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Summary of Notes from the April 2018 Muskegon ABLe Change Training

The following document summarizes the ideas generated by participants of the Muskegon ABLe Change training held on April 25-26th, 2018. These ideas will be used to guide efforts to create a more Equitable, Healthy Community in Muskegon.

This summary includes the following sections:

Vision for an Equitable, Healthy Community On day one of the ABLe training, participants were asked to close their eyes and imagine the following;

Imagine its some years in the future and you’ve done it!! Each child, youth, and adult in your community is thriving. There are no meaningful disparities in outcomes between people of different races, genders, income levels, LGBTQ status, immigration status or other characteristics. Your region has been recognized as the most equitable, healthy community in America. Imagine we are visiting you in this future. Take us for a tour in your community. What would you show us to help us understand why your region has the greatest equity in wellbeing?

Each individual took a few minutes to brainstorm their answer to this question. Individuals then shared their ideas in small groups and collectively they chose 5-7 ideas they felt were most important for the region; these ideas were each written on a separate card. These cards were then taped on the wall and sorted into clusters of similar ideas. As the group reflected on the sorted cards on the wall, they noted the similarities in vision elements that had emerged across participants. The table on the following pages includes the sorted notes from this process. These vision elements will guide the strategy design process on ABLe training days 3-4.

Vision for an Equitable, Healthy Community (p. 1)

Local Resident Groups Experiencing Greatest Inequities (p. 5)

System Barriers Contributing to Targeted Inequities (p. 6)

Engagement Goals (p. 13)

Local Partners with Direct Touches with Residents (p.14)

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Shared Vision Elements

Neighborhood and Physical Environment

Access to Healthy Food

Access to healthy food

Accessibility and promotion of good nutrition

access to food

More Farmer's Markets - Less deserts

Nutrition -Access to affordable, healthy foods

Access to local food/groceries

Quality Community Infrastructure

Infrastructure

Roads, Police, Fire

Green Safe Spaces for Gathering and Physical Activity

Safe Neighborhoods, Schools & Housing

Showcase gathering spaces: Gardens, Parks, Etc.

Maintenance & upkeep of neighborhood parks/recreation centers

Used public spaces by ALL: Beach Accessibility, Beaches, Ice Rink in Winter,

Safe Parks & Sidewalks

Everyone playing outside

Sidewalks & bike lanes in all areas - physical activity is present & visible

All areas have sidewalks and pathways where people walk freely

Green Spaces

Walkable Communities

Gardens (Communities)

Garbage (Recycling)

Access to physical activity

More Sharing doing together with communities

Community wide connected green space

Housing is Affordable and of Quality

Affordable housing (Home owners)

Zoning enforcement (# units)

Quality

Visual representation of equally distributed state/city funding for

infrastructure

Everyone has safe and adequate housing

Safe lead-free homes

Education funding is balanced across socio-economic factors

Transitional housing available

Housing blight has been eliminated

Transportation is Accessible & Everywhere

Transportation: Cheap & Frequent (Accessibility)

Unlimited community bus access

Fantastic public transportation to all parts of the community

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Economic Stability Jobs! Jobs! Jobs! (Economic Opportunity & Development)

Employment

Jobs (entrepreneurship)

Economic Empowerment

- Connected neighbors helping one another

- Sustained quality of life

Training +Education=Employment

Education High Quality, Equitable Education is Available to Everyone

Access to educational resources/quality education

We are a fully literate community

Individualized learning for Children & Adults

Strong education: schools, Cultural, Outdoor, Child Care

Education Resources are the same for every school district

High Quality Affordable Child Care & After School Care/ Pre K for Everyone

High quality & affordable child care that is accessible

Birth -5 Child Care

Social Context Trauma Informed Community Where All Residents are Respected and Supported

System is supporting families

Meeting people where they are: Respectful, Responsive, Trauma Informed

Bridging trust among people and systems that can bring about change

Leveraging cultural competencies in obtaining health equity

Neighborhoods/Zip Codes are Inclusive

Neighborhoods/Zip Codes are Inclusive

Inclusion - All thoughts, races, ethnicities, ages, education, interests,

genders, etc…

Neighborhoods are inclusive: All community members are active in the

best capacity they have to operate

Equally diverse (racial & socio-economic) populations across zip codes & in

each school district

All races mixed together co-existing. No judgements of any kind. Reaching

people on the same level

Zip code: discrepancies/barriers gone!

Progress toward healthy communities /families/individuals is

observable/documentable

Diversity: People, Opportunities, Points of View, Beliefs, Race/sexual

orientation/gender

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Residents Have Voice & Influence

Everyone has a voice

Client voice is being heard no matter what the background

Civic engagement

- All registered to vote

- Increased voter participation

- Improved policy

- Diverse representatives

- Quality representation

Strong Sense of Community

Close knit community efforts - Ownership of community and surrounding

area.

Greater inner city development - Resources made ready and available -

Take care of homes, yards, possessions.

Active neighborhoods associations where residents are the center of

change.

People are connected because of ease of association

- Safe spaces

- Transportation

- Varied opportunities

- Creating connections

Cultural and social activities *FUN*

Health Care System Quality Healthcare is Universal and Patient-Focused

Universal Healthcare - decisions in the hands of clients and providers instead of insurance and bean counters

Affordable quality healthcare accessibility

Unrestricted healthcare for all

Access: Including transportation, healthy food, and healthcare

Access to excellent healthcare

Access to Mental Health/Substance Use Care

Access to mental healthcare

Access to substance use treatment - not gender specific or race

Integrated Systems Promoting Equity Orgs working together in New Ways

● Organizations working together to address SDOH, reduce silos

● Individualized care plans: Health, Home, School

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Community Policies, Practices and Relationships Driven by Equity

● Systems created based on equity

● Appropriate treatment versus punishment. Accessible rehabilitation for

substance use.

● Free from Judgment (no eligibility restrictions)

● Understanding and addressing root causes of inequity in all areas

● Freedom from fear of:

- Discrimination

- Violence/harm

- Exclusion

- Lacking basic needs

- Not having living wage

- Being hungry

- Health crisis

● Feeling safe - Increase life skills and advocacy

Local Resident Groups Experiencing Greatest Inequities Training participants looked at local data on housing, food access, and substance use to understand which groups of residents are experiencing the greatest inequities. To see the data summary the training group used for this discussion, click here. The group used this data to identify the following groups to initially target with the local equity efforts:

• Race/Ethnicity: African American, Hispanic/Latino

• Age: 0-34

• Geography: Muskegon Heights, City of Muskegon, Northern Rural Communities

• Income: under $20k

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System Barriers Contributing to Targeted Inequities Training participants engaged in a system scan to identify current community and system conditions contributing to their targeted inequities. Participants discussed different types of system conditions in small groups (e.g., policies, mindsets, service components, resources, power, and connections). The following is a summary of these barriers. These barriers will be used in ABLe Training Days 3-4 to guide strategy design.

Barriers to Equity in Affordable, Quality Housing

Mindsets

The individually accepted “norm” for affordable housing are different from person to person and is shaped by: Environment, Parenting and families, and Ethnic, cultural, religious background

Economic classes have different mindsets, shaped by their: Education, Privilege (travel, experiences), and Birthright-Born into a particular experience

TV shows about “rich” lifestyles and homes

Understanding difference between a need and a want Service Components:

Access barriers o Individuals having needed skills to obtain better employment o People making under 15K have a disadvantage with transportation

Resources

Community lacks CDBG funds to improve housing stock and repair existing housing or add to housing stock.

Landlords don’t have funds or desire to improve housing stock (i.e. removal of lead-based paint)

There is a Cycle of Displacement vs. investment in communities that leads to gentrification.

Local City government is hesitant to increase local taxes because some stakeholders will veto or override the vote.

Regulations

Red lining Districts

HUD decision in 2006 to lower FMR Requires congressional action LIHTC restrictions

No local government will pass a PILOT with the exception of the house to build affordable houses

Power:

HUD/MSHDA control agenda

Funding agencies have a lot of power including LIHTC, HUD, and MHSDA

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Barriers to High Quality, Equitable Education

Service Components

Size of transportation area can limit student’s ability to take part in extra tutoring or activities

The newest teachers are often working in the most challenged schools. Resources

Low budget/income schools have decreased money meaning lower pay for teachers

Transportation funding gaps o State decides Transportation funding, State gives same amount of money to all o Large geographical area served by buses, which is expensive, so it uses a large part

of their budget

State Education Funding priority barriers o Number of “at risk students” can vary by geographical area but money don’t

increase/vary o Money for special education is $600 underfunded for Muskegon county as a whole

(Decided by state formula)

Schools with high number of special education students are disadvantaged

Local Revenue Barriers o Property Values-Low real estate value limits the money a community can raise o “Poor performing schools” can negatively impact property values – negative cycle o Flight of businesses and local infrastructure like parks further encourages flight of

families. Regulations

School of choice can not only cap number of students AND exclude those suspended or expelled (so behaviorally challenged students remain).

Barriers to Equity in Accessing Healthy Food

Mindsets

People may not be interested in “healthy food” because there are different definitions of healthy.

Some City Planners and store owners have lack of accurate data and mindset of “not my problem, not my neighborhood.”

Kids don’t know where food comes; have a lack of appreciation for nutritious food. Components

Equality vs. equity focus o Based on first come first serve as opposed to based on need

Limited healthy food retailers o No grocery stores (Muskegon Heights) o Minimal farmers market (Muskegon Heights)

Healthier food is more expensive-mental state, resources etc.

Access barriers

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o Not holding food truck events on good days and times. o People do not have close proximity to quality healthy foods. o Neighborhoods of low housing values have less access

Transportation barriers o Jefferson Towers experiencing transportation barriers o Those lacking transportation and are Hispanic or more than one race living in

Muskegon, Muskegon Heights, and rural Muskegon County.

Current efforts: Vegetable van, Walmart-bus route through [Muskegon] Heights

Local Food System/Local Farmers o Because funds are leaving community to big food/farms because of incentives from

USDA & cheap/efficiency of Gordon Food System, etc. o Local food is not being purchased/used/encouraged o No one appreciates farmers!

Connections

Poor communication and collaboration between food access leaders.

Stakeholders don’t have knowledge about healthy food Regulations

Regulations (Double buck up program)-not available everywhere or not accepted (Project Fresh coupons not accepted at Farmers’ Markets)

Resources

Barriers to funding healthy food o efficiency and ease of using Chartwells o Line item in the budget and kids have food

[Muskegon] Heights:

Lack of green space in poor neighborhoods impacts people’s ability to be active.

People who experience Housing Issues lack reliable access to healthy food/storage.

Grocery stores- There aren’t incentives for businesses to plant in a community

Wealthier communities are better funded

Power

Town hall meetings and focus groups not utilized.

Resident input not sought out (*Not knowing how decisions were made or why)

Not involving outside stakeholders such as churches, duplicating services.

USDA-Makes decision about what to incentivize

Barriers to Equity in Getting Mental Health/Substance Use Disorder Needs Met

Mindsets

Substance use within family is normal/not bad – Why change? Why prevent it?

People with mental health are viewed differently

Negative views towards people with substance use disorders o People view people with an addict as being “less than” or brought on by themselves

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o Some people of the older generation shun people with mental health o Some people think mental health is something to be ashamed of o Stigmas associated with using resources

Taboo subjects among certain races

Now that other ethnicities are affected, people want to get involved (i.e. Caucasian American). Problematic mindset: Why wasn’t the issue addressed when only races of color were accused of being addicts?

Trust issues o Minority populations may be disadvantaged because of trust issues created by

historical practices of the system o with clients sharing data o Sometimes people have preconceived ideas of mistrust of other agencies based on

past information or historical practices, resulting in decreased or non-existent connections.

Service Components

Resources not available or reaching people who need them o We don’t have a lot of access to resources to individuals who are Medicaid

beneficiaries. o Of resources available, they are not able to serve all who need it o Specialty programs/providers not accessible locally

lack of cultural competency o The cultural competency in all races-no rehab in Muskegon

Community knowledge of available services is lacking o Lack of system knowledge by providers/agencies and residents o Inadequate knowledge in community of resources for mental health/substance abuse o Lack of dialogue of what SUD are o No doctors to chat about services o Knowledge of what a SUD in an un-stigmatized way/manner that is understood o No connection that is trusted, fear of CPS taking children away o Expectations: Not communicating expectations well, Not understanding services

provided o Language and literacy barriers. Latino populations is disadvantaged because lack of

widespread linguistic competence. o Lack of outreach program

No family resources around SUD o Family case manager o Wrap around services

Insurance/cost barriers o No insurance will cover it; Many are uninsured/underinsured o Families can’t cover copays, deductibles, etc. o Only the wealthy receive treatment

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o People with private insurance are advantaged in that they have more choice of provider, but disadvantaged because the array of services available are not as broad spectrum as Medicaid benefits

o People with Medicaid are advantaged because there are a lot of options for care, but are disadvantaged because there are often barriers to access public mental health/SUB services

Eligibility o Funding specialists don’t accept mental patients as clients

Transportation o No transportation o Kids on a bus o Anxiety/mental health issues

Logistics o Time it takes o Employment restrictions o Lack of affordable childcare

Connections

We don’t share resources/data

Lack of unity and collaboration-unclear paths to care

Tunnel vision-different sectors only look at their own specialty-not a whole health, coordinated approach. o For example, mental health, substance use and physical health get separated.

Regulations

Minority data isn’t being collected/shared

HIPAA violations

No de-identified data among providers

Insurance companies limiting treatment sessions

Local and state regulations around seed to sale/dosage monitoring/licensing

Power

We don’t have the right voices in the room

Payers dictate care available

Barriers to System Coordination

Mindsets

Where one part doesn’t have the same feeling of the value, of the needs, of the community, or the organization.

Change overload.

Egocentric “logo love”.

Collaboration is de-incentivized due to competition and focus of grants and other funding/Competition mentality among CBO’s.

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Communities Caregivers are experiencing fatigue and burnout which impact the ability of the community to integrate delivery of care.

Community doesn’t want to duplicate resources, but resources are still needed.

Community willingness to discuss race and that it is time to talk about RACE.

Precedence “didn’t work in 70’s, it won’t work now”

Service provider lack motivation, engagement, and give ownership around addressing community disparities.

No ownership of inequity and reducing disparities in outcomes.

Client experiences or lack of trust for workers and system.

Service Components

Busy schedules inhibit Follow Through o Cannot attend meetings and hearings due to high caseloads. o Follow through is lacking due to busy schedules.

Understaffing, burnout, compassion fatigue

Narrow focus of some individuals and agencies myopic

Difficult to partner because Access Health is always changing and evolving

Connection

Barriers to Sharing Data o Data sharing – not being shared among partnering organizations particularly

mental health and substance abuse. o What is being done with the data? o “This is our stuff-”Not wanting to give up information. o Certain organizations have policies restricting them from sharing information. o PHI can’t be shared so it makes it hard to understand needs if we can’t

determine based on individual details. o Unwillingness to share data, whether due to legalities or personal reasons.

Communication barriers o We don’t know what each organization do or what they stand for. o Are we making everyone aware of the needs we serve? o Communication barriers between agencies. o Systems don’t talk to one another so we consistently ask the same

embarrassing questions that might turn patients/clients off. o Need more coordinated efforts

Funding is challenging o Even if there is funding, it may be designated to another program. Not flexible

to use or partner with emergent needs

How can faith-based organizations create crisis-teams and work with community organizations to bring about change.

Resources

Lack of leadership opportunity for new people/staff coming up in organizations

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o How can current leaders pass on skills and knowledge to others? Including succession planning or transfer it to community ownership.

o Skills and leadership of some “leaders/administrators” have not yet developed the skills of leadership on the level of need.

Knowledge and Skills to support coordination o Poor collective learning (targeted universalism). o Service providers lack knowledge and skills about cultural bias/stigma. o Gap in knowledge between medical community and communication services.

2-1-1 o 211 lacks updated information, service knowledge o opportunity to better utilize 2-1-1 so they can connect people to the right

resources

Lack of strong resource pool; Decreased resource knowledge

Lack of resource sharing ability between organizations

Referral processes always changing

Competition for funding among community services

Groups don’t know what other agencies have to offer

Regulations

Intake Procedure Barriers o Organizations have different intake processes. o Multi-stop intake process through three different agencies.. o Organizations and programs different eligibility requirements o Instability in information sharing for referral – unreliability, inconsistencies. o Coordinated assessment reporting, intake, need more assessment tools.

Government bureaucratic red tape o Rebranding helped the whole list is an issue o Outdated systems so hard to capture and share o Underfunded for the need

“Privacy” – overextension of HIPAA, lack of understanding impedes collaboration – legal threat is stopper

Power

The community has the same leadership who rotate through positions of power.

Poor prioritization of needs without user input

Services are cut due to lack of leadership

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Engagement Goals Training participants learned about a continuum of how residents can be engaged in local change efforts, from ignored to change agent (see pages 66-69 in ABLe Manual for more details). Participants indicated on a flip chart how they are currently engaging residents in their efforts (shown by the marks below the continuum), and how they would like to start engaging residents in the future (shown by the marks above the continuum). Participants will draw on these goals as they explore how to engage residents throughout the course of the ABLe Change experience.

Future Resident Engagement Goals

Current Resident Engagement Practices

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Local Partners with Direct Touches with Residents The following organizations and local partners have direct touches with local residents experiencing inequities. We will explore how to leverage these connections to gather input from local residents in the coming months.

Pathways to Better Health Home Visitors: Physicians offices, 9 community agencies (Judy Kell)

Prescription for Health (Sarah Rinsema-Sybenga)

YMCA- Diabetes Prevention Classes (Kelli Delong)

Capable outreach to seniors (Judy Kell)

Homeless Continuum Outreach (Michael Ramsey)

Fellowship Reformed Church Public Defenders Group (Laurie)

Muskegon DHHS (Shelly)

Rite Aid (Beth Hibbs)

Blue Cross Complete of MI (Kelsey LaTara)

Embrace Books (Taleah Greve)

Boys and Girls Club Muskegon Lakeshore (Deb Hayek)

The Hope Project (Rita Caviress and Sara Johnson)

70x7 Full Recovery Kingdom Live (Nate Johnson)

Sacred Suds 3rd space gathering place (Sarah Rinsema-Sybenga)

Community encompass (Sarah Rinsema-Sybenga)

Wedgwood Christian Services SUD Program (Jennifer Tornga)