A Roadmap for Authentic Community Engagement
We can’t improve maternal and child health without engaging community voices—without practicing what NICHQ Executive Project Director Kenn Harris calls “true, authentic community engagement.” This holds whether seeking change at the policy level or within an organization, hospital or clinic.
“The belief behind community engagement is that the people impacted by the problem have some of the best solutions,” says Harris. “They help us understand how they experience the system, their lived experience, and that’s not something we can learn anywhere else. When those experiences and their voices become part of the solution—when they’re combined with organizational knowledge, resources and expertise—it becomes a pretty amazing partnership that inspires innovative thinking.”
Harris has spent more than two decades working with the Healthy Start federal program, one of the first public initiatives that genuinely engaged communities as equal partners for improving the health of children and families. At NICHQ, Harris leads the Supporting Healthy Start Performance Project, which partners with all Healthy Start communities through a comprehensive capacity-building training program. Having witnessed the importance of community engagement first-hand, Harris is passionate about helping improvement initiatives across the country develop and sustain the authentic community engagement needed for change.
“There’s this large breadth to community engagement because it happens in so many places—in hospitals and individual clinics, in organizations and foundations, among systems improvement initiatives,” says Harris. “But no matter where it takes place, it needs to have the depth; it needs to be authentic and committed, locked-in with trust, to make it real.”
Developing this authentic community engagement requires intentional interest and decisions from all participants. Below, Harris shares some of his lessons, learned from nearly 30 years of working with communities.
Bring your most authentic self to the table
Authentic community engagement requires authenticity from all participants, explains Harris.
“If I come to a meeting with community partners and I am not being my real self, I can’t develop an authentic relationship with them. Being open to the reality that you don’t have all the answers, being honest about who you are and where you come from, and openly evolving every day—this is what’s required. It means being vulnerable, but it is also what builds trust.”
Harris recommends taking lessons from home and personal relationships and applying them to community engagement. The same requirements for intimate relationships—significant time and attention, honesty and authenticity, and dependability—are all needed to engage meaningfully with community partners.
Prioritize the three Ps
Whether you’re bringing together a meeting of community partners or engaging families in pediatric practice improvement, Harris recommends prioritizing three Ps: Place, People, and Practices.
- Place represents creating space for community engagement to happen. It should be a space that is inviting and respectful, so people feel comfortable and valued. Welcoming decorations, snacks or a meal for attendees, a space that can accommodate children—these considerations help lay the groundwork for authentic engagement.
- Prioritizing people means ensuring the right people come together. This relies on thoughtfully discussing how to connect with community partners, considering their individual circumstances and what might make it difficult to attend a meeting or join a call, and thinking through how to create an engaging and enjoyable event.
- Practices are the rules of engagement: the agreed-upon policies and practices that create a safe space for engagement. For a clinic prioritizing family engagement, this might mean implementing a policy for greeting families when they come through the door. For a community meeting, this might be the policies that guide behavior, such as how to facilitate inclusive discussion.
All three Ps are needed to support authentic community engagement.
Full engagement means giving up power
There’s a spectrum of community engagement, says Harris. It begins at an advisory level, then moves to focus groups, then to helping influencing decision-making, and then, at full engagement, to leading decision making and truly helping determine what happens. Full engagement is the most authentic engagement and the most powerful. But promoting it requires shifting power from whoever is leading the initiative—the clinician, the lead researcher, the organizational lead—to the community.
“For true engagement, you have to be willing to give up the power,” says Harris. “We talk about sharing power but that isn’t enough; I can’t share power unless I am willing to give some of it up. And this is the risk because we lose some of the control and we have to be vulnerable… but it’s what incites true partnership and ultimately builds momentum, causing you to go further together than you ever could have gone alone.”
Bring together state and community partners
Community engagement at the grassroots level—where organizations and individuals work together in the space where they live—inspires incredible community-based change; but too often, this change doesn’t trickle up to state and national policies and doesn’t influence broader systems that perpetuate inequities. Moreover, without systems change, grassroots initiatives can’t experience maximum impact because even the strongest community-based program can’t fully thrive in a flawed system. Helping policy makers and state leaders connect with grassroots community efforts results in greater impact and really demonstrates the true potential of authentic community engagement, says Harris.
“We often think about change as coming from the top-down, or from the bottom-up, but community engagement is most effective when the two meet in the middle. The magic is in the middle—that’s the good stuff; and my work is all about moving communities and organizations to the good stuff.”
And remember, always trust the process
“Authentic community engagement—the kind that has the depth that really works—takes time, so if you aren’t interested in it, don’t start it,” says Harris. “You have to believe that community engagement matters, trust in the process and not rush it for results.”
Interested in learning how states can better support community-based early childhood efforts? Read this recent article on how New York State is elevating the work at the community level to inform policy and program improvements.
Supporting Indigenous Families for Improved Health Outcomes
Indigenous mothers and birthing people, fathers, partners, caregivers, and families, can speak for themselves. So, make sure seats are available – and filled – on your projects, your teams, your boards. Many projects within the MCH field have steering committees, and all should have family representation. As I hope you’ve intuited, it’s not enough to carry a message. When I think about justice, equity, diversity, and inclusion with regard to our committees, our faculty experts, or even in our improvement advisors, I have begun to ask the question: Are there people from American Indian and Alaska Native communities here?
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Look for NICHQ at 2022 American Public Health Association Annual Meeting
Join the National Institute for Children's Health Quality (NICHQ) on Nov. 6 at 2 p.m. for The Ever-Evolving Path to Equity in Children’s Health, a panel highlighting the evolution of NICHQ's equity work at the 2022 American Public Health Association Annual Meeting.
NICHQ Collaboration featured in White House Efforts to Improve Substance Use Disorder in Pregnancy
With an emphasis on the need for collaborative efforts among hospitals, outpatient clinics, and local communities, the White House Office of National Drug Control Policy (ONDCP)'s recent report, Substance Use Disorder in Pregnancy: Improving Outcomes for Families, details the ways in which state perinatal collaboratives have been exceptionally effective in improving outcomes for pregnant women and infants such as by reducing risk of bloodstream infections and early term deliveries. From 2017-2022, Centers for Disease Control and Prevention’s Division of Reproductive Health funded 13 state perinatal quality collaboratives (PQCs) and the National Institute for Children’s Health Quality (NICHQ) as the coordinating center for PQCs.
NAPPSS-IIN Hosting Community of Practice Meetings to address policies and Share Experiences about Safe Sleep and Breastfeeding
The NICHQ National Action Partnership to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN) project will continue to convene six Community of Practice (CoP) groups from September 2022 – March 2023. CoPs include Birthing Professionals, Community Advocacy Organizations, Community-Based Home Visitors, Early Childcare Providers, First Responders, and Researchers. Each group will convene twice to continue to address policies, improve skills, and learn from each other’s experiences in the areas of safe sleep and breastfeeding.