Co-Designing a Thriving Family Life

Families in the United States today are struggling. Child care costs, already 10 percent of a married-couple family’s average annual income and 35 percent of a single parent’s income, continue to rise at a faster rate than inflation. While trending down, the median rent is still close to $2000 per month. And inflation remains high, which makes day-to-day expenses harder to afford.

These issues are even more acute for families with young children. Families with children ages 0-5 are more likely to live in poverty and to engage multiple public systems at once. The average two-parent household experiences a 14 percent drop in income while single parents, especially women, may have to withstand an up to 36 percent decrease.

When parents seek help from the government, federal, state or local, they are met with overwhelming administrative burden, which can prevent them from accessing the support they need. Without this help, families are more likely to remain in poverty. A family’s low socioeconomic status could have a severe, negative, and long-term impact on a child’s wellbeing. Research shows that children living in poverty are at risk of a wide array of issues, from health problems and a lower life expectancy, to increased chance of child abuse and academic difficulties.

It is critical that we develop a robust policy response to support parents and kids who have been cut out of opportunity and prosperity. To do this we must better understand how we can help families with young children thrive.

The field of public health has long been concerned with factors impacting lifespan and health outcomes, but with a historic focus on hygiene, epidemiology, and disease prevention. It was not until the 2000s that social determinants of health emerged as a distinct group of variables in improving longevity and quality of life. In 2005, the World Health Organization convened a commission to better understand social determinants of health, and in 2008 reported out on what factors contribute to health equity, and what can be done about it. Since then, the field has expanded to incorporate related concepts such as well being, thriving, and flourishing to help understand quality of life, as well as multiple frameworks and indexes to help measure it.

Despite the proliferation of research on human thriving, the United States has been slow to adopt such a framework. Given poor outcomes and high spending in health care- the U.S. outspends peer nations by several thousands of dollars per capita, with the lowest life expectancy to show for it. The Office of Disease Prevention and Health Promotion has developed a Federal Plan for Equitable Long-Term Recovery and Resilience (Federal Plan for ELTRR) to improve health equity in the United States among individuals and communities.

Between the census block and the individual is another important unit of study: families. Stanford’s RAPID Survey Project has begun important work examining the experience of households and families in response to the Covid-19 pandemic. Given the New Practice Lab’s focus on improving the lives of low-income families with young children, we are interested in adding to the body of knowledge of what good would look like. Engaging deeply with families to learn what factors contribute to their own thriving, and what obstacles stand in the way, will build on existing research and add new resources for policymakers and government implementers to draw from.

New Practice Lab has created a co-design workshop that explores a vision of what it would look like for these families to thrive and what support they would need to achieve that. Co-design is the process of engaging the users of products and services in the design process, with the idea that this will ultimately lead to improvements and innovation.

We believe families know a great deal about what they need, and a co-design approach allows those with lived experience to uniquely speak to the ways that public programs and social issues intersect and interact to impact their lives. [1]

Through this deep engagement with families, we will learn about what families need to thrive and anticipate the resources they need to be happy and successful during a variety of phases and life events. Our family-centered learning will both inspire the Lab’s delivery improvement projects in the current policy landscape and also inform our actionable recommendations for necessary and long-overdue systems and cultural transformations.

In keeping with the Lab’s ethical standards, participants receive a financial gift for their intellectual contributions and are invited to offer feedback and corrections on the work the Lab publishes. We also provide on-site child care so that there are fewer barriers to participation.

To date, we have conducted 4 co-design workshops with 35 people from families with a wide variety of backgrounds and experiences, including families from a variety of racial and ethnic backgrounds, those that live in rural, urban, and suburban communities, and have lived experience with a broad swath of social welfare programs across the federal, state, and local levels. Here are some things we’ve heard from families so far. Please note, all participant names have been changed.

Parents Are Overwhelmed and Struggling On Their Own

We heard that mothers in particular feel they have a never-ending list of things to do. They want more support from partners and don’t have community connections or support. Many families can feel isolated and have a hard time connecting with others in their community in a meaningful way. According to a recent Pew study, a majority of those with children 0-5 (57%) say being a parent is tiring all or most of the time.

“My brain is always going: this is what we need to do…when I get off work, I have to go here, I have to do this, I have to pay this, this, this, this, this, this... And when I finally get home, I'm dead.”

– Bianca, rural Minnesota mother of 1

Immigrants Strive to Find a Balance Between Two Cultures

Parents are eager for their children to take advantage of all the opportunities of the U.S., but want to make sure they stay connected to their heritage.

“Where I am from, there is a dialect in El Salvador that has practically ceased to exist… I think it would be the same as what we’d be doing here, if we deny our children the ability to learn Spanish. We ourselves are eradicating our language, because I know that English is spoken here and it takes a lot of focus, but they are also a new generation that is coming up and can change the system.”

– Enrique, rural Minnesota father of 3

Parents Need Trusted Child Care With Extended Hours

Before parents can pursue new skills, returning to school or even leisure time with friends, they need to know their children are being cared for. That is out of reach for many families, in part because of skyrocketing costs, likely to increase even further as pandemic programs come to an end. Many families expressed skepticism about the quality of care available to them, often based on past experiences and especially when a child had special health needs. A service would need to be transparent and proactive about anticipating needs for a family to trust it.

Families the Lab connected with during the co-design workshops will continue to share their experiences and dynamic support needs as their children grow. Over the course of 18 months, participating families will record their experiences using an audio-visual diary entry technology, allowing them to share valuable insights with flexible and minimal time commitments. They will also periodically meet with researchers to reflect on overarching feelings and experiences.

Based on the learning the Lab will gain from the workshops and diary study entries, and with feedback from the families, we will begin to craft a blueprint for what the social safety net could look like if it was encouraging families to thrive. We also continuously share with our government partners to explore ways to address the challenges that families mention sooner than later.

[1] We have learned from the work and received feedback from Hilary Cottam who has run large-scale co-design sessions with families and workers in the UK.