Innovator Interview: Susannah Burke, PB&J Family Services, New Mexico

Susannah Burke is the Executive Director of PB&J Family Services, a non-profit serving at-risk children and their families in New Mexico. PB&J serves over 1,800 families a year, providing a range of services including home visiting, Pre-K, therapeutic parenting sessions, and support to families impacted by incarceration. PB&J was selected as one of eight service providers to address adverse childhood experiences (ACEs) in Bernalillo County, as part of the County’s larger behavioral health initiative.

This interview has been edited for clarity and brevity.

What are the biggest challenges facing the County?

Susannah Burke: New Mexico has one of the highest rates of child poverty, highest rates of child hunger, and lowest ranking on child wellbeing. Our graduation rates are really low across the state. And the economy is not a vital one – it’s a state where there’s a lot of public land, not a lot of industry, and not a lot a lot of big businesses. So all these things contribute somewhat to it being a stressed economic environment. Everything is intensified in Bernalillo County because it’s the most populous county. We have one of the highest rates of incarceration in the state, as well as the highest fatality rate for children under 1 year-old due to abuse.

These are really troubling statistics, but at the same time there is so much to work with. Families love being able to solve their own problems, and love feeling like they have partners in that and people who will listen to them about what is the best approach for them as an individual family. In both of our sites in the County, families are very grateful to have a place that’s not just for individual services, but where they can be part of a support network for each other. There are intense challenges, but there’s also an incredible amount of vibrancy and willingness to engage in what’s going to make their lives better.

Can you describe the funding climate for providers like PB&J?

It’s a terrible climate for funding. Back in 2010, at the height of the recession, enormous cuts were made to what we felt like was already a weak early childhood system. But we realize now we had no idea what weak meant. We used to provide 19 hours of service a month to a child at- risk for a developmental delay due to the environment (domestic violence, history of abuse or neglect, incarcerated parent, violence in the community, etc.) – all the things that have been now been identified as ACEs. Now we can only get funding for 24 hours a year; so from 19 hours a month to 2 hours a month for the at-risk population. If a child is born without a delay but in to a high-risk family with multiple ACEs putting the child at risk, then the child will likely have a delay by 9 or 10 months or old. Yet it could be very different if we were able to continue serving the at-risk category. We also had an amount of funds that were available to support families with children in the home from birth to five. And that was completely taken away. So we started seeing less and less of a priority on prevention and early intervention – which is the service that makes the most sense.

New Mexico is a state with no comprehensive child abuse prevention or early childhood plans, and where all of the state agencies work as separate entities. A visionary leader could see those agencies as owning a part of child well-being. For example, you don’t typically think of the Department of Corrections (DoC) as a partner in child abuse prevention, but they used to be one of our biggest partners. All of the parenting programs in DoC have since been cut. We always need to be screening for risk, having coordinated referrals from the need to support services, and tracking gaps in the existing services. However, all of those things continue to be missing in New Mexico.

What was your reaction when you first read the ACEs Request for Proposals (RFP)?

To be quite honest, the very first response that I had was tears. I couldn’t believe what I was reading. They cared about screening. We always talk about the hard to reach families, and they talked about these families. They talked about being able to identify them and wanted to know what capacity we had to meaningfully support those families.

My second response was that this was written for us. We’d been doing ACEs before it had that name. That wasn’t new to us. What was so new to us, and what was so stunning, was the approach – they were looking for ‘creative’ pilots. You don’t hear the word ‘creative’ in RFPs really. Normally they don’t want to be creative and they want to be more prescriptive, so that was a delight to see that.

The RFP explained why ACEs matter and then put it in the context of Bernalillo County. They included all of the demographics – all of the stuff that applicants normally have to provide to prove our knowledge – and they had already done their homework. So right away it felt like there was a compatibility and connection. There was a level of excitement because it was like “these people get it”. They’re not coming at us and telling us “okay here’s what it is and now you have to conform in these ways.” Never did I get the feeling that we were going to have to conform or contort in order to respond to this RFP.

They put out what their values were. They cared about being culturally aware if applicants could be appropriately responsive to the communities because of the diversity in them. They cared about the existing healthcare system. There was a sense that they were starting from what was there and then focusing on how to provide what was missing. Those were the main things that really turned us on when we first read it. They acknowledged that it was an evolving field – and I know I sound dramatic, but there’s incredible power in the use of words like that. To acknowledge that implies there are going to be things we learn along the way and room for fine- tuning. It was fabulous to see this.

In the past, PB&J has been shot down in attempts to take a comprehensive approach. For us, we have to think about the child in the context of the family, and the family in the context of the community. We don’t have a client-style, we have a family-style. Normally funding would come with the child as an identified patient, and we don’t work that way.

How was it different from previous RFPs you’ve responded to?

I was reading it and I took it very personally. It felt like, “they’re interested in us; they’re interested in what we’re doing.” The way it was conveyed felt like entering a relationship. They were curious and asking how we would approach this problem. I felt very free to say this is how we’re doing it, and I didn’t feel the need to prove myself. It didn’t ask how many of us have a master’s degree or other things that are not necessarily an indicator of connecting well with families – it just asked how would we approach this. So it gave us more freedom to feel optimistic and engaged in that there was someone listening.

The next step was the pre-bidder’s conference, which I was really impressed by. When I arrived it was packed with people, but there was also a table full of people who were representing the County in all different aspects. There there was a representative from procurement, the GPL fellow, an assistant to the County manager, and the person in charge of evaluation. There was a whole team of them and that felt really good to me. We weren’t there to defend our proposals; they were there to answer questions. And you realized the investment, these people are very interested and want to make sure we were going to succeed. I loved this piece of it; it was a really important part of the RFP process.

Afterwards, county team members have continued to be a part of the discussions. This team approach is different from assigning a single contract manager who probably is managing many contracts and primarily attends to just the details of the contract at hand. The county team has multiple interests and they are attentive to the many interests of our program.

What is the ACEs project allowing PB&J to do differently?

First of all, it’ll allow us to work with more families then we’ve been able to work with; which is really good. The other thing is that we are serving children pre-natal to five years old, not cutting it off at three years old. Through this we’re able to go back to doing our more comprehensive ways of home-visiting. We can provide more all-inclusive services to actually support issues with older children, housing, relapse prevention, getting IDs, etc. We can work with all kinds of things with these families that are stressors when they’re not dealt with and that put kids at higher risk when they’re not dealt with. So it is really great to be able to get our whole-family model back up and running.

The other nice piece is that PB&J has a pretty highly evolved internal evaluation. The fact that the proposal is going to have an evaluation piece means we’re doing it with a different spirit – since we know that this is the right way to make a change.

What are some of the things you’re hoping to learn from this?

We’re just one of eight organizations selected to address ACEs through the County’s RFP. I’m hoping we start really working together in ways we haven’t worked together before. I really feel the potential with all of us working together through this RFP that Bernalillo County could become a leader in screening, referring, tracking, and identifying at-risk children. We could become an example for other counties and for other places in the country that have similar difficulties and want to sufficiently and meaningfully give families opportunities. I feel really good about this. I think the right players are at the table. What I want to get out of it is stronger relationships but primarily a system for effective support for families.

What was your experience like with the Government Performance Lab?

My first interaction with the GPL Fellow was at the pre-bidder’s conference. He really explained what they were hoping would come out of this, and came across as deeply invested in the project and knowledgeable. We came across him again at various stages and he was always great to work with. He was curious about us; it wasn’t ever a one-way conversation. He would put things out for our approval, and was very reciprocal in terms of his style.

The Government Performance Lab is grateful for support from Bloomberg Philanthropies, the Corporation for National and Community Service Social Innovation Fund, the Dunham Fund, the Laura and John Arnold Foundation, the Pritzker Children’s Initiative, and the Rockefeller Foundation. © Copyright 2017 Harvard Kennedy School Government Performance Lab.