Innovation in Flyover Territory

Just last week the Stanford Graduate School of Business’s Center for Social Innovation hosted a roundtable for the newly-created White House Office on Social Innovation.  Headed by Sonal Shah, formerly of Google, the Office of Social Innovation seeks to develop new funding for social innovation, expand national service, increase civic participation through new media, and develop new partnerships both within the federal bureacracy and with private partners. 

Seeing this raises two thoughts for me – on the one hand, it’s easy to think “Maybe I should pack up and move to the coast, where there’s lots of innovation experience to learn from and energy to inspire.”  On the other hand, some of what the new White House office wants to do aligns with what Innovation Lab here at CAP is all about – especially the part about building partnerships and using ”new” media (i.e. this blog).  And then I feel good that we’re on a good track, a track that may be more established elsewhere but is nonetheless just as critical to have outside the typical hotbeds of innovation. 

As Garth Saloner, incoming dean at Stanford’s Business School said at the roundtable, “The scarcity is not in the ideas, the scarcity is in the organizaitonal capacity to help grow these ideas.”  CAP and Innovation Lab believe this capacity is needed not just in Silicon Valley or Washington, D.C., but right here in Tulsa as well, and we’re proud to be a part of it.

Food Deserts or Food Swamps?

Ezra Klein, a health policy blogger for the Washington Post, links to a new report from the Food and Drug Administration examining the problem of food deserts – places that lack access to full-service grocery stores and the fresh produce they sell. This isn’t really a food equity blog, but since I recently posted on the topic this seems like a relevant follow up.

Jane Black, another Wapo reporter, read the report and notes that “there’s no significant evidence that increased access to fruits, vegetables, low-fat milk and whole grains actually reduces Body Mass Index (BMI).” Klein adds that “only 2.2 percent of Americans live a mile or more from a supermarket and don’t have access to a car.”

So what’s the problem with these so-called food deserts? Too much food.

The problem, it seems, is the opposite: food swamps. Areas dense with fast food and convenience stores. As the USDA puts it, “Easy access to all food, rather than lack of access to specific healthy foods, may be a more important factor in explaining increases in obesity.” The concentration of the obesity crisis in high-poverty areas thus brings us back to a pretty well-accepted hypothesis: The problem is with low-income areas where the cheap food is the bad food.

If its the abundance of junk foods rather than the scarcity of fresh foods that is the real culprit here, the policy implications are much different. Subsidizing grocery stores or “green carts” or farmer’s markets isn’t the solution. Getting people to buy the good stuff is, such as policies that provide bonus Food Stamps dollars for fresh produce.

“Looking for Hard to Reach Parents”

Over the course of two years, volunteer parents and community members went door-to-door in Chicago’s low- and moderate-income neighborhoods conducting surveys of more than 5,000 parents and caregivers.  The purpose? To better understand the barriers to preschool and Head Start faced by low-income families. Following the surveys, the project convened two community meetings to engage parents and stakeholders in an analysis of potential policy solutions.

As a result of their research, they discovered about half of eligible preschool aged children are not in a program of any kind. Their findings including the most common challenges to getting children enrolled and participating as well as recommended solutions are presented in the report, “Why Isn’t Johnny in Preschool?” Some highlights:

• Transportation was the number one barrier. Families did not have cars; found public transportation too difficult; were afraid or physically unable to walk their children to school especially grandparent caregivers; and/or struggled getting multiple children to different sites at different times.
• Preschool schedules that don’t accommodate work schedules and child care needs and various options are needed – all day, hours that match school hours of older siblings, and half-day programs at different times.
• Parents find the enrollment process to be too hard. Parents lack information on options or are overwhelmed by all the options, families aren’t aware of free programs, or which programs they qualify for.
• Programs should raise awareness of the importance of preschool and break down stereotypes that children are too young to go to school.
• Families worry about the loss of state child care subsidies, especially when it is a source of income for extended family and are concerned about the cost of child care co-payments.

Do these same barriers exist in Tulsa? Who are the hard to reach parents in our communities? What are effective practices to encourage enrollment and if we eliminate barriers to enrollment without addressing barriers to participation, what will we gain?  

In responding to a somewhat unrelated question recently posed to staff, a teacher from one of our Early Childhood Sites created her own list of barriers many of which parallel those found in the report: many families don’t know our services are free; families believe it’s difficult to sign up or they don’t know how or where; and parents are looking for child care and believe early childhood education is “out of their reach” prescreening themselves from programs labeled as early childhood education.

What barriers have you seen?

The Positive Deviant Solution to Our Health Care System

Just over a year ago, CAP hosted seminars in a new method of social change called “positive deviance.” The basic idea of positive deviance is that, within any given community possessing any given problem, some members through their own actions will fare better than others given equal resources. Observing what makes these “deviants” positive can unlock the secret to solving the challenges facing the community.

Recently the New Yorker ran a widely-praised article by Atul Gawande about the problem of health care costs in the U.S., focusing on the unlikely town of McAllen, Texas. As a follow up, the New Yorker posted a transcript of his commencement address to Northwestern University, in which Gawande explains the concept of positive deviance and  suggests applying a positive deviance approach to the national health care crisis:

Jerry Sternin was for awhile the director of a Save the Children program to reduce malnutrition in poor Vietnamese villages. The usual methods involved bringing in outside experts to analyze the situation followed by food and agriculture techniques from elsewhere.

The program, however, had itself become starved—of money. It couldn’t afford the usual approach. The Sternins had to find different solutions with the resources at hand.

So this is what they decided to do. They went to villages in trouble and got the villagers to help them identify who among them had the best-nourished children—who among them had demonstrated what Jerry Sternin termed a “positive deviance” from the norm. The villagers then visited those mothers at home to see exactly what they were doing.

Just that was revolutionary. The villagers discovered that there were well-nourished children among them, despite the poverty, and that those children’s mothers were breaking with the locally accepted wisdom in all sorts of ways—feeding their children even when they had diarrhea; giving them several small feedings each day rather than one or two big ones; adding sweet-potato greens to the children’s rice despite its being considered a low-class food. The ideas spread and took hold. The program measured the results and posted them in the villages for all to see. In two years, malnutrition dropped sixty-five to eighty-five per cent in every village the Sternins had been to. Their program proved in fact more effective than outside experts were.

If you attended our positive deviance seminars, led by a friend of the Sternins, you know this story by heart. Positive deviance has gone on to a distinguished history of discovering innovative, community-based solutions, particularly in healthcare. It’s shown success in reducing hospital infection rates by, gasp, encouraging medical staff to wash their hands thoroughly.

Gawande looks through this lens of positive deviance and sees solutions to today’s runaway health care costs that go unaccompanied with improved health:

Like the malnourished villagers, we are in trouble. But the public doesn’t know what do about it. The government doesn’t know. The insurance companies don’t know. …

Well, let us think about this problem the way Jerry Sternin thought about that starving village in Vietnam. Let us look for the positive deviants.

Time Running Out on PLANiTULSA

If you haven’t already reviewed the PLANiTULSA scenarios and submitted the short feedback survey, then you’re doing a serious disservice to the city you call home. The deadline to participate is TOMORROW, June 18.

Seriously, this is your chance to register your vision for our future before who-knows-what will happen in the hands of the City Council.

The scenarios are these:

• Scenario A: Trends Continue. If you like the way Tulsa has grown the past 20 years, this one’s for you. 83% of population growth goes to the ‘burbs.
• Scenario B: Main Streets. Existing communities benefit from new development and transit investments, especially along 11th Street, Harvard, Yale, and Peoria.
• Scenario C: New Centers. New hubs of jobs and housing concentrated around downtown, North Peoria, Southwest Tulsa, and East Tulsa. Lots of new development happens in previously neglected areas of Tulsa, but a lot of it is “green field” or open land development rather than infill or re-development.
• Scenario D:  Centered City. Transit and housing investments concentrate on downtown and inner-midtown. The objective is to create a much denser center city.

Get to it!

New Oases in the Food Desert

The New York Times reports on that city’s efforts to bring fresh produce to so-called “food desert” neighborhoods. The city launched an initiative called Green Carts, which created licenses for 1,000 new food vendors (carts) provided that they sell only fresh fruits and vegetables and that they locate in the designated food deserts, such as a Fordham-area neighborhood in the Bronx.

The city has approved 1,000 new mobile food carts for neighborhoods in the five boroughs that have long been isolated from traditional supermarkets, grocery stores and farmers’ markets offering fresh produce at reasonable prices.

“There is an epidemic of obesity and diabetes among those who are poor,” said Linda I. Gibbs, the deputy mayor for health and human services.

So far, 200 Green Carts, as they are officially called, are now on the streets. “Already, people are telling us they’re glad we’re here,” said Michael Bracho, the 42-year-old proprietor of the Decatur Avenue cart, a downsized former Office Depot manager who describes his new occupation as “lucrative if you do it right.”

Some of the vendors who hit the streets last year complained about low-traffic locations, and it will take a while to determine whether there is enough demand to keep all the vendors in business in neighborhoods where processed foods are dominant. And some local merchants could see the carts as competition.

The carts do not accept food stamps, though a government-financed pilot program will soon provide $1,000 all-weather wireless terminals so 15 vendors can accept food-stamp debit cards.

The cart permits restrict operators to designated impoverished neighborhoods in the five boroughs and limit sales to raw fruits and vegetables.

Many distressed urban areas lack a full-service grocery store that sells fresh fruits and vegetables. Grocery retailers usually explain that the overhead as well as loss rate (from theft) are unsustainable for the area – they can’t make a profit. Convenience stores that do operate in these neighborhoods say they can only carry minimal produce because it will go bad before it’s bought.

New York’s cart program works for a few reasons.

Getting Behind by Getting Ahead, continued

Last week I linked to an OK Policy post about “cliff effects” that reduce or disqualify people for benefits whenever they increase their earnings, sometimes leaving people even farther behind even as they get better jobs or benefits.

The Associated Press reports that ARRA, the stimulus legislation, is causing some cliff effects of its own, and giving the unemployed a little bit of boost and a little bit of bust:

Under the economic recovery plan, laid-off workers have seen a $25 weekly bump in their unemployment checks as part of a broad expansion of benefits for the poor. But the law did not raise the income cap for food stamp eligibility, so the extra money has pushed some people over the limit.

One unemployed man in Georgia was pushed over the limit by the bump, causing him to miss out on $300/month in food stamps assistance.

Since policymakers are becoming increasingly aware of the problems of cliff effects, they wouldn’t intentionally cause such dramatic consequences in entirely new, emergency relief programs, right? Wrong:

Lawmakers crafting the stimulus knew this would become a problem, said Stacy Dean, director of food assistance policy at Center on Budget and Policy Priorities, a liberal think tank. They could have headed it off by raising the income tax or declaring that the $25 stimulus checks would not affect food stamp eligibility. Both were expensive options that could have forced states to reprogram their computer systems.

But more importantly, hashing out those details would have taken time.

“People were aware of this but, as you recall, the stimulus was moving along and then it was passed in about a day,” Dean said. “There was not a lot of policy discussion on this.”

Getting Behind by Getting Ahead

David Blatt at OK Policy does a nice job of explaning the “cliff effect”, whereby people lose important public benefits as their earnings increase. This means that struggling families who manage to raise their incomes face a sort of “tax” on their efforts toward economic self-sufficiency:

The cliff effect is most dramatic for Medicaid health insurance coverage, which tends to be an all-or-nothing benefit. Children in Oklahoma are eligible for Medicaid up to 185 percent of the federal poverty level, while adults lose eligibility when they make less than 50 percent of the poverty level. Other work support programs, including the earned income tax credit, the food stamp program, and child care subsidies, minimize the cliff effect by phasing out the amount of benefits at higher incomes, or in the case of child care subsidies, requiring higher co-payments. The cumulative effect, however, is that for most low-income workers who are attempting to move up the income ladder, additional earnings can be largely or fully offset by higher taxes and the loss of benefits. At a certain threshold, workers find themselves in a situation where the rational response to an offer of a raise or a better job is to respond, “Sorry, but I just can’t afford it.”

I did some work on this issue a while back, in order to better understand what exactly those “cliffs” look like to our families. We found that a single mom with two children takes home an average of just 34 cents for every additional dollar she earns, with the largest impact (as Blatt notes) caused by the loss of health care coverage for her and her children.

Pre-K Teacher Brings the Knowledge

The organization Pre-K Now has a blog called Inside Pre-K that shares the stories and experiences of actual pre-K teachers. The advocacy organization already does very good policy work and an excellent daily newsclipping email, and the Inside Pre-K is a very creative contribution to the advocacy world. They should be congratulated on recognizing the saturation in the policy-oriented advocacy world and choosing instead to fill an important gap with personal stories and experiences.

I tell you all that because, despite my praise of their experiential niche, I’m linking to them today because of a very good policy post. J.M. Holland, a Head Start teacher in Virginia, rebuts some tired criticisms of pre-K program effectiveness by marshalling up some evidence I hadn’t seen before:

It is strange that [pre-K critic Chester] Finn would say that only a “few tiny, costly programs targeting very poor children have shown some lasting positive effects.”

A RAND corporation study disagrees and suggests that pre-k positively impacts the impact of every child who attends. RAND suggests that in calculating potential benefit of high quality preschool, high risk students may realize 100% of benefits, medium risk students may realize 50% of benefits and low risk students may realize 25% of benefits. A voluntary universal pre-k system would increase the total number of children realizing benefits that would be passed on to our society as well as provide the most benefit to the students that most need it.  

And:

It seems that high SES students would not benefit as much from attending a public preschool program but benefits exist. Affluence does not mean a student is not at risk.  In fact, high SES students have been shown to be at greater risk than low or middle SES students for depression and drug use in adolescence, both issues that are positively affected by preschool.

Elementary Absences and School Achievement

I feel like I’ve posted on this before, but my searches have been fruitless. Anyway, the National Center for Children in Poverty released a report a while back on chronic absenteeism in elementary school, called “Present, Engaged, and Accounted For: The Critical Importance of Addressing Chronic Absence in the Early Grades.”

The report finds that children who miss more than 10% of days in kindergarten fare far worse than their peers, with the effect lasting through fifth grade for poor children. It shouldn’t be surprising that absenteeism affects school achievement, but what is suprising is that it does so for so long afterward.

The paper examines the possible causes of chronic absenteeism, including parental engagement, socioeconomic status, language barriers, health, and school quality. It also calls attention to the need for better measurement, since “address chronic absence starts with counting.” Schools have traditionally relied on overall attendance measures and targets such as the average percent of students that attended on a given day (”average daily attendance”). But this measure does nothing to measure the degree to which individual students are missing class and falling behind, and may even mask the issue.

Anyway, all this is to say that the report’s author, Hedy Chang, has launched a blog and website that offers helpful tools for policymakers and school administrators to begin addressing chronic absence. This is the kind of thing our researchers need to do more of: take an outstanding body of research and show others how to apply it. The website is www.chronicabsence.net.