Thursday, December 15, 2016

What’s in a word? The challenge of “infrastructure” funding

By Lise E. Fried

Status of nonprofits
Donors and funders often want to know how much of a nonprofit’s revenue was spent on “infrastructure” or “overhead.” Donors and foundations want to fund “programs” not “infrastructure.”  But, how can programs exist without infrastructure?  At home you pay for heat, light, furniture, etc, and we have to do so at nonprofits too.  Restaurants have to pay for staff to order supplies as well as produce pizza.   It is the same for nonprofits.
I participated in a recent webinar by Guidestar 1 that showed some fascinating data on nonprofit status collected by Bridgespan.2  Some of the data are based in an important article, “The Nonprofit Starvation Cycle,” published in 2009 in the Stanford Social Innovation Review .3  It did not surprise me that in 2014, 24% of nonprofits were “in the red.”  What was more compelling was that the twenty nonprofits that Bridgespan studied spent between 21% and 89% of direct costs on “infrastructure.”  Back in the 1950s, the federal government believed that 15% of direct costs should be the overhead (infrastructure) goal for nonprofits. It was a myth and the federal government no longer believes 15% is appropriate.  It is a rare organization that can survive on that percent.  And, more importantly, as shown in the article mentioned above “infrastructure drives impact.”  So, spending little likely means accomplishing less than the organization could if it were better funded for core dollars.

Measuring impact

The Institute for Community Health (ICH) is a sixteen-year old participatory evaluation and innovative research nonprofit creating sustainable community health. ICH is moving from a primarily donor-funded infrastructure to infrastructure funded as part of the cost of doing business on grants and contracts.  For ICH, funding for infrastructure has always been an issue.  We struggled for years to show our donors the impact of their dollars. Their dollars paid for the organization to exist, lead, manage, pay rent, and more, all of which drives impact.  Moving to explaining this same issue to foundations and other funders, we have a similar challenge.  Again, it is not that different from a restaurant that needs staff to make food and management to run the restaurant.  We need staff to run our programs and staff to manage the organization.

Language of impact

I agree with other participants on that recent webinar that part of the problem is the word “infrastructure.”  We all agreed that some other terms might be better – “core funding” got the most votes.  Federal (and other) grants call it “indirect”, some call it infrastructure, but it all means the same thing.  Terms that highlight the fact that these costs are part of the work and not a separate set of costs make more sense.


Ultimately, what matters is impact.  Has a nonprofit organization helped anyone?  If so, how many people and in what ways?  Have we met our goals? If yes, then organizations funding the work that led to that impact should help pay the core funding dollars that made it happen.

1.       Tips, Tricks & Secrets to a Successful GuideStar Profile  (

2.       Eckhart-Queenan J, Etzel, M, Prasad S.   Pay-What-It-Takes Philanthropy, Bridgespan

3.        The Nonprofit Starvation Cycle, Stanford Social Innovation Review, Fall 2009


Thursday, October 27, 2016

Using photovoice to engage participants in qualitative data collection

By Ranjani Paradise

My Camera. Paul Reynolds, 2006, (Flickr).
Used under Creative Commons Attribution 2.0
Here at ICH, we do a lot of qualitative data collection as part of our research projects, program evaluations, and needs assessments. While we often use traditional methods such as interviews and focus groups, we also use photovoice as a creative and fun alternative to traditional qualitative data collection approaches.

What is photovoice?
Photovoice is a method that originally came from the world of participatory action research. It was first used by Caroline Wang and Mary Ann Burris in 1992 to empower women in a rural Chinese village[1] and is now used to explore myriad topics in a variety of fields. With photovoice, participants take photos to represent their perspectives about a particular issue, and the photos are used to stimulate discussion, reflection, and action.
What are some of the unique advantages of photovoice?

Photovoice is a great method for engaging participants and creating a safe space for open discussion. In our experience, photovoice can help you:

  Empower participants and give them a unique mode of expression

  Catalyze dialogue and reflection about personal and community issues

  Understand issues from others’ points of view

  Share participants’ stories in a compelling, visual way with leaders, policymakers, or others

How have we used photovoice at ICH?

At ICH, we have used photovoice as part of our evaluations of several programs, including:
  • GRO: A gardening program for immigrant and refugee families in the Boston area
  • Pathways to Family Success: A program for immigrant parents in Cambridge, MA to help them better understand the U.S. school system and support their children’s education
  • Young Men Matter Too!: A sexual health program for young men of color in Springfield and Holyoke, MA

As you can see, photovoice can be used to explore many different topics with many different populations!
Photo from the GRO photovoice project
“I took this picture because this man was walking in the street and smelled the basil. He said that every time he pass by he smells the nice smell of the basil and he needs this green. He likes this green.”
Photo credit: Amina Osman, Refugee and Immigrant Assistance Center
Want to learn more?
For a great introduction to the photovoice method, check out Caroline Wang’s paper entitled “Photovoice: A Participatory Action Research Strategy Applied to Women’s Health” (Journal of Women’s Health 8(2), p. 185-192, 1999).  
ICH will be presenting our second photovoice webinar in the spring of 2017, which will include a practical, step-by-step guide to conducting photovoice projects. Here’s what participants had to say about our first photovoice webinar, which we presented last spring:
“It was a very informative and well conducted webinar.  Thank you so much!”
“The webinar was well organized and informative.”
“It was useful and well presented.”
We hope you’ll join us for the 2017 webinar - keep an eye on our website for more information in the coming months!!
[1] Wang, C., & Burris, M.A.. Chinese Village Women as Visual Anthropologists: A Participatory Approach to Reaching Policymakers. Social Science & Medicine, 42, p. 1391-1400, 1996.

Thursday, September 29, 2016

Behavioral Health Integration and the Workforce: the Cambridge Health Alliance Experience

By Leah Zallman, MD, MPH

Behavioral health integration has caught the national eye for its potential to improve patient outcomes and patient satisfaction, in addition to reducing costs.  Behavioral health integration is a healthcare delivery approach that is geared towards addressing mental and behavioral health concerns in primary care.   Early success of these programs has led to increased attention to the immense need for developing a sufficiently and adequately trained workforce to deliver integrated care. Indeed, these programs require large investments in the workforce, and the work of integration requires a cultural shift in how healthcare institutions care for their patients.  And yet, relatively little attention has focused on how the workforce is responding to the work of integration – to what degree the workforce feels more supported in caring for patients with mental health conditions, is more satisfied with their work, or alternatively, is more burned out by the high levels of effort this entails.

 Informed by 25 years of care integration, one of our partners, Cambridge Health Alliance, has embarked on an innovative and extensive behavioral health integration program.  We have been working with Cambridge Health Alliance to better understand how this program is affecting their workforce through annual surveys of their primary care and behavioral health staff. Together, we have learned that primary care providers feel more knowledgeable about how to care for these patients, across a variety of measures. We have also learned that staff report higher degrees of systems integration –for example, more primary care providers report talking with their mental health colleagues on a regular basis, which is mirrored by an increase in behavioral health providers’ report that they speak with their primary care colleagues on a regular basis. 

First and foremost, this experience has highlighted the power of a well conceived and enacted program, like Cambridge Health Alliance’s behavioral health integration team, to change the workforce experience.  And it has also highlighted how thoughtful, prospective evaluation of the workforce experience can provide programs like Cambridge Health Alliance with meaningful data that helps shed light on the workforce experience.