Center for Health Equity Newsletter - August 2018 - Minnesota Dept. of Health

Center for Health Equity Newsletter
August 2018

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In this newsletter:
Greetings from the Center for Health Equity
Message from the Director
CONNECT: Results of our communications analysis
STRENGTHEN: Coaching program launched to embed equity throughout MDH
AMPLIFY: EHDI redefined: Exponentially Healing Diverse Communities, Intentionally

Greetings from the Center for Health Equity

With this August edition of the newsletter, we are excited to announce that a new Eliminating Health Disparities Initiative (EHDI) Request for Proposals (RFP) will be released next month. This RFP will make approximately $5 million available annually in grants to organizations focused on improving the health and well-being of American Indians and people of color.

Our team has been working hard over the past eight months to ensure the development of this RFP was guided by our CHE values and approaches, by feedback from members of the Health Equity Advisory and Leadership (HEAL) Council and by community and stakeholder input collected by the MDH and CHE in recent years.

The RFP will be released in September through our biweekly bulletin (if you receive this newsletter via email, you also receive the bulletin). We will also post the RFP and resources for applicants on our website and on social media. Interested applicants can learn more about the EHDI program, including current grantee projects, through the EHDI webpage.

Message from the Director

CHE Director Bruce ThaoAchieving equity is hard. For us at the Center for Health Equity (CHE) and for many of you, we know this statement all too well. Our work toward health and racial equity can, at times, feel both grueling and deeply rewarding. Some days you see the impact of your work. Other times it feels like snails are passing you by. In this issue of the newsletter, I would like to share two reflections that keep me energized in this work and on the long road ahead of us.

The first is light bulb moments. When the world around me feels chaotic and I am wondering if what I do matters, I try to recognize the “light bulb moments” happening around me. A light bulb moment is when I witness someone experience a breakthrough about equity. I had one of these experiences during the Advancing Racial Equity trainings we facilitate for MDH staff. A participant was struggling to understand how health and racial equity had anything to do with their job (a job that has little interaction with the public).

I asked the participant whether their staff meetings felt inclusive – whether they felt their colleagues could bring their full selves into meetings and not have to leave important parts of who they are at the door or change themselves to be accepted. In that moment, something clicked. They realized that they had influence over how staff meetings were run, which affects the culture they create in the workplace and whether colleagues feel welcomed and included. These are all critical components of equity. It was a light bulb moment for the participant and a reenergizing moment for me in this work.

The second is passing the torch. American Indian elders have taught me about the principle of making decisions by holding both the intentions of seven generations who came before and thinking about the impact on the next seven generations to come. I often think about this principle in equity work. How are we righting the wrongs that affected our ancestors generations ago while also ensuring the world is better for the future?

This principle requires recognizing who the leaders are that blazed the way for us to do our work. Who are we receiving the torch from? How are we seeking mentorship and guidance from them? How are we preparing the next generation? I often think about this with our CHE interns and with the many people with whom I do informational interviews who want to understand how they can be involved in equity work. It is our responsibility to invest in the leadership development of others, and to help open doors for them that may have been closed to us. Intergenerational approaches to equity work are critical in ensuring long-term sustainable change.

What are the light bulb moments that keep you going in your work? How are you receiving or passing the torches that light the way toward a more just and equitable world?

Bruce Thao
Director, Center for Health Equity

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We are a network hub – leading, connecting and strengthening networks of health equity leaders and partners across MDH and Minnesota communities.

Results of our communications analysis

CHE Intern Rachel GlissmannThroughout much of the past year, we had the good fortune of working with graduate student Rachel Glissmann of the University of Minnesota School of Public Health. For her master’s thesis, Rachel undertook an ambitious assessment of two of our primary external communications vehicles, the bulletin and the newsletter.

The goals of the project were to:

  • Clearly identify CHE’s current audience (i.e., find out more about our subscribers),
  • Evaluate the effectiveness of these two publications, which are distributed via GovDelivery email to our subscribers, and
  • Develop recommendations for improving our communications strategies going forward.

There were two main components to the assessment. First, an online survey was sent to all of our subscribers in the fall of 2017. The survey included questions regarding subscriber satisfaction, demographics and content preferences. A total of 140 people responded to this survey. Overall, respondents indicated a high degree of satisfaction with both publications (79 percent). Survey respondents indicated a preference for receiving information on learning opportunities. They also wanted more updates on resources and tools available to assist in health equity efforts.

There were several limitations to the survey, including a low response rate (just 17 percent of those who opened the invitation) and the fact that our subscribers are self-selected and may not be representative of the communities most impacted by health inequities. The survey results bore this out, with the majority of respondents identifying as white, urban and/or government employees.

To gain a more in-depth understanding of the communications needs of communities most impacted by health inequities, the second half of Rachel’s project entailed conducting key informant interviews with 10 people. Nine of the interviewees are members of the Health Equity Advisory and Leadership (HEAL) Council and one was a health equity partner from Greater Minnesota.

A few key themes emerged from these interviews. Community members emphasized the need for communications that go beyond written products and that focus more on in-person, “in-community" conversations and relationship building. This was a validating finding, as this type of engagement has long been and continues to be a top priority of our team.

Additionally, interviewees noted the importance of targeted or customized communications to serve the unique needs of different communities. One interviewee reminded us that our communications should heed the saying, "one size doesn’t fit all."

A third key theme was the importance of connecting organizations together, which aligns well with one of our core functions – to serve as a network hub to help community-based organizations connect – not just with us at MDH, but also with each other.

Finally, the need to amplify stories emerged as a theme from the interviews. As one participant said, "I think that each community has their own great example of how they themselves have created a …solution of how to overcome inequity."

In summarizing and wrapping up her work, Rachel offered us the following recommendations for improving our communications:

  • Clarify our values and priorities so community partners can better use us as a resource.
  • Work with community partner organizations to get information to grassroots community members.
  • Use a variety of communications tools and strategies, such as social media and in-person events, to reach people.

Using these results and recommendations, we are in the process of making the following changes:

  • The bulletin has transitioned from a weekly to a biweekly (twice a month) publication, and it includes more training announcements and fewer job postings.
  • The newsletter, which remains a quarterly publication, is shorter and all stories tie to our strategic priorities of connect, strengthen and amplify.
  • Starting with the May issue, we have changed our newsletter format to include a guest feature written by a community partner in each issue.
  • We will continue to post each of our newsletter stories on social media, in order to increase outreach and readership. Additionally, we plan to start bringing a limited number of printed copies of the newsletter to share at community events in order to reach more people in a different way.

From our staff here at CHE, we would like to thank all of the survey respondents and interviewees who took time out of their day to help us improve our communications. Your contributions are greatly valued!

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We provide leadership in advancing health equity and cultivate health equity leaders within MDH and across Minnesota communities.

Coaching program launched to embed equity throughout MDH

"How does this apply to my work?" is one of the most common questions we hear from public health practitioners across disciplines and topic areas when talking about equity. Applying health equity in practice is complex work – work that requires us to pause and reflect in order to open our space and practice to the possibility of doing things differently.

Shor Salkas coaching colleaguesRecognizing this need, the MDH Centers for Health Equity and Community Health (CHECH) is launching a coaching program to support MDH staff in embedding health equity into their day-to-day work. Through this new program, a team of Health Equity Coaches will provide three types of assistance to their fellow MDH staff: general technical assistance, program assessments and policy assessments.

Over the last few months, we have been assembling and training a team of coaches with experience and expertise in a wide range of equity-related topics, including:

  • Inclusion
  • Community engagement
  • Narrative training
  • Organizational alignment
  • Grant making
  • Racial equity
  • Health in all policies
  • Health impact assessment

These coaches will be available to help build capacity to advance equity within the specific topic area identified by an individual or team within MDH. Health Equity Coaches will bring a range of skills and technical expertise to these conversations, with the ultimate goal of working with MDH staff to uncover a path toward practicing and operationalizing health equity principles, practices and policies within each program, section or division.

The Health Equity Program Assessment is a tool we have designed to help MDH programs assess their readiness and progress in six areas of health equity practice: narrative and expanding the conversation, organizational alignment, health in all policies, racial equity, data inclusion and community engagement. After completing the assessment, programs will have a better understanding of their strengths and opportunities for growth so they can identify places to advance health equity in their work.

The Health Equity Policy Assessment is another tool that will provide a framework for assessing health equity implications of department-level policies. To complement the tool, technical assistance will be provided as requested to ensure that new policies are written in a way that considers equity implications.

Coaching and technical assistance are important vehicles in advancing equity because they help build the capacity of staff across the agency to be agents for change. As A Field Guide to Community Coaching states, "the core distinction about coaching is that coaches help unlock what is already present in people and groups and help them frame their own solutions."

We know that one of the greatest resources we have at MDH is each other, and spending time reflecting with a coach on how to plan for action around health equity may often serve as the catalyst we need to see transformational change across our agency.

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We amplify the work of communities most impacted by health inequities and support them to drive their own solutions. In this issue, we share a story written by a partner and guest writer, Dr. Maria Veronica Svetaz.

EHDI redefined: Exponentially Healing Diverse Communities, Intentionally

EHDI stands for the Eliminating Health Disparities Initiative; but in my work, I think of it as Exponentially Healing Diverse communities, Intentionally. There is no easy way to describe the power and impact of this program, but I will do my best to try to honor it. The best approach, I feel, is to explain it from the standpoint of those who have directly benefited from it.

The Community. Aqui Para Tí  (APT) or Here for You was conceived in 2001 when we applied for our first Eliminating Health Disparities Initiative (EHDI) grant from MDH. It was born out of the need to create a “parallel” healthcare space – a space to reflect, to share, to be heard and to feel safe. We designed the space after hearing the stories of teens wrestling with identity, trauma and the stress of growing up in a society that did not value them; did not cheer them on; and did not understand their struggles. We also heard about parents wrestling to understand the “landscape of adolescence” in a new culture. What does growing up look like in this culture? Most of the familiar “landmarks” of development were lost to them, and parents needed guidance to figure it out. Fifteen-minute visits were way too short to deliver trauma-informed care and holistic care that fostered healing and resilience. It certainly did not allow space for parents to be validated, heard or coached!Aqui Para Ti advisory board

We learned that many of the parents had even higher needs than the teens that were coming to see us. Half of our parents were presenting symptoms of depression, most of them severe. That is the mark of suffering and dealing with stress daily. It was also a measurement of unmet needs; a metric of the toll that immigrant parents endure to sustain their families in a new environment that offers harsh work, low pay and almost no “return on investment.”

Our APT space, sustained by 16 years of experience, gave us the privilege to witness the growth of teens as leaders, parents as coaches and communities as lighthouses to assure that resilience is a reality. This past year we served 30 percent more teens than in previous years, reflecting the need for and the unique value of our space.

The APT staff. APT has been lifted upon the shoulders of immigrant Latino-American women. EHDI was the platform that propelled all APT members into leadership. It drove us to places that we could not have reached without support. It allowed us to highlight what we were able to bring to our state and our new nation, bridging the skills that most of us learned in Latin America and pouring them into the heart of our new home. The grant helped us leap forward in a way that research shows is hard for leaders of minority backgrounds to do. We lead in different spaces; have conquered new “borders”; and we have pushed innovation and inclusion wherever we have been present. At the national level, we have significantly contributed to making diversity a driver of the Society of Adolescent Health and Medicine. All while bringing our expertise and the resilience we have developed vicariously through witnessing our teens and families conquer the most difficult challenges and thrive.

The spinoff projects. Parents needed more. This realization urged us to start working with the Program in Health Disparities Research and Extension at the University of Minnesota and with Centro Tyrone Guzman, another EHDI grantee. EHDI gave us the bandwidth to support the process to write grants and to build other funding strategies to develop the only community-based participatory research-based program to support Latino immigrant parents of teens, Padres Informados/Jovenes Preparados. The program recently completed a 5-year randomized trial funded by the National Institutes of Health, and it is currently being disseminated to other community organizations and adapted for further studies.

Meanwhile, the advent of Electronic Health Records was not prepared to deal with teens and their right to confidential care in certain areas. We took matters into our hands and became national leaders on this issue. When it was time to disseminate our learning system-wide, we created the Henne-Teen Initiative, now called Between Us using MDH Family Planning Special Projects funding.

The field of innovation in adolescent health. APT was one of the first Health Care Homes certified in Minnesota. With the Minnesota Department of Human Services (DHS), APT pushed for the creation of a new model of care – Health Homes that in Minnesota became known as “Behavioral Health Homes.” We presented our results, with DHS, to the State Legislature. We used our results to propel change in sustaining integrative services in Minnesota, and we passed legislation to make Health Homes a tool to decrease health inequities in our state.

APT also showed that having a family-centered approached does not hinder the ability to deliver developmentally appropriate confidential services, particularly around sexual health. Our results showed that we had better outcomes in family planning and STD screening than other services that are not family-centered. This result is a crucial contribution to the field, and will propel better integrative, intergenerational care for teens of all races.

None of this – none – would have been achieved if EHDI was not there back in 2001. This grant made possible the audacity of conceiving our space, created by and for our community. How do you measure the return of investment on these grants? The exponential power to create health and propel healing, fostering leadership in everyone who was part of this fantastic adventure, the advancement of innovation in clinical delivery and sustainability? I can’t. Just as I can’t measure the honor of being able to witness our Latinx youth thrive for the past 16 years. After all, it is our program’s quinceanera (sweet sixteen) too! Time to put in practice what our culture and patients taught us most: gratitude. Gracias, TODAS, EHDI!

Dr. Maria Veronica SvetazMaria Veronica Svetaz, MD, MPH, is the medical director of Aqui Para Tí (Here For You) and Between Us at Hennepin Healthcare and an assistant professor at the University of Minnesota School of Medicine. She has been an Eliminating Health Disparities Initiative grantee with Aqui Para Tí, is a clinic-based development program for Latino youths ages 11 to 24 and their families, since 2002.

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Updated Tuesday, 14-Aug-2018 11:58:42 CDT