Creating Effective Family Policies Begins With Involving the Families Most Impacted

Jennifer Crosswhite, Ph.D., CFLE, Director of Research and Policy Education
/ Winter 2018 NCFR Report

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Highlights from the Policy Panel at the Northwest Council on Family Relations (NWCFR) 2018 Conference

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From time to time, I ask others to guest author my NCFR Report article in an effort to share what other individuals are doing with respect to policy. For this edition, I am happy to introduce Sarah Feeney, Ph.D., CFLE, past president of the Northwest Council on Family Relations (NWCFR), and Jana L. Meinhold, Ph.D., CFLE, current president of NWCFR, who helped organize their affiliates 2018 conference around policy. They are guest writing this article. Drs. Feeney and Meinhold share what they learned about how individual well-being translates into community well-being; effective policies and programs that are currently in place to reduce health disparities and serve diverse families; and effective strategies for engaging in the policymaking process in support of family health and well-being. I hope you find the information valuable.

 


Sarah Feeney, Ph.D., CFLE, and Jana L. Meinhold, Ph.D., CFLE

The 2018 conference theme for the Northwest Council on Family Relations was “Promoting Healthy Families Through Policy: Challenges and Opportunities.” Approximately 75 students, faculty, and professionals attended the conference at Central Washington University in Ellensburg, Washington, on April 13.

The conference concluded with the engaging panel discussion “Current Perspectives on Policies for Healthy Families,” facilitated by Elise Murowchick, Ph.D., CFLE, NWCFR board member. Panel members from across the Northwest included the following:

  • Marilyn Watkins, Ph.D., policy director, Economic Opportunity Institute, and clinical assistant professor, University of Washington;
  • Cynthia Morrison, manager of access systems and Coordination, Washington State Department of Health;
  • Jenna Kiser, M.S.W., intake/safety program manager, Washington State Department of Social and Health Services; and
  • Ann Riley, M.S., director, Kittitas County Community Network and Coalition

The 2018 NWCFR conference theme called for an exploration of the intersections of policy, health, and families. In the world of policymaking, the focus is often to maximize benefits to the population as a whole. By contrast, health and human service professionals often work in ways that are focused on individual families or even individual members of families. To bridge these different perspectives, the three main goals of the panel discussion were to

  • Identify the ways that supporting individual families can have a larger impact on the communities they live in;
  • Identify what is working and what could be done better as far as policies and programs that are designed to promote family health and well-being and reduce disparities; and
  • Learn from our panelists’ experiences in the policy world and what suggestions they have for those who are starting out in their careers.

Each of the four panelists were asked the same questions, followed by questions from the audience members. The questions and panel responses are presented below.

 

Question 1 asked: Tell us about your roles as professionals and how they are connected to policymaking or policy administration or implementation.

Marilyn Watkins kicked-off our panel discussion by offering, “[The] economy is not like the weather, it [policy] does not just happen. It changes based on policy decisions.” Watkins noted the importance of working together with different groups to try to encourage legislators to adopt policy changes. Watkins’ recent efforts have led to new policy on paid sick days and paid sick leave.

Ann Riley shared that her work focuses on developing and implementing practices within organizations. An example shared by Riley was her focus on trauma-informed work with school districts on their disciplinary policies to be trauma-informed. She noted the KCCN (Kittitas County Community Network and Coalition) is encouraging organizations in the community to ask “what happened to you” rather than “what’s wrong with you.” Though she works mainly at a community level she noted that “We are greatly influenced by policy at a state level and local organizations can be helpful in making state policies happen.”

Communities, families, and individuals are interconnected in ways that when we do better everybody does better as well.

Cynthia Morrison started by sharing that she works with a very large division at the State Department of Health: Maternal and Child Health. “[My] responsibility is to make sure our most vulnerable populations are getting taken care of. I focus specifically on children with special care needs, mental health, and adolescents who are pregnant or parenting.” Morrison went on to name the many agencies she works with in her role: other state agencies, health departments, community-based organizations, schools, and communities. In her office it becomes clear how systems affect both individuals and how the individual affects the system. “[There is a] need to be adaptable and needs are going to change over time.” Morrison noted her work focuses “very much at the policy level but also implementation level.”

Jenna Kiser shared that she works for CPS (Child Protective Services) and also works on safety for children, safe sleep for infants, and works with mandated reporters at Seattle Children’s Hospital. In her role Kiser is “required to maintain quality and practice and work with the legislative bills that impact my program.”

 

Question 2 asked: In your perspective, how does individual family well-being translate into community well-being?

In response to question two, Watkins said that “Communities, families and individuals are interconnected in ways that when we do better everybody does better as well.” She also noted that stress from economic inequality often has a negative impact on well-being. Policies that prevent families from being economically stressed help individuals be more prosperous and have more positive outcomes all around. “We want a society in which everyone helps each other up and rather than pushing others down.”

Ann Riley followed with, “I think from a community perspective, family is really a foundation of our future health. Family well-being is a future indicator of what the child’s health will look like in the future. Trying to mitigate the impact of childhood trauma, decrease the incidence, and to help build resiliency when trauma has happened - by doing this we are improving the well-being of the community.”

Relationship building is really important and policy practice is a marathon not a sprint.

Morrison noted the challenge of measuring well-being. At an individual level, well-being may be measured using BMI, but “people are more than the sum of their parts.” There is added complexity when accounting for family and community well-being. “We may find that in “this population or this community we see this rate of chronic diseases or poverty, but really this still focuses on an individual level. The community is greater than the sum of our parts. A community of good well-being is one that provides opportunities, and good health care, and a chance to contribute back to the community.”

From the perspective of the children’s administration, Kiser noted that, “It is vital to interact with families. Nobody wants us telling them how to parent and no one is joyful that CPS is knocking on the door. What we try to do is coordinate with the family around who their natural supports are. Our goal is to expand their connections so that they can build a support network. If individual families are educated on child abuse and neglect and they know how to access community services, they would never have to connect with the child welfare system.”

 

Question 3 asked: What are some effective policies and programs that are currently in place to reduce health disparities and serve diverse families, and what further steps do you see as necessary in order to improve health equity and family well-being?

Marilyn Watkins energetically identified four policies her organization has been working on in response to our question on effective policies and programs. Starting with the Healthy Pregnancy Policy, she noted this new policy ensures workers have the right to ask for resources to keep healthy during their pregnancy. She then mentioned paid sick leave and safe leave policies which allow workers to take paid time off not only for illness or injury, but also legal or safety concerns related to issues like domestic violence. The third policy is the Equal Pay and Opportunity Act, which went into effect in June 2018. Finally, 12 to 18 weeks of Paid Family and Medical Leave will be available to all Washington workers in January 2020. She went on to emphasize that a major barrier to improving health equity and family well-being in Washington state is the tax system, which is the most regressive in the country. “Asking the wealthiest people to pay the same as other states would give us a better ability to pay for additional services.”

Ann Riley shared that her energy and focus is looking at trauma informed policy and really looking at what are effective policies. Riley identified that trauma-informed care “is a new area and so it’s hard to say what is effective.” Commenting on the pace of change, she noted that “At a local level, it takes a long time to change people’s minds.” Riley went on to mention resources like the Center for Youth Wellness, headed by Nadine Burke. Riley stated, “Burke is the rock-star of an adverse childhood experiences (ACE) study and has great information about screening for ACEs, care, and forming a multidisciplinary team to build resiliency.” Additional resources mentioned by Riley included federal level resources through SAMSA, which focus on trauma-informed health care practices.

If you want to engage in policy change you need to do something that you are passionate about. Nobody is an expert in your experience than the way you are an expert in your experience.

Riley continued identifying her focus on policy and how that plays out in programming at the community level. “We look at the policies in practice, that should be in place at the classroom, school, and district level.” Riley spoke to the importance of working with the community, building community resiliency, and educating the community about policy. Riley utilizes the Policy and Advocacy Guide, a step by step education book about the difference between lobbying and advocacy which is important to know for funding purposes. She believes, “It is a very practical guide,” for getting the community involved.

Riley went on to point out that to build effective programs, in regards to trauma informed policy, that community practitioners and task force leaders need to get together to discuss what they are doing and what is happening in their communities. Riley noted recent meetings and sharing groups as an important step in the right direction.

Cynthia Morrison dove right in, naming a policy that focuses on universal access to birth control or family planning. Morrison explained that we “Just passed a rule [in WA] if you do business as an insurance company you must cover all forms of access to birth control.” The second policy shared by Morrison was called Breakfast after the Bell. Schools have been providing breakfast and lunch for kids in need, but if a child arrives late to school, they may have been out of luck because the kitchen closed. Morrison continued stating that, “with breakfast after bell [kids] have access to food whether or not they show up before the bell.”

Morrison used the opportunity to then share her experiences with struggle and how they learned from their mistakes in building effective policy. In 2010 Morrison’s office received funding for a program to provide support for pregnant teens. Morrison began by confidently stating, “[We] thought we knew what we were doing. Coming into communities that ‘we’ identified as highest need and [we were] going to tell them how to do [programming] better.” Initially the assumption was that a teen pregnancy would be seen as a problem to be fixed. With a shift in her voice Morrison then stated: “Oh, wait a minute...maybe we should ask them what their values are?” Once Morrison’s team spent time with the community after asking themselves this question, they learned that the community’s views and needs were different than they had anticipated.  Morrison went on to name “transportation, health care, and culturally humble health care,” as key community identified needs. Cultural humility was identified as a best practice, replacing the idea of cultural competency. The community shared they didn’t have housing; many teens were couch surfing. So, with grant funding, Morrison’s group implemented a program called Housing First. “[We] started with safety in a place to live, a way to get to school, and a class on how to not get pregnant again.”

Jenna Kiser shared that, “we do not necessarily have a lot of children that need health coverage,” as many kids and families usually have access or health insurance. “There are many other things that get in the way - not only medical coverage.” Kiser shared that “If you live in Kittitas county and you have no public transportation to get to a clinic. How can we get people to their medical appointments?” Kiser indicated families “often find themselves within child welfare services because they cannot meet those basic needs (transportation and medical treatment). Or they do not know how to find out the information or communicate with their doctor.” So, it is important when it comes to effective policies and programs, we need to, “make sure their basic needs are met so that they can get to those appointments.”

 

Question 4 asked: Based on your roles and experiences, what do you see as effective strategies for engaging in the policymaking process in support of family health and well-being? What advice do you have for students or professionals who are new to the public policy field?

Watkins began by noting that “If you want to engage in policy change you need to do something that you are passionate about.” Rather than trying to become an expert in a new policy area, focus on your own experiences. “Nobody is an expert in your experience than the way you are an expert in your experience.” She mentioned that it is important to find organizations that work with public policy that matters to you and work with them and encourage them to get involved in changing policies that you seem to be interested. Watkins noted that the power of communities getting together and pushing policy is the only way that policies are being passed. “You need to have a lot of community support.”

Riley echoed that if you want to develop new policies and practices you need to have the people who are most impacted by the policy at the table, and noted “You would be surprised at how often that doesn’t happen.” She then added, “relationship building is really important and policy practice is a marathon not a sprint. You’re going to take a long time to develop a policy and raise awareness and start to have a common language about an issue before you talk about what to do about it.” Finally, she highlighted the importance of a long-term approach to policy. “It takes a lot of time to build trust. Failure is to be expected - you can learn from failure and look at it as an opportunity to discover, who did I miss, what can I do better, and learn how to go at it in another direction.”

It is vital to interact with families. If individual families are educated on child abuse and neglect and they know how to access community services, they would never have to connect with the child welfare system.

Morrison chimed in and emphasized the value of incremental change. “I would say don’t underestimate small policy. If you change a little here and a little there then you will have the data to support your big idea. If you tweak this or change that, then next thing you know you have a pretty large body of data that you can hopefully move up the legislature. Chew away at it and you will be successful.” She went on to echo the idea that including community stakeholders in the process is essential. “In our agency, we are very mindful about who and how we work with people. Families are always at the table. When we do new contracts we always require a family advisor. We require training when working with families. One employee’s main job is family consultant to make sure the right people are at the table.”

Kiser noted the importance of taking a broad and proactive approach to policy making. “When I started writing policy I came in with the idea that I am content expert. A more effective strategy is to consider questions like, how it will impact diverse families? How does this impact other policies that are already in place? Is it written in a way that families understand? It is awesome to advocate for families, but you need to understand what it is you are trying to accomplish and how that is going to impact other people.” In Kiser’s view, writing policy requires a global perspective that takes into consideration how it is going to impact society.

Kiser ended with a bit of advice to the audience that was echoed by other panelists, offering, “Get as much direct experience in whatever path you are choosing. When you get to the real world you want to have done practicums and internships. Get as much experience whether it is paid or not because it shows you what you want to do and what you do not want. Try different things because you can find a passion somewhere else. All the experiences you have turn you into a real well rounded professional.”

Our panel discussion ended with a handful of audience questions focused on panel members pathways to policy work and advice to those teaching in the area of policy. We appreciated the insights shared by the panel and the inclusive nature of their approaches to policy work and program implementation.