In April 2020, the Community Justice and Mediation Center (CJAM) and Bloomington Health Foundation (BHF) were jointly awarded a 30-month grant by the Robert Wood Johnson Foundation to analyze current practices, identify gaps, and develop a model for community engagement that is equitable and inclusive. The project, Community Voices for Health in Monroe County (CVHMC), aims to reimagine how decisions are made in our community and to transform existing practices into ones that are meaningful, community-wide, and embrace varying perspectives.

CVHMC and Public Engagement in Monroe County:

Public engagement is generally considered to be any process that involves the public in decision making, and includes consideration of their input in decision-making processes. The potential benefits of public engagement include:

• Identification of public needs, ideas, and recommendations;  

• Education of residents about issues and decision-making processes;  More effective and efficient government decision-making;  

• Accelerated project implementation through buy-in from a diverse range of community  members;  

• Enhanced trust between community and decision-makers;  

• Improved participation and leadership;  

• More democratic governance processes; and 

• Enhanced capacity for community to resolve complex challenges in a collaborative  manner.

Sources:

U.S. EPA, n.d., Public Participation Guide.  

T. Amsler, 1 July 2020, Effective Practices Guidance for Planning & Evaluating Public Engagement,” Presentation to the Community Voices for Health in Monroe County; U.S. EPA, n.d., Public Participation Guide; City of Portland, 2010, City of Portland Public Involvement Principles.

Literature Review and Engagement Scan

To ensure our work builds upon existing engagement processes and best practices in public engagement, our team first conducted a review of literature on best practices and aligned our approach accordingly. Then, the CVHMC team conducted an engagement scan of Monroe County that builds upon the concept of Public Agenda’s engagement scan of Pennsylvania, which models past public engagement efforts in the state of Pennsylvania.

Source: Public Agenda, 2019, Pennsylvania Engagement Scan.

The objectives of this Monroe County, Indiana engagement scan included:  

• Identify existing organizations leading engagement work, particularly related to health issues;  

• Summarize the results of past public engagement efforts, including purposes,  participants, process/es, lessons learned, perceptions of participants’ feelings of  inclusion, and identification of those included/not included in engagement efforts;  

• Summarize best practices in public engagement as identified in public engagement  toolkits, professional reports, and academic literature; and 

• Identify potential improvements to engagement practices, participant recruitment, and general process strategies, specifically around healthcare issues. 

During this phase of the project, the CVHMC team worked to establish a shared foundation of understanding about the existing public engagement infrastructure in Monroe County; develop a strategy for efficient, effective, and inclusive public engagement around health in the community; and identify ways that the strategy can be applied in other communities throughout the state.

Steps included:

• Compiling key background information about Monroe County, including demographic, economic, and health statistics;

• Examining past and present public engagement efforts in Monroe County, including a comprehensive listing of health decision-makers and social services organizations as well as a summary of case studies of past engagement efforts;

• Conducting interviews with community members to develop engagement strategies;

• Providing a comprehensive compilation of strategies to systematically, strategically, and equitably reach out to, include, and communicate with the key underrepresented groups in Monroe County.

Phase 1 Interviews

Between June and November 2020, the CVHMC project team conducted 46 personal interviews with 52 individuals using a semi-structured snowball approach, with our interviewers following an interview guide but not adhering strictly to a rigorous set of questions. We identified an initial set of interviewees representing government officials, healthcare professionals, nonprofit organizations, social service agencies, university researchers and staff, and community leaders familiar with the needs of underrepresented groups. Consistent with the “snowball” approach, we relied upon these early participants to make recommendations for additional participants. At the end of each interview, we specifically asked interviewee(s) to connect us with acquaintances who were part of the underrepresented voices we hope to empower through this project.

Phase 1 interview results included the following:

• Recommendations from community leaders about engagement strategies;

• Feedback regarding the current state of public engagement in Monroe County;

• Emerging challenges with public engagement and health amid the COVID-19 pandemic;

• A preview of health-related concerns we might expect to learn about from the community during subsequent Small Group Discussions;

• A preview of community health resources we might expect to learn from the community during subsequent Stage 2 Small Group Discussions;

• A preview of healthcare gaps we might expect to learn about from the community during subsequent Small Group Discussions;

• Recommendations for how to improve healthcare in Monroe County;

• Useful insights into mental healthcare resources in Monroe County;

• A preview of mental healthcare gaps we might expect to learn about from the community during subsequent Small Group Discussions

Phase 2 Data

In the first half of 2021, CVH collected information from a broad spectrum of community members about what matters to them about health, with a particular eye toward reaching underrepresented groups. Through facilitated small group discussions, individual interviews and written stories, the project has gathered a great deal of information to help understand how people see matters affecting health, and why they see them the way they do.

This data was compiled and analyzed by the Gnarly Tree Sustainability Institute, with input from the CVHMC Advisory Council, and informed the next phase of the project.

Deliberation Sessions

Equipped with the information from Phase 1 and Phase 2, the project hosted a series of community conversations bringing community members together with decision-makers to develop mutual understanding and begin to move toward solutions. The first session took place in person at the Monroe County Public Library at the end of August, 2021 and was highly successful, with both community members and decision-makers in attendance. Subsequent deliberation sessions took place on Zoom throughout the fall, including a Spanish language session on October 26th. Sessions will also take place in rural parts of the county throughout December, 2021.

Engagement with Elected Officials

Early in our project, we met individually via Zoom with each member of our elected government decision-making bodies to explain the initiative, our goals, and our planned activities. We then continued to meet with these officials to update them on progress, lead discussions around mechanisms for equitable policy setting, and explore how the community might move forward with more equitable decision-making.

Further, we invited officials to join our Advisory Council, which led to a representative of each government decision-making body or office becoming a member of the Council and providing ongoing input throughout the initiative.

Lastly, we scheduled a series of two meetings which included all elected officials. The first meeting focused on providing information on 1) principles of inclusive public engagement, 2) the concept of Health in All Policies (HiAP), and 3) the inclusion of health elements in comprehensive plans. To accompany the content of the meeting, we compiled an extensive collection of information and examples and distributed bound copies to all elected officials in advance. The second meeting focused on guiding the officials in identifying the potential benefits, opportunities, and challenges they could foresee if each of the three concepts was applied to our community.

Involvement with Existing Health Planning Processes

Every three years, the Monroe County Health Department, IU Health Bloomington, HealthNet, and the City of Bloomington Parks and Recreation Department lead a Community Health Assessment (CHA) that culminates in the development of a Community Health Improvement Plan (CHIP). This year, the CVHMC team shared our data and findings from community members for inclusion in the Community Health Assessment and participated in the CHIP planning process.

Think Tank Discussions

One of the ways the CHIP planning process involves community members is through Think Tank sessions. During these sessions, participating community members provide input on and prioritize the results of the CHA. They then identify the top three community health concerns to be addressed by the CHIP. CVHMC helped to develop a revised facilitation format for the 2022 Think Tank sessions, broaden the scope of participants involved, and ensure the sessions were more accessible to a variety of people. The format for each session included: an introduction to the 10 major community health concerns identified by the health assessment; interactive activities to guide discussion on these issues; consideration of what might have been missing; prioritizing the top three areas of concern; and finally, beginning to assemble “action teams” to address those issues.

For these Think Tanks, we created a “data walk” to spark rich discussion among participants. This consisted of large graphical placards mounted on easels depicting and explaining the ten identified community concerns and proposed solutions. They were available throughout the sessions for participants to consult at any time.

Assistance with Community Health Improvement Plan Action Teams

The three priority areas for action that were identified during the Think Tanks are: 1) Poverty and Navigating Health and Social Services; 2) Inequity, Discrimination, and Bias; and 3) Substance Use and Mental Health. During the summer of 2022, to attract participants for the action teams, a public kickoff event was held and presentations were made to community groups and government boards and commissions.

Formation of the Monroe County Health Equity Council

Over the last several months of the grant, we led the CVHMC Advisory Council (AC) in discussions about ways to sustain the work that was being done under the original RWJF grant. Members of the AC agreed that it was vital work and needed to be continued. Consequently, they made the decision to transition to an independent resident-led group, wrote and adopted a Purpose Statement to make their mission clear and guide their work, and chose “Monroe County Health Equity Council” as their new moniker.