Buncombe County HHS-Community Health Improvement Plan (2018-2021)

Alignment

Equity in Birth Outcomes & Infant Mortality - or "Birth Equity" for short - and the related result ("A thriving and save community, leading to 100% healthy births, mamas, and families...") are aligned with the following Healthy NC 2020 Focus Areas/ Objectives. 

• Focus Area: Maternal and Infant Health

  • Objective 1: Reduce the infant mortality racial disparity between whites and African Americans.

  • Objective 2: Reduce the infant mortality rate (per 1,000 live births).

Experience and Importance

How would we experience this result in our community if we are successful?

Our community partners identified the following themes as key elements of our desired result:

• Healthy babies: 100% healthy births (full term, healthy weight, no infant deaths)

• Healthy parents: Healthy, supported mamas and babies. Parents feel empowered with emotional well-being. Supported, educated, and engaged fathers/partners.

• Healthy community: Thriving safe community where everyone gets along, & has what they need to be healthy. Household stability. Health care for all. Reparations made.

If we achieved our desired result, we would feel:

• Peaceful, with more time and energy to engage with community
• More relationship driven
• People listening to each other & respecting each other
• Less stress
• Families can earn a real living wage to live in Asheville
• No drugs, alcohol, vandalism
• Respect, honoring each other
• Emotional and physical safety
• Less fear
• Children can safely play outside with their friends
• More connection with nature
• Less coal ash
• Less light pollution
• More edible gardens
• Quiet - no sirens
• Nicer police
• History of structural racism has been reconciled and repaired

 What information led to the selection of Birth Eqiuty and this related result?

Equity in Birth Outcomes and Infant Mortality was one of 10 standout health conditions based on the size and severity of the issue in our community and was reviewed separately from substance use. What made Birth Equity standout most was the data collected locally through the WNCHI telephone survey, from key informant surveys and via community input sessions gathered through listening sessions and brief surveys done in community gathering places ranging from food distribution sites to the Asheville Tourist stadium. Infant and Child Health as well as Family Planning were issues of key concern among community leaders in the Online Key Informant Survey; Secondary data revealed significant disparities in are present in birth outcomes, infant mortality and preconception health for African American and Latinx residents.

Key findings related to Birth Equity included:

• Preterm Births: 9.9% overall (2013-2017)
  • Black (13.8%), Latinx (9.8%), White (9.0%),
    • Black : White inequity ratio of 1.53
• Low Birth Weight: 8.3% overall (2013-2017)
  • Black (15%), Latinx (6.2), White (8.0%),
    • Black : White inequity ratio of 1.87
• Infant Mortality: 6.4 deaths per 1,000 live births (2013-2017)
  • Black (19.6), Latinx (6.2*), White (5.1)
  • *Rates based on fewer than 20 cases - as for the Latinx infant mortality rate - are unstable and should be interpreted with caution.
    • Black : White inequity ratio of 3.8 
    • Latinx : White inequity ratio of 1.2* 
• Teen Pregnancy: 21.1 per 1,000 women 15-19 (2017)
  • Black (35.3), Latinx (35.4,) White (17.2)
    • Black: White inequity ratio of 2.05
    • Latinx : White inequity ratio of 2.06

What Else Do We Know?

• The number of teen pregnancies that end in abortion has been steadily dropping since 2006 and Buncombe’s rate is consistent with the region and state (6.1/1,000 women 15-19) (NC SCHS, 2018) (North Carolina State Center for Health Statistics, 2018)
• There was no Black / White disparity in the percent of women (87.9%) receiving care in their first trimester. Latinas were even more likely (91.6%) to receive care. (NC SCHS, 2018)

Our CHIP Advisory Council, with representation from roughly 30 community organizations, working to broadly address health, social and economic needs, were actively engaged in 3 2-hour work sessions to identify which community health conditions to prioritize.  Using a tool to prioritize conditions based on relevance, impact and feasibility, birth equity emerged as one of the two areas to focus on for CHIP moving forward (along with Mental Health). 

Progress on Action Plan Strategies: 

• Advance Cross sector Collaboration to Undo Racism:
  • City MatCH Birth Equity Institute:  The Buncombe County City Match Home Team is working in partnership with Mothering Asheville as a container for collaboration, data sharing and strategy development for our local cohort.  During the final quarter of 2019 and early 2020, Buncombe’s home team has received coaching on Equity Strategic Planning and in the progress to identify data metrics for the projects. 
  • Power to Health - Title VI Training: Buncombe County Health and Human services has hosted as series of screenings of this important documentary on Title VI in partnership, with the AARP of WNC, and the Asheville Buncombe Institute for Parity Achievement (ABIPA).  Viewings are following by snap polling of the audience, group reflections and facilitated discussions to aide staff and community partners in the understanding or “connecting-the-dots” on how  the historical context of Title VI law informs our duty to service as we all work towards community healing resulting from racial segregation.
  • Buncombe County Government Equity Workgroup:   The Buncombe County Equity work will evalute the current effoort in various areas throughout the organization to articalte work unified, countywide approach to equity. The workgrups initial goals is to identify the challenges to racial and social equity and inclusion and brainstorm innovative ways to overcome those hurdles. It’s vital that Buncombe County makes all its decisions concerning policies and procedures in a way that is consistently equitable for all employees, county partners and the community. Inital goals for the workgroup: 
    • Draft an Equity and Inclusion vision statement and identify measurable goals
    • Recommend innovative ways to achieve positive outcomes across various sectors
    • Create a timeline and roadmap for initial goals to be implemented
    • Coordinate data compilation, analysis, and application
• Provide ongoing support to evidence-based strategies to improve maternal care, including doula care and other pregnancy home visiting programs:
  • Nurse Family Partnership: 2019 marked the NFP Buncombe’s 10 year anniversary, proudly serving over 500 families in the decade. 
• Promote breastfeeding friendly policies and services in local communities:
  • 10 Steps to Becoming a Breastfeeding Friendly Community: Buncombe County continues to make progress on the 10 Steps to becoming a Breastfeeding Friendly Community.  New initiatives are currently under consideration with Buncombe County Human Resources and Buncombe County Library System. 
• • National Day of Racial Healing: January 22nd, marked the  4th  Annual National Day of Racial Health.  To mark this day, Buncombe County called attention to the need for us all to ensure our community provides a  social, policy, and cultural environment for all families and mom to breastfeeding in a climate that gives lift to equity. 

What Is It?

Support doulas, pregnancy home visiting programs, and related evidence based strategies to improve the quality of pregnancy, birth, and postpartum care

Providing ongoing support for evidence-based strategies to improve maternal care, including culturally responsive doula care and other pregnancy home visiting programs was identified by community partners and community members as important work that is making a positive impact in our community.  When combined with other actions in our community, CHIP stakeholders believe these programs have a reasonable chance of making a difference in advancing birth equity our community. This is ongoing work in our community.

This strategy aligns with the North Carolina Perinatal Health Strategic Plan, Goal 1: Improving Health Care for Women and Men, Point 3. Improve the quality of maternal care (includes prenatal, labor, delivery and postpartum care). Specific strategies under Goal 1, Point 3 that this aligns with include: 

• Expand use of evidence-based models of prenatal care
• Ensure prenatal care that addresses underlying risk factors, such as: decreasing unnecessary c-sections, prevention of repeat preterm birth, addressing underlying health conditions such as high blood pressure and gestational diabetes, mental health screening and support, support to stop using tobacco and other substances, screening and support for intimate partner violence, etc. 
• Provide care coordination / case management / home visiting services that includes promotion of resiliency, mental health screening and support, support to stop using tobacco and other substances, life planning, chronic disease management, and access to health care
  • Increase doula care access, particularly for women at higher risk and in underserved communities (while doula care is not specifically named in the NCPHSP, this evidence based model of support has been a highly impactful local strategy to support in our community - particularly providing support for community-based doulas who are from the communities they are serving) .
• Provide evidence-based culturally responsive patient education and guidance

In collaboration with Mothering Asheville and the YWCA (also a member of Mothering Asheville), CHIP has provided support and technical assistance for the Home Visitors Collaborative and SistasCaring4Sistas - Doulas for Social Justice over the past CHIP cycle. Community partners voiced support for continuing support for these groups as they are helping to advance positive birth outcomes and reduce inequities in our community. The priority population for this strategy are pregnant and parenting families, particularly familes of color in Buncombe County. These programs aim to make a difference at the individual/interpersonal behavior; organizational/policy; and environmental change levels.

By 2027, Mothering Asheville aims to eliminate disparities in infant mortality in Buncombe County, changing the current data indicating that African-American babies die at 3.8 times the rate of White babies. Mothering Asheville is a cross-sector collaboration working to ensure that more Black babies are delivered on time, at a healthy weight, and survive their first year. Mothering Asheville works with partners to build community capacity, create clinical shifts, communicate strategically, and advocate for institutional policies that address structural racism, implicit bias, access to care, economic and other social factors that influence health. The local inequities in birth outcomes and associated social determinants of health reveal the need for clinical-community collaborations to support pregnant Black women, their babies, and people of color through their lifespans. Mothering Asheville was established as a response to this critical need, bringing together clinical providers, community resident groups, nonprofits, advocacy agencies and others committed to fostering health equity.

A key strategy of Mothering Asheville has been to support the growth and sustainability of SistasCaring4Sistas (SC4S). SC4S a group of Black community-based doulas supporting primarily Black women through pregnancy, birth, and postpartum who aim to eradicate disparities in maternal and infant mortality, providing education and doula services to families who face financial barriers and stigmas. SC4S has demonstrated positive impact in improving birth outcomes in their patient population and has cultivated significant community support and leadership presence.

The YWCA is dedicated to eliminating racism, empowering women, and promoting peace, justice, freedom, and dignity for all. The YWCA’s Women’s Empowerment Department provides services for women of childbearing age via its Getting Ahead and MotherLove programs. Getting Ahead supports women living in poverty to build resources for a more prosperous life. MotherLove provides mentoring and support for pregnant or parenting teens, building skills as strong parents and successful students with the goals of ensuring participants graduate high school, enroll in secondary education, deliver a healthy baby, and delay a subsequent pregnancy. In partnership with Mothering Asheville and CHIP, the YWCA has convened a Home Visitors Collaborative (HVC) since 2017, with representation from local perinatal home visiting programs, including key clinical, community, and specifically African-American community leaders. The HVC is focused on increasing the quality and quantity of support for at-risk, and specifically African-American, pregnant and parenting women.

Additionally, Buncombe County CHIP partners have been selected to participate in CityMatCH’s Institute for Equity in Birth Outcomes starting in the fall of 2019. CityMatCH is a national organization of city and county health departments' maternal and child health (MCH) programs and leaders. CityMatCH's mission is to strengthen public health leaders and organizations to promote equity and improve the health of urban women, families, and communities. Buncombe CHIP partners will be able to participate in the Equity Institute’s learning collaborative over the next 3 years, which will push us to authentically engage community partners, use data more effectively, and evaluate our work in promoting equity in our institutions as well as in our community. We anticipate the guidance of the Institute will be instrumental in shaping our collaborative work to undo racism and its impact on birth equity in our community moving forward.

Partners

Current partners with a role to play in this moving this strategy forward include Mothering Asheville*, The YWCA, SistasCaring4Sistas, The Home Visitors Collaborative+, CityMatCH's Institute for Equity in Birth Outcomes, and MAHEC. Additional partners may be identified as we develop our action plan for the coming year.

*The Mothering Asheville Steering Committee includes the following partners:

• Mother to Mother
• Sistas Caring 4 Sistas
• MAHEC
• Pisgah Legal Services
• YWCA
• Asheville Buncombe Institute for Parity Achievement (ABIPA)
• Children First/Communities in Schools of Buncombe County
• North Carolina Center for Health and Wellness at UNC Asheville
• Nurse Family Partnership
• Buncombe County Health and Human Services
• Buncombe County Community Engagement Team
• Community Care of Western North Carolina
• Homegrown Babies
• Mission Health

+The Home Visitors Collaborative includes: 

• Asheville Buncombe Institute for Parity Achievement (ABIPA)
• MotherLove at the YWCA
• Nurse Family Partnership
• Pregnancy Care Managers
• Project NAF
• SistasCaring4Sistas Doulas for Social Justice (SC4S)
• Verner Center for Early Learning

Work Plan

Evaluation and Sustainability

Evaluation Plan:

CHIP partners use Results-Based Accountability tools to identify shared measures for evaluating what is working to improve key birth outcomes and what needs to change. The group uses Clear Impact Scorecard, where community data, shared performance measure data, and stories behind the data can be shared and accessed online. Additionally, MAHEC has been developing data-sharing agreements with CHIP partners, including some of the programs participating Home Visitors Collaborative, and formed a shared data governance committee.

Sustainability Plan:

We will develop our sustainability plan using identified program performance measures to ensure ongoing effectiveness and demonstrate successes key stakeholders, communicating and engaging diverse community leaders and organizations, identifying champions who strongly support the work. We do need to identify a consistent financial base to support the collaborative work we are doing to advance birth equity, beyond our core financial base for the individual programs, which primarily provides funding for staffing and covering existing program costs.

Mothering Asheville, SistasCaring4Sistas, and MAHEC have been working for increased sustainability for SC4S by pursuing additional funding streams to support hiring the doulas as employees, and by advocating for doula reimbursement through multiple pathways; for example, advocating for pre-paid health plans (PHPs = commercial Medicaid payers in NC) to reimburse for doula services, and to do so at an appropriate and sustainable rate.

We have are hoping to explore whether the next round of North Carolina ICO4MCH grants will align with our work, and if so will work with partners to shape our application in alignment with this work. 

We would like to increase funding for authentic engagement with community partners and members, recognizing the need to be able to pay people for their time, expertise, and consultation, in addition to providing support for participation like food, childcare and transporation.  We also want to develop a plan to increase community awareness on the issue and demonstrate the value of the work to the public and stakeholders.

What Is It?

Strengthen families and communities:  Support coordination and cooperation to promote health within communities - Promote breastfeeding friendly policies and services in local communities.  The Buncombe County Community Health Improvement Process (CHIP) is working to improve birth outcomes and reduce the rate of infant mortality.  As breastfeeding is an important strategy to improving child and maternal health, community partners are working together to achieve designation as a breastfeeding friendly community by completing the Ten Steps The Breastfeeding-Family-Friendly Community Designation (BFFCD), as articulated by the Carolina Global Breastfeeding Institute.  The Buncombe will work closely with the WIC and the community partners to leverage existing resesources, capacity, and relationships to improve rates, lenghts and racial/ethnic demographic participation in breastfeeding. 

• In 2017, 74% of Black mothers were breastfeeding at discharge after birth in Buncombe County, compared with 89.5% of White mothers and 96.3% of Hispanic or Latinx mothers.
• Current Breastfeeding trends in Buncombe County and those served by WIC are as follows (As of May, 2019): 
  • 23% of Buncombe WIC Infants participants ae exclusively breastfed  Breastfeeding: we have opportunities to expand equity in the following
  • 24% of White WIC participating were exclusively breasted, compared with 17% of Black WIC infants.
  • 15% of White WIC participating Infants were partially breastfed, compared to 13% of Black WIC infants.
  • 59% of White WIC participating infants were fully formula fed, compared to 72% of Black WIC participating infants. 

• The opportunity presented in this data serves as a call on behalf of all babies, mothers and families to inform, support, advocate and encourage our county on the importance of becoming a breastfeeding friendly community. 

Partners

Partners With A Role to Play

The partners for this [insert program type] include:

Work Plan

Breastfeeding Friendly Designation Plan: Community organizations, businesses, childcare, and clinical providers seeking designation as Breastfeeding Friendly will be evaluated as follows:

Evaluation and Sustainability

Evaluation Plan:

We plan to evaluate the impact of Cross-Sector Collaboration to Undo Racism through the use of Results-Based AccountabilityTM to monitor specific performance measures. We will be monitoring How Much, How Well and/or Better Off Performance Measures. Our evaluation activities will be tracked in the Work Plan table, above.  

Sustainability Plan:

We will develop our sustainability plan using identified program performance measures to ensure ongoing effectiveness and demonstrate successes key stakeholders, communicating and engaging diverse community leaders and organizations, identifying champions who strongly support the work. We do need to identify a consistent financial base to support the collaborative work we are doing to advance birth equity, beyond our core financial base for the individual programs, which primarily provides funding for staffing and covering existing program costs.

We have are hoping to explore whether the next round of North Carolina ICO4MCH grants will align with our work, and if so will work with partners to shape our application in alignment with this work. 

We would like to increase funding for authentic engagement with community partners and members, recognizing the need to be able to pay people for their time, expertise, and consultation, in addition to providing support for participation like food, childcare and transporation.  We also want to develop a plan to increase community awareness on the issue and demonstrate the value of the work to the public and stakeholders.

Alignment

Mental Health and our related result are aligned with the following Healthy NC 2020 Focus Areas/ Objectives. 

• Reduce the suicide rate (per 100,000 population).

• Decrease the average number of poor mental health days among adults in the past 30 days.

• Reduce the rate of mental health-related visits to emergency departments (per 10,000 population)

Experience and Importance

How would we experience this result in our community if we are successful?

Our community partners describe a nurturing community that supports health and well-being. One that is safe and secure and where all individuals and families, regardless of  race and ethnicity, gender, and age can thrive.  

All will have their basic needs met - for healthy food, for childcare and for safe and affordable housing, with no financial stress.  They will have spaces that promote resilience and allow for creative expression and connection with nature. Parents have hope and high expectations for their children.  There will be a strong sense of place, of belonging, where multiple generations are able to support each other 

For those who are experiencing any degree of mental health challenges, services are responsive and someone only needs to ask for help once. Providers offer effective, evidence-based approaches.

But mental health and well-being is much broader than what happens in clinical settings.  The whole community contributes, including leaders who actively engage in the work. Wellness leaders expand beyond clinical services to provide support where people live, when they need it and in ways that support their unique needs

The system works because there is trust, stability, consistency, empathy as well as respite for those who need it.

What information led to the selection of Mental Health and Well-Being and this related result?

Mental Health was one of 10 standout health conditions based on the size and severity of the issue in our community and was reviewed separately from substance use. What made mental health standout most was the data collected locally through the WNCHI telephone survey, from key informant surveys and via community input sessions gathered through listening sessions and brief surveys done in community gathering places ranging from food distribution sites to the Asheville Tourist stadium.  

Key findings related to Mental Health and Well-Being included:

• 39.9% of adults experienced Emotional Abuse during Childhood 
• #1 most commonly experienced Adverse Childhood Experience (ACE) in Buncombe County
• 23.5% of adults experienced Household Mental Illness during Childhood - also considered an ACE
• 35.2% of adults reported they have experienced symptoms of Chronic Depression
• 16.3% were Unable to Obtain Needed Mental Health Services in the Past Year (This was nearly double from 8.3% in 2015 and was higher than other WNC counties)
• 18.9% had >7 Days of Poor Mental Health in the Past Month (This was an increase from 11.6% in 2015 and higher than other WNC counties)
• 74% of adults “Always” or “Usually” Get Needed Social/Emotional Support (This number has been steadily declining since 2012  and is lower than other WNC counties)
• Suicide Rate 17 per 100,000 population, 2012-2016 (This is lower than the WNC average)
• 7,034 individuals were served by area mental health programs in 2017

Our CHIP Advisory Council, with representation from roughly 30 community organizations, working to broadly address health, social and economic needs, were actively engaged in 3 2-hour work sessions to identify which community health conditions to prioritize.  Using a tool to prioritize conditions based on relevance, impact and feasibility, mental health emerged as #1 in in narrowing our priorities to five.

What Is It?

Cross-sector Collaboration to Create a Trauma-Responsive and Resilience-focused Community was identified by community stakeholders as an action, that when combined with other actions in our community, has a reasonable chance of making a difference in addressing Mental Health Wellbeing in our community.  While many organizations are actively addressing Mental Health inequities, existing programs and initiatives struggle to meet the need.  This is especially true as it relates to services and supports for our youngest community members and communities of color. This approach further aims to move beyond individual and clinical based-approaches to a greater emphasis on prevention and population-based strategies.

When asked "what's hurting" the mental health and wellbeing of our community, we heard that young people far too often grow up in toxic environments with no early intervention which continues to impact their health as adults.  In the past several decades, Adverse Childhood Experience (ACEs), the trauma resulting from exposure in childhood to psychological, physical, and sexual abuse, to violence or unstable household conditions, has received increasing attention. A screening tool was developed to assess exposure to ACEs with a 0-10 score.  The higher the score the greater liklihood of negative health impacts.  The WNCHI Telephone survey administered in this CHA cycle asked respondants about their exposure to adverse childhood experience.  In Buncombe County, 21% of respondents reported having an ACE score of 4 or more (considered high) and 39% of respondents indicated exposure to at least one form of childhood trauma with emotional abuse being the highest reported.

Our community also told us that there is not enough emphasis on prevention and upstream approaches that focus both on addressing trauma at the individual level but also at the community level. This concern is supported by the more recent recognition Adverse Community Experiences, as the "second" ACE.  This community-focused ACE calls attention to the negative impact of community environments plagued with violence, poverty, lack of economic mobility, social support and opportunities.  The Pair of ACEs (Building Community Resilience), the combination of trauma in the lives of children and youth coupled with a community environment, contributes to and/or compounds the adversity experienced by a child and is expecially toxic and much more challenging to overcome.  This is especially true for black and brown people who more likely to live in neighborhoods and communities impacted by poverty, violence and fewer resources.

How does this strategy address health disparities?

In 2016, the National Survey of Children's Health found a disproportionate number of children of color impacted by ACEs with that 61% of black children and 51% of Hispanic children compared to 40% of white children have experienced at least one ACE (Child Trends 2/20/18)  And research out of the University of California in Los Angeles Center on Culture have added to the growing body of evidence that experiencing racism and discrimination can be considered another ACE in that they contribute to a cumulative psychological stress burden (ACEs Connection Blog 6/29/15) 

Becoming a trauma-responsive and resilience-focused community addresses trauma at both the individual and the community level. At the individual level, it goes beyond just recognizing the impact of trauma on an individual to changing an organization’s culture, policies and practices to focus on better serving their clients who have experienced trauma.  A Trauma-Responsive and Resilience-focused community works to also recognize the Address Community Experiences that contribute to trauma and  to create changes in that environment at create protective factors and “promote community healing” and support the communities ability “to adapt, recover and thrive, even in the face of adversity”. (Prevention Institute 2/16)

Partners

Partners With A Role to Play

Multiple organizations have been actively engaged in converations and workshop activities to help identify arrive at this strategy.  However, specific commitments for serving in leadership, collaboration or supportive roles have not been identified. In previous Buncombe County CHIP cycles, staff from MAHEC and Buncombe County Health and Human Services have provided much of the leadership in convening and facilitating work to implement our community health priorities.  Beginning in 2015 we made the shift to place leadership within community organizations and MAHEC staff provided technical assistance and assurance that CHIP action plans were being implemented.  Much has been learned from this transition.  We are currently in the early phase of creating criteria for selecting organizations to provide leadership for our Community Health Priorities for 2018-2021. Our CHIP Adisory Council will be creating a task force in September to develop an application and selection process for what organizations will lead work around Mental Health as well as Birth Equity.

In early Fall 2019 we will be facilitating a daylong strategic planning session to create a detailed action plan for this strategy including action steps, timeline, roles and responsibilites and needed resources.

The partners for this Mental Health and Wellbeing Strategy include the organizations listed below.  A number of organizations and individuals have identified their willingness to either lead, collaborate, and/or support this work during our Talk to Action community converations or stakeholder engagement activities,  including: Buncombe County Health and Human Services, Buncombe County Justice Resource Center, Buncombe County Partnership for Children, Mountain Area Health Education Center (Community Integration, Psychiatry, Behavioral Health and Family Medicine, and School Health), Buncombe ACE Collaborative (which includes many community organizations), United Way of Asheville & Buncombe, Buncombe County Schools, Resources for Resilience, NAMI, Umoja Health, Wellness and Justice Collective, VAYA Health, and Youth Villages.  Many others have expressed interest and commitment to engage. Given this work is evolving, we expect to define and clarify roles by Winter 2019-2020 after we convene partners in an half-day action planning workshop. 

Others who have particpated in planning processes so far: ABIPA, Asheville Bereavement Therapy, Asheville City Schools, Asheville Housing Authority, Children's Home Society of North Carolina, City of Asheville, Family Preservation Services, Guardian ad Litem Association of Buncombe County, Helpmate, Jewish Family Services of WNC, Mission Health: Copestone, Mountain Child Advocacy Center, Mountain Housing Opportunities, My Daddy Taught Me That (MDTMT), NCSU, Pisgah Legal Services, RHA: Youth and Prevention Services, Peer Support, The University of North Carolina at Asheville, Trauma Recovery Alliance, Universal Mental Health Services, Verner: Early Childhood Learning, Parent and Americorps volunteer, WNC Community Health Services, and YWCA of Asheville.

• Umoja Health, Wellness and Justice Collective
• Under One Sky
• United Way of Asheville and Buncombe County
• Universal Mental Health Services
• Vaya Health
• Verner: Early Childhood Learning, Parent and Americorps volunteer
• WNC Community Health Services
• Youth Villages
• YWCA of Asheville

Work Plan

In early Fall 2019 we will facilitate a daylong strategic planning session to create a detailed action plan for this strategy including action steps, timeline, roles and responsibilites and needed resources.

Evaluation and Sustainability

Evaluation Plan:

The initial performance measure for this Cross-sector Collaboration to Create a Trauma-Responsive and Resilience-focused Community tracks development of a plan that will guide the work to acheive this strategy over the 3-year CHIP cycle and beyond.  An important component of this plan's development will be to research and identify performance measures to track successful implementation of this work in the community.  We plan to structure our evaluation approach through the use of Results-Based AccountabilityTM framework and tools to monitor specific performance measures to enable us to monitor How Much, How Well and/or Better Off Performance Measures.

Sustainability Plan:

We will develop our sustainability plan using identified program performance measures to ensure ongoing effectiveness and demonstrate successes key stakeholders, communicating and engaging diverse community leaders and organizations, identifying champions who strongly support the work. We do need to identify a consistent financial base to support this work, beyond our core financial base for the CHIP program which primarily provides funding for staffing.

We would like to increase funding for authentic engagement with community partners and members, recognizing the need to be able to pay people for their time, expertise, and consultation, in addition to providing support for participation like food, childcare and transporation.  We also want to develop a plan to increase community awareness on the issue and demonstrate the value of the work to the public and stakeholders.

What Is It?

Supporting Cross-sector Collaboration to Undo Racism was identified by Community Members, Partners, and our CHIP Advisory Council as a strategy, that when combined with other actions in our community, has a reasonable chance of making a difference in Birth Equity and in Mental Health & Wellbeing in our community. Although there is work already happening in our community to undo racism, this is a new strategy for CHIP to officially prioritize and support. 

The priority population for this Cross-sector Collaboration to Undo Racism are community institutions, organizations, and providers (including but not limited to healthcare, social services, other governmental bodies and organizations whose work influences health outcomes). Cross-sector Collaboration to Undo Racism aims to make a difference at multiple levels: individual/interpersonal behavior; organizational/policy; and environmental change level.

This strategy is focusing on addressing root causes of health inquities, recognizing the role of our institutional policies, practices, cultures, norms, and behaviors in impacting and perpetuating health inequities between racial and ethnic groups in our community.

Participants in our Talk 2 Action (T2A) process overwhelmingly prioritized the strategy of Addressing social & economic inequities by Supporting Cross-Sector Work to Undo Racism, which is Strategy 12 in the NC Perinatal Health Strategic Plan. The 

The NC Perinatal Health Strategic Plan suggests pursuing the following strategies to Undo Racism: 

- Point 12. Undo racism

+ 12A. Infuse and incorporate equity in the delivery of health services

+ 12B. Promote high quality training about institutional and structural racism and its impact on poor communities and communities of color

+ 12C. Modify and change policies and practices to address institutional and structural racism

+ 12D. Promote community and systems dialog and discussion on racism

Specific recommended actions identified by Talk 2 Action participants included: 

• Apply and require ROBUST racial equity training (& beyond) for providers across the board
• Increase root cause trainings (as being done by ABIPA and other boots on the ground nonprofits)
• Infuse equity into everything (policy, program/service provision, trainings, environment) - Equity in all policies)
  • Expand community involvement in designing and implementing programs and services
  • Get provider and organizations together on this (not just MAHEC),
  • PAY local organizations to do policy evaluations, co-design of trainings, walk-throughs of spaces (e.g. Mission birth floor), environmental assessments, etc.
• Support more events to build relationships between grassroots community-led organizations and bigger community agencies

Additionally, Buncombe County CHIP partners have been selected to participate in CityMatCH’s Institute for Equity in Birth Outcomes starting in the fall of 2019. CityMatCH is a national organization of city and county health departments' maternal and child health (MCH) programs and leaders. CityMatCH's mission is to strengthen public health leaders and organizations to promote equity and improve the health of urban women, families, and communities. Buncombe CHIP partners will be able to participate in the Equity Institute’s learning collaborative over the next 3 years, which will push us to authentically engage community partners, use data more effectively, and evaluate our work in promoting equity in our institutions as well as in our community. We anticipate the guidance of the Institute will be instrumental in shaping our collaborative work to undo racism in our community moving forward.

Partners

Partners With A Role to Play

This work is new for our community, and partners - including their roles and responsibilities - are still being solidified. Current partners for this work include:

• CHIP Advisory Council Members
• CityMatCH's Institute for Equity in Birth Outcomes (Role of Technical Assistance Provider)
• Buncombe County Institute for Equity in Birth Outcomes Team Members

Work Plan

As articulated by one of our CHIP Leadership Team Members, we aspire to develop a comprehensive plan to undo racism across systems through exploring story, aligning strategies, and igniting community action, however, we recognize that we need to cultivate more buy-in across partners before formally adopting this into our work plan. As this work is only just beginning, we have articulated the following activities as we get started: 

Evaluation and Sustainability

Evaluation Plan:

We plan to evaluate the impact of Cross-Sector Collaboration to Undo Racism through the use of Results-Based AccountabilityTM to monitor specific performance measures. We will be monitoring How Much, How Well and/or Better Off Performance Measures. Our evaluation activities will be tracked in the Work Plan table, above.  

In partnership with our RBA work, we hope to introduce and utilize tools provided by the Institute for Equity in Birth Outcomes, such as the Hogan Rowley Instititional Measure of Equity (HRIME) - however, we will need additional training on these tools first (which will be provided by Vijaya Hogan through the Institute at some point in the coming year), and will need to cultivate buy-in among our CHIP partners. 

Sustainability Plan:

We will develop our sustainability plan with support from the Institute for Equity in Birth Outcomes to ensure ongoing effectiveness and demonstrate successes key stakeholders, communicating and engaging diverse community leaders and organizations, identifying champions who strongly support the work. We do need to identify a consistent financial base to support this work, beyond our core financial base for the CHIP program which primarily provides funding for staffing.

We would like to increase funding for authentic engagement with community partners and members, recognizing the need to be able to pay people for their time, expertise, and consultation, in addition to providing support for participation like food, childcare and transporation.  We also want to develop a plan to increase community awareness on the issue and demonstrate the value of the work to the public and stakeholders.

We have submitted a pre-application/letter of interest to the Robert Wood Johnson Foundation for their Cross-Sector Innovation Initiative, and if invited to apply plan to shape our application in alignment with this work.