Two of the key tenets of Delta Center California are centering racial equity and engaging in co-design with our partners across the state. Three months into the initiative, the co-design process guided us to reflect on whether we were doing all we could to advance racial equity, and ultimately led to the restructuring of a major component of the work: the Learning Lab.
The Delta Center California Learning Lab
Delta Center California has two distinct workstreams (the State Roundtable and Learning Lab Teams) that symbiotically pilot and advocate for primary care and behavioral health integration. The Learning Lab was initially designed to include six local teams, three led by primary care and three by behavioral health, made up of payers and providers working together to test integration pilots. Through the process of revisiting and vetting the Learning Lab Team plan with our Advisory Group, some key learnings around designing for racial equity emerged.
Soliciting feedback through a co-design process can provide accountability and help surface disconnects between program design and stated program goals.
In November 2020, the Delta Center CA Program Office held a meeting with the State Roundtable and Advisory Group, a group of experts and leaders in primary care and behavioral health who help to inform the project’s direction. We had made clear that one of the key goals of Delta Center CA was to advance racial equity, and spent time discussing health equity data and the role of racial equity in care integration. Then, we presented the Learning Lab concept and asked for feedback. We swiftly heard that the design of the Learning Lab as it stood was not aligned with our stated intentions around racial equity. The feedback was that, “Our Learning Lab conversation [at the November meeting] felt like we were trying to shove equity into a racist system.”
“Health care should not be designed around what works for payers; we need to design around what works for consumers and families.”
Designing for equity means thinking critically about who the program is designed to serve.
Following this feedback, we spoke with members of our Advisory Group to delve deeper and determine how to restructure the Learning Lab to better meet our racial equity goals. We heard, “The design right now is structured around payers and providers - if we are centering equity, we may need to consider thinking about a different structure,” as well as, “Health care should not be designed around what works for payers; we need to design around what works for consumers and families.
"The missing piece is thinking about non-traditional providers or community based organizations that are part of the ecosystem but don’t fit neatly into the infrastructure being developed.”
Language and definitions influence what kinds of organizations or practitioners see themselves as welcome and included.
Our partners encouraged us to let go of traditional definitions of “providers,” moving past clinicians to also include nurses, licensed practitioners of the healing arts, community health workers, promotoras, social workers, therapists, counselors, traditional healers, peer support specialists, and more. One partner said, “We need to think outside institutions when we consider how health care is delivered; for example faith-based leaders.” Another said, “The missing piece is thinking about non-traditional providers or community based organizations that are part of the ecosystem but don’t fit neatly into the infrastructure being developed.”
Minimizing prescriptive thinking and limiting parameters can give grantees the power to shape their own work.
In response to this call to reconsider the design of the Learning Lab, we created three new scenarios that explored various iterations of the Learning Lab and presented them to some Advisory Group members. However, we heard that we were still too prescriptive in our thinking. We pushed ourselves to further analyze the barriers that existed in each scenario, and consider which elements of the Learning Lab were truly essential to the goals of Delta Center California. Ultimately, we outlined a small set of essential parameters for applicant projects, but left as much as possible unrestricted.
“How do we disrupt the selection process to include non-white groups in processes that usually require rigid RFPs?”
Application processes themselves can be unnecessarily exclusionary.
There were other aspects of the Learning Lab that we had not previously considered as being dictated by a white supremacist culture; namely, the Request for Proposals (RFP) process. Our partners prompted us to consider how traditional RFPs exclude community-based organizations and other groups that are not privy to the “secrets,” or unspoken rules and norms around succeeding in the proposal process. One partner asked, “How do we disrupt the selection process to include non-white groups in processes that usually require rigid RFPs?” To be truly equitable, we had to change our language and process to intentionally engage groups that are often excluded from this type of initiative. Instead of a traditional RFP, we created a brief Call for Applications, followed by an interview with applicant teams. We made efforts to outreach to organizations who were not “the usual suspects,” and encouraged them to apply. Additionally, we hoped that the CFA removed some of the time barriers that exist around grant writing and reporting, particularly considering the burden of COVID-19 in California and the limited resources available for many small community-based organizations.
The reconceptualization of the Learning Lab resulted in the selection of five teams representing partnerships of organizations, some of whom have never participated in learning collaboratives such as this one. Each team brings a unique set of experiences to the Learning Lab, with expertise specifically in areas of integrated care, human centered design, clinical experience, community-defined practices, the engagement of people with lived experiences, and advocacy for various communities, including the LGBTQ+ and Latinx communities, people with serious mental illness (SMI) and/or substance use disorder, and people experiencing homelessness. You can read more about each of their projects here, and about their collaboration around racial equity and lived experience in the first convening.
Through this process, we have learned that actors across the state are ready to implement policies and practices that are informed by racial equity at every level. Our partners have pushed us to think critically about how to make a more equitable initiative at each choice point we encounter, including but not limited to the selection process, organization involvement, team composition, project type, and measurement strategy. We are committed to staying accountable to our ultimate goal of improving care and reducing racial and economic disparities across the state, and we look forward to continuing to iterate to make sure we move the needle on care integration and racial equity.