How to Revolutionize Social Services

The United States faces unprecedented challenges, once thought to be something that only existed in science fiction apocalyptic films. We face public health and economic crises with ineffectual governments unable or unwilling to provide solutions. There is also decades of research into solutions for every one of these challenges, if only we could muster the political will to implement them.

A team of dedicated change agents are committed to building that momentum from the ground up, starting in New Mexico. We are researchers, strategists, and advocates for health and education equity who have been developing the nation’s first strategy to ensure we survive the unprecedented challenges caused by a collision of five crises: 1) an ever-evolving pandemic, 2) massive workforce disruption and joblessness, 3) interrupted K-12 and higher education, 4) lack of access to vital social services needed to survive and thrive, and 5) a long history of epidemic rates of adverse childhood experiences, family trauma, and the substance misuse associated with it. We are offering the cure for a society in a world of hurt.

These interrelated crises are not something the CDC will be solving with federal management. They require a local data-driven collaborate strategy with a clear goal, framework for change, evidence-informed activities, and stakeholder engagement across all public sector service areas—from health care to education to basic services like food and housing security.

In the last year and a half, as leaders of a New Mexico initiative committed to health and education equity goals, we have had a front-row seat to a woefully underfunded and understaffed public health care system. And yet in most states, governors are not talking about addressing health care disparities. While a lack of jobs threatens many people with hunger and eviction, in most cities mayors are not demanding a seamless system of services to ensure residents can endure with dignity until living-wage jobs with benefits appear. Our students have lost a year of fully functioning public education, but few school superintendents have presented a plan to show how that will be addressed, nor how we move forward when future lockdowns emerge. As for childhood adversity and trauma, how do we get the painful fate of our most vulnerable children on the public’s radar, with so many other challenges demanding immediate attention? We have not heard any state’s child welfare leader calling for a summit on the status of children’s safety lately.

Today, amid almost deafening silence on creating sustainable solutions, New Mexicans are speaking up and taking action. That state has a long list of local stakeholders working in the arenas of health care, education, housing, food, transportation, parent advocacy, youth mentoring, early childhood development, and higher education who have also said, “Yes, 100% of our residents should have access to vital services to solve our long-standing problems.” These are local stakeholders working in a new initiative called 100% Community. We are an experiment in its early stages, but one we believe merits close attention.

The 100% Community initiative was launched 2019 by the New Mexico Legislature, with New Mexico State University taking on its full implementation. The initiative is not tinkering around the edges, as almost all public health, education, and workforce development initiatives in the U.S. have done.

We created the 100% Community initiative to end a very long list of historic challenges exacerbated by the pandemic and ineffectual governance. For those seeking sustainable change leading to healthy populations, we’ve identified 13 costly interrelated challenges (by no means a comprehensive list) that have diminished the public’s capacity to learn, parent, become job-ready, perform at work, or make it through the day without self-medicating with alcohol or drugs.

Adverse childhood experiences, including abuse and neglect
Emotional challenges, trauma, untreated mental illness, and suicide
Substance misuse, which can lead to illness, injury, and death
Lack of school readiness in public schools and with younger children
Poor school achievement and dropping out
Domestic violence and related shelter and court costs
Lack of job readiness
Workplace challenges like absenteeism
Overburdened and dysfunctional child welfare systems
Overburdened first responders and emergency rooms
Physical challenges and illnesses that weaken our immune systems, putting us at greater risk for further illness
Antisocial behaviors affecting public health and safety, such as refusing to wear masks or get a COVID vaccines (among many other harmful behaviors)
The school-to-prison-pipeline, a result of institutionalized racism and classism that dooms entire communities to a hopeless future

These challenges have never been completely solved by anything government, nongovernmental organizations and foundations have attempted. We’re working with a data-driven process to change that by ensuring access to 10 vital services for surviving and thriving for 100% of residents: medical care, behavioral health care, food security programs, housing security programs, transportation to vital services, parent supports, early childhood learning, fully resourced community schools with health centers, youth mentor programs, and job training.

The initiative is county-based, and has a seven-step process that begins with a survey of community members, assessing what percentage of people who need each vital service had difficulty accessing it, and why. We identify barriers for people to receive those services, including a general lack of availability of the service, or transportation options to access it. Each county has action teams representing each of the 10 sectors who then take that data, analyze it, identify solutions to barriers, implement those solutions to the barriers, and then evaluate their results.

For example, a county may identify that 50% of parents wanting behavioral health care cannot easily access it. One possible solution would be funding school-based behavioral and medical health centers serving students and their families. A county-based behavioral health action team would commit to developing a plan to fund and implement such centers.

And then that process of identifying and fixing barriers to services is repeated until the barriers are removed and 100% of residents have access to the services. It’s a radically simple framework with an ambitious, audacious goal: to prevent childhood trauma, adverse community experiences, and social adversity in the form of barriers to vital services, racism, classism, discrimination, historical trauma, and a lack of good paying jobs with benefits.

This type of comprehensive initiative has never been attempted in New Mexico, let alone the nation. The 100% Community initiative is far from a short-term fix; it’s a long-term process of transformation on every level of government, with partnerships in the public and private sectors. County initiative leaders can measure progress each year—assessing the degree to which residents have timely access to vital services.

In many ways the work of the 100% team is political, but a leap of faith is also involved. Each county has a different history, culture, and level of economic prosperity. But change agents, in the form of medical clinic directors, city councilors, county commissioners, university professors, nongovernmental organizations focused on culture, and tribal health experts, are working to create a new norm that focuses on creating a culture of caring. This is altruism on a very large scale. We get to 100% through building trusting relationships among advocates for vital services and those state and local elected lawmakers who can fund full access to services. We also are acknowledging the long-term process of selfless caring ahead.

As we try to recover from the pandemic and all its destabilizing consequences, we have to remember that a return to normal is a return to trauma, disparities, social injustice, and extreme vulnerability to illnesses. The concept of 100% is a philosophy of altruism embraced by those of us who believe we can and must take the nation on a journey, from hurting and hiding to healing and helping.

Katherine Ortega Courtney has a Ph.D. in Experimental Psychology from Texas Christian University, where she studied at the Institute of Behavioral Research. Dr. Courtney worked with the State of New Mexico for eight years, first as the Juvenile Justice Epidemiologist, then as Bureau Chief of the Child Protective Services Research, Assessment and Data Bureau. Dr. Courtney championed and co-developed the New Mexico Data Leaders for Child Welfare program, which was implemented in NYC, Connecticut, and Pennsylvania. She has worked in policy and research and has led community initiatives, through her work, at the Santa Fe Community Foundation and the New Mexico Early Childhood Development Partnership. She is currently the co-director of the Anna Age Eight Institute at New Mexico State University. She can be reached at annaageeight.org/contact/.

Dominic Cappello is an advocate for turning crises into opportunities for improving systems, solving challenges using data, technology, and collaboration. He knows why systems that should protect us, can fail us — and teach leadership development and data-driven problem-solving. Cappello is a health systems strategist and New York Times bestseller author, whose Ten Talks book series on family safety reached a national audience when his innovative work was featured on The Oprah Winfrey Show. Cappello is also the co-author (with Katherine Ortega Courtney, Ph.D.) of 100% Community: Ensuring 10 vital services for surviving and thriving, Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment. He serves as the co-director of the Anna, Age Eight Institute, a program of New Mexico State University. He can be reached at [email protected]

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