Ensuring Representation

• To what extent do we understand the demographics of the community and populations our organization serves?
• What is the demographic make-up of our advisory committee or other groups of PWLE we partner with?
• Are there any significant differences between the demographics of the community our organization is located in and the demographics of our advisory committee or other groups of PWLE we partner with?

• Review available data – To understand demographics of your community and service populations, you can review available sources of data:
  • Data your organization collects about the demographics of people served
  • Census data
  • Community health needs assessments
• Compare community and service populations – Check for differences between the demographics of the community your organization is located in and the demographics of your patient/client base. Differences may highlight barriers some populations face  in accessing services or indicate strong ties to particular populations.
• Engage PWLE to address gaps – Work with PWLE to identify and understand  gaps in representation in your service population and build better connections in underserved communities to reduce barriers.
• Assess representation in your work with PWLE – After you understand the demographics of your community and service population, the next step is to review the demographics of your current advisory members and other PWLE partners to identify representation gaps. You may already have a process in place for collecting this data, or you may need to create a new process to do this.
• Key demographic considerations for representation:
  • Race/ethnicity
  • Gender identity and sexual orientation
  • Age
  • Zip codes/neighborhoods
  • Immigration status/country of origin
  • Primary language spoken
  • Socioeconomic status
  • Disability status
  • Relevant lived experience (e.g., health/medical conditions, housing status, caregiver status, substance use history)

Libby Hoy, Chief Executive Officer of PFCCpartners, discusses how defining the scope of engagement initiatives informs what representation looks like when engaging PWLE.

HealthierHere conducted a “membership gap assessment” for its Community Care Network Advisory Group (CCNAG). This involved reviewing the demographics of existing advisory group members and comparing them against the client populations served by their “hub” and the organizations participating in their network. This data-driven analysis helped identify specific priority areas for outreach to fill vacant seats with underrepresented groups.

Community Health Plan of Washington developed an “interest form” for its Community Advisory Council that allows individuals to describe their identity in their own words rather than being limited to predefined racial/ethnic categories, and asks about their areas of expertise and communities they represent.

“We have a requirement to collect demographic information as far as who’s represented on the council. So we wanted to think about how to collect this data without feeling like we are treating people like numbers. So we tried to create an interest form that was a little bit more inviting. Instead of having, you know, the five racial, ethnic groups, it’s just a question, “How do you identify and how would you like to be represented?” And there are, of course, data points that they can select from, but we kept it very open for individuals to write how they would like to be identified. And same thing with areas of expertise. I really wanted to get a sense of the expertise within the community, so that was an open question. For example, “what would you like to bring to the council? What areas of expertise do you bring and are there certain communities that you work directly with that you would like reflected or represented on this council?””

• What barriers might be driving limited participation from communities that are underrepresented in our engagement with PWLE?
  • What are the best approaches and strategies to address and remove these barriers?
• How can we intentionally and respectfully include trusted messengers (e.g., Community Health Workers, community-based organizations and community leaders and liaisons) in our strategies to build relationships with underrepresented communities?
• How can we think about operationalizing the concept “meet people where they are” in our outreach and relationship-building efforts?

• Develop a hypothesis about barriers – Consider why specific populations may not be participating. For example:
  • Lack of awareness about opportunities
  • Language barriers
  • Distrust or concerns about your organization’s reputation
• Create an outreach and relationship-building plan based on your hypotheses, which could include:
  • Improve language access – Translate outreach materials and provide interpretation support throughout engagement activities.
  • Partner with community-based organizations and community leaders – Connect with groups and leaders who are familiar with the populations you want to reach to learn about  needs, priorities, and barriers. In this process, it is important to:
    • Provide resources or benefits to support these organizations’ efforts.
    • Commit to authentic partnerships that respect the trust these organizations have built with their communities.
  • Hire community liaisons/Community Health Workers – Engage people with first-hand knowledge of the communities to help build connections.
• Meet people where they are – Consider strategies such as:
  • Attending existing community meetings and groups
  • Prioritizing listening and learning first, rather than immediately requesting participation
  • Engaging your colleagues who work directly with patients, clients, and community members to build connections and refer PWLE to engagement opportunities
  • Asking community liaisons and PWLE you work with to share recruitment materials through their social media rather than only sharing it through the organizations’ accounts,which other community members may be less likely to follow
• Address barriers to participation – This could include providing transportation, compensating for time, and/or repairing past harms
• Ensure inclusive, welcoming, and culturally appropriate space – When inviting people to come to your meetings or events, pay attention to:
  • Honoring cultural traditions and norms
  • Serving culturally relevant and appropriate foods
  • Location convenience and comfort
  • Accessibility of the space

Marya Gingrey, Chief Equity and Engagement Officer at HealthiereHere, discusses her organization’s approach to building authentic relationships with community-based organizations and community leaders.

Community Health Plan of Washington uses recruitment flyers and referrals from member-facing teams, explicitly targeting communities most impacted by health inequities, such as immigrant, refugee, elder, youth, and uninsured populations. They have seen success with tailored engagement for specific groups, such as increased Spanish-speaking member group attendance as a result of providing dedicated support.

HealthierHere’s Community and Consumer Voice Committee (CCV) and Indigenous Nations Committee (INC)  liaisons conduct research to determine how best to connect with PWLE to invite them to participate with HealthierHere.

One approach to conducting research included:

1. Reviewing the websites of community-based organizations that serve members of communitiesHealthierHere is trying to engage
2. Learning about the languages, religions, food, and customs of community that the liaison is seeking to engage
3. Identifying shared personal and organizational values between the liaison, HealthierHere, and the community
4. Meeting with the leadership of the two community-based organizations
5. Listening to the needs of the community, inviting them to participate in CCV as well as attending and hosting the community-based organizations’ community events.

As a result of these efforts, the CCV and INC liaisons regularly attend, or participate virtually, in meetings and community events where people with lived experience are present to be in space with community. Through that participation, the committee liaisons develop meaningful relationships with community members which has led to natural inquisitiveness about HealthierHere committees and partnership opportunities.