PVPC recently completed a project with the Massachusetts Dept. of Health to develop the concept of a Root Cause Solutions Exchange. pilot a “coaching” approach for potential users of a to-be-launched Root Cause Solutions Exchange.  The Exchange will serve to connect healthcare partners with resources to aid them addressing the root causes of health inequity and will also serve as a locus where partners can share their own “solutions” for addressing health inequity.

Coaching Approach

One potential tool to include in the RCSE is a Coaching Approach to addressing Root Causes of health inequities. In interviews regarding potential participation with Root Cause Solutions Exchange, rural healthcare partners expressed a concerns about potential barriers to effective engagement with a self-directed, on-line resource like the Exchange.  In response, PVPC developed, tested, and assessed a "coaching" approach to assist rural healthcare partners in their use of the Exchange.  The coaching approach involves conducting targeted research on resources Root Cause and SDOH resources targeted toward the partner's specific needs; soliciting the partner's existing "solutions" that would be useful additions to The Exchange for other rural partners; and identifying areas and providing guidance for skills-building around Root Causes and SDOH.

This project tests a "coaching" model of building local capacity. Coaching goes beyond the circuit rider model of information dissemination by engaging with the client throughout the process. At the initial assessment meeting, client needs are identified in terms of resources and skills-building; in addition, client resources that would make useful addition to The Exchange are solicited.  At the initial "solutions exchange" meeting, identified "solutions" are both delivered to and collected from the client.  At the final evaluation meeting, the cycle is reviewed for the effectiveness of the solutions offered.  Feedback on the assessment and research process is regularly solicited from the client.  The "coach" continues to engage in iterative cycles with the client as long as there are research and/or skills-building needs to be addressed.

Building Sustainability into Smaller Regional Transportation Services

The second pilot project for the Root Cause Solutions Exchange was an in-depth review of funding mechanisms for smaller on-demand transportation services in rural communities. In response to a challenge identified by the Quaboag Connector, which serves 10 towns on the eastern side of the region and into a portion of Worcester County, PVPC staff researched other sub-regional transportation providers and provided recommendations for the long-term sustainability of the Connector. This project highlights the importance of learning through an exchange of knowledge and experience to address one of the greatest barriers to health in rural communities - access to transportation services.

Documents

COACHING MODEL - OVERVIEW

COACHING TIMELINE

ASSESSMENT TOOL

SAMPLE “SOLUTIONS” SHEET

EVALUATION TOOL

QUABOAG CONNECTOR STORY

Root Cause/Social Determinants of Health Resources Resource/Tool Description Resource Type Racial Justice Root Cause Policy/Practice Change Social Determinants of Health Community Engagement Partnership With Other Sectors Interview with LaNicia Duke, CEO of Rural Black Network and Host of Rural Race Talks Rural Race Talks is a live call-in radio show hosted by LaNicia Duke on Coast Community Radio carving out space to grapple with our unique legacy of systemic racism and what that means for our present in honest and sometimes messy ways. The show comes at these conversations from multiple angles–everything from how we can begin to heal from our collective, social, and generational traumas to what 2020 taught us about race. Audio         We Have to Talk About Race in Rural America – The Forge In this conversation, Anika Fassia of the Race Class Narrative Action project and Adam Kruggel of People’s Action talk to four rural organizers — Alexa Howart and Abdulahi Farah from Faith in Minnesota, Mahisma Hallaji of Down Home North Carolina, and Maria Elena from Michigan United — about their campaigns to change the narrative about race and government in rural America and to scale up their organizing infrastructure to mobilize a base of multiracial voters. Audio           Achieving Rural Health Equity and Well-Being-Proceedings of a Workshop   To explore the impacts of economic, demographic, and social issues in rural communities and to learn about asset-based approaches to addressing the associated challenges, the National Academies of Sciences, Engineering, and Medicine held a workshop on June 13, 2017. This publication summarizes the presentations and discussions from the workshop. Document         Advancing Health Equity in Rural America   This report, produced in partnership with the University of California, San Francisco, assists those working to improve health, well-being, and equity in rural America. It is directed not only to those working in public health or healthcare, but also to those working in other fields—such as rural development, community development, housing, and education—that powerfully shape health. Document       Case Study – Harris County Institutionalizes Health Equity through Organizational Transformation   The Harris County Public Health Department, Texas, created a department-wide health equity infrastructure, establishing overarching health equity policies, procedures, and staff training to infuse an equity lens into all divisions and programs. Health Equity Policy https://publichealth.harriscountytx.gov/Portals/27/Documents/Organizatio... Health Equity Procedures - link pending Health Equity Workplans - link pending Document             Five Skills   Manual presenting information that can assist farmers in poor rural communities to successfully engage with markets; aims to improve livelihood of these communities Document       Health Equity Plan – Rice County Public Health   The purpose of this plan is to provide guidance to help strengthen staff understanding and build organizational capacity to address health equities. This includes ensuring that internal work institutionalizes health equity into public health policies, programs and services. Document           Health Equity Policy Framework - MPHA   This Health Equity Policy Framework1 is designed to provide a guide to the MPHA board, Policy Council, staff, and partners to operationalize our mission and vision to achieve health equity in Massachusetts. This Framework addresses five key areas: • Section 1: Definitions of Commonly Used Terms • Section 2: Framing • Section 3: Policy Development • Section 4: Community Partnerships • Section 5: Organizational Leadership & Culture Document             Let’s Talk! Discussing race, racism, and other difficult topics with students   Guide filled with strategies to help educators facilate difficult conversations about race and racism; can also be used to discuss other types of discrimination Document         Microaggressions   Document discussing what microagressions are, examples, and how to navigate them Document         What is Health Equity? – Robert Wood Johnson Foundation   The purpose of this report is to stimulate discussion and promote greater consensus about the meaning of health equity and the implications for action within the Culture of Health Action Framework. Document       Racial (In)Equity: An Infographic – UNC Frank Porter Graham Child Development Institute   What is racial inequity? Why is it important? How can we achieve racial equity? Graphic         The Health EquiTREE (2022) - illustration by Health Resources in Action for the Massachusetts Community Health and Healthy Aging Funds. The Health EquiTREE illustrates the relationship between health outcomes and the root causes of health inequities. It helps us envision how systems impact outcomes of individuals and groups. This is the COMPLETED VERSION. Graphic       The Health EquiTREE (2022) - illustration by Health Resources in Action for the Massachusetts Community Health and Healthy Aging Funds. The Health EquiTREE illustrates the relationship between health outcomes and the root causes of health inequities. It helps us envision how systems impact outcomes of individuals and groups. This is the BLANK TREE WITH LABELS. Graphic       The Health EquiTREE (2022) - illustration by Health Resources in Action for the Massachusetts Community Health and Healthy Aging Funds. The Health EquiTREE illustrates the relationship between health outcomes and the root causes of health inequities. It helps us envision how systems impact outcomes of individuals and groups. This is the BLANK TREE WITHOUT LABELS. Graphic       RAC Value Proposition Slide A series of slides that analyzes the various health factors that impact a community Graphic         Root Cause Analysis -Community Catalyst A brief training on conducting a root cause analysis with your priority areas. Slide Deck       Health Equity and Social Justice Toolkit – National Association of County and City Health Officers (NACCHO)   A Health Equity and Social Justice Toolkit for local health departments. Toolkit   Health Equity Curricular Toolkit (AAFP)   This toolkit provides a structured curricular tool to facilitate exploration of some of the most pressing questions around social determinants of health, vulnerable populations, and economics and policy. The toolkit also provides resources to promote skill-building to confront drivers of persistent and pervasive inequities. Toolkit     Rural Health Equity Toolkit   The Rural Health Equity Toolkit compiles evidence-based frameworks and promising strategies and resources to support organizations working toward health equity in rural communities across the United States. Toolkit Dialogues Across Differences – Growing a New Heart   This program was implemented by the Quaboag Hills Community Coalition under the leadership of JAC Patrissi and Tanisha Arena of Growing a New Heart as a way to integrate conversations about racism and marginalization around health concerns, primarily substance use disorder. Training         Fostering Constructive Dialogue – High School and Higher Education   A toolkit and trainings that are designed for use in educational settings. Training         Fostering Constructive Dialogue - Workplace   A toolkit and trainings that are designed for use in workplace settings. Training           Groundwater – Intro to Race Equity – Racial Equity Institute   In this virtual webinar, REI organizers will use stories and data to present a perspective that racism is fundamentally structural in nature. By examining characteristics of modern-day racial inequity, the presentation introduces participants to an analysis that most find immediately helpful and relevant. The Groundwater metaphor is designed to help practitioners at all levels internalize the reality that we live in a racially structured society, and that that is what causes racial inequity. Training           Health Equity 101 – University of Wisconsin-Madison – Population Health Institute   MATCH (Mobilizing Action Toward Community Health) partnered with the Wisconsin Center for Public Health Education Training (WiCPHET) to develop three Health Equity 101 training modules: ·       Health Equity Module 1 | Introduction ·       Health Equity Module 2 | Health & Power ·       Health Equity Module 3 | Operationalize Health Equity Training     The Roots of Health Inequity: A Web-Based Course for the Public Health Workforce - NACCHO   Roots of Health Inequity is an online learning collaborative and web-based course designed for the public health workforce. The site offers a starting place for those who want to address systemic differences in health and wellness that are actionable, unfair, and unjust. Based on a social justice framework, the course is an introduction to ground public health practitioners in concepts and strategies for taking action in everyday practice. Training   Transforming White Privilege – A Joint Project of The Center for Assessment and Policy Development (CAPD), MP Associates, and World Trust Educational Services, funded by the W.K. Kellogg   The Transforming White Privilege (TWP) curriculum is designed to help current and emerging leaders from a variety of sectors better identify, talk about and intervene to address white privilege and its consequences. The curriculum is organized into a series of topic-specific learning modules, each 30 minutes to two hours in length. The full curriculum can be delivered over a single two-day workshop, 2 one-day workshops or in other configurations that work for a given program, keeping in mind the cumulative nature of the learning and design. The curriculum uses small and large group discussion and exercise, roleplay, videos, movement and other transformative learning strategies. Training       Othering and Belonging   This video explains the differences between othering and belonging, highlighting why we should favor belonging using animation Video           Targeted Universalism   This infographic from FPG's Race, Culture, and Ethnicity Committee is the first in a series that begins to answer these questions. Video       Engaging Across Differences: Constructive Dialogue for Civic Health   This webinar introduces the practice of bridging to facilitate belonging, inclusion and civic participation.  Webinar           Training Series: Health Equity and Social Justice 101, NACCHO   This three-part training series consists of three pre-recorded webinars on the NACCHO YouTube channel. HESJ 101 Training: Part I The Politics of Health Inequity features Dr. Richard Hofrichter discussing how structural racism and class oppression are implicated as root causes of health inequities as well as strategies for acting upon root causes. HESJ 101 Training: Part II Intersectionality discusses intersectionality, a framework for understanding how multiple social identities (i.e. race, gender, class) intersect and are experienced at the individual level and reflect interlocking systems of privilege and oppression at the structural level, as well as applications for public health practice. HESJ 101 Training: Part III Stories from the Field features local public health practitioners discussing how to embed health equity and social justice into public health practice. Training   Action Learning Guide: Partnering With Residents   Webpage that provides guidance tools, and hands-on activities to engage with community residents Website         Advancing Racial Equity – NIH Website   This National Institutes of Health (Office of Equity, Diversity and Inclusion) website offers resources on advancing racial equity. Subpages include resources on: ·       Understanding Systemic Racism ·       Crucial Conversations in the Workplace ·       Racism in Health Website     Classism   Webpage that provides definitons involving classism, videos about classims in your personal life and in society, and questions to ponder Website         Community Supported Agriculture (CSA)   Webpage discussing the process of community supported agriculture and how it can positively affect a community Website         HealthEquityGuide.org   HealthEquityGuide.org is a resource with inspiring examples of how health departments have concretely advanced health equity — both internally within their departments and externally with communities and other government agencies. This website includes: - A set of Strategic Practices to advance health equity in local health departments - Key actions health departments can take to advance their current practice towards health equity - 25+ case studies from local health departments that describe how they advanced the strategic practice, factors that enabled the work, impacts, and advice for others - 150+ resources from allied organizations and others to advance the strategic practices Website             Health Insurance Enrollment Outreach and Support   Webpage discussing health insurance enrollment outreach and support programs for those who may not have affordable coverage Website       Implicit Bias Tool – Project Implicit   On-line tool to guide users in uncovering their implicit associations about race, gender, sexual orientation, and more. Website           One-Stop Shop Model   Resource about how to put together resources in one location that can benefit families Website           Programs Expanding Access to Care in Rural Areas   This website provides a collection of healthcare organizations that have provided support to rural communities across the US and increased teir access to some health services they wouldn't have received otherwise Website     Racial Equity Tools   Racial Equity Tools offers a “monthly compendium of resources from a wide array of sources… for people who want to increase their own understanding and to help those working toward justice at every level—in systems, organizations, communities and the culture at large.” Website   Rural Transportation Services   Webpage describing rural transportation service options, their benefits, and how to implement Website         Safe Routes to Healthy Food   Website that provides strategies that make it easier for those who live in rural communities to travel to the grocery store Website           State Community Health Workers Models - NASHP Many states are looking to build on their community-based workforce and are looking for sustainable funding sources for CHWs. The information on this map comes from a 50-state survey of a variety of stakeholders, ranging from Medicaid officials to Community Health Workers, on their states’ approaches to integrating CHWs into evolving health care systems in key areas such as financing, education and training, certification, and state definitions, roles and scope of practice.