Transforming Systems to Realize Equitable Health and Well-Being for Black and Latino Families

In 2021, in response to evolving dialogue about racial equity and the importance of child health and well-being, the Greater Rochester Health Foundation (GRHF) launched the Healthy and Equitable Futures (HEF) initiative. Serving children and families in Rochester and Monroe County, New York, HEF works with local child-serving organizations, parents, and families to improve health and well-being for Black and Latino children aged 0 to 8 by centering racial equity in child- and family-serving systems. HEF emphasizes systemic change to better support whole child health — which includes physical, cognitive, social, and emotional development — and uses three main levers to propel this change:

• Advancing family leadership: enabling families, especially those from Black and Latino communities, to take on leadership roles and act as experts in all decisions that affect the health and well-being of children and families.
• Delivering social and emotional support: ensuring that children have access to social and emotional support in safe play environments that are equitable and culturally sensitive.
• Creating representative and inclusive systems: building systems that implement policies and practices based on equity, with a focus on increasing the presence of Black and Latino leaders, staff, and providers.

Starting in January 2021, GRHF funded ten grantees and four consultants to work on the HEF initiative. HEF grants funded organizational policy, practice, and program changes aligned with the three levers. To center parents as key drivers of the initiative, HEF also funded parent leaders to serve as partners in GRHF-led efforts in each lever of change. Parent leaders also helped guide and inform how the HEF strategy was put into action, ensuring that parents' voices and decisions were central to GRHF's internal operations.

Approach

GRHF asked RAND to evaluate the implementation of the first three years of HEF operations and the progress of HEF toward its goals. Rooted in a systems change approach, the evaluation focused on understanding (1) how organizations implemented changes in each of the three levers (family leadership, social-emotional supports, and representative and inclusive systems), (2) what changes in organizational practices were realized with each lever, and (3) how the initiative's design centered parents and families and contributed to changes in the three levers and progress toward systemic change. Together, the answers to these questions assessed progress toward racial equity in child health and well-being by systems, organizations, and communities and examined the overall contribution of HEF toward these outcomes. In addition, the evaluation tracked broader changes in the community to which HEF contributed that could help the community meet its goal of racial equity in child health and well-being.

The figure illustrates the evaluation's framework. The evaluation principally focused on the implementation of HEF (dark blue) and the organizational and system-level progress and outcomes from GRHF investments in HEF (light blue) while also tracking some of the longer-term outcomes (dark green) and impacts (light green) to which HEF contributes.

Healthy and Equitable Futures

Strategies and Levers

Capacity building, convening, and advocacy supports

Short- to Mid-Term Outcomes

Implementation of policy/practice changes for family partnership, social-emotional supports, and racial equity, diversity, and inclusion

Community

Longer-Term Outcomes

Larger, sustained policy changes respond to family priorities, support the social-emotional well-being of Black and Latino children, and center racial equity

Long-Term Impacts

Power shifts to communities, and racial inequities in child health are reduced

Goal

Racial equity in child health and well-being

Evaluation activities included document review, interviews and focus groups with community members and organizations, and structured conversations with GRHF staff to assess whether and how this systems change approach met HEF objectives and influenced the community's philanthropic approach to racial equity in child health. This approach invited input from parent leaders, grantees, consultants, and other key individuals throughout the evaluation.

Key Findings: Areas of Progress

The HEF efforts, focused on three key lever areas, represent engagement with more than 5,000 children, family members, and providers annually, with parent leaders being central to these efforts. In its first three years, HEF concentrated on building organizational capacity and advancing systems change through efforts to enhance racial equity in health and well-being for Black and Latino children and families.

• Advancing family leadership. HEF enhanced the capacity of grantee organizations to collaborate with families and offered parents training and support to develop leadership and advocacy skills, including
  • enhancing organizational learning and resources to support family engagement by setting up formal procedures for family leadership and training staff on effective family engagement
  • increasing the number of parents in decisionmaking roles by motivating changes in organizational policies and practices for partnering with parents and families
  • strengthening parent leadership skills by providing parents with training and opportunities for skill building and certifications on equity, advocacy, and other topics.
• Delivering social-emotional supports and services. HEF expanded trauma-informed care and social-emotional well-being services, including
  • encouraging more training and learning opportunities in early childhood and infant mental health for early childhood providers
  • offering social-emotional health education and awareness building activities for families and communities
  • building capacity for play-related spaces and activities and advocating for play-related goals and activities.
• Building representative and inclusive systems. HEF improved representation and inclusion within organizations and systems, including
  • strengthening training, policies, recruiting strategies, and hiring practices to support equity and representation
  • encouraging organizations to use a racial equity lens in shaping their purpose, goals, and culture
  • promoting racial equity and cultural diversity in services and supports in diverse communities.

Learnings and Opportunities

Three insights can help HEF as it moves forward with implementation:

• By design, HEF requires more deliberate planning than other initiatives because it aims to change not just organizations but also systems.
• Although HEF has made progress in involving parents in decisionmaking, there is still variation in how much families are involved in decisionmaking across organizations and systems.
• Although HEF has led some community actions on equity and child health and well-being, its work is part of efforts by a broader community that continues to explore what equity-centered systems and policies mean, as well as the meaning of racial equity itself.

The evaluation findings also point to three opportunities for continued growth for HEF:

• To advance family leadership in child health equity, promote consistent and innovative approaches to ensure meaningful parent engagement. Parents need more supports and opportunities to exercise their advocacy and advance in leadership roles.
• For better social-emotional support services, improve coordination among local organizations, families, and social service agencies and increase awareness of family needs.
• To build more representative and inclusive systems, address structural barriers and allocate resources to move effectively from dialogue to impact. This includes overcoming organizational fragmentation and aligning racial equity actions among local organizations.

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Topics

• Child Health
• Community Health and Well-Being
• Community Organizations
• Complex Systems Analysis
• Families
• Health Equity
• New York
• Racial Equity