology like smartphones, tablets and computer apps to supplement lesson plans and make reading fun.

The District’s budget is my main concern. If the city does not provide the resources to support our children’s education, then the work of the campaign will not be able to be reinforced by the school system.

Doug Oliver

READ! by 4th is much more than a literacy program. It is, in fact, a very good example of how some of today’s widespread education challenges can be tackled. Indeed, the real power of  READ! by 4th may be in its ability to get diverse constituencies to agree on a common objective and then knuckle down to the hard work of achieving it.

Initiatives such as READ! by 4th don’t waste time picking sides or laying blame. They keep kids front and center and are focused on the reality that all of us need to get involved in supporting the needs of children in positive and meaningful ways.

The immediate benefit may be improved levels of literacy, but the potential for other programs built around other issues (math, science, etc.) is significant. I wholeheartedly support this effort on behalf of our city’s children.

In the end, we cannot lay the blame for the shortcomings of our education system at the feet of any one group, nor can we avoid the shared responsibility we have in improving education outcomes. That’s true whether you’re a teacher, parent, mayor, a legislator, a member of the business community or anyone with a stake in this issue, including the kids themselves. Yet the problems are real, and the demand for solutions grows ever more urgent. Which is precisely what makes this literacy program so exciting.

I’ll be doing what I can: highlighting the need for improved literacy, calling for real and sustained support for this program and others like it, and educating myself so that I too can always keep the needs of children front and center.

Milton Street

I haven’t heard of READ! by 4th, but I’m questioning who are they hitting, or are they programmed to hit some of the kids, but not everyone?

Being from the inner city, I know we have a lot of children that can and cannot read on level. This is a complicated problem with no easy solution. I think to help we have to stop the violence. If we can correct the violence, these programs get forward in a successful way. There are a lot of complicated problems contributing to children not being able to read.

Right now, [READ! by 4th] is a program I would probably support. I believe early literacy is really important. We have a situation where we don’t have programs that are all-inclusive. Is this a program that has the capacity to touch all 4th graders, or will it touch a percentage? Will I put my energy in a program that only touches a small percentage? What happens to the larger percentage of kids?

Once I get that information and make sure it has the capacity to touch all kids who get reading support and is reinforced for people with disabilities like reading and hearing and syntax -- then I will support it. There are a lot of problems with young people in growth and development. The kids that have these learning disabilities, what do we do with them? If they are in the program, are there any provisions to correct them, and how does it address those? Normally, it’s been my experience that those programs only touch a percentage of the population.

With education itself, there’s an overall problem with funding, and an overall problem because of violence in school. … We have to be really serious about our children’s education.

Anthony Hardy Williams

Philadelphia’s literacy rate among children and adults is among the root causes of poverty, and impacts Philadelphia’s ability to field a talented workforce to compete in the global economy. As mayor, I will be committed to making pre-K universally accessible, and I will renew and strengthen the Mayor’s Early Learning Advisory Council (MELAC)’s efforts to develop a citywide early learning plan aligned with the campaign, and use the “bully pulpit” to elevate the discussion.

Additionally, addressing literacy challenges for young children requires a “two-generation” approach, as 550,000 adults in Philadelphia are estimated to be low-literate. The Mayor’s Commission on Literacy should play an integral role in discussions about parental engagement and raising the literacy levels of families, not just children.

Ending low literacy in childhood starts with quality child care. Less than 15 percent of child care facilities in Philadelphia are considered quality. As mayor, I will order annual health and safety inspections of all child care facilities that do not meet statewide quality standards, and partner with child care operators to improve their quality.

Achieving success in this campaign requires a proven ability to generate funding – as I have done with the cigarette tax, which has garnered over $17 million for public schools so far – and sustained coordination between the government, business, and nonprofit sectors. With effective communication and a commitment to put our children first, we will achieve success.

Camden Copeland and Shannon Nolan are interns at the Notebook.

Introduction

The relationship between social entrepreneur and investor, nonprofit and funder, doer and donor is intriguing. You can talk to those with the capital and they will tell you how they are in constant search of innovation—to get in early and really make a difference by supporting an idea and making it a reality. You can talk to those with the ideas and they will tell you how they are in constant search of support (both capital and intellectual), looking to build a relationship with a funder and engage them in a way that they remain for the long haul. How these relationships begin, how they grow and change and how they ultimately serve some social good is at the core of this edition of the Philadelphia Social Innovations Journal. 

In the instance of the Brook J. Lenfest Foundation’s support of Mastery Charter Schools, it is a relationship that spans over twelve years, since the schools were merely a concept and the vision of theirfounder, Scott Gordon. This is more than a relationship between two organizations. It is a relationship between two people.I had the opportunity to talk with Brook and Scott about their relationship, about what motivated each of them and about what keeps them moving forward to achieve the vision Scott mapped out over twelve years ago. 


The Idea

According to itswebsite, the mission of Mastery Charter Schools is for all students to “learn the academic and personal skills they need to succeed in higher education, compete in the global economy, and pursue their dreams” (http://www.masterycharter.org). Scott’s original intention for Mastery Charter (at that time it was called High Tech High) was to reinvent secondary education. With the new millennium, it became clear that the world was evolving and kids needed new skills. Scott recognized that kids in Philadelphia were far behind academically and practically and he wanted to create a model school that would develop kids’ critical thinking to help them find a place in the real world. Scott was looking to meet business people and educators because he wanted to ensure that the schools’ educational platform would be aligned with the needs of businesses. 

Enter Brook J. Lenfest.


The Beginning of the Relationship

Brook realized early on in his career that there was not much opportunity without the right education. When the Lenfest family started their philanthropic work, Brook focused on education. He quickly learned of the state of Philadelphia’s public school system. He heard and learned from peers and colleagues. And when he started his foundation in 2000 he was able to articulate a clear focus, which remains today. The Foundation’s mission is to make people aware of positive life choices, and provide support and opportunities for those motivated to pursue them. In keeping with this mission, the Foundation focuses mainly on education, job training and mentoring programs(http://www.brookjlenfestfoundation.org). At a time when Brook started experimenting with some programs to attract teachers, Scott came along as an example as to what could be possible for Philadelphia schools.

Scott first pitched his vision at a meeting in Brook’s office in 2001, focusing on the idea, the team and the capacity of the organization he was starting. He painted a picture of something bigger, which would eventually grow into multiple school sites. Brook met with Scott a second time and asked for details—a business plan, a budgetand the like.  In Brook’s words, “nothing too rigorous.” At the conclusion of these initial meetings, Brook had decided to become the founding sponsor for Scott’s concept. Brook talks candidly about how he approached this relationship as an investment, viewing the proposal through a venture capital lens, and envisioning how the school they were creating would be a model to be replicated. 

The initial request was for $3 million to be paid out over a couple of years. Scott’s intention was to level the playing field between Mastery Charter Schools and the Philadelphia School District, as charter schools do not receive capital funding from the School District.

Mastery Charter leased a building on Broad Street for one year and then later purchased abuilding on 4th Street with the grant money.Brook offered to personally provide the guarantee on the loan for the property, a guarantee that remains today.


Finding the Right Social Entrepreneur to Support

A recent article in the Chronicle of Philanthropy, “Keys to Identifying Social Entrepreneurs Who Can Make Big Changes” by Cheryl Dorsey (2012), explores how funders can find the right social entrepreneurs to support. Dorsey calls on her experience at Echoing Green, a New York organization that aids aspiring social entrepreneurs, to let us all know what matters most.

Her first piece of advice is “betting on the right jockey.” This means that no matter what the issue, strong leaders share similar qualities like: perspective, purpose, problem-solving and charisma. Talking with Brook and Scott, there is an obvious and mutual respect for what each man brings to the table. A lot of what Dorsey talks about in her article is exemplified in this relationship.

Perspective, as defined by Dorsey, is the ability to look at the world with a sense of humanity and common dignity.One of the guiding thoughts Scott has held with him since the beginning is this idea of breaking the poverty cycle through education. He talks passionately about how the economy and the crime rate in Philadelphia could look so different if our educational system were more successful. The kids graduating from Mastery Charter Schools are going to live a different life than how they grew up,hopefully extending into future generations.

Purpose is about not getting caught up in a single goal, but rather having a willingness to change gears to achieve impact. One of the things Scott speaks confidently about is his absolute clarity about what success looks like and how to measure it. This is a critical criterion that continues to drive and influence Brook’s grantmaking, as well. The Foundation only supports organizations that can substantiate their impact. Brook says, “One of the things I really like about Mastery is, if you look at the philanthropic dollars versus individuals helped, Mastery is good value.” 

Problem solving is critical to the success of social entrepreneurs. Successful leaders know how to maximize and leverage strengths, talents and opportunities. When I asked Scott about what keeps him up at night he quickly responded that it is the quality of teaching staff. Mastery Charter Schools fundraises for innovation. Scott wants Mastery teachers to be the best of the best—masters of their craft. This focus on innovation has led to guidebooks on standards, creative tools for training and coaching teachers, and groundbreaking management practices.

Finally, charisma is the ability to enlist others in support of the venture. One of the comments I found most refreshing during our conversation came from Scott. He said, “I have been very honest with funders and supporters. There have been some struggles, but I respect our Board Members and I actually want their input and guidance. The longevity of Mastery Charter Schools has a lot do with transparency.”

One of the reasons Brook has supported the organization for so long is because of the evolution Scott has gone through as a leader. A lot of what Mastery is doing continues to be groundbreaking. That aspect is exciting to Brook and he believes they are doing a great job with managing growth and results.


The Relationship Today

Over the last twelve years, Mastery Charter Schools has raised about $20 million and established 12schools. They are looking to raise an additional $25 million through a capital campaign over the next five years. This current school year (2012-2013), Mastery Charter Schools serves 7,800 students. In five years, it intends to serve 14,000 students through 22 schools.

At the core of every Mastery school is a set of values that guides all of their actions. Mastery’s values are infused in the everyday life of the organization, including things like achievement, grit, joy, humor and the concept of one team. One team means that everyone is in this together. There may be disagreements, but at the end of the day everyone needs to support each other 100 percent.

This notion captures this relationship between doer and donor.

Brook’s Foundation remains the largest private funder of Mastery Charter Schools, and Brook remains on the Board. When I asked Brook about his thoughts on his time on the Board, he said, “If you are personally involved it’s a lot more satisfying than just giving the money.One thing with a start-up is that you have that hands-on involvement. What has changed the most is that this organization has gone from a start-up to a full-on, $80 million revenue organization. That’s exciting.”


The Brook J. Lenfest Foundation

The Lenfest family minimizes the overhead expenses of running multiple foundations by sharing staff. They currently have two grant cycles per year. Typically the Foundation does not put restrictions on grants. Brook believes in providing general operating support and leaving it in the hands of the leadership at grantee organizations to put the money to the best use. 

The Foundation enjoys a close and long-standing relationship with its investment advisor, LGL Partners. Chief Investment Officer of LGL, Bill Luterman, has worked directly with Brook for over a decade managing his personal and philanthropic needs. Through Bill’s strong relationship with Brook, he too has become involved with Mastery, lending his professional expertise and directly investing in their ongoing efforts. As advisor, LGL incorporates Brook’s philanthropic goals into his overall financial plan. Brook’s commitment to organizations does not waiver when markets decline, becausethat is when need typically increases. Understanding this dynamic, LGL has provided a long-term strategic plan designed to meet commitments while actively managing around market fluctuation.Bill, along with his partner and CEO, P. Scott Gregorchuk, has been working with families and individuals like Brook to achieve every aspect of their personal goals.This level of understanding between donor and advisor is integral in effecting change in through philanthropy.


References

The Brook J. Lenfest Foundation.(n.d.).Available at http://www.brookjlenfestfoundation.org.

Mastery Charter Schools. (n.d.).Available at http://www.masterycharter.org.

Dorsey, C. (2012, July 22). Keys to Identifying Social Entrepreneurs Who Can Make Big Changes.Chronicle of Philanthropy. Available at http://philanthropy.com/article/How-Donors-Can-Find-People-Who/132999/?cid=pt&utm_source=pt&utm_medium=en

LGL Partners. (n.d.).Available at https://www.LGLPartners.com.

Introduction

Collective giving—pooling one’s dollars with a circle of colleagues, friends, family, and acquaintances, in order to support nonprofits in a strategic manner—is redefining the way donors and nonprofits view philanthropy. It’s a new order of business best described as philanthropy with wide rather than deep pockets, capturing the smaller donations of many individuals and leveraging them into larger, more transformative grants.

Giving circles come in many forms, but are commonly geared toward making philanthropy more affordable and accessible, including to younger and diverse populations. Participation may range from attending a single event, to a one-year commitment, to lifetime membership. Nationally, collective giving overall has grown rapidly, with more than 500 giving circles in 44 states contributing more than $100 million (Eikenberry and Bearman 2009).

There are 14 giving circles in the Philadelphia region (see Figure 1).  While each has a different structure and grant-making focus, the organizations have some marked similarities. Most have an application process for nonprofit candidates, and a mission to educate their donor participants about nonprofits’ work and the needs of the community. Most also use a voting mechanism to determine which organizations receive funding, and the voting typically follows live presentations by the applicants. Most of the local groups are run by volunteers, and women play a prominent role—in many cases, the organizations are all-women.

Figure 1: Giving Circles and Other Collective Giving Organizations in the Philadelphia Region as of July 2012

Collective giving organization (website, year founded)

Funding, past 12 months

# participants,
last reported

Independent or
affiliated

Focus of funding/grant-making
(geographic focus)

Women of Vision
(jewishphilly.org, 1994)

$50,000

424 (women)

Jewish Women’s Foundation of Greater Philadelphia

Improvements in the lives of Jewish women and girls
(Greater Philadelphia and Israel)

Dining for Women
(diningforwomen.org, ~2005)

~ $2,000/ chapter

10 chapters in Philadelphia region (women)

Part of national organization

Improvements in the living situation for women and their families
(Philadelphia region)

Global Is Local
(globalislocal.org, 2005)

N/A

53

Independent

Solutions to extreme poverty in the developing world
(developing countries)

Spruce Foundation
(sprucefoundation.org, 2007)

N/A

500(young professionals)

Independent

Grassroots organizations that serve at-risk youth
(Greater Philadelphia)

Impact100 Philadelphia
(impact100philly.org, 2008)

$242,000

242 (women)

Independent

High-impact projects, lesser known organizations, under-served populations
(Philadelphia region)

Women for Social Innovation
(womenforsocialinnovation.org,
2008)

$15,000

35 (women)

Donor-advised fund of Women’s Way

Emerging social entrepreneurs who seek to improve life for women, girls and families
(Greater Philadelphia)

Asian Mosaic Fund
(asianmosaicfund.org, 2009)

$5,100

40

Donor-advised fund of The Philadelphia Foundation

Challenges in the Asian American community
(Philadelphia)

Philly Stake
(phillystake.org, 2010)

~ $5,000

150–300 (attendees at each event)

Independent

Creative and relevant community engaged projects
(Philadelphia)

Women’s Dining Circle
(---, 2010)

~ $5,000

~ 50 (women)

Overbrook Presbyterian Church

Nonprofit organizations selected to present at dinner events
(Philadelphia and international)

Impact Philadelphia
(philafound.org, 2011)

N/A

~ 50 (young professionals)

Donor-advised fund of The Philadelphia Foundation

Targeted focus each year; currently food shortages and workforce development
(Philadelphia)

Acharai Fund
(acharaifund.org, 2011)

N/A

35 (families)

Independent

Support programs affecting Jews in Israel
(Israel)

PhilaSoup
(philasoup.com, 2011)

>$1,000

> 200 (attendees)

Independent

Microgrants to educators
(Philadelphia)

Philly SEED
(---, 2012)

$5,000 plus pro bono services

N/A

Independent

Crowd-funding for educational entrepreneurs
(Philadelphia)

Philly4Philly
(philly4philly.org, 2012)

N/A

 --
(launched July 2012, goal 150 people)

Organized by Citizen Effect in Washington, DC

Match between individual donors and 150 smaller nonprofit projects
(Philadelphia)


What’s In It for the Donors?

These essential qualities seem to be the key to collective giving’s appeal:

  • Hands-on giving. Donors have the chance to be directly and personally involved with applicants, and to learn exactly what the donation will fund.
  • Fulfilling work. Perhaps the biggest draw to collective giving is its power to leverage each individual’s contribution into something more meaningful and effective.
  • Democratic structure. Members typically have an equal say in decision-making; their collective votes determine the funding recipients.
  • Social component. Individual donors with shared interests meet and learn from one another through their grant-making activities.

Together, collective giving organizations are enriching the regional philanthropic landscape, dispelling the notion that giving requires enormous individual wealth and underscoring the fact that women have funds—earned, inherited, and shared with spouses and partners—that they want to invest in their communities. Women now control 83 percent of household expenditures and 50 percent of personal wealth, according to Donna P. Hall, president of the Women Donors Network (Spector 2010).

As mentioned above, many of the collective giving groups in Philadelphia are women’s groups. This collaborative funding model appeals particularly to women, as evidenced by national trends as well. One of the first major giving circles, the Washington Women’s Foundation in Seattle, launched nationally in 1995. Leaders of the WWF also founded the Women’s Collective Giving Network, a national consortium of 29 giving circles that convene for a monthly conference call and an annual conference to discuss challenges and share best practices. WCGN donates $7 million annually (Women’s Collective Giving Network 2012).

In Philadelphia, Women of Vision was founded in 1994, and has donated nearly $560,000 to nonprofits here and in Israel, said Susan Lundy, endowment officer. Explaining their success, Lundy said, “Women understand philanthropy and what it means. . . they like to be hands-on in their giving and they find creative ways to allocate their dollars.”

Many local leaders said that as giving circles continue to democratize philanthropy, the word “philanthropy” itself becomes less intimidating, and less often associated with millionaires and well-endowed foundations. “It doubles, triples, quadruples what any individual can do,” said Debra Kahn, executive director of the Delaware Valley Grantmakers, allowing ordinary people to call themselves something they never would have considered previously: philanthropists.


What’s In It for the Nonprofit Applicants?

David Florig had only vaguely heard of giving circles in 2011 when the West Philadelphia Alliance for Children (WePAC) applied to Impact100 Philadelphia, which pools $1,000 gifts from at least 100 women to make $100,000 grants to lesser-known organizations. But winning that $100,000 grant was a “game-changer” for WePAC, said Florig, WePAC’s executive director. He had an audience of nearly 150 women at the Impact100 annual meeting where members voted to award grant funding. To have that many donors—and potential volunteers—all in one room was unheard of. “It’s a great way to connect with people outside our normal circle,” Florig said.

A year earlier, Jessica Franzini received the Impact100 grant for New Jersey Tree Foundation. “It was an extraordinary process that I’ve never seen anywhere else,” she said. “Even if we hadn’t received the grant, we were able to tell our story to lots of people, and I had the chance to learn about other nonprofits and make connections with them too.” Reflecting on the trend in collective giving, Franzini said, “It’s such a win-win. Donors are getting to impact an organization much more than they would on their own, and the organization is getting the chance to apply on a level playing field, and connect with individuals. It’s very grassroots and people-oriented, as opposed to traditional giving.”

Philly Stake deliberately set out to “turn the traditional granting process on its head,” said Kate Strathmann, a member of the organizing team. Applicants to Philly Stake respond to four questions, with answers of up to 100 words each, describing a project focused on creative engagement. Ten organizations are selected to present at a dinner event to an audience of 150 to 300 people. Diners, after paying a modest amount to cover the food and donation, vote to determine which organizations will receive funding. “Our process is very transparent,” Strathmann said. “The atmosphere is really supportive of whoever wins—it’s very celebratory. And it’s so cool to see how many great things are happening in Philly.”

The globalislocal Fund focuses on projects that address poverty in countries around the world, through grants for farming, water sources, and other improvements. Nearly all donors are based in Philadelphia, but all funding is awarded outside the United States. Potential grant recipients are selected in advance and travel to Philadelphia to speak directly to globalislocal donors at luncheon events throughout the year. “I think they appreciate the laid-back, intimate style,” said member Rhonda Mordy. “They get to know us and we get to know them.”


A Strong Trend, Continuing to Grow

Inspired by the success of the Asian Mosaic Fund, Carlos Cartagena, a long-time community activist who works in Philadelphia’s nonprofit community, is creating a Latino giving circle. He believes such a model is the key to boosting giving by Latinos (which is about 3 percent of U.S. philanthropic dollars donated annually, he said). His objective: Raise needed funds, but also give the Latino community a greater voice in how those funds are spent in their communities. Another group, launched in December 2011 by 35 Jewish families in the Philadelphia suburbs, is the Acharai Fund, which will award its first funding ($180,000) in September 2012 for projects in Israel.

New collective giving groups have often come to fruition with the support of existing foundations or groups. They tend to be collaborative not only within their organizations, but also across organizations doing similar work. Philly Stake, for example, is part of “a network of over 60 sister projects around the world,” said Strathmann. Women of Vision, part of the Jewish Women’s Foundation of Greater Philadelphia, recently joined in a collaborative donation with 14 other U.S. and Israeli organizations. Impact100 Philadelphia was closely modeled after the first Impact100 in Cincinnati; nationally, at least 15 current organizations, all independent but collaborative, have donated nearly $19 million over the last decade.

The collective giving trend has similarities to another recent movement, “crowdfunding.” An offshoot of crowdsourcing, which broadcasts a problem widely and seeks solutions from the public, crowdfunding broadcasts a need and seeks funding widely from people who might want to address the need, either online or through live events. Rapid communication and easy donation processing are the focus of websites such as Kickstarter, which has taken $250 million in pledges in three years of operations. Another effort making philanthropy more affordable is micro granting, where small grants are paired directly with a community program seeking initial startup funding or money for a critical project.


Conclusion

Democratic decision-making is one of the hallmarks of giving circles. This aspect means a member may feel passionately about projects that ultimately do not win the full support of the group. Yet this is not a deterrent to staying involved. “So often in life you find that people have their own agendas, but I didn’t find that at all in this. It wasn’t political; everyone was respectful. There was a common cause and everyone was trying to see where we could make a difference,” said Impact100 member Barbara Matteucci.

Matteucci continued, “We can see what we’re doing, very tangibly. It encourages someone like me to give even more, because I actually play a role in it. I can go see and appreciate what our contribution is doing. It makes me feel good that I’m involved.”

The Village of Arts and Humanities in North Philadelphia is one such beneficiary of this new breed of philanthropy. Its youth arts magazine, CRED, won a $100,000 grant from Impact100 in June. About winning, executive director Elizabeth Grimaldi said, “The grant differs from others in that I find it far more personal. . . and the potential beyond the direct funds is tremendous. We've been blown away by the number of women who have reached out just to learn more, or who have visited since the presentation.”

It may be too early to gauge the long-term impact of giving circles and other forms of collective giving. Will the trend continue? Will giving circles maintain and even grow in membership? No matter what the future holds, the growth of collective giving, especially over the past five years, has changed the landscape of funding in Philadelphia. More people now participate in grant-making, and in doing so, they see first-hand the tough challenges facing their communities and the work nonprofits are doing to tackle them.

Beth Burrell is a freelance journalist who began her career as a daily newspaper reporter covering local government and environmental issues, before leaving the field to earn a master’s degree in education from the University of Pennsylvania. She was a founding board member of Impact100 Philadelphia, serving for three years as communications chair. She is a long-time reading tutor in the West Philadelphia public schools for the West Philadelphia Alliance for Children (WePAC), and works part-time for the communications office at Friends’ Central School in Wynnewood, helping to produce weekly e-newsletters. She lives in Merion with her husband and three children.

Mary Broach’s career began in investment banking before shifting to nonprofit fundraising and management, and more recently to consulting. She serves as the board president of Tabitha USA, a nonprofit that supports community development work serving the poorest regions of Cambodia. In 2008, she co-founded Impact100 Philadelphia, and has served as co-president and communications chair. Together with Impact100 co-founder Beth Dahle, she was awarded PathwaysPA’s Trailblazer Award in 2009 and was named New Generation Philanthropist of the Year in 2010 by the Association of Fundraising Professionals Greater Philadelphia Chapter. She lives in Wynnewood with her husband and three daughters.

References

Eikenberry, A. M., and J. Bearman. (2009, May). The Impact of Giving Together: Giving Circles’ Influence on Members’ Philanthropic and Civic Behaviors, Knowledge and Attitudes. Forum of Regional Associations of Grantmakers, the Center on Philanthropy at Indiana University, and the University of Nebraska, Omaha. Available at www.philanthropy.iupui.edu/files/research/2009givingcircles_fullreport.pdf

Krotz, J. L. (2009, May). Making Philanthropy Count: How Women Are Changing the World. Women’s Philanthropy Institute at the Center on Philanthropy at Indiana University. Available at www.philanthropy.iupui.edu/files/file/making_philanthropy_count.pdf.

Spector, A. (2010, November). Women as Philanthropists: Who Were We, and Who Are We Becoming? Donna Hall Offers Her Perspective. Impact100 Philadelphia. Available at www.impact100philly.org/images/Impact100DonnaHallPresentation.pdf.

Women’s Collective Giving Network. (2012, April). Report to Members.

Introduction

Looking to expand its programming to serve more homeless people, but concerned about its dependence on limited government and foundation funding, Depaul USA explored options to increase its earned income. A program-related investment from the Patricia Kind Family Foundation structured as a low-interest, multi-year loan allowed Depaul USA to purchase a commercial cleaning franchise. The goal of the cleaning business, Immaculate Cleaning Services, a for-profit limited liability corporation, is to generate unrestricted income for Depaul USA’s programs. Immaculate Cleaning Services also provides a secondary benefit of employing residents of Depaul USA’s transitional housing program. Depaul USA is now busy managing the day-to-day operations of Immaculate Cleaning Services, but plans to pursue additional social franchising opportunities in the future.


Depaul House Opens

In 2009, a contract from the City of Philadelphia and local foundation support enabled Depaul USA to open Depaul House, a 25-room, transitional housing program for homeless men in Germantown, Philadelphia. Over the next two years, Depaul USA expanded its programming and staff at Depaul House. During this time, the funding model for Depaul USA essentially remained the same. The city contract covered approximately 60 percent of program costs and grants from foundations covered the vast majority of remaining expenses. These funding investments proved effective. Benefitting from robust services focusing on employability, each year approximately 80 percent of Depaul House graduates transitioned to independence— securing jobs and places to live.


The Need for a Sustainable Business Model

By 2011, Depaul USA was planning for further growth. Expansion, however, required a more sustainable financial model. While the city and foundations remained champions of Depaul USA’s work, an environmental scan revealed challenges. Budget cuts and looming deficits threatened future discretionary spending for housing programs at the federal, state and local levels. Foundation funding, by nature, was not guaranteed to be perpetual. Over time, some funders were certain to turn to other issues and needs.

In response to these challenges, Depaul USA determined to move forward on three fronts. First, programs would be reviewed to reduce base operating costs in an effort to become increasingly sustainable. Second, Depaul USA would develop a robust individual giving program. Third, Depaul USA would work to increase its unrestricted earned income.

To develop a strategy to attain this third goal, Depaul USA began assessing the effectiveness of social enterprises in funding nonprofit organizations. A review of the literature, however, revealed that many social enterprises succeeded more as job training initiatives than profitable businesses. This point was dramatically reinforced by the head of a nationally respected Philadelphia nonprofit who told me that none of her organization’s social enterprises had ever turned a profit. They had, however, reintroduced clients to the world of work and had raised the organization’s profile.

As Depaul USA’s primary goal was revenue maximization, my interest pivoted to “social franchising,” a sub-sector of the social enterprise movement. I learned that, across the U.S., more and more nonprofits are purchasing and operating franchise businesses, including restaurants and service companies, to generate operating income. The logic behind the franchise model is compelling. Franchises provide nonprofits with things they often lack—proven business plans, developed operating systems, brand names, marketing programs, and ongoing advice and assistance. All of these inputs exponentially increase a new business’ chances of success.


Immaculate Cleaning Services

In mid-2011, I convened a Franchise Working Group comprised of local business people to look at the social franchise movement and assess whether purchasing a franchise might make sense. The Working Group reviewed case studies of nonprofits that purchased and operated franchises, considered Depaul USA’s finances and operational capacity, met with local franchisors to learn about franchise operations, and surveyed franchise purchase opportunities. At the end of its deliberations, the Working Group recommended that Depaul USA purchase a commercial cleaning franchise.

This recommendation was based on affordability and low barriers to market entry. Cleaning franchises typically do not require costly investments in physical plants or inventory. Many also offer guaranteed contracts or “books of business” to their franchisees. In addition, the commercial cleaning sector has a reputation for being recession-resistant and the local market is large and not saturated. Our review of franchise business models revealed that a modest investment could produce $12,000 in unrestricted revenue annually for Depaul USA with the potential for significant future growth. Moreover, residents of Depaul House often found work as janitors, so the new business would have the added benefit of a potential in-house source of labor.
Depaul USA staff researched and interviewed different commercial cleaning franchises, ultimately selecting Heits Building Services as its preferred franchisor. Depaul USA began contract negotiations with Heits and drafted a grant proposal for local foundations requesting seed funds to purchase the franchise and a van to transport workers, as well as hire an attorney specializing in social enterprises to determine and establish the franchise’s legal structure. In a nod to its location on the campus of the Church of the Immaculate Conception, Depaul USA christened its new business “Immaculate Cleaning Services.”

After learning about Depaul USA’s grant request, Laura Kind McKenna, Managing Trustee of the Patricia Kind Family Foundation, reached out to Depaul USA and made an intriguing counter-offer. Instead of making a grant to Depaul USA, she proposed a multiple year low-cost loan with a gradually increasing payment schedule. Ms. McKenna noted that structuring her foundation’s investment in Depaul USA as a loan would provide multiple benefits. “This loan can do multiple duties,” she told me. “Initially, the funds will help Depaul USA launch a social enterprise. As Depaul USA repays the loan, the funds can then be re-invested in other programs that benefit still more Philadelphians.” According to Ms. McKenna, the loan will also help Depaul USA run its janitorial franchise as a true for-profit business. “In order for Immaculate Cleaning Services to succeed, it is very important that Depaul USA think like a business. A loan creates greater incentives than a grant to focus on the bottom line and be fiscally disciplined.”

At its February 2012 meeting, the Depaul USA board authorized management to accept the loan from the Patricia Kind Family Foundation. Staff then focused on concluding negotiations with Heits and working with its attorney to incorporate Immaculate Cleaning Services. On April 18, 2012, Immaculate Cleaning Services was incorporated as a limited liability corporation with Depaul USA as its sole member. On May 3, 2012, Depaul USA signed a contract with Heits, becoming that company’s first nonprofit franchisee. In mid-June 2012, after interviewing, selecting and training Depaul House residents as its employees, Immaculate Cleaning Services, LLC began cleaning a daycare facility and dialysis center.

Conclusion

Revenue from Immaculate Cleaning Services alone will not resolve Depaul USA’s financial challenges. A material change to our bottom line requires investment of a scale far greater than Depaul USA’s current capacity. It would also likely require multiple partners. To this end, I am exploring the concept of a “social franchise fund” seeded by a consortium of nonprofits, foundations and venture capitalists. The fund would allow member nonprofits to take equity positions in new franchise ventures across the Delaware Valley without assuming the resource-consuming responsibility for these ventures’ day-to-day operations. Professionally and sagely administered, the fund could generate significant returns for the nonprofits while simultaneously catalyzing the creation of job-generating businesses in neighborhoods across the region.

In the interim, the process of purchasing and inaugurating a franchise has increased Depaul USA’s board’s familiarity and comfort with social enterprises. It has also created a more entrepreneurial staff culture. My goal is that this familiarity and the success of Immaculate Cleaning Services will create the appetite for a larger franchise venture in the future. For her part, Ms. McKenna told me she would like to see more small and medium-sized Philadelphia foundations offer program related investments (“PRI”) to area nonprofits. “PRIs like the Depaul USA loan are straightforward to structure and, given their financial return, they allow foundations to make more investments and impact more programs and people,” she explained. “The Patricia Kind Family Foundation views its loan to Depaul USA as a potential model that can be replicated throughout the Delaware Valley.”

Charles W. Levesque, Executive Director, Depaul USA, has a law degree from Northwestern University, a Masters in Public Administration from the University of Illinois and graduated from Georgetown University, School of Foreign Service. He served as Chief Operating Officer and General Counsel for the Interfaith Youth Core, Chicago, June 2007 to August 2010, was Deputy General Counsel for the Chicago Housing Authority, August 2002 to February 2007 and Program Officer for the U.S. Department of State, Diplomat, 1996 to July 2002.

Summary

To control costs, healthcare providers and insurers need to focus on achieving population health outcomes rather than simply treating the symptoms of individual patients. Improving population health requires investment in a coordinated, multi-disciplinary approach involving healthcare professionals, social service providers, and legal service providers. The Medical-Legal-Community Partnership (MLCP) integrates legal professionals into healthcare teams to detect, address and prevent the health-harming legal needs of patients. The MLCP improves health outcomes by helping patients obtain health insurance and income supports while decreasing their stress and increasing their confidence and ability to take control.

The Medical-Legal-Community Partnership (MLCP) integrates legal professionals into healthcare teams to detect, address and prevent the health-harming legal needs of patients. Volunteer lawyers and law students collaborate on-site with medical and social service staff to address legal needs like Medicaid eligibility, protection from abuse, utility shut-offs, and food stamp denials. The MLCP is a partnership between Philadelphia Legal Assistance (PLA) and the Philadelphia Department of Public Health (PDPH) to provide legal services to PDPH Health Center patients. We have operated at Health Center 3 since 2013 and Health Center 4 since 2015.

Why Put Lawyers into Health Centers?

To control costs, healthcare providers and insurers need to focus on achieving population health outcomes rather than simply treating the symptoms of individual patients. Recent research estimates that 60 percent of an individual’s health is determined by environmental and social determinants, while only 40 percent of health is influenced by medical care and genetics.1

Many of the social determinants of health are legal problems: apartments with code violations, domestic violence, and lack of adequate income for food. The American Bar Association reports that every low-income individual in the United States currently faces 2-3 health-harming legal needs. However, only 20 percent of low-income people with such legal problems obtain the assistance they need.2

This suggests that improving population health requires investment in a coordinated, multi-disciplinary approach involving healthcare professionals, social service providers, and legal service providers.

Integration of Legal Care

By connecting the patients of Health Centers 3 and 4 with legal services, the MLCP seeks to ameliorate health-harming legal needs and empower clients to live healthier, less stressful lives.

When healthcare providers at Health Centers 3 and 4 identify a patient’s legal need, they refer them to the MLCP legal advocate on site. The legal advocate meets with the new client to determine the appropriate course for addressing the issue, which involves offering legal advice, opening a case, or referring the client to an external civil legal aid organization that offers specialized legal services, such as in divorce or immigration cases. Once a case is opened, a team of MLCP legal advocates work together to pursue the legal issue and keep in frequent contact with both the client and the healthcare provider who made the referral. Teams consist of pro bono lawyers and law students, who collaborate on casework to ensure that the highest quality of legal services is provided to clients. When the legal advocates finish their legal work, they report back to the referring provider about the outcome of the referral.

This is a departure from the traditional ways that healthcare and legal services have been delivered. Instead of providing legal services from a downtown office, lawyers are embedded into health centers located in communities where low-income people live. Traditionally, healthcare experts and legal services experts have worked in separate silos. The MLCP brings these areas of expertise together. Legal advocates teach healthcare providers about the law so that they can better spot legal issues.

Over one-third of cases handled by the MLCP in 2015 were related to access to health insurance. MLCP advocates helped clients apply for Medicaid and Medicare, enroll in the Affordable Care Act’s insurance exchange, and challenge improper insurance rejections. When appropriate, advocates also helped clients to access public benefits such as Social Security, disability, food stamps (SNAP), and utilities assistance (LIHEAP) in order to increase low incomes and reduce the health impacts of poverty. The remaining 30 percent of cases were related to employment, wills and estates, housing, and family stability. The majority of patient referrals came from physicians and benefits counselors, who help patients apply for insurance and thus are well-positioned to identify complex cases and improper denials.

The MLCP measures the effect of its work on patients, healthcare partners, and its own volunteers. In 2015, legal advocacy by the MLCP helped clients obtain $320,176 in ongoing annual benefits, such as healthcare coverage and public benefits, as well as $206,242 in one-time benefits, such as the elimination of medical debt. Of patients surveyed, 88 percent said that they felt less stressed as a result of the legal care they received from the MLCP. Three-quarters of healthcare staff surveyed agreed (and 30 percent strongly agreed) that as a result of the legal services they received, patients appeared to be “better able to cope with or manage challenges in their life” (the remaining 25 percent said they did not know). One hundred percent of law student volunteers surveyed said that they would recommend the MLCP as a volunteer opportunity to their fellow law students.

The Business Case for Medical-Legal Partnership

Currently, the MLCP is funded by a combination of government and foundation grants, which support one full-time attorney. The MLCP leverages resources of volunteer lawyers, law student volunteers, and fellowships in order to maximize the quantity of legal services provided per dollar of funding. On average, we spend $700 per case. We achieve $1,050 in average one-time financial benefits per case, as well as an average of $1,460 in annual on-going benefits.

We think our model is cost-effective and scalable. In five years, we would like to have a presence at all eight health centers operated by the Philadelphia Department of Public Health. In order to expand, however, we will need to find a stable source of funding.

Our strategy for growth and long-term sustainability is to demonstrate to government, healthcare providers, and insurers that the MLCP provides a social and financial return on investment. For example, if we successfully appeal a Medicaid denial, the healthcare provider will be paid for services that it might otherwise have to write off. Hospitals benefit because patients have options for care that are less expensive than going to the emergency room. If we assist a “super-utilizer” of health insurance with ameliorating the social determinants that keep them coming back to the hospital, then we can help the insurance company reduce costs.

If healthcare stakeholders can realize the alignment between the MLCP’s mission and their goals, they may provide funding to grow and sustain the MLCP. The MLCP now has a three-year track record and has assisted over 400 patients. We have started conversations with a variety of stakeholders in the healthcare industry about sharing data in order to measure the cost-savings and long-term health outcomes attributable to the MLCP’s work.

There are challenges to funding legal interventions in this way. We have noticed that when our cases result in healthcare cost-savings, these benefits are usually are distributed across many institutions. Until the industry is more coordinated, individual stakeholders may be reluctant to bear the cost of services like the MLCP when the benefits of the service may accrue to non-contributing competitors.

In this environment, the most logical funders are central payers who can fund medical-legal partnerships on a regional or national level and realize the aggregate cost-savings. There are signs that the federal government is moving in this direction. For example, the Health Resources and Services Administration recently clarified that a portion of the Health Center Expanded Services Supplemental Funding could be used to fund medical legal partnerships. 

Conclusion

The MLCP improves health outcomes by helping patients obtain health insurance and income supports while decreasing their stress and increasing their confidence and ability to take control. It is one of many interventions that, when widely adopted, will help the healthcare industry achieve lasting health outcomes and ultimately reduce the cost of care.

References

1. Steven A. Schroeder, “We Can Do Better—Improving the Health of the American People,” New England Journal of Medicine 357 (2007): 1221-28, doi: 10.1056/NEJMsa073350.

2. Helaine M. Barnett, “Documenting the Justice Gap in America: The Current Unmet Civil Legal Needs of Low-Income Americans,” Legal Services Corporation (2009), Accessed October 16, 2016, http://www.lsc.gov/sites/default/files/LSC/pdfs/documenting_the_justice_gap_in_america_2009.pdf.

Author Biographies
Caitlin Weiss is a Philly Fellow and AmeriCorps VISTA member serving at Philadelphia Legal Assistance, where she is the Director of Community Outreach for the Medical-Legal-Community Partnership. She earned her Bachelor of Arts degree from the University of Pennsylvania.
Jonathan Pyle is the Contract Performance Officer at Philadelphia Legal Assistance (PLA), where he is responsible for compliance, reporting, and implementing new uses of technology to analyze, streamline, and expand service delivery.

“You don’t just take from the society, you have to give back.” Those are the words Wesley R. Payne IV, board chair at Bethesda Project, emphasized as a theme throughout the conversation I had the privilege of having with him about Bethesda Project, how he got into the nonprofit sector and his leadership style. For more than thirty-six years, Bethesda Project has been working to end homelessness one life at a time. Bethesda Project’s mission is to find and care for the abandoned poor, and to them, the people that they serve are not nameless numbers, they’re members of the Bethesda Project family. The core values of service and family that the Bethesda Project represent are consistent with Wesley Payne’s background and ideals, making both a great fit for each other.

Before assuming his role as board chair at the Bethesda Project, Wes was a board member for more than six years. In addition to his work there, he also serves on the board at the Homeless Advocacy Project, and sits on several pro bono and civil boards while active in many legal organizations. Apart from all of this, Wes is a partner at White and Williams LLP, a law firm with over 240 lawyers in ten offices. Based in Philadelphia, Wes has over twenty-six years of experience representing insurance carriers and insurers in first- and third-party litigation matters. He also serves as a Judge Pro Tem for the Philadelphia Court of Common Pleas. Wes obtained his BA from Washington and Lee University and his JD from the University of Maryland, School of Law.

The duty to serve others and give back to society has been instilled in Wes’ mind throughout his life. When he was in seventh grade at The Boys’ Latin School in Baltimore, Maryland, Wes had the opportunity to be involved in a community giving program where he worked with kids who were on the verge of being homeless. As a result, the mindset to serve others and give back to society followed him through his years at Washington and Lee University and to the army. To this day, as an attorney, he still believes that you have to do something for others, not just for yourself.

Wes’ attraction to Bethesda Project (“Bethesda”) came about through many sporadic exposures. One of his earliest interactions with Bethesda’s work was when his eldest daughter prepared meals for residents at one of Bethesda’s locations as her high school service project. Another exposure was through the legal clinic that Wes ran at Our Brothers Place (one of Bethesda’s locations) where he got to know many of Bethesda’s residents. The final draw that led to Wes’ deeper involvement with the organization was when he met Bethesda’s founder, Father Domenic Rossi. Wes was moved by Father Domenic’s passion and vision to end homelessness by becoming a family to Philadelphia’s most vulnerable citizens, the chronically homeless. Wes recognized this as a great concept to end homelessness in the city and he ultimately joined the board of directors. 

Wes said what makes Bethesda unique is that many organizations believe that “the way to address [homelessness] is to start at the top of the ranks and work your way down. Bethesda does the exact opposite; it is the most affected chronic homeless that we target to help. So the people at the very bottom, the people who are literally falling through the cracks, [they] are not on most organizations’ radars. If we can save one life, one year or winter, then it was worthwhile.”

When asked about how Bethesda measures impact, Wes admitted that it is an area that Bethesda is working on improving. Because of the qualitative nature of their mission, Wes said that the best examples of impact are the individual stories of the residents who have gone from rock bottom, to a daybed, to a bed of their own, to almost living self-sufficiently because of their experience with Bethesda Project. Wes emphasized that “it is great to be able to say everybody [we serve] progressed, but that is just not true, people hit rock bottom, they try, they fail, go back to rock bottom, they keep going and trying, but what Bethesda is there for is to be that family that says ‘it’s ok to fail as long as you keep trying and you will eventually succeed.’”

Speaking about socioeconomic impact and how Bethesda’s work benefits the city of Philadelphia, Wes understands that it’s important to obtain grants or corporate sponsorships. However, Wes’ focus is not on how businesses can specifically benefit from Bethesda. At the end of the day, Bethesda values getting people out of the cycle of homelessness and getting them back to the society, thereby society is stronger and businesses profit from a strong society. When asked what Bethesda’s greatest funding needs are, Wes quickly said “unrestricted gifts for operating costs.”

Additionally, Bethesda hopes to secure funding for the Bethesda Project Beacon. The Bethesda Project Beacon fulfills Bethesda’s vision of creating a one stop shop for all needs relating to homelessness. According to Wes, raising seed money for a redevelopment project such as Bethesda Project Beacon is as challenging as raising operating funds. Not many donors are excited to give seed money, as they want their money to directly help the individuals. Though challenging, Wes is optimistic about the project and the many individuals it will benefit.

Bethesda Project has had its share of setbacks, one of which, according to Wes, has been a failure to plan ahead. The founding concept of the organization “has always been every nickel that we can put forth to getting people off the streets, do it. Even our board meetings are run with that thought process in mind. If donations or grants come in, we automatically look to whoever is next in line to help now and not really who we can help three to five years from now.” However, the Board has started to embrace the idea that it’s good to have more reserves for the future to prepare for a rainy day. 

Guiding and implementing this slightly new financial concept is one of the challenges Wes faces as board chair. But what Wes loves about the Bethesda board is that it is run through consensus and everything is voted upon. “The first thing about leadership is knowing who you are and not who you want people to see you as.” Wes was a commissioned officer in the army and everyone always assumes that when you give orders, the orders get followed, but that’s not how Wes was taught to lead. Wes is a great believer in listening, “not just listen, but really listen and appreciate.” This is advice that he would share with anyone at any stage in life and profession. Wes believes that an effective leader is one that utilizes the people and the team around them, “you don’t have all the ideas, sometimes the best ideas come from those around you and it’s the leader’s job to select and implement those best ideas.”

When I asked Wes whom he admires as a leader, Wes responded with a very historical choice, Abraham Lincoln, which surprised me. Wes probably sensed that I was slightly shocked and went on to explain that he admires Abraham Lincoln because he was an individual placed in an impossible situation and he had never been trained to lead a country through a civil war, having to make some very tough decisions while getting consensus. “And somehow, through self-confidence and not thinking too greatly of his own importance, he was able to cobble together not only a way to eventually win the civil war, but to do it in a way to not allow the country to be split.”

When I asked Wes what inspires hime every day, he answered that it is his family. Everything he does, he does so that his family can be proud. Wes never wants to feel ashamed to tell his family what he did that day. From our conversation, it was clear that Wes and Bethesda Project have the same core values, which are family and helping those in need. It is evident that Wes is part of the Bethesda Project family and is extremely passionate about Bethesda’s mission. Even when we talked about the challenges and setbacks of Bethesda, he committed to the ‘glass half full’ perspective that everything will be ok in the end as long as Bethesda Project continues its goal to end homelessness one life at a time.

Introduction

Why, in a developed country like the United States, where free public education is available in almost every city, are there so many nonprofits focused on education and youth? Is public education not enough anymore? In recent years, public education has lost its power to “equalize” high- and low-income families. Summer Search provides students with the character-building extracurricular activities and mentoring support that will keep them motivated throughout the challenges of puberty, high school and college. Unfortunately, low-income students have difficulty finding this in their own families, and many nonprofits try to fill the gap in some way, but only Summer Search offers a holistic service.

Summer Search deeply believes in the pressing need to level the playing field, and offers a combination of experiential learning and practical skills, one-to-one mentoring, and a support network that will keep low-income students in a positive trajectory towards college. Through these services, students develop their leadership and communication skills, and become reflective and accountable individuals who are not afraid to dream of a better life. They know and happily accept the challenge that their life is their own and that they alone are responsible for making the best out of it. This motivation, this fight against resignation, is what Summer Search’s students receive throughout the program, and it is what keeps them on the right track to becoming well-prepared citizens who will positively contribute to society.

Summer Search’s model has been overwhelmingly effective in helping students graduate from high school in all seven cities in which it operates, and Philadelphia is no exception. After four years in operation, Summer Search Philadelphia has a high school graduation rate of 100 percent and a college attrition rate of 100 percent. The benefits accrue not only to these students themselves, but to society as a whole.


The Problem: An Uneven Playing Field

Education has proven to be one of the most effective vehicles for achieving upward social mobility in America. But upward social mobility can be more easily achieved if the education students receive gives them the skills needed to continue on to higher education and if the students are motivated and willing to stay in high school until they graduate.

Nationally, in October 2008, approximately three million 16- through 24-year-olds either dropped out of high school or did not attend one. This translates to 8 percent of American youth who do not have a high school diploma. In Philadelphia in 2009, only 56 percent of students graduated from high school (Mayor Michael A. Nutter's Office of Education 2010). According to the Center for Labor Market Studies:

Dropping out of high school imposes very high costs on the individual who drops out of school mainly through poor labor market outcomes. Other costs imposed are restricted access to higher education and training and a weaker voice in the political and electoral system. The weak labor market outcomes of high school dropouts result in reduced annual earnings, low income levels, a sharply higher risk of poverty, and all the negative personal and family consequences associated with life at the margins of the labor market. . . . [E]mployment opportunities for unskilled persons have declined sharply as the industry structure of employment has shifted from manufacturing to service industries and as the production of the nation’s output has become more technologically sophisticated raising the literacy and educational requirements of the workforce (Fogg, Harrington, and Khatiwada, 2009).

Although a labor market exists for unskilled workers, legal and illegal immigration and the effects of globalization offering cheaper labor force markets have reduced unskilled employment rates and wages.

This change in the structure of our economy makes a college degree no longer a luxury but a must-have. College degrees allow individuals to specialize and differentiate themselves in an ever-growing labor market, access higher-paying jobs, expand their network of professional and personal relationships and continue on to postgraduate education.

While dropping out of high school has negative effects on the individual, it also has an important effect on society as a whole. According to the National Center for Education Statistics, dropouts’ lower incomes and lower level of participation in the labor force means that dropouts contribute less taxes, are more reliant on health and welfare systems, and make up a higher percentage of prison and death row inmates (Chapman et al. 2010).

National statistics show how making an immediate transition from high school to college is related to family income and parents’ level of education (Aud et al. 2010). Overall, 69 percent of high school graduates transition to college, and the gap between high- and low-income students is about 25 percent. While 82 percent of high-income students transition immediately to college, only 57 percent of low-income students follow the same track. Looking at the parents’ level of education, we can see a 29 percent gap between students who transitioned to college whose parents had at least a bachelor’s degree (82 percent) vs. students whose parents had at most a high school degree (54 percent). High-income families with high levels of education provide the student with resources, connections, support and knowledge of what needs to be done in order to succeed academically. They transmit the values and serve as an example of why graduating from high school and later on from college determines the future of the teenager.

Who supports and guides low-income high school students who might be the first generation in their family to go to college? Who can understand what they are going through and help them have the same opportunities as high-income students? How can we level the playing field for low-income students have the potential to thrive?

The History of Summer Search

Summer Search is a national organization that was founded in San Francisco in 1990 by family and adolescent counselor Linda Mornell. Mornell, the mother of two herself, first saw the benefits of summer trips for high school students when her own children and their friends participated in summer experiential programs:

My own children had so many resources, and during their challenging adolescent years they gained a lot of confidence from doing summer programs. I became interested in the transformative power of those experiences and saw they were almost exclusively available for affluent families. I wanted to provide diversity and make it a richer experience for everyone (Haughey 2010).

As a result, Mornell sought funding through friends and family to be able to provide scholarships to low-income students from nearby schools so that they too might partake in these summer experiences. However, feeling that this was not enough, Mornell went on to create a program that would accompany the trips with one-on-one mentorship and advisement for the participants. In 1990, she piloted the program with a group of fourteen students, and this model grew into Summer Search in communities across the country.

Summer Search Philadelphia is Summer Search’s newest branch. Established in 2006 and piloted with its first class of students in 2007, Summer Search came to Philadelphia at the request of the School District of Philadelphia, which recognized its problem of low graduation rates and even lower college enrollment rates. The district contacted the national office in 2005, and a year later Summer Search Philadelphia was established. Now, Summer Search Philadelphia works with over ninety students from more than ten schools across the city. They have graduated 99.6 percent of all of their students, and helped send 96 percent of them on to college or university.


The Summer Search Solution

Summer Search has been so successful in Philadelphia, as well as in all its branches, because of the comprehensive nature of its model. “We offer a very holistic, individualized program that is operating year round,” says Elizabeth Stamm, Development Manager at Summer Search Philadelphia. Summer Search realizes that academic success can be influenced just as much outside the classroom as within, and also that individual success is determined by more than just academics. As a result, Summer Search uses a multi-faceted approach that is in large part inspired by Mornell’s experience with adolescent psychology. This approach begins with the selection process.

Students must be recommended to Summer Search through referral partners who work directly with the students in local high schools. Young men and women who are selected do not necessarily have to excel academically, but must demonstrate seeds of specific leadership qualities. Upon referral, students apply for an hour-long individual interview with a member of the Summer Search team, in which they are evaluated based on their aptitude for the Reflection-Altruism-Performance (RAP) behaviors that Summer Search finds essential for their program (see chart). It is these characteristics that Summer Search is uniquely adept at fostering and that eventually lead Summer Search alumni to greater achievement in their lives and communities. Summer Search chooses to focus on these skills because they see them as keys to personal as well as civic development.

All of Summer Search’s programming is geared toward nurturing these behaviors and characteristics in ways that will equip the student with the necessary tools to overcome the obstacles they face academically and elsewhere. The “Performance” set of skills, including problem-solving, communication, adaptability and follow through, are essential for success in higher education and in any workplace. The “Reflection” skills are encouraged to give the students enhanced motivation as well as a better understanding of themselves and others. Finally, the “Altruism” skill set is included to create a population of students who are not only equipped to improve their own lives, but also dedicated to improving the lives of others. Fostering empathy, appreciation and service is meant to encourage every Summer Search graduate to give to others in the same way they have been given to, thus magnifying the Summer Search impact exponentially.

Taken together, these skills have been found to be aspects of a sort of ideal personality that has been proven to be attractive to employers. While this was not Summer Search’s original intent in focusing on these behaviors, it is important to note that they do have a positive consequence not only in the personal and civic lives of the students, but also in their professional lives.

A Five-Year Program

Summer Search students generally start the program during their sophomore year of high school and continue on through their second year of college or university. During high school they participate in Summer Search programs all year round, attending workshops and one-on-one mentoring during the school year and participating in challenging summer trips over two consecutive summers. While in college they continue to communicate regularly with their mentors, and can participate in Summer Search alumni activities. The workshops focus on practical skills for the students, including SAT preparation, postsecondary goals, college preparation and financial aid applications, while the mentorship is intended to provide guidance and a support system. It is the summer trips, however, that many feel to be the life-changing experiences that truly cement Summer Search’s lessons for the students. Umar, a graduate of Mariana Bracetti Academy, describes his experience and what he learned from his first summer trip to Seattle:

I most enjoyed the challenge of rock climbing. While climbing I was shaking but I knew I had to keep moving up the wall because if I stopped I would have never made it. I was forced to trust the person holding the rope in order to succeed. Looking back now, I relate climbing up the wall to climbing through life. Just like the wall, if I stop and shake in fear I will never succeed. I changed in 22 days. . . . I progressed and even I see that my confidence has grown. I share my thoughts and opinions in class and see that teachers and students value them. On course I led by example and I continue to use this skill in Philadelphia.

These essential life lessons of trust, confidence and overcoming fear are things that cannot be taught by one person to another, but must be learned from pushing yourself as Umar did. Without Summer Search, students like Umar would rarely have the opportunity to be outside of their comfort zone while still connected to a network of support and encouragement, and would therefore risk never learning these lessons.

The second summer trip looks to challenge participants mentally and emotionally to encourage a different kind of personal growth. Students are asked to find a service trip, an international home-stay or an academic summer program for their second summer experience. On this trip, the focus is more on further establishing the RAP behaviors, and therefore on urging students to find success academically or as civic leaders. The progress they make in a university setting or in serving others will give them a glimpse of the success they can have as college students and community leaders, thus encouraging them to continue toward those ends. Prior to this trip the students are required to do much of their own planning—finding an opportunity, applying for a position and handling the logistics themselves. Often this is the first experience the students have with this type of responsibility and independence. Being trusted to handle the arrangements themselves, while still having the supervision and support of their mentors, prepares them for future responsibilities such as filling out school or job applications or balancing hectic schedules. As an example of success, it also proves to students their own capabilities, and therefore motivates them to not give up on academic or personal goals.


Mentors Make the Difference

While the participation in summer programs and supplemental workshop training that Summer Search students receive certainly go a long way in helping the students achieve their goals of graduating high school and heading on to college, these activities alone cannot explain Summer Search’s exceptionally high success rates. Many programs in Philadelphia send students on challenging excursions, and even more offer academic training and college preparatory courses. Very few, however, come close to the graduation rates that Summer Search has come to expect. What sets Summer Search apart from these other organizations is exactly what Linda Mornell first noticed over twenty years ago; in order for these interventions to have a lasting impact, they must be accompanied by professional mentoring.

Summer Search Philadelphia’s mentors are full-time staff members who are highly trained in mental and emotional adolescent development. This training, along with the greater amount of time and dedication the mentors are able to give their students thanks to being staff rather than volunteers, allows Summer Search mentors to better understand the internal issues the students are facing. Program Director Olanike Ayomide tells the story of one of her students who recently started college. The girl called Ayomide one day in a panic, exclaiming that she hated her new school and had to transfer. After a lengthy conversation, Ayomide was able to discern that the anxiety the girl was experiencing stemmed not from her choice of school, but rather from feelings of doubt and insecurity about being the first member of her family to graduate high school and attend college. With this understanding, Ayomide was able to help the girl understand the true reasons for her anxiety and then help her to deal with them. Such issues arise often for Summer Search’s students. Without a trusting, sustained relationship with a mentor like Ayomide they can go unrecognized and unresolved and often lead to failure.

Each Summer Search student is assigned a mentor during the first year of participation, and, barring unforeseen events, will stay with that mentor until leaving the program during the sophomore year of college. While in high school, students are required to be in contact with their mentors at least once every week. This stability helps foster the trust between the mentor and the student that allows for straightforward, open communication. The mentors not only understand and support the students, but also challenge them when necessary. Ayomide explains, “The mentoring is really reflective listening to the student, holding them to their behaviors, to their thinking patterns, to anything they wouldn’t notice, and helping them to discover different things about themselves and to work on different things about themselves.” More than anything, she says, “The mentor is there to challenge you, to help you see things that you haven’t seen or that you don’t want to see.”

Using a rubric they have created to quantify the students’ exhibition of RAP behaviors, the mentors also track the students in each of their encounters. They take note when the student is being more or less reflective, whether or not they are using their problem-solving skills, if and when they are looking to give back to their community, etc. When they see a change (positive or negative), it is their role to challenge the student to see this change and to understand why the change has taken place. Although students obviously fluctuate in their level of skill in different areas at different times, overall the mentor is looking for an upward trajectory in all of the RAP categories. Through their mentorship, they hold the students accountable for this trajectory. Summer Search believes that these characteristics are indispensable life skills, and therefore keeps them at the forefront of their goals for mentoring and student development.

Through its mix of practical training, behavioral guidance and professional support, Summer Search provides a system for students that leads not only to personal success, but also to a greater societal impact. Students who participate in Summer Search are not just taught life skills, but also helped to see the importance of altruism and positive support in their communities. Nationally, 72 percent of Summer Search graduates are involved in service to the community. If this number holds true for the Philadelphia office, roughly 70 young men and women from the current Summer Search classes will give back to the city of Philadelphia. Further, each student who graduates from Summer Search and goes on to college becomes an example of success to those around them. Their propensity for service suggests that they will use what they have learned to create support systems for countless other young men and women in their families and neighborhoods.

Henry, a current Summer Search Philadelphia student, explains how the lessons Summer Search taught him have helped him reach out to his family. “My family is always in need of help, and now I can serve them more without getting easily frustrated. Also, being resilient and patient will help me communicate more effectively with my family about our issues.” With increased practical skills such as filling out college applications and heightened RAP behaviors like problem-solving and empathy, they will be able to help their brothers, sisters, cousins or neighbors in ways that they could not be helped by their support systems. In fact, Ayomide expresses this as one of Summer Search Philadelphia’s primary goals: “What we’re working to do is to change that student’s life to impact them and to help them learn their own leadership potential, but also to give them all these practical experiences and tools along the way that if their life is changed they can come back and help their community and their family. They are examples for everybody that’s around them.”


Social Return on Investment

In addition to Summer Search’s outstanding high school graduation and college enrollment and retention results, the program has a remarkable social return on investment.

The total cost for one student in the five-year Summer Search program, including the two summer trips (national and international), personalized mentoring services, college advising, Bridge Alumni, having a prepared staff to serve them and the administrative costs of running the operation, is $33,572.

As a consequence of being exposed to different, challenging and exciting experiences through the summer trips in conjunction with the weekly mentoring sessions where the student reflects, is held accountable, and at the same time develops his or her communication skills, the Summer Search students develop the confidence that anything is possible if they work for it. Christian, a junior at West Philadelphia High School, expressed this well: “I feel more responsible, and I’ve realized I don’t have time to waste sitting around waiting for opportunities to find me. My life isn’t in anyone’s hands but mine.”

Summer Search unlocks their yearning for a better and brighter future and develops in them the tools that they will need to achieve what they dream. They realize that graduating from high school and pursuing college is an open door that could bring them closer to a better life, not only for them, but for their family, their community and society in general. As Umar puts it, “Before Summer Search, I went through life by saying, ‘The sky is the limit.’ But now I know the sky is not the limit. I can go beyond that.”

According to a study of leadership skills and wages published by the Journal of Labor Economics, “Employers of new college graduates report that communications skills, motivation/initiative, teamwork skills, and leadership skills are all more highly valued than academic achievement/GPA” (NACE 2000). The authors estimate that leadership skills have an 18 percent effect on earnings. Other research has shown that “Sociability, friendliness, thoughtfulness and general activity have an effect on earnings independent of parental background, cognitive ability and schooling.”

By graduating from high school and earning at least an associate degree, a Summer Search student will have average lifetime earnings of $1,389,858, which is $932,769 more than the average high school dropout would earn in his or her lifetime. If we assume that the Summer Search student would have graduated from high school even without Summer Search, then the return to the student would be $519,233.

Education Degree Mean Annual Earnings Mean Lifetime Earnings Mean Lifetime Earnings
*leadership effect
High school dropout $9,663 $457,08 $539,36
High school graduate $19,437 $870,62 $1,027,338
Associate degree $26,723 $1,177,846 $1,389,858
BS or higher $47,613 $2,051,455 $2,420,717

Source: Fogg, Harrington, and Khatiwada (2009).

For society at large, Summer Search’s outcomes have a positive and quantifiable benefit. By ensuring that these students will graduate from high school and pursue college education, Summer Search is decreasing the number of dropouts who would otherwise incur both monetary and non-monetary social costs. High school dropouts contribute less to federal, state and local taxes, rely on cash and noncash government income transfers, and have a higher probability of being incarcerated (a cost also assumed by society) (Fogg, Harrington and Khatiwada 2009).

According to the Center for Labor Market Studies, the lifetime mean annual net fiscal contributions1 of adult Philadelphian high school dropouts is (-)$319,000. Meanwhile, an adult with a high school degree is expected to have a positive fiscal contribution of $261,000, and with an associate degree of $260,000. Therefore, the return to society is not only the positive net fiscal contribution of the high school graduate or associate graduate, but also the savings of $319,000 that a dropout would cost society. In total, a person with an associate degree who would not have otherwise graduated from high school would have a return to society of $579,000.

In addition to the quantifiable benefits to society that a Summer Search student would bring, it is also important to consider the student’s qualitative positive effect as a role model in his or her family and community. Summer Search students are living proof that opportunities are everywhere and for everyone to take, if they are willing to work for them. They are an example to their siblings and peers, a sense of pride to their parents and a motivation for teachers and mentors who have helped them to continue to support other students like them.

In conclusion, taking into account the cost of the five-year Summer Search program, the return to the student and the return to society, we find that Summer Search has an impressive social return on investment. It is important to note that since it is impossible to determine how many Summer Search students would have graduated high school with or without Summer Search’s help, we calculated the net social return on investment for both scenarios.

In the case where the Summer Search student otherwise would have dropped out of high school, Summer Search has a social return on investment of $1,479,197. This means that for every dollar invested by Summer Search in a potential high school dropout student, society gets $44 back.

In the case where the student would have graduated from high school without Summer Search but not pursued a higher level of education, Summer Search has a social return on investment of $484,661. For every dollar invested by Summer Search in this type of student, society gets $14 back.

Social Return on Investment Earned associate degree and would not have graduated from high school Earned associate degree and would have graduated from high school
Return to the student $ 932,197 $ 519,233
Return to society + $ 579,000 + $ (1,000)
Cost of the program - $ 33,572 - $ 33,572
Total Social Return on Investment $ 1,479,197 $ 484,661

Conclusion

Thanks to Summer Search’s impact, more and more students each year are becoming educated, civic-minded contributors to society, an outcome whose true value obviously goes beyond the financial gain we have estimated. However, in order to ensure these positive returns, it is essential for Summer Search to strengthen its funding base. Summer Search’s Philadelphia office is in transition as its initial funding from the national office is projected to be spent down within the next two years.

At a time when the nation seems to be recognizing the flaws of the public educational system and its tendency to let many students fall through its cracks, Summer Search Philadelphia’s remarkable results prove its model to be a promising solution. What’s even more encouraging is that this is a model easily replicated in any community. Summer Search has already reproduced itself in seven cities across the nation, with remarkably high success rates. In locations as different as Silicon Valley and New York City, the Summer Search model has been implemented to fulfill students’ needs and help them achieve their goals. It has succeeded everywhere it has been tried.

Moreover, through adopting some of Summer Search’s techniques, youth development organizations that already exist throughout the nation could very easily see the same success. Summer Search’s example shows that having a mentoring staff of trained professionals dedicated to strengthening the students’ RAP behaviors and providing them emotional support will result in a class of participants who are mentally capable of success. By providing practical college-prep skills and increasing access to extracurricular activities and leadership opportunities, the organizations can also give them the practical knowhow to graduate high school, obtain a degree, and become a professional.

With a staff of professionals trained and dedicated to support teens through high school and onto college, and with increased access to extracurricular activities and leadership opportunities, students across the country will be able succeed regardless of their families’ income or educational level.

Laura Rojas is an MS candidate in Nonprofit and Non-governmental Leadership at the University of Pennsylvania. Laura earned a Bachelor of Arts in Economics from Universidad de Los Andes in Bogota, Colombia. She cofounded a nonprofit organization that has advanced child development for underprivileged children in Bogota for the past 10 years, while at the same time working as a business consultant and processes director in the private sector.

Emily Marchese is a candidate for an MS in Nonprofit and Non-governmental Leadership from the University of Pennsylvania’s School of Social Policy and Practice. Emily earned a BA from Boston College, and has dedicated herself to studying and working toward increased global economic justice. 

References

Aud, S., W. Hussar, M. Planty, et al. (2010). The Condition of Education 2010 (NCES 2010-028). National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education. Washington, D.C.

Chapman, C., J. Laird, and A. KewalRamani. (2010). Trends in High School Dropout and Completion Rates in the United States: 1972–2008 (NCES 2011-012). National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education. Washington, D.C. Available at http://nces.ed.gov/pubsearch.

Eren, O., and I. S. Ozbeklik. (2010). Leadership skills and wages revisited: Is there a causal relation? Working paper, University of Nevada. .

Fogg, N., P. Harrington, and I. Khatiwada. (2009). The Tax and Transfer Fiscal Impacts of Dropping Out of High School in Philadelphia City and Suburbs. Center for Labor Market Studies, Northeastern University

Diplomas Count 2010. Graduation by the Numbers: Putting Data to Work for Student Success. (2010). Education Week, June 10. Available at http://www.edweek.org/ew/toc/2010/06/10/index.html.

Haughey, S. (2010). Linda Mornell on grooming teens for success. San Francisco Examiner, December 12.

Kuhn, P., and C.. (2005). Leadership skills and wages. Journal of Labor Economics 23(3); 395-436.

Mayor Michael Nutter’s Office of Education. Shaping an Educated City: Two-Year Report on the Mayor’s Education Goals, January 2008–December 2009. Available at http://www.phila.gov/PDFs/featureEducation.pdf.

Martin, N., and S. Halperin. (2006). Whatever It Takes: How Twelve Communities Are Reconnecting Out-of-School Youth. Washington, D.C.: American Youth Policy Forum.

Nyhus, E., and E. Pons. The effects of personality on earnings. Journal of Economic Psychology, 26(3): 363-384. Web.

U.S.Department of Commerce, Census Bureau, Current Population Survey (CPS), October Supplement, 1972–2008.

The READ! by 4th Campaign is an ambitious attempt to help increase literacy rates among young Philadelphia students and thereby improve education in the city.

With the May 19 mayoral primary fast approaching, the Notebook asked each of the announced candidates -- Democrats Lynne Abraham, Nelson Diaz, Doug Oliver, Milton Street, and Anthony Hardy Williams -- to say, in 300 words or less, how they plan to support this early literacy campaign’s efforts, and what obstacles they thought might hinder its success. Here is what they had to say. The comments of Diaz and Street were edited for length.

Lynne Abraham

Nothing is more important to the future of this city, and the nation, than a well-educated population. Reading is the single biggest component of childhood and lifelong education. Reading is the gateway to entry into the knowledge-based economy and the most meaningful jobs in the modern world, in science, technology, engineering, art, and math (STEAM).

The investment of the Annie E. Casey Foundation and the Philadelphia Free Library system are welcome gifts to our children’s future. Teacher training is key, and our branch libraries provide an excellent community venue for children all over the city.

While programs like READ! by 4th require sustainable funding and coordination among agencies, a mayor can help support the program by keeping literacy at the top of her agenda.

As mayor, I will do everything in my power to support childhood literacy in our schools and throughout the branch library system.

Nelson Diaz

Improving education will be my number one priority as mayor. For every $1 spent now on a child’s [high-quality preschool] education, more than $7 is saved later on. I fully support the literacy efforts undertaken by PCCY, the Urban Affairs Coalition, and the more than 50 public and private partners committed to the READ! by 4th Campaign.

First, we need to get the parents involved. As mayor, I would explore ways in which we can improve the collaboration between the District and community organizations like Springboard Collaborative that are training teachers to effectively work with low-income families on literacy education. I would work to ensure that universal pre-K is available for all Philadelphia’s children and that our most vulnerable children get the community services they require.

I would identify reading education services for children who are monolingual in their native language so that they can then transition those literacy tools to English. I believe that effective literacy tools need to be learned at a young age before they can be prescribed to English in our schools.

I would work with the District to bring back school libraries and hire certified librarians. I would find ways to keep class sizes down, particularly from pre-K to 3rd grade when kids need individualized attention as they are learning to read.

I would continue to address “summer slide” and expand the city’s program to use the recreation centers to provide literacy education in the summer. I would also explore the use of educational programs that use technology like smartphones, tablets and computer apps to supplement lesson plans and make reading fun.

The District’s budget is my main concern. If the city does not provide the resources to support our children’s education, then the work of the campaign will not be able to be reinforced by the school system.

Doug Oliver

READ! by 4th is much more than a literacy program. It is, in fact, a very good example of how some of today’s widespread education challenges can be tackled. Indeed, the real power of  READ! by 4th may be in its ability to get diverse constituencies to agree on a common objective and then knuckle down to the hard work of achieving it.

Initiatives such as READ! by 4th don’t waste time picking sides or laying blame. They keep kids front and center and are focused on the reality that all of us need to get involved in supporting the needs of children in positive and meaningful ways.

The immediate benefit may be improved levels of literacy, but the potential for other programs built around other issues (math, science, etc.) is significant. I wholeheartedly support this effort on behalf of our city’s children.

In the end, we cannot lay the blame for the shortcomings of our education system at the feet of any one group, nor can we avoid the shared responsibility we have in improving education outcomes. That’s true whether you’re a teacher, parent, mayor, a legislator, a member of the business community or anyone with a stake in this issue, including the kids themselves. Yet the problems are real, and the demand for solutions grows ever more urgent. Which is precisely what makes this literacy program so exciting.

I’ll be doing what I can: highlighting the need for improved literacy, calling for real and sustained support for this program and others like it, and educating myself so that I too can always keep the needs of children front and center.

Milton Street

I haven’t heard of READ! by 4th, but I’m questioning who are they hitting, or are they programmed to hit some of the kids, but not everyone?

Being from the inner city, I know we have a lot of children that can and cannot read on level. This is a complicated problem with no easy solution. I think to help we have to stop the violence. If we can correct the violence, these programs get forward in a successful way. There are a lot of complicated problems contributing to children not being able to read.

Right now, [READ! by 4th] is a program I would probably support. I believe early literacy is really important. We have a situation where we don’t have programs that are all-inclusive. Is this a program that has the capacity to touch all 4th graders, or will it touch a percentage? Will I put my energy in a program that only touches a small percentage? What happens to the larger percentage of kids?

Once I get that information and make sure it has the capacity to touch all kids who get reading support and is reinforced for people with disabilities like reading and hearing and syntax -- then I will support it. There are a lot of problems with young people in growth and development. The kids that have these learning disabilities, what do we do with them? If they are in the program, are there any provisions to correct them, and how does it address those? Normally, it’s been my experience that those programs only touch a percentage of the population.

With education itself, there’s an overall problem with funding, and an overall problem because of violence in school. … We have to be really serious about our children’s education.

Anthony Hardy Williams

Philadelphia’s literacy rate among children and adults is among the root causes of poverty, and impacts Philadelphia’s ability to field a talented workforce to compete in the global economy. As mayor, I will be committed to making pre-K universally accessible, and I will renew and strengthen the Mayor’s Early Learning Advisory Council (MELAC)’s efforts to develop a citywide early learning plan aligned with the campaign, and use the “bully pulpit” to elevate the discussion.

Additionally, addressing literacy challenges for young children requires a “two-generation” approach, as 550,000 adults in Philadelphia are estimated to be low-literate. The Mayor’s Commission on Literacy should play an integral role in discussions about parental engagement and raising the literacy levels of families, not just children.

Ending low literacy in childhood starts with quality child care. Less than 15 percent of child care facilities in Philadelphia are considered quality. As mayor, I will order annual health and safety inspections of all child care facilities that do not meet statewide quality standards, and partner with child care operators to improve their quality.

Achieving success in this campaign requires a proven ability to generate funding – as I have done with the cigarette tax, which has garnered over $17 million for public schools so far – and sustained coordination between the government, business, and nonprofit sectors. With effective communication and a commitment to put our children first, we will achieve success.

Camden Copeland and Shannon Nolan are interns at the Notebook.

This edition of PSIJ—It Starts with a Conversation—introduces readers to alternative and innovative strategies for educational reform and extends the conversation to all who care about our children and their education.  Well aware of the politics in education, we aim to bridge the current knowledge gap, with the hope and expectation that such a bridge will unite all interested parties for collective impact. 

The scale and complexity of the U.S. public education system has thwarted attempted reforms for decades. . . .[T]he country now ranks 18th among the top 24 industrialized nations, with more than 1 million secondary school students dropping out every year.  The heroic efforts of countless teachers, administrators, and nonprofits, together with billions of dollars in charitable contributions, may have led to important improvements in individual schools and classrooms, yet system-wide progress has seemed virtually unobtainable (Kania and Kramer 2011).

Said in another way, the politics of special interests in the education section—no doubt well-intended—often gets in the way of progress and results in fear of change. 

According to Pennsylvania System of School Assessment results, Philadelphia children perform poorly in comparison to their peers across the state.  Despite recent gains in student achievement for Philadelphia’s children, only 54 percent and 57 percent of students served by the School District of Philadelphia and public charter schools, respectively, read and perform math at grade level.

This edition of PSIJ—It Starts with a Conversation—introduces readers to alternative and innovative strategies for educational reform and extends the conversation to all who care about our children and their education.  Well aware of the politics in education, we aim to bridge the current knowledge gap, with the hope and expectation that such a bridge will unite all interested parties for collective impact.  

The articles are written by local and national educational experts, operators, advocates and consumers.  They offer an understanding of the complexities of education reform and paint a potential roadmap toward creating disruption in the education system to achieve collective impact.  Collective impact is the simple idea that all forces (organizations and individuals) unite their agendas and resources toward holding each other accountable to one common goal. A collective impact does not mean that everyone loses, but existing education organizations and leaders may have to give up some control, and create win-win situations for all parties.

It Starts with a Conversation presents a futuristic vision of the potential of our education system and how it might be accomplished.

  • Imagine that unions, in addition to ensuring that teachers and administrators receive their due diligence, helped those who should not be teachers or administrators to transition out of education into another field. 
  •  Imagine that all of our educational universities prepared our teachers to not only discuss and argue pedagogy but also to teach with the skills and competencies needed to ensure that our students can compete in a global economy.  
  • Imagine that all school operators and districts, in addition to educating our children, welcomed the talents and energy of the rest of us to help and be part of the solution. 
  • Imagine that all of us actually believed in the capabilities of students and parents without economic means to make the best decisions for their children about their education.
  • Imagine that all children attended school in a safe and friendly environment and could focus on learning.

None of us, individually, has the solution to creating the best learning institutions.  However, collectively we can guide reform through some simple truths, however politically challenging they may be, and innovations:

  1. A simple change is to create an environment where risks are encouraged and accountability lines (student performance) are clear. We need to let those who can teach, teach and those who can lead, lead, and we all need to feel comfortable taking risks, without the worry of losing our jobs, to educate our children.  Accountability needs to revolve around student performance.
  2. Let parents, who care most about their children, make the educational decisions on behalf of their children.  Parents without economic means will improve our educational system simply though their selection of quality schools. The right legislation, if written correctly, takes the authority away from school administrators and policymakers who most often do not have their own students in public education and gives it to parents of children in public education to demand better educational options.   
  3. Stop trying to coerce school operators and districts through shame and embarrassment, but rather become part of the solution by creating learning communities in which gradual improvements can be noted and continued.  Stop trying to coerce universities to change their practices, but rather have school operators rank the best universities by quality teachers—student selection will follow.
  4. Stop focusing education reform decisions around money and politics, but rather focus them on accountability and results for children.
  5. Acknowledge that not all kids learn alike. Our educational system for the most part teaches to the common denominator.  However, by doing so, we fail kids with special needs and basic learning abilities who, in alternative environments that focus on how they learn, would thrive.

This edition of PSIJ is about educating the American people so that they can become part of the solution through their voices and actions. Too many of us feel that our advice or offerings of help fall on deaf ears.

We offer articles from more than 50 educational leaders and experts.  We begin with a 20-year history of educational reform nationally and in Philadelphia and discuss how groups across sectors can identify a shared agenda and mobilize the human and financial resources required to forward that agenda.  We hear from the new and emerging generation that is flooding the system with talent and creating teacher and leadership accountability.  We read about schools that are leading the field through innovations such as shifting instruction to a knowledge economy and that have set new standards for transparency, accountability and integrity.  We hear the voices of parents who are demanding choice, and through that choice are demanding quality education, safety and engagement.  We hear from professional development educational agencies and operators who are doing a better job of preparing our teachers and leaders to teach and lead than some of our universities. We hear about educational quality measure standards that are alternatives to test scores.  We hear about creating connections and links between our K–12 and higher education institutions and the real world economy.

After reading It Starts with a Conversation,you should be able to:

  • Articulate the history of education reform in Pennsylvania and Philadelphia.
  • Articulate what is working and what should change in current education legislation.
  • Understand how alternative models of education (accelerated schools, cyber charter schools, vocational models, etc.) are providing new models for consideration.
  • Understand why economic support in the form of choice (i.e., scholarships, vouchers) and school transparency and public accountability are part of the reform solution.
  • Understand how higher education institutions can better prepare teachers and principals for better educational outcomes.
  • Articulate how specialized schools meet the needs of specialized populations and achieve academic excellence.
  • Understand alternative higher education models that tackle the question of affordability and accessibility. 
  • Understand that education excellence is not just about money, but also the application of financial resources. 
  • Understand how both the lack and surplus of school facilities can be coordinated across school systems.
  • Articulate how supporting organizations such as The Free Library and Summer Search and foundations and corporations can partner to be part of the solution. 
  • Understand how the health and wellness needs of students are critical to academic success.

Many people view education as the number one civil rights issue of our time. Some education advocates spend much of their time critiquing our educational leaders, under the assumption that public pressure will force education reform.  Other advocates and system reformists have articulated an understanding of the entrenchment of schools and school systems, but have not articulated concrete solutions/suggestions on where or how to create education reform.  Yet as you will read, solutions are all around; we need to embrace them, step beyond our political comfort zone and take action.  The future of our region and country depends on it, and we depend on you to get engaged.  Be inspired to take action and push for systems reform!

We hope that this edition will serve as a rich resource for not only educational operators, advocates and education consumers, but for everyone in the region, providing an understanding of the complexities of education reform and a potential roadmap that will advance the education reform agenda toward collective impact and a brighter future for all of us.

References

Christensen, C., M. B. Horn, L. Caldera, and L. Soares. (2011). How Destructive Innovation Can Deliver Quality and Affordability to Postsecondary Education. Available at http://www.innosightinstitute.org/media-room/publications/education-publications/disrupting-college/.

Kania, J., and M. Kramer. (2011, Winter). Collective impact. Stanford Social Innovation Review. Available at http

Introduction

For children who are deaf or hard of hearing, today’s world is one of limitless opportunities. The rapid advent of technology combined with intensive therapy and education has completely revolutionized what is possible for these children.

Universal newborn hearing screening has made it possible for hearing loss to be detected shortly after birth. Babies can be fitted with hearing aids as early as one month of age, and receive cochlear implants before their first birthday. After receiving intensive auditory, speech and language therapy, many are ready to enter mainstream schools by kindergarten – listening, learning and speaking on par with their peers with typical hearing. 

In the United States, two to three of every 1,000 children are born each year with hearing loss in one or both ears1.  Ninety-two percent are born to parents with typical hearing, the vast majority of whom are choosing a listening and spoken language approach for their child’s primary mode of communication2.  

Clarke’s Expertise

Clarke is a preeminent leader in teaching children who are deaf or hard of hearing to listen and speak. In addition to Philadelphia, Clarke has locations in New York City, Boston and Northampton, Massachusetts, and Jacksonville, Florida, and uses teleservices to reach children and families throughout the country. Each day, Clarke teachers travel to mainstream schools to support students with hearing loss and train classroom teachers – many of whom have never before worked with a student with hearing loss.

Clarke alumni represent a new generation of children who are deaf or hard of hearing. They play in orchestras and on soccer teams, chat on cell phones with friends and thrive in neighborhood schools; some even attend Gifted and Talented programs. According to data from the National Center for Education Statistics, the national high school graduation rate was 81% and college enrollment was 65.9% in 2013. The percentages of Clarke’s former students who graduate from high school and pursue post-secondary opportunities have historically exceeded these rates.

Yet, throughout the country, many children born with hearing loss are lagging in school. They may also be socially isolated and disengaged, and their parents may have little to no support or professional guidance.

Genesis of A Partnership

For over a decade, Philadelphia infants and toddlers with hearing loss received Early Intervention services from Clarke’s Bryn Mawr location. But funding for out-of-city programs stopped at age three, and many children lost access to professionals who were making a profound difference in their ability to learn spoken language. 

Determined to provide these children with access to vital therapies during such an important developmental window, Clarke formed an innovative collaboration with La Salle University and the family-centered social services agency, CORA (Counseling or Referral Assistance). A site was chosen on La Salle’s campus, and the space was renovated to meet Clarke’s rigorous acoustic and educational standards. The program was immediately embraced, with Clarke’s Philadelphia team of speech-language pathologists, teachers of the deaf and an educational audiologist working closely with families of infants and young children diagnosed with hearing loss.  

The partnership has proven to be highly effective and financially sustainable. La Salle offers reasonably priced space, while Clarke provides graduate students in La Salle’s Communication Sciences and Disorders program with the opportunity to perform practicums at Clarke. The educational model known as purposeful inclusion enables Clarke preschool students with hearing loss to have optimal access to learning and spoken communication in a mainstream environment. Simultaneously, they are developing listening and spoken language skills commensurate with their hearing peers during planned activities with CORA children throughout the week.

The partnership is such a success that the facility has expanded twice in the last three years to accommodate the high demand for services. Not a day goes by without a parent exclaiming how amazed they are that their child’s future is going to be as bright and full of promise as any other child’s.

Decades of Difference

The promise of a life filled with such opportunity didn’t always exist for children with hearing loss. Before the arrival of newborn hearing screening it was not uncommon for deafness to remain undetected until school age. At that time, 80% of children with hearing loss were sent to schools for the deaf, often from elementary through high school. Today, 80% of children with hearing loss who receive Early Intervention Services go on to attend the same schools as their friends with typical hearing3.  

Universal newborn hearing screening has dramatically lowered the ages that diagnosis takes place and treatment begins, which has subsequently improved language outcomes for children with hearing loss. Due to early diagnosis, children can receive hearing aids as early as one month old and be on track for cochlear implantation if necessary. These devices provide access to sound that is vital in developing spoken language.

Technology and Educators

Unlike a child putting on a pair of eyeglasses and seeing clearly instantaneously, hearing devices by themselves cannot bring about a child’s ability to listen and talk. In order to be effective, technology must be used in tandem with a team of early childhood development specialists including speech-language pathologists, teachers of the deaf and audiologists.

While the ear collects sound, the brain is really where we listen. So although a child with hearing loss may hear a dog barking, she likely has no understanding of what that sound means. For a child to develop spoken language, she must be able to attach meaning to sound, and the earlier the better.

Early Access and Intervention

Clarke does not teach sign language, instead it teaches children to develop Listening and Spoken Language (LSL) skills. Long before a child actually speaks, the auditory centers of the brain where sound is processed are building a personal language center to last that child a lifetime. If not adequately stimulated by sound during the first few years, the auditory centers may not develop to their full potential. That is why it is vital that children receive access to sound via hearing aids or cochlear implants as early as possible. In fact, the Joint Commission on Infant Hearing recommends a “1-3-6 Rule” of screening by 1 month, diagnosis by 3 months and Early Intervention by 6 months.

Family Involvement

For many families, the presence of a Listening and Spoken Language (LSL) program in the heart of Philadelphia is a dream come true. The earlier that parents are equipped to promote their child’s spoken language, the better the outcomes for that child. The partnership between Clarke, CORA and La Salle is helping to ensure that families with infants, sometimes only weeks old, have access to Early Intervention services. Additionally, more children from a broader range of backgrounds and ethnicities are gaining access to expertise not readily available to them in the past.

Working with Clarke experts, parents are learning strategies to help support the development of their child's listening and speaking skills. At eighteen months of age, children and their families can join Clarke’s toddler group, and at three years old, children can attend Clarke’s state-of-the-art preschool program. In acoustically-designed classrooms equipped with FM systems for additional amplification, children learn kindergarten-readiness and pre-literacy skills while engaged in language-focused activities.  

The Impact of a Level Playing Field

The outcomes of the Clarke, CORA and La Salle partnership are astounding. Children at Clarke average 1.5 months of progress for each month of enrollment. From 2010-2014, 100% of the children in Clarke’s Pennsylvania preschool program met or exceeded standard scores in receptive vocabulary, expressive vocabulary and total language – areas that are predictors of strong literacy skills. Since 2009, 100% have transitioned to mainstream kindergarten classrooms readily equipped with the requisite skills for academic success.

These outcomes stand in stark contrast to the statistics.  On average, high school graduates who are deaf or hard of hearing leave school with a fourth grade reading level4 and 37% have failed at least one grade level.  Most of the population who is deaf or hard of hearing earns only 50% to 70% of that earned by adults with typical hearing6.  

On the cost side, Clarke’s commitment to early investment in education for children with hearing loss yields both short- and long-term savings of public funds. The National Center for Hearing Assessment and Management (NCHAM) reports that detecting and treating hearing loss at birth for one child saves $400,000 in special education costs by the time that child graduates from high school7. Clarke’s efficient model of service delivery contains costs from the start with an on- average annual cost per child of $40,000, compared to that of $70,000 or more for other programs serving children with hearing loss.  

Conclusion

Clarke’s collaboration in Philadelphia demonstrates that when three previously unrelated entities pool their concern, creativity and resources, they can transform the lives of so many in their community. Because of this partnership, young children with hearing loss – who otherwise would not have had access to Clarke’s expertise – are learning to listen and to speak. Their lives will be filled with limitless possibilities.

Lillian Rountree is the senior development officer for Clarke Schools for Hearing and Speech, and spends much of her time building individual and corporate relationships in the Philadelphia area. The former director of outreach and development at DePaul School for Hearing and Speech, Lillian holds a master’s degree in adult learning and leadership from Teachers College, Columbia University.

References

1.“Quick Statistics,” National Institute on Deafness and Other Communication Disorders (NIDCD), accessed January 27, 2016, http://www.nidcd.nih.gov/health/statistics/pages/quick.aspx#1.

2. Mitchell, R.E. and M.A. Karchmer. 2004. “Chasing the Mythical Ten Percent: Parental Hearing Status of Deaf and Hard of Hearing Students in the United States.” Sign Language Studies 4 (2): 138-163. 

3. NPR Staff. “Cochlear Implants Redefine What It Means to Be Deaf.” National Public Radio, April 8, 2012. http://www.npr.org/2012/04/08/150245885/cochlear-implants-redefine-what-it-means-to-be-deaf (accessed September 4, 2014)

4. Traxler, C.B. 2000. “The Stanford Achievement Test, 9th Edition: National Norming and Performance Standards for Deaf and Hard-of-Hearing Students.” Journal of Deaf Studies and Deaf Education 5(4): 337-348.

5. Bess, F. H. 1998. “Children with Minimal Sensorineural Hearing Loss: Prevalence, Educational Performance, and Functional Status.” Ear and Hearing 19: 339-354.

6. Mohr, P.E., J.J. Feldman, J.L. Dunbar, A. McConkey-Robbins, J.K. Niparko, R.K. Rittenhouse, and M.W. Skinner. 2000. “The Societal Costs of Severe to Profound Hearing Loss in the United States.” International Journal of Technology Assessment in Health Care 16(4): 1120-1135.

7. Karl R. White, “Early Identification of Children’s Hearing Loss: A Silent Revolution” (lecture, Utah State University, Logan, UT, September 28, 2006).

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