State of Minnesota, Department of Health
What has been most instrumental to your progress?
Outside Leadership: The Maternal Wellbeing Innovation Project (MWIP) started with year of community innovation, structured around 3 lab meetings in two different locations (6 meetings in all). The meetings were designed to bring in members of the target communities to develop, together, a proposed plan or concept to support maternal wellbeing in their community. We contracted with Clarity Facilitation (Anne Gomez and Michael Bischoff) to lead the lab meetings. It was obvious, even from the very beginning, that their assistance in both preparing/planning the events and leading them was key to their success. As government employees, the MN Department of Health (MDH) staff come into every interaction with non-government employees with a certain amount of baggage, hard to quickly eliminate. Michael and Anne allowed the state employees to be participants instead of leaders, as much as logistically possible, which helped to even out the power dynamics. They also brought a thorough understanding of the community innovation process, which showed in the thoughtfully planned and executed meetings.
Openness: The value of the innovation process was very clear, especially at the point of developing the “scenarios” the group chose from when they identified the model for the pilot projects. The Core Team developed a set of four scenarios and took it to a small group of leaders from the Twin Cities lab. The leaders proposed a totally different scenario that was included in the final decision making time, and ended up being the chosen model (Open Space). It is a model that is the most different from a clinical model of all the proposed scenarios, and the most focused on maintaining wellness as opposed to treatment or services. It was great that the facilitation and structure allowed the women involved to push their voices forward. The professionals were involved in providing data, examples, system knowledge, but the women really were able to design the model they wanted, which is what ended up in the RFP for pilot programs.
New Partnerships: We had identified the Twin Cities as a site for this work, and held our lab meetings in north/northeast Minneapolis. After the RFP was launched, Minneapolis Public Health contacted us and offered to fund an additional pilot site. It confirmed that we were addressing a need- the MPH had been looking for ways to better serve these populations, both more intensely and from within the culture and it confirmed that we were doing this in a new way. That was obvious when it came to selection time, as we had to spend a lot of time helping the MPH staff understand why we weighted selection criteria in the way that we did, leading to the selection of smaller, grass roots organizations with less established histories of grant management.
Key lessons learned
Geographic/Cultural Focus of Project: We originally planned on addressing needs of women in the Twin Cities and Bemidji through one course of lab meetings. Very early on it became obvious that we needed to have two totally separate groups. In the end, the groups were very different. Bemidji was smaller with a lot more consistency in attendance, and a very clear focus on American Indian women. In the Twin Cities, because we chose not to focus on one cultural group, we had larger group participating, but less consistency from one meeting to the next. When the Core Team reviewed it in the end, most thought that the more focused group in Bemidji was stronger and built more relationships and strength from the women. That said, the Open Space model that was chosen was best articulated in the Twin Cities group. After it was developed we took it to Bemidji and they decided it was exactly what they wanted also. This made writing the RFP easier, since both locations had the same model. The Bemidji lab may have developed this on their own, but it was helpful to have the Twin Cities work it out first. We had a much harder time selecting the pilot sites in the Twin Cities.
Bureaucratic Complexity/Innovation: A major part of our innovation, that wasn’t clear when we started the project, has been to help our organization adapt or build up our ability to support small, grass roots, culturally-based organizations. After the groups were selected for the pilot projects, it became clear that this is a good opportunity to build that capacity at MDH. However, that means getting the initial contracts in place and launching the pilots is taking much, much longer than anticipated. The elements that have been tricky, but in the long run will be helpful, are the use of a fiscal agent, providing an advance payment, and contracting with an organization that is less than 1 year old. After the contracts were prepared, a variety of MDH staff from different levels of financial/risk management have gotten involved. We have prepared extensive documentation about the oversight we will provide the pilot projects and have had to be very detailed in their budget justifications. In the future these models may be used by other areas of MDH as they also seek to build support and relationships with smaller organizations.
Reflections on inclusive, collaborative or resourceful problem-solving
Inclusive: The most exciting and productive part of the innovation process has been gathering together women from the effected communities and supporting them in creating their own model to pilot. We have heard repeatedly from the women that they feel like they were able to lead in this process. They have also expressed that even the act of gathering together to talk about birth and maternal wellbeing felt like a healing activity. It was good to hear women express real fears around mental health that don’t really show up strongly in research and data compiled from the broader community. It felt like even if the pilot projects demonstrate that these models don’t work, the innovation process itself has been helpful and capacity building.
Other key elements of Community Innovation
Clear focus on specific outcomes: improvement of mental health of mothers in cultural communities and creating sustainable income for those efforts. This has allowed us to identify a scope and keep it in mind when both building the pilot models and selecting pilot sites. The addition of the sustainability piece is what has helped the projects be more innovative and (by definition) more sustainable. An issue like “maternal wellbeing/mental health” is so broad and is affected by many factors, so these focuses helped it be a bit more manageable.
Understanding the problem
It has become clearer that there are great, caring and effective community leaders out there supporting women in maintaining or creating mental wellbeing, and that because of their size and history (youth) as organizations, they have a difficult time securing funding. Although many entities want to fund diverse groups, it seems like they don’t always fully understand the needs the groups often have, that the funder can help meet, in order to be able to work with them. For example, filling out a due diligence form is important and just because a group hasn’t done one, and needs help, shouldn’t mean they can’t be a part of the grant. Allowing room for groups to ask for and receive this kind of assistance may be new and take time, but it is necessary to change how we do business.
If you could do it all over again...
Start from the beginning with two separate lab groups. It would have made everything easier, especially in contracting and budgeting.