State of Minnesota, Department of Health
Report date
May 2018
What has been most instrumental to your progress?
The social innovation lab was extremely important to the progress and overall program. The facilitation was led by Anne Gomez and Michael Bischoll of Clarity Facilitation. They did an excellent job of working with us to understand our needs as well as helping us understand the innovation lab process. They provided culturally appropriate facilitation that allowed us to build deep relationships with women and community leaders from the two communities the project was targeted in. Although it wasn't something we had planned, the artistic element that Anne brought was essential in creating an innovative, design space and in making people feel comfortable and creative.
The willingness of community partners to work with MDH as we figured out both the social innovation process and the pilot project process was essential. There was a lot of explaining what we thought we were doing and then circling back to explain how it was actually working and engaging folks in every change. There is a lot of process to work through on the MDH side, in grant making, and the community members were patient enough to stick through the project through that process. When it came to running the pilot projects. the details of grant agreements and reporting pushed two of the three pilot project grantees to increase their administrative process. That was tricky, maintaining the balance between getting the financial and programmatic reporting that the State needed while still allowing the pilots to run in an organic context. For example, we wanted all of the participants to be screened with specific mental health tools. We got push back that the tools weren't working and the entire process didn't make sense in the relational context of some of the projects. We were able to explore possible other tools as well as focus on the intent- to get women to help if they were ill.
One of the greatest innovations that we achieved was the partnership of the mother/baby services with mental health services, through the collaboration of Ahavah and Mental Health Resources. The staff of both agencies were incredibly receptive to the idea and very thoughtful in both planning and implementation. It turned out to be a very long launch process (3-4 months of occasional training) and launched on a smaller scale than planned (3 Ahavah staff certified to provide mental health (ARHMS) services), but it actually did work, without additional pilot/training funds. We learned a lot from even that small start and I think there's great potential for the model to have lasting impact: increased mental health services for perinatal women with severe and persistent mental illness; increased numbers of people of color entering the mental health workforce and climbing the career ladder; and increased fee for service income for a community based, birth centered organization.
Key lessons learned
It was an interesting challenge to marry the financial and programmatic innovation with the (very reasonable) risk-averse state agency. In the end, many of the project activities were seen as "risky" but we were still able to do them, with support from MDH leadership. This was primarily a financial issue: advance payments, use of a fiscal agent, granting to an agency with a non-existent previous budget, committing a very large investment of staff time for a relatively small program. The risk was primarily mitigated by the low manager: grantee ratio. For comparison, other grant managers have 12-35 grantees, this grant manager had only 3. It was a success in that we discovered it can be done and documented how to support very small community based groups in providing culturally appropriate services and helping them increase their administrative capacity. However, it did demonstrate the large amount of investment needed to do it. It was clear that this was a project that fit very well with nongovernment funding, but harder to see how to adapt traditional "government" funds to this model- high cost, low numbers.
The middle space between "mental illness" and "mental wellbeing" is vast. There was a tendency to want to focus on those in crisis or illness, when really this was an opportunity to invest in moving folks who are just surviving into thriving. The basic conversation around wellness (not illness) was new to almost everyone. I think we learned a ton about how to talk about it, as evidenced in the stories and statements from the pilot projects, but I also think we underestimated that part of the challenge.
I think we’ve figured out quite a bit about what culturally-based support looks like and what it means to fund/support it in the community. It means a lot of flexibility in expectations (will they serve 8 people or 80) and in what sort of activities “count,” like quilting circles and home visits by lay people, and a great investment of time in grant management. We’ve also seen a great demand for the services, especially for Ahavah, in the realm of prevention work for Child Protective Services, which is actually a good space for public health to work in.
I think we’ve figured out quite a bit about what culturally-based support looks like and what it means to fund/support it in the community. It means a lot of flexibility in expectations (will they serve 8 people or 80) and in what sort of activities “count,” like quilting circles and home visits by lay people, and a great investment of time in grant management. We’ve also seen a great demand for the services, especially for Ahavah, in the realm of prevention work for Child Protective Services, which is actually a good space for public health to work in.
Maintaining the relationships with lab members to support ongoing participation was difficult. It was especially hard for the lab in the Bemidji area, since we were only there a few times. This meant that the change in the makeup of the group between sessions was significant, and that at the end, when we went to try to gather the groups back together to assess the pilots, it was really hard to reach everyone. If we did this again, we would need to focus much more of the grant manager's and facilitator's time on investing in those relationships. Also, many of the people involved had their own mental health concerns, and I don't think we realized that would be an issue. I think we adapted well- I had individual "off-line" conversations with a number of folks and tried to do warm handoffs to appropriate resources -- but in the future we'd prepare better for that.
Reflections on the community innovation process
Testing the solutions, the pilot phase, was certainly the most dramatic and led to the best stories and examples. We learned a lot about wellbeing could be and the challenges in even talking about it. The pilots demonstrated community approaches to wellbeing, which both laid groundwork and showed the level of investment needed. The work on sustainability was especially interesting, and I think the Ahavah model could be one that is replicable and highly innovative, if investment on it continues.
Progress toward an innovation
There have been a number of practical implications from the grant, but the most exciting innovation is the collaboration happening between Ahavah and Mental Health Resources. We know that women of color have a difficult time accessing mental health support and we know that perinatal mental health has a huge impact on baby health outcomes. The collaboration happening here might be a good way to both meet the needs of moms and babies and be able to pay for it. I think it's an exciting model. We learned that the launch is difficult and that maintaining it will take an investment. There's a chance it could be both a good model for birth work and a new model for prevention services, like to prevent child protection services involvement.
What it will take to reach an innovation?
More work needs to be done at the baseline level, in explaining the very idea of mental health and how it affects overall wellbeing. We believe it is crucial to spread the message to the Karen community that someone who may be mentally unwell or under stress is not “crazy”, “bad” or “shameful”. We also hope that there can be a more wide range of culturally-specific services available to the community to better suit their mental health needs. Most of our participants were resistant to the idea of speaking to a counselor and but were more comfortable having someone of their own culture or with similar experience or feelings to listen to them and help them identify coping strategies, validate their feelings and remind them their feelings are human responses to stressors. Our intent is to try and find an appropriate middle ground. We believe that the more we learn about and work with the other cultures, the more likely it is that we can find solutions that will fit their needs, beliefs and customs.
What's next?
The pilot projects will all continue, in various iterations. The innovative collaborative will continue between Ahavah and Mental Health Resources, and the City of Minneapolis Public Health will support the project, at least in 2017. In order for that to continue, Ahavah will need to increase their administrative abilities (complete more thorough and timely reporting). On the MDH side of things, the project has been highlighted by the department-wide community engagement leaders, and the social innovation process will be passed on.
If you could do it all over again...
I would have started from the beginning with two labs (not trying to combine Twin Cities and Bemidji) and I would have set aside more time and stated the clear responsibility to maintain the relationships with community members to keep them engaged in all of the lab events (not just the first ones, but all the way through to evaluation).
One last thought
I think we’ve figured out quite a bit about what culturally-based support looks like and what it means to fund/support it in the community. It means a lot of flexibility in expectations (will they serve 8 people or 80) and in what sort of activities “count,” like quilting circles and home visits by lay people, and a great investment of time in grant management. We’ve also seen a great demand for the services, especially for Ahavah, in the realm of prevention work for Child Protective Services, which is actually a good space for public health to work in.