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Diversity, Equity, and Inclusion – Moving Principles into Practice

Alison McCarthyWe’ve been busy this Spring! As promised, we want to be transparent in sharing our journey to incorporate Diversity, Equity, and Inclusion (DEI) principles here at Spark. This blog post describes our DEI updates since May.

Tools for sharing and reflection

One of the early activities identified in our DEI plan was to develop a project checklist. The intent of this checklist is to ensure we consider DEI principles in all Spark projects. Not all the items on the list will apply to all projects. However, it reminds us of our values and probes us to ask questions like: “Could this element be included/considered? Why or why not?” It is meant to be a tool to help us think critically about the incorporation of DEI principles into our regular practice.

As we drafted the project checklist, we also recognized the importance of integrating DEI elements into the work before the project launch phase. We decided to develop a project proposal checklist so DEI can be integrated from the beginning of the project design process.

We adapted our checklists from work by Public Policy Associates and Equitable Evaluation. While we are still piloting them and anticipate they will be tweaked over time, we’d love to hear any thoughts or feedback you have on what we’ve come up with so far:

It’s also important to note that we understand that something as complex and crucial as DEI cannot be boiled down to a couple of checklists – we don’t see these tools as the end-all-be-all. Rather, we see them as a starting point, a way to prompt us to integrate these values into everyday practice.

DEI Awareness and Learning

In addition to our process tools, we’ve looked at other ways to elevate DEI within Spark.

As a team, we started regular DEI Discussions where we select an article, video, podcast, or other resources on a relevant DEI topic and get together to discuss it over coffee. Our first conversation was centered on a Denverite article on the gentrification of the Welton Corridor/Five Points. Since Spark is housed on Welton Street, we felt it was important to consider how we interact (or don’t) with our neighbors and the changes occurring in the neighborhood. We asked ourselves an important question: If Spark were located somewhere else, what, if anything, would change? The question spurred thoughtful reflection and rich discussion. Next month, we plan to focus on inclusion in the workplace, basing our discussion on this article from Psychology Today.

Additionally, Spark’s Social Innovators Breakfast Series launched a special summer focus: Navigating the Unintended Consequences of Systems Change. Though we anticipate DEI will be an important component for all events in the series, we decided to kick things off with a DEI-specific topic: Navigating the Unintended Consequences of moving from Equality to Equity. You can listen to the panel discussion on our YouTube channel. Keep an eye out for next blog post, which will be a reflection on this conversation and the lessons that emerged!

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Systems and Programs: Moving from Enemies to Friends

Too often, programs are framed as the enemy of systems change.

Over the past few years, there has been an increasing emphasis on the need for “systems change” to achieve large-scale social impact.

As someone deeply embedded in research and evaluation at the systems-level, I fundamentally believe that addressing complex problems requires system-level solutions. An increasing emphasis on systems – including a greater focus on multi-stakeholder collaboratives, discussions of leverage points, and the need to shift how organizations operate – gets me excited. I see the potential to do things like reform the justice system, shift to a more prevention-focused model of health and tackle big issues like climate change.

There is, however, one framing of how to address complex issues that dampens my excitement: systems versus programs. The discussion can become a battle between two opposing forces, including phrases like, “we don’t fund program work,” “we only focus on systems,” or “we need to move from a program focus to a systems focus.” Systems and programs are painted as victor and villain,  fundamentally at odds – and I believe this framing is not only incorrect but has the potential to hamper meaningful change.

Too often, programs are framed as the enemy of systems change.

I am in full agreement with the adage that we cannot program our way out of complex problems. Programs alone are rarely the solution. In my years as a researcher and evaluator I have learned time and again that focusing entirely on programs can prevent us from addressing structural inequities and root causes. Often, one of my first questions to an organization with a completely programmatic focus is, how does the program fit within your broader agenda to change the system?

That does not mean, however, that programs are fundamentally at odds with the system in which they are situated. It also does not mean that programs are not a critical component of addressing complex problems.

Consider a parable most of us have heard: A fisherman notices people are falling and drowning in a river; so, he goes upstream to prevent it from happening by building a bridge (a systems change). Great idea! But the problem is unlikely to be solved with construction alone. What if people don’t know how to use the bridge or do not see its value, won’t you have to educate them? Moreover, it is highly likely that no matter how beautiful the bridge, not all people will use it (maybe it is too far away), are you going to let those people who fall in drown?

Programs play a critical role in addressing complex health and social challenges. To lower teen pregnancy, we need to provide evidence-based sexuality education, alongside systems to increase access to contraception. Food banks and school meals programs are critical components of a well-functioning food system. In youth development, school-based mental health services are a key strategy to address issues such as trauma. For economic development, opportunities for meaningful employment need to be coupled with job training programs that set people up for success. The list goes on and on…

Programs contribute to sustainable systems-level change.

To me, what is needed is a balance between systems and programs: we must consider how programs fit within a systems change strategy.

In a recent study of 25 collective impact initiatives, changes to programs and services were identified as a critical component of achieving population-level outcomes.

I think it is time that we, as a field, pause and ask ourselves some tough questions: How can we make sure that we are appropriately delivering and scaling programs while also working to change key parts of the system? How can we best use programs to advance a systems-change strategy, for example, training community leaders to advance system reform? In what ways can programs be integrated to better address root causes? It is time to swap the pendulum approach for one that forces us to consider how programs and systems are related. With this shift in thinking, we might then begin to see that programs and system are not enemies, rather, they are friends – maybe even best ones.

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Addressing Health Disparities Linked to Climate Issues

Jacob BornsteinIn April, I had the pleasure of facilitating the Alliance of Nurses for Health Environments (ANHE) two-day strategic planning retreat. The goal was to chart a path forward that incorporated equity into their work, and we conducted interviews with members of the nursing community who were familiar with ANHE to understand how ANHE could best do this work. I walked away so impressed with the organization and the individual participants. They are all doing such amazing work. In particular, I was struck by the role nurses and other health professionals play in addressing health disparities related to climate issues and asked that ANHE author a blog for Spark to share with our network.

Jacob Bornstein, MS
Director of Consulting

By Monica Harmon, MSN, MPH, RN1; Anabell Castro Thompson, MSN, APRN, ANP-C, FAAN2; Lillian Tom-Orme, PhD, MSPH, RN, FAAN3; and Ruth McDermott-Levy, PhD, MPH, MSN, RN4

Climate changes health. The influence of climate change on health affects nursing practice, as nurses are observing the health impacts upon the people, families, and communities in their care. The Alliance of Nurses for Healthy Environments (ANHE) is addressing the impact of climate change on the health of Americans by developing tools to educate and prepare nurses to respond and advocate for climate mitigation, adaptation, and resilience strategies. ANHE nurses are also researching climate-health impacts and nursing preparation related to climate change.

In March 2018, leaders within ANHE, as well as nurse leaders representing National Black Nurses Association, National League for Nursing, National Association of Hispanic Nurses, and the National Alaska Native American Indian Nurses Association, came together in Oracle, AZ to discuss the organization’s priorities with a focus on the specific needs of underrepresented nurses in the climate and health discussion. This meeting was particularly important because, although climate change is affecting the health of everyone, socially marginalized pockets of Black, Latino, and Native American populations have additional vulnerabilities related to the health impacts of climate change.

In the United States, people with higher poverty rates have fewer choices when it comes to housing, access to health care, employment, transportation, and food. People living in poverty also are less likely to have additional resources to mitigate effects of climate change and rebuild or relocate as needed after climate problems. Race/ethnicity and socioeconomic status are shown to be determinants of health compounding public health promotion and disease prevention activities. Due to the legacy of colonialism and structural racism, Black, Latino, and Native Americans are most frequently represented as marginalized groups living in poverty. Poverty influences a group’s ability to respond to the impacts of extreme weather events seen during climate change. During Hurricane Katrina, we saw residents of New Orleans’ 9th Ward, a low-income community, unable to evacuate as a result of limited resources. Many in the community did not have transportation to get away from the event, and they were at the epicenter of the disaster.

For Native American communities, the disruption of communities as a result of the changing climate leads to loss of culture, language, access to food sources, and health effects. Many villages in Alaska, for example, rely on subsistence food sources and with ice melts, their food from the sea is moved further out and not easily obtained. Village life disintegrates as communities are relocated, families might split up, some move to urban areas to find stability but lose access to cultural ties, language use, and support systems. Generally, Native Americans who move from rural reservation or communities find it difficult to access health care services in their new community.

These phenomena mean that marginalized populations are often disproportionally impacted by weather extremes from climate change such as flooding, extreme heat, and wildfires. Additionally, such populations have higher rates of chronic illnesses such as cardiovascular disease, diabetes, kidney disease, and asthma and COPD. For example, in 2006 severe flooding in El Paso Texas led to $200 million in damages to homes and businesses. Hispanic identity was most significant health risk after taking everything else into account. Language ability is another important factor that nurses must consider when addressing climate risk in underrepresented communities. Often the plan for what to do when a crisis happens is not provided in the language of the community most at risk or in a culturally appropriate manner. Those who are most vulnerable to climate impacts are left in a situation where they cannot move forward, get away, or have resiliency. This leads to greater health impacts including psychological problems such as PTSD following climate change events.

It is critically important that Black, Latino, and Native American nurses are included in the discussion and solutions to address climate change and health. Their perspectives inform best practices to address the unique needs of each community. ANHE will continue to make the inclusion of nurses who work in and identify with marginalized communities a priority in their work to address climate change and health in nursing research, education, advocacy, and practice.

1Chapter President, National Black Nurses Association of Southeastern Pennsylvania, Ph.D. candidate student at Villanova University
2President, National Association of Hispanic Nurses; Senior Vice President of Equity, Diversity and Inclusion at Equality Health
3Former President, National Alaska Native American Indian Nurses Association; Research Assistant Professor in the Division of Epidemiology and Adjunct Assistant Professor and Diversity Coordinator for the College of Nursing, University of Utah
4AHNE Education Workgroup co-chair; Associate Professor & Director, Center for Global and Public Health, M. Louise Fitzpatrick College of Nursing, Villanova University

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Our Diversity, Equity, and Inclusion Update

Alison McCarthyWe are committed to being open and transparent throughout our process of implementing Diversity, Equity, and Inclusion (DEI) at Spark. We have a lot of progress to share this month and hope it will be helpful to our staff, local community, peers, clients, and the people most affected by our work.

After announcing our DEI commitment and sharing our plan in January, we searched for and hired a DEI consultant, Maria Velasco from the Spring Institute. We feel lucky to have talked with so many incredible people; it’s heartening to see how many qualified folks are out there doing this work.

Here’s a list of names and contact information of the DEI consultants with whom we spoke. We are so excited to begin our work with Maria!

In preparation for our DEI “kickoff” with Maria, we conducted a literature review to identify tenets and measurements of organizational inclusiveness. Literature suggests that the essential components of inclusiveness are:

  • Fairness and opportunity
  • Belonging
  • Trust and respect

We then developed an internal staff survey that would incorporate these components and help us to better understand our baseline regarding diversity, equity, and inclusion. We adapted three commonly used instruments to ensure relevance to our organization. They include:

We have administered the survey to staff, and are hoping for a 100% response rate. We’ll work through the results with Maria at our next DEI staff training.

In the coming weeks, we’ll share our efforts at developing a DEI project and proposal checklist – serving as a prompt for incorporating DEI principles into all Spark projects. As always, we welcome your insights and questions as we move forward on this journey. Feel free to use the chat box below with any comments.

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Keeping Youth Out of the Juvenile Justice System: Creating Policy and System Change

By Lauren Gase, Spark Policy Institute and Taylor Schooley, Los Angeles County Department of Public Health

Each year, roughly one million young people are arrested in the United States. Contact with the justice system is not only a public safety issue – research shows that it can lead to a range of negative health and social outcomes, including damaging family functioning, decreasing high school graduation and employment rates, increasing the risk for involvement in violence, and worsening mental health outcomes.

Contact with the justice system is also an equity issue; persons of color are disproportionately represented at every stage of justice system processing. It should concern anyone interested in promoting health, educational achievement, and community and economic development.

The public health sector can be a strong leader in creating justice systems transformation because it has experience bringing together diverse stakeholders to facilitate meaningful dialogue and collaborative decision-making. Public health focuses on prevention, holistic wellbeing, and the root causes of poor outcomes. It is grounded in using data to drive decision-making to identify opportunities for improvement.

To illustrate this, we’ve gathered examples of several jurisdictions that have begun to advance promising solutions to justice reform in partnership with public health:

  • In Los Angeles County, California, the Board of Supervisors established a new division of Youth Diversion & Development within the integrated Health Agency. This division is tasked with coordinating and contracting community-based services in lieu of arrest or citation for youth countywide.
  • In King County, Washington, Executive Dow Constantine announced an executive order to place juvenile justice under the purview of the public health department. The order aims to change policies and system to “keep youth from returning to detention, or prevent them from becoming involved in the justice system in the first place.”
  • A recent analysis from Human Impact Partners examines the impacts of youth arrest on health and well-being in Michigan and identifies a number of recommendations, including diverting youth pre-arrest, training agency personnel to be trauma-informed, sealing youth records, and changing state sentencing laws.

To promote health, safety, and racial equity, we need to transform our current justice system to create the social, economic, and political conditions that allow individuals, families, and communities to thrive. Some jurisdictions have begun to advance public health solutions to justice reform, but there is more to be done. We need to think differently about the role of multiple partners – including law enforcement, courts, health, schools, social services, and community-based organizations – in creating opportunities for young people to avoid or minimize formal processing in the justice system.