When the Community Justice and Mediation Center (CJAM) was awarded a Community Voices for Health (CVH) grant from the Robert Wood Johnson Foundation in early 2020, they knew that the first step of creating lasting change in health policy is changing the public engagement process in Monroe County, Indiana. Located an hour south of Indianapolis and home to Hoosier National Forest as well as Indiana University, the mix of rural and urban has been ripe for ideological rifts over health issues ranging from mask mandates to vaccines.

As Executive Director at CJAM, a non-profit organization devoted to restorative justice, education, and mediation, Liz Grenat’s experience bringing people together to solve common problems helped to create a deliberate and thoughtful process without sacrificing the need to act urgently. Over the past two years partners from CJAM, Bloomington Health Foundation, Gnarly Tree Sustainability Institute, Indiana University’s O’Neil School and the Political and Civic Engagement Program, and more have been building a foundation of public engagement so that all community members can have their voices heard and given equitable weight in determining what’s needs are addressed the community.

CVHMC: What? 

In the first months of the grant, the CVHMC team surveyed the landscape of engagement work, particularly related to health issues and perceptions of public engagement. Reviewing the results of past public engagement efforts and industry best practices, the team was able to identify potential improvements to engagement practices, participant recruitment, and strategies around healthcare issues as well as identify the decision-making stakeholders including policy makers, funders, and health programming and services decision makers. 

With a fresh view of the landscape the team began connecting with individuals familiar with the needs of underrepresented groups. Team members conducted interviews with over 50 individuals representing self-identified members of underrepresented communities, government officials, advocacy organizations, healthcare professionals, social service agencies, and business, faith and other community leaders. From fall of 2020 through June of 2021, the CVHMC team facilitated small group discussions with underrepresented community members using two basic prompts, “what’s important to you about health?” and, “what do you want elected officials to know?”  

“Effectively, we all [low-income individuals] have PTSD from knowing that with one false move, everything could be yanked from us.”

-Small Group Participant

In addition to the facilitated small group discussions, they collected individual interviews, written stories, and information to help understand how people see matters affecting health, and why they see them the way they do.

CVHMC: So What? 

Having heard from decision makers and community members the next step of the project was to bring the two together in a series of community conversations with a goal of developing mutual understanding and moving toward solutions. The first session took place in person at the Monroe County Public Library in August 2021. Subsequent deliberation sessions took place virtually via Zoom throughout the fall, including a Spanish language session. In-person sessions took place in rural parts of the county throughout January 2002. The final session, hosted specifically for members of the black community, took place in February 2022.

CVHMC: So, Now What?

Each step of the CVHMC project was made with the intention of imbedding this framework into the policy and decision-making processes of Monroe County governments and health systems. Throughout the spring CVHMC worked with the Monroe County Health Department, the city of Bloomington, and Indiana University Health to engage the public in “Think Tanks” to develop the new Community Health Improvement Plan (CHIP). 

Participants not only learned the results of a community health survey and heard about the topics that emerged from the CVHMC work, but then were also invited to vote on which issues to prioritize for the next CHIP. By sharing data as well as stories, participants were able to see how their own priorities compared to other segments of the population and several remarked that they gained a better understanding of community health challenges and strengths. Designing the experience this way was another step towards creating a shared vision of health and collective ownership of solutions. 

In addition to these think tank meetings the CVHMC team met with city and county local elected officials and partner groups to share updates on the project and start to build capacity for the work to continue in Monroe County beyond the life of the grant and so far, the feedback has been encouraging. From one Monroe County Council member:

“I really want to see us get some big wins on the board for this program. You all deserve it, and so do the constituencies of the community. The intentions here are strong, the information impeccable, and opportunities immense… (there are) some strong inclinations on changing county council dialogue with the public. That said, I am hoping there is even more that we can do.”

-Local Elected Government Official

With any project aimed at changing how we relate to each other, there is much more work to be done. But the last two years of CVHMC have created exactly what the team intended when they started: to create a foundation for change.

To learn more about Community Voices for Health Monroe County please visit: https://www.communityvoicesmonroecounty.org/