Shaping policy through advocacy

Tym Rourke and Charitable Foundation President and CEO Richard Ober will be speaking at the Center for Effective Philanthropy’s Conference in May. They will be joined in a session on “Foundations and Policy Leadership” by Community Foundation of Greater Flint President and CEO Isaiah Oliver and Melville Charitable Trust Senior Program Officer Susan Thomas. This article originally appeared on the Center for Effective Philanthropy’s website.

In a way, we did things in reverse.

Compared with how funders usually enter into policy work, our order of operations was…the opposite. At the New Hampshire Charitable Foundation, we did not start by funding pilot projects and community work in substance use prevention, treatment and recovery, and then (acknowledging that changing policy was the best way to address problems at their roots) start funding advocacy.

We started by funding advocacy.

I had not yet joined the New Hampshire Charitable Foundation when Oliver Hubbard, a chicken farmer and poultry breeder from Walpole, New Hampshire made the first part of a multi-stage, $43 million gift to combat addiction by shaping public policy.

I was working in prevention. And I remember the reaction among people in that field: It was something akin to rage. What do you mean this huge windfall of money will not immediately fund programs and services?

But Hubbard, dismayed by a lack of state leadership and funding for this issue, had made the gift to make a difference at the public policy level, to make lasting and meaningful change on this incredibly complex issue.

One significant complicating factor: there was no nonprofit policy shop working on substance use issues in New Hampshire.

So the Charitable Foundation – with counsel from an advisory group that included the state attorney general, experts in prevention and treatment, physicians, people in recovery, legislators, and a consultant from the nation’s largest public-health philanthropy – launched one.

That organization, New Futures, has over two decades:

• Increased understanding, shaped public policy, transformed the way services are funded – and helped save lives.
• Played a key role in the passage of Medicaid expansion in New Hampshire, which gave more than 50,000 people access to health insurance that included coverage for addiction treatment.
• Played a pivotal role in the creation of a dedicated state funding stream for treatment, prevention and recovery (at the time of Hubbard’s gift, only $25,000 in state funding went toward prevention or treatment – instead, any limited services available were funded with federal pass-through funds and most health insurance plans did not include coverage for substance use disorders or other behavioral health care.)
• New Futures was instrumental in the passage of laws that have helped protect New Hampshire’s young people, and expand service coverage for thousands of citizens. And New Futures has trained hundreds of citizens to advocate for policy change. Hubbard’s gift continues to support that work.

The Foundation’s policy and systems-change work has been multi-layered, always built on partnerships across all sectors – public, private, nonprofit – and much of it done in the public square. The public square can take some getting used to.

When I joined the Charitable Foundation in 2008, more than a decade after Hubbard’s initial gift, I was a member of the Governor’s Commission on Alcohol and Other Drugs. Shortly thereafter, then-Governor John Lynch asked me to chair that commission. The Foundation’s leadership team and board recognized that the best thing we could do to affect positive change for the state was to dedicate our time and leadership to that position. While this was not completely unfamiliar territory for the Foundation – CEO Richard Ober had chaired the state’s Energy Efficiency & Sustainable Energy Board while also on staff, and other staff had participated in similar bodies – it would become a far more high-profile and high-stakes endeavor than anyone could have anticipated. The onset of the state’s opioid epidemic put the commission in a white-hot spotlight.

For eight years, a significant portion of my time as a program officer was spent on that commission – mobilizing public will and public resources for big-systems change. I was frequently called upon to testify to the legislature and comment not just on statewide stages and in local media – but in the national and even international press. I became, for a time, the de facto state “drug czar,” (and don’t even get me started on how much I hate that term.) Sometimes, it felt like a high-wire act. I still sit on that commission, on which the Charitable Foundation now has a permanent seat.

From the start, partnerships have been key. The Foundation partnered with the state’s Bureau of Drug and Alcohol Services to establish the Center for Excellence in Substance Use Services, a resource in best practices, which provides critical support to the state’s regional public health networks and addiction treatment providers. That work resulted in systems being built and strengthened that put the state in a much better position to respond to the current opioid crisis than it would otherwise have been.

Our partnerships with the state have spanned six gubernatorial administrations – three republican and three democratic. Recognizing the need for a high-level state policy advisor on substance use issues, the Charitable Foundation funded the first year of a salary for that position to be created in the governor’s office. That position is now permanent and state-funded.

After beginning with policy, the Foundation began strategic grant-making in prevention, treatment and recovery – but we never dropped the policy lens. When we set about to launch a new youth substance use screening and intervention protocol in medical settings, we also funded advocacy to make sure insurance would reimburse providers for using it. Now, as we fund treatment programs for pregnant and newly parenting women, we also fund advocacy to reduce barriers so they can get the care they desperately need.

One direct result of this policy-first approach: far more dollars invested in the field than would have been though Hubbard’s gift alone. Since 1996, the Foundation has granted more than $40 million for prevention, treatment and recovery, including for advocacy and policy work. These efforts have helped secure more than $100 million in state resources to prevent and treat addiction and support recovery; bring in an additional $50 million to the state since 2009 alone in federal and private grants; and to inspire other generous people to contribute to the work. Hubbard’s gift is positioned to support this work in perpetuity.

The initial flash of rage at the Charitable Foundation’s decision to focus on policy first has dissipated over the past two decades, as evidenced, in part, by grantees’ feedback in recent Center for Effective Philanthropy Grantee Perception Report surveys. Grantees from our Substance Use Disorders program provide extremely high ratings for our effect on public policy — at the 100^th percentile in the dataset if we were to compare this program to the results of other foundations. These grantees’ perceptions of our impact on the field are also strong — in the 71^st percentile compared to other funders.

Now, we are applying what we have learned to policy work in other areas: narrowing the opportunity gap, promoting workforce development, pushing for increased investment in early childhood education.

We still face massive challenges. We’re still learning.

But we know that philanthropy can play a key role in ending America’s addiction crisis. Funding and engaging directly in advocacy that shapes policy are among the most effective and efficient ways we can do that.