- Hello everyone. Welcome to the 19th installment of Building Health Equity Webinar series, Building Community Partnerships to Achieve Health Equity. Today's objectives are: to discuss current issues and concerns related to building community partnerships from the health equity perspective, address certain populations that face barriers to community partnerships and explore any potential partnerships or strategies to successfully initiate community partnerships to build health equity within a community. I'm Tricia Kitzmann. I am faculty here at the University of Iowa College of Public Health. I work with the Institute for Public Health Practice, Research and Policy at the University of Iowa College of Public Health. Just some house cleaning or housekeeping. This is being recorded, so please note that this is being recorded for later viewing. We will periodically stop throughout the presentation today to see if there's any questions and answer anything or again, engage in the conversation to make sure we address some of your questions and giving you, when you leave today, the information you're looking for. We'll try to get to as many questions as we can, as time allows. I do encourage you to use either the Q&A or the chat. Right now, please introduce yourself. Tell me your name, where you're from, and what organization you work with. And I will invite our guests to also do the same. Jacquie, do you wanna kick us off?

- Sure. My name is Jacquie Montoya. I am the public health program planner at Linn County Public Health in Cedar Rapids, Iowa, or Linn County, Iowa. And I primarily work on planning the community health assessment and the community health improvement plan at Linn County Public Health.

- Wonderful. Welcome, Jacquie. Monika, you wanna go next?

- Yes, I'm Monika Jindal. I'm the medical director at the GuideLink Center, which is a behavioral health access center in Johnson County. That's a third of my role. I'm also double boarded in family medicine and psychiatry. And so I have a little bit of a family medicine practice in Riverside, Iowa, which is in Washington County. And then I'm also the program director for the Family Medicine and Psychiatry Residency. So I have a little bit of an education component to my role as well.

- Wonderful. Well, thank you both for agreeing to spend an hour with us today. Really appreciate it and looking forward to digging into some of the questions that we have for you guys. So you kind of introduced yourselves already, but let's dig in a little bit deeper. Can you gimme a little bit more about your background? How did you get involved in this area of work and what do you do? Kinda what does your day-to-day look like? Monika, do you wanna kick that off?

- Sure, absolutely. So I, gosh, so I guess let me start with giving you a little bit of context for GuideLink. So GuideLink, like I said, is a behavioral health access center. Access centers are written into Iowa Code to provide crisis support services for someone experiencing a mental health crisis or a substance use disorder crisis. It's for folks that are too sick to remain kind of in the community in typical kinda outpatient care, but maybe not sick enough to quite need the hospital level of care. And so it's for folks to kind of have a safe place where they can go and receive support for, you know, their mental health concerns or their substance use disorder concerns. So we have crisis stabilization services, we have some immediate crisis support services. We have medically managed withdrawal services, or formerly called kinda detox or detoxification services. And then we also have a sobering unit there. And so as the medical director, I oversee some of the medical components to those services and one of the things that we very much pride ourselves on at GuideLink Center and work really hard at is development of these community partnerships, really considering who our stakeholders are and who our consumers are and how can we best meet their needs and serve them, particularly in navigating the really complex and unfortunately under-resourced mental health landscape and substance use disorder landscape that exists really everywhere, but certainly here in this state. In terms of how I got interested in this work, you know, I think some of it comes from that background, like I said, in family medicine and psychiatry and really just seeing some of the health inequities that can occur, particularly in folks that have severe mental illness or have substance use disorders and just really thinking about how can we serve them better, how can we meet them where they are, as opposed for waiting for folks to come to us 'cause I don't think that works very well. And so just really thinking about how can we be innovative with how we are best able to help people.

- Wonderful, thanks Monika. Jacquie.

- So I kind of come from a social services background. I actually have a degree in Ethnic Studies, American Studies from University of Iowa. And I've always been interested in diversity and inclusion. So it kinda has melded in with working with caregivers of young children for the last, I don't know, 14 years or so. And then I just started with public health about two years ago and health equity has just kind of naturally been part of this. And as a program planner, I basically plan programs. I work with our four focus areas, currently we have four, for community health improvement plan and just look at ways we can support efforts that are already going on in Linn County, but also look at ways that we can maybe reach out to underserved populations or populations that we aren't necessarily engaging in the process of our community health assessment and community improvement plan and best ways to reach people and get them involved in the work that we're doing. And that's kind of what I do on a day-to-day basis, is just look for opportunities to talk to people, engage with people and get them engaged in our processes.

- Wonderful. Well, we're excited to have both of you here. Can you share a little bit more about some of the projects that your organization is currently involved in within your communities? Jacquie, you wanna kick this off?

- Yeah, I can talk about a couple of things that we're currently working on. One of the areas, well, one of the programs we're currently working on, and it actually just opened, is Chain Reaction by Bike Hub, which has been a huge collaboration in our community. And it's kind of a community bike program where we've been getting bicycles from the landfill that people are just throwing away and we're taking those and upcycling them and they will be available for at-risk youth or our unhoused population or any referral or a voucher through social service agencies for people to get bicycles. There's a couple of ways. I mentioned the voucher, but there's also sweat equity. They can earn a bicycle by volunteering and working on their own bike. So it's also, they'll have a mentor. So they're kind of using the bicycle as a conduit to teach social skills, some of those soft skills that are good for employment. Also giving at-risk youth or any youth something to do other than, you know, just look for trouble or wait for trouble to find them, give them something positive to do. And also helping them skill up so that maybe it starts a career path. You know, maybe there'll be a bicycle mechanic, which is in high demand, or maybe we're working with Kirkwood to, hopefully they have some sort of track that they can kind of go through a certificate program. Maybe it's a diesel mechanic or welding or something like that. So giving some options. And it has been just a huge project that in a year actually heard about the Iowa City Bike Library on one of these Building Health Equity webinars. And it went from there a year ago and it just opened to the public May 1st. And so we're very excited to see where that goes. There's a lot of components to that, and that's just been a huge project for the last year. We also have a collaboration that has been going for many years, the Together Healthy Win, which helps with our CHA CHIP process and it has many different members of the community as part of that. We also have our Prevail Grant, which is from the CDC, and that again kind of works with at-risk youth, youth that are involved in group violence or have been identified that they might be heading into that. And that has been kind of in parts of all of the different programming that we're doing to kind of help change that trajectory a little bit in our community.

- Wonderful. Thank you, Jacquie. Monika.

- Yeah, so GuideLink Center is involved in several projects, but also kind of, I would say multiple, system of care type of groups or advocacy coordination, kind of collaborative groups. So one of the recent things that we recently got a grant to work on is development of immediate access to care for folks at high risk of violence. And so working closely with the criminal justice folks to identify some of those people. And so how can we get them into care quicker rather than having long waits before they can see a mental health provider, whether that's a psychiatrist, a psychologist. So we are still working out the nuts and bolts of that program, but we've been working on trying to find ways to get folks, like I said, wrapped into some immediate access to care, to like a care manager, to a med provider, and to a therapist or psychologist or counselor or somebody for therapy as well. So that's kind of one piece that is relatively new actually. We're still kind of working with the grant distributor to figure out what components of that we can put together, but that's kind of one piece. And one of our partners, like I said, there is working with folks that are criminal justice involved to help keep them out of, you know, to keep them outta jail or prison if possible, by being able to treat their addictive disorder or their mental health issues. Other kind of collaborative efforts that we're involved in we work with a monthly system of care group that meets in Johnson County to identify some of the gaps in the mental healthcare system and really brainstorm ways that we can try to address some of those gaps. This involves a lot of community stakeholders. So like, again, some criminal justice folks are there, like the Sheriff, Johnson County Sheriff is often there. There's representation from Johnson County Ambulance Service. There's representation from local community groups. There's representation from a parent of a loved one with mental illness. There is Community and Family Resources who is our community-based substance use disorder program. I'm leaving out a bunch of people. There's representation from the university, which around here is also a big player in that landscape. The East central region who oversees some of the funding for mental healthcare for our area, including Linn County as well, is also at those meetings. And so really just getting all of those community stakeholders at the table to really identify what are some of the gaps and what can we do to address some of the gaps. And that's actually how GuideLink was developed as well, that process started I think if you look at some of the data or some of the information like 15 to 20 years ago where people started thinking about this programming. And so it's really kind of the second iteration of that, of what are the gaps that remain and how do we continue to work towards those. And I think, you know, from a health equity lens, certainly being mindful of the population that we're serving and understanding that, you know, even at GuideLink, about a third of the folks that we see are unhoused, about two-thirds of the folks that we see have Medicaid, a percentage of folks are uninsured or underinsured as well. So just really acknowledging that the people that are most likely to fall through some of those gaps are people who are experiencing some of the most inequities there. Another collaborative group that we're involved in as well, we actually host monthly meetings with all the access centers in the state so that we can kinda share some of the things that are working, not working, be on the same page about some of like the legislative things that are coming down or policy things that are coming down. And I think in that way we're able to also information share like, "What are you doing that's working? Oh, we haven't tried that. Let's see if we can try that instead." And through some of those kind of communications, we've been able to develop, for example, finding a way for ambulances to be able to bring people to GuideLink Center rather than the hospital where hopefully they can get more immediate access to care, particularly, like I said, for those first responders. So for us, a lot of what we do is work around, how do we develop some of these community collaborations so that again, we can kind of best serve people and again, the system that has a lot of holes and has a lot that can use some additional support.

- Wonderful, thank you. Yeah, it's, there's gaps, right? That's part of our job is to identify where those gaps are and try to fill those gaps. So thinking about this, what are some of the issues and concerns related to building community partnerships from a health equity perspective? I think we use the term health equity a lot, but might not necessarily be hitting the nail on the head when we are really trying to build those partnerships. What strategically do you do to start making sure that you're addressing health equity when you are building these partnerships within your community? Jacquie, you wanna kick us off?

- Yeah, sure. I think one of the most important things is to consider who you're trying to reach and then reach out to either agencies, or individuals, or groups of people, whoever you can kind of strategize who you wanna reach out to that will be most effective engaging who you're your audience is. I think you have to get buy-in from people and they have to trust you. And that sometimes is, especially I think at public health, there's a distrust sometimes or a not knowing. And so you have to reach out to the people that they do trust, that the community trust, and then then use them as an ally and just say, "You know, can we talk?" And identify, what are the concerns? What are the things that they are really dealing with? Because I can sit back and say, I think this is what this population needs, but I don't know unless I have similar lived experience or that I, you know, have a good insight into what they really do need. So I think, you know, just engaging community-based organizations that serve populations you're looking to engage. One of the things that we've done in Linn County Public Health is our health equity coordinator, Ann Carter, and I have done these things called community conversations and we just have gone to different organizations and it was mostly at the beginning, her and I just kind of saying, "I know a person here, I know a person here." And we went and we talked to, some were churches, some were, you know, other organizations, small groups, groups in the community and they just wanted to know more about what Linn County Public Health did, but also our CHIP process and how they could get involved in our four focus areas. And we've seen a large increase in some of those populations being involved now in our next iteration of our community health assessment. And that brings those voices to the table and it's nice to have that diversity in the room when we're discussing things, somebody to say, "That's not quite really we're seeing, here's what we're really seeing," and let's focus on that. Or in the case of our mental health focus area, you know, we obviously identified we can't create therapists and we can't create prescribers in a three-year iteration. And it really has come about that we're focusing on those community supports, those peer-to-peer networking, those peer-to-peer specialists. And those are things that we can support. We can, you know, connect organizations with the state training for peer specialists and kind of have a baseline there, at least, for anyone to access. And of course most people are comfortable with people who share a live experience or look similar to them. So it's a really, really good way to get that initial step into mental health care and you know, then moving on to, "Okay, you need a little bit more than I can provide, so let's look for that," and have trained people who know where to go from there.

- Jacquie, you talked about your CHA CHIP, your community health assessment and your community health improvement plan has four target areas. What are those four target areas?

- Our current iteration, which will end December 31st, 2024, the focus areas are food security, mental health, equitable opportunities for physical activity and gun violence prevention. And so obviously a lot of those things coexist, and/or we've seen an increase in issues with food security, mental health, but it's, you know, we're in the process of doing our next iteration and I believe many of those things will still be on the next iteration 'cause we can't solve those big problems in three years, but we're working towards making headway hopefully.

- Awesome. Thank you. Monika.

- Yeah, so I agree a lot with Jacquie with what you were saying too in terms of going to those community organizations, going to those community stakeholders, really having those conversations, asking them like, "What are the challenges that you're facing? What are some of the things that you would like to see? What are some of the ways that we can help and be of service," finding some of those shared missions, goals, beliefs, finding some of those shared challenges that you both really wanna work on, I think really helps because I agree we could think like, "Hey, this is what we're seeing and this is the problem." And sometimes you go to those community organizations and they're like, "Oh, we can actually help with that. We have a pretty good system for this." And so you're like, "Oh cool, that was a good connection, and really helped me work through that and let's find something else that maybe we can work on and work towards." And so it's really being quite deliberate with some of those efforts. And sometimes it feels like being kind of annoying about those efforts to continually reach out to someone and say, "Hey, let's find the time to chat, even if it's like quick, even if it's, you know, whatever, but let's find a time. I'll come to you, you tell me kinda how to make that work the best." But sometimes that is kinda what it takes. And you know, I'm thinking, particularly when we first opened GuideLink, for example, I mean we were meeting with the emergency rooms once every other week or so to see if there was anything from their perspective that we could do differently to help serve folks. We were meeting with law enforcement weekly. We continue to communicate and collaborate regularly with like Shelter House, with Community Crisis Services. Actually, Community Crisis Services is also in the building. And so that kinda helps with some of those collaborations as well. So really just being pretty deliberate and thoughtful and mindful about having some of those conversations, identifying some of the challenges that, you know, that you're facing and that they're facing. And I would also kinda... Along those lines, I think, one, you have to be very deliberate about addressing some of those health inequities, but I think also if you really look at some of those challenges that you're facing, I think at the, I don't wanna say at the root of some of 'em, but I do think there will inevitably be some health equity issues at play as you're looking at some of those challenges, right? Because some of them are coming up because of ability to access care. Some of them are coming up because of, you know, again, substance use disorders or mental health issues getting in the way. Some of them are coming up because of transportation issues with accessing care. They're coming up because of insurance and under insurance. They're coming up because somebody is, again, overly criminal justice involved and they've been, you know, kicked out from 14 other places and nobody wants to be able to take care of them, right? So like at the heart of so many of those things, there is, you know, health equity at play. If you are really able to go to some of those community organizations and figure out what are the challenges they're facing and how does that kind of meet with some of the things that you can offer so that you can work together on some of those challenges.

- Right. When we talk about, you know, building those partnerships, are you seeing or have either one of you or your organization had any or witnessed any maybe population, subpopulations, or partners that are maybe not benefiting or not being involved or have not been actively involved? And are there suggestions you have to including these partners? I know, Monika, you kinda talked about being that squeaky wheel, right? Like constantly saying, "Hey, we wanna meet, we wanna partner," especially when you're first, you know, building that trust or building that relationship. But are there other partners or other organizations that you have experienced that may be more hesitant and maybe need additional probing or additional support to be seen as a community partner?

- I would say, I mean, I can think of a couple or probably more, but I'll keep it to a couple. One would be the immigrant and refugee population. I think again, it goes down to cultural beliefs. Maybe, you know, the country that they've come from, there's a big distrust or there's definitely a very different concept of medical care, and even, you know, like vaccinations. Like there's a very, "I'm not sick, why do I need a shot?" You know, it's just, you know, kind of trying to walk through some of that. And so getting them engaged. Sometimes I think with any population it's the unknown. "We don't know what your process is. What are we gonna get involved in? What am I signing up for? How much time is this gonna take me? Am I gonna feel uncomfortable there?," I think. And one thing that we've talked a lot about is going to where people are at, and not expecting them to come to us. Sometimes, people, they feel more comfortable in a place that they're more familiar with, whether that's their home, their church, their school, their community space, whatever that is, versus "Come to the Harris building," you know? It's, you know, maybe a little bit scary if you've, you know, not been there. So definitely I would say the immigrant refugee. We've also seen engagement with Crush, which is a local addiction support and recovery group. They've really become involved in the last few months with a lot of our efforts and attending meetings and giving that input. We've also seen, oh, a total, oh, you know, the unhoused population. I think a lot of times they're kind of a forgotten entity that we forget that they have a lot of lived experience that they're very willing to share and they can, you know, help us understand what is best to support you, what is best to help you. And again, with the bike program, that has definitely been something we've looked at, because this transportation for them is their bicycle and they don't always have the resources to fix their bicycle the way it may be needs to be fixed. So this way, they will have access to tools, workbench, parts, someone who is a trained mechanic that can maybe even help them with that. And so it also gives them an opportunity to possibly be involved in the work out the . So then it's giving them a purpose, something to go to every day. So I think those are just a few populations that I really can think of that can sometimes be a challenge to engage, but we really have learned a lot from engaging those populations and hearing from them what their needs are.

- Monika, ?

- I would echo some of that, all of that. I would also kind of add, in addition to kind of that immigrant and refugee population, also folks who are not English speaking I think is a very challenging population to engage and often doesn't seek care. And when they do seek care it's, you know, hard to find appropriate interpreter translation services. You're often resorting to using a family member and it's not clear if you're really getting the history from them versus getting the, you know, who's really telling that history. So you know, just kind of also adding that other group to kinda immigrant and refugee population. But I'd say for folks that are non-English speaking would be another population that I think has been difficult, difficult to engage. Like it's just their, again, I think you need some of those people with lived experience or, you know, some of the people that are able to really engage some of those populations. I know for us at GuideLink kind of agreed going back to where people are and meeting them where they are because I think, you know, I think particularly when we're talking about healthcare, I try to be really mindful of the fact that, particularly in also mental healthcare, a lot of minoritized populations don't have a good view of healthcare and mental health care and rightly so sometimes, right? Like they have been, you know, subjected to some pretty unfortunate things at times. And so being really mindful of kind of some of that mentality coming in and trying to be very approachable and kind of meeting folks where they are. So for us, like thinking about, we've recently been trying to collaborate a little bit more with the like interfaith coalition thinking about, you know, heading to churches or places of worship where people are and may feel more comfortable. And again, they're not in our space, we're hopefully in theirs a little bit. It might be a way for us to just kinda say, "Hey, here's what we can do if you're interested." Interestingly, we've also reached out to the business community a little bit because I think sometimes, particularly in the work landscape we're seeing right now, we're seeing folks that are highly stressed. We're seeing people going to their bosses with mental health concerns that don't really know what to do with that. They've not received any training on what to do with that. So really being able to share some of our resources and what we're able to do within that community as well. I think that's another one that you don't think much about, but I think it's another one where people kind struggle with how to manage some of the mental health concerns that come their way as well. So, yeah.

- Great. No, I agree. I think it's easy to overlook subpopulations that are more vulnerable, that are harder to reach, but it's also easy to forget to include our community partners that are private and public business, right? Because they also have maybe employees, loved ones, friends, family that are also needing support in various sectors, whether we're talking mental health, maybe food access, et cetera. So great to make sure we're involving many organizations from across our community. What makes community partnership successful? How do you guys define success in your definition when you're looking at building community partnerships and what are some of the community partnerships you felt have been successes in your line of work?

- I can start this one off.

- Fantastic.

- Yeah, I think, I mean, first and foremost, I think is kind of an openness and a willingness to collaborate, which seems really simple, but sometimes I think there has to be this willingness to kinda break down silos. There has to be this willingness to kind of, you know, not just say, "This is my thing and this is what I'm gonna do," but kind of understand that like, there are a lot of kinda issues at play and how can we help each other so we can ultimately help people and help take care of people. And so just coming into it with that type of an understanding and working with other organizations that have that type of an understanding. I think there has to be, again, kind of a willingness to address some of the health equity issues and a willingness to acknowledge some of those, to be able to really kind of tackle some of those. I think openness in a lot of ways. And what I mean by that is, like I said, sometimes you have to be like the squeaky wheel, but you can't like always have to be the squeaky wheel 'cause then that gets to be really challenging when it's kinda like, "Hey, this, what about this? What about this? What about this?" And then you kinda don't hear anything back. So that kind of like open communication and being able to have some of that communicativeness. And then I think also like owning part of that yourself. And what I mean by that is you also then like, we have to be reliable, we have to be responsive. It's a two-way street. And so really recognizing that we also have to do our part to maintain that, that relationship and that collaboration.

- I agree. I think that we definitely have to have that willingness to compromise sometimes. There's more than one right way to do things. And when you bring a group of people from very different backgrounds, different expertise, different strengths, different weaknesses, sometimes you just have to learn. It's good people skills, basically. You have to learn when to give and when to take, you know? And I think just identifying partners that might be outside what you normally would work with. Again, I think it goes back to the way we've always done things. If you do things the way you've always done it, you're going to continue to get the results that you've always gotten. So just thinking a little bit outside the box and not seeing any sector as the enemy. Maybe enemy might be a strong word, but somebody that you can't collaborate with. With the bicycle program, one of the, actually the very first people we talked to were the bicycle retailers in Cedar Rapids area. We didn't wanna step on any toes, we didn't wanna be like, we aren't replacing your program and nobody knows the bicycle community better and what it looks like, the landscape in Linn County, better than the people who are selling the bicycles. And resoundingly, they were just like, "We wholeheartedly support this. This is amazing. We wanted to do this. We just didn't know how." Because they also recognized that while they sell really good quality bikes, not everyone can afford that. And they want to get those good quality bikes in the hands of people who can't afford it. So how can we do that? And they have been our biggest supporters. They continue to, not just through donations, but also work, volunteering, things like that. So, you know, thinking outside the box. Coming from a social service background, retailers aren't always the people I think to collaborate with. I might go to them for funding, but I don't necessarily think, hey, they're gonna be at the table when we're talking through these things. And so I think there's many, you know, along with the populations with lived experience, think about who best knows the community, whether it's the population that you're trying to reach or just the community as a whole. Like who knows what's going on in the community? And again, openness. Just I tend to meet people in very strange places that I end up collaborating with, and there's many stories I could share about that, but just being and going places. I've gone to picnics to support a nonprofit to get to know more about what they did. And that is a very different environment than having a meeting in a boardroom. You know, you get to see them in action and you get to see what they're doing. And so I think stepping outside your own comfort zone is a little bit of what that collaboration looks like also.

- Sorry, can I jump in because I... Sorry, Jacquie. You gave me some ideas too. I think some of it too is like you have to step outside your own comfort zone and you have to be willing to be pretty humble at times. Like you have to be very willing to be like, this person knows some of this landscape better than I do and I need to just like stop and listen. And I'm thinking of, you know, for me being in like the medical field, I know the medical system pretty well and going into this kind of community-based setting with these community-based providers who sometimes are used to operating without a physician on site, like that just blew my mind. I've never been in an environment where there's not a physician on site. And so really just taking a step back and asking a lot of questions from a place of like, "Help me understand, because this is fascinating to me." So I'd also say maybe from a place of curiosity sometimes too, to be curious about, what are they doing? How are they doing it? You know, what makes it work? You know, as I was describing this to someone, actually earlier this week, you know, I think there's some things that certainly I can bring as like a medical provider, prescriber, you know, my clinical skills and what have you. But as Jacquie said a couple times too, you know, having focused with that lived experience, I can't bring that, I can't bring that in the same way that they can into, you know, that clinical encounter. And so really recognizing the skill set that other people bring and having to be really humble within that, to be able to ultimately collaborate and again, like meet people where they are and really... And I think it's all the more important when you're dealing with communities that have faced some inequity and injustice because they don't, like, they're not gonna relate to me as well. They're not always gonna do what I say. And sometimes like the community organizations have been doing some of this work for a long time. And so really kind of, yeah, like working with them, but having to really kinda set aside what you think, you know, sometimes, and then being willing to kind of mold what you're thinking and that, you know, to really take that in and have a new way of being able to look at things differently, I think is really crucial sometimes to some of this work too.

- And then now something you said made me think of something. I totally agree going into it with humility, but also building up the person or the people that you're trying to engage because a lot of the people with lived experience that we're trying to engage in things have been told that their lived experience is not important. And so just getting them to realize that, "You bring something to the table that I can't bring. I can, you know, have a degree, I can have multiple degrees, whatever, I can understand certain things, I understand the things I've been through, I don't understand what it's like to be you and that's what I wanna know and you are the expert in you." I had this discussion with a 16-year-old boy and he literally said, "I don't know why you wanna talk to me. I don't have anything." And I was like, "You have so much." And then once he started talking, I was like, "See, that's a perspective I don't have, I've never been a 16-year-old boy," like, you know? And so it definitely, you know, I'm like building up people, and that part of that is gaining their trust and then, you know, helping them see the importance of what they've experienced and how not only can it help inform policies and changes, but how they can also build other people up or help guide other people who might be going through similar things. And that's a huge thing, just getting people to kind of understand their worth even that your input is worth something.

- Excellent points, you guys. I think that that's... I'm not even gonna ask you the specific question about how have you created some of these networks and partnerships because, right, it's going to the community itself, and sometimes it's not even for a meeting. It's being involved and attending a festival so you start learning a culture. It is running into that person at a grocery store and maybe not the typical grocery store, maybe it's an ethnic food grocery store that you're going to for the first time and asking those questions. It's not tradition, right? This is really about thinking outside the box and going boots-on-the-ground work with the communities that you're trying to partner with or those organizations 'cause it's not just an organization you're trying to partner with, it's trying to make the health impacts on communities and whatever that community definition is at that time, right? Maybe it's a neighborhood, maybe it's a specific zip code, maybe it's a business organization, or maybe it's a nonprofit, but it's really about getting out there and learning it and being actively involved. That may not always be confined to four walls in a conference room. I don't know which one of you said that, but I think that's great. You know, getting out there and having those lived experiences and then having them share, like you said Jacquie, you know, none of us can know what it's like to be someone else. And so making sure we're listening and engaging in those conversations and involving those folks because every voice matters and every lived experience matters to be able to improve the health and well-being of communities, especially when we talk about equity and health equity. So I wanna dig in a little bit deeper. How can local public health agencies participate in some of the initiatives that maybe your organization is involved with, or ideas that you have on how they should be, whether if our folks online today, if they're not from a local public health agency, if they're from a different organization, how do they get involved? And so what are some of the things that you would encourage them to do? What are the action steps that they should be taking? Monika, you wanna kick that one off?

- Oh, sure, yes. So I think speaking specifically to access centers in general in the state of Iowa, I think they're, I always get this number slightly wrong, but I think there's seven access centers now in the state of Iowa and that they're not quite based on the mental health regions, but that roughly-ish. So I think certainly for local public health agencies, it would be a matter of reaching out to either your local access center, the access center within your region, if there is one, or the one that's closest to you to see, first of all, if there's any partnerships that, again, finding some of that shared space. So if there's any partnerships that you all wanna collaborate on. But also, you know, certainly if you all have anyone that comes in that you think would be appropriate to refer to the access center, just to identify what those services are and what that kind of mental health landscape looks like. Also kinda with that would also be reaching out to the mental health region to see what services exist there too for local public health officials. And I can tell you, you know, I know we've had Johnson County Public Health reach out to us to kind of collaborate or at least start talking about projects. Sometimes we can make 'em work, sometimes we can't make 'em work. What I would also encourage is despite whether that time it works, keep trying because sometimes, you know, that particular time, it might not be the right project at the right time, but another time it might be the right project at the right time. So that again, I think probably applies to any collaborations is, you know, just because it like didn't work out this time, I would at least keep connecting if you think that like, "Hey, this could be a good partner for this, let's bring it to them, let's bring something else to them and see if it works." Because I think through that you'll also get more understanding of what each other does, but also you might be able to then connect on the right project at the right time.

- I would definitely agree with that. You know, it may not be the right time. Continue to keep engaging. So going back to, you know, how you can start a partnership with local public health, reach out to your local public health. Find out where your local public health is if you're not part of one, and see what they're working on. See what their current CHIP is like, you know, or what areas they're focused on, what they're working on. Public health, my understanding, is looks very different in every area. And I noticed, you know, we've got some people from outta state, so I definitely am not familiar with other states' setup of public health, but you know, reach out and just have a conversation and say, I'm just curious, you know. What are you doing at public health right now? And again, maybe something that you work on will coincide with what they're currently looking at or working on, and maybe it won't this time. But maybe you'll bring a concern to them that they didn't know was going on in your community even. And you know, again, we don't know what we don't know. There's a lot of things that are very much out there and are very important, but being open, I think it goes back to that. One of our local representatives is a friend of mine and she sent one of her constituents to me because her daughter uses a power wheelchair and she did soccer, had a soccer league prior to COVID, but it hadn't been started again. And they were really looking how they could do that. We've had some meetings, I've kind of helped to connect them with some people, but you know, if I was like, Oh, you can't talk to me... I'm a very approachable person I've been told. So you know, just let people know that, you know, you wanna hear about it and, you know, you may not have the capacity to do something right then, but I always tell people, "If I don't know the answer, I probably know someone who knows an answer or knows someone who knows someone who knows an answer. So I can start you down a road at least." And so just, you know, letting people ask those questions. Don't be afraid to ask questions, I think. And that kinda goes back to what Monika had said, you know, just being kind of the squeaky wheel, but also ask questions and be curious because that just tends to open up a lot of things that you probably didn't even anticipate.

- Any specific strategies that you would recommend or that you've used that helps ensure people, regardless of their race, nationality, gender, or any other identity, is being left behind, is there any strategies that you guys have used or felt were successful for you that we haven't really touched on yet to engage?

- I would just kind of go back to the going to where people are and having those conversations with them there. And it can be big and it can be small. Like you said, maybe you're at a festival and you start talking to people and then they mention, "Hey, I've got this group, this book club" or whatever, you know, and not being afraid to just talk about what we do. Sometimes I think that, you know, it can be seen as being too forward to talk about what we do and how we help people or maybe it's a little like we're boasting or whatever. But I think for me, I always look at it like, "You've got something that could contribute to what we're doing and so here's what we're doing. How would you like to join in?" I'm usually like, "So can I invite you to a meeting?" And people are like, "Whoa, I just wanted to have a conversation." And I respect that boundary too. You know, I understand not everybody wants to come and sit and even give their point of view, but I think again, just thinking outside the box on how we can engage people. I will say too, we've had a really good collaboration with our local colleges, University of Iowa, but also here in Cedar Rapids and getting interns in and they bring a certain amount of energy for one thing, but they also bring a whole different level of connection because they're connected to people that, again, might be a population that I wouldn't necessarily think to look at. They bring a lot of good things to the table also.

- Great. Are there any specific local or state partners that you wanna make sure as we are talking about today that community partners are collaborating with, or that you have found success in collaboration with?

- I don't know so much about state, but local, obviously municipalities, the cities, the counties, the cities, but also community action programs. They tend to have a widespread touch in communities because they are definitely dealing with very vulnerable populations, but they also have a lot of programs. So as far as getting out to meet people, that is a good place to plug into because they may have various different programming that you can go and meet the public, yeah, I guess is a good way to put it. But they also have people who are boots on the ground. They have the experience of working with the people. I also, you know, United Way is a good, when you're looking for volunteers. Also engaging volunteers in what you're doing in programming is also a really good way to broaden your reach because a lot of volunteers have other jobs, you know. And we've seen with the bicycle program, for example, a lot of people are coming from some of the major manufacturers in the area or other nonprofits or things like that. So they bring a whole set of skills that we can use, but also they bring that connection now to something in your community that can support in different ways. So I can't really think of... You know, we, obviously, we collaborate with IHHS and we do a lot of collaboration with the local people. I would say nationally, NACCHO is a really good... We've collaborated on a lot of different things with NACCHO, which is the, and I will not be able to say it, National Association for Cities and County Health Organizations, so, 'cause I thought you might ask me what that stood for. It's actually spelled like Nacho, but it's NACCHO. And that's a public health organization that's national and we get a lot of collaboration through different areas that way. I'll let Monika, if you have any.

- Yeah, you know I think and, Jacquie, you were kinda alluding to this too, I think some of it is tricky because you have to kinda know your community partners, like you have to know who exists within your local community. And so, you know, it's, you know, for us I would say if there are mobile crisis services in your community, figure those out. If there's any community-based crisis services, figure those out. If there's, what was I gonna say, like community-based substance use disorder services, figure some of those things out. Just kinda knowing where and what some of those services are just because it can be very different community to community and even just kinda what the statewide landscape looks like for that. We also kinda, here in the state of Iowa, like you said, are currently, this is supposedly changing for next year, divided into mental health regions. And so just like understanding what your regional support is and kind of where some of that funding stream and structure comes from, I think kinda helps understand where the services are and why the services are what they are. In terms of, you know, some of those partnerships on like a statewide level, like similarly, you know, we work with our, you know, regional folks and who report up to the state. We also work with Iowa, with Iowa Health and Human Services too, in terms of some of that funding. So I think a lot of it is, you know, understanding and recognizing what some of your local resources are. If those, you know, don't exist, then also like seeking some of that additional support from the services that are supposed to be giving you some of that, which is the regions. They're tasked by the state to be providing some of, particularly for mental health support and actually, increasingly, substance use disorder services and support as well. So kind of reaching out to some of those folks to be able to collaborate and try to get some of that additional support or letting them know what the challenges are again, so that sometimes they can identify this pattern of like, you know, I can think of one that we, you know, figured out recent, well, we've been saying it for a long time, but we're able to say it even more, is that transportation continues to be an issue. If somebody is, you know, leaving from somewhere and we're trying to get them over to us or if they're coming to us and we're trying to get them somewhere else, like we just don't. And sometimes people don't come to us because they don't have a way to get to us or a way to get home once they do come to us. And really kind of just in some ways, again, being the squeaky wheel of just like, "Here is the problem, here's what's continuing to happen, you know. How can we work together to find a solution here?" So yeah, so some of those networks are a little bit different place to place just depending on the structures. But I would say like here in Iowa, you know, from a mental health perspective, we have the mental health regions that then kind of are tasked with working locally. So really understanding some of those networks.

- Wonderful.

- Since you mentioned transportation, and again, it kinda goes back to the thinking outside the box. Transportation is a huge barrier for many of the programming that we're looking at, also the focus areas. And so I, you know, I'm on committees and things for transportation with the metropolitan and planning organizations and you know, just being that squeaky wheel again and saying, "Yes, it's all good and well if you have a car, but what if you don't have a car? What does that look like? And you know, how can we make things a little bit better for people who don't maybe fit that demographic?" So that just kind of reminded me of another local organization. Thinking outside the box doesn't really... You wouldn't think transportation has a lot to do with mental health or other things, but it does, ultimately. It's kind of that cross-cutting problem that it carries over to all of the different areas.

- I am going to pause for a moment. We have about four minutes left. If anyone has additional questions or follow up questions that you would like to put in the Q&A or in the chat box, that would be great. It looks like we do have one question in. "Which transportation organizations have you partnered with?"

- So I work closely with the metropolitan in our Area, It's the Corridor Metropolitan Planning Organization, MPO. I don't know outside the state of Iowa, if that's something that they have. ECICOG, which I do not know what that stands for, does anybody know? But just kind of finding out. Where I would start is with your local transportation. So if you're in a city. If it's a city of, you know, relatively good size, find out where your transportation department is and who is the person that is part of that, and then go from there. It depends on where you're at. If you're in Linn County, you know, again, the MPO, but also LIFTS. I work with Carter Baldwin from LIFTS a lot on various different areas. And again, once you get to know somebody at these organizations, it's much easier to go to them with concerns, or with ideas, or with thoughts. And so just kind of starting that conversation. If you don't have the concern currently, find out who it is that you talk to, and just kind of form that relationship.

- I am not gonna ask the last question. I think that we've covered it with giving everyone ideas on how to approach or start getting involved in their community. I do wanna thank Monika, Jacquie. Thank you both for your time and sharing your experiences in building community partnerships and addressing health equity within communities. But this is our last webinar for the spring. Please be on the lookout for future webinars, more than likely kicking off in the fall. I do encourage you to join our Building Health Equity email distribution list if you have not already. That will be one way we will be making announcements for our next webinar series. But again, thank you both for your time today. Thanks all of our participants. I appreciate you spending your afternoon with us today. Have a wonderful day. Take care and be healthy.