Public health practice partnerships are evolving, and they are beginning to naturally spread into the realm of the social-determinants of health in more innovative ways with programming integrating elements of multiple sectors. America SCORES is such a program, combining the expressiveness of the arts with the kinetics of sports and lessons from service. Just as after-school programs can teach valuable lessons, so too can the leaders of the nonprofit organizations that support them. From memorable moments and management mantras, to the many facets of fundraising and the power of poetry, this piece attempts to capture the wisdom of a nonprofit leader and the work she and her organization accomplish to impact the complex outcome we call “healthy.”
Play is essential. From the time we are children, it is one of the cornerstones of our interactions and teaches lifelong lessons. Play builds strength, character, communication skills and self-awareness. Play helps us relate, and in so doing it facilitates our ability to build community. For those of us who enjoyed it, we remember playing, even if it was not a formal competition it stirred something in us that stayed with us. We remember teammates and team moments. The goals and the misses. The wins and the defeats. The lying breathless on the field after a killer conditioning session. The support we got and the support we gave. We have probably forgotten half of what we learned from playing, and yet we still benefit from it, because the experience was just that rich.
So what does all this talk of play and teams have to do with innovation in the population health sector? I open this piece with that commentary on play because I believe it so essential to health. By that I do not simply mean “elements of being healthy” including physical activity or eating a balanced diet, but health in every sense. Health beyond disease and beyond healthcare and the clinical encounter. Health outside the framework of pills and procedures (important though they are). Health as a social outcome requiring a deliberately diverse and yet still integrated approach. Health as something that happens in sentences and theory without the word "health" actually being used. Why do that, you ask? Because we have been all too effective at building siloes that prevent health from being an outcome that is shared across multiple sectors. Accountability for great social outcomes is not usually shared, but rather apportioned or assigned. It does not have to be this way.
I believe that our notion of where public health happens needs to be retooled. Public health is useful for the entire population, and as such qualifies as a “public good” meaning it should be free of rivalry or exclusion, and yet public health outcomes are vastly disparate, and our siloed approach is to blame. From a sector perspective, government alone cannot address all public health issues. Similarly, medicine cannot be held responsible for all health outcomes. There is too much complexity on the path to hold one sector accountable. Health outcomes are the result of effective interplay between multiple factors including education, employment, housing, transportation, community development, planning and more. It is a multifaceted challenge, and requires innovative multidimensional approaches to improve it. This is particularly true for communities where, due to a combination of sociopolitical and economic factors, health has been absent for some time. As many of you who read this journal know, this makes for more of a challenge, but it also presents a great opportunity for us to work together in a way we may not have done before.
In all honesty, we may have been too willing to accept “complex” as being equivalent to “impossible.” Looking at the magnitude of our population health issues can quickly become overwhelming. Obesity, high blood pressure, homicide, HIV and early child death are difficult problems to address, but not impossible. Especially if we take more “upstream” approaches to get to them. I see America SCORES as an example of an organization that has seen fit to fold health into a suite of outcomes that includes youth development, education, the arts and play. To talk about this, I solicited the input of Holly O'Donnell, executive director of America SCORES, a national nonprofit serving 10,000 students at more than 175 public and charter schools in fourteen major cities. As the leader of a nonprofit organization that uses a programming schedule combining education, arts and sports, and as someone heavily invested in the outcomes her organization can help create for children in under-resourced communities, Holly was one of the best people to talk to about the intersections and innovations that make cross-disciplinary programs like SCORES work so well.
I met Holly in 2011 after I began serving on the board of her organization's District of Columbia affiliate, DC SCORES. I had been drawn to the work by their mission, the crosscutting nature of their approach and all of their leadership in the District’s after-school space. The SCORES program uses a game I love, soccer (which, being British, I prefer to call football, but when in Rome...), a medium I love, spoken-word (see "hip-hop" for reference) and what I perceive to be among the most effective learning modalities, service-learning, to engage children in activities that help them play, socialize, create and learn in a setting that helps them associate school with a larger context: their communities.
A couple emails were exchanged to set things up and the call was a go. After catching up on our respective lives, we got down to the conversation. Holly is one of those people whom you can “hear” smiling. She has infectious energy and clearly loves what she does, so it was easy for us to have a great conversation.
The kids who participate in SCORES programming are taken on a mental and physical journey. They are tested in a number of ways and by all reports, age-out of the program only wanting more. I asked Holly about her journey to becoming the point person at America SCORES. She explained that she grew up in a household where a premium was placed on civil service and education and so it was natural for her to secure a position on the staff of “America Reads” as a Presidential Appointee for President Bill Clinton. A government transition brought her time at the Department of Education to a close, so she applied for a job at America SCORES’ national office, though she did not get the position. However, her resume’ was circulated and she instead became the executive director for the local affiliate in Washington, D.C. (DC SCORES), where she stayed for five years. She then left for eight years to work for a health-focused foundation and to oversee all the after school programs and partnerships for Pittsburgh Public Schools before returning to DC SCORES’s parent organization, America Scores (SCORES), as their national executive director in 2013.
Replays are a big part of soccer, and in our DVR and on-demand world, we now have the ability to go over almost any moment of recordable footage with the press of a button. The beauty of “being present” when SCORES’ poet-athletes are doing what they do, is that there are moments they create that we wish we could play again. I wanted to know what memorable moments Holly had experienced through SCORES.
HO'D - "For me the moments that cause people to pause, those that show us something unexpected, or mak[e] people change their minds, those are the moments I want to replay and have hundreds of people there with me to experience it. I want to be able to share the experiences that are so often not recorded.”
She went on to tell me about the time she walked into a classroom in Chicago where 20 elementary school boys were writing poetry. When their soccer coach told them it was time to go out to play, the transition did not go well. “The boys were furious,” she said, explaining how they were so engaged in their writing that play was not on their minds. That moment, showing their disappointment at being pulled away from their words, is something that she wishes she could share, because so many assumptions are made about what boys of this age would want to spend their time doing, and this is a moment that had to be seen to be believed.
The second example she gave was from St. Louis, Missouri, where shortly after the well-publicized unrest in Ferguson in 2015, she received a call from a coach at one of their affiliates. The purpose of the call was to let her know that in spite of the news that the school was about to lose major operating funds, the SCORES team planned to continue to maintain the after-school activities for the kids in the program. This demonstration of resilience and commitment was another “replay” moment for Holly, and a testament to the connection the staff has to the kids and the program.
Holly's story about the prospect of the loss of resources in Missouri was a great lead-in to my next question. In my experience, local jurisdictions often struggle to consistently fund effective after-school programs. Combine that challenge with the competition that already exists for limited nonprofit funding, and I am sure it can feel like the viability of SCORES' affiliates are in constant flux. I asked Holly how she influences people to support the organization, and for any advice she might want to share with the community-organization leaders who are new to the world of collaboration building and fundraising.
HO’D - “America SCORES was built on foundation grants, and our infrastructure came from those grants. Having diversified funding is important. You have to identify your mission and build around that so it is easy for people to make the link to give to your organization. Finding something that brings people into the organization and matches what you do. For SCORES, the way we do that is through the "SCORES Cup" which is a corporate soccer tournament that has been replicated in all 14 SCORES cities. We wish we had ten events like the SCORES Cup, but we are happy to have one.”
Holly’s advice for nonprofit leaders is in the form of a three-part mantra she developed during the second week of her time in the executive director's seat. She laughed as she recounted the origin of the mantra and repeated it for me. “Simplify, simplify, simplify,” she said in reference to the message you are sending about your work. “This is the work, this is the work, this is the work,” as related to focusing and being persistent. Lastly, she said, “Not perfect but better, not perfect but better, not perfect but better.” These are reminders to keep things in perspective, which is sage advice on all fronts.
Part of what drew me to become more involved with D.C. SCORES was the art component to SCORES’ programming. It made the organization and the experience they were offering to participants so much more unique in my eyes, and I was curious to know how that part of the program resonated with Holly.
HO'D - " I think about this a lot," she said, and explained that she saw spoken-word as an "accessible art" for both teachers and children, which made it more valuable because unlike the soccer component of the program, "it starts as something students do individually." Spoken-word represents a “quiet time (for the poet-athletes) to reflect on their day, their lives or to celebrate something.”
The students work on their pieces and share their work with each other. They practice and then perform for a live audience of community members, coaches and other students. Holly told me how this part of SCORES is “structured sharing, and an outlet for expression of emotions and experiences both positive and challenging.” With a deliberate process for taking full advantage of the medium, an engaged set of writing coaches help the children write, revise, rehearse and then recite their pieces. The simplicity of this particular art form makes it all the more appealing. “It does not require the supplies of music or visual arts like painting, it can be done at home with just a pen and a piece of paper.”
For many of the kids engaged by SCORES, playing soccer and competing in a league brings another opportunity for intensity to lives already all too familiar with a number of environmental challenges. Competition is inevitable, but I was interested to hear how Holly and the organization saw the competition benefiting the children who engage with SCORES, and what significant lessons she sees them learning through their engagement.
HO'D - “The most important thing for healthy competition is well-trained coaches. America SCORES invests significantly in training coaches and setting expectations for behavior before and after the game.” She described how the topic of competition is an ongoing discussion within America SCORES, with some sites focusing more heavily on it than others. “Children keep track of wins and losses in spite of our saying we are a non-competitive league or format,” she said. “Making sure they understand how to win gracefully and when they lose how to communicate their frustrations in an appropriate way. I believe there are winners and losers and it is important to know both sides of this (reality).” Then she returns to the coaches, “For the most competitive situations, the coaches and referees are trained to ensure that the environment is such that the competition can be healthy.”
In closing I asked Holly if she had any final words of wisdom to share, and here is what she stated: “There continues to be a higher demand for after-school programs in urban areas. This is reflected in America SCORES with 17 schools on waiting list in D.C. alone, and more across the country, and we want to grow to meet this demand.”
I found it fitting that she would close clearly stating a need, and I was not surprised because at the end of the day, “this is the work, this is the work, this is the work.” In all of the examples Holly gave us about what makes SCORES special, health is a valued outcome for which the organization collects data, but it is not their raison d'etre, and I am satisfied with that. As long as the outcomes of our work serve to improve tangible and intangible health metrics while having social impact, I believe we should be happy and looking to create more programs capable of doing just that.