Lessons Learned and Engagement Insights from Community Voices for Health @) PUBLICAGENDA | MARCH 2023 Introduction In 2019, Public Agenda and Altarum partnered with the Robert Wood Johnson Foundation to launch the Community Voices for Health (CVH) initiative, a program designed to create more equitable health outcomes and participation in health policymaking. By facilitating community engagement, community-engaged research, and open dialogue with local policymakers, CVH aimed to strengthen civic infrastructure and create pathways to involve public voice, specifically underrepresented and marginalized voices, in shaping health policy in their communities. Six state-based grantees and their community-based partner organizations were accepted into the CVH program and awarded funding through a competitive selection process over- seen by Public Agenda." The grantees were located in Colorado, Georgia, Indiana, Nevada, New Mexico, and Pennsylvania. The grantees' work began in April 2020 in the midst of a global pandemic that forced project plans to accommodate the changing world and landscape of community health. These grantees worked to identify and leverage existing engagement assets, build new engagement practices, support community-engaged research efforts, and connect with local decision-makers. Their work centered on building partnerships for impact with community- based organizations, government entities, and community members. Public Agenda provided support for grantees in the development of place-based networks by convening grantees for collective learning and resource sharing and by providing technical assistance. Altarum provided additional technical assistance and training in support of grant- ee efforts. For recommendations and considerations for those looking to build and execute projects involving a grantee network-based approach to expanding community engagement in policymaking, see Appendix A. 1 In order to be eligible for a grant, the CVH initiative required state-based grantees to partner with community-based organizations. Both the state-based grantees and their community-based partner organizations were funded through the grant. Unless otherwise noted, "grantees" refers to both state-based grantees and community-based partner organiza- tions together. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH | essons Learned A e e - e -- Public Agenda's research team conducted 18 in-depth confidential online interviews across all six teams, with state-based grantees, community-based partner organizations, and community members who served on steering committees.? Interviews were designed and conducted to allow for reflection on the work completed, identify best practices, and consider improve- ments. The data collected for the report is not representative of all work in the community engagement or community-engaged research field. Therefore, findings outlined in this report are specific to these six initiatives and not necessarily generalizable to other engagement initiatives. The goal of this report is to inform the efforts of people working to strengthen health policy in communities through community engagement and community-engaged research and those who support that work. 2 The research department at Public Agenda did not provide technical assistance to anyone in the CVH initiative and had no other previous experience connecting with anyone involved in the CVH initiative. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 3 el LESSONS LEARNED INCLUDE THE FOLLOWING: Trust is essential for a successful initiative; building and maintaining it is time-consuming but necessary. Thoughtful and deliberate partnership composition is important; attention to the inclusion of diverse perspectives and approaches to achieving the same goal adds value. Sustaining an initiative requires community buy-in and authentic ownership. Initiatives need to be flexible to address community needs. Time to evaluate, reflect, and adjust is valuable. Diversity alone is not enough: People recognize when they are invited but not heard. Policy change takes years, but engaging lawmakers from the start may help the process. Technical assistance is valuable: More is welcomed, especially how to find additional funding. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH Grantee Snapshots Colorado Georgia STATE-BASED GRANTEE: Colorado Consumer Health Initiative COMMUNITY-BASED PARTNER ORGANIZATIONS: Center for African American Health and Chris Armijo Consulting, LLC COMMUNITY FOCUS: African American community members BeHeard Colorado launched the People's Health Empowerment Project, a cohort of community leaders, to increase leadership capacity of African Americans in the Denver metro area through community-based participatory research, enabling community leaders to influence health equity as a focus of health policy discussions. STATE-BASED GRANTEE: Georgia Watch COMMUNITY-BASED PARTNER ORGANIZATIONS: Georgia Advancing Commu- nities Together, Georgians for a Healthy Future, and Morehouse School of Medicine COMMUNITY FOCUS: Community health workers (CHWSs) and their communities The Georgia CVH team leveraged partnerships with the Georgia Community Health Worker Advocacy Coalition-which included Georgia Watch, Georgia Advancing Communities Together, Georgians for a Healthy Future, Morehouse School of Medicine, and Advocates for Change board, an advisory board of community health workers-to equip CHWs with the resources they needed to strategically mobilize marginalized communities around policy issues. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH Indiana STATE-BASED GRANTEE: Community Justice & Mediation Center COMMUNITY-BASED PARTNER ORGANIZATIONS: Indiana University and Gnarly Tree Sustainability Institute COMMUNITY FOCUS: Community members and community-based groups The Indiana team built a coalition of local and state partners to conduct community-based participatory research on health-related issues and to implement deliberative public and stakeholder engagement, with the goal of creating strong pathways for collaboration and shared policy decision-making among community members, local advocates, and public officials. Nevada STATE-BASED GRANTEE: Kenny Guinn Center for Policy Priorities COMMUNITY-BASED PARTNER ORGANIZATION: Clark County Social Services COMMUNITY FOCUS: Nevada youth The Nevada CVH team established Nevada95, a statewide network with a focus on engaging young people and empowering youth in public systems and community organizations. The team set out to encourage younger voices to co-design leadership opportunities and improvements to social service systems that address the needs of underrepresented and at-risk communities. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH New Mexico STATE-BASED GRANTEE: New Mexico Alliance of Health Councils COMMUNITY-BASED PARTNER ORGANIZATIONS: University of New Mexico, Center for Health Innovation, New Ventures Community Building, and Pres- byterian Healthcare Services COMMUNITY FOCUS: Health councils and their communities The New Mexico CVH team developed community-based participatory research tools with county and tribal Health Councils that were piloted in six high-need areas across the state. The participating Health Councils engaged in training sessions about community-based research, which empowered community leaders to address urgent needs in public health, primary care, behavioral health, and social determinants of health. Pennsylvania STATE-BASED GRANTEE: Pennsylvania Health Access Network COMMUNITY-BASED PARTNER ORGANIZATIONS: Housing Alliance of Pennsyl- vania and Temple University COMMUNITY FOCUS: Community members and community groups The Pennsylvania CVH team organized BeHeard BeHealthy Pennsylvania, a citizen-centered health advocacy project led by the Pennsylvania Health Ac- cess Network (PHAN). The goal was to surface community needs and priori- ties, all while putting the spotlight on underrepresented voices by recruiting participants, hosting sessions, and facilitating dialogue with a wide group of Pennsylvanians. For more information about initiatives, please see here. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH Findings in Detail Trust is essential for a successful initiative; building and maintaining it is time-consuming but necessary. Interviewees often spoke of the importance of building and maintaining mutual trust between state-based grantees, community-based partner organizations, and community members.? They viewed trust as the crux to working effectively and efficiently across all aspects of the initiative and a necessity for equitable work. Interviewees indicated that relationships built on mutual trust among state-based grantees, community-based partner organizations, and engaged community members provided a cyclical pattern for constant improvement: When there is mutual trust, everyone shares ideas and opinions freely, all ideas and opinions help shape initiative design and create ownership, ownership helps sustain engagement, and therefore new ideas and opinions are continuously provided to help improve and shape the initiative. Likewise, interviewees acknowledged that a lack of trust among state-based grantees, community-based partner organizations, and community members held up progress and undercut impacts. Yeah, to be honest, if we had a different partner, we would have gotten further because we wouldn't constantly have to be working on the trust challenges."* COMMUNITY-BASED PARTNER ORGANIZATION 3 "Community members" refers to people in the community who did not participate in the initiative through any orga- nization and who could be involved in the initiative through different roles, including a steering or advisory committee. 4 Quotations have been minimally edited for clarity and to ensure confidentiality. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH However, many interviewees indicated that time is a large barrier to building and maintaining mutual trust. Interviewees expressed a wish for more time to engage in team-building activ- ities, which they saw as a way to establish a foundation in which trust can develop. They also recognized that trust is something that has to be constantly maintained, especially given challenges such as staff turnover or the development of new partnerships during the initiative's lifetime. While interviewees expressed a need for more time to engage in team-building activities to develop trust, they also identi- fied other ways, discussed later in this report, to both develop and maintain trust, including engaging already trusted members of the community, having clearly defined roles and responsibilities, and ensuring everyone's voice is heard. ( ) ' ' It's a challenge to build trusting relationships in a short amount of time. Really you need a year of building the relationships, but that becomes a challenge because you've got to produce." STEERING COMMITTEE MEMBER / - ' ' We had the right people at the table and we can be far more impactful than we have been, you know, if we trust one another." STEERING COMMITTEE MEMBER \ J ' ' Especially given, you know, historical divisions between Asian and Black, as well as African and African-American. To have us all working on something, and really this first six months the goal was just relationship building." COMMUNITY-BASED PARTNER ORGANIZATION \ / another job." STATE-BASED GRANTEE There's a lot of staff turnover. Whenever there was staff turnover, trying to maintain the engagement of the organization took relationship building. Which took some time. Often it would get comfortable after a while, everybody just shows up and works together. Then somebody moves to ~ LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH Thoughtful and deliberate partnership composition is important; attention to the inclusion of diverse perspectives and approaches to achieving the same goal adds value. There was a general understanding among grantees that they are not alone in the work they are trying to advance and that there are many organizations undertaking similar work both in and outside of their community. While some interviewees acknowledged that partnerships can slow down the work, in general, interviewees valued the bene- fits of strong, trusting partnerships over the challenges. Grantees spoke about the importance of creating partner- ships with those who have shared goals, although partners do not necessarily need to share the same approaches to achieving that goal. In fact, many interviewees spoke You're not in this alone whether you're the sole grantee or not, you're not in this alone. And so think about who else cares about this work before you start." STATE-BASED GRANTEE about the importance of "thinking outside of the box"" about potential partners and actively seeking diversity in perspectives on community health. For example, while health depart- ments are beneficial partners, grantees also saw the benefits of partnering with organizations or individuals connected to other social determinants of health, such as housing, labor unions, food banks, and education. These "nontraditional" partners could increase the reach in a community and support a multidisciplinary approach to improving community health. While the structure of the teams varied dramatically across the initiative, grantees articulated the importance of partnering with organizations or community members with a diverse set of skills to fill a variety of roles. Interviewees did not speak of these roles An ideal team composition included: as mutually exclusive, and they empha- sized the importance of developing 1. On-the-ground service providers; partnerships specifically with organizations 2. Community members or organizations and community members that are already that serve as cultural resources; trusted by the communities they serve. 3. Advocacy and policy experts; and Grantees spoke of utilizing a variety 4. Lawmakers and other elected officials. of tactics to identify and connect with organizations and community members, including the use of steering committee LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 10 member connections, word of mouth, email lists, social media marketing, and existing coa- litions. When identifying and building partnerships, interviewees stressed the importance of being able to clearly articulate initiative goals and emphasize the benefits of participation- recognizing that potential partners are usually already strapped for time and resources. Interviewees spoke about emphasizing benefits such as saving money or generating a larger impact than working alone. It was a general consensus among grantees that developing partnerships with other organi- zations was a time-consuming process that could take months, if not longer. 4 N ' ' A lot of planting seeds. | don't need you to change your mind today, | just need to plant the seed today. I'm going to water it over the next six months to a year, and if it grows it grows and if it doesn't we move on to the next seed." STATE-BASED GRANTEE J - ' ' So we wanted to make sure that we're working with partners who can act as trusted resources, as kind of gatekeepers within their communities, to say, 'Hey, this is a legitimate group."" STATE-BASED GRANTEE ~ J ' ' It wasn't one of us coming and saying, 'Hey, we have this idea if you want to jump on and be part of it.' It was more like, 'What can we do better together?'" COMMUNITY-BASED PARTNER ORGANIZATION \ J of their spaces." STATE-BASED GRANTEE ' ' Partnerships slow the process a little bit. But they create sustainability and they create a synergy that leverages the work throughout the community system. So to me having the complexity and possibly a slower timeline is worth it because every partner that is engaged in that core group now knows and understands the project, what's happening in our communities, and | believe that understanding influences the work that they are doing in each ~ LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 1" How can this work benefit them, because that's the secret of engage- ment. You engage in things that matter, that are meeting your needs and those of your organization, because nobody has time to waste." STATE-BASED GRANTEE I | think that there's probably a lot of people that would've been willing to work with us and collaborate with us-if they'd had a better understanding of what we did or our funding structure or exactly what we're able to do or offer." STATE-BASED GRANTEE LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 12 Sustaining an initiative requires community buy-in and authentic ownership. Interviewees often spoke of wanting to create an initiative that is sustainable beyond the grant period and has lasting impacts. They recognized that to do so they needed deep engagement, continued buy-in, and initiative ownership from the community, which first required the state-based grantees to gain the trust of the community. However, some inter- viewees spoke of the difficulties of inserting themselves into a community that may be wary of, or not trust, outsiders. A few even suggested that communities may be wary because of past instances when other organizations or initiatives were introduced only to disappear once funding dried up, reiterating the need to create a sustainable initiative. While some grantees spoke of partnering with already trusted organizations or individu- als as a way to initially gain trust, other grantees spoke of needing to modify how they discussed their work depending on the political leaning of a community. Grantees stressed the importance of not only gaining the communi- ty's trust but also maintaining it in order to create community buy-in and ownership of the initiative. Interviewees identified several ways to gain and maintain trust, including being upfront about initiative objectives, clearly articu- lating community members' role in the initiative and how their partic- ipation will improve the initiative and impact their community, and ensuring meetings or events are not spread too far apart. And really the goal has been, or my goal has been while we are kind of the project team, we should be in the background, especially if we want this to be some- thing that sustains itself and keeps living in the community." COMMUNITY-BASED PARTNER ORGANIZATION There is sort of a long history and slew of examples from various nonprofits or even governmental bodies of jumping into a community, and it may even be for a year or two, but then the funding goes away and they disappear. And we are really trying and hoping to avoid that on this project." STATE-BASED GRANTEE LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 13 Interviewees often spoke of the impor- tance of making meetings and events Some of the most cited ways to make accessible to all community members. meetings and events accessible include: They believed that accessibility not only 1. Holding meetings outside of work hours, increased community engagement and such as on weekends or nights; buy-in but also helped their initiative to become equitable and inclusive. 2. Offering incentives such as food, child care, transportation, or hotel costs; 3. Using surveys for those who cannot attend events or do not like to speak up at events; and - ' ' The parameters of what - 4. Offering in-person and virtual meetings. we were actually able to do should have been explained to us from the /- ~N beginning. They should ' ' I have been really trying to figure have told us what this out for two years how | even insert grant is actually capable myself into the community as an of doing." organization. Even calling yourself STEERING COMMITTEE MEMBER an organizer, that is a challenge J in rural communities. You are kind of met with some defensiveness. . Language is important for how you ' ' | can imagine people sort guag P y of falling off after the first meeting, and then it is present yourself in the community." STATE-BASED GRANTEE four months, and it is like, 'Wait, this feels like forev- er ago. | have other stuff going on."" COMMUNITY-BASED PARTNER ORGANIZATION LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH Although virtual meetings seem to be an easy way to navigate barriers such as child care, transportation, and time constraints, many interviewees often spoke of limited to no internet access in rural communities-making online meetings next to impossible. Additionally, interviewees spoke of the importance of having interpreters available at meetings and events and translating any materials and surveys so they were accessible to all community members. While many grantees were able to find ways to translate their materials into Spanish and have Spanish interpreters available at meetings, some requested more support for additional languages. Many interviewees spoke of the importance of not only creating community buy-in but ensuring that community members had ownership of the initiative as a way to help increase trust and build sustainability. They pointed to the value of inviting commu- nity members to co-create, if not fully design, many aspects of the initiative. - ' One Sunday we held two groups. Well, it turns out buses don't run on Sunday. So it's a middle-class assumption that every- one has a car. That's a bias." STEERING COMMITTEE MEMBER \ J ' ' There's a handful of other languages that it would have been really great if we someday could have that capacity, just because | feel like that way we could be that much more inclusive of these commu- nities that are already marginalized as is." STATE-BASED GRANTEE ~ - We led it, but then once we got those community members to help us design the program, we stepped back and we let them take the lead. So, they actually appointed a president, a vice president, and a secretary. They set their own agenda. They set their own meetings. So, they actually became the lead and we became the support. | think that was very vital because it gave them buy-in into the design, into the implementation, and even into being so involved that they want to continue this even though the project has ended." COMMUNITY-BASED PARTNER ORGANIZATION LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 15 Yet even with community ownership and continuous buy-in, some interviewees identified other barriers to sustainability. In some instances, grantees spoke of a lack of resources avail- able to community members such as physical space for meetings or monetary incentives that could be used to increase participation. Others questioned the expectation that community members would gain the skills needed to engage independently in their communities from a few training sessions. They saw the I" need to create practical "next steps" to help bridge the gap between training and independent engagement, but some were unsure of what those practical "next steps" should be. We were able to say, 'Here is how you can be clever in putting together a com- munity engagement activity, so use your local library or partner with a restaurant who wants more promotion and have them offer to donate food and things like that." So we kind of helped them to think outside the box when resources are not available." STATE-BASED GRANTEE I'm sorry, but we have this unrealistic expectation of people that they are going to come take a class and be like, 'Okay, | know everything to do, thanks.' Like the course is one thing, practicum is another, and giving them the real-life experience is something that we could do." STATE-BASED GRANTEE PR L BT | W) cap P PO E G (. L $ il oomy IR dad il L T ¢ e T B Rl ol eyl T R L s o LRl LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH e _______________________4 I : Initiatives need to be flexible to address community needs. Time to evaluate, reflect, and adjust is valuable. Interviewees saw the value of having clearly defined objectives and responsibilities to create new partnerships among organizations and community members and to center equity in the initiative from the outset. At the same time, many interviewees also spoke to the impor- tance of having a flexible and adaptive scope of work throughout the duration of the project. The most obvious example of the need to be flexible happened in March 2020, when the COVID-19 pandemic caused nationwide lockdowns and grantees had to continuously adjust to the new safety protocols. But even outside of the disruption of COVID-19, there was a general understanding among interviewees that there will always be barriers such as staffing or leadership changes within the initiative that require constant adjustments and flexibility. / ' ' Two staff who had left had established a really good base and had good directives and things generally for us to do in terms of specific events or volunteer opportunities. So it kind of seemed like when they left, it felt like there's just kind of a lull. And | think in those couple months we kind of lost some people and lost some direction." STATE-BASED GRANTEE / Well, | think the major thing was the partner organization had numerous staff turnovers. And then they did not hire a community liaison until six months after the project started, and she only stayed about five months on the project. So, fortunately, we stepped in and helped out." COMMUNITY-BASED PARTNER ORGANIZATION J Interviewees saw the scope of work as an iterative process that required repeated evaluation. They described creating a scope of work as a balancing act between having too little direction and too much rigidity, both of which were seen as affecting the success of a project. For example, some grantees spoke of creating partnerships only to lose engagement because of a lack of clarity about tasks to work on. On the other hand, some interviewees spoke of taking time to create a whole plan only to have it change. In some cases, interviewees spoke of rigid objectives as barriers to pivoting an initiative to meet community needs. Interviewees also acknowledged the important role of funders in allowing initiatives to be flexible and adaptive rather than prescriptive. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 17 ( ) ' Always be ready to be flexible, because nobody comes in with the perfect project on day one. We want to expect it to grow and to change and to develop, not stay the same, and so it's really import- ant to know from the beginning where are the core pieces and where are the flexible ones." STATE-BASED GRANTEE Although interviewees did not always use the word "evaluation," many spoke of the impor- tance of grantees and community members taking time to reflect on the initiative, ensure everyone is on the same page, and adjust direction when necessary to better serve the community and produce equitable impacts. Although some grantees had the opportunity to conduct these types of evaluations, most indicated they wished for more time to do so. Other interviewees indicated an interest in collecting more quantitative data through surveys but questioned their skills and capabil- ities related to survey programming and data analysis. However, as discussed in more depth in Finding 5, interviewees pointed out that if evaluations are meant to truly improve the outcomes and ensure equitable initiatives, state- - The grant is just a guideline, it's not the end of the story, and so always keep your fo- cus on the change you want to make and look at the funder as a partner in mak- ing that change. They would have never offered the fund- ing if they didn't care about the issue. And they know and we know that nobody has a plan that's the perfect plan out of the chute." STATE-BASED GRANTEE J Well, | would say first and foremost, make sure that you have a clear plan of what you want to do. Once you have your clear plan get your backup plan, because a lot of times some of your initial plans don't always go forward." COMMUNITY-BASED PARTNER ORGANIZATION \ J based grantees must trust community-based partner organizations and community members enough to address and incorporate feedback formed during these evaluations. ' ' I think it would have really made a difference to have more time to just reflect and think about what was working, what we could do better, what we could do differently, and what are the gaps." STATE-BASED GRANTEE LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH | don't think you can know which direction to move We also continued to ask for your work without know- ing where you're trying ¥ evaluations informally, sometimes to go and how you were formally, and sometimes we used successful in getting there just what we could see. If people in the past and where the looked disengaged or we saw gaps are and what you attendance slipping, we would need to improve upon." start to reevaluate." STATE-BASED GRANTEE STATE-BASED GRANTEE It created a space for folks to fill out the survey, and it was very helpful because after each session | would review the results with the team and it allowed for iterative improvements." COMMUNITY-BASED PARTNER ORGANIZATION LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 19 Diversity alone is not enough: People recognize when they are invited but not heard. State-based grantees understood that it was important to allow those who know their community best, such as their community-based partner organizations and community members, to direct and design the initiative. They identified this as a way to not only ensure sustainability but also create equity within the initiative to support equitable community impacts. While most interviewees understood that equity and inclusivity were best achieved when they permeated the whole grantee structure from the start of the initiative, it seemed as if some grantees were unsure how to successfully achieve it in practice. Other interview- ees tried to address equity and inclusivity once the initiative was already up and running and realized it would have been beneficial to think of equity from the start. / We had professors and we had doctors, so in my mind we had mostly leaders. I'm not really sure exactly what we needed to have done to find people who would have created the kind of group we wanted to create initially." STEERING COMMITTEE MEMBER N J And the advisory council, we had really decided that we wanted it to be a good cross-sector collaboration of leaders, policymakers, allies, and actually self- identified representatives from underrepresented communities." STATE-BASED GRANTEE \ J Most interviewees spoke of achieving equitable initiatives through ensuring diversity of partici- pation among community-based partner organi- zations and creating diverse and representative steering committees with members who have lived experiences and can best speak for the communities they would serve. Some grantees spoke of the importance of recruiting diverse community members, with attention to race, geography, income, age, and ability, to not only serve on steering committees but also participate in trainings, meetings, and events. Some interviewees questioned whether recruitment strategies were reaching only the usual suspects. While diversity was important to address equity, some interviewees also spoke of the impor- tance of creating spaces among grantees and community members in which everyone felt comfortable collaborating and ideas could be shared without judgment. Creating these types of spaces requires trust among grantees and community members. Others spoke of the importance of precisely analyzing data to ensure voices are accurately represented. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 20 However, even though initiatives were created to be diverse and allow for honest conver- sations among community members and within grantee teams, some interviewees still did not feel heard and questioned whether, intentionally or not, their participation was merely tokenism. Some interviewees expressed frustration about being recruited because they were trusted community members yet they were not trusted to help direct the initiative. They also suggested that not feeling heard negatively impacted community buy-in and ownership, which as discussed in Finding 3 could threaten the long-term sustainability of the initiative. - ~ Interviewees identified ways for grantees to ' ' They also know that any- address concerns about not feeling heard by time they come to us with outlining specific responsibilities and clearly something, it is going to be articulating how, and to what extent, they are without judgment or, you to influence the initiative, along with potential know, blame. It is always limitations of their position. However, some ex- very person-centered and pressed that specifying responsibilities meant what can we do for you?" little when they were not trusted to complete COMMUNITY-BASED their work, leading to micromanagement or PARTNER ORGANIZATION their ideas being dismissed. _J 4 N\ ' ' And | think despite good intentions, it often felt like we are being partnered with so they can say, 'We are working with people of color."" COMMUNITY-BASED PARTNER ORGANIZATION J - ' ' When you're dealing with underrepresented groups you want people to feel heard, and so you have to be very per- fectionistic in your data analysis, because your goal in that situation is to make sure people feel heard and included in the process." COMMUNITY-BASED PARTNER ORGANIZATION J LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 21 ' ' You find qualified people within the community who have a history of doing the work, trust them. And provide them support. That is what your role is. Your role is not to show your funders how diverse you are all of a sudden, or to tokenize people and put them in your organization in this totally uncomfortable relationship." COMMUNITY-BASED PARTNER ORGANIZATION / ' ' Every time we had asked what we were supposed to be doing, the response was always, 'Whatever you guys want.' It sounds like it is a good thing, but if we come to you with an idea and every single one is shot down because it is too complicated, it is too pricey, you know, there is too much risk involved, then it is not really whatever we want." STEERING COMMITTEE MEMBER LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 22 Policy change takes years, but engaging lawmakers from the start may help the process. Although few initiatives have made a direct impact on health policies to date, interviewees were proud of the impacts they were able to make in their communities. Though at times they spoke of these impacts as being "little" compared to affecting policy, many interviewees spoke of these impacts as fundamental in creating larger future change. Time was consistently highlighted as the factor in creating change at the policy level. Interviewees questioned how many years is actually enough time to realis- tically have large systemic impacts. It takes time to create partnerships, build trust, and develop buy-in among com- munity-based organizations and commu- nity members; collaborate to co-develop objectives and scopes of work to create ownership among community members; and assess and modify the initiative to ensure it is continuously focused on best serving the community. On top of all this, interviewees spoke of difficulties engaging lawmakers in general or get- ting their attention only to have to start over when those legislators were not reelected. Others pointed to the chal- lenges of the bureaucracy itself and how, even with legislator support, any policy change takes time to pass. Whether they did so or not, most inter- viewees spoke of the importance of engag- ing elected officials early on in an initiative. Having elected officials involved in the beginning creates investment not only Across the interviews, grantees and community members alike identified the following impacts of their work: 1. Connecting community members to one another and to elected officials to continue to raise awareness of health issues in the community; Directing community members to resources and information they did not have access to otherwise; Creating steering committees that express interest in continuing the work after the funding ends; Providing trainings that equip commu- nity members to then train others or become facilitators in their communities; and Providing trainings to community members about how to effectively communicate with elected officials. ' ' But | feel like, yeah, there's some momentum here, there's some mindset changing that is happening." STATE-BASED GRANTEE LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 23 from them but potentially from their office, which could help support continued engagement when the official leaves office. Some also spoke of engaging lawmakers early in the initiative as a way to be responsive to their needs and address what type of information or data they would like to help create policy change. Inter- viewees spoke of different ways to involve lawmakers, including inviting them to trainings about how to speak and present ideas to elected officials, inviting them to act as allies to gain support among their legislative peers, and having them engage in an initia- tive as community members. However, interviewees also stated that engaging elected officials or their staff was another time-consuming activity. ( ' ' | think the result of this steering committee was that it connected people with the resources that they didn't know before and in doing so inspired policy and social change." STEERING COMMITTEE MEMBER ~ L 4 s Ca o B R L) L | P r - ) ' ' Some of our participants have started some of their own work in the community in one way, shape, or form, or one of them is sort of co-facilitating another project or program with our facilitator." STATE-BASED GRANTEE ' ' We have a lot of people thinking about their priorities around health, and we did form an advisory group that is staying together in this configuration." STEERING COMMITTEE MEMBER J ' ' And next year is a mayoral election. Our city is a very mayor-led city. So who that person is and how invested they are in this kind of work will make a big difference." STEERING COMMITTEE MEMBER LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 24 If we had to do it over again, | probably would have engaged the elected = officials a lot earlier on so that they could be thinking about how they might There were one or two city-elected officials on the advisory council. Huge important lesson. If you want use the data coming out to effect change at an elected- of our project to inform decici i . official level, at a policy level you ecision-making processes. have to get people involved really, COMMUNITY-BASED really, really early on and let them PARTNER ORGANIZATION sort of grow up with the project." STEERING COMMITTEE MEMBER LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 25 Technical assistance is valuable: More is welcomed, especially how to find additional funding. Grantees were appreciative of the flexibility of the grant itself and also found the techni- cal assistance provided by Public Agenda and Altarum helpful. Some indicated that provid- ing technical assistance was a way to show the grantees that the funder cares about their success and wants to actively be engaged in supporting the work they are doing. They also appreciated that they could turn for help to an intermediary that was not the funder, feel- ing they could be somewhat more honest and open with independent organizations about the challenges they were facing. Interviewees said the technical assistance offered by intermediaries not in the weeds of the project provided a good sounding board, along with a potentially different, and some- times broader, national perspective to address challenges that arose. Others appreciated that the technical assistance offered opportunities for the six grantees to connect across projects and learn from others who were facing similar challenges. In addition to using the technical assistance provided, grantees were apprecia- tive of being connected with one another as collaborators undergoing similar work. - Robert Wood Johnson Foundation stayed engaged through Public Agenda, through Altarum, and through our liaison. Funder engagement in the work says something to the grantee about the value of the work and also about the concept of partnership and collaboration. So | think that was really a powerful statement without words." STATE-BASED GRANTEE / Sometimes we could get so engrossed in this work that we have tunnel vision, so it was always good to have both Public Agenda and Altarum to say, 'Okay, well, what about this?"" COMMUNITY-BASED PARTNER ORGANIZATION ~ ' The best thing was the ability to talk to other grantees, because they were doing something similar. It was nice to know that they were having the same challenges." COMMUNITY-BASED PARTNER ORGANIZATION LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH While interviewees suggested other resources and support that would be beneficial, such as translation services and data analysis, they also requested assistance in finding other funding opportunities to sustain their work. Creating sustainable and impactful projects takes years, and although grantees felt they were on their way to creating sustainable initiative infrastructures, they also noted that additional funding could likely secure the longevity of the initiative. Also, many inter- viewees saw the value of the initiative in the community and were eager themselves to continue what they started. They were inter- ested in finding other sources of funding to support their involvement and were looking for guidance on where to search or apply for more grants or other funding opportunities. - I'm still trying to adjust to once the grant ends. How do we continue to engage with communities, how do we continue to keep the work going? Because | think it's a disadvantage to kind of start this ball rolling and then we're no longer supported to be able to keep this going." STATE-BASED GRANTEE \ J | would say | wish there was more technical assistance on how to find other grant dollars for this type of work because it had just sparked such interest. | hate for the interest to die because the project ended or the fund- ing ended. Do you have any resources or connections or recommendations of any foundations or anybody that you are hearing around the country that is funding this type of work?" COMMUNITY-BASED PARTNER ORGANIZATION LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH N 27 Methodology Public Agenda's research team conducted 18 in-depth, confidential online video interviews over a three-month period between November 2022 and January 2023. Interviewees were recruited by outreach done by Public Agenda's public engagement team and snowball sam- pling based on interviewees' involvement in the CVH program. Three people from the initia- tive in Colorado were interviewed, three from Georgia, three from Indiana, four from Nevada, three from New Mexico, and two people Pennsylvania. Across all six initiatives, interviewees included eight individuals from state-based grantee organizations, six individuals from com- munity-based partner organizations, and four community members who served on steering committees. The interview guide was designed by the Public Agenda team. Interviews were conducted by two members of the research team, recorded, and transcribed by an outside vendor, Kelsey Transcripts. While the interviews were being conducted, Public Agenda's research team concurrently analyzed the transcripts of completed interviews. Through an iterative process, Public Agen- da developed a codebook that included variables of interest based on project objectives and internal conversations with Public Agenda's public engagement team involved in the project. Two members of the Public Agenda research team coded each transcript using the Dedoose platform. Within Dedoose, Public Agenda analyzed the coded transcripts thematically. Al- though the data collected, analyzed, and reported on is not representative of all work in the engagement or community-engaged research field, the analysis produced insights based on the reflections of those involved in various stages of community-engaged research. For further detail about the research, contact research@publicagenda.org. Support for the Community Voices for Health initiative was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation. To learn more about the initiative and the six grantees, please visit Community Voices for Health. @) PUBLIC AGENDA LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 28 Appendix A: Reflection on Program Design Community Voices for Health relied on a multilayered approach to support lead state-based grantees and their partners through regular opportunities for connection, training, and technical assistance. This included working with grantees in the development of place-based networks; providing training related to equitable program design, community-engaged research, and policy work; and convening the group monthly for collective learning and resource sharing. We offer the following recommendations and considerations for those looking to build and execute projects involving a grantee network-based approach to expanding community engagement in policymaking. Ensure clarity about goals for grantee support and training. Establishing the goals for grantee support early provides a structure for impact and trust. Program managers need to understand if they should be focused on accountability for outcomes and progress toward goals or positioned as partners in advancing the work- focused on sharing ideas and resources. The roles of program managers and technical assistance providers should also be clearly articulated for the grantees to establish expectations and create a basis for trust. Make time for co-learning and establishing responsibilities. Similar to what we heard from grantees in reflection, trusting relationships are central for high-impact projects. This includes relationships between funders, program managers, technical assistance providers, and grantees. Investing time at the beginning of the initiative to learn from one another, understand the unique contributions of all the partners in the project, and thoughtfully map individual roles and responsibilities will establish the founda- tion for open communication, institute and maintain continuous improvement, and enable full leveraging of all project assets. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 29 Create structures and processes that support collective learning and resource sharing. While technical assistance on engagement strategies and site-specific policy research was important, grantees also wanted to learn from other grantees who were conducting similar work through a similar model. Strong program design should create pathways, such as virtual spaces for sharing materials, different modes for communication, and regular time for conversation and reflection, as an aspect of training and technical assistance. The role of the program manager is to "set the table" through processes and structures that facilitate peer- to-peer learning and to make strategic connections among grantees that empower them to assist one another. Supporting grantees as a unified network versus individual site-specific projects allows for deeper impact by making individual knowledge and innovation part of the collective work. Embrace change management! Program managers and technical assistance providers need to be able to adapt and shift their approaches as grantee needs change and also to be a source of support and guidance for grantees as they manage changes themselves. This initiative was launched as COVID-19 was disrupting life and work worldwide-requiring deep attention to change management. We recognize the value in building a collective space (among funders, program managers, technical assistance providers, grantees, and their partners) for acknowledging the need to pivot approaches and the need to work together on a shared path forward. As a shifting landscape is truly a constant in any change effort, it is important to pay attention to onboarding new contributors and to keep reflecting on past and current direction. LESSONS LEARNED AND ENGAGEMENT INSIGHTS FROM COMMUNITY VOICES FOR HEALTH 30