ENSURING EVERY CHILD, FAMILY AND COMMUNITY HAS AN EQUITABLE OPPORTUNITY TO SUCCEED
Speech to the Oregon Alliance
May 5, 2022
American novelist Wendell Berry once said: “It’s all a question of story. We are in trouble just now because we do not have a good story. We are in between stories. The old story, the account of how we fit into it, is no longer effective. Yet we have not learned the new story.”
It’s no wonder. We’ve just been through two of the most difficult years in recent memory. A pandemic that disrupted just about everything and exposed the magnitude of longstanding social and economic disparities that disproportionately impact people of color. We watched communities and even families torn asunder over vaccinations and mask mandates. And all of this has been layered onto a preexisting environment of partisanship and polarization that has been spun, by both the right and the left, into a narrative that focuses only on our differences.
We need a new story — because the story we tell ourselves as we emerge from this difficult time — perhaps into an even more difficult time—will either magnify the divisions in our society, or bring us back together as an Oregon community.
It is a story about how we finally recognized that we don’t have to settle for dealing with problems piecemeal and on the back end — whether that is addressing mental health and substance use disorders, homelessness, or children in foster care. It is the story of how we finally exercised our power as a community to prevent these outcomes in the first place by addressing the conditions injustice that were so starkly exposed during the pandemic — the story of how we secured our future by ensuring that every child and family in this state has an equitable opportunity to succeed.
Those of you gathered here today are among the most credible and powerful advocates in Oregon for children, youth and families. That is why the new story begins with those of you in this room, and it begins with a simply question: is your advocacy complete? I am asking you to consider whether the moral and fiscal imperative to prevent—or at least dramatically reduce— the need for the critical services that you provide should be an equally compelling and urgent focus of your advocacy.
This morning, I challenge you to look beyond the contours of your individual organizational missions and service profiles and ask: “How can I help prevent the need for the very services that I exist to provide?” I challenge you to imagine a world without the need for foster care, a world without children and families living on the street for lack of affordable housing, a world without neglect, abuse and addiction. How much better would that world be for children? How much stronger would we be as a community?
This is a BIG IDEA, but one I believe is consistent with the mission of Oregon Alliance: championing and advocating for the health and well-being of children, families and communities across our state.
Some of you are old enough to remember President Kennedy’s 1962 speech challenging the nation to go to the moon:
“We shall send to the moon, 240,000 miles away, a giant rocket, made of new metal alloys, some of which have not yet been invented, capable of standing heat and stresses several times more than have ever been experienced, on an untried mission, to an unknown celestial body, and then return it safely to earth, re-entering the atmosphere at speeds of over 25,000 miles per hour, causing heat about half that of the temperature of the sun– and do all this, and do it right, and do it before this decade is out.”
What an amazing leap of imagination. Kennedy did not give us a roadmap, only a destination. But in doing so he changed the debate from where we wanted to go to how we were going to get there—and unleashed the innovation and passion of the nation in common cause. And we did it, we did it because we imagined it— because the storypreceded the accomplishment. Today I am asking you to imagine and write that story for Oregon’s children, families and communities.
To make my case, let me share two experiences that helped shape my perspective on this issue. The first took place during my internship when I watched a baby die. On a cold winter morning, a young woman in labor arrived in the emergency room of Denver Children’s Hospital. She had been living on the streets and was cold, malnourished and anemic. I delivered her baby—who I will call Sam—in the ER. He weighed less than three pounds and his lungs were not fully formed because of his prematurity. I was part of his short life from the time he was born until the moment of his death two days later.
I remember standing beside him during the final hour, knowing what was going to happen and feeling depressed and helpless. He was a small, fragile figure. His nose and mouth were covered with a clear plastic mask which carried oxygen and warm mist through a green tube. His tiny fist gripped the tube as if he wanted something stable to hold on to, and when he tried to inhale the skin between his ribs was sucked in with the effort. And then he was gone, leaving only the soft hiss of oxygen and the mist drifting up around the mask.
Sam died in the ICU of a modern hospital. He didn’t die from lack of access to the medical system. He died because he lacked access to the most basic social investments necessary for healthy pregnancies, stable families and safe communities—the basic social investments that could have given him an equitable opportunity to succeed … indeed, an equitable opportunity to live.
That was in 1974, twenty years before the study on Adverse Childhood Experiences, so I suppose, one could argue that we didn’t know any better. Yet three decades later this was still happening. In a 2001 speech to the Portland City Club, announcing the Oregon Children’s Plan, I told the story of Susan and her daughter Patty.
Susan fled an abusive family to the streets of Portland. Alone, homeless and looking for somewhere to belong, she continued to be victimized, abusing alcohol herself and becoming pregnant at 17. Without any prenatal care or emotional support, she continued to use alcohol and drugs during her pregnancy.
Like Sam, her daughter Patty was born prematurely and suffering from fetal alcohol syndrome. Susan returned to the streets where, at the age of 19, any hope she might ever have had for a healthy nurturing life had all but evaporated. Patty is today a ward of the state. She was been diagnosed with depression and multiple mental disorders. Her original adoptive parents gave her up because of her severe behavioral problems. She had 26 different foster placements—twenty-six—before being admitted to a residential mental health facility where she now lives.
All of this happened before her tenth birthday.
There is no yardstick that can measure the depth of this tragedy. The tragedy of a mother, who will never know her daughter. The tragedy of a young girl who is severely mentally ill and who will live out her life within the walls of an institution. And, most of all, the tragedy of knowing that we could have prevented this outcome – but failed to do so.
That was twenty years ago and today we do know better. And yet our system remains focused largely on the consequences of abuse, neglect and addiction, rather than on the root causes. We see these consequences in our foster care system, on our streets, in our addiction crisis, and in our fragmented and overburdened mental health system. To some these are statistics, but to those of us in this room—and to those directly affected—these are human tragedies that play out over and over again, in Oregon and across our wealthy nation … and with every tragedy that could have been prevented, we are diminished as a society and we lose a little more of the soul of our community.
We are all familiar with the social determinants of health and that zip code is a far more important predictor of lifetime health status than genetics. We know that one of the most powerful social determinants of health, one that dramatically undermines the opportunity for a child to succeed, is growing up in a family under stress—and two of the most significant factors that lead to stress and family dysfunction are systemic racism and poverty.
We are all familiar with the ACE study and the correlation between the level of traumatic stress in childhood and poor physical, mental and behavioral outcomes later in life. We also know that chronic stress and malnutrition, both before and during pregnancy, can alter genetic expression in the unborn child—increasing the risk of emotional problems, behavioral disorders and learning disabilities—thus passing the factors that can undermine childhood success from generation to generation.
Ensuring that every child, family and community has an equitable opportunity to succeed, means breaking this generational cycle by striking at its very roots —by striking at the conditions of injustice that exist before conception, during pregnancy and during the first few years of life. This demands a holistic approach that recognizes children exist in an ecosystem that includes their family and their community—and that the earlier we can intervene, the more successful we will be.
Let me offer an analogy. Airplanes on long trips are constantly being taken off course by cross winds, weather and other factors. Any long flight has a series “way points” to guide the necessary course corrections required to arrive at the destination. Suppose an airplane takes off from Portland on a flight to New York City and the flight is a few degrees off course when it clears the runway at PDX. Without a correction in the flight plan, the plane will end up somewhere north of Montreal, Canada. Once the error in trajectory is discovered, it is much easier to make the course adjustment at a way point over Boise, Idaho than over Chicago. And at some point, the course correction becomes so extreme that it becomes nearly impossible to reach the original destination.
Children also have “way points” in their development that indicate whether they are on a course to success. These include certain physical, social and emotional developmental way points in the early years of life, then Kindergarten readiness, reading at level in third grade, on track to graduate in the ninth grade, etc. These way points represent a continuum of child development and the earlier we intervene in the life arc of a child who is heading off course, the more successful that child will be in achieving their full health potential—and the less costly it will be, both in terms of the investment involved and the avoided cost later on.
Notwithstanding all of the incredible work those of you in this room are doing—important work, necessary work— it is our failure to address root cause, our failure to definitively break the generational cycle of the ACEs, the is perpetuating and accelerating the anonymous tragedies like those of Sam, Susan and Patty. And the longer we wait to act, the more difficult it will be to turn this around. Eventually we will reach a point of no return and, like the airplane that is so far off course, we too will not be able to reach our destination.
So, the challenge is twofold. First, we need enough resources to make sustained investments in children and families before conception, during pregnancy and up to the age of three. Second, we need a new community-based delivery system intentionally designed to address the root causes of childhood trauma and adverse experience that exist before conception, during pregnancy and during the first few years of life.
Let’s start with funding. I suspect that every organization in this room is underfunded, given the growing demand for the critical services you provide—which of course, is part of the problem. For example, Oregon now ranks second worst in the nation for addiction, but is in last place among states for access to treatment. That means that the competition for limited public resources will grow ever more intense and historically, prevention loses out to acute needs. This is due in large part to the fact that the impact of these upstream investments will not become apparent over the course of a few years and yet to be effective, they must be sustained over several budget cycles—while the legislature tends to fund the visible, compelling and immediate.
In other words, we prioritize immediate problems over investments that could prevent those problems in the first place. For example, if given a choice between funding prenatal care—or paying to resuscitate a 500-gram infant in the neonatal intensive care unit— the emotional and political imperative always puts money into the hospital rather than into the community. To policy makers and to the political system, the neonate is highly visible while the thousands of women who lack prenatal care are anonymous and therefore invisible.
Our challenge, and indeed our responsibility, is to move the conversation in our state beyond this either-or choice—by giving voice to the voiceless and making visible those who are now unseen. We must demand that addressing root caucus becomes a top priority in our budget. So, a central part of our strategy must be to build a new, broad-based coalition that can elevate the importance of, and help sustain these critical early investments.
The fact is that addressing the sources of childhood trauma and adverse experience, is not only a health care issue and an education issue, it is a social justice issue, a public safety issue and a social support issue—and the constituencies for all of these policy areas must be part of the coalition. In short, ensuring that every child, family and community has an equitable opportunity to succeed starts here.
All the money in the world, however, will not break the generational cycle of the ACEs unless the funding flows through an integrated, collaborative, community-based delivery system that can get the right treatments, supports, interventions, and other protective/prevention strategies to the right children and families, in a way that is ethnically, culturally and linguistically appropriate, and for long enough to make a difference.
To me, creating this system—which I will call the Child Success Delivery System—will be a far greater challenge than securing the necessary funding. Why? Because such a system does not currently exist, and creating it will require a leap of imagination not unlike the one that took us to the moon.
We know that the range of culturally and linguistically specific treatments, supports and interventions that may be required for a given child and his or her family could be extensive and will certainly include things like safe, affordable housing, good nutrition, child care, transportation, behavioral health/substance use disorder services, job training and employment.
We also know, that in any given community, there are often scores of different agencies, programs, community-based organizations, foundations and institutions involved in providing these services and supports. In many cases, however, these diverse entities are dealing with only one or two of the risk factors, but not necessarily as a constellation. Often, they are not aligned or coordinated and sometimes operate in silos. There may or may not be coordination in the hand-offs between programs and services.
Children wander through this “system” seeking services and supports rather than having the services follow the child and their family over time and across the community. While we can show positive results from various individual programs, we are not narrowing the opportunity gap across the population as a whole. In many cases this is a “last mile” problem—actually getting the right services to the right children and families, at the right time, in the right amount and for long enough to make a difference. In a very real sense, we are “program rich and system poor”, we are “failing the community one success at a time.”
The national Campaign for Grade Level Reading, which has now engaged 43 states, 344 communities and over 3900 local organizations, illustrates the problem. Although this effort is showing progress in moving the needle within individual programs, double-digit gaps persist in every state and almost every community. Ralph Smith, the Managing Director of the organization, attributes this, in large part, to the fragmentation and duplication of efforts, the proliferation of silos and the difficulty of accessing and effectively utilizing data. That is exactly what we are facing here in Oregon.
Turning this around will be by far the most difficult—and I would argue, most important—component of this work. Why? Because it will require that dozens of programs, organizations, agencies and institutions—and those who work in them—subordinate their organizational, programmatic and institutional interests to serve a larger common purpose: the long-term success of children and families as they move across what is now a very siloed landscape.
We don’t need a new program or organization—we have a good programs and organization filling this room today. What we need is some kind community-based governance or coordinating entity that can reach far upstream, identify the risk factors that threaten the success of a child and their family, aggregate the various supports, services, interventions and protective factors necessary to mitigate those risks, then ensure that they follow the child and their family over time and across the community, in a way that is ethnically, culturally, and linguistically appropriate.
This kind of delivery model does not currently exist, but work is underway to design it. In late 2019 Eric Hunter, the CEO of CareOregon, and Bob Stewart, the Superintendent of the Gladstone School District convened what they called the Roundtable for Healthcare and Education to “explore collaborative, innovative approaches to meeting the needs of the children and families we collectively serve.” Over the past 18 months, this group took a deep dive on the need to find a way to address the root causes of childhood trauma and adverse experience, and to make more strategic and sustained investments in prevention and success. The result was a White Paper called: Achieving Oregon’s Promise – An Equitable Opportunity for Every Child, Family and Community to Succeed.
A new 501c3 has been established, called the Oregon Roundtable on Healthcare and Education. It will stand up a number of pilot projects around the state. These pilots will not be “demonstration projects,” but rather “blue sky” design efforts to identify the key elements of such a system, to estimate how much it would cost to ensure that every child has an equitable opportunity to succeed, and the kind of community-based workforce that would be needed. The goal is to create a “moon shot” conceptual design—a “blueprint,” if you will—for a Child Success Delivery System.
Once this foundational work has been completed, demonstration models can set up to offer the proof of concept—with each model implementing the conceptual design in a way that reflects local circumstances and empowers those most affected in that particular community. This, then, would allow us to begin to scale the model by marrying it to the funding strategy we discussed earlier.
Let me leave you with the words of French philosopher Albert Camus, by paraphrasing something he said in 1948. “Perhaps we cannot prevent this world from being a world in which children are harmed. But we can reduce the number of harmed children. And if you don’t help us, who else in the world can help us do this?
I am asking for your help — your help in building a powerful coalition for prevention and success, your help in creating an Oregon in which all of our children families and communities have an equitable opportunity to succeed.
This is a big idea. But that is what Oregon needs right now —and it’s not impossible. We can do it. If we can imagine it, we can do it. Remember: the story must precede the accomplishment. This is not a challenge of technology—it’s a challenge of leadership, of will and compassion, and of the depth of our commitment to one another as Oregonians and as fellow human being. And it’s not nearly as difficult as going to the moon.
Perhaps more than at any other time in my memory Oregon needs a new story. We need something hopeful to reach for. Something that can transcend the hyper-partisanship and polarization that is tearing us apart, and undermining our ability to act together as a community to secure a bright future.
The story I am asking you to imagine and to begin to write today can provide that renewed sense of shared identity and common purpose, a new and hopeful story about Oregon and Oregonians. This is a story in which all of us can see ourselves—a story rooted in our children, our families and communities in the land that help define us, embracing people from every walk of life and in every corner of our state.
Let this be Oregon’s future.