Upstream Approaches to Improving Community Health 2015 Minnesota Cancer Alliance Working Meeting May 7, 10 am-2pm Presented By: Maria Regan Gonzalez Bloomington Public Health

How upstream is our work? Very upstream…. Conditions that create health (SDOH)

One of Many Upstream Approaches Latino Childcare Provider Network Nutrition and PA, school readiness, licensing, workforce development Comfort Inn Worksite Wellness Transportation and income Healthy Living Hub Cultivation of community leaders, culturally appropriate & accessible HP activities In-house 3 year old preschool screening services in identified communities Bridging barriers to preschool screening and services Bridging cultural barriers to healthy food access (Fare for All) Workforce development, environmental change, relationship building with community Bridging cultural barriers to participating in youth and adult programming provided by the school districts Workforce development, bridging cultural and religious barrie If there is success and need, they will incorporate and expand into programming Explain how upstream our approaches are to all three projects…very upstream. Focus on SDOH or the conditions that create health.

The Why: Barriers to Health for the Latino Community Youth obesity Adult chronic disease Childhood poverty School readiness Free and reduced lunch Home ownership Employment and income Health insurance coverage 4-year high school graduation

How the Project Started Listening to the community (over 2 years) Childcare was a top concern Barriers to healthy children Physical inactivity Poor nutrition Poverty Barriers to becoming licensed providers Cultural beliefs around childcare Barriers to education Isolation Funding: UCare and SHIP

The What and How

What has been done to date? 1. 120 providers from around the metro area Mostly unlicensed providers Average of 4 kids x provider (~480 children) 2. 20 trainings since 2013 Nutrition Physical activity Licensing requirements and resources for providers School readiness & CPR Toy making workshop (school readiness) Community resources for providers 3. Opportunity for social connection and support 4. Identification of individuals to become trainers (in-progress) 5. Connections to support becoming licensed 6. Providing information to those within the system about the network and population

http://www. preventioninstitute http://www.preventioninstitute.org/component/jlibrary/article/id-105/127.html

The 5 C’s 1. Content Expertise and 2. Collaboration Skills Cross sector collaboration with experts in the field of childcare Church of the Assumption Latina childcare providers Early Childhood & Family Education Fairview Southdale Hospital University of Minnesota Extension MN Department of Health Develop Think Small Hennepin County Licensing Hennepin County Child Care Assistance Program Minnesota Department of Education Help Me Grow Program Child Care Aware Church of the Assumption a. Lead the project, recruit participants, populate database, collect information, host trainings Latina childcare providers Participant Recruitment Early Childhood & Family Education Co-sponsor some training Space for trainings Info about school readiness Fairview Southdale Hospital Provide educational opportunities for the kids in childcare while adults are in the training University of Minnesota Extension Provided training support MN Department of Health Funding for physical activity and nutrition workshops Spanish resources around PA and Nut Technical assistance Develop (Org. that approves trainers and trainings) Ta to make sure trainings we are offered and are approved Think Small Info session about licensing requirements and process Promoted with our network with their contacts Sent our contacts to them Provided TA in understanding the barriers and requirements to licensing Hennepin County Licensing TA about licensing process for providers Hennepin County Child Care Assistance Program TA about licensing interested providers With Somali community, they provided list of FFN providers in Somali community in our area Minnesota Department of Education Information about the Child and Adult Care Food Program, figure out requirements Spanish resources for school readiness Help Me Grow Program TA to provide school readiness materials and resources in Spanish Child Care Aware Discussion and attempts to incorporate PA and nutrition into required trainings for licensed providers  

From the 2014 Advancing Health Equity Legislative Report The 5 C’s 3. Systems Change Literacy Addressing childhood obesity is not as simple as teaching parents and childcare providers about healthy eating and physical activity Change the way we (public health) works Support the community’s literacy and action in systems change From the 2014 Advancing Health Equity Legislative Report

The 5 C’s 4. Strategic Communications Grassroots communication strategy Word of mouth, church bulletin, in-person, texts Listening to the community Understanding our role within the context of power dynamics Language, meeting format and times Bi-cultural, bi-lingual BPH staff person, resident of the community as staff lead

The 5 C’s 5. Cultural Competency Build relationship & trust Culturally appropriate services Bi-cultural, bi-lingual staff Community-led work Cultural perspectives on childcare, communication and education Culturally appropriate communication Addressing community’s barriers to health

12 Guiding Principles for our Partnerships with Communities The number one beneficiary of collaboration is the community it serves; Partners must commit to humility when collaborating and begin by learning from the community before it can share the knowledge and resources it brings to the community; Partnerships will utilize the wisdom and expertise of the community to build capacity and leadership from within; The community partner will lead the development and implementation of the work plan; Organizational partners will follow the leadership of the community; The collaboration will adapt to the community’s work style;

Guiding Principles Cont. 7. Partners will work with the community, not for the community; 8. Existing history, work and partnerships will be honored; 9. Educational activities will be done in a language the community understands; 10. Culture, tradition and flexibility are considered valuable assets; 11. Partnering organizations will provide connections, resources and support to the community and the community will decide how partners can contribute in way that is effective and meaningful; and 12. Collaborations and partners will not duplicate existing efforts.

Successes and Barriers Expanding our reach, quickly via word of mouth Multifaceted approach to addressing barriers to health Reaching an isolated community Creating networks and connections Identifying gaps in the system Building community leadership Informing key partners who can make changes Barriers Funding has not caught up to the reality of the community Need to start limiting promotion and registration Many systemic barriers identified Little to know culturally appropriate staff within system Systems, systems, systems barriers

Pictures We need to think about our heal

Closing Remarks “Those who profess to favor freedom and yet depreciate agitation, are people who want crops without ploughing the ground; they want rain without thunder and lightning; they want the ocean without the roar of its many waters. The struggle may be a moral one, or it may be a physical one, or it may be both. But it must be a struggle. Power concedes nothing without a demand. It never did and it never will.”- Frederick Douglass In order to effectively advance health equity and address the conditions that create health, we need to work at the intersections. Intersections of PSE, spectrum of prevention, community organizing and empowerment, and SDOH. There needs to be a fundamental change in the way we do this work….1. funding needs to change, 2. workforce needs to change, 3. relationship and power dynamics with communities need to change

Thank You María Regan González Health Specialist City of Bloomington Public Health Division   1900 W. Old Shakopee Road Bloomington, MN 55431 PH: 952-563-8995 mregangonzalez@BloomingtonMN.gov