Dr. Timika Anderson-Reeves, Director of Maternal Child Health & Women’s Health Community Integration and Westside Healthy Start, Project Director, PhD, MSW
Community-led programs and organizations that focus on addressing the social drivers of health through a racial and health justice lens are collaborating with marginalized families and leverage the voices and expertise of these community members to achieve health equity. Funded by the Health Resources and Services Administration, the Healthy Start Initiative is a community-driven program with nearly 30 years of experience in improving perinatal health and racial disparities among marginalized communities across the nation. Communities employing the Healthy Start (HS) Initiative model strive to:
- Improve women’s health
- Improve family health and wellness
- Promote systems change
- Assure impact and effectiveness.
These objectives are pursued as communities partner with consumers of services and community decision-makers to reduce high infant mortality rates. According to the Centers for Disease Control and Prevention, African Americans experience infant mortality at a rate of 10.8 deaths per 1,000 births, which is nearly two times higher than the national average of 5.7 deaths per 1,000 births.[1],[2]
Healthy Start Initiative communities across the nation in tribal, rural, and urban areas, which are promoting system-level changes at the community level, are required to employ the collective impact (CI) framework to identify social problems specific to their targeted community area. The CI framework’s core principles assist with bringing about social change and include setting a common agenda. The next step is to gain a consensus on which data will be collected and evaluated to conceptualize the selected social problem. Performing mutually reinforcing activities helps keep all partners focused on the set plan and promotes continuous communication to share lessons learned. Lastly, the CI framework’s most crucial principle is the backbone organization, which serves as the lead facilitator to ensure all aspects of the project are followed and addressed.[3] This framework has guided HS Initiative programs in developing a diverse community action network (CAN) to establish a strong collaborative spirit between consumers, community members, and decision-makers in creating a shared action plan to achieve racial and health equity.
Developing Strategic Partnerships and Consumer Leaders
Historically, the city of Chicago has struggled over the years to meet the housing needs of marginalized communities. Families in these communities have faced obstacles, from redlining to overpriced housing rentals, and shortages of affordable housing; it is not uncommon for struggling families to be forced to choose between accessing health care and obtaining secure housing.[4] The lack of stable housing among pregnant and parenting women has created barriers to access and utilize health care services designed to improve perinatal health outcomes.[5] To combat the myriad of challenges associated with homelessness, a Chicago-based HS program used the CI framework to help leverage the CAN to engage and empower homeless pregnant and parenting consumers, and community members, to become part of a governing body and develop meaningful strategies that translated to achieving racial and health equity.
The CAN governing body included consumers, strategic-minded community-based leaders, and innovative partnerships among health and housing decision-makers. This body helped reframe the way housing policies prioritize pregnant and parenting women. The HS program recognized the value of including the various ranges of expertise, from consumers to decisionmakers, and developed a leadership enrichment curriculum to sharpen the skills and enhance existing knowledge of the entire governing board to create a common place for equitable social change.
The Leadership Series (L-Series) enrichment curricula was developed for the governing body, with a focus on providing soft skills-based training on four key topics:
- Training on using Roberts’s Rules of Order to help members participate effectively in organized community meetings.
- Training on public speaking principles to equip members to express concerns effectively in less than a minute when attending organized meetings.
- Knowledge and insight into the importance of remaining civically engaged in their respective communities.
- Learning how to collectively advocate to establish equitable policies related to housing and health effects.
This innovative approach to promoting community-level change was key to helping consumers become strategic leaders to articulate their personal challenges and their lived experiences with homelessness to decision-makers and legislative officials. Use of this approach created a safe space for consumers to also talk about the racial and housing inequities that they have experienced when accessing housing support services in previous incidents, and how these challenges have caused unnecessary barriers when accessing health care services. To address the social determinants of health and after hearing the concerns of homeless pregnant and parenting women, the HS program worked closely with its backbone organization to ensure all women screened for homelessness are tracked in an electronic database — this is the primary data collection method to determine barriers to housing stability. It is important to leverage nontraditional partnerships with housing organizations when attempting to eliminate housing disparities among marginalized populations. For example, All Chicago is a community-based organization that provides resources and partners with housing entities to support homeless populations.[6],[7]
Moving from Partnership to Policy
All Chicago is recognized as the convener of all things related to homelessness in Chicago and has helped to spotlight the various types of homelessness, which include living in cars, emergency shelters, and transitional housing. Working in tandem with All Chicago, and the Continuum of Care, a membership comprised of community-based organizations working to prevent and end homeless in Chicago, health system decision-makers and the HS program gained insight and leverage to vocalize the need to establish equitable health and housing policies that focus on pregnant and parenting populations. Forming a partnership between health and housing programs helped to reframe existing housing policies and integrate recommendations that prioritize pregnant and parenting families’ needs to gain immediate access in securing rapid, affordable housing placements that help minimize barriers to health care access. The deadline for passing legislation to support the recommendations in Chicago has not yet been determined; however, other small policy wins have not gone unnoticed by the Healthy Start Initiative program and community members:
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As one example, this innovative partnership between health and housing facilitated the dissemination of critical information to the larger community, which helped simplify how pregnant and parenting families, and community members, became aware of and accessed the intake application entry point into housing support services.
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Through this simplified process, the City of Chicago utilizes a central telephone line, 311, to serve as the intake entry point. This process minimizes instances where individuals go directly to a shelter of their choice and determines what type of emergency housing placement is best suited on a case-by-case scenario.
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Productive partnerships like this one have also helped families understand why and how they should follow standardized policies and procedures when accessing housing placement services. They gained realization that following procedures optimally can translate to more long-term-based housing, which in turn creates space to focus on their health.
Forging Future Partnerships at the State Level
While community-level partnerships are vital to setting a robust policy plan to improve marginalized communities’ social injustices, nontraditional partners also have an opportunity to collaborate with Title V programs more broadly. For example, creating a Title V-led homelessness coalition among housing and maternal and child health decision-makers and consumers of services could provide momentum for an action-based plan to improve housing and racial disparities to improve perinatal health outcomes. In addition to maintaining a vested partnership, sustaining continuous dialogue through use of a CAN or similar network will help reframe health and housing policies that coincide. It is then that we can achieve equity among maternal and child health populations.
Dr. Anderson-Reeves currently serves as the Director of Maternal Child Health & Women’s Health Community Integration and the Westside Healthy Start Project Director at Access Community Health Network, an integrated network of more than 30 community health centers serving medically underserved communities in the Chicago metropolitan area. Dr. Anderson-Reeves also volunteers for organizations that have a mission to improve and transform the lives of families residing in communities that continue to experience social injustices.
[1] https://www.cdc.gov/nchs/fastats/black-health.htm
[2] https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm
[3] Ennis, G., & Tofa, M. (2019). Collective impact: A review of the peer-reviewed research. Australian Social Work, 73(1), 32–47. doi:10.1080/0312407x.2019.1602662
[4] Swope, C. B., & Hernández, D. (2019). Housing as a determinant of health equity: A conceptual model. Social Science & Medicine, 243, 112571. doi:10.1016/j.socscimed.2019.112571
[5] Clark, R. E., Weinreb, L., Flahive, J. M., & Seifert, R. W. (2019). Homelessness contributes to pregnancy complications. Health Affairs, 38(1), 139–146,146A-146C. doi: 10.1377/hlthaff.2018.05156
[6] Sheward, R., Bovell‐Ammon, A., Ahmad, N., Preer, G., Ettinger de Cuba, S., & Sandel, M. (2019). Promoting caregiver and child health through housing stability screening in clinical settings. Zero to Three, 39(4), 52–59. Retrieved from https://www.pec-cares.org/uploads/2/9/3/9/29391481/ztt_journal_homelessness-2019-march.pdf#page=52
