Equality and Equity

For many of us, the result of the presidential election was surprising and left us wondering what it meant for our country. Part of the uncertainty came from the statements and sentiments of us vs. them embedded in the discourse leading up to and following the election. Gender, race, national origin, sexual and gender orientation, education, geographic location, social and income divisions showed up and affected how individuals thought about their choice for president. At the moment, it is hard to find messages of reconciliation and commitment to move forward as an entire nation that is authentic and meaningful.

All of the ways in which we find ourselves divided can impact the way in which we think about the health, including mental health, of the whole population. Since our inception at CM, we have always supported a public health approach to health. We believe that health and well-being for communities can be achieved if we promote positive health, prevent problems early, treat health conditions effectively as and when needed, and support individuals to reclaim a fulfilling life in the presence of a health condition or challenge. In our public health approach, we offer a framework that includes assessment, intervention (promotion, prevention, treatment, and reclaiming) and ensuring health (access, quality and well-being). The framework is built on a foundation of values in which we encourage local stakeholder groups to identify and define for themselves taking a systemic approach.

So what do the election outcomes and a public health approach have in common? Equality and Equity. In a public health approach, taking a population lens to health and well-being requires systems and structures that increase access and opportunity to achieve optimal health for all. In our democracy, equality has been cited as a core value of the formation and evolution of our country since the beginning. Equality holds that all people must be treated fairly and with dignity, and be able to gain access to opportunities for education, economic success, political involvement, and a fulfilling life. It is time for us to step back and think about whether we still continue, as human beings and US Citizens, to commit to equality as a core value. And if the answer is yes, what does that look like? What are we prepared to do in service of our commitment to equality?

Equity in a public health approach means that all people are treated fairly and with dignity and can access support that is focused on what they need to achieve health and well-being in environments where they live, learn, work and play. Equity in our diverse mosaic of a country means that we have to be vigilant to support and ensure that all people (and we do mean all) find what they need, in places where they live, to flourish individually, and contribute their gifts to their communities.

Equality and Equity are defining values in our work at CM. These values help guide who we want to be in our work, and the important work that we choose to do every day. Outside of our professional identities, we persevere to and take steps to promote equality and equity in our everyday personal interactions. To connect, engage, and show respect to those who may be different from us; to speak up against discrimination when needed instead of condoning it or standing by; to be grateful and show grace. We are striving for this and encourage you to do the same however you can, and wherever you can.

“When you practice gratefulness, there is a sense of respect toward others.” Dalai Lama

Another helpful resource: When to Take a Stand and When to let it Go: https://www.ted.com/talks/ash_beckham_when_to_take_a_stand_and_when_to_let_it_go

For more information on how to ensure equality and equity is a hallmark within your systems, structures, programs, and services, contact us at questions@changematrix.org.

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Coaching Tool: The Wheel of Life

In our coaching training, we at CM were introduced to a tool called the wheel of life (WOL). The purpose of the WOL is to identify different areas of your life, be able to see areas as part of a whole, and assess your level of satisfaction in each area. Often, completing the tool reminds you that while you might feel challenged in one area, you don’t in others. The process of completing the tool allows you to see balance and imbalances in overall satisfaction with the whole and a sense of where to focus your effort to increase overall satisfaction.

The WOL can be used as an individual, for your organization or an overall system. Steps for using the wheel:

  • Draw a circle
  • Divide it up in to 8 equal pieces
  • Write or label each piece with a domain or area. (for example, as individuals, we chose domains such as health, family, friends, work, leisure, faith, etc.)
  • Rate your current level of satisfaction with each area from 1 to 10 (10 being the highest)

When looking at your WOL, what do you see?
What surprises you?
What feels challenging?
What are you motivated to do to increase those domains with lower scores?

Keep the wheel and reassess every few months to see where you moved, where you didn’t and recommit.

This tool was adapted from The Circle of Life by:
Williams, J.A. (2014) Super Training Guide: Academic Life Coaching’s Training Program. Academic Life Coaching: Portland, OR

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National Minority Mental Health Awareness Month Is a Time for Action

July is National Minority Mental Health Awareness Month. At, CM our values of social justice and equity guide our work and passions. July is a time to further highlight the need for all of us to increase our awareness and knowledge and turn that into action. We are always eager to share our content and training experiences in addressing health disparities and equity.

Here are a few resources to share:

NNED share: a collaborative space to share resources and intervention efforts to improve the delivery of behavioral health care interventions in diverse populations, learn about resources and innovative community efforts across the county, and connect with others to learn from each other and support each other’s efforts.

NNED Community-defined Evidence Project Learning Cluster: This project developed an inventory of effective practices in the Latino community and an approach to community-defined evidence applicable to ethnic and cultural groups and was related to the development of the CRDP in CA through the leadership of Dr. Rachel Guerrero.

NAMI Infographic on Minority Mental Health: The National Alliance on Mental Illness (NAMI) has developed fact sheets and infographics about the prevalence and impact of mental illness in diverse communities.

Advancing Health Equity for Native American Youth: This report summarizes presentations and discussions from a workshop by the National Academies of Sciences, Engineering, and Medicine. Presenters describe cultural strengths, including community traditions and beliefs, social support networks, close-knit families, and individual resilience.

Black & African American Communities and Mental Health: Mental Health America has developed unique materials for Black/African Americans, you can download brochures, fact sheets and access other resources on their website.

A Snapshot of Behavioral Health Issues for Asian American, Native Hawaiian and Pacific Islander Boys and Men: This brief highlights the issues related to (a) gender and identity, (b) social determinants of health and well-being, (c) mental health, substance use, and sexual health, (d) misdiagnosis, treatment bias, and the lack of culturally competent screening instruments and treatment strategies in behavioral health, (d) the impact of profiling and stereotypes on behavior, and (e) unique culturally based strategies and programs.

Mental Health — Faith & Spirituality: This brief was developed by the Alpha Kappa Alpha Sorority, Inc. and the National Alliance on Mental Illness. The organizations are working together to increase mental health awareness in the African American community.

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California Reducing Disparities Project: Technical Assistance Providers

Change Matrix is proud to announce another exciting initiative partnership with the Center for Applied Research Solutions (CARS) and the California Department of Public Health (CDPH), Office of Health Equity (OHE). CM is partnering with CARS to provide technical assistance as part of Phase II of the California Reducing Disparities Project (CRDP). The CRDP aims to reduce mental health disparities across five target populations that include African Americans, Asians and Pacific Islanders, Latinos, Native Americans and Lesbian, Gay, Bisexual, Transgender, Queer and Questioning (LGBTQ) communities.

Population-specific Technical Assistance Providers selected for Phase II include: 1) African American: OnTrack Program Resources, 2) Asian and Pacific Islanders: Special Services for Groups, 3) Latino: University of California, Davis and 4) LGBTQ: The Center for Applied Research Solutions. Responsibilities for the Statewide Evaluators and Technical Assistance Providers will include oversight and advisory consultation to the capacity-building and implementation of pilot projects that will be addressing culturally and linguistically appropriate mental health services for the five target populations identified in Phase I of the CRDP.

As TA providers, CARS and CM will provide consultation and coaching to the capacity-building and implementation pilot projects that will be addressing culturally and linguistically appropriate mental health services for the LGBTQ population.

The CRDP is funded by the Mental Health Services Act (Proposition 63) that was passed in November 2004. This Act imposes a one-percent income tax on personal income in excess of $1 million.

Learn More about the CRDP project.

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Community Engagement from a Public and Community Health Perspective

I was sitting in Professor John Hatch’s “Rural Health” class in graduate school twenty-five years ago when I first really learned about community engagement. I latched onto his words, “When you go to a small, rural community [to do research, program development, or to provide support], first, just sit, listen, and observe.” Sit…listen…and observe – okay, that should be easy enough, right? But it also seemed like it could take a while to actually get anything done. But Dr. Hatch underscored the value of patience in identifying the community leader – not the loudest person, but the natural leader who people in the community look to when they need help. He suggested that we ask people who they go to when there is a genuine community crisis – a major fire, for example – when the community needs to come together, to act, to heal.

It was a simple message, and although I don’t remember the specific community stories that Dr. Hatch calmly and proudly shared with us in order to impart the message, 25 years later, I remember the intent of his message. The bottom line — he was sharing two essential life lessons for those of us who fell in love even with the word community, those of us who knew then that in some capacity we would spend the rest of our lives trying to help communities – to improve health and eliminate disparities, to ensure equitable service provision and access, and to implement models that really make sense and can lead to true community change.

The two lessons? If you want to make a difference, if you want to see a community achieve lasting change, 1) you can’t just impose your own ideas on the community; and 2) you have to involve the community in a meaningful way.

Everything started to make a little more sense.

After college, I had made my way to Washington, D.C., and eventually to the Children’s Defense Fund (CDF). For four years, I worked within walking distance of the Congressional buildings and occasionally walked those halls, visiting various offices in an effort to persuade members of Congress to vote in favor of children’s programs. I had been convinced that Washington, D.C. was where the decisions are made and where the important work needed to be done in order to most effectively help families.

I wasn’t wrong. There is no one place. However, after a while, I decided that it’s really the people back home in communities who make the difference. So, I went back to learn more about how communities work and try to make a difference there. After graduate school, I went to live in rural Nicaragua. I was interested in working with immigrant, Latino communities in the U.S., so I wanted to get a better understanding of where they were coming from and the type of community life they were used to. I knew, of course, that one community is just one community, but at least I would get a sense of how that one community worked. And when I came back to the U.S. two-and-a-half years later, I went almost directly to work at a migrant and community health center in a small town in the northeast. I was proud to have known and learned from the person who founded the first rural community health center (Dr. Hatch, along with a few others). While I worked at the health center and lived in the small community, I began to understand more about why the community engagement piece was so important. It’s not enough just to build a community health center or to promote your services. We hired people as outreach workers and community health workers (promotores) from the community to help us do outreach and health education. We went out to visit people where they lived, to do screenings, to visit again, to do health education and make it fun with “games” (for example, dínamicas like these: https://multco.us/file/16373/download) to build trust, and then eventually to bring them in to the health center. And they kept coming back, and they told their friends, and they even shared with their friends some of the lessons they learned from our health education activities.

I had done it – in the words of Lao Tzu,
“Go to the people. Live with them….”

But, then something else happened that enabled me to embraced the rest of what Lao Tzu said,

“…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.”

This second part is what community engagement, and meaningful and lasting change are about.
So what happened to help me realize this? I participated in a train-the-trainer health education workshop. The curriculum was based on participatory learning. The trainer and the first module spoke of Paolo Freire, the Brazilian educator who was sometimes known as “the father of popular education.” I would say that popular education is a much more intense version of community engagement, with the ultimate goal of community empowerment, social justice, and change.

Paolo Freire pointed out the ineffectiveness of “banking education” – where the teacher is active, and the student is a passive recipient, just as Professor John Hatch had cautioned against preaching your own ideas to a passive community.

Yes, participatory education can take a little longer. It takes time to find out about people’s experiences, to start where they are, to build on what they know, and to learn together with them. But, more invested, active learners are more likely to be engaged and to direct their own positive behavior change.

And, similarly, actively engaging communities and families in a meaningful way can take a little extra effort. Usually, it’s worth it, because you might see that families stay enrolled in programs, show up to appointments, practice what they’ve learned, and you might actually find that families, neighbors, service providers, decision makers and other “leaders” work in partnership with each other. So, whatever you call it — whether purpose of community engagement is to bring a community together around an issue or initiative, or to tackle a problem or challenge a community is facing, or to empower community members, or to create social change or any kind of change…. community members can actually make the community a better, healthier, safer, and happier place to live.

What is Community Engagement?
Community engagement involves dynamic relationships and dialogue between community members and local health department staff, with varying degrees of community and health department involvement, decision-making and control. In public health, community engagement refers to efforts that promote a mutual exchange of information, ideas and resources between community members and the health department. While the health department shares its health expertise, services and other resources with the community through this process, the community can share its own wisdom and experiences to help guide public health program efforts. “Community” may include individuals, groups, organizations, and associations or informal networks that share common characteristics and interests based on place-, issue-, or identity-based factors. These communities often have similar concerns, which can be shared with the health department to help create more relevant and effective health programs.

Source: http://bangthetable.com/what-is-community-engagement/

Some additional reading:

Community Engagement in Public Health (pdf)

An Introduction to Popular Education (pdf)

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The Many Hats of Lived-Experience

As a young professional, when do I choose to offer my lived experience and when do I choose not to? And where does the lived-experience go when I’m not a ‘youth’ anymore? Which part of my lived experience do I choose to offer in this part of the conversation? When should I switch roles? When am I over-sharing? How do I still portray myself as a professional when I’m being asked to share my experience as a recipient of services as part of my job?

These are questions that young people and their colleagues who work to incorporate youth voice confront every day. While there is no clear, one-size-fits-all answer, there as been some emerging guidance from many of our young adults who have lead the way in figuring all of this out.

When do you know what hats to wear, when do you switch hats, and when do you give away the hat to goodwill?

As youth, young adults, and young professionals, when asked to bring in their lived-experience as a professional skillset, we bring in a whole extra set of ‘hats’ that we wear. We must be aware of all of those hats, know when to switch hats, or throw the hats away altogether. When young adults are in the role of Youth Advocates, the roles are a little more clear. When transitioning into Advocates for Youth, roles become increasingly complex as we move further into our career, becoming clinicians, directors and Executive Directors, Technical Assistance Specialists, Peer Support Providers, case managers, consultants, etc. In some positions, offering the perspective of lived experience is an explicit expectation of the job description; in other positions, young adults are implicitly expected to ‘figure it out.’ There can be repercussions when navigating through ‘figuring it out’ with little guidance. And even within the same position, it is appropriate and required to switch hats several times, sometimes even within the same conversation or hour-long meeting.

Further confusion can occur for our colleagues who didn’t come up through the ‘youth advocate’ pipeline (that is, start their professional career as a youth advocate and work their way up into a more expanded professional role), and have never shared their lived experience publicly, but still bring lived experience to their profession – what about that hat? Where does it fit in?

I believe it is helpful to make a clear distinction; while some colleagues have lived experience and choose not to share it publicly, their lived experience implicitly shapes and informs their work in making the world a better place for our families and youth. However, it is critical to note that there is a different set of expectations, skillsets, and necessary support when individuals are explicitly asked through their job descriptions or requirements to utilize that lived experience as a professional skillset.

It is also important for advocates to explicitly communicate which ‘hat’ is being worn and for which purpose., For example, a youth coordinator might wear their Youth Advocate hat to share their lived experience to discuss why a policy might need to change, and then switch to an Advocate for Youth hat to discuss why additional young people should become part of the discussion, and then may entirely switch to their Young Professional hat when offering their expertise on evaluation as to why that specific policy might need to change. This could all happen as the same part of a single meeting, and it’s helpful to share when these roles are changing ‘out loud’ so that colleagues of advocates can understand the purpose and intent of each of these hats.

Youth Advocate

The Youth Advocate role has the most clear cut expectation for utilizing lived-experience. It is the explicit expectation that a Youth Advocate shares their story to inform, educate, and influence toward positive change. This ‘hat’ may also be put on from time to time by Advocates for Youth or even Young Professionals if there are no other Youth Advocates in the room to do so.

Advocate for Youth

When becoming an advocate for youth, sometimes sharing individual lived-experience is not required anymore. Advocates for Youth can promote and support opportunities for the next generation of Youth Advocates to step in and share their lived experience. Advocates for Youth may find themselves switching hats the most frequently out of any of the roles mentioned here.

Young Professional

Many Advocates for Youth choose to stay in the field and transition into a broader professional role. While Youth Advocates and Advocates for Youth will always be experts in youth engagement, they often pick up additional skillsets along the way, such as expertise in social marketing, evaluation, clinical services, financing, management, etc. As young professionals transition into these new roles, it is important to recognize and respect them in these new roles, with their new skillsets, and not keep them limited to being the ‘youth expert’. As such, these young professionals may or may not choose to utilize their lived experience in these new roles, and that wish should also be respected.

Supportive Adult

Supportive Adults are people who may or may not have lived experience, but support Youth Advocates and Advocates for Youth in sharing their lived experience. Supportive Adults may also occasionally don the ‘Advocate for Youth’ hat if there is no youth voice present, and is necessary to advocate for youth voice to be present at the table. Supportive Adults also serve as mentors and coaches in order to further the professional development of youth and young adults in various roles.

Professional Colleague

Professional Colleagues, like Supportive Adults, may on occasion wear the ‘Advocate for Youth hat’ as they advocate and promote opportunities for youth voice. More often, Professional Colleagues work in partnership with Youth Advocates and Advocates for Youth to implement positive changes through implementation of initiatives and services. The most important thing a Professional Colleague can do is to understand what lived experience is, the intended use of lived experience, be trauma-informed in the way that they work with Advocate Colleagues, and partner equally with Advocates who expected to share their lived experience as part of their professional skillset.

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Negotiating Together…Again

Twenty years ago this summer, Phyllis Magrab from the Georgetown Center for Child and Human Development Center and Liz piloted a two-day training for family advocates on interest-based negotiation. Grounded in the work of Fisher and Ury and with the help of Greg Abel from Sound Options Group, LLC, we sat in a coffee shop and outlined a training curricula that we hoped would help participants that were feeling somewhat adversarial in their advocacy find a more collaborative way of partnering. Continue reading “Negotiating Together…Again”

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