Last Modified: 2/1/2025

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These terms of use are entered into by and between You and Â鶹´«Ã½Ó³»­] (the “Organization,” “we,” or “us”). The following terms and conditions, together with any documents they expressly incorporate by reference (collectively, “Terms of Use”), govern your access to and use of / , including any content, functionality and services offered on or through /  (the “Website”), whether as a guest or a registered user.

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We may revise and update these Terms of Use from time to time in our sole discretion. All changes are effective immediately when we post them, and apply to all access to and use of the Website thereafter. However, any changes to the dispute resolution provisions set forth in Governing Law and Jurisdiction will not apply to any disputes for which the parties have actual notice prior to the date the change is posted on the Website.

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Copyright Infringement

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Marketing Team
Â鶹´«Ã½Ó³»­
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If you fail to comply with all of the requirements of Section 512(c)(3) of the DMCA, your DMCA Notice may not be effective.

Please be aware that if you knowingly materially misrepresent that material or activity on the Website is infringing your copyright, you may be held liable for damages (including costs and attorneys’ fees) under Section 512(f) of the DMCA.]

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The owner of the Website is based in the Commonwealth of Massachusetts in the United States. We provide this Website for use only by persons located in the United States. We make no claims that the Website or any of its content is accessible or appropriate outside of the United States. Access to the Website may not be legal by certain persons or in certain countries. If you access the Website from outside the United States, you do so on your own initiative and are responsible for compliance with local laws.

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You understand that we cannot and do not guarantee or warrant that files available for downloading from the internet or the Website will be free of viruses or other destructive code. You are responsible for implementing sufficient procedures and checkpoints to satisfy your particular requirements for anti-virus protection and accuracy of data input and output, and for maintaining a means external to our site for any reconstruction of any lost data. WE WILL NOT BE LIABLE FOR ANY LOSS OR DAMAGE CAUSED BY A DISTRIBUTED DENIAL-OF-SERVICE ATTACK, VIRUSES OR OTHER TECHNOLOGICALLY HARMFUL MATERIAL THAT MAY INFECT YOUR COMPUTER EQUIPMENT, COMPUTER PROGRAMS, DATA OR OTHER PROPRIETARY MATERIAL DUE TO YOUR USE OF THE WEBSITE OR ANY SERVICES OR ITEMS OBTAINED THROUGH THE WEBSITE OR TO YOUR DOWNLOADING OF ANY MATERIAL POSTED ON IT, OR ON ANY WEBSITE LINKED TO IT.

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Governing Law and Jurisdiction

All matters relating to the Website and these Terms of Use, and any dispute or claim arising therefrom or related thereto (in each case, including non-contractual disputes or claims), shall be governed by and construed in accordance with the internal laws of the Commonwealth of Massachusetts without giving effect to any choice or conflict of law provision or rule (whether of the Commonwealth of Massachusetts or any other jurisdiction).

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Arbitration

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Limitation on Time to File Claims

ANY CAUSE OF ACTION OR CLAIM YOU MAY HAVE ARISING OUT OF OR RELATING TO THESE TERMS OF USE OR THE WEBSITE MUST BE COMMENCED WITHIN ONE (1) YEAR AFTER THE CAUSE OF ACTION ACCRUES; OTHERWISE, SUCH CAUSE OF ACTION OR CLAIM IS PERMANENTLY BARRED.

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Entire Agreement

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This initiative involved a multi-phased approach to examine the department’s equity practices, develop a forward-thinking strategic plan, and equip staff with the tools to enact meaningful change. Recognizing the diverse needs of its divisions – public health, behavioral health, primary care, developmental disabilities, and administration – the project sought to align organizational culture and the department’s mission of equitable service delivery. At its heart, the initiative represented Lincoln County’s commitment to nurture an environment where equity is a value, outcome, and daily practice.

How it worked

±á¸é¾±´¡â€™s Health Equity Framework served as the underpinning for the overarching project as well as each individual phase. Central to this framework is the belief that advancing equity requires challenging entrenched narratives, fostering authentic engagement, and addressing power imbalances—principles that guided Lincoln County HHS throughout this process.

This project consisted of three phases:

1. Assessment. The initiative began with an honest examination of the organization’s culture and practices through an equity assessment. The assessment process used staff surveys, focus groups, and community conversations to establish a clear baseline of the department’s strengths and areas for growth.
2. Strategic planning. Assessment findings informed the creation of a three-year strategic plan that prioritized four key areas: access to care, community engagement, staff voice, and organizational culture.
3. Capacity building. Staff training sessions strengthened the department’s capacity to address power imbalances and foster a shared understanding of equity principles. These sessions emphasized the importance of collaboration and accountability, ensuring that staff at all levels felt empowered to contribute to this effort.

Continuous, authentic engagement. A key strength of this project was the inclusion of a Staff Advisory Committee. This committee played a pivotal role in shaping the project’s direction, serving as champions of equity and stewards of organizational change. Their ideas and feedback helped facilitate a process that was inclusive, relevant, and responsive to the needs of both the organization and the community. This dynamic approach ensured that equity was not merely an outcome, but a continuous and evolving process, integrated into the core of Lincoln County’s mission and identity.

Impact

±á¸é¾±´¡â€™s framework illustrates that equity-driven culture change – a shared set of values, beliefs, and behaviors – is most effective when embedded into daily operations through thoughtful shifts in policies and practices. By grounding the work in the Framework, the department equipped staff with the language, tools, and confidence needed to confront inequities both within the organization and in the broader community. This culture shift has sparked conversations, collaboration, and a renewed commitment to equity as a shared responsibility among staff.

This initiative stands as a powerful example of what is possible when local health departments prioritize internal change as the first step to advance equity. By fostering alignment and accountability within their walls, Lincoln County HHS is paving the way for more compassionate and effective service delivery, positioning themselves as leaders in the ongoing pursuit of health equity and justice.

The success of this initiative was further recognized on a national stage when Lincoln County HHS and Â鶹´«Ã½Ó³»­ were selected to present their work at the National Association of County and City Health Officials NACCHO 360 Conference in 2023. This honor highlights the significance and replicability of this project, offering an inspiring example for other health departments striving to advance equity. By sharing their journey, Lincoln County HHS is leading the work locally, while also contributing to a larger evolution of public health systems across the country.

Equity is the soul of social justice in public health – when we dismantle barriers within our systems and reimagine how we serve, we honor the humanity of all people and ignite lasting transformation for generations to come.

Jennifer Masdea
Director, Health and Racial Equity, Â鶹´«Ã½Ó³»­

Why it worked

While assessments are vital for identifying strengths and gaps, they often leave local health departments without the tools or guidance needed to act on their findings. By integrating capacity building and strategic planning, this project goes beyond the traditional approach of standalone assessments in favor of a cohesive, wraparound approach to advance equity at the local level. This approach ensures insights gained through assessment translate into effective strategies and sustainable results.

The project’s capacity building sessions equipped staff with the shared language, knowledge, and frameworks needed to understand and address equity challenges. These sessions fostered collaboration, trust, and a sense of shared ownership, cultivating and supporting future collective action. The addition of a strategic planning phase provided a roadmap for success, with clear priorities, measurable goals, and actionable strategies that align with the organization’s values and mission.

What makes this project unique is its holistic approach. The integration of equity as a process and outcome ensures that the work is data-driven and deeply rooted in organizational culture and capacity, creating a model that other health departments can replicate or adapt.

The work we did with Â鶹´«Ã½Ó³»­ helped us lay the foundation for our teams that equity is intrinsic to the work we do.

Florence Pourtal
Public Health Division Director

Looking ahead

The results of this project set the direction for Lincoln County’s new strategic plan. Equity is now central to the organization’s mission and embedded throughout their redefined vision, values, and guiding principles. Soon, Lincoln County will further this work by rehiring a position within the Public Health division that will focus on equity and community partnerships.

Leadership

Valerie Polletta, MSc
Managing Director, Community & Culture Transformation

Meghan Guptill, MPH
Associate Director, Research & Evaluation

Jennifer Masdea, MPH
Director, Health & Racial Equity

Kevin Myers, MSPH
Director, Planning & Facilitation

The post Advancing health equity at the local level appeared first on Â鶹´«Ã½Ó³»­.

We believe that it is not only possible but imperative to address emergent needs in the field for an organization to remain relevant and compelling. To do this, philanthropic organizations must creatively shift their investment strategies at pivotal moments. ±á¸é¾±´¡â€™s Pivot framework (Figure 1) offers guidance on how to realize these changes while remaining true to the organization’s purpose. Using our work with a long-time client, we illustrate how to implement investment shifting activities.

The Jeffress Trust Pivot

The Thomas F. and Kate Miller Memorial Trust (herein the Trust) has worked with Â鶹´«Ã½Ó³»­ since 2013. The Trust provides funding to Virginia-based scientists conducting research in bioinformatics, astrophysics, drug development, and material science to benefit residents of Virginia.

Below is a synopsis of how the Pivot framework informed our work with the Trust.

A Final Note

The Trust will soon announce its third cohort of recipients. We invite you to about the work of current awardees and follow their progress.

Â鶹´«Ã½Ó³»­ seeks to address the root causes of health across all its funding mechanisms. our experienced and trusted team members to learn how we can support you.

The post Advance equity with a pivot to your philanthropic investment appeared first on Â鶹´«Ã½Ó³»­.

The has announced the 2024 recipients of its Awards Program in Research Advancing Health Equity. Congratulations to the awardees!

Scroll to see the 2023 recipients.

2024 Awardees

Partnership/Collaborative Establishment Awards

Advancing Health Equity for Birthing People With Substance Use Disorders: Capacity Building Of A Community Partnership Team For Intervention Development And Implementation ResearchÌý

Caitlin Martin, MD, MPHÌý
Virginia Commonwealth University
in collaboration with Urban Baby Beginnings, Rams in Recovery & OB MOTIVATE ClinicÌý

Data demonstrates that structural racism is a key driver of large gaps in treatment continuity experienced by Black birthing individuals with substance use disorder in central Virginia. VCU and collaborators will develop and implement a patient navigation model specifically for Black birthing people with SUD. This model will incorporate peer recovery support specialists, doulas, and people with lived experience as Black birthing parents with addiction.ÌýÌý

RVA Latino Youth Coalition: A Community-Academic Partnership to Support The Mental Health Of Latino Youth In RichmondÌý

Gabriela León-Pérez, PhD
Virginia Commonwealth University
in partnership with Waymakers Foundation, Richmond Public Schools, the City of Richmond’s Office of Immigrant and Refugee Engagement & Virginia Department of HealthÌý

The mental health problems experienced by Latino immigrant youth in Richmond, Virginia are well-documented. To address these inequities, VCU and collaborators will create a community-academic partnership – the RVA Latino Youth Coalition. The project team will establish Youth and Parent Advisory Groups comprising Latino community members to advise the coalition, facilitate a community-informed strategic planning process, and conduct a participatory community assessment to identify the drivers of mental health inequities and existing mental health resources and services available to Latino youth in Richmond.Ìý

Building Enclave Solidarity to Improve Health OutcomesÌý

Carol Cleaveland, PhD
George Mason University
in collaboration with Gainesville-Haymarket Rotary Foundation & Georgetown South Community FoundationÌý

Undocumented Latino immigrants experience pronounced health inequities, often exacerbated by a lack of health insurance. GMU and collaborators will establish a research consortium to improve access to preventative care for undocumented Latino immigrants by strengthening social networks and knowledge-sharing among community members. The team will develop a strategic plan, with the aim to deliver vaccines and preventative health services to 10,000 Latino individuals living in low-income neighborhoods.Ìý

Virginia Healthy Pantry Initiative

Meaghan ButlerÌý
in collaboration with Blue Ridge Area Food Bank, Capital Area Food Bank, Feed More, Inc., Feeding Southwest Virginia, Fredericksburg Regional Food Bank, Foodbank of Southeastern Virginia and the Eastern Shore, Virginia Peninsula FoodbankÌý

Led by the Federation of Virginia Food Banks, the Virginia Healthy Pantry Initiative (HPI) is a statewide movement of advocates and pantries committed to breaking the cycle of food insecurity and poor health. More than half of Virginia’s 1,100 pantries have already joined the Healthy Pantry Initiative. The Federation seeks funding to better understand the practices’ successes and challenges at scale and ensure equitable access for people and places most in need. Collaborators have committed to regular peer support, data sharing, and consistent evaluation practices with a vision to improve hunger and health outcomes for more than 800,000 Virginians facing hunger.Ìý

Research Award

(Re)Building Trust in Tap Water through Community Advocacy and ActionÌý

Sarah HollandÌý
in collaboration with Virginia Tech and Virginia Community Health Workers AssociationÌý

Mistrust in and subsequent avoidance of tap water has critical implications for health equity. The project will employ iterative cycles of participatory action research in geographically focused communities across Virginia that are most impacted by water inequities. Community health workers serving as water advocates will play an integral role in facilitating the research process, sharing findings back to community members, and (re)building trust in tap water. Acknowledging that water issues and solutions are highly localized, this project lays the groundwork for the development of a statewide network of communities that act, advocate, and engage in local decision-making to advance water security.Ìý

2023 Awardees

Partnership/Collaborative Establishment Awards

Impact of Medical-Legal Partnership (MLP) Collaborative Upon Social Determinants of Health of Low-Income Individuals in Rural Southwest Virginia

Matthew Loos, MD, FACS, MBA
Ballad Health, in partnership with Appalachian School of Law – Virginia Tech – STRONG Accountable Care Community

Despite the establishment of numerous MLPs throughout the U.S., there are few published studies on the impact of MLPs on healthcare and outcomes. This collaborative project establishes an Advisory Council to collectively study and develop MLP best practices for programmatic and coordinated community response. We anticipate the data will illuminate how health-harming legal needs are impacted through MLP intervention with free legal services to address social determinants of health (SDOH).

Centering Black Voices: An Exploration Of Current And Historical Black Breastfeeding Experiences In Their Own Words

Sara Rothenberg, MPH
Eastern Virginia Medical School, in partnership with The Consortium for Infant and Child Health – SonShine and Rainbows Lactation – From the Start Holistic Doula Services – #757Breastfeeds

The project seeks to address and uproot structural racism that underpins maternal and child health inequities by centering Black voices, building community capacity, and decolonizing breastfeeding research.Ìý Through sustainable, respectful collaboration, this project will lay the groundwork for future research, publication, and more effective public health strategies for advancing maternal child health equity.

Advancing Health Equity through a Regional Coalition for Reducing Opioid and Substance Use

Shuntay Z. Tarver, PhD, MSW
Old Dominion University, in partnership with African American Creative Community Series – James Barry Robinson Institute – Hampton-Newport News Community Services Board

There is a critical need in Virginia to reduce opioid and substance use (O/SU) and overdose related deaths. The project seeks to advance health equity with the development of a culturally-informed, data-driven regional coalition. The desired outcome is to decrease O/SU and overdose-related deaths among Black and low-income families within the cities of Norfolk, Hampton, and Newport News, VA.

Research Awards

Keep People Covered: Analyzing the Medicaid Unwinding and Redetermination Process through a Person-Centered, Racial Equity Lens

Freddy Mejia
The Commonwealth Institute for Fiscal Analysis, in partnership with Sacred Heart Center – Peter Paul Development Center – Virginia Poverty Law Center – Virginia Community Voice

In April 2023, Virginia will begin to review all Medicaid enrollees’ eligibility, a process called “unwinding� and start ending coverage for those found ineligible. The unwinding process will require enrollees to update contact information and submit all required paperwork in a timely fashion. Caught in the middle of this process are approximately 160,000 individuals and families who remain eligible but are most at risk of losing coverage because of administrative hurdles and/or language access issues. The current administration in Virginia has not shared its posture on the Medicaid redetermination process. This is concerning to advocates due to national research from the Department of Health and Human Services. Research estimates children, Black, and Latino individuals are most likely to be disenrolled while still being eligible for coverage.

At the core of this project are three goals:

• First, through research and analysis, act as a watchdog that brings accountability and an equity focused lens on a complex process that may leave individuals and families uninsured on account of technicalities.
• Second, drive education efforts to help as many people as possible weather the “unwindingâ€� storm and preserve their health insurance.
• Third, leverage the research to change systems to improve the current redetermination process in the moment and create better health access programs, processes, and communications in the future.

Using a participatory research approach combined with analysis of data from EnrollVA and state agencies, and advocacy action we can achieve both meaningful research findings and changes in public policies. We plan to create and maintain a real-time dashboard that can inform decisions during the three year period. Additionally, we will disseminate findings with strategic communications and coordinate with our partners including members of the Collective Work coalition focused on racial justice and the Health Equity Action Leaders program.

Uncovering Immune Inflammatory Axes of Racial Disparities Linked with Gestational Weight Gain in Pregnant Women

Sepideh Dolatshahi, PhD
University of Virginia

Obese Black women experience an increased risk of inadequate Gestational Weight Gain (iGWG) compared to White women within the same BMI groups. Importantly, obesity and iGWG are both associated with adverse pregnancy outcomes such as preterm birth, which in turn predispose the newborn to a myriad of early-life health complications. As such, concurrent higher prevalence of iGWG and obesity in non-Hispanic Black women points to distinct profiles of Social Determinants of Health (SDoH) that separately drive these risk factors to birth disparities.

The proposed study aims to dissect these two hypothesized distinct pathways of racial disparities from the root/trunk (SDoH) to the middle branches (perturbed baseline immunity and the immune remodeling) to the outer leaves (adverse clinical outcomes) of the tree. While sparse attempts to stratify the contributors to obesity and iGWG as they relate to pregnancy outcomes have been published, these studies are essentially lacking in the Virginia. Moreover, African Americans have been underrepresented in immunological studies of pregnancy.

To address these limitations, we will use innovative systems biology and data-driven statistical modeling approaches to examine a unique cohort of racially diverse pregnant women of Virginia. By combining SDoH information with high-plex maternal and placental measurements, we anticipate that we will identify novel social and immune axes that may inform the design of preventative, diagnostic, and therapeutic strategies that will improve pregnancy outcomes.

Â鶹´«Ã½Ó³»­ the Trust

The Thomas F. and Kate Miller Jeffress Memorial Trust, founded in 1981 by Robert M. Jeffress in memory of his parents, is guided by its mission to benefit the people of Virginia and their research in chemical, medical, or other scientific fields. Since its founding, the Jeffress Memorial Trust has been a steadfast benefactor in support of scientists and research across the state of Virginia supporting mathematical modeling/simulations and analytics in bioinformatics, astrophysics, mathematical biology, drug development, and material science. To further the mission of the Jeffress Trust to benefit the people of Virginia, the program was changed in 2022 to theÌýJeffress Trust Awards Program in Research Advancing Health Equity.

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Background

The CHI framework as we know it rose to prominence in the mid-1990s by way of the Institute of Medicine Committee on Using Performance Monitoring to Improve Community Health (). Later, the Affordable Care Act (ACA) spurred the IRS to introduce new regulatory requirements for tax-exempt organizations. This included implementing regular community health needs assessments and implementation plans () and the introduction of accreditation for local and state public health departments ().

±á¸é¾±´¡â€™s Approach to Community Health Improvement Work

±á¸é¾±´¡â€™s staff has a long track record of supporting CHI processes in many hospitals and health departments. Health departments and care providers alike maximize the benefits of CHI work when they invest in the full cycle of the process. As seen in Figure 1, ±á¸é¾±´¡â€™s Approach to CHI work comprises six steps:

• Assessment
• Prioritization
• Planning
• Implementation
• Monitoring
• Evaluation

Each of these steps builds upon the previous step, creating a comprehensive and intentional process with health equity at the core. Community engagement is the essential element at each phase of the CHI process. Integrating community engagement and leadership ensures health equity is a focus and outcome of CHI work. As our framework demonstrates, ±á¸é¾±´¡â€™s approach to CHI reflects a deep commitment to equitable community engagement. (See our approach in action.)

Sticking Points

CHI work often stagnates after planning. Four of the most common reasons include:

• Inadequate time and resources
• Insufficient community engagement
• Unclear systems of accountability
• Lack of integration with practices and systems

Does this describe your institution? Here are a few practical strategies to support completion of the CHI cycle:

Inadequate time and resources.

Community engagement is rarely (if ever) the only initiative underway at any moment. Like any other effort, community engagement work vies for limited resources. Even if financial resources are not a limiting factor, time certainly is. Strategic plans only last for three to five years, and organizational and community leaders have competing priorities; additionally, CHI work is often added to plates without adjusting other priorities. What do you do when your team or institution does not – or cannot – allocate sufficient time or resources to conduct deep, continuous community engagement?

STRATEGY: Provide sufficient resources (including dedicated time and funding) for staff and community leaders conducting CHI work.

Community members are essential to successful CHI work. Engagement starts at the beginning; it both informs and integrates with the methods and approaches outlined in the assessment, continues as appropriate through each phase, and influences planning for the next round of the cycle. Ensure that you factor in fair compensation for the time and the lived experience of community members and the staff who work with them. This means meeting residents where they’re at and when they’re available, providing translation services, and rebalancing responsibilities—during AND beyond the assessment phase.

Insufficient community engagement.

Improving community health requires deep, authentic, sustained community engagement. By limiting your engagement to the people that you work with regularly in the assessment and planning processes or relying on secondary data, you are likely missing the voices of those most impacted. Offering limited options for participation or failing to follow up in future phases can damage relationships with the community. How can you deepen your community engagement work efficiently and effectively?

STRATEGY: Create varied and recurring opportunities for power shifting and decision making.

Community engagement that considers the different needs within the community can increase the likelihood of your CHI work creating impact. Identify opportunities for sustained engagement throughout the process, such as multiple community meetings at a variety of times (considering varying work and caregiving schedules of participants). Collaborate with existing coalitions and community groups to reach folks in places where they already congregate.

Ultimately, the community should strongly influence the selection of priorities based on what is important and relevant to them, as well as the development, implementation, and improvement of the strategies put into place. Use the to explore how you might lift up community voice and incorporate public participation strategy

Unclear systems of accountability.

Generating community impact requires collective effort within complex institutions and among diverse stakeholders. Typically, a single unit is not responsible for all parts of the CHI process. However, the work can end up falling on the shoulders of one individual or department, or tasks can be lost in the shuffle of unclear systems of accountability, drastically limiting your potential impact.

STRATEGY: Coordinate communication among partners.

When partner engagement is done well (authentically and sustained), your hospital or health department will not be solely responsible for all CHI work. Careful coordination of communication and outreach is needed when there are multiple stakeholders responsible for the plan. Defining roles at the project outset, as well as setting a schedule for regular monitoring and reporting are critical steps to ensuring accountability, continuous buy-in, and impact.

Lack of integration with practices and systems.

Hospitals and health departments often struggle to implement a plan that is not sufficiently integrated with their other work, does not have internal and external investment and support, and is not regularly monitored and reported.

STRATEGY: Integrate with existing practices and systems.

Thoroughly integrating CHI work with other critical work will ensure that the work gets done. Identify areas where CHI work intersects with existing practices and systems. Look into other initiatives happening in your community and identify places where you might collaborate on data collection, engagement, dissemination, and more. Considering existing avenues can streamline your work and build stronger partnerships with anchor institutions and community members.

Conclusion

The CHI process offers an opportunity to create healthy, equitable communities. Authentic, sustained community engagement throughout the CHI process is critical to success. Pour the time, dedication, care, and feeding into your process and the impact will be worth the effort.

Learn more about ±á¸é¾±´¡â€™s CHI work and team.

Want to borrow our lens? Connect with us.
Suggested citation: Community Health Improvement Lens (2024), illustration by Â鶹´«Ã½Ó³»­.

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Dismantling structural and systemic racism is an essential part of promoting health equity and improving health outcomes. Yet the meaning of these nuanced concepts can differ depending on a person’s identities and lived experiences. We must develop a mutual understanding to operationalize these concepts so that they can inform both the day-to-day work and support the long-term vision. Doing so creates a shared language that can foster trust and build strong relationships among partners working to advance health equity.

In this piece, we share an example of how the work of creating shared language and understanding has been approached through one of our projects—the (The Funds). In addition, we share a tool and guidance developed by the project team to help facilitate these conversations in a way that also promotes shared ownership of the work among partners.

The Massachusetts Community Health and Healthy Aging Funds

The Funds is a collaboration between the Massachusetts Department of Public Health (DPH) and Â鶹´«Ã½Ó³»­ (Â鶹´«Ã½Ó³»­). This program is explicitly designed to disrupt and remove barriers to health, including structural and institutional racism, poverty, and deep power imbalances in the Commonwealth of Massachusetts. As the Funds’ fiscal agent, Â鶹´«Ã½Ó³»­ is responsible for managing the planning and implementation of the program including developing requests for proposals, providing technical assistance to grantees, measuring success of the program, and more. DPH oversees and makes final decisions regarding the Funds with support from the Executive Office of Elder Affairs (EOEA), which provides guidance and expertise and makes decisions regarding the Healthy Aging Fund. We also engage a statewide advisory committee to provide recommendations for the operations of the Funds. Led by Managing Director Alberte Altiné-Gibson, Â鶹´«Ã½Ó³»­ provides resources to groups throughout the Commonwealth that improve health outcomes through community-centered policy, systems, and environmental change approaches.

Coming onto the team, I was immediately struck by how engaged and passionate the Â鶹´«Ã½Ó³»­ team, awardees, DPH, and EOEA were in doing this work.

Being intentional in how we do the work, how we talk about the work, and respecting and working closely to understand the experiences and perspectives of those doing the work at every stage of this intricate project demonstrates the core values of all involved in advancing healthy equity at its core.

Alberte Altiné-Gibson, Funds Director

Â鶹´«Ã½Ó³»­’s Role

As stewards of these resources, we have a responsibility to tackle the root causes of health inequities., “The intentional allocation of investments to tackle systemic racism – which is entrenched in white supremacy culture,â€� explained Nineequa Blanding, former Vice President of Grantmaking at Â鶹´«Ã½Ó³»­, in , “is a way to drive progress in creating conditions in which everyone, across all forms of identity, can thrive. This is the path toward health and racial equity.â€�

Disrupting structural and institutional racism throughout Massachusetts cannot be accomplished without strong collaboration. It requires a connected statewide movement of partners working toward a shared goal. This work requires these partners to develop a shared language and mutual understanding to ground and guide the work. One way the Funds team does this is by using the Health Tree. This visual metaphor is used by Human Impact Partners and other public health and social justice organizations to demonstrate the connection between health outcomes and their root causes.

The Evolution of the Health Tree

The health tree metaphor was a helpful tool to ground the development of our funding strategy in 2020, which focuses on funding efforts to disrupt and remove barriers to health including structural and systemic racism through transforming policies, systems, and environments. However, our team recognized a need and opportunity to update its graphic and written elements to better elicit the connection between health outcomes, social determinants of health, root causes, and white dominant culture.  We worked on a revision that made these connections explicit, better reflecting our shared values and unique contributions. Shared language must be established collaboratively, so our team sought wide ranging feedback and used a decision-making approach called to determine the final product. The approach employs wider range of responses than ‘yes’ or ‘no,’ helping team members and other stakeholders offer honest feedback and collectively reach a decision. The resulting version of this visual is called the Health EquiTREE.

The Health EquiTREE illustrates the relationship between health outcomes and the root causes of health inequities. It helps us envision how systems impact outcomes of individuals and groups. The framework below provides context to improve understanding of the tree metaphor.

Understanding the Health EquiTREE

Below are descriptions of each part of the tree and how they map onto our understanding of the relationships among health outcomes and systems. The elements of the tree that are above ground (leaves, branches, and trunk) represent the components of health that are visible.

• LEAVES – The leaves of the tree represent health outcomes. These include the physical and mental health of individuals and populations.
• BRANCHES – Health behaviors such as diet and exercise influence an individual’s risk of poor health outcomes. While individuals can make lifestyle changes to improve their health, it’s important to consider the factors that influence their ability to engage in healthy behaviors.
• TRUNK – Certain conditions influence people’s ability to engage in healthy behaviors. Social determinants of health (SDOH) such as education, employment, and housing are the environmental conditions in which people live, learn, work, play, worship, and age. These conditions affect a wide range of health, functioning, and quality-of-life outcomes and risks.

As noted in the illustration, the tree does not just exist above ground. There are critical components that exist underground (roots and soil) and cannot be easily seen.

• ROOTS – When we think about making lasting changes in the social determinants of health, we need to think about what created these conditions in the first place. How do policies and systems impact these conditions? The tree graphic highlights some of these root causes of health, including racism, poverty, ageism, and other structural and institutional barriers.
• SOIL – The underlying systems of dominant culture and narratives are represented by the soil in which the tree stands. Dominant culture is “the culture that has been able, through economic, social, or political power, to impose its values, language, and ways of behaving on other culturesâ€� (). Like the soil surrounding the root system, dominant culture and narratives can often be nearly invisible given its position as “normal.â€� Through this work, we acknowledge and aim to dismantle white supremacy culture and narratives, which have tainted the soil, and restore it to a healthy, diverse, sustainable state of being. In this metaphor, healthy soil leads to healthy roots, trunk, branches, and leaves. (This conceptualization of the soil dovetails with another metaphor described in the Groundwater Approach by the Racial Equity Institute.)

The tree metaphor is designed to visualize how underlying systems, root causes, social determinants, and health outcomes are integral parts of a health ecosystem. Inequities in health outcomes and social determinants are a direct result of deeply rooted systems of oppression—policies, systems, and environments—and the culture and narratives in which they are steeped. The overlapping network of tree roots is an intentional design element illustrating the complexity of these influences that we must grapple with and embrace through our work to transform our communities.

Using the Health EquiTREE

Our Health EquiTREE is just one tree in a forest of interpretations. To support our partners in facilitating their own conversations, we created a blank version of the tree and some accompanying guidance on how to use it to evaluate the root causes of specific health outcomes. This exercise can help:

• Build understanding of embedded concepts,
• Brainstorm upstream approaches to address certain health outcomes, or
• Identify the niche where the work would have the greatest impact.

As another example of its use in the field, ±á¸é¾±´¡â€™s Research & Evaluation team has used it to facilitate discussions with communities as a part of a . This process helps a group identify key health needs and issues in a community. Our colleagues report that the Health EquiTREE has been useful in guiding discussions, informing analysis and interpretation of findings, and drawing attention to less visible causes of inequities.

Building on the context above, we offer this guidance on how to use the tree in your own discussions.

• Begin with the leaves. When using the tree to discuss the overarching idea of health outcomes being a product of social determinants of health and root causes OR when using the tree to explore a specific health outcome affecting a community and potential solutions, work backwards, starting with the leaves and moving down the tree to the roots.
• Be open-minded. A key element of effective brainstorming is saying yes. When exploring the many different factors that contribute to health outcomes, be willing to consider the range of potential factors related to the problem you are discussing. Then, narrow down as needed to achieve the goal of your exercise, whether it be finding your niche to create a solution, identifying an area to advocate for policy change, etc.
• Imagine. Visualize what a healthy tree might look like for your particular situation. Put them side by side if it’s helpful for your group.
• Revisit. Return to the tree as needed to monitor progress on a particular issue, reconsider or build your understanding of a particular issue, or to contemplate alternative approaches.

Conclusion

The Health EquiTREE is a powerful visual and exercise to help build shared understanding and shared language around foundational health equity concepts. Yet this exercise is only the beginning of a continuous process of learning and evolving together. The collective work that facilitates its development also serves as a pathway for deeper understanding and stronger connections. The way in which we communicate and the language we use as we learn with and from each other is key to effectively advancing our collective work. We have a responsibility to continue conversations that build trust and increase our understanding of one another and our varied experiences of health inequities.

Visit the for more.

To download completed and blank versions of the Health EquiTREE, navigate to mahealthfunds.org/resources.  If you use the tree, please share your experience by contacting MACHHAFunds@hria.org. Please use the following attribution as appropriate:

The Health EquiTREE (2022, 2024), illustration by Â鶹´«Ã½Ó³»­ for the Massachusetts Community Health and Healthy Aging Funds. https://mahealthfunds.org/resources/

Acknowledgements

Many thanks to The Funds team—past and present—involved in updating and refining the tree illustration – Abby Atkins, Emily Breen, Hannah Carliner, Jamiah Tappin, Jennifer Lee, Kevin Myers, Mayowa Sanusi, Nineequa Blanding, Pri Rana. Thank you to our colleagues at Â鶹´«Ã½Ó³»­ including Mo Barbosa and Brittany Chen, and our collaborators at DPH for their input. Thanks to talented illustrator Chris Ariñez for designing the original tree and Wide Eye Creative for our exciting 2025 update.

We thank the many organizations and people who have pushed these conversations forward: Integrative Inquiry, Human Impact Partners, Racial Equity Institute, including authors of the Groundwater Approach (Bayard Love and Deena Hayes-Greene) – and Dr. Camara Phyllis Jones’s whose insights inspired the Groundwater Approach and who inspires us.

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The pandemic has exacerbated the growing behavioral health crisis in the U.S, with disproportionate impact on communities of color and young people. Those in need of services deserve and require empathy, advocacy, and support. When someone needs services for substance use and problem gambling—that’s where the Helplines come in.

What is a Helpline?

A helpline is a statewide resource for finding harm reduction, treatment, and recovery services for substance use, problem gambling, and other behavioral health issues. Like 211 or 311, Helplines are a public service available to all residents in an area regardless of their circumstances. This confidential resource connects consumers (meaning anyone who reaches out to us by phone, chat, or text) to caring, trained specialists who help assess the consumer’s needs and navigate the complexities of the treatment, recovery, and harm reduction system.

Unlike a crisis hotline that provides emergency counseling, helplines provide information and connect consumers with service providers. While helplines don’t solve underlying issues of access, such as lack of beds, inadequate services, or lack of insurance coverage , they ensure that people in the greatest need always have someone on their side, supporting them wherever they are on their path. With over 25 years of experience and a portfolio of five statewide helplines, Â鶹´«Ã½Ó³»­ has developed a unique, holistic, and scalable approach to screening and information services.

Helplines create connection

Helplines are central to ±á¸é¾±´¡â€™s behavioral health services and the broader harm reduction infrastructure. They are often a person’s first interaction with the treatment continuum, but they can also be a bridge service, providing connection and support at any point in a person’s journey to recovery. Helpline Screening and Information Specialists, or SIS, provide a critical link between a person in need and available services.

Recognizing the gravity of this responsibility, ±á¸é¾±´¡â€™s approach to helpline services is grounded in empathy and honors the lived experiences of consumers. Our team of specialists, many of whom are in recovery and/or have loved ones with addiction, are highly trained and have the skills, knowledge, and expertise to help address and reduce barriers to accessing services and help to motivate the consumer to follow through in seeking the services that are right for them. We provide access to everyone through multi-lingual specialists, on-call interpreters, translation, and services for those who are deaf/hard of hearing or visually impaired.

To ensure appropriate referrals, we maintain a sophisticated database of service providers through the state, including detailed and up-to-date information on their services, hours of operation, specialties, insurance accepted, and other key information that can help consumers assess their options.  We also support self-advocacy by educating consumers on their rights in the systems they are trying to access. Depending on the state of residency, helpline specialists can be contacted by phone, chat, or text, with some available 24/7. In 2023, ±á¸é¾±´¡â€™s helpline team received over 57,000 calls, chats, and texts.

Helplines are an essential social service

±á¸é¾±´¡â€™s Helplines are part of an essential social service structure, including 411, 911, and . We have coordinated with the local providers for 988 across states to ensure they can direct consumers to the appropriate Helpline for substance use and problem gambling needs. With crisis line services more accessible than ever, we work with the state to increase awareness of Helpline services while simultaneously building out a strong, reliable technical infrastructure that can easily handle any increases in call volume, ensuring that Helpline access is always available.

What happens when someone contacts an Â鶹´«Ã½Ó³»­ Helpline

Whether a consumer is seeking help for themselves or a loved one, specialists guide them through a process to best match them with appropriate services. The four elements to our comprehensive services  are: Screening, Listening, Connecting, and Following Up.

• In Screening, a specialist performs a brief assessment to determine the consumer’s concern(s). In some states, we screen for both substance use and process disorders like problem gambling. The screening is conversational, guided by (but not beholden to) a script to ensure that every Helpline interaction is both thorough and tailored to the consumer’s needs.
• From the start of the call, specialists engage in active Listening, employing strategies like motivational interviewing to elicit important details about the consumer and what kind of help they are seeking.
• Once they understand the consumer’s needs, a specialist will identify appropriate services through our sophisticated service provider database, offering the consumer a menu of options, and then Connecting the consumer to the appropriate services either through a direct “warm transferâ€� or a list of options provided verbally or by email.
• Finally, specialists will ask the consumer if they would like a Follow-up call from one of our clinicians on staff to ensure that they received the services they need and to provide additional support on their treatment journey.

We work hard to remove barriers to connecting with the helpline, but it still takes incredible courage to make a call and ask for help. Below, you can listen to some feedback received by our Helplines, or visit our websites to hear stories from folks with lived experience.

You can hear stories from people in recovery and the folks that support them through the links below.

• Illinois Helpline:
• Illinois Helpline:
• Massachusetts Helpline:

Helplines and other relevant projects at Â鶹´«Ã½Ó³»­

Helpline services have been part of the fabric of Â鶹´«Ã½Ó³»­ for almost half of our 65-year history.  We now operate substance use helplines in four states, with two also addressing problem gambling. We also provide many other complementary initiatives designed to improve access to services and reduce the negative impact of substance use and problem gambling. Please visit our websites for more information:

The Â鶹´«Ã½Ó³»­ Helplines Team

The Â鶹´«Ã½Ó³»­ Helplines Team is growing. If you are interested in applying or sharing opportunities with you network, visit for more information.

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This post answers the questions:

1. How can the community be engaged at each of the three phases of the assessment process (design and planning; data collection; and analysis and interpretation)?
2. Why is community engagement important at each of these phases?

While this post provides an overview of community engagement in the assessment process, this approach should be seen as a loose framework rather than step-by-step instructions. Each community is unique, and engagement efforts should acknowledge this and be tailored to best fit the needs and preferences of a community.

Assessment Design and Planning

Community engagement is not a step in conducting an assessment; it is a critical element to the entire assessment process, beginning with the planning of the assessment. Community expertise is required to appropriately design an assessment, and there are no greater community experts than its members. One way to engage community in the beginning of an assessment is by establishing and/or collaborating with an Advisory Group.

An Advisory Group is made up of community leaders that are members of and/or work with the communities of interest, as identified by the assessment’s sponsoring organization, and its partners. Members could include residents who are formal and informal leaders in their community (e.g., head of a tenants’ organization, informal leader in the church, mosque, etc.) as well as providers and staff from community organizations that work closely with community and/or are community members themselves (e.g., social service providers, community health workers). Advisory Group members are often experts on a community (for example, cultures, language, norms, practices) and do not necessarily need to be experts in an assessment’s topic of focus (for example, a specific disease or condition). The appropriate types of Advisory Group members vary by community and the focus of the assessment.

Engaging community Advisory Groups during the early stages of an assessment supports four fundamental factors of success:

1. Define the community,
2. Create a relevant assessment approach,
3. Ensure cultural relevance of tools, and
4. Build trust and shared understanding.

Define the community

At the beginning of the assessment, members of the community Advisory Group can be engaged to define the community. The definition of community will inform outreach to community members, identification of secondary data, and framing for qualitative data collection. Self-defining by a community helps us better understand who and what makes up a community rather than simply looking at how a community is defined by external sources. In an assessment examining cancer attitudes and practices among foreign-born Asians, the Â鶹´«Ã½Ó³»­ team identified Burmese as one of the targeted ethnic groups for data collection. When the targeted communities were reviewed by the project’s Advisory Group, a member who worked closely with southeast Asian populations noted that this would be too broad a definition and the assessment should instead target Karen and Karenni ethnic groups. This change lead to data collection being done in the appropriate languages and a better targeted assessment.

Create a relevant assessment approach

In addition to defining the community, an Advisory Group can be instrumental in creating the overarching approach to an assessment and coming up with guiding questions that are relevant and impactful for their communities. While researchers may come in with an idea of the question(s) they’d like to answer through an assessment, those may not be the questions that are most important to a community itself. Asking an Advisory Group what questions they want answered through an assessment process can be an important step towards shifting power to the community, as well as increasing the likelihood that the findings from the assessment will be actionable for the community.

Ensure cultural relevance of tools

Engaging a community Advisory Group as part of an assessment is also valuable for the process of designing surveys or qualitative data collection instruments that best answer the guiding research questions the Advisory Group has helped to create. Advisory Group members should be engaged through the design and review of data collection tools by informing the questions being asked, identifying areas of potential cross-cultural confusion, and addressing any linguistic or cultural translation nuances. For example, concepts and words that are considered commonplace in the dominant culture or language may not exist in other cultures or languages. Direct translation of words into another language may lead to confusion. An example of this comes from ±á¸é¾±´¡â€™s work looking at attitudes and practices about cervical cancer screenings among foreign-born Muslim women. In an initial draft of educational materials developed as part of the assessment, a direct translation into Arabic erroneously translated eggs (reproductive) as eggs (food). A member of the Advisory Group, engaged in reviewing assessment deliverables, identified the correct translation, avoiding potential problems in later assessment steps and beyond.

Advisory Group input can also assist researchers in phrasing questions that are respectful of cultural beliefs about health, community, or modesty. A community-leader Advisory Group will raise these considerations and more during the design process and will help to solve problems from the beginning so that the assessment doesn’t find itself lost in translation in later stages.

Build trust and shared understanding

By engaging members of the community in the planning process, an assessment also builds early community buy-in. Having existing relationships and community support for the assessment helps facilitate later activities like data collection and analysis. Involving community input from the beginning also helps to ensure that the assessment is asking the right questions of the right people in the right way. Communities are experts on themselves – let their expertise help create a better designed assessment that will lead to richer findings.

Further, Advisory Groups can help provide a deeper understanding of not only the challenges that a community faces, but also its assets and strengths that can be explored during the data collection phase and later leveraged for intervention.  In previous assessment work, Advisory Group members have encouraged Â鶹´«Ã½Ó³»­ to explore formal and informal methods of communication that community members already use for sharing information about health and medical care. These networks have later been capitalized on to pilot test tailored education materials developed as part of the assessment.

Data Collection

±á¸é¾±´¡â€™s preferred method of engagement in support of data collection is partnering with community-based organizations. Partnering with community-based, religious, or other organizations that work with members of the assessment’s target communities is a powerful, authentic method of engagement that helps ensure that data is accurate and complete and the process of collection effective, efficient, and thoughtful. The four strategies for engaging communities in data collectors are: 1) Engage community members as data collectors, 2) Engage in community-centered qualitative data collection, 3) Meet them where they are, 4) Conduct key informant interviews with community leaders.

Engage community members as data collectors.

Professional researchers will encounter numerous challenges when conducting data collection for a community health needs assessments. The invisible barrier between the researchers and community members, regardless of who they are, can hinder the process. A more effective way to collect data is to engage community members as data collectors. This approach also builds capacity among community members themselves. With community members conducting data collection activities, individuals may feel they can speak more freely than they might in a group facilitated by a perceived outsider. In a large collaborative assessment involving hospitals, non-profit organizations, community development corporations, and the health department, engaging community members in the data collection process was foundational. In this effort, Â鶹´«Ã½Ó³»­ provided multiple trainings to residents and staff from community-based organizations for them to build their capacity and feel comfortable as survey administrators and interview facilitators for the assessment. ÌýÌýÌýÌýHaving them in this role was critical as they were trusted community sources and knew residents’ preferred languages. This role is also especially important for assessments covering more sensitive, personal topics, such as those around physical health or mental health. It’s no longer a research group—it’s a community conversation in which researchers can participate.

Engage in community-centered data collection

Researchers can partner with community-based organizations, religious organizations, and other programs or organizations that work with members of the assessment’s target communities, to organize and facilitate data collection (e.g. through community member focus groups or survey distribution).Ìý In addition to continuously building buy-in and activating the community’s social capital, working with community-based organizations helps ensure that community voice is heard in the data. Centering community voice in the data collection process enables researchers to hear about lived experiences firsthand and strengthens assessment findings. Hearing directly from communities about their perspectives leads to richer and more nuanced data. Additionally, for many communities, secondary data is limited (if it exists at all) and rarely tells the whole story. Therefore, community-centered data collection may fill in gaps in existing data and/or provide context for the “whyâ€� behind the quantitative data (“the numbersâ€�) that do exist. Engaging communities in data collection in a meaningful way can answer the question of “whyâ€� needs, barriers, or disparities persist; knowing “the whyâ€� will help to create a more appropriate outreach or intervention plan going forward.

Meet them where they are

Expecting community members to travel to the researchers (for example, hosting focus groups only held at and staffed by the lead research organization) is likely to result in poor community representation and incomplete, biased data. It is important to go where residents already are, to places that community members trust to have their best interest in mind. One way to do this is to partner with community organizations who are, as one Advisory Group member for an Â鶹´«Ã½Ó³»­ assessment called them, “the gatekeepers to the community.â€� Obtaining the buy-in of these organizations makes community members feel more comfortable participating in data collection, whether it’s participating in a focus group or filling out a survey. These organizations can also help the assessment engage harder to reach communities, such as linguistically isolated communities or recent immigrants.

Conduct key informant interviews with community leaders

In addition to engaging community members as data collectors, researchers should also consider interviewing community leaders as well. Community leaders can often speak from two perspectives, their own and the communities, giving research both a micro- and macro-view. Leaders can also often speak to both the community and the system and see both sides of an interaction.

Data Analysis, Interpretation, and Results

Effective community engagement continues beyond the completion of data collection. This can be done through sharing early results with community stakeholders to validate findings, obtain candid feedback, and adjust the interpretation of data. Based on our previous framework, two groups that should be engaged in this process are 1) the Advisory Group and 2) any partnerships with community-based organizations. Additionally, we recommend that researchers explicitly and vulnerably ask these two groups where the assessment fell short.

Share data with the Advisory Group

The presentation of data back to the assessment’s Advisory Group provides guidance on interpretation, dissemination of findings, and planning for next steps.Ìý Researchers may bring their own experiences or biases as lenses to the interpretation of the results, which may be different than those of the community. Engagement at this phase ensures a more accurate interpretation of findings, from ensuring that any quotes presented are framed accurately to advising on whether key takeaways resonate with the community’s experience.

Share data with partnering community-based organizations

Community engagement at this phase can also occur by going back to community-based organizations or groups that participated in data collection to share the findings and ask for input on results and next steps. This closes the loop on community engagement and helps to build lasting relationships with communities.

Ask (and be willing to hear) what the assessment got wrong

Communities are experts on their lives and experiences and their expertise should be valued and trusted. This includes times when the assessment gets something wrong in its approach or analysis. Researchers should consider explicitly asking “What did we get wrong?� when sharing findings to make the audience more comfortable offering this kind of feedback. That feedback should then be considered when planning next steps and incorporated into any final deliverables.

Key Concepts for Community Engagement

In addition to the framework described above, there are several key concepts and strategies that are critical to success throughout and beyond the assessment process. Ongoing community engagement should be done with the following in mind:

Research with, not on, communities

The community is a partner in the assessment and should be treated accordingly. Ongoing communication about process, requests for input, and dissemination of findings should be key components of community engagement in any assessment. If possible, offer partnering community-based organizations and community leaders shared ownership over data to use for their own purposes.

Reduce the burden of participation

Engaging in an assessment project as a community partner can be burdensome, and activities should be designed to reduce burden as much as possible. This includes, but is not limited to, the following:

• Conduct activities in the native language(s). If this is not possible, provide real-time translation.
• Provide culturally appropriate food during activities
• Offer access to supporting resources such as childcare services and transportation
• Hold activities on days and times that are most convenient to the community; offer varying times to ensure maximum participation

Additionally, whenever possible, offer communities financial compensation for their time spent participating in advisory Groups, focus groups, or reviewing and revising deliverables. They are taking time out of their lives for the assessment, providing valuable insight and expertise. Whether or not financial compensation is possible, offer to share data back with communities to use for their own assessment and planning purposes.

Build capacity through the assessment process

Community engagement should be approached as a learning opportunity for the researchers and organizations leading the assessment. Thoughtful engagement throughout the process is an opportunity for researchers to learn about and partner with communities that they are not a part of. Community members can also benefit from the process, as it can be done in a way to intentionally build the capacity of a community to assess and advocate for itself.

True community engagement takes time

Authentic community engagement, as outlined above, is a lengthy yet worthy cause. When assessments are designed, implemented, and analyzed with the community as a partner, the data and findings are often richer and more informative. Additionally, developing trusting, bi-directional relationships between researchers and communities can build a foundation for ongoing collaboration.

Community Health Assessment Resources

• Learn more about Â鶹´«Ã½Ó³»­’s assessment and other community health improvement services
• Explore how hospitals can partner with communities for health improvement

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