In addition to the strategies outlined throughout the population domain narratives, Louisiana Title V has invested in strategies that aim to build internal capacities and improve performance in the cross-cutting areas of health equity, family engagement, communications, and public policy development.
During the FFY 2016-2020 strategic period, BFH completed an organizational strategic planning process that led to a structural reorganization which included creation of the Strategy, Policy, Alignment, Communications, and Equity (SPACE) team. The team was created to facilitate the development of systematic processes for strategy development and program quality improvement across the Bureau.
Cross-cutting / systems building priority needs and performance measures
The 2020 Needs Assessment identified key issues including promotion of health equity, engagement with families and communities, and improvement of evidence-based strategic development as cross-cutting priorities for Title V programming in the state of Louisiana. To strengthen the systems and supports that shape these factors, Louisiana Title V continues to execute strategies that align with the following systems priorities:
- Boldly work to undo systemic drivers of disparities and institutionalize equitable policies and practices
- Partner with families, youth, and communities at all levels of systems change
- Ensure Title V strategies are outcomes focused and rooted in essential public health services
Throughout the FFY 2021-2025 strategic period, Title V investments in cross-cutting and systems strengthening initiatives in Louisiana aim to effect the following state-level performance measures (SPM):
- Percent of recommended actions resulting from externally assessed equity audit that have been successfully implemented (SPM 1)
- Organizational Commitment to Family Engagement in Systems Change (SPM 2)
In FFY2024, Title V supported programs in Louisiana will implement strategies to achieve the following objectives:
- By June 2024, BFH Title V personnel will have increased access to learning opportunities concerning health equity and related concepts
- By September 2024, a draft family partnership strategy will be defined.
- By September 2024, identify key stakeholders, prioritizing those representing targeted MCH population, for each population domain who have the potential to be engaged as future partners of the BFH.
- By June 2024, BFH Title V team and the new Association of Maternal and Child Health Programs (AMCHP) family delegate will collaborate to define the roles and responsibilities of the Louisiana family delegate.
- By September 2024, new training and technical assistance will be available to support BFH staff who have a direct role in supporting or leading one or more public boards, councils or commissions, which will contribute to their increased confidence and competence to support, organize, and facilitate effective meetings.
Planned Title V efforts and alignment with cross-cutting priorities
Systems Priority: Boldly work to undo systemic drivers of disparities and institutionalize equitable policies and practices
BFH has intentionally worked over several years to develop the organization’s foundational knowledge and awareness of the impact of systemic oppression, particularly racism, on the health of Title V target populations. Now that these critical foundations have been established, BFH is better positioned to institutionalize equitable strategies, practices, and policies to promote health equity, while providing continuous support to staff development and learning.
Institutionalize equity within BFH by establishing or amending existing policies and practices to ensure BFH operates with equity, consistently incorporating a social justice and anti-racism lens: In FFY2024, Title V will continue efforts to establish or amend existing policies and practices to ensure BFH operates with equity, consistently incorporating a social justice and anti-racism lens. As described in the 2022 Narrative Report, progress is underway on the implementation of an action plan responding to nine recommendations resulting from an external equity audit in FFY2021. In FFY2024, BFH’s health equity coordinator will develop an updated set of objectively measurable indices to enable improved monitoring of progress in achievement of the nine recommended actions. Following approval of the final Equity, Diversity, and Inclusion (EDI) and anti-oppression statements, the health equity coordinator and SPACE team will work to promote widespread awareness across BFH teams and promote reflection on how to operationalize these equity commitments in the daily work of the organization. The health equity coordinator will also focus on ways to streamline communications in alignment with the recommendations, and determine how to support BFH staff in their health equity work. Title V will continue to utilize SPM 1: Percent of recommended actions resulting from an externally assessed equity audit that have been successfully implemented to measure progress in relation to these strategies.
In FFY2023, BFH’s health equity coordinator met with programs and team leads to learn what they are doing to institutionalize equity to determine gaps, what can be enhanced, modified, or can be implemented bureau-wide. In FFY2024, the health equity coordinator will continue building upon those conversations to guide future health equity work through BFH’s internal communication systems.
BFH’s Health Equity Work Plan, framed within a template provided by the LDH Bureau of Community Partnerships and Health Equity, was updated in FFY2023. In FFY2024, the health equity coordinator will disseminate the work plan and continuously collect feedback from BFH staff. The coordinator will monitor progress, ensure the work plan remains updated, and that the BFH management team remains informed of progress, bottlenecks, and lessons learned.
In 2016 and 2017, BFH formed a Health Equity Action team (HEAT) Advisory Board and sub-working groups to promote health equity throughout BFH. HEAT was paused in October 2022 due to limited staff capacity and was un-paused in spring 2023, when staff capacity increased. The relaunch of the work groups led to a reflection period and critical examination on their overall effectiveness in realizing BFH’s health equity vision. In FFY2023, workgroups redeveloped their purpose statements and created work plans that could be more easily integrated into member’s day-to-day work. In FFY2024, BFH will work with a contractor to facilitate a strategic planning session, which will aim to deliver guidance on how to effectively organize working groups and achieve concrete tasks towards realizing the overall HEAT action plan. After the planning session, the health equity coordinator, supported by the HEAT Advisory Board, will be responsible to coordinate the improvement of work group functioning.
Activities to further examine the evaluation, promotion, and pay structures of BFH and OPH through a DEI lens (Recommendation #2) will continue in FFY2024. In May 2023, OPH leadership approved the request made by OPH HEAT to implement the Employee Life Cycle Recommendations within OPH. In FFY2024, a concrete work plan will be defined to clarify separation of roles between OPH and BFH as well as to agree on priorities and overall methods to be employed.
LDH-OPH-BFH’s current holiday schedule excludes many religious faiths and values while overly reflecting others. Rather than following a standard holiday schedule, floating holidays can be offered as paid time off (PTO) that staff can decide when to use. Advocating for floating holidays brings equity to the holiday structure. In FFY2024, OPH HEAT will advocate for a change of the current holiday schedule to reduce the number of holidays on the standard schedule and offer 1 or more floating holidays, which can be used by employees on the day(s) of their choice. This process will involve looking at data of when employees generally use PTO, research what needs to be involved to make this change possible, and advocating for action.
Build workforce and partner capacity to promote health equity, anti-racism, and social justice: In FFY2024, BFH will continue to offer formal and informal learning opportunities on health equity, anti-racism, and social justice. BFH provides a bi-monthly health equity orientation for staff that explains key health equity concepts, shares BFH’s EDI statement, and how BFH works towards health equity and equitable outcomes. A previous communication survey found that most staff would like more opportunities to improve their knowledge and capacities around EDI promotion. However, following several years of progress in the promotion and training around EDI concepts, the capacity development needs of longer tenured staff vs. newly arriving employees creates a need to diversify capacity development modules and modalities.
In FFY2023, the health equity coordinator developed a plan to revise the health equity and EDI learning experience for staff at BFH which included inventorying and mapping BFH’s current EDI resources into four learning phases (awareness, knowledge, skills/application, and mastery). In FFY2024, the coordinator will continue to build out the series of modules and make them available in BFH’s learning management system (Moodle). An external contractor will be utilized to develop an overall learning strategy (especially in the skills/application phase) and develop evaluation metrics to ensure staff are meeting the learning goals of each module as well as to ensure that learning is applied in the daily life of BFH.
Future efforts to build workforce and partner capacity also involves work at the OPH. The OPH HEAT state fiscal year (SFY) 2023 work plan consists of developing a subgroup to be named the Employee Resource Group (ERG) committee. ERGs, also known as “affinity groups”, are composed of staff that are centered on a common interest. ERGs can be voluntary or requested by the organization and are commonly formed around the aspects of identity: age, disability, gender, parental status, national race/ethnicity, sexual orientation, and religion or belief. ERGs are beneficial to an organization and staff because they provide staff with a sense of belonging; feeling like they can be their authentic selves at work, and while also adding more meaning and purpose to their work. In FFY2024, the ERG committee of the OPH HEAT will define the structure of ERGs and establish benchmarks for ERG creation and implementation. By June 2024, the committee will establish two ERGs with clear leadership and goals assigned to ERGs. The ERGs will report to OPH HEAT.
System Priority: Partner with families, youth, and communities at all levels of systems change
BFH believes that the delivery of transformative MCH services requires full, honest, and equitable partnership among families, health practitioners, communities, and statewide policymakers. The Bureau seeks to pursue an integrated strategy to support the exchange of information, purposeful interaction, and meaningful participation of all key stakeholders in the design of programs, projects, and initiatives relevant to MCH populations.
Recognizing the need for meaningful participation of all key stakeholders, specifically including persons with lived experiences and family members, the Bureau does aim to define a comprehensive strategy for family, youth, and community engagement, the core components of which are summarized below. Title V introduced SPM 2: Organizational Commitment to Family Engagement in Systems Change for the FFY 2021-2025 cycle to promote accountability as BFH works to institutionalize partnerships with families and communities as a foundational component of all systems change initiatives.
Improve active participation of persons with lived experience and/or family members in BFH supported Boards, Councils or Commissions: A key element of the overall family engagement strategy is the inclusion of persons with lived experience and/or family members in the 16 statewide public bodies (i.e., boards, commissions, councils) and two internally created action bodies supported by the Bureau.
One key barrier is the reality that the structure of most boards, commissions, and councils were created without a designated space for families, advocates, and caregivers, thus making it difficult to actively engage their participation without formal representation in membership. Currently, only four out of the 16 boards, commissions, and councils have a named family delegate as a voting member of the public body; however, close to half of the Board, Councils or Commissions have dedicated seats for individuals with lived experiences and/or family representatives. The entities that do have designated membership for persons with lived experience and/or family members see consistent and active participation of these members. When there are vacancies in these seats, the Bureau supports potential replacements to understand the roles and responsibilities of their participation if they choose to accept nomination to join.
In accordance with the state’s Open Meetings Law, all meetings of the 16 statewide public bodies are open to public participation. The Bureau promotes the participation of any and all community members, including persons with lived experiences and family members, as non-voting observers. It is the policy of the Bureau to post meeting agendas no later than two weeks in advance. This policy allows for ample notice of upcoming public meetings, with the hope that families and individuals with lived experience can make the necessary arrangements to actively attend.
Facilitate space for local partners and community based organizations to increase input into BFH program planning, monitoring, and evaluation: Throughout all population domains, BFH programs collaborate and/or partner with a variety of community based organizations and stakeholders including contractors, implementing partners, community based organizations, family led organizations, professional associations, self-advocacy organizations, academic institutions, etc. The Bureau has identified a cross-cutting need to develop guidance on recommended practices and approaches for engaging with these varying program stakeholders. Guidance will be specifically relevant for onboarding of new program staff who may have less familiarity with the MCH stakeholder landscape in the state and how BFH’s mission and values should inform our approaches to working with our partners and key stakeholders. In FFY2024, BFH will organize internal information sessions to facilitate reflection on the Bureau’s mission and values and sharing of experiences and lessons learned concerning partner and stakeholder engagement. The information sessions will clarify key differences between contractors, implementing partners, community based organizations, family led organizations, professional associations, self-advocacy organizations, etc. and discuss different partnership modalities related to each. The sessions will also support identification of further capacity building needs.
Increase resources and opportunities for the BFH family representative to fulfill the role of effectively participating in BFH strategic planning processes: In FFY2024, the Title V team will take the lead in working closely with the newly appointed AMCHP Family Delegate to co-create a role and scope of work for advising Title V implementation. The Title V Block Grant Strategy Manager will explore recommended practices from other states, as well as AMCHP resources, to facilitate dialogue about definition of the roles and responsibilities of the LA Family Delegate. By June 2024, a proposed outline of the roles and responsibilities of the LA Family Delegate will be presented for the BFH management team's consideration and feedback.
Continue to support the Title V Helpline as a resource for families: The toll-free helpline is an important resource for families seeking information about MCH services available throughout the state. BFH will continue to support families to have access to essential information by continuing to make the toll free hotline available on a 24/7 basis. Helpline staff will continue to conduct a brief screening to collect information about each families’ situation and make referrals to the most appropriate services including but not limited to: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), prenatal care, pregnancy testing, evidence-based home visiting (family support and coaching) programs, Medicaid, breastfeeding, immunizations, family planning, substance abuse and other social service information, children with special health needs.
Support Project SOAR (Screen Often and Accurately and Refer) with implementation of the Targeted Universalism framework and family engagement strategy to inform the development of a BFH-wide family partnership strategy: As described in the Child Health domain narrative, during year one of implementation, the BFH Project SOAR team made significant adjustments to the project work plan to better align with the Targeted Universalism (TU) equity framework. This shift was intended to create accountability for centering equity and leadership from P-3 families and providers for the duration of the project and beyond.
Guiding all Project SOAR strategies, the five steps of the TU equity framework are:
- Set a universal goal.
- Assess the general population performance relative to the universal goal.
- Assess and identify the performance of groups that are performing differently with respect to the universal goal.
- Assess and understand the structures and other factors that support or interfere each group from achieving the universal goal.
- Develop and implement targeted strategies for each group to reach the goal.
During FFY2023, the SOAR team, with the support of the grant’s project officer and the TA team, dedicated time to refining the work plan to ensure a keen focus on family participation and leadership building opportunities, alignment with other state prenatal-to-three initiatives, and expediting the data collection interval to advance the timeline for creation of the early childhood developmental health state strategic plan. The project pivots enabled formulation of a solid work plan that supports implementation and testing of system strengthening strategies co-developed with family and provider partners before the term of the grant.
As the project moves toward full implementation, the SOAR team will lean into existing relationships with internal and external partners that touch young families. Community partners such as FHF, the FRC, and the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, along with the Young Child Wellness Collaborative (YCWC) advisory body, will play a significant role in recruitment of community families to participate in the SOAR initiative. Additionally, family partners and programs with family leadership expertise, will help inform leadership development strategies for families interested in participating in systems improvement efforts.
Support the MIECHV program with implementation of the Home Visiting Collaborative Improvement and Innovation Network (HV COIIN) 2.0 Parent Leadership Toolkit:
LA MIECHV has adopted the HV COIIN 2.0 Toolkit to Build Parent Leadership in Continuous Quality Improvement as the framework for family engagement efforts. The toolkit proposes five stages for integrating parent leadership into continuous quality improvement (CQI) initiatives and sustaining parents’ involvement, from early readiness to long-term strategies for bolstering the infrastructure and team functioning required for parent leadership to flourish. Over the course of the project period, LA MIECHV will implement Stages 1-3 of the toolkit, which outline activities to support 1) getting teams on board with parent leadership and developing a more comprehensive understanding of program and team-level readiness; 2) setting concrete goals and developing team-specific action plans; and 3) engaging in short term strategies to learn more about local communities, build relationships, and recruit parent leader.
LA MIECHV will continue to administer the annual Client/Parent Satisfaction Survey. Each year the survey is adapted based on survey results and home visitor feedback to ensure questions asked will lead to programmatic improvement for clients. In FFY2024, LA MIECHV will work directly with families to update the survey as part of our efforts to build parent leadership using the framework outlined in the HV COIIN 2.0 parent leadership toolkit.
System Priority: Ensure Title V strategies are outcomes-focused and rooted in essential public health services.
Implement a Bureau-wide strategic communications plan to assure consistent messaging across communication channels and products related to Title V priorities: In FFY2023, BFH Communications team created and memorialized a process for how the team functions. Templates such as a Needs Assessment Form and Project Planning Document were created to guide the process and document each step of the collaboration between communications team members and program experts. Monday.com was introduced as a project management software to track projects as they were edited and approved to ensure timelines were met.
In FFY2022, the communications team was restructured to better align with BFH’s current priorities and vision for the future. Many staff members were hired in FFY2023. The restructured communications team now consists of the following positions within the larger SPACE team:
- Health communications operations and strategy manager, who oversees the communications unit and works to set and guide BFH’s strategic communication goals so they consistently articulate and align with BFH’s current priorities. The health communications operations and strategy manager is also responsible for developing and continually improving the processes and tools that can be used to align key information and messages across initiatives and communication products. This position was filled in May 2022 - June 2023, and a search for a new candidate is currently in process.
- Health communications projects manager, who manages and assures timely and quality completion health communication plans projects for all materials and reports across the bureau. Health communications projects manager also serves as the communications lead for the Bureau’s various public-facing reports.
- Three health education and communications specialists, who are responsible for implementing and executing the Bureau’s communication projects. These positions were filled in FFY2023.
Title V is aiming to redevelop the overall BFH communications strategy using an evidence-based approach to develop coherent, audience-tested narratives about priority health outcomes and establish messaging consistency across all BFH programs. In FFY2024, the BFH Communications team will continue work toward implementing a strategic communications approach across the Bureau. The team will focus on addressing larger, Bureau wide projects such as evaluating the effectiveness of websites and exploring avenues for increasing efficiency and viewership, creating a standardized process for how programs within the Bureau can utilize translation services, and increasing partnership efforts with the LDH Bureau of Media and Communications team to increase engagement on social media channels.
Provide high-level support to the legislatively-mandated commissions and action bodies under the purview of BFH to build their capacities as agents of systems level change: In FFY2018, BFH recognized the need for a Policy, Research, and Development team dedicated to liaising with policymakers and legislative stakeholders to track ongoing issues of concern to the Bureau, coordinating the Bureau’s inputs to public policy dialogue including responding to regular inquiries/requests from state policymakers, and strengthening of the 16 public bodies (Boards, Councils and Commissions) and the two internally-created action bodies under its purview. Located within the larger SPACE Team introduced above, the team continuously researches national and state health policy trends relevant to MCH populations and ensures that BFH teams are informed of relevant policies and up to date on ongoing policy development processes. The team also coordinates work with the state-required rulemaking process to ensure the BFH operational framework is aligned with the intent of existing legislation, long-term plans, policies, and procedures. When needed, the team provides interpretation of revised statutes, rules, regulations, policies, and procedures for BFH program teams, members of the Boards, Councils and Commissions under the purview of BFH, and other community partners.
In FFY2024, the team will continue to develop guidelines and protocols for transparency in operations of supported Boards, Councils and Commissions to ensure compliance with state Open Meeting Laws and related regulations. The team will also provide capacity building to members of supported Boards, Councils, and Commissions through development and facilitation of training on public body protocols and tailored coaching of individual members.
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