Voices for Health Justice: Findings from interviews with state project teams

Abstract

Background
As part of the evaluation of the Voices for Health Justice program, the Institute for Community Health (ICH) conducted semi-structured qualitative group interviews with state project teams in the Fall of 2021. Through these interviews, ICH sought to deepen understanding of how teams are thinking about and approaching their work within each of the six core domains of inquiry for the evaluation, which are: a) deep and broad community engagement; b) power ecosystems; c) sustained capacity growth; d) narrative change; e) policy, budget, and administrative outcomes; and f) community power. Through the interviews, ICH also gathered feedback and recommendations related to the overall grant structure and the technical assistance support.

Findings: Power ecosystems
Building on the notion that each state project team is its own local power ecosystem, project teams were asked to consider which factors made it easier for coalition members to work together. State project teams highlighted that shared values and history of collaboration between partners helped facilitate successful collaboration and strengthen the power ecosystem. Alongside these factors interviewees also noted that transparent and regular communication, complementary skill sets and/or
capacities among organizational partners, and role clarity were facilitators. Some teams also said that the flexibility of the grant program created an environment of learning and adaptation that fostered relationship-building.

State project teams also identified collaboration challenges related to building and navigating relationships within newly formed coalitions, particularly when working with organizations with dissimilar goals, priorities and capacities. Additionally, coming together with a shared understanding of racial/health justice issues across different communities proved to be difficult for some state project teams. Finally, working virtually due to COVID-19 made it more difficult for team members to build relationships and required teams to develop new approaches for grassroots organizing.

Despite some challenges in developing their coalition relationships, many organizations described significant benefits and value added by working in collaboration with one another. Not least of these benefits was the emotional support and companionship that came from working closely together. Teams also described the productive thought partnership they found in their coalition relationships, and ways in which their partnerships increased their effectiveness, such as by increasing their credibility with different communities.

Findings: Approaches to power-building and systems change
State project teams shared their approaches to organizing and leadership development as components of power-building, highlighting that they are focusing on the most marginalized populations, including low-income communities and communities of color. Many state project teams were in early phases of their organizing work, and described their efforts around building relationships, earning trust, and learning from communities. Teams highlighted that they were hoping to build a broad base of support and bring together different communities of color to further the work. Interviewees also described their approaches to leadership development, including informal ways to identify and encourage leaders as well as more concrete leadership training programs and curricula.

Another important component of the Voices project is developing communications strategies that have an impact on the broader narrative in each project’s area of focus. State project teams reported that they are in early stages of narrative change work, but consider this central to achieving their longterm goals. Teams are working to debunk misinformation and false narratives and replace them with positive narratives in support of their project goals. Interviewees described their communications strategies, which included community education, building narratives that connect health equity and racial justice, and building support for health equity policies by connecting them to universal moral values.

Through the Voices projects, teams are focused on building community power and also directing that power towards policy, budget or administrative goals. Since our interviews were done relatively early in the grant period, we focused the inquiry on understanding how teams identify policy goals and engage communities in this process. State project teams described how the organizational partners within their coalition have worked together to find a shared policy goals some noting that this was
difficult due to differing organizational priorities. Additionally, state teams recognized the importance of involving community members in identifying and shaping policy goals. Interview participants also talked about the importance of being flexible and responsive to community needs and shifting political landscapes, and discussed how policy wins and losses can impact community members’ engagement on issues.

Finally, state teams discussed how they center race and racism in their work. Many participants expressed that a racial justice or anti-racism lens is core to everything they do, although this was operationalized in different ways among the Voices organizations. Interview participants described activities such as internal trainings on racial justice topics, hiring efforts to diversify staff, looking at data disaggregated by race, centering race in communications, and re-orienting organizing work to have a
racial justice focus by more intentionally following the community’s lead in identifying priorities. Some interviewees also shared that the Voices partnerships have helped them further a racial justice priority.

Findings: Feedback on grant structure, TA, and supports
In general, interview participants found that having access to TA provider knowledge, resources and training opportunities strengthened their project work. Project teams commented that TA providers bring added capacity, policy expertise, and relevant knowledge to support their work, and some expressed appreciation for TA providers’ responsiveness. Some teams highlighted that TA support has helped facilitate communication within their coalition and/or has helped them connect with relevant
outside organizations. Regarding areas for improvement, some teams felt that TA calls were too frequent or too oriented around progress updates, and expressed a desire for more flexibility with TA requirements and structures, as well as more focus on problem solving, idea development, and brainstorming.

Regarding the grant structure, several teams commented that the flexibility and openness of the Voices program has facilitated innovation and allowed them to be more intentional about spending time on relationship- building and maintaining focus on community priorities. Although a couple of state project teams noted having to navigate uncomfortable relationship dynamics during the process of identifying their Voices coalition, others felt that the coalition structure of Voices brought new capacities that have benefited their work.

State project teams provided feedback and recommendations for the RWJF and the Steering Committee, sharing that more funding is needed to adequately cover the time spent on project work and the efforts of all partners. Interview participants also offered ideas for how to structure future programs to reduce competition among organizations in coalition, such as allowing organizations to co-lead, developing a collaborative process for dividing funds, and dedicating extra time and funding for new coalitions to develop their relationships and processes for working together. Teams called for longer-term grants and for funding and TA that supports organizational development and infrastructure building. Finally, teams recommended that funders dedicate more resources to newer organizations and to states with a less robust power-building and advocacy landscape.

Recommendations
A salient theme that cut across interview topics was the dynamic and long-term nature of this work, with teams highlighting multiple stages of work involved in the path to long-term change. This includes building relationships and trust within coalitions, as well as relationships with the communities of focus. Policy goals and associated plans identified in the grant proposal phase may need to be reoriented as the work proceeds, necessitating a responsive and iterative approach. Overall, based on the themes identified through our interviews, we suggest some ideas for structuring future programs that aim to advance community power-building for health justice. These include redesigning proposal templates to encourage responsiveness to community input rather than predetermined policy goals, funding a discrete planning phase to facilitate coalition-building, reassessing award amounts and grant period timeframes, more customization of grant objectives to meet groups where they are at, and more support to help grassroots organizations successfully take leadership roles.

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