State of Minnesota, Department of Health

Report date
November 2016

What has been most instrumental to your progress?

This year was dedicated to the launch of the three pilot projects, which are all working at implementing the vision set by the community innovation lab. The labs (one in Bemidji and one in Minneapolis) had generated ideas and then created the RFP which then was used to find organizations to pilot projects. The pilot groups are Neighborhood House Karen Baby Talks, Ahavah Birthworks, and Mewinzha Ondaadiziike Wiigaming. In Fall 2016 we were able to finalize all of the grant agreements with these groups, and they all launched in December. They have had a variety of challenges in getting the programs moving in the direction and vision of the lab, but all are now moving and actualizing that vision in unique ways that suit their communities.

In 2016 the pilot grantees have been meeting as a cohort to problem-solve on issues like start up, sustainable funding opportunities, and integrating mental health discussions into their relationships with moms, in ways that suit their cultures. It's been a great challenge to address mental health, even from within the culture, and specifically to identify professionals and treatment that would be acceptable when they have crises.
One of the pilot projects, with Ahavah Birthworks, has been able to develop an innovative partnership with a mental health services provider, MHR, Inc. They are very slowly implementing, using a model of pairing the mental health worker with the Ahavah worker to support moms in initiating and starting treatment for serious and persistent mental health needs. This is an exciting innovation which has potential to provide a consistent source of funding for Ahavah and a deeper level of treatment and support for the moms Ahavah works with. In a recent survey of their clients, more than 45% reported some level of diagnosed mental illness. Another potential innovation in practice is Ahavah, and their fiscal agent, Community Wellness Center's, approach to working along side county child protection services to support high-risk families, attempting to build up a partnership instead of a fear-based relationship.
In the summer of 2016 most of the time on the project was spent in writing and promoting the pilot project RFP. The lessons learned from that, along with the lessons from the grant agreement (contracting) process and the launch, are really helpful for moving the MN Department of Health forward in our ability to partner with small, culturally or community based organizations. MDH is working on this in general, and the lessons we learned have been passed on through a variety of meetings and conversations, and are used currently in our efforts to make our grant-making more equitable.

Due in part to the nature of our funding (federal and state restrictions) the very act of writing the RFP has often been a very insular activity. Through this grant we actually worked along side Lab members to do the actual writing, editing, and publication along with the scoring and selection. MDH continues to look for ways to, as Commissioner Ehlinger says, "strengthen the capacity of communities to create their own healthy future." Finding ways to include community members and advocates in the planning, not just implementation, of programs is essential to that effort.

Key lessons learned

I'm not sure if it was a failure, but it took a lot longer than expected to get the pilot projects up and running and they are running very differently than I expected they would. First of all, and I knew this but underestimated it, the bureaucratic structure, and the projects weren't ready to start with our funding until 3 months after they were selected. Then, after the start, two of the three took a very long time to get up and running. One did finally hire the right staff, after 4 months, and one has been going a different direction than we thought. It's been good to be able to extend their timeline (no cost) but it also was a good lesson about the ability of a small non-profit to handle a big increase in income and activity.
It is way, way harder to find acceptable mental health treatment than I knew. The barriers for access for women - stigma, money, transportation, cultural congruency of staff -- are just huge and it's very overwhelming. The burgeoning partnership between Ahavah and MHR, Inc. might be a great tool for bridging those barriers, so I'm excited about that, but the overall need is overwhelming.

Reflections on inclusive, collaborative or resourceful problem-solving

Inclusive: with the leadership of our facilitator (Social Innovation Lab) the Lab meetings were inclusive, supportive, and hopeful. We were able to tap into community networks to bring insightful and passionate community members together to have real and productive conversation. Multiple times, in both Minneapolis and Bemidji, women participating talked about how the lab session itself had been healing and hopeful for them. As a public health/government staff person, I was really enriched by the variety of perspectives and open communication from others. A number of women shared about their specific fear of losing their children to CPS if they spoke openly about their depression or anxiety. I didn't have that fear myself and it was helpful and daunting to hear it straight from other moms.

Other key elements of Community Innovation

The consistent, leadership supported, push toward advancing health equity at the MN Department of Health has helped in the grant progress. Even though the systems often seem unwieldy and hard to change, there actually is a great deal of commitment and time put toward trying to make changes. This has allowed the grant to have greater effect, for example for the lessons learned to be heard by a wide crowd and have potential for policy or systems change.

Understanding the problem

It has highlighted both the severity of the need and the deep-seated fear related to it. As we continue to learn more about the connections between trauma, addiction, and mental health, I see our project as helping to illuminate the connections between these and CPS and the loss of children. Minnesota women have lived through great trauma and pain, including for some separation from their birth families, which sometimes leads them into mental health issues and addiction. If they get pregnant, carrying the child can lead to hope and a desire to find a way through those barriers, but if they mention their addictions, pain, or trauma, they are worried they'll lose the baby. I'm understanding the need at a deeper level, but also understanding the gap between what our system offers and what women need.

If you could do it all over again...

To have given ourselves more time for piloting. The projects just take a lot of work and the effort to create sustainability, which I think is a key aspect, is the most daunting and time consuming.

One last thought

We were very lucky to have gained a partner in the Minneapolis Public Health Department and to do this at a time when there is rising interest in the role of public health in mental health. We had budgeted for two pilot projects, but when we put out our RFP the Minneapolis PHD contacted us and asked if they could contribute money and fund an additional pilot within the city limits. That allowed us to add Ahavah to the group, which has turned out to have the most potential for a sustainable (financially) model. We also have come to a time when public health is asking what mental health promotion is, so our projects are ahead of the curve on this.