Session 1.2: Creating Equity Opportunities

Introduction

Working with diverse stakeholders across settings to to create equity opportunities can be a daunting process, but one critical to advancing health equity at national, state, and local levels. Tools such as the new Creating Equity Opportunities Discussion Guide allow us to:

• Reflect on priorities for what a well-functioning MCH system would look like.
• Share experiences of structural and system-based determinants that do or could contribute to health equities in your setting.
• Uncover inequities, root causes, and meaningful opportunities for improvement in your setting.

The purpose of this tool is to identify opportunities to transform an aspect of your MCH system to better advance equitable outcomes. The process of developing an Equity Opportunity Statement — a carefully-crafted one- or two-sentence summary to clarify the problem to be solved or opportunity at hand — follows a two-part process, beginning with individual brainstorming and moving to group discussion. It’s important to include a diverse group of people with lived experiences, family members, youth, and those disproportionately affected by inequities in this conversation in order to have an authentic and meaningful discussion.

MCHwork provides a jump start to developing Equity Opportunity Statements through a Ready-Set-Go approach. Use the following resources to start your learning, dig deeper, and move from knowledge to practice.

READY: Creating Equity Opportunities — Identifying Leverage Under the Water Line

Before we dive into writing Equity Opportunity Statements, we need to ground ourselves with some background on understanding the systems in which we hope to make improvements and identifying the root causes for issues that we want to address. Watch this video from the National MCH Workforce Development Center that discusses this process, including a review of the Iceberg Model of Systems Thinking:

Resources from the MCH Navigator. Use these resources to dig deeper and understand how to implement what you've learned:

1. Understanding Systems. First, we need to quickly refresh ourselves on what systems are.

• Systems Integration Resources. This portal page starts with a background on systems integration and then presents a number of tools and learning resources, including the Five-Minute Systems Mapping Series of microlearning videos.
• Systems Integration Spotlight. This resource provides a deep dive into systems integration, including trainings on terminology, problem identification, system solution methods, and evaluation. It frames systems integration as a new leverage point for change.
• Systems Integration Toolkit. This checklist provides tools to see your work in the context of the “big picture” and strengthen collaboration within agencies and across sectors.

2. Identifying Underlying Causes. Next, we want to understand what the underlying causes are that lead to an acute event or issue. The Iceberg Model explains how structures “below the surface” or waterline of an iceberg are often invisible without systems analysis, but lead to events, trends, and patterns above the waterline. Racial and health equity can be seen through the Iceberg Model.

• Cultural Iceberg. This two-minute video explains the Iceberg Model of Cultural. It is part of Project READY’s Reimagining Equity and Access for Diverse Youth curriculum.
• The Iceberg and Systems Thinking. This seven-minute video emphasized the Iceberg (or Pyramid) in understanding behavior change on a systems level.
• The Cultural Iceberg. This twelve-minute video digs deeper into the model and provides multiple examples of culture above and below the surface.

SET: What Needs to Change to Produce Equity in Your MCH System?

An Equity Opportunity Statement is a carefully-crafted one- or two-sentence summary to clarify the problem to be solved or opportunity at hand. It helps to identify root causes to avoid addressing only symptoms of the issue. Watch this introductory video from the National MCH Workforce Development Center to reflect on what a well-functioning MCH system would look like:

Resources from the MCH Navigator. Use these resources to dig deeper and understand how to implement what you've learned:

• Writing an Opportunity Statement. This one-page worksheet provides six questions and example responses to craft an opportunity statement.
• How to Write a Clear Opportunity Statement for Better Problem-Solving. This blog post provides background, examples, benefits, and helpful tips to develop opportunity statements.

GO: Brainstorming Actions to Transform Your System and Dismantle Inequities

Combining the Iceberg Model with Opportunity Statements is a way to brainstorm ways to dismantle inequities. When we “flip the iceberg,” we can envision a different purpose for the structures we identified and begin planning to address inequities. This process allows us to envision what needs to change to produce equity in our MCH systems. Watch this video from the National MCH Workforce Development Center:

Resources from the MCH Navigator. Use these resources to dig deeper and understand how to implement what you've learned:

• Systems Thinking and The Iceberg Model Tool. This tool provides a one-page background of the Cultural Iceberg Model and a fillable two-page tool that can be filled out to “flip the iceberg” and start problem solving solutions that could shift one structure toward a desired purpose for the system.
• Creating Iceberg Models: A Powerful Systems Thinking Method. This two-page worksheet provides eight-steps of instructions, pros and cons of the model, and a fillable form that tracks the events, patterns/trends, system structures, and mental models and assumptions needed to analyze root causes and produce leverage on a systems level.
• Iceberg Worksheet: What’s the Root Cause of the Problem. This webpage provides probing questions to explore the domains of the Iceberg Model. It also provides a downloadable tool to that helps to crosswalk questions raised to possible solutions that can be used individually or in a group.

PUTTING IT ALL TOGETHER: Creating Equity Opportunities Discussion Guide

The Creating Equity Opportunities Discussion Guide is a structured conversation guide you can use with diverse partners and collaborators across setting to:

• Practice using a structured facilitation tool to consider system-based determinants contributing to health inequities in your setting.
• Learn to write Equity Opportunity Statements.
• Identify targets for action for improvement in your setting.

Key considerations before you begin:

• Please ensure facilitators use meeting facilitation techniques that ensure all voices are heard in this conversation. At the part of the process where the group is moving from individual statements to group consensus, ensure that no voices are silenced and community voices are lifted up prior to settling on a final statement to work on as a group.
• The purpose of this tool is to create an opportunity to practice using a structured facilitation method to open the communication around root causes with the goal of disrupting entrenched patterns, institutional practices, and mental models that perpetuate systemic inequities. There are other tools to examine the pathways in which structural determinants contribute to health inequities, which you may want to explore prior to or as a result of using this tool. Please ensure you have a facilitator that can address that or reach out to the WDC for additional guidance.