The shifts that come from listening

I've talked about the difference between hearing and listening to community before.

And even though it's something I believe in deeply, I'm still surprised at the shifts that happen when we truly do that.

A couple weeks ago, for work I'm doing in DC around systems-level shifts to school mental health, we brought together youth to generate ideas around how to improve youth engagement in the school context.

Here are some of the ideas that came up repeatedly:

• "Having an area where we can take a break/chill"

• "I WANT A MENTAL HEALTH DAY"

• "Having more relatable/trusted adults"; "Respect is a two way street"

If we asked adults how we can improve youth engagement in the school context, what answers would we have gotten? I'm willing to bet this list would have been completely different.

So far, we've just heard these young people. How can we listen to them? By figuring out how to make more of these things happen! One thing that struck me about these ideas that bubbled to the top are that in theory, they shouldn't be that hard to make happen - but it does require adults setting aside their own perspectives and egos and prioritizing what young people most want.

One student shared how one of their teachers opens their room to students during lunch time, and how deeply they appreciate that space to chill - and only when I heard that did I remember some of my favorite memories from high school were in Mrs. Fort's English lit classroom, where a handful of us would go at least a few times a week to have our lunch.

Several students talked about specific teachers or other adults in the building that made them feel respected. What did that boil down to? The adult cared what the students had to say. They didn't talk down to the students. They made things fun. They listened. The conversation made me think of my favorite teachers through the years - they checked all those boxes too.

We were all young people once, but we quickly forget the day-to-day of that experience and how we felt about things.

If we can truly listen to and act upon what we hear from young people - or whoever your community members are - we might shift not only our solutions but even how we define problems.

But listening isn't always easy.

I've been thinking a lot about how we practice listening. We recently had a friend visit who loves birdwatching and taught our six year old more about birds in a weekend than we could have taught her, well...ever. But my favorite part of the whole experience was the emphasis on being still and listening - it's amazing what you hear when you do that.

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A fish, an elephant, and an iceberg: Orienting community towards root causes and systems

When a community is trying to address a public health problem, the immediate causes are often the most apparent.

Too many youth aren't physically active. Why? They don't understand the value of physical activity or the consequences of not being active. What should we do? An education and mass communication campaign to help them understand this value and these consequences, so that they are motivated to be more active.

Not only are immediate causes often the most apparent, the solutions required to address them are often (relatively) non-controversial and don't require the upheaval of established systems.

But to truly transform health in communities, we need to move beyond the immediate. We need to 1) drill down to root causes and 2) fly up for a systems wide view.

On the first point -

WHY are too many youth not physically active? Do they have safe spaces to run and play in their neighborhood, and do their schedules allow them to do so? Are the costs of joining recreational sports leagues prohibitive? Are the apps on their phones designed to be addictive, so they have less time for everything else?

To get community members thinking about root causes, one exercise I have found quite helpful is a fishbone diagram (where you start with the problem, which is the "head" of the fish, and then brainstorm multiple causes, as well as causes of causes). This diagramming is often paired with the "5 whys" facilitation strategy (where you keep asking "why" five times to drill down to deeper root causes). The idea here is that this process can help identify countermeasures (things that prevent root causes) instead of merely solutions (things that might just put a bandaid on the problem by treating a symptom instead of a root cause).

On the second point -

HOW might systems be transformed to encourage more physical activity among youth?

First, we need to be able to take a step back and see the system as a whole. I find the elephant analogy an incredibly helpful way to remind ourselves and our communities to do this. It’s an ancient parable you may have heard before about blind/blindfolded individuals encountering an elephant for the first time. Each person feels only one part of the elephant and comes to a conclusion about what they are encountering based on that. It leads to a lot of misconceptions and no single person who has the full and accurate picture.

To take community thinking a step further, from recognizing there is a broader system to understanding how we can improve that system, I love using the iceberg model of systems thinking. It's a great way to reminder ourselves that what we can see of a problem is usually only the tip of the iceberg. "We know that an iceberg has only 10 percent of its total mass above the water while 90 percent is underwater. But that 90 percent is what the ocean currents act on, and what creates the iceberg’s behavior at its tip." Most public health issues are like this as well! I especially appreciate the way this model helps community members walk through the process of identifying trends, underlying structures, and ultimately mental models.

I've often had clients point to a fairly surface-level approach or solution and say, "This is what our community said they want to see." This may be true, and I'm 100% on board with community-driven approaches. However, we also need to ask ourselves if we've walked ourselves and our communities through the kind of tools above to make sure that the solutions we're brainstorming are oriented towards root causes and systems.

Have you had success with setting the stage to approach problems in a way that is focused on root causes or systems? Or have you tried using any of the tools mentioned above? Please share your experience with me!

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Hearing vs. Listening to community

You want to transform health in your community. And you recognize that can’t be done without communities in the center and in the lead.

But how do we actually DO that?

We’ve talked about meeting community where they literally, physically are and these strategies are great to hear what they have to say, but today, I want to push us a little further. Because there is a HUGE difference between hearing and truly listening.

Merriam-Webster defines hearing as “the process, function, or power of perceiving sound, specifically: the special sense by which noises and tones are received as stimuli”.

On the other hand, the definition of listening reads, “to pay attention to sound; to hear something with thoughtful attention: give consideration”.

There’s a lot of lip service being paid to community voice these days, as well as genuine efforts to elevate community voice. But either way, community voice isn’t enough if we merely hear it, but don’t listen to and act on it.

The “act on it” piece is vital - I’d take the definition of “listening” and argue for us to take it one step further than paying thoughtful attention and giving consideration to actually internalizing and acting on what community has to say.

I’ve had the pleasure of working with the Allegheny County infant health equity coalition over the last couple years, and we’ve been incredibly intentional about trying to do this. What does this look like in practice?

• The coalition is composed of moms, doulas and other birth workers, nutrition advocates, community leaders, as well as nonprofit, healthcare, and government leaders;

• We used strategies like focus groups in a box that put community members and leaders in the driver’s seat of leading discussions with community members;

• As we continue to gather community input (as we just did a couple months ago during a community kick off event for implementation of the action plan), we reflect back what we’re hearing to community in ways that are easily digestible (you can see our summary of input from the kick off here);

• We directly link the input we receive through these strategies to our action, implementation, and learning/evaluation plans and we make these connections explicit (for example, you’ll see we quoted community members directly throughout our action plan to demonstrate the connections between what we heard from community and what ended up in the action plan);

• We’ll be capturing community feedback in learning and evaluation activities that directly ask them whether they felt listened to and their input acted upon - and we’ll modify our approach to reflect what we learn.

How are you and your coalitions/organizations working to go beyond hearing from community members to actually listening to them? Drop me a line and let me know!

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How to meet community where they (literally) are

One of my favorite parts of my work with community coalitions and collaboratives is working with them to meet the community where they are.

As a recovering academic, let me tell you why communities don’t trust academics and researchers - even when academics are trying to get community input, the typical model is that they bring folks together in a new space where the researcher has all the power and then ask community members to answer a bunch of questions to serve their own research needs and then the community never hears from them again.

Harsh, right?

I’m not trying to throw academics under the bus, I used to be right there with them, and their hearts are often in the right place. But we’re generally not trained in academia to share power with community members and meet them where they are.

You know who does that well? Community coalitions and collaboratives!

Working hand in hand with these groups over the last several years, here are some of my favorite strategies we’ve employed to meet community members where they are:

• Listen where community is already gathering. I’m part of a coalition where I live in Fairfax, Virginia, and last year, we launched our very first community-wide event called Healthy Together Fairfax. We knew we wanted this to be an event by the community, for the community, so we started by…listening. Just listening. Sounds simple, but it’s a step many skip! We knew there were dozens of community groups already gathering regularly to talk about health, so we simply reached out to them, attended meetings, and listened. We took notes, drew out key themes from what we were hearing, and let those themes drive the planning process.

• Focus the conversation through Focus Groups in a Box. In the first phase of my work with the Allegheny County Infant Health Equity Coalition, our top priority was crafting a community-driven action plan. The Coalition awarded small research grants to community partners that were already gathering places for community members, so that they could lead their own focus groups. I helped develop a standard focus group guide and reporting template that was then shared with these partners, and they shared back insights gathered through the conversations they led to inform the development of the plan. This is an approach that checked a bunch of boxes: we put the power in the hands of community members (they led the groups and were compensated for their time), we met community members where they already were, we heard from dozens of additional marginalized community members that we wouldn’t have reached otherwise, and we got meaningful feedback that could be incorporated directly into the plan. So many wins.

• Widen your reach with Street Stalls. There’s a problem with the two approaches I just shared - there’s a certain type of community member that’s already part of existing groups and community organizations. There’s another type - actually many types - of community members that aren’t part of those groups. And sometimes - scratch that, most of the time - those are the folks we most need to hear from. Knocking door to door isn’t typically an option, but what we can do is gather community input on-site at community locations and events (think community centers, recreation centers, festivals, farmer’s markets). We used this approach last year to gather input to inform the Children’s Behavioral Health Blueprint led by Healthy Minds Fairfax. I designed and set up a tri-fold poster board (don’t underestimate the low-tech options!) with various categories of resources and had teens/children use green dots and caregivers/parents use pink dots to vote on the community resources they find most helpful. Another section the board had an open-ended question about what they’d most like to add/change in their community to support children’s mental health, with blank post-it-notes and markers available for passers-by to add their responses. End result: we got helpful input from a wider range of community members and not just those that would self-select into completing a survey or participating in a focus group.

These strategies are great to meet community where they literally, physically are and hear what they have to say. But there is a difference between hearing and truly listening - find that in our next post!

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