Expect Success: Four Oaks’ TotalChild Program

An Insight from the 2015 Human Services Summit

Part of a Series

This Insight is a part of the 2015 Human Services Summit Report.

To see the complete report, click here.

In 2007, the board of directors at Four Oaks—a non-profit child welfare, juvenile justice, and behavioral health agency in Iowa—was excited and concerned. Founded in 1973 to serve ten children in Cedar Rapids, a city in eastern Iowa, the agency was enjoying a decade in which its budget nearly doubled, and it was serving almost 14,000 clients in more than a dozen cities across the state. Nevertheless, the board was troubled by something more foundational: it had no way of knowing whether the organization was fulfilling its mission of “assur[ing] that children become successful adults.”

The problem was rooted in the agency’s approach. Four Oaks was a “single-service” organization focused on how its interventions affected specific conditions (e.g., whether a child had housing) in the short-term. In order to effect more far-reaching change, Four Oaks needed to become a multi-service agency that understood the interaction among its programs and evaluated whether they collectively contributed to a child’s long-term self-sufficiency. “Our theory of change was really regulatory,” said Anne Gruenewald, then the Executive Director and now the President and CEO of Four Oaks. “We really realized…that we were going to have to make the shift to…holding ourselves accountable for the long-term results.”

In other words, Four Oaks had been employing a siloed business model that isolated its programs and processes. Under this approach, it could respond to episodic incidents and satisfy the demands of funders focused on isolated outcomes. However, the organization aspired to integrate those programs so that it could respond to clients’ comprehensive needs; produce more sophisticated, data-driven analyses that attracted new financing; and create an environment in which stakeholders would share data and ideas and the organization would embrace a more nimble, modular culture—facilitating novel and deeper impact. Simply put, the board wanted to progress along the Human Services Value Curve and (at a minimum) create an integrative business model and ideally move toward a generative approach.

These [were] stretch objectives, but it’s really important because that’s why we’re in this business.”
Anne Gruenewald
President and CEO, Four Oaks

To guide its pursuit of this objective, the board settled on a simple but powerful vision: “Expect success.” It also introduced plans for TotalChild, a new program, which would monitor children’s progress through their 18th birthdays. TotalChild would provide holistic, integrated services in four core areas: youth, community, family, and school. To outside observers, the plan was well thought out. “When I think about the methods used to create the new strategy,” said Alex Neuhoff, a partner in The Bridgespan Group, which published a study on TotalChild, “it was…figuring out the point of arrival, contrasting that with where they are today, and then creating the sort of specific plan to get them from today to the point of the arrival.”

Nonetheless, actually implementing the plan created numerous challenges. Among them: How would the organization orient and equip the staff? Could Four Oaks cultivate support from community stakeholders and funders? Most fundamentally, would TotalChild serve as a catalyst to propel the organization forward, or would the weight of reform drag the entire organization down?

What is the Human Services Value Curve?

Learn more about the framework being adopted in the Health and Human Services field >

Preparing the Organization for Change: 2008 – 2010

One of the first steps for implementing TotalChild was identifying someone to spearhead the initiative. Jim Ernst, then the agency’s CEO, chose Gruenewald, a Four Oaks staff member since 1981 then serving as the agency’s executive director. She would take on the newly created post of Chief Strategy Officer, and her primary responsibility would be getting TotalChild off of the ground. “A planning effort of this kind essentially means that…you will question every aspect of the way your organization has been operating,” Ernst later said of the decision to tap Gruenewald for the post, “And without someone looking out for the initiative overall, we wouldn’t have gained any traction.”

Gruenewald and her teams—which included a steering committee, leadership committees, and task teams focused on specific issues (e.g., administration, technology, and finance)—then sought to revamp the agency’s staffing model and evaluative approach. This included creating a new position, a success manager, who would use a “stability matrix” to track each client’s progress in the agency’s core programs until his/her 18th birthday. The success manager would also be responsible for ensuring that programs across the organization were in dialogue with one another. Fostering this collaboration was imperative, Ernst explained, because the agency was “operat[ing] in silos administratively as well as programmatically. People were not necessarily aware of what was going on across the street.”

As Four Oaks introduced success managers, Gruenewald saw that the new team members were getting spread thin and in some instances struggling to find their voice in the existing supervisory structure. Even so, she and her team pressed ahead with the plan, buoyed by the belief that the potential benefit of far-reaching reform outweighed the internal friction it might produce. “What really drove the change for us,” Gruenewald said, “was taking a look internally and saying, ‘What are we really achieving, and are we okay with that?’”

Launching the Pilot and Building Relationships: 2011 – 2014

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In July 2011, Gruenewald and her team launched a pilot of TotalChild serving 300 children in Cedar Rapids. The pilot cost approximately $2 million; this was roughly 6.5 percent of the agency’s operating budget at a time when non-profits across the country were reeling from the effects of the Great Recession. Four Oaks financed the project through its strategic reserve and only planned to reach out to funders to expand the initiative if it proved successful.

Although Four Oaks was not seeking new donations, senior staff kept the agency’s supporters abreast of progress. In 2012, when they added to the pilot an effort to acquire and rehabilitate 100 houses in Wellington Heights, one of Cedar Rapids’ poorest neighborhoods, they wanted to connect with a range of community stakeholders. To that end, Four Oaks introduced a neighborhood engagement leader who was responsible for liaising with the police, neighborhood associations, and other community groups. The agency also devoted a substantial amount of leader “time [to] partnering with the city, the county, the council, the neighborhood association, and community and business leaders.”

This incremental approach to cultivating support paid dividends. In his 2013 Condition of the City Address, Cedar Rapids’ mayor lauded the TotalChild program and Wellington Heights initiative as forces that “will have great rewards well into the future for…the whole city of Cedar Rapids.” At the same time, prospective funders expressed enthusiasm about the program, which had helped 96 percent of participants achieve stability and resulted in the refurbishment of 58 properties in Wellington Heights. “When you shine a bright light on a target and you measure and communicate those results,” said Chris DeWolf, the President and CEO of Lil’ Drug Store Products, Inc., a national health care and beauty products supplier, “that’s incredibly compelling for community leaders.”

A planning effort of this kind essentially means that at some point, you will question every aspect of the way your organization has been operating.”
Jim Ernst
Former CEO, Four Oaks

Expanding TotalChild: 2014 – 2015

Since 2014, Four Oaks has focused on expanding TotalChild in and beyond Cedar Rapids. This has required a major push with state funders, many of which, Gruenewald noted, demand evidence of the program’s return on investment and replicability. Gruenewald, who in 2014 became Four Oaks’ President and CEO, and her team have drawn on data from the University of Iowa—which evaluated the pilot against a traditional service delivery model—to show that TotalChild has not just benefitted clients but also produced more efficient services because of reduced recidivism. Supporters have responded: the agency has raised more than $6 million to support expanding efforts in Cedar Rapids, the state legislature began allocating funds for TotalChild, and the agency is expanding the program to two additional sites.
At the same time, Four Oaks’ leaders are developing TotalChild 2.0, a revamped version of the program that will try to identify more clearly the role and place of the success manager and also expand services for clients beyond the age of 18. According to board member Lydia Brown, “The board is saying, ‘Okay, now we know it works. Now let’s make it better.’”

Even as Four Oaks endeavors to improve TotalChild, its staff can take pride in the fact that they have already made a substantial impact. As of June 30, 2015, the organization had enrolled nearly 850 children, and TotalChild had resulted in a 70 percent improvement for all at-risk and in-crisis clients. More broadly, Gruenewald and her team have taken an organization, which by the CEO’s own admission, was in the “regulative” dimension of the Human Services Value Curve, and transformed it to an “integrative business model.” More specifically, Four Oaks has woven together multiple programs and in the process strengthened customer service, expanded its operations, and produced data-driven evidence of its impact. With more funding coming into the organization and Four Oaks’ commitment to continued evaluation and renewal, all signs suggest that the organization can continue to scale the Human Services Value Curve.

To her counterparts across the country hoping to effect similarly far-reaching reform, Gruenewald emphasized the importance of “leadership with some stubbornness and some real drive to do some problem-solving,” adding, “These are stretch objectives, but it’s really important because that’s why we’re in this business.” She also offers a more concise but nonetheless powerful piece of advice: “Expect success.”

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