Leveraging the Collective Impact Model to Advocate for Pregnant and Parenting Teens

In 2020, our team of pediatricians and social workers serving teen parents at Children’s National Hospital partnered with Howard University and the District of Columbia Primary Care Association (DCPCA) to collectively advocate for the health and well-being of pregnant and parenting teens. DCPCA is an established local policy organization with experience leading prior citywide efforts to improve maternal health in DC. Recognizing that teen parents must access a multitude of resources to sustain healthy and successful lives for themselves and their children, this initial collaboration was intentionally multidisciplinary; the organizations have complementary expertise in the domains of healthcare (Children’s National Hospital), education (Howard University), and policy (DCPCA) for this population. After being awarded a 3-year programmatic federal grant by the Department of Health and Human Services, Office of Population Affairs to collectively promote the health and well-being of pregnant and parenting teens, these 3 partnering organizations formed the leadership team of DC NEXT.

The leadership team completed an environmental scan of programs and services used by teen parents in Washington, DC, built a stakeholder map, and recruited potential organizations to join DC NEXT as network partners. These network partners are community organizations, nonprofits, health centers, government agencies, schools, and childcare centers that engage in providing services or advocacy to expectant and parenting teens. Some partners have a primary focus on this population, for example, an organization providing school-based support for teen parents in DC high schools. Other network partners, like the DC Women, Infants, and Children administration, do not exclusively provide services to teen parents but are a critical resource for this population and were therefore also included in the network. Fourteen key stakeholder organizations have contracts with DC NEXT, through which organizations receive funding for staff member time and involvement in DC NEXT activities (Fig 1).

The DC NEXT leadership team also recruited a context team of young adult and teen parents residing in Washington, DC. Complementing the content expertise of the network partners, they are uniquely able to provide contextual expertise rooted in their lived experiences as teen parents. For recruitment, the leadership team created a job description that was widely circulated by network partners and on social media. Over 90 individuals applied. After interviews, 10 young adult and teen parents were hired to join the context team (Fig 1). Context team members are involved in every aspect of DC NEXT, including developing the common agenda, selecting projects, and disseminating program efforts. They are paid for the hours they spend on DC NEXT activities.

Given the interdisciplinary nature of DC NEXT, we chose the collective impact model to guide the network’s operation. The model offers a structured framework for diverse stakeholders to work together to achieve change and solve complex problems with a shared vision and goal, rather than operating alone. The conceptual model of collective impact was first described by John Kania and Mark Kramer⁹  and has since been recognized as an important framework for community-wide collaboration and problem solving.¹⁰  Kania and Kramer defined 5 conditions essential to successful collective impact partnerships. These components and their relationship to the DC NEXT organizational structure are illustrated in Fig 1.

The first condition of collective impact is a common agenda, which requires all participants in a project to agree on the problem being addressed and to have a shared vision for change. Given the interdisciplinary nature of the collaborations, the activities within the collective impact network are naturally diverse and multifaceted; however, the activities should be mutually reinforcing. This condition requires that stakeholders’ efforts fit into an overarching plan that aligns with the common agenda and recognizes that the multiple causes of social problems, and the components of their solutions, are interdependent. Each organization can lead in its areas of expertise while simultaneously coordinating its actions with the other participating stakeholders.

The next condition is a shared measurement system, which allows for the various projects to be accessed and communicated with similar methods, thus also allowing for alignment. The success of the collective impact model is also grounded in continuous communication. A focus on communication helps to build trust and understanding, ensure that all voices are heard, and maintain the infrastructure of the diverse group of stakeholders that comprise the collective impact group. Being transparent and keeping partners engaged helps all partners understand goals and develop common objectives. Lastly, managing a collective impact network requires a distinct organization to provide backbone support to support the entire initiative and maintain the common agenda and shared vision. Although collective impact is rooted in a shared leadership model, the role of this organization is to ensure that the collective impact stakeholders are successful in working together and aligning with the prior 4 conditions of collective impact.

DC NEXT met its overall objective to establish a collective impact network to advocate for teen parents. Five hundred and fifty youth, caregiver, or community members have been engaged directly in DC NEXT activities, and another 700 teen parents are estimated to receive services from network partner organizations. To date, DC NEXT has hosted 19 network meetings with an average attendance of 28 attendees from 14 organizations. All meetings were virtual because of coronavirus disease 2019 (COVID-19) safety precautions until May 2022, when the network decided to host a combination of in-person events and virtual meetings. Detailed process outcomes in each of the 5 domains of collective impact, and how these lead to improvements in the health and well-being of adolescent parents, are described in detail here.

From September 2020 through March 2021, DC NEXT undertook a process to determine the common agenda. The leadership team of DC NEXT first gathered the context team and network partners for individual meetings and larger group meetings to survey their understanding of the problem, mission, vision, guiding principles, and outcomes for DC NEXT. The leadership team then collated this information to create draft documents that were presented, discussed, and further edited during network wide meetings. Given that all meetings were held virtually because of the COVID-19 pandemic, small group breakout sessions and participant voting were used to maximize the participation and perspectives of all partners and context team members. The process was iterative with the problem statement defined first, followed by the guiding principles, vision, and mission, and finally the outcomes. Over 6 months, consensus was reached on all elements and the leadership team created the final version of the common agenda. (Fig 2). The common agenda is publicized to all DC NEXT participants, including on the landing page of the DC NEXT web site,¹¹  serving as a guide for network initiatives and ensuring that all network partners share the same conceptual model to improve the health and well-being of teen parents.

Within the stakeholder group of DC NEXT, multiple organizations were measuring outcomes related to teen parenting, such as repeat pregnancy and high school graduation rate. However, no 1 program was able to offer comprehensive information on the outcomes for teen parents at a citywide level. Recognizing the necessity of this information to make strides toward achieving the 3 overarching outcomes for DC NEXT, in the first 2 years, DC NEXT worked to determine baseline data and develop a process to solicit network involvement in measurement systems. DC NEXT conducted a pilot citywide well-being survey of teen parents in Washington, DC. The leadership team created an initial draft of questions adapted from validated scales of quality of life and well-being and presented these to the network and context team to solicit a diversity of perspectives. They gave feedback on what outcomes to measure and how to ask specific questions. The survey measured teen parents’ demographics, support systems, views on parenting, and self-reported assessments of health and well-being. After the survey was finalized, network partners and context team members publicized the survey to potential respondents utilizing their program contacts and social media presence. Respondents received a $25 gift card as an incentive for completing the survey. The survey was open between January and March 2022 and received over 200 responses from teen parents. The pilot survey results served as a baseline of health and well-being of teens in DC. DC NEXT has assembled a measurement stakeholder group who will lead the next iteration of data collection. In the next phase, data will be tracked over time and will be used to advocate for policy change and program implementation to support teen parents and their families.

DC NEXT leverages diverse expertise from individuals, service providers, and policy experts in the network who advocate for expectant and parenting teens. Every monthly DC NEXT network meeting begins with program updates, so individuals, service providers, and context experts can describe programs or ideas that can be developed into mutually reinforcing activities.

To achieve the outcome of enhancing a trauma-informed and human-centered care environment for expectant and parenting teens, DC NEXT has held trainings in a mutually reinforcing manner. The leadership team solicited educational training priorities from network partner organizations that aligned with DC NEXT outcomes and determined what expertise existed within the network to provide these trainings. To date, there have been 10 network-wide trainings with over 260 partner participants, consisting of human centered design (4 hours), trauma-informed care (2 hours), youth mental health first aid (2 hours), adolescent sex education (1 hour), and health equity (1 hour). The trauma informed care training was collaboratively developed and delivered by a leadership team member with expertise in this area and the remaining trainings were led by content experts who were recommended by network partners. Leveraging the existing knowledge of specific network partners, DC NEXT has trained dozens of staff members in the city on core topics that will improve their skills to provide effective teen-centered care.

To work toward improving access to pathways for mental and physical well-being, service providers within DC NEXT learn about overlapping resources and programs for their clients and work together to refer participants to each other’s programs. For example, school-based programs have shared information with their students about healthcare programs and parenting classes offered by other organizations within DC NEXT. These interactions allow for closed-loop communication about referrals between programs.

An example of a successful mutually reinforcing activity that encompassed all 3 outcomes of DC NEXT came in February 2022 during the recall of a major formula supplier. Many teen parents found themselves unable to find formula for their infants at major grocery stores. The direct service providers who interface with teens were able to identify and quickly communicate this need with policy experts at DC NEXT. These experts then advocated for the affected population by presenting patient testimonials to DC policymakers and administrators at the DC Women, Infants, and Children administration. Building on this effort, one network partner had access to an emergency funding mechanism and was able to quickly order 100 canisters of formula, which were distributed to teen parents through DC NEXT network partners. Because of the infrastructure of regular communication and a shared vision, this group of patients, service providers, policy experts, and funders were able to rapidly come together to address the need. This experience highlights the outcomes that can be achieved through collective impact. Each partner provided its own expertise, which was reinforced by others in the network with access to other knowledge or resources.

DC NEXT has various methods to support continuous communication. During monthly DC NEXT meetings, network partners review current projects and allow partners to advertise upcoming activities. A quarterly newsletter emailed to partners contains program spotlights and project updates. In addition, there is a web site where partners, stakeholders, and interested public parties can go to learn about network initiatives. DC NEXT also understands the importance of using social media to communicate, especially with teens and young adults, and publicizes material via Instagram and Facebook.

Regular communication occurs between the leadership team and context team. The context team meets twice a week. Leadership team members take turns presenting project updates to the context team in this smaller setting to get their feedback on all initiatives within the network.

DC NEXT is administratively housed at DCPCA, a local nonprofit advocacy organization. DCPCA was the primary recipient of federal funds to start the DC NEXT collective impact initiative. DCPCA supports 3 dedicated staff members: the DC NEXT program director, program manager, and program coordinator. These 3 staff members are responsible for developing deliverables and sustaining the infrastructure to support collaboration between the various stakeholders of DC NEXT. Their backbone support activities include managing funding and budgeting of the network, handling communication and formal agreements with network partners, and hiring and coordinating the context team.

The dedicated DCPCA staff are members of the leadership team and collaborate with the other leadership team members to provide additional backbone support for DC NEXT. The professionals on the leadership team include 2 academic pediatricians, 2 nurse practitioners, 1 professor of nursing, 2 public health professionals, 2 social workers, and 2 policy experts (Fig 1). Funding from the initial DC NEXT grant supports their protected time to dedicate to DC NEXT activities. Leadership team members meet frequently with network partners to learn in depth about new initiatives, referral mechanisms, and opportunities for collaboration. They conduct outreach to prospective network partners, plan and facilitate network events, and disseminate network initiatives and knowledge. The leadership team also engages the context team regularly to review program goals and progress. The leadership team hosts the monthly DC NEXT network meetings that allow for longitudinal collective impact work.

DC NEXT provides a case study of how interdisciplinary partners, each with their own unique strengths and approaches to solving a complex problem, can come together and collaborate to mutually advocate to improve the health and well-being of an under-resourced population. DC NEXT has been able to bring together over a dozen key organizations, together with people with lived experience, to obtain baseline data, deliver trainings, and provide needed resources in critical times of need.

A notable lesson learned is the value of a common agenda. To center and ground a multidisciplinary collaborative, being able to reference the common agenda and have it guide the network’s activities and progress has been indispensable. Another key lesson learned is the benefit of a context team. Inclusion of individuals with lived experience is critical to ensure that the initiatives are contextually appropriate and sustainable. Although sustained engagement was a challenge, we found that clear delineation of roles, responsibilities, and time commitment at the outset, flexibility with the unique challenges of school schedules and young children, and compensation were keys to retention.

The work of DC NEXT also underscores the initial investment needed to start a new collective impact initiative. Resources such as full-time staff members and protected time for leaders are critical as significant time and energy are required to establish each new process to coordinate partnerships, determine communication strategies, and evaluate efforts. Staff time to develop each of these processes was possible because of grant funding. Securing funding to allow stakeholders and staff adequate time for the project will be important to sustain this work and for those desiring to replicate similar efforts.

We have also learned that despite the effort invested to develop the network, progress can be slow. Though the network was conceptualized 2 years ago, we are still working to engage additional key stakeholders. Government and third-party payer partners are critical resources but have been difficult to engage in network activities, as they are not specifically focused on the population of teen parents. Other new partners continue to learn about and join the network, such as the owner of a local small business to support teen parents that was initially unknown to the leadership team. With each new partner, DC NEXT staff invests time to orient them to the collective impact model and prior successes and to engage them in ongoing work.

The collective impact model provides a structured framework to approach complex social problems such as improving the health and well-being of expectant and parenting teens. Such complex problems cross multiple domains, including healthcare, housing, schools, and public benefit systems. DC NEXT recognizes that no organization can improve health and well-being outcomes for teen-headed families in isolation and instead is using a collective impact approach to work toward shared outcomes and systems change.

DC NEXT plans to continue as a collective impact network following the initial 3-year grant-funded period through the pursuit of additional federal grants and philanthropic support. The highest priority is to continue to financially support the context team so they can continue to work alongside program staff from various organizations to develop collaborative processes rooted in the common agenda and innovative solutions targeted to the common agenda’s 3 outcomes to positively affect the health and well-being of expectant and parenting teens in Washington, DC.

The DC NEXT collective impact initiative will continue to support deep, longitudinal relationships with interdisciplinary partners in Washington, DC. We hope that this case study can serve as a model for others who wish to implement advocacy initiatives alongside organizational partners and community members.

DC NEXT

District of Columbia Network for Expectant and Parenting Teens

DCPCA

District of Columbia Primary Care Association