Supporting Equitable Communities through Technical Assistance

What is an “equitable community?” What role do social determinants of health, and inequalities or disparities in health, housing, education, justice, access to services, or in affordability, appropriateness, safety and stability play in building and maintaining an equitable community? Where does equitable and timely access to information fit in? And how does Change Matrix (CM) respectfully inspire sustainable community growth and change, build on expertise in the community, and keep power in the community?

“Go to the people. Live with them. Learn from them. Love them. Start with what they know. Build with what they have. But with the best leaders, when the work is done, the task accomplished, the people will say ‘We have done this ourselves.”         -Lao Tzu

Since the 1979 publication of “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention,” the US Department of Health and Human Services (USDHHS) has focused on the reduction of health disparities. Nearly 40 years later, many of the same health disparities mentioned in that report persist. In fact, the National Academies of Sciences, Engineering and Medicine’s Committee on Community-based Solutions to Promote Health Equity in the United States, recently noted that, “racial and ethnic disparities are arguably the most obstinate inequities in health over time, despite the many strides that have been made to improve health in the United States.”

(NOTE: We are broadly defining “community” – for example, a geographic community, an organization or institution, a diverse population, or a population that shares the same culture.)

Contributing to some of the observed health disparities is a racial divide in the US, where non-white populations – particularly African American communities – bear the brunt of individual, community and institutional biases, discrimination and racism. In such an environment it is unlikely that disparities will be eliminated. Rather, research demonstrates that toxic stress, such as that experienced when people encounter racism and implicit or overt bias, can lead to poor health outcomes and exacerbate disparities.

Knowing health and other disparities exist at disproportionate rates for some communities in our country, what are we doing about it? One thing (CM) offers is technical assistance (TA) to communities and programs – many of which have experienced and/or work to address the disparities described above.

For those who have limited interactions with the federal government, the term TA may not resonate. We have been asked if our work in TA is related to information technology (IT) services, or some other high-tech field. Actually, our work is grounded in local, state, tribal and territory communities and exists to support their goals and anticipated outcomes. We make an effort to meet people where they are at. We go to them, we listen and learn from them and we help them grow, while often sharing in that growth experience.

The way TA is delivered and the way it is received can and does look different for each individual program or community. For example, one program may require assistance locating information/resources on evidence-based, best practices in their field. For this type of request, the TA delivered is straightforward and relatively quick to deliver. Another program may require assistance developing a sustainability plan for their work. This type of request is much more involved and requires the TA provider to learn about the program’s current structure, staffing and services and their vision for the future. It also requires an understanding of the social, political and fiscal environments, project scope, key stakeholders, community buy-in/involvement, etc. – all of which can have an impact on sustainability and any related planning.

TA depends not only on a community’s needs, but also on its culture, as well as on a consideration of how the community itself wants and best receives information and support. Regardless of the need, request, or delivery, the most successful TA is received voluntarily, where a community or program truly asks for and wants it, and is willing and able to invest time and resources.

Consistent with CM’s core values and guiding philosophy, we believe that to be effective and sustainable, TA needs to be respectful, honest, responsive, and provided in partnership with the recipient. To work in partnership with a community or program, TA needs to be approached with humility, equality, and transparency. Humility that enables everyone to learn from each other; equality in power and expertise that values the community or organization as the experts about themselves, their context, their experiences, and that values the TA provider for their experience and skills; and transparency with information and expectations, and a fundamental principle of transparency is unfiltered honesty. TA needs to be bidirectional: not only can the community benefit from what TA has to offer, but TA providers can learn and grow deeply from the expertise and magic within a community.

Any other approach to providing TA, any other perspective about the necessary transparency involved in providing TA truly disempowers the community/recipient. It assumes that the community isn’t on equal footing, can’t “handle” certain information, or doesn’t deserve to or isn’t capable of making an informed decision about what is best for them. In fact, it is culturally destructive. Any lack of transparency in sharing information about or related to the community in a timely fashion serves to perpetuate and control a power differential. There is a saying, “how you do anything (or one thing) is how you do everything.” At CM we try not to make a distinction between our professional and personal philosophy — that philosophy is based on humility, equality, and transparency, and we aim to practice this philosophy in all we do, including TA.

Related Resources:

Contributed by: London Losey, Naomi Ortega Tein, Rachele Espiritu
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Engaging Fathers in Home Visiting for Long-Term, Culturally-Aware, Family Involvement

The Partner Parent Network provides an example of how parents can fit into the governance structure of a Home Visiting program.

The Commonwealth of Northern Marianna Islands (CNMI) Data Analyst, Jodina Attao, was asked the following question – “Why do you think parent involvement is important, particularly father involvement, in the home visiting program, and from a cultural perspective what it is that you need to address to engage them?”

Jodina Attao’s response: “In my opinion, parent involvement is an essential element in any child’s success in life. I truly believe that if our ultimate goal is to empower parents to develop positive beliefs about their role as a parent we need to work WITH them and not FOR them; just as they need to shift their paradigm to working WITH their children, not just FOR them. In our culture, however, this has always been deemed a challenge. Although we try to approach the family as a whole, it always seems like later down the line of services, engaging fathers becomes a bit more difficult. This is because we have always practiced matriarchal dominance in the CNMI. Fathers tend to lean toward being the sole breadwinner, and their beliefs have been set that their only parenting role is to provide FOR their family. Mothers, on the other hand, have to work WITH everyone in the household to ensure their success, and address the lack thereof. Fathers are usually seen as the disciplinarian, compared to mothers being the more nurturing parent; which has eventually encompassed a set of beliefs that parenting a child needs to be done separately instead of building the family as a whole.”

Other factors that come to mind according to Ms. Attao when thinking of father involvement are things like: insecurities that a parent may have, both the mother and father’s viewpoints; many fathers not be used to giving and receiving the type of attention (and compliments, for that matter) a child/mother usually gets.” Another factor is the native language; Ms. Attao feels that it always appears to come with negative connotation, due to the way the sound emerges – very firm, harsh, and “brush it off” kind of tone – which leads to the perceived attitudes and behaviors of fathers.

Quotes from Fathers

“I have always wanted a family of my own, now that I have them, I never take them for granted and I always make sure I make time to spend quality time with them.”

– Jose Reyes, Program Participant, Tinian site

“A father’s engagement in their children’s lives is important for their social and emotional well being. Teaching them to be responsible and able to make the right decisions and choices also helps us to build relationships with our children from the day they are born, into their teenage years, and when they become adults. The 5 foundations in our home for communication are: Love, Trust, Honesty, Respect, and Understanding.”

– Nestor Catbagan, Program Participant, Rota site

“Being an active father and having a strong bond with my son is important to me because mothers will always be too fragile with their children. It isn’t bad, they just need a father who will allow them to explore more, so they can be strong and learn to do things on their own instead of always seeking help.”

– Brandkief Castro, Program Participant, Saipan site

“I appreciate our home visitor for supporting us in our daughter’s cognitive and language development. Without the program, I wouldn’t have known how to go about raising my child. It’s important for me to learn so that I am able to teach my own child. I want other father’s to know that we are responsible to teach our children responsibility and respect. The way I was brought up I never had emotional support from my father, so I want my daughter to grow and feel that I have supported her in every way. I believe that fathers who interact with their babies they will grow up to be very humble and compassionate. To all fathers out there, I encourage you to embrace your children, read to them, play with them, be with them, so they are able to make better choices because all they really need is you.”

-Kevin Taitano Kapileo, Program Participant, Saipan site

“I think it is important because being engaged in their life makes the child have a bond with their father, and being engaged will benefit the child in many ways. Being there for your children should be your number one priority. This shows your child/children that they can count on you and that they have your full support.”

– Willis Kani, Program Participant, Rota site

Contributed by: Suganya Sockalingam
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Being Female in a Safe and Supportive World

Safety…Early childhood experts say it is critical to successful development through those early ages and stages. Safety is the first trauma-informed principle and some might say that it is the foundation upon which the other principles rest. As we listen to #metoo stories and #timesup messages and consider that safety isn’t a given for girls, it becomes apparent that girls and women do not feel safe. It is estimated that 25%  of girls will experience sexual assault[1] and and 25% experience[2] dating and domestic violence in their homes and in other environments. We can’t help but see that girls and women feel unsafe in their homes, in their communities, in their schools, and in their workplace, and it is not hard to imagine how that impacts their levels of stress and mental health.

What does it say about our collective sense of safety when parents of girls feel the need to prepare their girls to protect themselves by walking with another person (preferably male) at night, carrying protective devices like mace (or a gun), or putting their keys between their fingers? And of course, there is the guidance about safety at parties. Don’t drink anything that you did not pour or see poured. Never put your drink down. Why not? Because you are not safe.

There are also the environments where our lack of safety is not as clearly visible. But we still feel it. In school, girls stop participating in class because, as girls, they have been taught directly or indirectly to be respectful, to not be too attention-seeking and not to fail. The traits they have been taught as young girls can create self-doubt in girls in school and inhibit participation that is crucial to engaged learning. In the workplace, women make daily choices to accommodate, stay neutral, or confront behavior that promote the identity of women as primarily sexual beings and not intellectually equal. The problem is, if she speaks up, she is seen (or viewed as) aggressive or difficult, and if she doesn’t speak up, then how can it be that big a deal? This constant negotiation with the world about female identity and corresponding power, or inequity, for women is exhausting and many times scary. It is unsafe.

And so here we are at another point in time when conversation seems possible. Some would say that we (#metoo) are at risk for being so extreme and black and white, that our progress could be compromised. This is a nuanced and complex conversation that is based upon thousands of years of history. It deserves thoughtful, participatory, and respectful exploration of healthy relationships, how we show up as men and women and our relative power rather than knee-jerk reactions.

The hopeful part of this point in time is that men are having this conversation as well. Several articles have emerged describing the uncertainty that men also feel about what it means to be a man or what it means to be masculine. There seems to be an effort to explore masculinity and femininity in a way that may lead to mutual respect, equity, and the freedom to choose what that means individually, in relationship to one another, and in our society.

Research underscores the role that gender inequality and rigid gender roles play in lack of safety felt by girls and violence experienced by girls. So what does it mean for us who are working to support states, communities, organizations and individuals to provide access to services and supports that lead to healthier people and environments? For one thing, as we are probing questions of cultural and linguistic competence, a focus on gender that includes LGBTQ and cis gender children and youth should be included. Everyone deserves a space to determine who they are and what that means in a society where individuals respect and care for each other. Everyone deserves to feel safe walking to their car, interacting with peers, raising their hands and achieving professional success.

[1] The Center for Family Justice

[2] National Domestic Violence Hotline

Contributed by: Elizabeth Waetzig & Peg O’Neill, executive director of WISE of the Upper Valley in New Hampshire
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