Engaging Native Communities to Build Maternal/Child Health Capacity Multnomah County Health Department, Community Health Services

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1 Report for Project # Engaging Native Communities to Build Maternal/Child Health Capacity Multnomah County Health Department, Community Health Services 1. In brief, what was the aim of your project? The Future Generations Collaborative (FGC) is an innovative partnership among American Indian and Alaska Native community members, community-based organizations, and public health agencies to increase healthy pregnancies and healthy births in American Indian and Alaska Native communities. Through community engagement, capacity building, and working towards collective impact, the FGC is identifying and addressing the causes of substance-exposed pregnancies among year-olds urban Native women living in Multnomah County. A key strategy to our approach was the recruitment and training of Elders and Natural Helpers (E/NHs). The E/NHs are American Indian and Alaska Native community members that serve as community organizers. They E/NHs mobilize the community to address root causes of substance-exposed pregnancies, engage in personal and community healing, and provide peer-to-peer education on the causes of Fetal Alcohol Spectrum Disorders (FASDs). 2. What is the current status of the project? The project consists of four Phases: Phase 1 Initial Planning, Partner Recruitment, and Relationship Building; Phase 2 Partnership Building and Community Engagement; Phase 3 Action Planning; and Phase 4 Organizing Community Commitments. Phases 2-4 were funded by the NWHF to focus on Community Capacity Building. The project is currently in Phase 3, with the completion of the GONA scheduled for January 2-4, Active partners/members of the coalition include: Harmony Paul, Community Member (E/NH and National Leadership Academy for the Public s Health team member), Heather Heater, Multnomah County Health Department; Charmaine Kinney, Multnomah County Mental Health and Addictions Services; Donita Sue Fry, Native American Youth and Family Center, Jillene Joseph and Jay LaPlante, Native Wellness Institute; Toni Matt, Native American Rehabilitation Association; Kelly Gonzales, Amanda Mercier, Dean Azule, and Susie Barrios, Portland State University; and Lesa Dixon Gray and Nicole Browning, Oregon Health Authority. Resource and funding partners include: Northwest Portland Area Indian Health Board, Planned Parenthood of Columbia Willamette, Northwest Health Foundation, Health Share of Oregon, and Oregon Health Authority. Project Successes Since the project began in 2011, the Collaborative has achieved several successes, including securing funding from Health Share of Oregon, preparing for the Gathering of Native Americans (GONA), and being accepted into the National Leadership Academy for the

2 Public s Health, a training academy funded by the Centers for Disease Control and Prevention. Organizational partners remain committed and highly engaged in the Collaborative. This can be seen in increased in-kind support, consistent participation at FGC meetings and events, assistance with coordination of the GONA, dedicated staff FTE, and increasing organizational buy-in and project awareness. The Collaborative continues to develop trust, build relationships among current partners, and effectively use the Trauma-Informed Model to guide activities and process. The Collaborative is becoming more strategic and intentional with opportunities and has a greater appreciation for the scope of this work and a more realistic assessment of capacity and infrastructure needs to sustain momentum and achieve long-term goals. Organizational partners are becoming more adept at and committed to leveraging their circle of influence to secure resources for enhanced collective impact. Through commitment to reciprocal dialogue and learning, and through securing additional capacity building technical assistance and training, the Collaborative is increasing capacity and skill of partners and E/NHs. Community involvement and awareness of the FGC has increased. The Collaborative overcame significant historical barriers between two Nativeserving partner organizations and has made significant inroads in healing deep levels of mistrust in the community regarding working with County government. All partners continue to make incredible strides to repair, restore, and re-imagine relationships. During the project period, the Collaborative successfully obtained additional in-kind infrastructure support for administrative, evaluation, and communications functions from MCHD, NARA, and NAYA. The Collaborative is on track to complete the GONA January 2-4, Future Opportunities Professional development and healing opportunities for Elders and Natural Helpers Sustainability planning for the collaborative Community healing to address the health effects of historical and intergenerational traumas Integrating indigenous values and processes into bureaucratic, dominant culture systems Building strong political support within City and County governments Leveraging momentum to reduce health inequities in the system-wide Coordinated Care Organizations Triple Aim focus A national focus on the Community Based Participatory Research process, trauma-informed approaches, and health equity work make the collaborative well positioned for future funding Challenges to the Collaborative

3 Funding: Limited funds pose a challenge for infrastructure support. This creates a resource demand on partner organizations, delays the Collaborative s ability to respond to new opportunities in a timely way, and creates difficulty in showcasing current successes (e.g. promoting and disseminating the Community Forum Analysis). Solutions we have implemented include identifying opportunities for cooperative funding opportunities; prioritizing pass-through funding to CBOs to reduce their financial and infrastructure burden; and using a strengths-based assessment to identify roles. We currently have one FGC member focused exclusively on manuscript development, which will aid us in seeking larger, more strategic funding opportunities. Political Champions: The County has not reached critical mass in adopting the Trauma- Informed Model broadly. The FGC is working to identify political champions in City and County government through engagement and outreach. Evaluation: Due to the fact that the FGC has spent considerable time building community capacity and repairing inter-organizational relationships, and due to staff turnover, the Collaborative is behind schedule in developing an evaluation plan and impact measurement tools. However, the Collaborative has secured additional infrastructure support from MCHD to assist with evaluation planning. We also have one FGC member who is currently completing her graduate thesis using the FGC as her focus. She is completing analysis on a year-long participatory evaluation that is examining how FGC members and the greater Portland Native community members evaluate the FGC s community-based participatory process. The evaluation focuses on the effectiveness of the FGC in integrating Native cultural values and using the trauma-informed collaborative model into our CBPR process. Elder and Natural Helpers Support: The FGC faces challenges in fully addressing the depth and breadth of healing and leadership development requested by E/NHs. The current FTE capacity is stretched thin and the demand is high for focused, intensive, and structured mentorship and guidance to support ongoing capacity building among the E/NHs. Multiple obstacles prevent full and active participation from the entire E/NH cohort (lack of transportation, childcare, ongoing trauma and recovery-related obstacles, intimate partner violence, and other social determinants in addition to positive constraints like job and school responsibilities). The effect of historical and intergenerational trauma has led to challenging conversations between Elders and Natural Helpers cohort as lateral oppression and signs of internalized racism continue to surface during this critical first phase. Although these conflicts have been challenging, they are the gateway to substantial and deep rooted change. Investing in reparations between community members leads to a more united front in addressing pregnancy and birth outcomes. Current strategies to address conflict within the E/NH cohort have included implementing a restorative justice process using the relational world view and trauma-informed collaborative model to address the root causes of conflict and provide skill-building and healing to all collaborative members; offering mediation services to members directly involved in conflict; providing one-on-one mentorship by community elders to those individuals involved in the conflict; providing more robust support at E/NHs meetings

4 including intentional assistance with ground rule development, meeting agendas, and facilitation. We are working to reduce barriers to E/NHs involvement by intensively engaging in restorative justice process, budgeting for stipends and other supports such as childcare and transportation assistance to ensure those issues do not prevent E/NHs from attending meetings. 3. What activities have been conducted toward grant goals and objectives in the time frame covered by the report? Public health research and interventions within AI/AN communities have often been implemented without reference to the effect of historical trauma and cultural genocide on these communities. This lack of awareness, along with a lack of integration of culturallyspecific ideology, has caused a loss of effective communication and trust among many Native communities. Today, many interventions, community-planning processes and research practices continue to disregard or ignore Native cultural values. Bureaucratic processes and institutionalized disregard for Native cultural values create significant barriers to effective community engagement. Other barriers include deeply rooted mistrust of government among Native peoples and fiscal constraints to engage in collaboration and capacity building. Trauma-informed community-based participatory planning can help to rewrite the story of how government and urban Native communities work together to address health inequities. Activities completed to meet Phase 2 and 3 goals include (Events lead or co-facilitated by E/NHs): Orientation for primary facilitator by Jillene Joseph and Jay LaPlante of Native Wellness Institute. Orientation for FGC interns two Native community members served as interns/work study opportunities at MCHD and MHASD Training of Elders and Natural Helpers in skill-building and effectively applying values and principles of Trauma-Informed Model to addressing community conflict by Jillene Joseph and Jay LaPlante of Native Wellness Institute. Recruitment and training of 18 Elders and Natural Helpers (3 elders). Of the 18 original E/NHs recruited in Feb. 2012, 11 remain active participants regularly attending meetings, trainings and events. Eight community forums held by E/NHs: two with young men age 15-24, four with young women age 15-24, one with male and female adults age 25-54, and one with male and female elders age 55 and older. A total of 67 E/NHs and 74 community members participated in the forums. The forum objectives included: o Gauge the knowledge base of Fetal Alcohol Spectrum Disorder o Obtain feedback from Native youth, adults and elders on the impact of historical trauma within the urban Native community o Examine community and cultural strengths to address healing and promotion of healthy families

5 o Solicit ideas to further engage the community to promote support, guidance, belonging and giving back. Two making meaning meetings provided community validation of community forum data Eleven presentations to new and emerging community partners, including: o Multnomah County Office of Diversity and Equity o Multnomah County Department County Human Services o Multnomah County Board of County Commissioners o Multnomah County Department of Community Justice o Native American Heritage Month Multnomah County Proclamations (2012 and 2013) o Oregon Department Human Services Foster Care Services o Department of Indian Education o Confederated Tribes of Siletz Portland Office o Planned Parenthood of Columbia Willamette o Family Care Health Plans o Health Share of Oregon Outreach to Native community members through five events, including: o Nesika Illahee Pow Wow o Delta Park Pow Wow o Grand Ronde Pow Wow o NARA Alumni Picnic o Bow and Arrow Culture Club Spirit of Giving Conference presentation Solicited additional funding and sponsorships, including: o $96,000 Health Share of Oregon o $10,000 Oregon Health Authority o $2,500 sponsorship from NWHF to support GONA Collaborated with the Multnomah County Office of Diversity and Equity to support adoption of trauma-informed approaches county-wide and providing TA in using Relational World View and Trauma-Informed Collaborative Model in development of community-based participatory planning and implementation of trauma-informed care models. Accepted into National Leadership Academy for the Public s Health (cohort of four members includes one E/NH and one CBO partner representative) Gathering of Native Americans: scheduled January 2-4 th. The GONA is for local Native community and allies to gather, learn from one another, strategize ways to prevent substance-exposed pregnancies, strengthen families, laugh and cry, and support one another. GONA draws upon the wisdom of Native people to promote healing for all community members. Since 1993, thousands of Native people and allies have participated in GONAs to begin or strengthen their healing path.

6 4. If there are any community events or other opportunities for visibility related to this project planned for the next six months, please describe them here, as well as any opportunities for KPCF / NWHF / KP involvement Opportunities for Visibility include: the GONA (January 2-4, 2014), the Contemporary Northwest Tribal Health Conference (March 28-29, 2014 Portland OR; presentation proposal in development), and the Governing for Racial Equity Conference (March 24-25, 2014 in Portland OR; presentation proposal to be submitted). Opportunities for NWHF/KPCF/KP Involvement include: Assist with dissemination of community forum and GONA analysis; promote action plan Collective impact: o Advocate for integration of trauma-informed model to health and social service systems, o Continue developing strong regional momentum for integration of culturallyrelevant health promotion planning such (e.g. integrating the relational world view into health equity work) o Link FGC to other community initiatives working to address social determinants of health and organizations working to address inequities in maternal, child, and family health, particularly in communities of color in Multnomah County and the tri-county region. Continue to support systems needs assessment regarding current capacity of health and social service organizations to integrate trauma-informed collaborative model into organizational approaches Help tell our story communications support for digital storytelling, increasing social media and web presence 5. Any issues affecting the completion of the project as proposed and as scheduled (including changes in personnel or activities). If you encountered unexpected circumstances or challenges, how did your organization respond and adapt to them? Staffing Funding Change in Program Design External Factors Other

7 Staffing Three staff members who provided critical infrastructure supports left the Health Department during the project period, severely disrupting evaluation planning and analysis. NARA had a change in staff representation on the Collaborative mid-year. Funding Despite securing additional funds for critical components of community engagement work, the FGC has a continued need for funds to staff a project coordinator, stipends and other supports to ensure E/NHs are able to participate at their fullest level, and evaluation staff to build community capacity for participatory evaluation and communications. Lack of sufficient funding delayed the FGC s ability to find an event space that was large enough and within budget and the GONA date had to be adjusted. Given these setbacks, the FGC is optimistic about the additional funds received and will continue to seek funding to support the next phases of the work. Change in program design FGC has made an adjustment in the implementation of its phases. The project consists of four Phases: Phase 1 Initial Planning, Partner Recruitment, and Relationship Building; Phase 2 Partnership Building and Community Engagement; Phase 3 Action Planning; and Phase 4 Organizing Community Commitments. The project is currently in Phase 3. The Collaborative found that more funds were needed to support integration of E/NHs into meetings than originally planned. The Collaborative underestimated the need for healing circles to address trauma in the Elders and Natural Helpers cohort. This will be primary focus for 2014, rather than recruiting additional cohorts. Without additional funding for staff and infrastructure support, the Collaborative will need to delay its assessment of the technical assistance participant organizations require in order to implement trauma-informed, collaborative approaches. Phase 4 of the initial NWHF project proposal will be delayed until the Collaborative can secure sustainable funding for additional healing and training opportunities for E/NHs and a project coordinator to lead the CBPR functions of the work plan. Other The delay in scheduling the GONA has delayed the development of a community action plan. Following the GONA, a number of activities anticipated to occur during this grant period will occur, including: o Obtain organizational and community commitments for the community action plan.

8 o Formalize the FGC leadership structure for sustainability and community accountability. An interim process for coordination was developed and roles were identified. The structure will be finalized after the GONA. o Conduct a series of community meetings to identify other strategic issues and actions to improve urban Native Maternal and Child Health. 6. How were funds expended? Please present this information in two side-by-side columns: how the budget was originally proposed versus how funds were actually expended.. OR, attach a spreadsheet (below). NWHF Grant #16326 Engaging Native Communities to Build Maternal/Child Health Capacity Grant Period: 01/01/13-04/30/14 Grant Award: $50,000 Reporting period: 01/01/13-12/31/13 Expense 01/01/13 through 03/31/13 04/01/13 through 06/30/13 07/01/13 through 09/30/13 10/01/13 through 12/31/13* Total Project Budget Personnel - - 6, , , , Materials and Supplies 1, , , Travel , Consultants and Contracted Services - 7, , , Meeting , Professional Training and Development , Other Budget Items , Indirects , , TOTAL 1, , , , , , * MCHD accounting period for December 2013 will not close until 01/20/14