On: October 29, 2021

Nearly six months into a three-year guaranteed basic income pilot to help first-time mothers get off on a strong foot, we’ve learned a few lessons about what it will take to go to scale. 

Five and a half months ago on Mother’s Day 2021, we enrolled our first mom-to-be in the Family Health Project pilot. She was one of 15 young women in Lynn, Mass., living in poverty and about to have their first child. Each would receive $400 a month for three years to use as they needed. 

The goal of the pilot program is twofold. First and foremost, we hope the $400 each month will help these young mothers invest in their baby’s early development at this critical juncture in their lives and lift them out of the harmful grip of poverty.  

Second, we want to test  this model in the most authentic way, by actually operating it, so we can perfect it, thereby taking it to scale and reaching thousands of young mothers at a diminishing cost per person. Scale is critical to public health efforts like these, but it is still far too rare

To “go to scale” is an iterative, fail-fast process. The task is to figure out how to scale while you’re scaling. In fact, if something works well you can count on the fact that you’ve messed up but you just don’t know quite how yet.  

In that vein, below are the lessons we’ve learned so far. 

But first, the elements that, in theory, should make the Family Health Project scalable. Importantly, in each case, we did not hire or train new professionals. We have no overhead, no payroll; we have no offices. We rely on the expertise of others who do their job well.

The Elements of the Family Health Partnership That Make It Scalable

Element 1: The first critical element is the referral process because as Family Health Project founder Joe Knowles put it, “You can’t just put up a billboard and ask people who want money to contact you.” We use a referral source that, importantly, is found nationwide—a Federally Qualified Health Center (in this case, Lynn Community Health Center). FQHCs serve more than 30 million low-income patients and operate in every U.S. state—reach that will be critical to scaling. The referral is simple and adds only minutes to an already planned meeting with a caseworker during the woman’s third trimester of pregnancy. 

Element 2: A social service agency (in this case, Wellspring) to support the mothers in other aspects of their lives and to act as a human touchpoint for them. Wellspring has more than 40 years of experience as a hands-on, in-depth service provider. Wellspring caseworkers are also accustomed to working with an individual for longer periods of time, which in the case of our young mothers will be three years. That span gives Wellspring an opportunity to help the mothers get established in life, with a job or education or other supports. 

Element 3: A scalable way to deliver the money, in this case via a debit card company that specializes in digital transactions without requiring Social Security numbers, which would otherwise prevent undocumented women from participating.

On paper at least, it should work.

Lesson 1: Referrals. If you don’t set up a system that randomizes the caseload, it won’t happen.

After 5 months, we had referrals for 15 women, our cap at the time. But rather than being a group of women from different backgrounds reflecting the diversity of greater Boston, or even Lynn, all 15 were from Central America and spoke only Spanish, and they all were in dire need. 

It turns out that caseworkers will, by their nature, refer those with the most need first, and in this case, one of the two caseworkers worked extensively with Central Americans–thus the preponderance of Spanish speakers. 

While it seems imperative to help those with the most need, more caseload diversity ensures those who need the most attention will get it if not everyone is having the same issues at the same time. The Spanish-speakers also required us to invest in translation technology, including texting and telephone programs. Wellspring has also stepped up their timeline for hiring a native Spanish speaker.

Solution: We are still determining how best to randomize the referrals, but one option is to refer those who show up for, say, the 9 a.m. and 3 p.m. appointments one day and the 11 a.m. and 2 p.m. the next. 

Lesson 2: Face-to-face relationship-building is critical

For a variety of reasons, the young mothers’ first reaction to hearing we are giving them $400 a month is “are you for real?” They are wary of no strings promises, and because of this group’s immigration standing, they are doubly leery of “officials.” 

“We built in a fair amount of in-person contact in the first few weeks,” said Dimond, in order to assuage doubts and build trust. 

Wellspring staff also spend time explaining how the $400 a month income bump will affect any other government supports they are receiving. A rise in income can mean the loss of other programs like food stamps or housing vouchers. Family Health Project had managed to secure a special state waiver from such “benefits cliffs” in all programs except housing. Two women chose to not participate because they would lose their housing support.

Lesson 3: Don’t assume recipients are familiar with debit cards

Coaching and tight communication are essential in using the debit card. Wellspring spends considerable time explaining how to avoid bank fees, how to set up passwords (and what to do if you forget it), and even how to use an ATM. Some of the moms are quite young (the youngest is 16) and have never had an ATM card. About one-third needed hands-on coaching, said Dimond. 

The most unexpected lesson came from lost passwords. It’s a common thing, of course. Forget a password, try one too many times with a guess and get locked out, followed by a bank’s email alerting you to potential fraud. But for an undocumented woman from Central America, a big red “fraud” message from an official sends her underground. The team learned that delivering the debit card in person one month before the baby is born offers a chance to explain what to expect and walk through any hiccups face to face. The caseworkers also reassure the women that this is not a bank account in their name, that a Social Security Number is not required and everything remains anonymous. 

Wellspring also learned that having access to the woman’s account allowed staff to trouble-shoot when problems arose. Rather than calling customer service, which can be overwhelming, the moms can call Wellspring for help. “Call us first,” is our first line of defense, Dimond said. 

These are just the start of the lessons we’ll be learning from and adjusting as we go, all with the aim of helping increasingly more young mothers and their babies secure their futures. Stay tuned as we continue to learn and adapt.