By Uma Ahluwalia1

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In 2009, amid economic recession and rapid demographic change, leaders from the Montgomery County Department of Health and Human Services and Office of Community Partnerships joined local service providers, grassroots organizations, philanthropic funders, and community members to create the Neighborhood Opportunity Network (NON). NON offers a more streamlined, effective, and culturally competent response to growing need in the county.

This brief describes the evolution and structure of NON and the key lessons we have learned in the process. These lessons can help inform the efforts of other communities interested in crafting more collaborative, cross-cutting, and community-based approaches to addressing suburban poverty and promoting self-sufficiency.


In the late 2000s, Montgomery County, MD—like the rest of the nation—was in the throes of the worst economic recession since the Great Depression. The effects of the recession in Montgomery County were reflected in the growing share of school children eligible for free and reduced-price meals, which reached one-third by 2011 (an increase from one-quarter in 2007); the rapid expansion of the Supplemental Nutrition Assistance Program (SNAP) caseload, which increased by 160 percent between 2007 and 2012; and the high number of uninsured residents (110,000 in 2013).

At the same time, the county was changing demographically, on its way to becoming majority-minority for the first time. By 2012, minorities accounted for 52 percent of the county’s population, and one in three residents was foreign born. This traditionally wealthy and largely white suburban county was becoming browner and poorer.

Amid these demographic and economic changes, in 2009 the Montgomery County Department of Health and Human Services (MCDHHS) had a conversation with school principals in neighborhoods most affected by the recession, which revealed that the increasing number of transient students—those who move from school to school during the school year often due to a lack of stable, affordable housing—was becoming a critical issue. This conversation prompted MCDHHS to look for overlap among our emergency rental assistance, utility assistance, and homeless programs in the ZIP codes from which these schools were drawing their students. The data were revealing. We identified seven ZIP codes in need of safety-net services given their significant financial need and high concentrations of uninsured and unemployed residents.2 These ZIP codes also coincided with areas of focus designated by the school district for their high concentrations of students lagging behind in academic achievement, many of whom were low-income, black or Latino or other racial-ethnic minorities, or spoke English as a second language.3

Although MCDHHS and our community partners provided a fairly robust continuum of safety-net services throughout the county, the service support system was overwhelmed by the rapidly increasing need. At the same time, newer groups of residents who were eligible for services were hesitant to seek aid at established government sites. In addition, an internal study showed that, of those who did come to the MCDHHS Germantown offices, approximately 40 percent needed to gather more information but failed to return.

The question facing the county and our philanthropic and nonprofit partners was: How can our community leverage the strengths in the neighborhood, the network of public and private helping providers, and a community engagement approach to better meet growing need and promote empowerment and self-sufficiency? We founded NON to creatively and collaboratively provide the “bit of help” that can ensure a struggling family’s temporary crisis does not become a chronic condition.

The Model

In 2009, MCDHHS hosted a faith community convening to address the growing and increasingly diverse needs in the county. At the convening, we planted the seeds for the NON model by asking attendees to join us in linking residents to available safety-net services and to help our agency penetrate deeper into the community with our services.

Following that meeting, IMPACT Silver Spring, a community-organizing nonprofit, reached out to MCDHHS to share a neighborhood engagement and empowerment model that it was building based on its experience with renter empowerment circles and Parent-Teacher Association engagement efforts. This model helped inform the creation of NON.

We had two primary goals in developing the NON model with the help of IMPACT Silver Spring. The first was to reach eligible residents and connect them to a range of services provided by the county and nonprofit organizations, including Temporary Assistance for Needy Families, SNAP, Medicaid, rental and utility assistance, behavioral health, domestic violence, and maternal and child health services. In addition to accessing services, we considered it equally important to connect people to their neighbors and to involve them in networks that can help them become less vulnerable. Assisting families in building their social networks offers a dignified way to support them as they move toward self-sufficiency. For example, strengthening networks could allow a young, single, working mom to connect with an older, home-bound, elderly person to provide babysitting services. In return, the young mom could monitor the health and well-being of the elderly person.

The Community Foundation of Montgomery County, the Consumer Health Foundation, and the county supplied the financial support to launch the NON initiative. To provide streamlined access to services in high-need communities, MCDHHS partnered with Family Services, Inc., in Gaithersburg; Catholic Charities in Wheaton; and Mary’s Center/TESS (Takoma Emergency Social Services) in Long Branch. These “anchor” nonprofit organizations agreed to establish NON sites at their locations in three of the target neighborhoods identified through the county’s data analysis.

The model required three key components:

1. Culturally competent system navigators.

MCDHHS created a cadre of part-time community assisters, also called community connectors, to help clients access the county and nonprofit services for which they were eligible through a more streamlined, integrated intake process. We hired these employees from within each community targeted by the initiative. New hires were previously unemployed but were considered natural leaders in the community. Residents could trust the new hires and receive culturally competent guidance from them as they navigated the safety net. The community assisters were hired to work 19 hours per week, and their salary was paid for by MCDHHS.

2. Trusted nonprofit partners.

Rather than being based in a government office, the community connectors are housed at the partner/anchor nonprofit organization. The anchor nonprofit organizations had well-established relationships in the community and were often more trusted than government agency sites. We believed residents were more likely to turn to these organizations when they needed help, particularly if their community leaders worked as system navigators. Each anchor nonprofit organization—which was designated as a NON community service center—donated the space for the community assister at no cost to MCDHHS and also provided staffing from a separate case manager.

3. Community engagement and empowerment.

To complement the community service center model, we instituted the community engagement/empowerment and door knocking approach developed by IMPACT Silver Spring. The underlying premise of this strategy is that the social fabric in these communities was becoming more transient and less connected and the NON partners needed to help reknit the community. A group of neighborhood volunteers, in addition to network guides who act as community concierges, knock on doors and spread the word about the NON sites and encourage people to seek help. In addition, the volunteers and network guides encourage residents to participate in neighborhood exchanges (larger community meetings to learn about available services and discuss community issues) and opportunity circles (small group meetings designed to build supportive relationships among neighbors). Currently, 14 opportunity circles are in operation—all of which are building networks while working on social, economic, and civic projects that improve the lives of participants.

For the last two years, we have been in the process of extending the reach of the network, particularly in Long Branch and Wheaton, two communities that have experienced pronounced increases in economic hardship since the recession and have developed strong community organizing roots through their work with IMPACT Silver Spring. We have also established a part-time presence at our Montgomery Works One Stop workforce development site. New start-up activities have also emerged in the community of Bel Pre and East Montgomery County.

As NON has expanded, numerous partners have joined the network, offering what we call “intervening support”, such as food (Muslim Foundation for Montgomery County), easy access and low-cost or free registration for recreation activities (Department of Recreation and Takoma Soccer), community improvement projects (Silver Spring Green and Global Communities), and free furniture (A Wider Circle). Extending the reach of the network also attracted new financial partners (Capital One Bank, the Latino Economic Development Corporation, and the Economic Development Group) that are supporting families as they create entrepreneurship projects that build skills and generate income.

When the model started in 2009, almost 88 percent of MCDHHS clients had sought services before and had established connections with county services. However, through NON’s outreach efforts, the number of new clients increased from 12 percent of all clients served in 2009 to 35 percent by 2013. After the program began in Fiscal Year 2010, NON sites saw 2,381 clients in the first year. In only the first six months of Fiscal Year 2014, NON had already seen 6,402 clients.

A recent census of the network revealed the following regarding NON’s clientele:

  • 90 percent are women
  • 66 percent are Latino
  • 30 percent are black (including African Americans as well as Continental Africans and immigrants from the Caribbean)
  • 72 percent are married
  • 70 percent have at least one child in the home
  • 66 percent speak Spanish as their first language
  • 70 percent are working and/or generating income of some type
  • 80 percent are making less than $40,000 per year

In addition to clients served, so far in Fiscal Year 2014 our engagement activities have reached 3,857 households. Not surprising, many of the people we find in the community via knocking on doors are not in immediate crisis, but many are in vulnerable circumstances. Given this reality, it is important that we can share information and build peoples’ awareness (and level of comfort) with the network. In the process of this engagement, we have spoken with people and shared the contact details for the neighborhood service centers. In addition, we have worked with key residents to train and equip them to serve as outreach workers in their community. For example, participants in the child care providers opportunity circle receive information about safety net services available in Long Branch and Wheaton that they can share with the parents of the children in their care.

Lessons Learned

We have learned several lessons in this process that other communities looking to replicate this kind of model should consider:

1. Data should drive decisionmaking.

To successfully start such a project, it is important to carefully identify the area to be served, its needs, and the barriers that local residents face–transportation, language, knowledge of the social service system, separation from family or other common support structures, and isolation. It is also important to ensure the network model is organized to address these issues.

To identify our NON target sites, we began by assessing our data across multiple programs from a geographic perspective (in this case we focused on analyzing the data at the ZIP code level). From there, much of our deployment was based on a broad assessment of need within our target communities and the availability of partners to address what we determined to be the presenting issues.

2. Track your impact.

Although we made several attempts, we failed to secure funding that would have allowed us to comprehensively evaluate the model from its inception. We have documented key outputs and indicators, but the absence of a full evaluation of the model’s efficacy hinders replication of the model in other communities.

However, in December 2013, we developed a new network mapping software that allows us to track the growth of new connections among participants (Figure 1). Our work is built on the premise that supporting people in vulnerable circumstances helps them build their networks and establish stronger social and economic resiliency, thereby strengthening the success factors in their lives that lead to self-sufficiency. Using our recently developed reporting tool, we can now document concrete effects from our networking model (Figure 2). For instance, one neighborhood circle of approximately seven households came together to explore small business opportunities. By sharing resources and savings strategies, the circle saved $13,000 in seven months.

Figure 1. Increase in Reported Community Connections Among NON Participants in East Montgomery County
Figure 1. Increase in Reported Community Connections Among NON Participants in East Montgomery County
Figure 2. Self-Reported Improvements in Quality of Life Indicators for Participants in the Park Montgomery Community Circle

3. Early and ongoing community outreach is critical for success.

The success of the network depends on acceptance by the community. Therefore, community outreach must occur before launching a NON to create buy-in and to build trust, which is also why we chose to situate NON sites in nonprofit organizations instead of government office buildings. To build trust, make inroads in the community, and support collaboration, we also engaged natural leaders in each community—individuals who were trusted and known in the community, often through local churches, and who were recommended by other local leaders.

Engagement and outreach is an iterative and ongoing process. For example, our sites in the early stages experienced significant traffic from the Latino community. The Asian and Continental African communities in need were then reluctant to use these sites because they were perceived as places specifically for Latinos. We continue to provide considerable outreach to these populations to build trust, increase awareness, and encourage them to access services and resources from these NON sites.

4. Invest in community connectors.

Engaging community leaders in the outreach and systems navigation processes has been central to building relationships between residents and service providers in these communities. Many of the clients who come to NON sites develop a real relationship with the connectors. This probably owes to several factors: (a) the amount of time we spend with the clients; (b) the personalities of the connectors; and (c) for the Spanish-speaking clients in particular, the fact that the connectors speak their language. Because of these factors, connectors can then provide excellent customer service to our clients, ensuring they have access to all the resources they need and often going the extra mile to assist them.

However, building these close relationships also means that some clients rely on the connectors to the point that the clients visit every week to ask for assistance with small matters. It can also mean that clients become reluctant to see someone else if their connector is unavailable. This can cause some connectors to have backlogged appointments, whereas other connectors may have an open schedule. We have had to create policies to deal with this issue. For example, if a client wants to see a specific connector, the client will have to make an appointment with him/her for another day rather than receive same-day assistance.

5. Pick the right partners.

To build trust and improve access to services for vulnerable residents in the community, we intentionally placed our neighborhood service centers in buildings belonging to anchor organizations that already had established strong reputations in the community. It is important to pick trusted partners with both capacity and mission alignment to serve vulnerable residents. In addition, these partners should be able to provide space that is easily accessible, near public transportation, and visible. The space should also have some flexibility for use and should be of sufficient quality to indicate a reasonable level of respect for the people who come through the door.

6. Get the right funding foundation in place from the beginning.

Before launching the initiative, it is important that the partners agree on how the model will be funded moving forward. For our initiative, this funding foundation included public funds to support the connector salaries, nonprofit in-kind contributions for space and case management, and philanthropic support for nonprofit capacity building and emergency assistance.

In terms of philanthropic support, the Community Foundation for Montgomery County and the Consumer Health Foundation joined forces to fund various aspects of the work. The Community Foundation created a Neighbors in Need fund to add resources to the emergency assistance funding that MCDHHS provided for eviction prevention, utility assistance, and housing assistance grants. The Community Foundation and Consumer Health Foundation also funded IMPACT Silver Spring to build their resident/neighbor engagement models and empowerment circles.

7. Equip staff with the necessary information and training.

Staff who interact with NON but who are part of other helping systems should be trained to understand the business flow (e.g., the streamlined access to services) and outcome potential of NON. This ensures that they fully understand the broader system and can help their clients connect to the network. It is also important to ensure that NON staff receive basic training in areas such as mental health first aid because people in housing or job crises may need to stabilize their emotional state before addressing their economic problems. The ability of NON staff to refer clients in need to broader helping systems is as critical as the reverse flow of case referrals. Family Services, Inc., had three client suicides in the face of eviction or foreclosure during the first two years of the recent recession. Housing counselors and others must be alert to warning signs.

8. Provide consistent hours.

The operating hours of each center should be consistent and clearly communicated so that the community can depend on the centers as service resources. Initially, because our community connectors were only hired to work 19 hours, the centers were only open for 19 hours a week. That created confusion about hours of operation in the community, so access to services was inconsistent. At the Gaithersburg site, we staggered schedules to ensure that the center was open for a standard 40-hour work week, resulting in far greater use of the center and the services it offered.

9. Create regular opportunities for community members to connect.

By providing routine opportunities for people from the community to come together, we have seen not only improved community connections and trust but also innovative, community-led initiatives emerge. For example, the group of seven neighbors that was able to save $13,000 in seven months decided to build on that progress by creating a joint microenterprise initiative with those funds.

10. Be flexible and responsive to the changing needs of the community.

Do not limit the potential of the network by narrowly defining services. Instead, adapt as the community changes. The essence of the NON concept is a partnership with people in the community. What we do with people is ultimately more important than what we do for people. This lesson is exemplified by El Rosal Sewing Circle.4 A community of women came together to build a sewing cooperative to create financial self-sufficiency for themselves and their families. While our original model focused on providing food, shelter, and safety-net services for families in crisis, the women, once connected, chose to pursue a venture that could help improve their financial stability more generally.

Looking Ahead

Now that NON has been in operations for four years, we are making several adjustments to improve the model’s responsiveness and effectiveness. Currently, NON is working to do the following:

1. Leverage technology.

We hope to introduce more technology applications into our engagement work to streamline our data collection efforts and to connect residents to opportunity more seamlessly—whether at the neighborhood service center, in an opportunity circle, or at another value point in the network.

2. Reduce staff turnover and create career pathways.

The connectors love their jobs, and this is reflected in the quality of their customer service. However, because the current model only offers 19 hours per week of paid work without benefits, most staff must work a second job to supplement their income. The current model also leads to increased turnover as staff find jobs that offer more hours of paid work to meet family needs.

Staff consistency is particularly important to the NON model. It takes time to learn about all the resources available in the community and for clients to feel comfortable with a new connector. Moreover, if given the opportunity, most connectors would be happy to work full-time in this capacity.

As we explore options to address these staffing challenges, we would like to transform the NON program into a career development program for the connectors so they can also obtain economic independence with full-time positions and benefits. Many of our staff are low-income with limited skills and education. A career development program would provide staff an opportunity to obtain their GED or enroll in a local college to receive their associate or bachelor degree. They would also continue to receive job training through the county Continuous Career Learning (CCL) training program. We would also help staff with their résumé writing and interviewing skills. Our goal is that, by the end of the program, staff will obtain positions within the county or private sector.

3. Build on the existing model.

Now that the recession, which prompted the formation of NON, is fading, what is the next iteration of the network? We are confident we have built infrastructure and community capital that can be leveraged for other health and human services initiatives such as implementing the Affordable Care Act, improving mental health first aid capacity, and increasing focus on economic empowerment and self-sufficiency. This design and development effort is currently ongoing.

In the meantime, given their early success, we are looking to increase the number of opportunity circles in the network. Currently, IMPACT Silver Spring recruits participants for the circles through our neighborhood engagement efforts. We have created a corresponding framework to hold these circles within the broader network called Circle U! The People’s University.

As we consider our next phase, the experiences of the residents who participate in the circles and the broader network inform our endeavors. We wish to create a framework for inclusive local economies that introduce policy mechanisms and community practices, thereby creating more access to economic opportunity for the low-income families we serve.

1Uma Ahluwalia is director of the Montgomery County Department of Health and Human Services. Thanks to Thom Harr of Family Services, Inc. and Ronnie Galvin of IMPACT Silver Spring for their contributions to this brief.

2Visit to explore community dashboard indicators in more detail.

3For more information on Red Zone and Green Zone schools, visit—montgomery-county/red-zone-green-zone-mcps-focus-and-non-focus-schools.

4For more information on the El Rosal Sewing Circle, see

Photo credit Flickr user @Mr.TinDC