How It Works


Shifting the Paradigm

Transition to Success (TTS) is dedicated to transforming the nation’s understanding of poverty, from a stigmatized and shameful character flaw, to a treatable, environmentally-based condition. We are shifting the social and cultural paradigm around poverty, framing the issue around the understanding that exposure to the social determinants of health leads to myriad issues and a diagnosis of poverty.

Maximizing Resources

TTS responds to the social determinants of health by coordinating care across healthcare, human service, government, faith-based and educational organizations—resources already in place and funded. By maximizing these existing streams and integrating uniform protocols based upon best practices, we can improve the health and self-sufficiency of those struggling with poverty.


Measuring Outcomes

TTS is a scalable, sustainable, multi-generational, measurable, generative business model. TTS curriculums define specific treatment protocols with a 19 domain, reliability-tested tool that assess and measures outcomes related to social determinants affecting health, education and economic self-sufficiency.


Coordinating Care

TTS-trained, direct-care staff work with clients to identify, prioritize and ensure access to all available services across their community. We employ what we call CARE (Coordinating All Resources Effectively) management integrated with peer mentoring, financial literacy and volunteerism opportunities.


Training a Community

Using a collective impact social enterprise model, the community-based, TTS-lead organization champions the TTS model and trains leaders within their community—a group that makes up the organization’s CARE Network. The train-the-trainer approach creates generative, community-led transformational change and brings consistency in practice and analytics, while improving access and accountability to all available programs.


Tracking Success

TTS is based on a continuous quality improvement model with independent evaluation partners that employ social-determinant and CMS-approved behavioral health and substance abuse screenings—creating an integrated, billable and clinically accurate screening process; as well as a care management platform that identifies all resources, and tracks referral completions and data across multiple providers.