The United States health care environment is a fast paced, ever evolving space with endless opportunities to improve and advance the health and well-being of our nation. More recently, these efforts have expanded to include how advancements can be made, delivered, and accessed equitably. Historically, underrepresented communities have developed mistrust in the health care system that was not initially built to protect or care for them. As our nation strives forward to build trust and incorporate diversity, equity and inclusion to better support future generations, there are a lot of efforts being made to establish what that looks like in practice.
Community engagement refers to the process of ensuring that people who are most impacted by physical health, mental health and social health challenges have a say in designing and implementing solutions to these issues as partners in change.
In the midst of the COVID-19 pandemic and rise in hate crimes against Black Americans and Asian communities, the Child Health Advocacy Institute (CHAI) at the Children’s National Hospital sought to tackle this effort in one way through the creation of the Community Engagement (CE) Guidebook. The purpose of this effort was to provide Children’s National staff, leaders and partners with information and resources to help inform community engagement efforts for new and existing programs. The Community Mental Health (CMH) CORE Strategy Workgroup was launched in 2020 and comprised of CHAI team members with experience and expertise working across different settings. The workgroup developed a definition, values and framework for community engagement that was disseminated internally across the hospital and presented in a workshop during 2021 Community Health Improvement Week. The CMH CORE Strategy Workgroup worked with an external consultant to examine existing community engagement frameworks and draft the CE Guidebook. After an extensive review that included an 81-item document scan, detailed review of 31 promising resources, and review of 9 other children’s hospitals, the Community Engagement Guidebook and Framework were finalized in early 2022. Our selected community engagement framework is an adaptation of the New York City Department of Mental Health and Hygiene’s 2017 Community Engagement Framework, which we tailored to align with our needs.
*Image adapted from NYC Department of Health and Mental Hygiene
In our community engagement framework, the levels of community engagement are not intended to be fixed and may share some overlap with one another. The different levels of engagement generally build together as the degrees of capacity, participation, and empowerment increase. For example, the “Inform” level of engagement represents the most basic form of community engagement and is inherently assumed in the subsequent categories. Each successive level requires more community capacity (i.e., time, commitment, and skills) to engage effectively. At the same time, each successive level enables communities to build their capacities. While engagement is more robust toward the right side of the continuum, it is not necessarily expected that every program would (or should) embody the “Shared Ownership” category of engagement. Instead, the type of community engagement used should be individualized and selected to align with the scope of the specific work to be completed while continuously striving for more meaningful levels of engagement. Programs may find the framework below helpful as a reference point to assess their current engagement efforts and identify an appropriate level of engagement to aim for, both in the short-term and in the long-term.
The CE Guidebook was built with the intention to support Children’s National community initiatives to examine existing programs and relationships and plan for how to continue to foster and build trusting relationships with future stakeholders and communities through the work the department is leading and collaborating on.
In practice, a team, or department would work through identifying who their stakeholders or community are in the work they are supporting and collaborating on, where on the Community Engagement Framework continuum their current efforts are, and where they would like to be. By reflecting on the framework above and using the worksheets outlined in the Quick Guide, a team can evaluate how well they have incorporated their stakeholders or community into decision making, successes that have been made, and barriers that have been encountered. Through this exercise, programs and interventions can be more wholistically developed and implemented, allowing for greater outcomes successes and community engagement moving forward.
The CMH CORE Strategy Workgroup is now in the implementation and dissemination phase of sharing the CE Guidebook and has presented the tool and framework at several stakeholder organizational meetings. Most recently, a CE Guidebook Ambassador program is being piloted to support the sharing of this tools in settings within the Children’s National organization and outside of the CHAI department. Additionally, Children’s National and HSC Health Care System’s Community Health Improvement Plan Workgroups are utilizing the CE Guidebook to plan their outreach and engagement activities to address four priority areas identified in the Community Health Needs Assessment that focus on specific neighborhoods in the District of Columbia and Maryland: early childhood education, healthy food access, health insurance coverage and employment rate.
This CE Guidebook is meant to be an evolving document and the CMH CORE strategy working group invites your thoughts! If you would like to access the CE Guidebook, please reach out to cmhcore@childrensnational.org .
Many thanks to the CHAI Community Mental Health CORE Strategy Team for reviewing this post!
References
NYC Department of Health and Mental Hygiene. (2017). Race to Justice: Advancing Racial Equity and Social Justice [White paper]. https://www1.nyc.gov/assets/doh/downloads/pdf/che/community-engagement-framework.pdf
Header photo by Hannah Busing on Unsplash
Body photo by Ronda Dorsey on Unsplash
