Among the hundreds of programs that scholar Ron Haskins examined for his persuasive new book on social policy, one stands out in his mind: a home visiting initiative in Texas that sends nurses to visit teenage girls who are pregnant or new mothers. In this program, the nurses and girls often develop close bonds. Those bonds, he realized, helped explain why girls in the program were more likely than other girls to seek prenatal care for their newborns and use contraception in order to prevent another pregnancy.
Home visits, he told me, show promise. Like some other initiatives of the President Obama administration that he details in his book, they have not yet been proven scientifically to produce significant results consistently. More testing needs to be done. But, said Haskins, formerly a senior advisor on welfare for President George W. Bush, "I'd like to see more of that kind of program."
Reducing teen pregnancy is one of six bi-partisan, social policy initiatives examined by the Obama administration and outside experts to determine which initiatives are working and which are not. Haskins, co-director of the Center on Children and Families at Brookings Institution, argues that programs demonstrating solid scientific evidence of success - and not funded by special interest groups or political parties - should be what taxpayers are asked to support. It's a position that he feels strongly about - and that doesn't always sit well with some of his former political colleagues.
One program in the Washington, D.C. area that is not featured in the book, but employs the kind of oversight and accountability that Haskins' book champions, is Mary's Center. The center is federally qualified and offers medical, social, and educational services to a largely Hispanic population, from babies to seniors. It was started in 1988 by public health nurse Maria Gomez, its president and CEO. Gomez, who received a President's Citizen Medal from Obama in 2012, is a member of the transition team of Washington mayor-elect Muriel Bowser.
According to Mary's Center statistics, the organization, which has one main program downtown and five smaller ones scattered around the Washington area, serves 40,000 people. Two-thirds are female, three-fourths are Hispanic. It has a budget of $39 million and uses outside evaluators to measure its performance in accordance with the National Committee for Quality Assurance.
As the home visiting section in Haskins's book suggests, however, good programs succeed not just because of the way they're structured or because they're run by highly skilled executives and well-connected boards of directors. As important as those people are, a program's accomplishments ultimately depend on the energy, enthusiasm and sensitivity of trained staff. Celia Woo, who works with teens and their families at Mary's Center, is an example.
Woo, who grew up in El Salvador, has been working at the center for 17 years, and her continued enthusiasm for her job is obvious to an outsider. She says a young client recently asked her if she ever got tired of asking the same questions to the young people she serves.
"I had never thought about it," she says. "Everybody is different."
One situation she encounters regularly is learning that a teenage girl - often, a young teenage girl - is considering having sex for the first time. Woo says she will ask the girl how long she has known the boy, and if she has family members whom she can talk to. Woo will explain the benefits of waiting to have sex until one is older. She also, in her words, "will educate the girl about the different methods of contraception and ask her if the boy is worth putting hormones in her body."
Once Woo learns that a girl is having sex or thinking about it, she will schedule an appointment for the girl with a health educator who will explain different methods of birth control and how to acquire them A girl may be ambivalent about, or scared of, birth control, and attempt to approach another staff member at the center. The message from that staffer, says Woo, will be the same: If you're going to have sex, you must use an effective method of birth control.
"We must give young people all the tools they need if we want them to succeed," says Woo. "I act on what can be good for them in the future."
Usually, the girls come with a parent and Woo is not shy about telling the parent (usually, the mom) that she's going to talk to the daughter about birth control. "The parents welcome our efforts," says Woo, "especially the Hispanic parents. They don't want their kids to start having sex, but they also want to know how their child can avoid getting pregnant. They're also afraid of STDs. We talk about abstinence, but they know that if their daughter has a child, they'll be the ones raising it. They want someone to talk to their kid."
So yes, programs supported by taxes, foundations and individual donors need to be evaluated - rigorously and regularly - for quantifiable results. And evaluators must make sure to include in their observations the "someones" who contribute to those outcomes.