Children's Voice Mar/Apr 2008

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Management Matters

Proving You Make a Difference

Donors want accountability with their investment, but how do you measure improving an abused child's life?

By Vern Ricker and Jim Grote

A measure of society's justice and decency is how that society treats its weakest members. Without a doubt, the weakest members in our society are children. One in five live below the federal poverty line; the rate for young children is even higher.

Our experience working with abused children tells us that when it comes to funding, children in general, and abused children in particular, are not a major priority in our society. Government funding is always scarce, and private funding for abused and neglected children is a low priority within the philanthropic community. Private philanthropists and government agencies alike understandably want to get the most bang for their buck in making a difference in their communities via measurable outcomes. The buzzword for this approach is venture philanthropy, which takes the corporate world as its model of doing business.

Unfortunately, abused and neglected children don't fit well inside this model. The return on investing in a struggling Harvard student is obviously more spectacular than the return on investing in a child who grew up with an alcoholic father and a schizophrenic mother. We contend, however, that this corporate outcome mentality reabuses abused children by discounting the smaller successes they do achieve through social service agencies and provides a rationale for giving less to social services agencies than to other philanthropic causes like private schools, universities, and churches.

Abused children can be dismissed easily with the attitude, "They are pretty much lost causes anyway. Let's put our money where it can make a real difference." This attitude has a long history, going back to Andrew Carnegie's Gospel of Wealth, in which he argued that private philanthropy should concentrate on causes that help the rich and poor alike--projects like libraries, universities, parks, recreation facilities, and art museums. Obviously, these projects make a visible community impact, but they don't address the pressing needs of our communities' weakest members.

Making Children a Priority

One would think the richest country in the world would be doing more to take care of its children, especially the poor and abused, but it isn't. Why?

One explanation is the strength of lobbyists. In 2005, AARP spent $36 million lobbying for the rights of the elderly. The Humane Society of the United States--just one of 250 animal rights groups--spent $1.8 million lobbying for animals rights. The same year, CWLA's lobbying budget was $400,000. Thus, while powerful lobbyists advocate for animal rights and elderly Americans, the lobby for protecting children is relatively weak.

The effect is obvious. CWLA's 2006 report, Ten Years of Leaving Foster Children Behind: The Long Decline in Federal Support, found federal support for children in foster care has declined 18% in the past several years. State funding tends to follow the same trend.

How do agencies serving children compensate for the funding shortfall? They look to the private sector for donations, but more than 90% of all private philanthropic dollars go to institutions primarily serving nonimpoverished citizens. To make matters worse, 2005 studies reported in the New York Times and USA Today show private giving to organizations directly serving the poor has hit a record low. Fewer than 10% of all private charitable contributions go to these human service organizations.

Studies demonstrate increasing growth in private charitable dollars going to institutions such as churches, private schools, universities, and nonprofit hospitals:
  • Over the last few decades, charitable giving to health groups and educational institutions rose faster than similar giving to human services groups.

  • The American Hospital Association calculated that spending on uncompensated care (charity) by nonprofit hospitals was 4.4% of their costs in 2002, compared with 4.5% by commercial hospitals.

  • The 1998 National Congregations Study of church spending showed less than 3% of the average congregation's total budget was spent on social services.

  • Many of the biggest foundations fighting poverty, such as the Bill and Melinda Gates Foundation, have turned their focus overseas.
Criticism of this trend in private giving has included a bipartisan investigation by Congress on whether tax exemptions are justified for certain types of institutions, particularly those with multibillion-dollar endowments.

Measuring Success: Balancing Expectations and Reality

This brings us to the young people we serve at Father Maloney's Boys' Haven. Boys' Haven started in 1948 as a residential treatment center in Louisville, Kentucky. As the needs of our young people became more complex, we expanded our services to include an on-campus school, foster care, in-home counseling, case management, permanent housing, transitional living, life skills training, employment training, and a new equine program. In the last five years, the number of youth served has grown tenfold, as has our need to fund services.

Well-meaning people have told us that although they give something to social services, they hesitate to give large resources because the impact and success rate are more dubious than donating to a university or church. How can Boys' Haven and other social service agencies prove donor dollars make a difference? Can we measure and demonstrate success in our programs and the lives of our clients? Can we meet the current challenge and trend of capturing success in terms of measurable outcomes? The task is not easy.

First, we must demonstrate that comparing the abused children we serve to your average churchgoer or university student is like comparing apples to oranges. Second, we must show that outcomes for our clients can be measured, but they must be measured according to expectations that fit our clients.

At Boys' Haven, our clients often are youth who have been bounced from foster home to foster home until no one wants them anymore. The level of abuse we learn about every day is difficult to imagine, like the boy whose uncle hid eyeballs of stray dogs and cats in his mashed potatoes just to terrorize him, or the boy whose father locked him in a horse stall for days at a time when he was bad, or the girl who said she became addicted to cocaine at age 11 because her mother's boyfriends thought it was fun to get high with a little kid.

Our Director of Nursing, Beverly Schaefer, can describe the plight of our children better than we can. According to her experience, recounted in the regional health care paper,

Medical News, "A history of physical, sexual, and emotional abuse is the biggest issue I encounter here at Boys' Haven. Just about every young person admitted here has this history. I've seen kids who have been beaten with belts, lead pipes, baseball bats, you name it."

She continues, "Many of our kids are too distraught and anxious to eat, so we have to work with them closely to develop a healthy diet. Sleep disorders are rampant. Many kids have nightmares and flashbacks in their dreams, so they fight to stay awake because they are literally afraid to go to sleep. And obviously they all have huge issues with trust and interacting with others. Many of the kids who come to Boys' Haven are starting life all over again with no basic social skills. They have to learn everything from scratch. This takes a lot of patience on the part of our staff and a lot of perseverance on the part of the kids."

Determining successful outcomes among this population of children is difficult, yet donors have every right to demand accountability from the charities they fund. By one measure of success--physical safety--Boys' Haven is 100% successful in protecting the youth in our care. But by another measure--how many of our kids attend graduate school--we are less successful. Would a statistic on how many of our children go to graduate school even be a fair measure of our success?

As Schaefer told Medical News, "We have incredible success stories at Boys' Haven, but most people never see them because they involve such simple things as learning how to cook a meal or to wake up for school on time each morning. For kids who have grown up with nothing but abuse and neglect, these aren't even successes, they're miracles."

As we write this piece, one of our kids is on a scholarship to study in Hong Kong, another is graduating from Navy boot camp and enrolling in the SEALS program, and another is attending graduate school in chiropractics. We are proud of them, but we cannot expect such success from all our clients.

The Boys' Haven Pyramid of Success

Can any human being, especially a young person, ever be considered a lost cause? Our answer is a resounding, "No!" There are no lost causes, only different degrees of success.

We have found one method of measuring success in an adaptation of Abraham Maslow's famous hierarchy of needs, which moves from basic needs, like hunger and safety, to higher needs like esteem and self-actualization. Likewise, our Pyramid of Success describes the fundamental challenges our clients must master before reaching true independence.

The Boys' Haven Pyramid of Success model has helped us communicate to our constituents the degree of dysfunction our children suffer as a result of abuse. We also use the pyramid to inform our federal and state representatives about our programs and how they fit into existing government goals.

The bottom levels of the pyramid are so basic we often forget these accomplishments entail major successes for our young people. Growing up in an abusive household is like growing up in a war zone: Nothing can be taken for granted. If outcome measures don't account for this, the measures become another, more sophisticated, type of abuse.

Our Pyramid of Success shows that success is not an absolute phenomenon, but one relative to the starting point of the person whose success is being measured.

The bottom level of the pyramid is physical safety. Our abused clients have never experienced physical safety. They expect mistreatment and think it is normal. Hence, they are always on guard. The first step toward trusting others and themselves must be established before they can move on to more challenges. Physical safety is a prerequisite to later feelings of emotional safety and security.

The next level of the pyramid includes daily-living activities. Many clients have virtually no experience in simple activities we take for granted--sleeping through the night (without nightmares), bathing and hygiene, shopping for food, eating at regular times, preparing meals, keeping an orderly environment, and getting exercise. Once again, trying to fast-track these early steps guarantees failure at higher steps.

Next, young people who have grown up in abusive situations must learn simple social skills like verbalizing their feelings, asking questions, making eye contact, and shaking hands. Other social skills we teach include anger management, etiquette in public, and conversational skills.

Finally, after these first three stages are mastered, Boys' Haven helps clients obtain their high school diploma, GED, vocational certificate, or college degree. We also help with interview skills, developing a work ethic, and obtaining entry-level jobs. Many funding sources might think we begin our work at this level and forget that at least 60% of our work comes before this.

At the top of the pyramid is independence. Independence entails much more than our clients living in their own apartments. Primarily, it refers to their ability to meet their own needs, including knowing when to ask for help and how to access community resources. When people ask us what our success rate is, we have to stop and think. Do they mean physical safety, activities of daily living, social skills, education and employment, or independence?

At the first level we're 100% successful. At the next two levels, we are 90% successful. At the fourth level, at least 75% of our clients complete educational goals and land first jobs, and more than 50% achieve some independence.

Success Through Taxpayer Savings

Another area where we have had substantial success is saving taxpayer dollars, both by reducing future government expenditures and increasing tax revenue through employment programs. The enormous social cost of child abuse is obvious: Society either pays less now or more later. Society can choose to invest adequate dollars now to give these children the care they need; or we can pay later by supplying the welfare benefits, mental health services, prisons, substance abuse treatment, and emergency room treatment the children will most likely need as they become adults.

Have you ever wondered, for example, what happens to children in foster care when they turn 18? Most suddenly are on their own, and few are prepared. (Luckily, in Kentucky foster youth can recommit to state care for a few years if they stay in school.) Most are truly at risk of becoming homeless. We catch them before this happens. We offer them their own place to live, supervision, support in their efforts to work or go to school, and training to enable them to live responsibly on their own--to be independent. By investing in these youth, we prevent a tremendous future drain on social services. (See Failing to Invest Early Means Paying the Price Later.)

Doesn't it make more sense to invest a little in young people now rather than spend a lot more later on treatment and rehabilitation? Consider the 19-year old schizophrenic man who came to us from a public mental hospital. He had already begun a life of what we call "institutional roulette," or moving from one service to another. His future looked bleak, and we could see him using all of the above services over a lifetime. With help from a Boys' Haven nurse and case manager, he now lives in a supervised apartment setting, is stabilized on the proper medication, and working a full-time job for the first time. Now he requires only a modicum of supervision. The cost of caring for this young man has been reduced drastically.

At Boys' Haven, our goal is to turn a "throw away" kid into a contributing member of society for a fraction of the cost it would take to provide for that individual as an adult.

More important than saving tax dollars, we save lives and help abused and neglected kids find a meaningful niche in the community.

Vern Rickert LCSW, LMFT is Executive Director, and Jim Grote CFP is Director of Development, for Father Maloney's Boys' Haven in Louisville, Kentucky.

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