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Case Study #12: Tapping the Power of Pro Bono

Case and Eli Lilly spread Give an Hour across the nation

In 2005, Barbara Van Dahlen was a successful child psychologist in Bethesda, Maryland. “I loved it,” she says, “but had a feeling I could probably take what I knew and apply it on a bigger scale to help more people.” During her training years earlier, Van Dahlen had encountered Vietnam veterans in mental-health centers. With all we’ve learned since then, she thought, surely the nation will be prepared for the psychological needs of those coming home from Iraq and Afghanistan.

After hearing news stories about returning veterans adjusting to civilian life, Van Dahlen decided that rather than just observing the process she might become a helpful contributor. Her solution was simple, and had deep professional roots: “Most of us in this field are encouraged to do pro bono work. I thought: I’d be willing to give a little bit of my time, build it into my practice.”

Why not donate some of her expertise every week, and ask professional colleagues to do likewise? Taken together, their individual contributions could amount to quite a substantial resource. With a little naming advice from her daughter, she founded Give an Hour (GAH).

Van Dahlen not only had a full-time weekly caseload of 28 to 30 patients, but also managed two offices and a team of associates. And she had daughters to raise. Yet Van Dahlen had always considered service to others as central to her life’s work. By the time she had the idea for GAH, she had already been volunteering her time for years, and loved donating her services to low-income families. “I assumed that there must be other clinicians out there like me who, seeing a need, would want to provide care. And if I made it easy for them to give, they would.”

Van Dahlen realized that if she could involve some of her fellow psychologists, counselors, and psychiatrists, her volunteer efforts could be repeated many times over, and many more veterans could be helped. That might well have ended as a private pipe dream. Van Dahlen had no background in managing charitable work. She had no funds to set up a network capable of matching veterans looking for guidance with professionals willing to donate their services.

Fortunately for the thousands of men and women who have since benefited from the services donated by Give an Hour, the Case Foundation of Washington, D.C., stepped in to help build a framework for spreading its volunteer mental-health services far and wide. “We invest in people and ideas that can change the world,” says Jean Case, who started the foundation with her husband, Steve, the co-founder of internet pioneer AOL. “Where something transformative has happened, there’s usually a great leader behind it,” she notes.

Case had known Van Dahlen and admired her organizing energy before Give an Hour was even dreamed up. “Barbara started with an idea, but she really needed to turn that into a concrete plan and begin to assemble a team. We are a foundation that is comfortable with that early stage of investment. We don’t just write checks; we surround organizations with resources and support in every way, connect them to people, and bring talent.”

Case saw promise in the idea of getting lots of professionals to each give a little. During her time as chair of the President’s Council on Service and civic Participation, she had previously recruited large corporations to donate pro bono help to nonprofits in certain high-skill areas like accounting and marketing. The Case Foundation didn’t become financial supporters of Give an Hour until several years into their relationship, but Jean Case made valuable introductions, especially on the organizational and computer technology fronts, that allowed Van Dahlen to gradually build her young nonprofit into a working national exemplar.

Getting mental-health professionals to donate an hour of time per week seemed plausible. The “risk in the business model,” as Case puts it, lay in matching them to veterans in their area. “How do we connect them with people in need?” asked Van Dahlen.

Their answer was an internet platform. Inspired by Craigslist, the informal online market for goods and services, they built a simple matching service. “If we can create something where we’ve got the providers on one side, and those in need have access to them, bingo,” thought Van Dahlen. She recruited a team that used open-source technology to build an online mechanism for matching veterans wanting help with mental-health volunteers in their area.

The seeker simply puts in his zip code and how many miles he is willing to travel. He can request general counseling, or zero in on any number of special areas (marriage counseling, child therapy, substance-abuse help, bereavement services, brain injuries, anger management, pastoral guidance, and others). He can make an appointment in an office or request telephone counseling. Providers are available in a wide range of health specialties, and both veterans and any of their household members are eligible for the free services.

When the volunteer providers register, Give an Hour confirms their identities, verifies their licenses, and checks for any problems in their professional records before allowing patients to contact them. If a patient has difficulty finding a convenient or properly specialized provider, Give an Hour works with him to find a professional he can consult by phone, or tries to recruit a new provider in an area where none exists.

“Even in places like Texas where we have hundreds of providers, we occasionally have niches where someone might have to drive an hour and a half to the closest volunteer,” says GAH program specialist Jess Grove. Grove manages the provider network, and arranges about 50 “warm handoffs” per month on average.

“I thought: I’d be willing to donate some of my time. Why not ask professional colleagues to do likewise?” –Barbara Van Dahlen

When she was recruiting volunteer professionals, one of Van Dahlen’s crucial early partners was Paul Burke, president of the American Psychiatric Foundation, the charitable arm of the American Psychiatric Association. When the two met, Burke was impressed with Van Dahlen’s “crystal-clear image. I was struck by the simplicity of the call to action: Just give an hour of your time, whether you are a psychiatrist, a psychologist, a social worker. I didn’t see anyone else doing that in an organized way.” With more than 25,000 member psychiatrists, the APA served as an ideal recruiting pool for Van Dahlen’s burgeoning army of mental-health donors. Within a year, the first 500 pro bono professionals were signed up.

The Eli Lilly and Company Foundation Takes a Chance

Give an Hour’s partnership with the American Psychiatric Foundation went beyond recruiting volunteers. The two organizations won a $1 million grant from the Eli Lilly and Company Foundation (Lilly Foundation). The money was provided to allow the two groups to conduct a national public awareness campaign, and help Give an Hour connect veterans to professionals.

As a major pharmaceutical firm, Eli Lilly has both deep expertise in mental health and a finger on the pulse of the medical community. In 2007, Lilly Foundation president Rob Smith recognized an opening for philanthropy—the burdens of war, including mental-health strains, fell on a small fraction of the population, and although many health-care providers wanted to contribute to the well-being of the military population, few had any available outlet.

A Lilly Foundation associate brought Van Dahlen’s work to Smith’s attention. “It was a great match with what we had been looking for—a systematic way to tap into talented people and give them an opportunity to give something back to help our soldiers and their families.” A major investment in a brand-new 501(c)(3) charity was, however, unheard of at the foundation at that time. Its two big philanthropic projects were five-year $30 million grants to well-established organizations combating diabetes and drug-resistant tuberculosis.

As a young organization, Give an Hour would be a risk. Smith received many questions from his board and colleagues. Yet “the more I interacted with Barbara, the greater confidence I had that this was not only a good idea, but that she had the skills and connections and credibility to pull it off,” he explains.

The Lilly Foundation played an important role in funding and counseling Give an Hour through the tricky process of “building supply and demand at generally the same time.” If the group had expanded its provider database without reaching out to potential clients at the same time, the mental-health professionals might have become disillusioned at not being engaged quickly enough. If client demand had been built up without sufficient providers, Give an Hour would have been in the terrible position of making promises on which it could not deliver. Yet keeping these two elements in balance was not easy.

With its three-year seven-figure grant from the Lilly Foundation, Give an Hour went to work. The partnership with the American Psychiatric Foundation led to alliance with more than a dozen associations of mental-health professionals, like the National Association of Social Workers and the American Psychological Association. Give an Hour was able to increase the size of its pro bono network from about 1,000 providers in 2008 to more than 6,500 in 2012, with representation in all 50 states. The cumulative number of counseling hours donated since founding increased from 1,400 in 2008 to more than 82,000 hours by the fourth quarter of 2012.

Give an Hour’s platform on the Internet allows patients to get services easily while maintaining personal privacy.

On the client side, Give an Hour used television and radio spots to mount a public education and awareness campaign. Around $2.5 million in donated media time was secured. Messages were ultimately aired on 300 television channels and 750 radio stations.

The Give an Hour model has two major strengths. It makes things simple for mental-health professionals to volunteer their time. And its open platform allows patients to easily get services without stigma, or approval from insurance or a physician, while maintaining personal privacy.

These same strengths, however, also make it hard to evaluate the program methodically. While each mental-health professional is responsible for tracking and treating Give an Hour patients just like any others in their individual practices, no patient data makes its way back to the national organization. Thus, official outcome assessments aren’t possible.

“I got a lot of pressure to have patients register with the national Give an Hour headquarters. But I said no—it has to be confidential and anonymous,” explains Van Dahlen about her hard choice. The relationship between individual patients and individual volunteers is direct and unmediated. The number of pro bono hours given is therefore how the organization measures its impact.

Beyond Matching Patients and Providers

In addition to its core mission of convincing mental-health professionals to donate an hour per week to veterans in a traditional clinical capacity, Give an Hour has also taken on some additional contributions. The group cooperates with the Wounded Warrior Project, a nonprofit that, among other programs, runs a call-in center for veterans. WWP refers its callers in need of mental-health services to Give an Hour, and Give an Hour trains and provides medical personnel as group counselors on WWP recovery trips.

Give an Hour has also provided mental-health volunteers to assist Team Rubicon, a service organization that uses veterans as first-responders after natural disasters. Van Dahlen’s group has also helped fellow nonprofit Student Veterans of America bring a mental-health lens to their work with veterans on college campuses. Give an Hour has also embarked on a project to offer 100,000 mental-health providers with specific training that will make them more effective with patients who have military backgrounds.

Early on, Van Dahlen received many questions about how her work meshed with what the Department of Defense and Department of Veterans Affairs were supposed to provide. Her answer? “We’re here to fill gaps—there are phenomenal clinicians at the V.A. and DoD, but they can’t be everywhere at once.” It’s not only geographic and convenience issues that make Give an Hour attractive for many individuals; there are also eligibility issues. Family members, for instance, often don’t qualify for public benefits, but Give an Hour is happy to counsel all.

Interestingly, government agencies have begun to approach Give an Hour about working together. Van Dahlen reports that in late 2012, “the Army National Guard reached out to me and said, ‘We have a problem—we have nowhere to refer some of the women and men who have experienced sexual trauma.’” With a memorandum of understanding in place, the National Guard now refers those whom it can’t help to Give an Hour’s network of providers. Similarly, the nonprofit now has a memorandum of agreement with the V.A. by which suicide coordinators can refer certain patients to Give an Hour for services.

In just the few years since its founding, the increases in pro bono time offered and taken up through Give an Hour have been impressive. From just 2010 to the end of 2012, pro bono hours jumped 25-fold. A conservative estimate of the value of the time contributed by its mental-health volunteers is $8.3 million since the group’s founding. It costs the national organization $17 per hour donated to maintain and build the network and provide these services to clients at no charge.

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