Sonoma County Human Services Connects More People with Data to Drive Evidence-based Change

Sonoma County’s community-wide commitment to early investment in children, families and individuals increases positive outcomes and reduces societal, punitive costs.

Sonoma County is considered a travel destination due to its artisan foods, wine, and abundant green spaces. The Sonoma County Board of Supervisors is dedicated to ensuring this beautiful space is also a place where community members can thrive and does so by prioritizing local funding for early investment in the prevention of health and social problems.

Concerned that a growing share of the County’s general fund was going towards criminal justice costs, county officials decided changes must be made; they sought ways to “invest early, invest wiser, and invest together” to drive greater impact. So, in 2010, the Sonoma County Board of Supervisors chartered a collective impact initiative called Upstream Investments, which is dedicated to improving well-being and deescalating criminal justice costs through a results-based prevention model. Upstream Investment’s guiding principle is that all Sonoma County partners work toward advancing racial and social equity and uprooting poverty.

Making results-based accountability a reality

For the County to see real impact, they knew they needed to fundamentally shift the focus of policies, funding, and programming toward early-stage (“upstream”) investments. The method of determining where, when, and how to invest had to be evidence- and results-driven. To accomplish this, Upstream Investments focuses on several practical components of prevention programs and services that address well-being across a person’s lifespan. For example, Upstream staff provide frequent training and assistance to community-based organizations (CBOs) to enhance their program models and continuously improve their quality of services. It also develops relationships with funders and facilitates multi-stakeholder collaboration to ensure better coordination of services for program participants. Over the evolution of Upstream, this has been accomplished through strategies such as the Portfolio of Model Upstream Programs, training, and coaching.

Upstream also provides practical support to partners through the shared outcome measurement system, which is supported by Social Solutions Apricot 360 software. As of May 2022, Upstream Investments is connecting 22 CBOs, 21 schools, and many government agencies to this shared outcome measurement system, which they use for decision-making and continuous program improvements. Through an equity-centered, results-based accountability model, Upstream Investments is empowered to improve and expand programs with the highest potential to improve education, health, and economic well-being for people in Sonoma County.

Setting the standard for data use & collaboration

Sonoma County is on the cutting edge of data collection and application using Apricot 360. Its innovative shared outcome measurement system is opening the door for collaboration that will shift the focus from reactive to preventative and coordinated case management across all of its partner organizations while maintaining a strong focus on addressing inequities revealed by data and reports. Many organizations will find Sonoma County’s story inspirational as they lead the way on how to use case management software to bring like-minded groups together to accomplish shared goals. This case study outlines several tactical ways the County is utilizing Apricot to rewrite the rules on data usage and collaboration in the social good space.

Reaching a collective “North Star”

Upstream Investments focuses on innovative ways to provide data access to more organizations. A considerable amount of the social services organizations Sonoma County works with share common goals and objectives, such as improving educational attainment or care for foster children. Data sharing between agencies can be difficult for compliance and confidentiality reasons, but Sonoma County has successfully navigated how to share data between these like-minded groups by using data agreements that protect client confidentiality and maintain compliance requirements. In addition, Upstream Investments established multi-sector teams dedicated to certain prevention areas, such as early childhood intervention or violence intervention, and shares data across partners within those groups.

Upstream Investments works together under a collective impact model to align its resources and focus on a common goal. It determines how to measure the difference its CBOs are making and then shares those measures as a group. By working with like-minded groups, Upstream Investments’ performance measures are similar enough that it can help coordinate a focus on tracking the difference it’s making on a population level.

Broadening access to critical data

Upstream Investments works with many different-sized organizations in many different areas of interest. Some smaller partner nonprofits do not have the budget or expertise to gather data or interpret it. Upstream Investments provides a shared outcome measurement system and training to help these organizations access, analyze, and measure the critical data they need for their particular areas of focus.

The shared outcome measurement system is used in several early education initiatives, such as Sonoma County’s Road to the Early Achievement and Development of Youth (READY) project, a collaborative effort funded by First 5 Sonoma County.

READY is supported by dedicated Upstream Investments employees who help coordinate data sharing within the Apricot system. In the READY project alone, Upstream Investments coordinates data collaboration among 21 schools across eight school districts. They coordinate data entry profiling about 2,500 kindergarten students on things like parent surveys about at-home support, which they then use to determine readiness or predict intervention needs earlier in a child’s educational journey to reduce the chances of them falling behind in school. READY data is also used to identify opportunity gaps for families and inequitable access to early learning resources and supports the impact of how successful a child will be in school. Tracking these outcomes proved especially important during and after the Covid-19 shutdown as it helped the schools advocate for additional resources based on the decline in kindergartner readiness witnessed in the data.

Upstream Investments utilizes Apricot 360’s customized reporting capability to determine what critical data each nonprofit or partner agency needs the most. As the needs of CBOs shift, Upstream Investments can quickly pivot to collect the data that is most useful in that time and place.

One example of this is how data from kindergarten teachers is supplemented. Upstream recently committed to a larger focus on race, ethnicity, and gender, which is data collected through a parent survey and matched to teacher assessment data. This information, coupled with in-classroom observations by teachers, is compiled into one profile for each child and used to track disparities in kindergarten readiness by various demographic metrics. These capabilities allow Sonoma County to make stronger policy arguments when and where it is needed.

Thinking outside of the box

Sonoma County has redesigned its database to be completely participant-focused and is creating what it calls a “participant-centered system” built on the importance of strong data governance. By instituting the use of a universal underlying data element—including consistently collecting race, ethnicity, and other demographic categorical data—it can more effectively understand the individuals being served and get a better sense of their comprehensive needs at any point of their program involvement.

Upstream encourages every site within its system to adopt the new universal structure in order to continue with Upstream Investments. Moreover, everybody within Upstream Investment’s shared outcome measurement system will be encouraged to adopt the social determinants of health screen. This tool asks each client questions about their identity groups, family structure, economic status (e.g., employment and housing), and any needs related to material support such as childcare or food. This tool is critical to better serve its community as the screening results will help staff understand participants’ needs. This knowledge about needs can help case managers better coordinate service referrals and program managers better design programs that address presenting needs rather than imagined needs. By focusing on collecting the right data from the right people, Sonoma County can deliver on the real-time needs of its residents.

“That’s exciting for us as a human services agency because it means that we can anticipate what people need and better tailor our services and grant-seeking efforts to meet these needs.”

—Holly White-Wolfe, Upstream Investments

These universal profiles allow the County to know critical contexts of its clients across all of its systems, which leads to more comprehensive outcome measurement. Over time, these profiles will be able to paint a more detailed picture of families and communities on a larger scale. For example, metrics on a grade-school child can be analyzed under the context of their larger household (i.e., if their parents have been served by the Family Resource Center or other programs).

Upstream envisions using Apricot as a case management system that unifies many social service agencies so they can clearly see if and how their partners are making a difference as a whole group. Their results-based accountability model is one that many multi-sector groups could model and to which they can aspire. This case study highlights just one program of many to demonstrate how exceptional and unique Sonoma County’s application and utilization of data is. Soon, Sonoma County will scale up this model in support of COVID recovery. Human Services and partners will use the system to document and track the outcomes of $40 million dollars in American Rescue Act funding.

Along with scaling up the system to monitor the return on public investment, Upstream will help its partners advance racial and social equity by creating reports and dashboards that disaggregate outcomes by demographic groups. These Apricot reports will be essential to monitoring whether the recovery efforts benefit groups that were disproportionately impacted by COVID-19. Apricot is a vital tool for using data to make impactful decisions in Sonoma County.