DR. RICHARD SUSSMAN: Our first grant to this project was a nine-month planning grant for $18,000. In part, the grant was awarded because of the Foundation's belief in the applicant as a sparkplug in this community, the concept of developmental surveillance, and the congruence between the project and the goals of the Foundation's early childhood initiative, Brighter Futures. A three-year grant of approximately $400,000 to initiate the project was subsequently funded when the authors were able to demonstrate the engagement of a wide set of players in this project (citizen, and non-healthcare providers) and a business model as to how this work would be sustained.
DR. PAUL DWORKIN: The process here was never responding to an RFP, sending in a proposal, and finding out whether we were funded or not. This has, in each instance, been a partnership and has been highly collaborative. There is absolutely no question that the Hartford Foundation for Public Giving, the Children's Fund of Connecticut, and the Commonwealth Fund have not just supported, but have shaped the programs that they have ultimately funded. And the processes were extraordinarily helpful in moving the initiatives forward.
All foundations do not offer that level of real-time advice and guidance. Submission of grants is not always a collaborative process, not always a partnership. Yet that is highly characteristic of each of these funding processes and that has contributed to the accomplishments of the programs.
DR. JANICE GRUENDEL: We must think about getting to scale, which would mean touching all children in the State of Connecticut. The cohort is about 40,000 births a year, of which probably a quarter are at some predictable risk, predictable simply by living below an economic sufficiency level. That is 10,000 children a year, a big enough number to be concerned about, yet small enough to believe we can do it.
I wish to make four points. First, we need to figure out to partner up the United Way capacity as "a giving community" with the foundation capacity. We now have the chance to do that nationally and in a number of states because of the Partnership for Learning, My Mind in the Making and Success by Six initiatives. So in Connecticut, we are working to bring those pieces together. The United Way has a presence in all communities in Connecticut and foundations are different, in that they don't necessarily cover all communities. So we need to stretch our notion of what is the "giving community."
Second, the monies in the foundation community are important for their flexibility and their ability to be progressive and not crisis-oriented or reactive. But the money that we need is already in the system in the state and local coffers. Connecticut has a 15 billion dollar budget. Just in public education, the State puts in 1 billion and communities put in five or six billion. In K-12 public education, we spend almost $7,000,000,000 a year. The bottom line is that when we look at where the resources are, they are already in the system. So, when we talk about needing $100,000,000 or $200,000,000, we must reallocate and leverage across our existing systems of paying for services. That is where the real money is; it is already in the system.
Third, when we talk about resources, we think about money only. Yet the credentials that the giving community brings to the table are often much greater than just money: your boards of directors and your policy influencers. There is a latent power that we haven't tapped very well at all and we need to think about that. Resources are more than just money.
Fourth is the very exciting opportunity we have here in Connecticut to reinvent government in many different ways. This is a case example of how we can build a proper system that is geared in a developmentally-appropriate way; that applies what we know about when investment is most effective and when we get the greatest return. We talked about economic analysis at our lunch table. We actually know how to do economic analysis, and even if all the research is not yet in, we have enough to move forward. In this context, at least for the next year and likely for the next four or five years, regardless of who runs the State, we have the opportunity here to reinvent the way that we deliver services, to make the State system not only more responsive with less silos but more flexible so that it might, over time, use its money the way that foundations use their money.
It can provide a base when a community knows what it wants to do, when it knows the children who are not going to be ready or healthy. Hartford knows it is some 10,000 children born every year. So if we rethink government in a way that allows new or reallocated resources to be much more systemically driven and flexible, so that we leverage at the State level new monies, we could make an unbelievable difference and prove it.
DR. WILLIAM HOLLINSHEAD: We have occasionally said to the Rhode Island Foundation that we can identify $50,000 if somebody else can provide the other half or the other two- thirds or whatever is necessary. But some private sector investors, including the United Way, seem to prefer to be first, or at least to have thought of it before the government did. The diplomacy is a challenge.
DR. EDWARD SCHOR: Our Assuring Better Child Health and Development (ABCD) Program, is unique in many ways. It is actually a grant program to State Medicaid Departments. People look at us and smile and say, "You're giving grants to the government?" In fact, if you talk to foundation people, they ask, "Can you give grants to the government?" Yes, you can. The advantage is that foundation dollars, if properly granted, can be used to draw down Medicaid match dollars. We fund Medicaid because that automatically doubles the dollars that we give. Any foundation will like that since they can go to their Board and say, look, we leveraged a match for all the dollars that we put in.
My own experience in public health is that government often doesn't look to private funders as partners. How often does a public health department go to the local foundations in their state and say, "we have an idea and we'd like you to fund us?" Government agencies tend to fund their own work or the work of other public or not-for-profit agencies. They don't think about going to private funders for additional support, but that is perfectly legitimate.
MS. HELEN PELLETIER: The amount of ABCD money going to the states is not huge. In this round, it is $50,000 a year matched by Medicaid. In those states, it raises the awareness of the issue. It motivates people. It brings people to the table who would not normally come to the table, because it is a national demonstration project that has elevated the issue in each of the ABCD states. It starts to build without a huge investment on the part of The Commonwealth Fund.
MS. DEDRA MARKOVICH: It has also sparked some other initiatives in Illinois to train physicians in practice through the EPIC model to provide an enhanced service to families on developmental issues. We are now looking at ways that we can maximize that federal match for those training programs, as well. Because we are serving in Illinois such a high Medicaid population, we are also looking at that match process to double the number of practices that we can serve with those foundation dollars.