Putting the pieces together for children to learn

Fellow Becky Miles-Polka, Senior Consultant, Campaign for Grade-Level Reading

This post shares Becky's journey as a fellow in the first cohort and was first published in September 2019. Becky continues to work on this issue as part of the second cohort of fellows.

THE JOURNEY

In her consulting role, Becky focuses on how to improve children’s ability to read and succeed at school. One key strategy is to foster healthy child development. With a past that includes working in maternal and child nursing, she also has a strong tie to working on children’s health issues.

“I was interested in joining the fellowship to have some concentrated time to go deep on a subject where I would hopefully effect some change,” Becky said.

Becky’s initial idea was to lead efforts to integrate data between health care and education systems, so providers could have a more complete picture of a child. But soon into the fellowship, she discovered that Early Childhood Iowa was working on developing a system with a cross-department state team. The news left her wondering where to focus next.

Shortly after, Suzanne Mineck, president of Mid-Iowa Health Foundation (MIHF), presented Becky with an opportunity to work on Medicaid reimbursements for home assessments and remediation to help children manage chronic asthma. “Becky had all the knowledge and experience to be the one perfectly positioned to push this forward,” says Suzanne.

Still, the learning curve was steep, and Becky had to start by learning the research and meeting with key stakeholders, with support from a former CEO of a managed-care organization (MCO) that had left the state and the national Green & Healthy Homes Initiative technical assistance team.

The Issue

A child must know how to read by the end of third grade. After that, they must read to learn. The Campaign for Grade-Level Reading focuses on ensuring low-income children can build critical reading skills by addressing factors, such as chronic absenteeism, summer learning loss, and school readiness. Becky had been part of a team looking at how health determinants— such as asthma care, oral health, and nutrition—impact early school success.

Healthy Homes Des Moines received a technical assistance grant from the national Green & Healthy Homes Initiative to try to gain Medicaid reimbursement for home assessment and remediation for children with chronic asthma. The assessment identifies asthma triggers and provides home repairs and family education to support children with asthma or at risk for the illness.

Becky’s goal was to foster relationships with MCOs and make a case for why this change was in their best interest. Although she was not an expert in this area, Becky says, “I have a lot of expertise in change initiatives and helping guide a group of people through a process to arrive at a common vision.”

Successes

Becky met with leaders at three MCOs and had the entire agenda at the Iowa Medicaid Enterprise meeting where MCOs meet monthly. She even secured an agreement with one MCO to launch a pilot in Polk County just before that organization pulled out of Iowa’s market. With instability among MCOs and uncertainty with the upcoming election for governor, Becky’s efforts with the MCOs were put on hold. She continued to work with the technical assistance team from Green & Healthy Homes and local stakeholders to evaluate the current operating model of Healthy Homes Des Moines.

During the fellowship, with support from the technical assistance team, she was able to review public and program data from Healthy Homes Des Moines to create a business case for expanding the program from a local to regional to statewide effort based on emergency room visits and hospitalizations across the state. The work revealed that the current operating structure needed to be more streamlined and costs reduced to make the program sustainable long-term.

Serving as liaison between Green & Healthy Homes and Healthy Homes Des Moines, Becky then helped vet service providers, which resulted in the decision to have EveryStep become the lead organization for implementing the program. The next step is to identify a sustainable payment mechanism for home assessments and remediation. At the time of this report, strategic partnership conversations had reignited with one of Iowa’s two MCOs and the MCO indicated readiness to move forward with a pilot project with EveryStep in Des Moines. Becky will be working with Green & Healthy Homes to create a funding model that all parties can support.

“We watched Becky put together a big giant puzzle of people who need to be involved and to garner that collective vision and to help others see what their role is in that collective vision,” Suzanne says. “That’s system-building work. It’s hard work.”

Becky also has served as a leader for other fellows on how to build relationships to change systems.

“Beyond all the data and all the facts, all the subject matter expertise and talk about systems, it’s about people,” says mentor Rick Kozin. “It’s about identifying people who can make decisions and figuring out how to build relationships with people.”

Lessons Learned

Becky experienced what Ralph Smith, her boss, describes as “being opportunistic.” When her original project didn’t work out, “I was worrying about this investment the foundation was making in not only me, but the work.” Then this new project arose that fit her goals.

“Probably my biggest aha was that the Iowa Department of Human Services and the Iowa Medicaid Enterprise existed in such a politically charged environment, and that relationship and trust building would take much longer and be far more difficult than I anticipated.” Yet, she found that once she got in the door to present her business case, the leaders were receptive to her ideas.

“I have also learned that I don’t want to give up on the progress we made over the course of the fellowship,” she says.

Benefits of the Fellowship

As an independent contractor with a team working across the nation, Becky is limited in having face-to-face time with colleagues. The fellowship gave her a chance to connect with other advocates and to view issues through different lenses. She’s even asked other fellows to present their work with her national network, while she’s built new relationships nationally and locally.

The fellowship funding also helped Becky attend national leadership convenings to gain new ideas. She attended The Harwood Institute last fall and that gave her renewed optimism for what is possible during difficult times. She brought that spirit back to the group, providing a restorative yoga session when many fellows were feeling deflated.

The Future

Becky is unsure what the future holds and is comfortable with that unknown. She knows that EveryStep needs to build capacity in taking on the lead service provider role. She also knows the Healthy Homes Des Moines program needs to continue to reduce costs and to re-engage MCOs to make a new case.

“In my professional capacity, I often serve as a coach and mentor to a network of local leaders throughout the state,” she writes. “At heart, I love to learn and then to share new ideas with others. I didn’t imagine when I started that I would have the opportunity to experience one of the steepest learning curves of my career as I accepted the new project. While I have at times felt stymied and frustrated by the slow pace of progress and the lack of control over key relationships to move the initiative forward, the benefits of working with the technical assistance providers and our Des Moines team has been incredibly rewarding.”