The Evolution of Healthier Together
What began as a collective impact initiative has grown to a highly dynamic network approach for community-led change work. Early in the Healthier Together initiative, Palm Health Foundation staff was drawn to the work of Tamarack Institute. Their orientation, which combined an approach with community participation and shared leadership, has deeply guided the evolution of the foundation’s place-based grantmaking strategy.
In 2016, Tamarack Institute published a paper which describes Collective Impact 3.0 – an iteration of community initiative work. Adding a leadership paradigm which moved the approach from management to movement building, as well as reconceiving the five conditions of collective impact, this paper captured the Palm Beach County experience through the Healthier Together initiative, and gave the foundation new, more accurate language for the efforts in the six communities.
Influencing policy demonstrates the influence and lasting impact of the Healthier Together initiative. Policy changes represent the incremental steps necessary for shifting conditions holding health disparities in place. A powerful testament to the effective community organizing strategies are the policy impacts, the “little p’s” and “big P’s,” identified and pursued by activated residents seeking better health for their lives and their communities.
“Little p” policies generally influence practices at an institution, department or agency level. “Big P” policies come in the form of changes to state or federal law, city ordinances and comprehensive plans.
Emerging as Healthier Together’s most sustainable outcome, county government, municipalities and private and nonprofit organizations are integrating resident-responsive practices and plans as a result of working together with the initiative’s communities.
- Healthier Delray Beach’s leadership in introducing Mental Health First Aid throughout the city influenced the Delray Beach Police Department to institutionalize the training for all officers. The training was a catalyst for the next step the department took—hiring their first full-time licensed behavioral health professional. The chief of police retains a close connection to Healthier Delray Beach as a steering committee member.
- Healthier Jupiter partnered with MyClinic for the uninsured to offer a 17-week “doctor prescribed” green market in collaboration with Living Hungry’s Food is Medicine initiative. The program supplied over 60 families with fresh fruits, vegetables and other healthy choice items to help family members living with diabetes or a pre-diabetic condition. While clients waited for their free bags of healthy food, they were weighed, had their A1C levels checked, and spoke with nutritionists about their progress.
- Healthier Neighbors has engaged pastors and members of the faith community to become ambassadors for the initiative. The program is mutually beneficial as the pastors are shifting from an internal focus (their congregations) to a more external focus (all who live in their surrounding communities) to live more deeply in their missions. One example of impact is a church’s partnership with Healthier Neighbors and the Palm Beach County Food Bank to offer an onsite pop-up pantry.
- A new countywide behavioral health initiative was modeled after Healthier Together with the first project director of Healthier Delray Beach at the helm. “BeWellPBC” evolved from Palm Beach County foundations, system partners and community members joining together to create an entity that will focus on systems coordination and alignment, community solutions and workforce pipeline. Palm Health Foundation is the backbone organization for BeWellPBC, which is widely engaging community members in innovative solutions.
- The Health Care District of Palm Beach County and the Department of Health saw the value in aligning with Healthier Together and recognizing residents’ interests and insight, particularly around two of the top three priorities for the Palm Beach County Community Health Assessment: mental and behavioral health and active living and healthy lifestyles. The subsequent Community Health Improvement Plan (CHIP) was to address the needs in the community, incorporating Healthier Together into the plan as a lead community partner for specific plan goals: to 1) improve mental and behavioral health through prevention and by ensuring appropriate, quality services; and 2) promote health and reduce disease risk through healthy lifestyles.
- Healthier Neighbors is facilitating and helping to implement the health component of The Mayor’s Village Initiative, a City of West Palm Beach effort to prevent and reduce youth violence and improve outcomes for young African American males 25 years old and younger living in three neighborhoods disproportionately impacted by violence, crime, and social/economic disadvantages. Healthier Neighbors will champion the health pillar in the mayor’s plan to: 1) locate current resources and gather an inventory of services provided in the community; 2) redefine health in the African American community based on resident input; and 3) ensure community healthier behaviors include a cultural competency lens.
The Value of a Health Equity Network
Through our community-based networks across the Healthier Together initiative, we are continuing to evolve in ways that support the dynamic conditions influencing the overall health and well-being of Palm Beach County residents. At the heart of these approaches is a genuine willingness to engage with individuals and communities free of pre-determined solutions on their behalf, a focus on the power of social capital and human ingenuity, and interest in tapping into a community’s natural strengths. These established county-wide networks are focused on health equity, working to ensure residents with the greatest disparities are part of the process and prioritizing space to respond to emergent and shifting needs in our rapidly changing environment. Never was this more valued than during the COVID-19 pandemic.
The COVID-19 disruption caused a cascading effect, serving as a reminder of how interconnected we are as families and neighbors, and among our communities and institutions. And it is our most vulnerable neighbors, those experiencing the greatest disparities, who are most at risk for the negative health, economic and environmental impacts like that of COVID-19. The virus put everyone’s adaptability to the test—from government leaders to neighbors—and placed a spotlight on health equity.
Healthier Together networks—together with BeWellPBC’s behavioral health network—offered tested avenues to navigate a turbulent time and mobilize residents to develop solutions responsive to local needs. Project directors, well entrenched in adaptive leadership, sprang into action deploying tools and tactics to cultivate social connectedness and counteract stress, social isolation and concern about the future. Three methods materialized to ensure residents with the greatest disparities were part of the process and to respond to emergent and shifting needs in the rapidly changing environment:
Using SenseMaker®, an online storytelling collection tool with robust analytics, residents were invited to share their COVID-19 stories and to “make sense” of them within their individual and community contexts. Utilizing additional digital tools, like Facebook Live and Zoom teleconferencing, and reaching out to residents without computer or internet access, a formal county-wide feedback loop was established. Once stories of extreme hardship started to appear, a rapid response network was established through community partners to offer resources and support for hunger relief, mental health crises, COVID-19 concerns and other emergency situations.
In an effort to seek community-driven solutions, the Healthier Together communities established mini-grant processes to engage residents without traditional grant making constraints, allowing for safe-to-fail experiments to lead the way. Healthier Glades, which had several mini grant recipients prepared to implement just before the outbreak, pivoted to allow the residents to use funds for the immediate needs of the community.
As the realities of the new/temporary “norm” settled in, combatting the effects of social distancing and social isolation was paramount. Through tools like Facebook Live and Zoom, the Healthier Together communities linked people to one another to emphasize positive, hopeful and timely messaging, share information about local resources and voice needs to be shared with city decision makers.
It became clear that amid the multi-faceted county response to COVID-19 by nonprofit and government agencies, the foundation’s main value was in addressing health equity and fostering more adaptive, resilient systems. The networks established through Healthier Together had already laid the foundation for achieving shared purpose under conditions of uncertainty, innovative problem solving and setting conditions for resident leaders to have some degree of control in helping their own communities.
It also gave the networks an accelerated way to deploy the power of social capital and human ingenuity and tap into communities’ natural strengths to address health inequities. This experience, coming at the end of year five, provided invaluable guidance for greater health equity county-wide as Healthier Together looks to the future.
What “We” Means to Us
Shared values and resources. Greater equity. Understanding that we’re all in this together. Through Healthier Together, we have embraced these principles along with the social determinants of health and the powerful shift to working in complexity. But our greatest navigators have been, and will continue to be, the people of Palm Beach County. They are the ones who are building a culture of health.