Cleveland, Ohio - www.provhouse.org

Crisis Averted

The Crisis Nursery Model.Positive Outcomes For Family

Preservation and the Prevention of Child Maltreatment

Natalie Leek-Nelson, CEO & President

What Are Crisis

Nurseries?S

Definition of Crisis Nursery CareFederal Legislation defines Crisis Nursery care as:

› Temporary care for children who are at risk of abuse and neglect or who have experienced abuse or neglect.

› Offer child care free of charge for a maximum of 30 days in any year.

› Usually available 24 hours a day. › Accept children at any time, day or night, in order to relieve a potential or existing emergency in the family.

Arch FactSheet #1, revised March 1994 www.archrespite.org

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Why is Crisis Nursery Care Effective?

Protects at-risk childrenPrevents child abuse and neglectPreserves fragile families

Why is Crisis Nursery Care Effective?

Removes children from situations which present possible danger

Breaks the cycle of abuse and neglect

Keeps children out of public system

Offers proactive, preventative & innovative care

Reduces Child/Family Separation: Reunification in shorter period of time

Tremendous economic value at county, state and national level

How do Crisis Nurseries prevent Child Maltreatment?

Placement is voluntary and often free› Provides families an early intervention alternative when crisis presents risk

Extended lengths of stay are emerging in crisis nurseries over early traditional models› Most new nurseries are offering 30+ days of placement

Intensive intervention and holistic family services prevent child abuse/neglect and stabilize the family long-term› Temporary Child Placement› Stabilize Family and Child Crisis› Provide Family Case Management, Support and Education› Offer Family/Child Assessments and Service Linkages› Create a system of support for families who have not had access to healthy

and helpful support

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Providence House History

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Providence House HistoryProvidence House, Inc. was founded in 1981› by Sr. Hope Greener, CSJ to provide a safe haven for children in Cleveland

0-5 years old whose families were experiencing a crisis.› Provided day only respite services during first years› Next moved to overnight for up to 7 children.› Transitioned to 7 nights, then 30 days in expanded facilitiesfor15

children› Extended to a 60 day placement in 1982› Additional House added in 1990 to expand placement for 26

children› In 2006, new legislation allows for 60-90 day placement based on

referral/placement need.N

TodayThe Providence House Crisis Nursery program is a comprehensive crisis intervention, abuse/ neglect prevention, and family preservation model

Serves nearly 200 at-risk children each year

Offers round-the-clock services and emergency shelter placements lasting from 24 hours to 60 days› 90 days available if a parent is in an inpatient program for substance

abuse, mental health or medical issues. Short term incarceration also qualifies.

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Service OfferingsAn integrated model of 4-tiered services is offered throughout each child’s placement, which includes:› Children’s Crisis Care Services

Emergency Child ShelterDirect Early Child Care

› Family Education and Preservation ServicesFamily Case ManagementFamily Education, Visitation, and Aftercare

These services provide support, guidance, education and comfort to our children and families, as well as address the specific short and long term needs of both the child and parent, allowing time to stabilize the crisis and begin healing the family.

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Legislation

Licensing and LegislationOhio’s first licensed Crisis Nursery. In 1990, a special licensing category was created in state legislature solely for the services provided by Providence House.

In 2006, Providence House led a legislative effort through Ohio’s General Assembly to further define these licensing and operational standards specifically for Crisis Care Facilities,

(Crisis Nurseries).

The passage of SB242 allows for the provision of residential crisis care to children newborn through age 12 for up to 90 days.

Federal definitions have been established through CAPTA, Ohio is only one of 13 states supported through formal legislation for Crisis Care Facilities.

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Who Are The Children?

Providence House 2008-09 Service Demographics and Trend Data

Children are referred to Providence House for residential care from primarily economically disadvantaged families who are actively in a crisis situation. The children are at serious risk of abuse, neglect or dependency.› 76% of children were at risk for abuse/neglect› 45% of families were homeless› 8% of children were witness to domestic violence› One in four children had a caregiver with a medical crisis› One in seven had a caregiver affected by a mental health crisis

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Race/Ethnicity?

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Gender?

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Ages?

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How are they Referred?

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2008-09 Referral Sources

Cuyhoga County DCFS16%

Hospitals17%

Private Child Serving Agencies

3%

Neighborhood Center

4%Mental Health

Agencies2%

Public Children's Welfare

1%

Department of Justice/Probation or

Incarcaration 1%

Homeless Shelters/Housing

Programs10%

Self Referral44%

Domestic Violence Shelter/Program

2%

Placement Trends

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Providence House Placements - 5-Year Trend

0

50

100

150

200

250

300

Wait ing 37 58 78 66 74

Total Placements 193 167 143 183 194

Resident ial 193 167 143 183 194

2005 2006 2007 2008 8.09

Average Length of Stay

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Average Length of (Days) Placement

27 2724

29

27

5

10

15

20

25

30

35

2005 2006 2007 2008 .08.09

Child Length of Stay Placements Averages

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Child Length of Stay

0

25

50

75

100

125

150

Length ofPlacement

2005

2006

2007

2008

8.09

Readmissions

38% = 19 days or less

39% = 20-39 days

23% 40-60 days

Service Offerings

Service OfferingsChildren’s Crisis Care Services:

Children’s Emergency ShelterDirect Early Childcare Services

Family Preservation Services:Case ManagementFamily Education

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Providence House Program Components

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Making It a Home-like Environment

Emergency Child Shelter

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Giving Children a Sense of Self

At Providence House, every child receives:› Their own bed or crib › 5 new sets of clothing › Seasonal items – Boots, Coats, Gloves, Mittens› A handmade quilt› A Teddy Bear to provide comfort at night

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Homelike SpacesComfortable playrooms, bedrooms and dining areas, classrooms and parent visitation spaces in homelike structures situated in a residential community.

Each child receives three nutritious home cooked meals a day and three healthy snacks served “family style” to focus on communication, behavior.

Children are monitored day and night for behavior, health and safety.

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Providing Families with Building Blocks

In cases where the child may be going back to a home environment in need of basic childcare items Providence House Provides children and families with:› Cribs and Beds› Strollers› Linens (sheets, towels, blankets)› Diapers› Food and Formula › Toys and Books for children› Cleaning supplies

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We Couldn’t Do It Without Them

Direct Care

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StaffingLicensed facility with professional staff; one LISW, and 3 LSW’smonitoring staff, families, programming and compliance issues

1:4 ratio for all age groups, 1:3 with trained volunteer support

Highly trained professional childcare staff

› Newly hired childcare workers are required to complete 70 hours of training within their first year of hire.

› Training includes an intensive curriculum focused on issues of child development, behavior management, crisis intervention, identification of child abuse and neglect, and CPR/First Aid.

› To ensure ongoing quality care, all childcare workers are required to attend 24 hours of training each year following their initial year of hire.

› All staff are offered medical benefits, LT/ST disability, vision, dental, 401K, life insurance, PTO and shift preference

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What the childcare staff do daily

New 5-Shift Staffing Model in 2008› Increased satisfaction and retention of staff› Supports more traditional work hours on all shifts› Gives staff respite with consecutive days off each week

Provide Care 7 days a week, 365 days a year› Monitor and document all daily children’s activity› Plan and coordinate children’s activities› Cook, serve and participate in meals› Comfort and monitor sick children› Provide transportation for existing educational or therapy programs, medical

care, field trips› Laundry and housekeeping

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Assigned Childcare ProcedureThis worker is responsible for every level of care that their assigned child requires for the duration of their stay.

They bathe, clothe, feed, nurture and love the child as if they were their own.

Childcare workers also document› daily care › concerns and critical incident reports› instructions for the next shift› developmental milestones met by their assigned child

Act as Peer Mentor to their assigned child’s family

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Why Assigned Childcare?

This individualized care model supports:

› Healthy child attachment, bonding and development

› Allows each assigned childcare worker to build quick rapport with children

› Vital for disclosures of critical incidents, accurate developmental assessments and modeling of appropriate parent/child behaviors

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Direct Care ServicesSelf care skill enhancement› Potty training› Hygiene› Nutrition› Self guided discipline

Triage and Medical Care follow up

Children’s educational enhancement programming› Weekly education themes› Circle time› Arts and Crafts› Cooking Projects› Outdoor Exploration› Fieldtrips

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Supporting Advocacy with a Crisis Nursery Model Before, During and After Placement

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The Backbone of Crisis Nursery Care

Case Management

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Admission CriteriaChild at risk for neglect

Child at risk for abuse

Homeless type 1: evicted

Homeless type 2: unsafe living conditions

Drug or Alcohol treatment (inpatient or outpatient programs)

Domestic Violence

Mental Health (inpatient or outpatient treatment programs)

Parent or guardian medical treatment (inpatient, outpatient or home recovery)

Adoption Plan

Medically stable child need stepped down from a medical facility

Short term incarceration in limited circumstances

MR/DD crisis respiteS

Inquiry to Referral to Placement

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Core Componentsfor a Successful

Placement

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Parent InvestmentParents sign a Family Preservation Contract. They agree to:› Engage with community agencies within 2 weeks of

placement› Visit with their children 2-3 times per week› Participate in individual and group parent education sessions

2-3 times per week › Parents agree to fully complete homework assignments› Participate in peer mentoring sessions› Share information that is vital to family well being and the

placement of their children› Participate in a 12-month Aftercare Program

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Collection of Social History

18 page Intake packet› Family history› Referral source and community linkages› Current functioning › Health and Medical Information› Behavior History and Specialized Services› Parent Authorizations and Agreements

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Complete Medical Reviews & Ongoing Treatment ServicesTriage of all Children - Within 5 days of Placement

Clinic Visits (sick child visits)

Emergency Medical Care

Specialty Referral and Follow Up

Onsite Space is provided for:› Physical Therapy› Occupational Therapy › Speech and Language Therapy › Counseling

All medical Services Funded by Children’s Insurance or Foundation Dollars S

Diverse range of Assessment Tools

2-7 Day Internal Assessments› Developed by Internal Case Management Staff. › Assists in assessing the adjustment of the child on all 3 shifts› Helps drive referrals for children

Ages and Stages Questionnaire (ASQ) and Ages and Stages Social Emotional (ASQ-SE)› Both ASQ and ASQ-SE are conducted at 14 days and at the time of

discharge by childcare providers and licensed social workers› Assess progress in five areas: gross and fine motor skills,

communication, problem-solving abilities, and personal-social skills. › Tools assist with making referrals to outside service providers for

additional support and treatment for the child and familyS

Discharge PlanningMost Discharges are PlannedFamilies transitioned to outside agencies for case management coordinationAll discharge recommendations are documentedCalls made to DCFS if child maltreatment is suspectedContinued support is offered to the families through the after care programFamilies are given five outfits of clothing for their children, toys, hygiene and cleaning products, blankets, sheets, food staples, and other items to help support their transition back to being the primary caregiver

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Closing the Gap in the Service Circle

Parent Education

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Family VisitationThroughout the child’s placement ongoing parent visitation is required in addition to the classroom and hands-on education curriculum. › 2-3 times a week is the recommended minimum based on family size

• Onsite Visitation• Day Visits• Medical Visits

• Home Visits

Visitation plays a tremendous role in the continued bonding between parent and child› Strengthens the ability to reunify the family› Provides an opportunity for observation of parent/child interaction

Inpatient situations are accommodated through special arrangements

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Parent Investment is Required

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Parent Education DeliverablesMeasurable deliverables are achieved at any length of placement - from day one through sixty

› 80% of families will fully comply with family preservation/parent education programming

› 75% of families will be successfully reunified following completion of parent ed/family preservation program

› 100% of successfully reunified parents will have a reduction of abuse and neglect indicators scored through the AAPI assessment

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Parent Education Outcomes

AAPI Provides Curriculum FocusResults of the AAPI assessment tool provide an individual curriculum for each and every parent enrolled in our Parent Education program.

Five AAPI construct areas:› Appropriate Expectations› Empathy› Discipline› Appropriate Family Roles › Supporting Children’s Power and Independence

The classes build on both parent strength and identified growth areas.

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Parent Education Model

Each curriculum topic addressed in the one-on-one session is followed by unique hands-on reinforcement

Traditional parenting programs offer group classes one time per week for participating families; the Providence House program is an intensive program offering individualized classes 2-3 times per week.

It’s all about Hands-OnEach curriculum topic addressed in the one-on-one session is followed by unique hands-on reinforcement

› Activities done with the parent’s own child allowing for:

• modeling• practice • observation • assessment• feedback by the Family Programming Specialist

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Program EvolutionGroup Education› Inspired by parent feedback› Launched August 2007› Topics include nutrition, domestic violence, family literacy,

career planning, budgeting, and child safety.

Family Meals› Dinner or Brunch offered once a week.› Occurs prior to group education classes.› Parents share a home-cooked meal with their children in a

group setting with meals served family-style.› Allows for visitation and normalizes the environment for

parents with children placed at PH.

Parenting Technique Response

I have learned new parenting techniques as a result of this parenting session

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New Skill Application

I feel able to apply the skills I have learned in today's session in my day to day parenting

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Empowering Parents

I feel empowered by this session to be a more nuturing parent

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Parent Satisfaction with PH Parent Education Program

Overall, I am satisfied withthe parent education Program at Providence House

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Parenting Satisfaction Response

Peer MentoringChildcare Workers provide double duty, as they are also the assigned childcare workers for children in placement.

Peer mentors share with parent/guardians:

› Updates on their children’s daily care› Nutrition,› Behaviors› Development

Behavior management techniques

A listening ear and understanding to parents that are in need of reassurance and non-judgmental support.

Peer mentors have scheduled time with their assigned families once a week and more frequently as needed.

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Parent Satisfaction with Peer Mentoring

0% 10% 20% 30% 40% 50% 60%

Most Satisfied

Satisfied

Average

Somewhat Satisfied

Least Satisfied

Parent Satisfaction with Peer Mentoring

Collaboration and Referral for

Community Linkages

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Individual Service Plans developedby Licensed Social Workers

Individual Service Plans outline objectives for successful reunification › Families must participate in goal development in weekly

case management meetings with a licensed social worker› Referral source collaborates in drafting the family’s goals

through continued support of the family as well as weekly contacts with one of the agency’s licensed social workers

› Objectives and goals are established to enhance family functioning

› Identifies referrals needed to reduce the current crisis› Reviewed twice during placement to allow for more

comprehensive discharge planning and wrap around services

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Team Meetings

Facilitate collaboration between the family and all engaged social service providers› Meetings are conducted on-site at 30 days and at discharge to

review service plans› Licensed social workers, childcare supervisors, referring agency

workers, and other socials service representatives to assure consistency of care and interagency cooperation and investment

› Provides a united support team for the family

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Long-term System to Support and Manage

Future Crises

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Do the children come back?

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Why they come back

After Care Communications

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After Care PlanningAfter care program provides ongoing support to families after children are discharged from the agency› Additional agency referrals› Extended contact and emotional support from licensed social workers

12-month post-discharge follow up and tracking› Admission, Discharge and at 1, 2, 3, 4 and 6 weeks following discharge › 3, 6, 9, and 12, months after discharge› First 6 months – agency initiated, Last 6 months – family initiated

Aftercare Tracking Report › Documents status of family situation, engagement of support services, active family

needs, family progress – employment, housing, education, etc.Interesting ways to engage families and keep them in contact› Contact by phone or in person› Vouchers for Gift in Kind following a completed contact› Assesses client satisfaction with programming elements

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Aftercare Program Benefits / Outcomes

The benefits of the aftercare program are determined by all of the families’views on the family education program, their ability to use the program to meet their basic, unmet needs, and their use of the referral services provided.

127 families participated in aftercare interviews for this program. 100% were given material items to support them in meeting the basic needs of their children.

Referrals were made for 91 families to housing agencies, community shelters, child development and counseling supports, parenting support groups, and family counseling agencies.

This represents 100% of the families that indicated a need and interest, at the time of the aftercare interview, to engage community services for ongoing support beyond the scope of Providence House’s range of services.

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Aftercare Program Contact and Satisfaction

Satisfaction Questions and Average Responses on a likert scale of 5 being most satisfied

I feel that the parent education classed increased my parenting skills - 3.8

I feel that the classes met my family's individual needs - 3.9

I feel that the classes and the program are culturally competent - 3.9

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Crisis Nursery Outcomes of Service

For Children and Families

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OutcomesMore than 150 medical visits were provided › No cost to parents; either billed to insurance or Providence House is

the guarantor funded through foundation requests

Over 17,700 meals & 11,800 snacks were served

Nearly 40,000 diapers were changed

More than 1,000 outfits were given to children along with shoes, blankets, toys and books

ASQ Developmental Progress

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Average Change in Scores from Pre to Post Test

2.892.22

3.173.173.32

0.000.501.001.502.002.503.003.50

PersonalSocial

Comunication Gross Motor Fine Motor ProblemSolving

Family Preservation Outcomes

The End Result:Preserving the Family

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Discharge Placements

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Trend Data: Family Reunification - 5 years

Stating The Value:

The Human and Economic Impact

of Crisis Nursery Care

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A 2006 Friends Resource Center Study highlights the benefits of Crisis Care:

15% of families had placed dependent family members in out-of-home foster care prior to receiving respite› Only 3% had placed family members in out-of-home care since receiving

crisis care or crisis respite

82% said that the availability of Crisis Respite reduced the risk of harm to their child(ren) to a “very” or “extremely”high degree› 20% of caregivers would have left their child(ren) with an inappropriate

caregiver› 20% of caregivers would have kept their child(ren) in an inappropriate

situation› 2% of caregivers would have left their child(ren) unattended

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11% of caregivers said they would have requested out-of-home placement for their child(ren) were Crisis Respite not available› An additional 36% said that it was “moderately” to “extremely” likely that

their children would have been placed in out-of-home care by authorities, were Crisis Respite not available

91% of caregivers said they felt their child(ren) were “very” to “extremely” safe while receiving respite care

Prior to receiving Crisis Respite, 24% of caregivers rated themselves as “extremely stressed, and an additional 46% rated themselves as either “quite” or “very” stressed[1]

[1] Friends National Resource Center for CBFRS Programs, Fact Sheet Number 9, Benefits of Planned and Crisis Respite Care

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Providence House vs. County Child Welfare System

In a review of outcomes of traditional long-term foster care placements within Ohio versus the results of Providence House a dramatic disparity exists in the rates of reunification.

Providence House 2008-09 reunification rates are more than triple the State of Ohio and Cuyahoga County DCFS average*

At Providence House, 100% of our children were reunified with their parent or kinship provider in 2008-09

The average length of stay for a child was only 27 days. This is:› 80% higher than the rate of reunification for the State of Ohio in 90% less

time› 88% higher than the rate for Cuyahoga County in 95% less time

* 2005 most current data available N

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Crisis Nurseries Reunify Children Faster than Traditional Foster Care Systems

Crisis Nursery care vs. Traditional Foster Care

The Providence House average length of stay in is 27 days based on 2007 placement data. › 22% of our children are placed for the full 60-day period › 78% are in care for periods 24 hrs to one month.

At the state level:› 90% of children (91% in Cuyahoga County) in foster care are still in out of

home placements after 6 months*; a period 90% longer (95% in Cuyahoga County) than the average residential crisis care placement at Providence House.

› In the per diem foster care payment model, this represents a difference of millions of dollars in care for a short term crisis nursery placement versus long-term out of home care.

* 2005 most current data available N

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Crisis Nurseries Reunify More Children than Traditional Foster Care Systems

Economic Impact ofCrisis Nursery Care

The direct and indirect costs of child abuse and neglect to the State of Ohio are $3.8 billion and $375 million in Cuyahoga County alone.

› Crisis Nurseries stabilize family crisis and align them with support services helping to keep the family together and children out ofthe foster care system.

A number of states have enacted legislation to license Crisis Nurseries and are seeing successful economic outcomes.

› New York has reported a savings of $14 million in children’s’services costs and $40 million in related adult services annually –all because crisis nurseries PREVENT children from entering the system long-term

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To estimate similar savings for Ohio, we can utilize the national average cost for family foster care ($47,608) and the average length of stay at Providence House versus the average length of stay in family foster care in Ohio. In this forecast, we can expect a savings of:› $31,825 per child versus the State› $66,389 per child in Cuyahoga County› Annually, an average of 120 families served at Providence

House represent a savings of nearly $10 million to Cuyahoga County

Savings to the localCounty Children’s Services Department

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Crisis Nurseries Cost Less than Traditional Foster Care Systems

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Confirming the Case:

Crisis Nurseries as a Differential

Response to Foster Care

A Long-Term Case with CaseGroundbreaking study project led by Case Western Reserve

University’s nationally recognized Mandel Center for Nonprofits and Mandel School of Applied Social Sciences to examine the long-term impact of crisis nursery services on at-risk children and their families.

First of its kind nationally to analyze the long-term impact of intensive crisis nursery intervention on at-risk children and families in a client by client match against public child welfare system data over a five year period.

Our goal is to raise awareness at the local and national of the impact of crisis nursery services for at-risk families as a viable alternative to foster care (differential response) and assess the capacity for replication

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A Long-Term Case with CaseThe studies that will examine the long-term outcomes of Providence House program services on clients:› How served vs. unserved children engaged public system› How “doses” of more intense services impacted engagement › What long term strategic opportunities does this model

present for the child welfare industry

The study is being anxiously awaited by many child welfare leaders across the country as each continue to assess programs which may finally offer relief to families in crisis as well as the overburdened public agencies and systems struggling to meet the overwhelming needs – and costs – of serving at-risk children and families

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Funding Crisis Nursery Care

Pricing your Services for

Fees or Fundraising

Using Your Data to Establish Value

Pricing Your Product

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What’s the Cost?

Help to break down costs of services into measurable and affordable price units for clients or funders:

BenchmarkingTime studiesCost benefit techniques

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The Unit Cost of Services

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Selling the Impact of Support

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Services Count

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A Piece of the Pie

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Where Does the Funding Come From?

In fiscal year 7/1/08-6/30/09 our funding breakdown on a $1.7 Million budget was:› Individuals 43% - direct mail, special events› Foundation 21% - grants› Estate Gifts 19% - planned giving program› Company 12% - sponsorship, events› Groups, Schools, and Churches 3%* - direct mail, events› Public/Govt. Funding 2% - down 17% from 07-08

*Nearly $200,000 of gifts in kind are not reflected in this percentage.

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Say it Quick… Say it LoudHighlighting Key Data in Funding Requests› Start at the cover letter!

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Our Next Steps in

Sustainability and Service

Trauma Informed Care ModelLaunching a Trauma Informed care model in 2990-1010 to:

› Integrate philosophies of care that guide clinical interventions› Are based on current literature › Are inclusive of the survivor's perspective› Are informed by research and evidence of effective practice› Recognize that coercive interventions cause traumatization and re-traumatization

and are to be avoided

Until recently, trauma exposure was thought to be unilaterally rare (combat violence, disaster trauma) Recent research has changed this. Studies done in the last decade indicate that trauma exposure iscommon even in the middle class

› 56% of an adult sample reported at least one event› 90% of public mental health clients have been exposed› Most have multiple experiences of trauma› 34-53% report childhood sexual or physical abuse› 43-81% report some type of victimization

NASMHPD Medical Directors and NRI, Inc.

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Trauma Informed Care Model –Respite & Crisis Nursery Implications

Here is a small sample of triggers unaddressed in non-informed care models that can re-traumatize a client:› Bedtime › Room checks › Loud noises› Darkness› Lack of privacy› People too close NASMHPD Medical Directors and NRI, Inc.

Many of these occur regularly in a crisis nurseryHow many happen in your respite program?

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A Children’s Village

Main Entrance / Adult EducationWest 32nd Street

A Children’s Village

Children’s Houses

Site Plan

First Floor Plan

Village BenefitsIncrease from 26 to 40 beds for children’s emergency shelter – a 45% increase

in placement capacity to address waiting lists of 50+ children and 1,000+ days a year.

Increase in age range from 0-5 to 0-10 year olds, to support increasing demand for older sibling placements, who often serve as caregivers for younger siblings in families who utilize Providence House services.

Ability to support on-site medical assessment, treatment, therapies and residential sick care to children at Providence House.

Ability to offer community-based enrollment in our Award-winning Parent Education/Family Preservation programs to meet demand from our referral agencies.

Capacity to meet demand for community enrollment in our CDA/CEU accredited Early Care Provider education program - currently offered only to Providence House families and staff.

On-site access to critical community support services such as housing, job placement, domestic violence, mental health and substance abuse counseling services in a new “no wrong door” Family Support Center to assist in removing common barriers to stabilizing families.

Business Venturing

A new 18-month Strategic Directions Planning Effort is underway to identify opportunities for the agency to develop a more sustainable and self sufficient revenue model.Considerations include:› Expansion› Replication› Differential Response (foster care diversion) demonstration funds› Fee-based programs› Earned income models(consulting or copyright content models)› For-profit businesses launched as agency revenue feeders

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The Key to Our Success:Doing the Next Right ThingProvidence House continually assesses its risk, quality, and performance in every area of the agency› See samples at Breakout E-1 tomorrow: Risk and

Response in Crisis RespiteThis results in constant improvement, accurate data-driven decision making, and credibility among our fundersWe are always striving to “do the next right thing”for our children and families

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Question and Answer Session

Cleveland, Ohio - www.provhouse.org