Cape Cod Child Development is a trailblazer in applying Lean Six Sigma to the nonprofit world. Watch this 30 minute success story webinar to learn how Laura D'Angelo is helping to improve teen mother enrollment and as a result, more teenage parents will gain support around child development, parenting skills, and ability to attend school or work as the result of having childcare for their infant or toddler.

1. Increasing Enrollment in
Teen Parent Program by 50%
Presented by Laura D’Angelo
Director of Teen Parent Program – Families United Network
Cape Cod Child Development

2. About Our Presenter
• Director, Teen Parent Program
• Cape Cod Child Development
Laura D’Angelo

3. Take Away: This was an important project to do, and an important goal of providing more
support for teen parents and less number of steps in the enrollment process for services.
Executive Summary
Afte
r
Befor
e
Business Case
Root Cause Analysis
What are the critical findings/root causes that w ere discovered?
Solutions Implemented
Enrollment fluctuates greatly for several reasons: scheduling w ith teenagers may be
difficult w ith their responsibilities; follow -through is also difficult because need to care for
their child and also w ork or attend school; provider availability may impact, as some
providers not in convenient location for parents, transportation is only provided in tw o
tow ns. The enrollment process also takes too long at times, due to reasons such as:
scheduling may be difficult w ith the teen's responsbiliities w ith their child and w ith school or
w ork; placement may take longer if a provider is not available, especially an infant provider;
forms may be delayed due to protocol, such as requirements for eligibility; excess forms
may cause delay and need to be streamlined.
Graphical Display of Improvement
Insert a chart, graph or visual demonstrating process improvement
List key solutions that w ere implemented to address root causes
More outreach has been done, including outreach to high schools, pediatricians,
obstetricians, community programs. In terms of numbers, 11 telephone calls or emails have
been made to community agencies; 5 letters have been sent to obstetricians; 12 letters have
been sent to pediatricians; and 9 telephone calls or emails have been made to high schools.
Paperw ork and enrollment process has been reduced regarding number of forms and
amount of appointments/time needed for parent to meet.
Executive Summary
Project Results
What is the importance of doing this project? (State in lost dollars, productivity loss,
customer dissatisfaction, cost avoidance, risk, etc.)
What are the measureable process improvements/w ins?
Measurable results--enrollment has gone from six to nine enrollments in the program.
Measurable by number of enrollments; number of families w aiting. Regarding the
Business Case, the negative impact of low enrollment causes less teenage parents to
gain support around child development and parenting skills, and the baseline of six
enrollments has not increased greatly.
By doing this project, more teenage parents w ill gain support around child development,
parenting skills, and be able to attend school or w ork as the result of having childcare for
their infant or toddler. State funding w ill be able to be utilized to full capacity.
Afte
r
Befor
e

4. Define Phase

5. Take Away: It is definitely necessary to increase enrollment in the teen parent program, as the impact is
that more support will be given to more teens, and it is important to have a significant amount of time to
outreach and to incorporate a streamlined enrollment process which includes all necessary parties.
Project Charter
”
Phase Planned Actual
Define: 28-Feb 28-Feb
Measure: 29-Mar 21-Apr
Analyze:
April-May 2017 19-Jun
Improve:
June-Sept 2017 12-Sep
Control:
Sept-Dec 2017 Nov/Dec
Process Start: Position Person
Process End: Team Lead Laura 6-9 mos
In: Sponsor Anne 6-9 mos
Team Member Marly 6-9 mos
Out: Team Member Nancy 6-9 mos
Team Member Andrea 6-9 mos
enroll teen parent
referrals to come in, collaboration with stakeholders,
ernollment process to review
wait time w/enrollment process, & for referrals/follow
through
Goal Statement Timeline
The goal is to increase enrollments from 6 (baseline) to 13 enrollments
(target) by December 31, 2017 (target date)
Scope Team Members
outreach to community Time Commitment
Project Charter
Project Name: Increase teen parent program enrollment & streamline enrollment process
Problem Statement Business Case & Benefits
Baseline is 6 enrollments and capacity is 13 enrollments, which results in
less teens having support.
It is important to do this project so that more teen parents can have support.
It also impacts services such as WIC, Healthy Families, High Schools as
they are stakeholders and have an interest also in providing support. If not
done now could be at risk of being able to help more teens and losing part
of contract.

6. Take Away: The scope of the project is from the moment a referral is made to
the teen parent program, to the moment that they are enrolled in services.
SIPOC
S I P O C
Suppliers Inputs Process Outputs Customers
parent referrals
Health Imperatives
teen parent
enrollment
teen parents &
children
Hospitals
Schools
SIPOC:
outreach
community
call to
schedule?
teen has appt.
for application
find provider
Customer Requirements
childcare within one month?
enroll teen
13 Teens enrolled

7. Customer Comment
(What Are They Saying?)
Gathering More Understanding
(Why Are They Saying it?)
Customer Requirement
(What Do They Want?)
enrollment process takes a while may not have time with school, job enroll within 10 days of meeting
provider takes too many days off with short
notice
won't be able to go to school or work
consistent care-measure number of days
off
infant placement not available need care so can attend school or work
childcare placement for infants--measure
by numbers of providers available
placement too far
want to be close to children. Far to travel,
get to school or job late
childcare within 5 miles of home
Voice of the Customer Translation Matrix
Are services available? & placement?
in need of support. No childcare affects
going to work or school
support; childcare; availability and more
providers--measure by survey?
wait for childcare need childcare/worried
wait no longer than two weeks for childcare
placement
Voice of the Customer

8. “As-Is” Detailed Map Segment
Take Away: The team learned a more efficient way to enroll a parent in the program,
including how to reduce the number of steps in the process. When first starting the project
there were many steps that needed to be clarified in terms of responsibilities, how the
process worked, and what to streamline with paperwork.

9. Measure Phase

10. Data Collection Plan
Take Away: By doing this data collection plan, was able to see the amount of time needed
and that they are continuous measures. The end point/stop of the cycle time is when the
family is officially enrolled in the program.
Measure
Data
Type
Operational Definition
Stratification
Factors
Sampling Notes Who and How
cycle time
of
processing
continuou
s minutes-
hours
Start the moment the teen referral is made
and stops when teen is enrolled in the
program
by time of day to
meet for
application
sample every
referral(random), for 4
weeks
teens,
programs/stakeholders
# teens
enrolled,per
month
discrete
# of teens going to school or have
voucher, per month
by time of day to
meet for
application
sample every
referral(random), for 4
weeks
teens,
programs/stakeholders
Data Collection Plan

11. Baseline – Teen Enrollment
Take Away: This Run Chart shows the variation in number of enrollments over
time, and that it is evident that it may unfortunately fluctuate.

12. Analyze Phase

13. Fishbone Diagram
Take Away: Areas of the most concern for analyzing purposes were that the enrollment
process may take a while, and that provider availability/placement is not always available.
placement too far
placement too far causes delay in care, services,
too far placement or inconsistent
Fishbone Diagram
Systems
services
availalbe?
placement
available?
availalbe?
available?
Process
w ait for
childcare
infant
Forms
forms need to
be streamlined
forms get
delayed w ith
protocol
enrollment
process takes a
w hile
provider takes
too many days
off w ith short
notice
People Policies Place
Low
Enrollment

14. Map Segment Showing Analysis
Take Away: The process shows how steps in the enrollment time can be streamlined. With
further analysis, the focus was to reduce the number of steps in the enrollment process,
and this is the area that was streamlined.
S wimlane Map for Teen P arent P rogram E nrollment
Teen
P arent
Group;
Homve
Visits
(Marly)
R eferral
Call
received
(Laura)
Enrollment
(Marie)
Family Child
Care(Andrea,
Nancy)
P arent
Community
Laura receives
referral;explains
process; elig.
ques.;CCCD appl.
scan to Andrea &
Marie
prov.
avail?
Nancy, Andrea
enroll parent&
email regarding
placement start
date
Laura makes
referral to
Healthy Families
if parent not
already in
program
Child begins
childcare;
regular contact
with parent
regarding
communicatesto
team; emails re
status of provider
Andrea calls family,
mails FCCpacket;
Marie
follow up home visits and
regular visits begin;attend
monthly parent support
group
parent meets with entire team for paperwork;
visits provider;confirms interestin provider
Laura in
communication
with parent
meeting arranged
with parent,for
eligibility with
Marie andFCC
paperwork with
Andrea

15. Root Cause Hypotheses & 5 Whys
Take Away: Waiting for services may be impacted not only by availability of
providers, but by availability of teen with scheduling enrollment appointment.
Hypothesis # Possible Root Cause (x) Root Cause Hypothesis Result
1 Teens
Teens need to be at work or at school which limits their
availability for meeting with staff
TRUE
(# cancellations)
2 Number of providers
Teens cannot start the program because they are still waiting
for childcare
TRUE
( # teens waiting
to start)
3 Number of providers
There are not enough providers resulting in reduced ability to
place infants
TRUE (2 infants and
currently 1 provider)
4 Provider location childcare placement too far
TRUE
(# waiting)
5 # Steps
enrollment process takes an average of 2 weeks to complete
the enrollment
TRUE
(Data)
7 Parents parents have busy schedule or not interested in support
TRUE
(# not following
through)
8 Forms
Teens find the number of forms to fill out "too much" which
results in them having to come back or dropping out of
TRUE (# not
following through)
9 Excess emails
The number people involved slows down the enrollment
processs
TRUE
(5 people on emails)
Root Cause Hypothesis

16. Why? Because Why? Because Why? Because Why? Because Why? Because
Why is there
a wait for
services?
Enrollment
process
delay
Why is there
a wait for
childcare?
Because of
request for
process or
availability of
provider
Why is infant
placment not
availalble?
Because of
lack of
providers
Why is
childcare
placement too
far?
Because of
lack of
providers
Why does
enrollment
process take a
while?
Because of
protocol and
schedule of
teen
5 Whys
Why 1 Why 2 Why 3 Why 4 Why 5
5 Whys

17. Improve Phase

18. Selected Solutions
Take Away: Outreach had the most impact as it helped with increase in enrollments, yet
streamlining the enrollment process also helped simultaneously as it greatly impacted the
wait time for the program to begin.

19. Implementation Plan
Take Away: The implementation plan was very valuable in determining some items that
needed to be changed in the enrollment process. The steps were very helpful with
analyzing the process further and determining responsibility as several staff members are
involved. It was also valuable to have a due date in order to set the goals necessary for
change.
Action Item
(List steps required to implement solutions)
Responsible
(List person(s) responsible
for action steps)
Due Date
(Indicate when action items
must be completed)
Meet with team again to review childcare enrollment process and how to continue to
streamline
Nancy, Andrea, Marie August 25th; completed
Review teen enrollment forms with Marly completed August 4th
Go with Marly on home visit to observe implementation of enrollment forms for teen program
and to consolidate them
Marly August 25th; completed
Mark "x" on forms not needed while on home visit/those forms that are a "stumbling block" Marly August 25th;completed
Review forms with Marly again Marly August 25th; completed
Implementation Plan

20. FMEA
Take Away: As a result of this activity, the most important action taken was that the steps
and paperwork for the enrollment process continued to be streamlined, thereby reducing
the number of steps to enroll.
(Rev.):
Process Step/Input
Potential Failure
Mode
Potential Failure
Effects
Potential Causes Current Controls
Action
Recommended
Resp. Actions Taken
increasing
enrollment for teen
parent program
not enough teens
with children
interested in
program
won't have
additional support
7
not being referred
6
observation of
numbers
5 210
more outreach to
community
Laura Laura did outreach to
several stakeholders,
by phone calls,
emails, mailings
7 6 4 168
services
available/wait for
childcare/infant
placement
not enough
providers
families without
childcare
9
not enough interest
in being a provider
7
observation of
availability of
providers/discussion
at FCC meetings
7 441
outreaching to
potential
providers;contacting
EEC?
family childcare unit family childcare unit
outreaches to
potential providers 8 6 6 288
placement too far teens
difficulty/late
gettingto
school/work
missing school,
work
10
not enough providers
within appropriate
traveling distance
7
observation of
number of times
teens late for school
or work
7 490
outreaching to
potential
providers;contacting
EEC?
family childcare unit family childcare unit
outreaches to
potential providers
10 7 7 490
enrollment process
to streamline
delays in
processing
paperwork
taking time away
from school, job
8
too many steps,
regulations,
requirements/paperw
ork and time to
complete
6
observation of
number of forms,
time takes to
process
6 288
continue to
streamline
process/number
people involved
all team members Laura streamlines
paperwork, reviews
with family advocate
6 4 4 96
Responsible: Laura and team FMEA Date (Orig.):
FMEA Form
Process/Product Name: Teen parent program enrollment Prepared By: Laura
DETECTION(1-10)
RPN
What is the process
step or feature under
investigation?
In w hat w ays could
the step or feature
go w rong?
What is the impact on
the customer if this
failure is not
prevented or
corrected?
What causes the step or
feature to go w rong?
(how could it occur?)
What controls exist that
either prevent or detect
the failure?
What are the
recommended actions for
reducing the occurrence
of the cause or improving
detection?
Who is responsible for
making sure the actions
are completed?
What actions w ere
completed (and w hen)
w ith respect to the RPN?
SEVERITY(1-10)
OCCURRENCE(1-10)
DETECTION(1-10)
RPN
SEVERITY(1-10)
OCCURRENCE(1-10)

21. “To Be” Map Segment
Take Away: Steps continue to be reduced in the enrollment and paperwork process.
Everyone is involved in communication. The process was changed to reduce the number of
steps involved with each member of the team, and to have clarity on how the process
would work, for instance, each person now knows which tasks are their responsibility, in
order to eliminated duplication of tasks.
S wimlane Map for Teen P arent P rogram E nrollment
Teen
P arent
Group;
Homve
Visits
(Marly)
Referral
Call
received
(Laura)
Enrollment
(Marie)
Family Child
Care(Andrea,
Nancy)
P arent
Community
Laura receives
referral;explains
process; elig.
ques.;CCCD appl.
scan to Andrea &
Marie
prov.
avail?
Nancy, Andrea
enroll parent&
email regarding
placement start
date
Laura makes
referral to
HealthyFamilies
if parent not
alreadyin
program
Child begins
childcare;
regular contact
with parent
regarding
communicatesto
team; emails re
status of provider
Andrea calls family,
mails FCCpacket;
Marie
followup home visits and
regular visits begin;attend
monthly parent support
group
parent meets with entire team for paperwork;
visits provider;confirms interestin provider
Laura in
communication
with parent
meeting arranged
with parent,for
eligibility with
Marie andFCC
paperwork with
Andrea

22. Run Chart – Improved Teen Enrollment
Take Away: Enrollment may fluctuate, especially during the summer months. Other factors,
such as schedules of the teens, and not having interest or needing childcare only rather
than all services of the program.
Befor
e
After

23. Control Phase

24. Monitoring & Response Plan
Take Away: Reflecting on more specifics and thinking in regards to input, process, output in
this exercise was very helpful in determining a plan for further steps needed to make
improvements in the enrollment process.
number of the
measure
Input,
Process or
Output?
What is the
Target?
Method of Data
Capture
Checking
Frequency
Person
Responsible
Upper/Lower
Trigger Measure
Who Will
Respond?
Reaction Plan
number of handoffs I 5 steps
record # steps
previously/observation
2-3 x week Laura
need 14 teens to
enroll
Laura communicate with other team members
excess emails P 2-3 emails record # emails daily Laura
need 14 teens to
enroll
Laura communicate with other team members
number of forms P 6 forms mark form not needed weekly Laura
need 14 teens to
enroll
Laura communicate with other team members
number of teens enrolled P 13 teens
record # enrollments
and enrollments to
occur in next two
months
daily Laura
need 14 teens to
enroll
Laura
communicate with other team members and with
community stakeholders
Monitoring Plan Response Plan

25. Lessons Learned
Take Away: Despite this being a difficult area to assess, it was definitely very helpful to have this goal for the project.
Because of this focus, an in-depth look at the program’s processes occurred, with a very positive result of a decrease in
the number of processes, amount of forms, and an emphasis on more outreach to the community, as a result.
*Paperwork and enrollment process has been reduced through several meetings,
and process walks, regarding number of forms and amount of appointments/time
needed for parent to meet.
*Through conversation with the team members, particularly the eligibility unit, it
was realized that this may have been a difficult area to assess for the project.
Parents meet to update their status, reviewing every six to eight weeks. This in
turn could affect whether the parent remains in the teen parent program.
*Old and new lists can show differences in numbers, changes made, and
improvements, as those for this project. Unfortunately, there was not any
previous data from prior years of the Teen Parent Program running, to compare
the trends in enrollment, therefore the comparison was made for the past eight
months.
*An increase in outreach appeared to help, although numbers were still not at full
enrollment. Several factors may also be impacting this, such as difficulty with
scheduling with the parents due to their commitments; some parents preferring
childcare only without program services (home visits and monthly support group);
some parents not able to call back to confirm appointments; work schedules
impacting keeping appointments, many teens had often cancelled or been “no-
shows” for appointments for paperwork.
*On the plus side, some families have met earlier, a few months before
delivering, and the planning for childcare can be easier.

26. It was very helpful to do this project, to see what areas needed to have a focus and to be
analyzed further. By doing this project:
*Areas needing improvement were emphasized, such as the need to reduce the number
of steps in the enrollment process, as well as the need to increase the number of teen
parent enrollments.
*More clarity was gained in terms of roles and responsibilities of team members, as many
are involved in the process, though working in different units of the organization.
*A better understanding of what works and does not work, such as forms that are not
necessary to use, was helpful with the streamlining focus.
*A better understanding of eligibility was also learned, as there are several factors that
can cause changes in eligibility and there are different criteria that apply.
*A better understanding of how the Family Child Care division enrolls and what
regulations and protocols are in place. More knowledge is always very valuable!
*Great suggestion by Anne at presentation: $500 in free diapers for participating in Teen
Parent Program!
Project Benefits

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