Policy & Practice | April 2022

The Magazine of the American Public Human Services

Association April 2022

How to Achieve Social and Economic Mobility Advancing Race Equity

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contents

Vol. 80, No. 2 April 2022

features

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12

Stanford Social Innovation Review / Winter 2022

More Nuanced Research A Better Way to Serve Black Families With Children

Centering Equity in Collective Impact A Decade of Applying the Collective Impact Approach to Address Social Problems Has Taught Us That Equity Is Central to the Work

departments

3 President’s Memo Shifting Structural Power to Advance Race Equity

20 APHSA Insights There’s Room for Everyone at the Table: Leveraging Employment and Training to Close the Racial Wealth Gap 21 APHSA Insights Food Insecurity Among BIPOC College Students: Expanding SNAP Education, Outreach, and Access to Address College Campus Hunger 22 From Our Partners You Can’t Hire Your Way Out of the Staff Turnover Crisis: Addressing the Realities of Staff Turnover Through Process 32 Staff Spotlight Jess Maneely, Senior Policy Analyst, Technology and Analytics

5 Technology Speaks Health Equity Under the Microscope: How Might Analytics Help Us Understand and Solve Racial Disparities? 6 From the Field Building Together: Creating Equitable, People-Centered Services 7 From the Field Narrowing the Front Door: Using Economic and Concrete Supports to Create a Just and Equitable Child and Family Well-Being System

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April 2022 Policy&Practice

Strategic Industry Partners

APHSA Executive Governing Board

Chair Dannette R. Smith, CEO, Nebraska Department of Health and Human Services Vice Chair Rodney Adams, Former Director, Mecklenburg County (NC) Department of Community Resources Immediate Past Chair David A. Hansell, Former Commissioner, NewYork City Administration for Children’s Services Treasurer Reiko Osaki, President and Founder, Ikaso Consulting Elected Director Derrik Anderson, Executive Director, Race Matters for Juvenile Justice Elected Director Vannessa L. Dorantes, Commissioner, Connecticut Department of Children and Families

Elected Director Kathy Park, CEO, Evident Change Elected Director

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Terry J. Stigdon , Agency Head/Executive Director, Indiana Department of Child Services Elected Director Jennifer Sullivan , Senior Vice President for Strategic Operations, Atrium Health Elected Director Eboni Washington , Assistant Director, Clark County (NV) Juvenile Justice Services Leadership Council Representative Justin Brown, Director, Oklahoma Department of Human Services Local Council Representative Antonia Jiménez , Director, Los Angeles County Department of Public Social Services

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Policy&Practice April 2022

president‘smemo By Tracy Wareing Evans

Shifting Structural Power to Advance Race Equity

T he work of advancing race equity to achieve social and economic mobility, the theme of this month’s issue, is undeniably multifaceted and complex. It requires a long-term com mitment to continuous and intentional learning at individual, organizational, community, systemic, and societal levels. While there is no single way forward nor quick fix, there is a clear path for leaders seeking to accelerate the journey— we must simultaneously commit to shifting structural power. To do so requires that we under stand what we mean by structural power and be able to name and under stand where and why it exists in our daily work. To illuminate where the imbalances lie, we have to understand the dynamics of power structures better, especially between government services and people who have been historically disenfranchised and mar ginalized. We have to talk openly about who benefits from structural power and who does not.

have also taken steps to learn from people who have or are receiving services by including them on advisory councils (and compensating them for that service) or hiring them as agency staff. As Sixto Cancel from Think of Us implores system leaders, we need to be able to “hear the unvarnished truth.” While these have been important steps to take, it is not enough to bring people with lived expertise to the table if we do not also create the conditions to act on what we hear, and, in turn, shift our

A few years back, there was a lot of energy on creating “shared governance structures” to improve outcomes for families by connecting multiple systems together more seam lessly. These were complex endeavors requiring leaders from adjacent sectors like education, employment, health, and justice to come together through formal data-sharing and shared resources. In hindsight, these efforts missed the fact that the most meaningful shift we could make as public leaders was on the ground with people and communities. In other words, creating shared governance across systems does not, in and of itself, create more balanced power structures. Over the past decade, many public-sector agencies

See President’s Memo on page 24

Image via Shutterstock

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April 2022 Policy&Practice

Vol. 80, No. 2

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Policy & Practice™ (ISSN 1942-6828) is published six times a year by the American Public Human Services Association, 1300 N. 17th Street, Suite 340, Arlington, VA 22209. For subscription information, contact APHSA at (202) 682-0100 or visit the website at www.aphsa.org. Copyright © 2022. All rights reserved. This magazine may not be reproduced in whole or in part without written permission from the publisher. The viewpoints expressed in contributors’ materials are the authors’ own and do not necessarily reflect the policies or views of APHSA. Postmaster: Send address changes to Policy & Practice 1300 N. 17th Street, Suite 340, Arlington, VA 22209

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Policy&Practice April 2022

technology speaks By Kristin Thorn, Joseph Fiorentino, and Erin Drucker

Health Equity Under the Microscope: HowMight Analytics Help Us Understand and Solve Racial Disparities?

H ealth inequity remains a sig nificant problem in the United States. While COVID-19 did not create the inequity, the pandemic dramati cally exposed and compounded the disparities. Addressing the needs of historically disinvested populations is the prerequisite for a fair and thriving society. There is growing recognition that the status quo is unacceptable with increasingly urgent calls for change at the federal and state levels. The root causes of health inequity are challenging to address. In addition to being couched in neutral language or binary terms of “right vs. wrong” or “good vs. bad,” the root causes are laden with hidden judgments against people who are already disadvantaged. Simply because a policy or process exists does not mean that it is right or just. Consider a common managed care process: prior authorization. When a patient needs specialized services, their doctor may need to confirm that the health plan is willing to pay for these services. If the insurance company rejects the request, the patient has the right to appeal that decision with the support of the physi cian. When a person with Medicaid appeals a decision, they may also have the option to request Continuation of Benefits. Checking that box on the paperwork helps ensure that their services continue while the health plan reviews the appeal. But amid complex legal language and explanations for the denial, patients may not recognize their right

to continued care. Some may not even understand what “Continuation of Benefits” means. This is one of many examples where equity-focused analytics can help. To explore the question— Is this policy further marginalizing certain populations? —equity-focused analytics would pull data to measure differ ences in appeal decision times when Continuation of Benefits is selected. This exercise also would help identify whether certain groups or demographics are less likely to select Continuation of Benefits and therefore less likely to have equitable access to care. If there are differences, what might account for them? When we examine patients who do not select

Continuation of Benefits, is there a correlation based on their primary language? Are there differences based on patients’ disability groups, race/ ethnicity, or age? If the answer to any of those questions is “yes,” there is a strong case that this policy is imposing barriers to continuous care and needs to be changed or removed. The Art and Science of Equity-Focused Analytics As the Continuation of Benefits example illustrates, equity-focused

analytics can help reveal where a policy is causing unintended

See Health Equity on page 25

Image via Shutterstock

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April 2022 Policy&Practice

from the eld By Aurelle Amram

Building Together: Creating Equitable, People-Centered Services

T he health and economic crisis caused by COVID-19 left tens of millions of people needing assis tance and pushed existing systems and benefit-granting agencies to the brink of their capacity. State leaders quickly implemented new policies and programs and leveraged digital solutions to meet the real-time needs of residents. We understand from conversations with state partners that we’re coming out of the pandemic differently. While the need for assis tance is ongoing, many state agencies are facing new challenges, such as lower staff capacity. The challenges of today’s social services systems require us to both build on this transforma tion and respond to these emerging needs, implementing modern and innovative approaches rooted in the principles and practices of the digital age to build together toward people centered services. Code for America, a nonprofit orga nization, has worked together with hundreds of governments, from city departments to federal agencies, to take a human-centered approach to better understand and address the needs of the people they serve. Our approach to problem solving puts human needs, capabilities, and behavior first. It is then designed to accommodate those needs, capabili ties, and ways of behaving. We explore problems and work on solutions col laboratively with clients, caseworkers, and state leadership to reduce the

benefits applications that save time and make it easier for eligible individuals and families to sign up for benefits. This initiative will build on Code for America’s experience working in partnership with states and commu nity-based organizations. Here is a small list of examples of our work with states. n Reduced SNAP denials due to missed interviews. In Los Angeles County, one in three SNAP applicants were denied because of a missed interview. In partnership with the

advance human-centered services. The cornerstone of this effort is direct part nership with states to support them in reimagining the delivery of essential public benefits. In particular, they will focus on closing the Supplemental Nutrition Assistance Program (SNAP) participation gap by tackling high impact administrative barriers, increasing Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation by expanding the use of digital tools and services to meet the needs of families and community agencies that serve them, and developing integrated

structural causes of poverty. Recently, Code for America

announced a new multiyear initiative to expand our work with states and

See Building Together on page 26

Image via Shutterstock

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Policy&Practice April 2022

from the eld By Jennifer Maurici

Narrowing the Front Door: Using Economic and Concrete Supports to Create a Just and Equitable Child and Family Well-Being System

L ong-standing systemic inequi ties, coupled with implicit bias and pejorative stereotypes, have been disproportionately impacting Black children and their families for decades. Temporary Assistance for Needy Families (TANF) is one example of a policy whose genesis was seeped in anti-Black racism and sexism. 1 Since its creation in 1996, not only has financial assistance to families with low-incomes declined immensely 2 but Black children are more likely than White children to live in states where benefits are the lowest. 3 When we examine the disproportionate overrep resentation of Black children and their families in the child welfare system, the intersection of race and poverty is salient. Childhood poverty dispro portionately impacts children of color 4 and children living in poverty are more likely to come to the attention of child protective services. 5 The New York State Office of Children and Family Services (OCFS) is committed to creating a just and equitable child and family well-being system by redressing the punitive policies that have falsely equated low-risk poverty-related matters to abuse and neglect, perpetuating struc tural racism, and plunging families of color deeper into poverty and, as a result, the child welfare system. Through partnerships with a variety of stakeholders—including local departments of social services, not for-profit providers, community-based organizations, and our sister state

that have been accepted by the New York State Central Register for Child Abuse and Maltreatment where there is no safety concern that rises to the level of immediate or impending danger. The FAR approach focuses on both child safety and family engagement. Community partners and stake holders are also invited to learn about and support the use of a differential

agencies—three strategies, high lighted below, are centered upon the belief that providing economic and concrete supports to families in need will improve their overall well-being by providing the resources needed to help parents and caregivers keep their children safely at home. The Family Assessment Response (FAR) is New York State’s differential response program. FAR may be used for child protective services reports

See Front Door on page 26

Illustration by Chris Campbell

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April 2022 Policy&Practice

By Chrishana M. Lloyd, Sara Shaw, and Brent Franklin A Better Way to Serve Black Families With Children

T

he policies that authorize and guide implementation of human services delivery are often based on research that informs who receives

services, what services will best meet their needs, and how these services are delivered. For this reason, it is critical that programs that serve families with children draw on research that captures the most accurate picture of families and their needs. However, historical approaches to researching Black families in the United States, in particular, have fallen short and have not always captured families’ and children’s unique and varied experiences, characteristics, and outcomes. These approaches, or perspectives, broadly fall under three umbrellas and have heavily informed human services policies and practices. 1 legacy of slavery has created a Black family unit that is disorganized, pathological, and unstable, and at risk for poor outcomes across a wide range of domains. Implicit in this nar rative is an assumption that Black families are deviant because they do not mirror White middle-class families in structure or behaviors. n The second perspective also includes a focus on real or perceived deficits in outcomes for Black families, but places primary culpa bility on a long history of structural racism embedded in U.S. systems. In this perspective, cultural assets specific to Black families have helped them navigate discrimination, racism, and oppression to varying degrees of success, but the commonly employed definition of n The first perspective is one of Black families in disarray: According to this perspective, the

experiences can inform policy and practice that will, in turn, enable human services programs to better meet the needs of Black families and support their well-being. 2 A NewWay to Conceptualize and Use Research on Black Families With Children Child Trends—along with other researchers and organizations 3 —is actively attempting to shift approaches to research on Black families. Toward that end, we have developed a concep tual model that provides a new way to think about the various avenues by which research (including data) informs policy and practice, while also recognizing the demographic changes in, and varied contexts of, Black families (see Figure 1). The conceptual model recog nizes various levels of policy (on the left)—federal, state, and local—and the ways in which policies affect the systems, institutions, and organiza tions (in the center) with which Black families with children (on the right), interface. The arrows in the model indicate bidirectional and differential levels of influence between the model components, with solid-line arrows representing a stronger level of influ ence than dashed ones. The reduced level of influence represented by the dashed arrows from Black families with children toward systems, institu tions, and organizations recognizes the ways in which context—including historical discrimination, racism, and oppression—can limit the agency and power of Black families, despite their numerous assets, strengths, and efforts to ensure family well-being. This model can be used to guide research, including that which is undertaken by and for programs that serve Black families with children. Recommendations for Human Services Policymakers and Practitioners We contend that research that is grounded in the three historical per spectives shared previously—and that is not based on a conceptual or theoretical framework such as the one we have developed—can result in an incomplete picture of Black families.

success also tends to over-rely on White middle-class outcomes as the standard families should achieve. n The third perspective—that indi vidual Black families can navigate systemic racism with varying degrees of success based on their socioeconomic and cultural assets— focuses primarily on an intra-racial understanding of Black families, but often does not include Black immi grants and still tends to center White middle-class standards as aspira tional outcomes. While these points of view are much wider ranging and gradated than can be described in this space, their lack of nuance in approaching the study of Black families does suggest a need for shifts in perspective. Our work suggests that a forward-looking research perspective that more fully captures Black families’ diverse

The end result is the development and maintenance of policies and practices that may not benefit families, and could potentially be harmful to their well-being. We offer the following suggestions to strengthen the ways in which research and data can be used to inform policies and practices that better serve Black families who interface with human services organizations and systems. These recommendations focus specifi cally on the examination of personal perceptions and organizational culture, and on ways that human services professionals can be more intentional about how they collect, interpret, and use data and research. Maintain a curious and critical stance about research and data on Black families that are used to inform program policies and practices. Given the importance of research in policymaking and human services provision, we suggest that human services professionals draw on research that accounts for often-rapid changes in Black families’ demo graphics, circumstances, and assets and strengths. There is considerable diversity among Black families in the United States, and research that informs policy and programs should consider a range of family and house hold structures and characteristics. For example, much prior research on Black families has focused on family types such as female-headed households, even though Black children live in married, cohabiting, coparenting, and single-parent households (including single parents who live with an unmar ried partner or with another family). 5 Many studies of Black families have also been limited in terms of demo graphic characteristics, which has led programs to identify families simply as Black or African American without acknowledging that family members may be Black and another race, or may identify as Black and not from the United States—distinctions that may imply considerable differences in families’ lived experiences and access to resources. In short, policymakers and human services professionals who implement programs should draw upon national, state, and local research and data that attend to variation

Chrishana M. Lloyd is a Senior Research Associate at Child Trends.

Sara Shaw is a Senior Researcher for Chapin Hall at the University of Chicago.

Brent Franklin is the Editorial Director at Child Trends.

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Policy&Practice April 2022

Figure 1. Conceptual Model of the Black Family Research Agenda

history of affirming practices, such as including Black families and community members as partners. Because local and community context is critically important to high-quality human services provision, programs that wish to more comprehensively understand families’ needs should not simply use and review static statistics and numbers. Instead, to best serve Black families, whose cultural assets and shifting demographics are often not reflected in large-scale data sets, programs should engage with more thoughtful research that considers families’ voice and experiences. While researchers are typically not embedded in human services agencies, programs can partner with community-based researchers to conduct such activi ties and facilitate a more holistic view of the strengths, assets, and needs of Black (and other) families and inform the design of supportive policies and programming. 10 Guiding Questions As human services programs and professionals consider these recom mendations, we suggest that they use the following questions to guide their thinking about the best use of research and data to better serve Black families: n What are your personal values and how do they show up in your work? n How does the culture of your orga nization influence the ways in which you design policies and program matic practices? n What does your agency know about the families receiving your services? How do you know this information? n What doesn’t your agency know about the families that utilize your services? What would you like to know about these families? How might you learn this information? n What types of research, data, or other information are used to inform your program operations and policies? What is/are the source(s) of this information? Do they use a strengths-based and/or asset-focused perspective? Do they capture the variation of and in Black families? How often do you revisit these sources?

in Black families (family structure, living arrangements, economic status, gender, sexual orientation, disabilities, geography, religion, etc.) to develop a more complete understanding of Black families and potential intersections in their identities and characteristics. Examine assumptions and biases—especially the ways in which professionals’ personal experiences, values, and organizational cultures may affect their approaches to col lecting data, providing services, and making policies. Human services practitioners regularly collect, organize, and interpret information about families; identify and assess family strengths and limitations; and work with family members to develop goals and determine intervention strat egies. These activities and exchanges are generally in service of families, but also result in the creation of program matic data that are not value neutral. 6 For instance, an individual’s biases and worldview; their knowledge of families; and their agency protocols, procedures, and culture all influence the types of questions that they ask of families, the ways they interpret responses, and the steps they take to follow up. Human services agencies should dedicate the time and resources needed to reflect on how individual worker and systemic factors—such as biases and racism—may influence how they collect, interpret, and use data.

Ensure that analysis processes in human services programs are strengths based and asset focused. The ways by which program data are both collected and analyzed can result in ineffective policies and service provision for families that do not meet traditionally biased conceptions of family units. For example, when assessing a family’s living situation, some human services professionals might consider the presence of non nuclear family members or other people in a home as problematic. Families, however, might consider these other people to be assets—indi viduals that can be drawn on for emotional and other forms of support. 7 Without confirming families’ thoughts on their living situation, it would be impossible to know whether they welcome the presence of others in their home, or not. This issue is par ticularly salient for Black families, who according to research, often may live in multigenerational homes 8 and draw on extended family and others as sources of support. 9 This type of strengths based and asset-focused analysis should extend to other issues that may arise when working with families, particularly when engaged in activities such as conducting screenings, assess ments, and developing treatment plans. Initiate partnerships with racially and culturally astute organizations, or with researchers who have a

See Nuanced Research on page 27

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April 2022 Policy&Practice

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Stanford Social Innovation Review / Winter 2022

Centering Equity inCollective Impact By JohnKania, JuniousWilliams, Paul Schmitz, Sheri Brady, Mark Kramer& Jennifer Splansky Juster

Illustration by Julia Schwarz

A decade of applying the collective impact approach to address social problems has taught us that equity is central to the work.

n 2011, two of us, John Kania and Mark Kramer, published an article in Stanford Social InnovationReview entitled “Collective Impact.” It quickly became the most downloaded article in the magazine’s history. To

We also noted that these core elements would need to be adapted to the specific circumstances of each initiative. Over subsequent years, many practitioners and collective impact networks 2 have refined and expanded on these five original condi tions in helpful ways. 3 In 2016, together with the Collective Impact Forum—an initiative of FSG and the Aspen Institute Forum for Community Solutions to support practitioners of collective impact— we published eight additional principles of practice for implementing collective impact, which, importantly, included engaging community members and placing a priority on equity. Reflecting on the past 10 years, we have observed through our own personal and professional journeys and the experience of oth ers that the single greatest reason why collective impact efforts fall short is a failure to center equity. Thus, we believe that we must redefine collective impact to include centering equity as a prereq uisite. In this vein, we propose a revised definition of the concept: Collective impact is a network of community members, organizations, and institutions that advance equity by learning together, aligning, and integrating their actions to achieve population and systems-level change. To center equity, collective impact efforts must commit to a set of actions that we will explore in this article. What Is Equity? In committing to centering equity, we first confront the problemof inconsistent understandings of what equity means. Among many alternative definitions, each with its own virtues, the one we have found most helpful comes from the research and advocacy orga nization Urban Strategies Council: Equity is fairness and justice achieved through systematically assessing disparities in opportuni

date, it has garnered more than one million downloads and 2,400 academic citations.More important, it encouragedmany thousands of people around the world to apply the collective impact approach to a broad range of social and environmental problems. Indepen dent evaluations have confirmed that the approach can contribute to large-scale impact, 1 and a global field of collective impact prac titioners has emerged. Their efforts have immeasurably deepened our understanding of the many factors that can foster or stymie collective impact’s success. In the original article, we defined collective impact as “the com mitment of a group of important actors from different sectors to a common agenda for solving a specific social problem.” We further identified a structured process with five essential conditions that distinguish collective impact from other types of collaboration: 2. Shared measurement , based on an agreement among all partic ipants to track and share progress in the same way, which allows for continuous learning, improvement, and accountability; 3. Mutually reinforcing activities , integrating the participants’ many different activities to maximize the end result; 4. Continuous communication , which helps to build trust and forge new relationships; 5. A “backbone” team , dedicated to aligning and coordinating the work of the group. 1. A common agenda , shaped by collectively defining the prob lem and creating a shared vision to solve it;

Editor’s Note: This article is reprinted from the Winter 2022 issue of the Stanford Social Innovation Review .

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Stanford Social Innovation Review / Winter 2022

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Stanford Social Innovation Review / Winter 2022

ties, outcomes, and representation and redressing [those] disparities through targeted actions. 4 This definition speaks to the needs of many different groups and populations that function daily under structural constraints that have for generations curtailed their ability to thrive, resulting in severe and compounding marginal ization and oppression, regardless of where they live in the world. Only when collective impact efforts take the time to understand who has beenmarginalized and why and how they are experiencing marginalization, and, after such investigation, take targeted action to create policies, practices, and institutions that address current and historical inequities, will these communities be liberated to achieve their full potential. In what follows, we focus on racial equity, as people of color are often the most structurally, institutionally, and interpersonally marginalized in the United States and many other countries. 5 We believe, however, that focusing on racial equity also enables us to introduce a framework, tools, and resources that can be applied to other areas of marginalization—including disability, sexual orien tation, gender, class, caste, ethnicity, religion, and more. Exploring the marginalization of people along multiple identi ties can also create space for taking an intersectional 6 approach to the work, recognizing that those holding multiple identities (e.g., women of color) are often worse off than others. We encourage practitioners to examine local data and listen to the experiences of people in their community to understand which populations are most systematically left behind, and then to work with marginal ized populations to adapt the strategies shared here to improve their lives. Given the heightened awareness of racial equity at this moment in time, sparked in part by the May 2020 murder of George Floyd and countless other, similar victims of racist violence, the disparate impact of COVID-19 on people of color, and growing recognition of the debilitating consequences of entrenched structural racism throughout society, our intensified focus on equity will come as no surprise to most. The challenge that we and so many others are grappling with, however, is the question of how to center equity in the practice of collective impact. We hope with this article to offer specific and practical guidance to those participating in collective impact efforts on what they need to be doing differently in their work to achieve this goal. In particular, we believe that centering equity requires rethink ing the supposed facts that define the problem by recognizing that marginalized populations within any community have experiences that are very different from those of many individuals and organi zations who work to help them. As outsiders, we often don’t know enough to be as helpful or effective as we should be, so we need first to talk, listen, and learn. We have also come to recognize that collective impact has last ing effectiveness only if it is focused on changing underlying sys tems, not just adding new programs or services. Centering equity further requires diverse representation in leadership and specific strategies to shift power, so that those with formal power—in the United States and much of the Western world, mostly white and male—are able to engage with, listen to, share power with, and act on the wisdom of the community. Finally, everyone involved must recognize and take personal responsibility for their own roles in

JOHN KANIA is the executive director of the Collective Change Lab. He was previously global managing director at FSG, where he continues to serve as a member of the board of directors. JUNIOUS WILLIAMS is the principal of Junious Williams Consulting, Inc., and a senior advisor to the Collective Impact Forum. He is the former CEO of Urban Strategies Council. PAUL SCHMITZ is the CEO of Leading Inside Out and a senior advisor to the Collective Impact Forum. He is also the author of Everyone Leads: Building Leadership from the Community Up .

SHERI BRADY is vice president of strategy and program at the Children’s Defense Fund. She was previously the director for strategic partnerships at the Aspen Institute Forum for Community Solutions. MARK KRAMER is cofounder and senior advisor to FSG and a senior lecturer at Harvard Business School. JENNIFER SPLANSKY JUSTER is the executive director of the Collective Impact Forum.

perpetuating and correcting inequities—a process of inner change that is often overlooked.

How Equity Transforms Collective Impact Centering equity alters the way practitioners implement collective impact. Consider the collective impact initiative Chattanooga 2.0, which launched in 2016 in Chattanooga, Tennessee, and works to ensure that all children and youth receive a quality education and promising career opportunities. The effort named equity as a desired outcome from the start, but participants neither fully understood this nor proactively addressed it until the nation’s recent racial jus tice awakening led them to recognize that an entirely new strategic plan was required. “Part of the issue was that our community didn’t have a shared lexicon about what equity meant, and so often community division seemed to hinge on semantics, instead of the actual issue at hand,” says Molly Blankenship, the white executive director of Chattanooga 2.0’s backbone team. A new strategic planning process to set the com mon agenda fielded a much more racially diverse, cross-sector group of residents and leaders that incorporated community input and explicit public commitments to action on racial equity. Chattanooga 2.0 also changed its governance structure to increase racial and positional diversity and to ensure transparency. All members of the coalition were asked to sign a public letter committing to equity in both process and outcome. Chattanooga 2.0 also restructured its measures of progress to disaggregate data by race, revealing stark differences within the community. They explicitly named and addressed power imbalances that affected communication and relationships among participants, thereby shifting the internal culture to ensure that contributions from all members of the collaborative were valued equally. They also focused on building empathy and understanding among leaders engaged in the work, especially those who lacked direct experience of the issues. “As power accumulates, the ability to relate to those who have been disenfranchised and disempowered often dimin ishes,” Blankenship says. Chattanooga 2.0’s attention shifted from programmatic inter ventions to more systemic changes, such as working with the city of Chattanooga to transition from a patchwork of providers to a more coordinated and aligned early-childhood educational system. Even the backbone team had to reconceptualize its role. With the support of her executive and steering committees, Blankenship stepped into a new capacity.

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Stanford Social Innovation Review / Winter 2022

“As a white leader who feels a great deal of onus in this work, I can provide cover for coalition members to do bolder work,” she says. “I can utilize my privilege to make space for and elevate the voices of BIPOC [Black, Indigenous, and people of color] leaders and community members. And I can use my own voice—the platform and political capital I’ve been afforded—to speak the truths that need to be spoken, to stand in the crosshairs, where appropriate, and be helpful to our coalition’s beneficiaries.” Blankenship’s experience highlights the steps required by those with power to center equity in collective impact and better serve the communities they seek to help. Without explicitly articulating the work to center equity and making space to do that work, col lective impact efforts will fall short in their potential to dismantle long-standing inequities, repair historical injustices, and advance better outcomes for those who have been left behind. Five Strategies for Centering Equity Fortunately, many collective impact efforts around the world have already made progress in centering equity. In studying equity focused collective impact efforts across regions and issues, we see five strategies in particular emerging as critical to centering equity: 1. Ground the work in data and context, and target solutions. 2. Focus on systems change, in addition to programs and services. None of these strategies is new, yet they remain areas that require understanding and commitment to do well. Taken together, they form the basis for a comprehensive and integrated approach to centering equity in collective impact. Let’s consider them in turn. Strategy #1: Ground the work in data and context, and target so lutions. | Grounding the work in appropriate data and context re quires that participants in the collective impact initiative develop a new and shared understanding of terminology, history, data, and personal stories. Manywidely accepted but false and damaging nar ratives in our society are used by those with power—intentionally or not—to conceal structural racism. Long before analyzing data or proposing solutions, participants must create a shared language of agreed definitions about race and equity. 7 Further, participants must share a more accurate understand ing of the origins and nature of existing inequities. This awareness must include an appreciation of the difference between structural racism and personal blame, as well as the development of empathy beyond individual feelings of guilt among the privileged or shame among marginalized people. Effective anti-racist equity work almost always starts with a deeper understanding of history. We see this strategy in the work of Zea Malawa, MD, a Black female public-health professional, practicing pediatrician, and mother who leads Expecting Justice, the backbone for a collective impact initiative focused on improving infant and maternal health among Black and Pacific Islander families in San Francisco. Despite the city’s wealth, one in seven Black babies is born prematurely— 3. Shift power within the collaborative. 4. Listen to and act with community. 5. Build equity leadership and accountability.

double the rate of white babies. Since its inception, Expecting Justice has oriented its entire effort toward addressing racial inequities as the root cause of disparate birth outcomes. “I always try to think about how we might make anti-racism seem irresistible,” Malawa says. Her team begins by ensuring that all participants understand the history behind the data. “People can identify that others may be poor, and that their health is suffering because they’re poor, but most times they can’t tell you why,” she explains. “And in the absence of being able to describe why, people come up with really racist cultural assumptions.” To reframe the issue, Malawa highlights critical moments in American history, from the time of slavery in the United States to modern forms of oppression that have denied Black people the opportunity to fairly participate in American economic progress. 8 Deliberate government endorsement of redlining practices in financ ing homeownership after World War II, for example, is the reason people of color were segregated into impoverished neighborhoods and denied access to homeownership, and thereby cut off from the primary source of intergenerational wealth for white middle-class families. Malawa shows redlining maps from decades ago that pre cisely trace the outlines of low-income neighborhoods today. Malawa offers further help to those leaders in the Expecting Justice effort who do not have much direct experience with the community the initiative serves so that they better grasp the drivers of inequity. For example, she constructed four different scenarios illustrating structural barriers for women facing childbirth—on a spectrum from racially marginalized to racially privileged, and then engaged steering-committee members in developing a “map of understand ing” for the expecting mother in each scenario, highlighting how the obstacles and challenges increase for racially marginalized mothers. False narratives live not only in history but in the data we col lect today. We are accustomed to describing society’s problems with aggregate data: the national unemployment rate, high school graduation rates, the number of people living below the poverty line, or the percent of neonatal fatalities. Aggregate data, however, mask variations by characteristics such as race and ethnicity, gen der, age, sexual orientation, income levels, and geography. Unless the data is disaggregated, we cannot truly understand problems, develop appropriate solutions, or document progress. For example, we witnessed the harm that can arise from the failure to disaggregate data and target solutions during the COVID-19 pan demic, whenmany jurisdictions were not collecting and/or reporting infection rates or testing data by race and ethnicity and learned later about disparate and possibly preventable rates of illness. 9 Simply obtaining disaggregated data can pose a challenge, because they are often not collected with sufficient specificity, such as data collected for “Asians” without specifying national origin. The lack of precisely disaggregated data conceals many problems and can result in ineffective programs and policies. One important systemic change that can come from collective impact efforts is advocacy to public agencies, researchers, and other custodians of administrative data sets to improve the precision of their data col lection and reporting practices to support more equitable analysis and more targeted solutions. Disaggregated data are essential but not sufficient. Centering equity in the work of collective impact requires a more holistic

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and culture that consistently produce, and often were designed to produce, racist or otherwise inequitable outcomes. Systems change is an often discussed but little understood con cept. One framework that has proven useful to many collective impact practitioners is to consider system changes at three levels of explicitness. 11 First is the level of structural change: shifts in policies, practices, and resource flows. This level is explicit, in that people engaged in the system can readily identify these conditions. Second is the level of relational change—specifically, relationships and connections, and power dynamics among people or organiza tions. This level tends to be semiexplicit in that sometimes people can see these dynamics and sometimes they happen out of sight of some players in the system. The third level of systems change is transformative change—the mental models, worldviews, and narratives behind our understanding of social problems. This level is typically implicit in the effort but has the most power to guide individual and system behavior over the long term. When engaging in systems-change work, many people and organ izations invest the bulk of their time and resources in attempting to change conditions at the first level. Such structural solutions are important. However, changing structure without shifting relation ships, power dynamics, and mental models can lead to irrelevant, ineffective, unaccountable, and unsustainable solutions. This tendency particularly holds if the solutions were developed in a context where marginalized groups had no voice and power. Collective impact efforts must therefore work concurrently at all three levels of systems change in order to bring about deeper, more sustainable change. While systems-change work is essential to achieving equity, pro gress is typically longer term and not visible to community members who are struggling today. Interventions that improve programs and services meet people’s needs now and often keep residents and com munity members active in the collaborative’s efforts because their impact is more tangible and relevant to people’s daily lives. Pro grammatic work also can inform the structural, systems, and policy changes needed to achieve larger outcomes. Most high-capacity col lective impact efforts work at both programmatic and systems levels in ways that center equity. Expecting Justice provides one example. In its programmatic efforts, Expecting Justice works to strengthen and expand existing programs to meet more immedi ate needs of Black and Pacific Islander mothers in San Francisco. For example, Expecting Justice cultivated funding to support and expand the offerings of SisterWeb, a San Francisco community doula network. Research shows that doula care contributes to improved labor and delivery outcomes, especially for low-income women of color, and expanding this program has potential for immediate ben efit for parents in San Francisco. In its systems efforts, Expecting Justice is engaged at all three levels of systems change. At the structural level, Expecting Justice is launching the Abundant Birth Project—a pilot program to pro vide unrestricted supplemental income during pregnancy and for six months postpartum to Black and Pacific Islander mothers in San Francisco. This guaranteed income for mothers during preg nancy is the first of its kind in the United States, paving the way for a broader, state-funded basic income program in California, and its impacts will be studied for further policy implications for San Francisco and beyond. At the relational level of systems change,

understanding of the life experience of marginalized populations that can come only from interviews, surveys, focus groups, personal stories, and authentic engagement. Too often data sets, particularly data sets that are solely quantitative, fail to capture important con text that only the people most impacted and those closest to them know, and groups interpreting the data do not often include those with lived experience whenmaking sense of the data. To address this problem, many collective impact efforts begin with “data walks,” in which all participants in the collective impact effort, including organizational leaders and residents with lived experience of the issues, review easy-to-understand visual data and together ana lyze, interpret, and create shared meaning about what the data say. Expecting Justice has made putting data into the appropriate context a core principle of its work. A majority of its steering com mittee is composed of white leaders from government agencies and other large organizations, many of whom have limited direct contact with mothers and families, but it also includes several Black and Pacific Islander mothers. The backbone team recognized the need to elevate these mothers’ experience as essential data and spent several months building trust and relationships with the group to create space for them to share their stories as part of the steering committee’s context-building work about preterm birth. The very act of seeking out and listening to stories from the affected group can provide a foundation for building trust with community stakeholders. Active use of stories can also serve to locate and center the narrative for change in the community. This step can shift conversations about solutions frommore conventional programmatic responses to more systemic solutions focused more concretely on achieving greater equity. Once collective impact efforts have drawn sufficient insight from historical context and disaggregated quantitative data and qualitative data outlining the experience of those being marginalized, partici pants must target strategies differentially to subgroups to achieve better community outcomes. The targeted universalism approach of john a. powell, of UC Berkeley’s Othering & Belonging Institute, demonstrates one way to operationalize racial equity through tar geting interventions to subgroups. “Fairness is not advanced by treating those who are situated differently as if they were the same,” powell says. “A targeted universal strategy is one that is inclusive of the needs of both the dominant and marginal groups but pays par ticular attention to the situation of the marginal group.” 10 Targeted universalism importantly argues that our goal should be not just reducing disparities but moving everyone to better out comes. If only 50 percent of white children read at grade level and 30 percent of Black children read at grade level, closing the disparity still leaves 50 percent of children below grade level. We may have a universal goal for our community, such as reading proficiency, but we need to understand the different barriers various subgroups face and tailor our strategies and resources to address those specific barriers. Failing to target interventions is likely to maintain, and sometimes exacerbates, the existing disparities. Strategy #2: Focus on systems change, in addition to programs and services. | Equitable outcomes and solutions that focus on address ing root causes of social problems at a community, regional, or na tional level cannot be achieved one program at a time. They require deeper changes in public and private systems, structures, policies,

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