Building a Culture of Health at the Neighborhood Level Through Governance Councils

Across sites, most Governance Council members stated that the Governance Council fosters collaboration among its co-located partners, brings them together to build cohesiveness, develop partnerships and work together as one body. Being at the Action Centers offered increased opportunities for cross-partner collaboration and relationship building, not only with co-located partners but with other community partners who they meet when they are invited to present about their programs. One East Harlem member referred to the dynamics that occur in the Governance Council as an “organic” process, where collaboration became a natural and continuous process as partners got to know each other and their respective work. Forming synergistic and beneficial relationships with other partners improved cohesion among co-located partners, giving members a sense of being part of a larger team.

We can collaborate with them around criminal justice and different things that, you know, people that we've spoken to really want to be engaged with. So, it's just great. It's like having a larger team, right within this building. (East Harlem Governance Council Member)

Many Governance Council members viewed the meetings as a platform for various organizations to come together, share information about their programs and learn about other programs. Besides program updates, members and external community organizations were invited to make presentations about their programs. Members particularly appreciated the structure of having guest speakers, as this gives them the opportunity to hear about other programs and services available in the community.

Information shared between partners at the meetings created opportunities to connect and have follow-up conversations, and in several cases, has resulted in increased access to resources for their clients, and increased referrals and connections among internal and external partners.

[The] Governance Council for me is a way for all of the programs to get together and talk about their services, and … the services that their outside partners provide. And it's really about information sharing, because that's really important. I feel like, a lot of times programs don't share information and we're kind of blind to what each other does. (Tremont Governance Council Member)

Members reported feeling a sense of commitment fostered largely by meeting consistency. They felt that convening on a monthly basis has helped establish the meeting culture and sent the message that the Governance Council is a vital part of Action Center operations. Some members expressed that there were good processes for communication among partners that help facilitate planning for activities such as sharing meeting minutes and creating a monthly directory of events based on information shared by partners during the meeting.

I think like actually maintaining the meeting ... the tone is set that, you know these are important and this is part of what we do, and this is how we function. So, I think that that's an accomplishment in itself, because that's hard to do. And that takes leadership, you know. (East Harlem Governance Council Member).

Members reported that emergent issues such as building- or operations-related issues or staff trainings after a traumatic community event are addressed as they arise. They said the Governance Council meeting was a place where members felt free to voice their concerns and suggestions, which are considered and resolved at the meeting or elevated to leadership, as needed.

I think the once a month meeting really fosters that camaraderie to feel comfortable with everybody who's here … it makes you feel like you belong. (East Harlem Governance Council Member)

Members shared that one of the benefits of co-location and the Governance Council structure was the facilitation of relationship building among members. They stated that there is now more “inter-connectedness” between partners in the building and this has resulted in an increased sense of having a shared identity as the Action Center. Members shared that the increased spirit of collaboration with other partner organizations allows them to leverage each other’s strengths to benefit their clients and the wider community. One member noted that new people representing external organizations are frequently invited to present at the meetings, which shows that new connections (and potentially access to additional resources) are continually being made.

I am glad to say they [the Governance Council] brought a sense of unity to this building. That was part of the problem in the beginning, there was no unity. We've got a sense of unity, we understand what each... clinic, what everybody is doing. (Brownsville Governance Council Member)

Members also reported that being at the Action Center has allowed them to build relationships with community residents. Because the Action Center is an open space for community residents, they reported that many have embraced the programs and are coming in repeatedly to utilize the resources. As a result, members are getting to know entire families and are beginning to better understand the needs of the community. One member shared that being at the Action Center has sensitized them to the depths of the inequities experienced by the community, and this has made them more aware, open, and willing to listen and learn to find ways to disseminate information about the resources available at the Action Center.

Well, I see a lot of regulars, like families, like the parents and the kids [and] we form relationships with them, with the babies … and they come to the program. So, I see a lot of interaction like that. A lot of the mothers, they come to a lot of programs and they're very involved. (Brownsville Governance Council Member)

Members shared that being part of the Action Center has positively impacted their access and reach to the communities they serve. They reported increased access to community resources for clients through knowledge of Action Center resources or by learning about resources in the wider community that they could refer clients to. Many programs expanded with increasing referrals to their programs, and many have been able to reach and retain more clients.

Being at the Action Center has really given us access to a community that we previously didn't have access to. (East Harlem Governance Council Member)

Members also stated that they have benefited from increased access to staff support for program promotion and referral services at the Action Center. For example, partnering with Action Center health promoters to conduct outreach and program promotion have resulted in an increase in Action Center visits. Access to Action Center navigators who inform and direct clients to program services, health promoters who work to inform neighborhood residents about local health and social services, and referral specialists who assist with referrals both within and outside the Action Center has helped in communicating with clients and facilitating referrals to services. For example, uninsured visitors to clinical services are referred to a co-located partner who can help them navigate the Health Insurance Marketplace to enroll in health insurance.

When they have patients that come in and don't have health insurance or their health insurance has been discontinued, they'll refer people to [co-located community-based organization]. So I guess that's a success. You know, making sure that people have health insurance and can essentially receive the services. (Brownsville Governance Council Member)

Members also reported that they have found ways to share resources by engaging in the planning process together. Learning that many members attend the same events, they decided that they could work smarter and increase their capacity and attendance at events by cross-promoting programs.

While members acknowledged that there has been increased foot traffic through the Action Centers, they perceive that there is still a need to engage in activities that would build community trust. Some communities generally distrust government and may view the Action Center building as strictly a government entity. Related to this, each Action Center, like most government buildings, has a uniformed Health Department police officer, who is usually the first person a client sees when they enter the building. Members perceive that they may be intimidating to the public and may deter some neighborhood residents from visiting.

You know, I think there are still a lot of people out there that are difficult to engage … the Health Department has already made it very, very clear that, you know, coming to get services from the Health Department will not put them in danger. But still, there are segments of the population that are very untrusting and that has to do with like historical experiences. (Tremont Governance Council Member)

Members reported that there is still a lack of awareness of what the Action Centers offer, which is in part due to the lack of exterior signage advertising the services available in the building. This is especially important after hours when the building is closed. Members also stated that while they can and do advertise on the general Health Department social media platform, they feel they can be more impactful and visible if each Action Center were to have their own social media platform which is currently not the case.

Not having social media really makes their life (health promoters), their jobs harder and it makes us less visible. There's a bunch of flyers out there and that generic brand is just like not noticeable. (East Harlem Governance Council Member)

Additionally, one member pointed out that the Action Centers still grapple with a branding issue of being associated with services previously offered there, such as STD or HIV testing and treatment or immunizations. As such, they felt that community outreach is even more crucial to build awareness of the Action Center and its new programs and services, to garner community support and involvement.

I think inherently what the Action Centers have had and what they grapple with is a branding issue. Anecdotally, a lot of the residents that I’ve spoken to in passing when I told them where we sit, they say, “Oh, the AIDS clinic, the STD clinic.” (Brownsville Governance Council Member)

Members mentioned challenges in having to go through many layers of approval inherent in a government bureaucracy which sometimes create roadblocks for certain projects at the Action Centers. They stated that adherence to bureaucratic protocols can sometimes prohibit or hamper decision-making at the local level, and sometimes delay or prevent projects from moving forward. They indicated that this is a major obstacle when working with partners, especially when they cannot deliver on partners’ requests or promised services in a certain timeframe.

Some of the more ambitious projects are a little bit hard to get off the ground. They're good but, as soon as when you get to a certain spot, there are hard stops, not from us. It’s the politics or the red tape. (Brownsville Governance Council Member)