Health Equity Actions: The Importance of Engaging Community Advocacy to Improve Equity in Health Care

June 2, 2023

Transcript

Dr. Angela Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the kid experts where the complex is our every day. Each week we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge, and perhaps change how you care for kids.

Welcome to Talking Pediatrics. I’m your host, Dr. Angela Kade Goepferd. On this episode, guest host Adriene Thornton, interview Cindy Kaigama, Director of Community Health, and one of our kid experts at Children’s Minnesota. Cindy talks about her own experiences as a patient family at Children’s and how this informs the way she partners with community to improve equitable care and outcomes.

Adriene Thornton: So, today we are welcoming Cindy Kaigama. She is our new Director of Community Health, here at Children’s. And, I could tell you all about her. I know her quite well, but I’m going to let her tell you about herself.

Cindy Kaigama: Hi Adriene. Thank you so much. I really appreciate the opportunity to be on your podcast today, and I’m very grateful and humbled for having this opportunity to partner with Children’s, and serve during this time. My son was born at Abbott, and spent seven weeks in The Mother Baby Center almost 10 years ago. So, I had firsthand experience as a patient, or my child was a patient, for seven weeks in The Mother Baby Center in specialty care.

He was born at 29 weeks, two pounds, 13 ounces, and he stayed in The Mother Baby Center for seven weeks. So, I had the opportunity to be able to access services when I was a patient, and life has come full circle. And now, I am partnering with you and other team members as a Director of Community Health at Children’s Minnesota, where I lead our Community Connect program, and our Healthcare Legal Partnership program for our patients who are having to need assistance at this time for social services and community related needs.

Adriene Thornton: Let’s dig into that a little bit deeper. So, it’s always amazing to me when people have a Children’s story. And, when I am out and about in the public and I have on my Children’s Minnesota, it is a rarity that somebody doesn’t come up to me to share their Children’s Minnesota story, there. It’s always, “Oh, my child was at Children’s Minnesota and it was wonderful.” Or, “My grandchild was in the NICU at Children’s Minnesota and it was wonderful.” So, knowing that you have that history with Children’s Minnesota, how does that impact the work you’re going to be doing? Does it make it more special for you? Is your passion greater because you have that experience? Or, is it just like another day in the office?

Cindy Kaigama: In full transparency, my experience with Children’s during that seven weeks was very interesting. I had some great experiences. And, just like with any other human, you have not so great experiences. And, because my child was born at a very young age, there was an expectation that he would need more assistance than he needed. So, we were grateful that he was there to grow. So, it wasn’t as if he was in specialty care. He came out, they were surprised, “Wow, he’s 29 weeks. His lungs are healthy, he’s passing all of the tests.” I don’t know what all the tests are, but he was doing well. So, he was there to grow. So, initially, my experience was different. Because, oh, he wasn’t a high need. So, they literally only came in when it was time for their round.

As a new mother, we were told, “Oh, you can’t have kids.” And then, we were blessed with a child that I didn’t know all of the things that we were supposed to know as a new mother. So, it was interesting being in The Mother Baby Center. My experiences weren’t always great, so I took those learnings that I had as a patient, and for my son, and now given the opportunity to work in this organization and partner with other people, partner with patients, and partner with people in our community, so that were those opportunities where there was a great experience, we leveraged those and that’s wonderful. But then, when there’s opportunities that we can partner together from a health equity lens in your area, and understanding cultural differences in how we engage families and patients that may be different than how we are in our experiences as people who’ve been here for generations as Americans, that is something that I’m really looking forward to in partnership in this role so that we can not serve helpers, but we serve as partners to our families that we’re serving and let their voice lead.

And also, when we are in these situations, it’s almost a crisis. So, you don’t expect your child to be born early. You don’t expect to have complications during your pregnancy. So, the programs that I lead, there are people who are needing assistance because of social determinants of health, where they made us need childcare, or housing, or it may be an eviction, or it may be a social need to help them to improve the health of their family and their child.

Having been through those things myself, I lead with a different lens because I also have lived experience having to also need some of those resources. So, it’s not just, “Oh, here is this person in this director level because I have education and the work experience.” I also have lived experience in these spaces as well. So, I come along and I want to be able to empower our families and not service charity care to them, like we’re doing you a favor.

No, we’re partnering. We’re coming along together as you’re navigating life. And, I’m doing what I can in this role and space with other people in the organization to provide resources and community. And then, after we’ve gone from a crisis situation, how do we partner with them to create stabilization, to then lead to self-sufficiency? Because, there are people who come in at different points in their life. We have people from all over the globe who we serve at Children’s Minnesota, and we want to be able to offer service that is comfortable for them, based on their lived experiences and how they’re showing up in our doors.

We want to do that in the lens of respect. We want to create dignity. We want people to feel welcome and included when they come to us. So, my role as a Director of Community Health is also partnering and developing and cultivating relationships with external organizations, and making sure that those partners also align with our values at Children’s. And, that when the people that were referring to those organizations, they go out, but they also feel a sense of dignity and respect.

So, I’ve been really doing a lot of work and asking a lot of questions, being very curious and how our experiences are with the patients that we’re serving, currently, and then how can we work together after we’ve made some assessments to identify partnerships that will be creating sustainability so that they may not have that crisis situation, and we partner with them. Also, it would be awesome if we can employ some of the people, because we’re an employer. So, one of the things I want to be able to do, and a vision I have, is that if there’s an opportunity to create a pilot that we can work with families, and they become an employee of Children’s, there’s a success story that we have. There’s a person who just joined our team, and she let everybody know that she was also a person who received services through our Community Connect program when she was going through some things in her life, and now she’s a resource navigator.

So, those are the types of success stories that we want to be able to continue to share, to be able to increase economic capacity for the families, and partner with them to create skills and improve their financial capacity so that the resources and the services that they need may not be from a crisis situation, but they’re able to move forward from an economic capacity, and they can become a employee of Children’s.

Adriene Thornton: Can you tell us a little bit more about what is Community Connect and Health Legal Partnership? What are we doing with them? What do they do? How do they support our patients at Children’s Minnesota?

Cindy Kaigama: Community Connect is a service that we provide in four clinics. One is in Brooklyn Park, one is in West St. Paul, one is in St. Paul Hospital and one is in Minneapolis Hospital, and we have resource navigators. So, from a clinic perspective, they’re tied to the clinical outcomes for social determinants of health needs. And, there’s a screening so when they come in for their well visits, they are screened and asked specific questions about what their needs are. Do they need help with food assistance? Do they need help with housing? Do they have a legal issue? Is there a family law that they’re experiencing that they need some assistance with? And if they check yes to any of those on the screening, then they’re referred to Community Connect within the four clinics. Our Community Connect is not available, currently, to all of Children’s. It’s only in these four clinics where there are higher needs. The healthcare legal partnership is system-wide. So, they are referred through our social workers, through our care coordinators and also Community Connect. There are specific areas that we’re working on because we have identified that there’s some things from a legal perspective that is out of scope for the patients that we’re serving.

So, how do we create language to partner with our staff so that they understand these are the things that we’re referring patients for from a legal perspective, and then this is, maybe, other resources that you can access in community to assist the family, because it may not be necessarily something that is a legal issue. So, we have partnerships with SMRLS and Minnesota Midwest Legal Aid.

SMLRLS is one side, and then the Minneapolis Region. So, it’s two different regions that we’re serving. If it’s family that’s coming in that’s outside of those regions, then they refer them to Legal Aid services within the cities that they live in. That’s outside of the scope that we’re serving.

Adriene Thornton: Oh, wonderful. And then, are there plans to expand Community Connect and Health Legal Partnership? Because, it sounds like the services they’re providing will be beneficial to all of our patients, and so it would be great if we could expand it to other clinics. But, especially to our inpatient units as well. So, do we have plans to expand those programs anytime soon?

Cindy Kaigama: As a new leader coming into the organization, I am assessing what the current need is, and then being able to identify opportunities. And then, after we’ve done that and made an assessment, then we’ll be able to decide if there’s opportunity for growth in other areas. But, what I wanted to do is create a assessment right now to see, because I’m new, I’m coming into the organization, I’ve only been here a couple of months, to identify how can we strengthen the relationships that we currently have within the clinic walls and also externally, and then be able to grow once we’ve done that.

So, it is a possibility, yes, that the program can grow within a year or two. But, in this first year, I want to be able to dig deeper and have a better understanding and assess what the needs are from our families, what the needs are from our staff, and create greater alliances within the clinics that we’re already in right now.

From a Health Care Legal Partnership, that actually has grown over the last five years. And, they started out, I remember talking to some of the attorneys and they were saying that they had to find patients. And now, our attorneys are at capacity. So, we’re like, “Okay.” Not to say slow down, but one of the things that I’m doing is creating value for the program as well, and partnering with our team so that we can show intense value. So if there’s an opportunity for growth, then that will be determined during our assessment phase.

Adriene Thornton: You mentioned in several of your comments, about community, so communities in your title, it’s in the title of the Resource Navigators, and you talked about engaging the community. So, can we talk a little bit about community engagement, what it is and what that looks like for your area? Because, someone once said, you can’t provide to the community if you don’t include the community. And so, a lot of our work going forward in 2023 is really going to focus on that community engagement piece.
So, tell us a little bit about how you define community engagement, what that looks like and what your plans are for your departments going forward in 2023?

Cindy Kaigama: Adriene, I have a background working in community-based participatory research, and leading needs assessments, and have been doing this work for a long time before I had all these titles associated with it. So, I may have a different scope in what community engagement looks like versus what the definition of community engagement is. And, when I hear community engagement and community partnership, it’s not always the organizations leading and telling people what to do, and not specifically calling out Children’s. But, traditionally it’s like, “Oh, we go in an organization and we’re telling them, ‘this is how you need to do things, this is how you need to interact.'”

But, sometimes community engagement means just showing up and listening and be quiet, and understanding what the lived experiences are of the people and inviting them to the table to be able to have a voice in the work that we’re doing as partners. And, it takes time and it takes relationship building. It’s not just, “Oh, this organization looks great. Let’s partner with them.” We have to make sure that we’re aligned and that both of us are getting the things that we need for our prospective organizations and also in community. What community may look like for the community that is being served may not look like that for the organization. So, you have to make sure that they’re both having alignment.

Sometimes, community engagement may also create discomfort. And, that’s the reality at that time, maybe, of the people that are experiencing those things. And, we have to be okay with being uncomfortable. I was taught you always have to be comfortable with being uncomfortable. So, community engagement may feel like discomfort, but if that discomfort is also doing service so that you heal from trauma or that there’s unintentional harm that has occurred, then how can you reestablish trust with the people that you’re serving and the people in your surrounding areas who live and work and play and stay where organizations are not the organization coming in and saying that, “I know best.” But, being humble sometimes to say, “You know what? I don’t know everything, and I may not even live in this community.” Or, “I may live in a community but not be aware of what the issues are that are happening and what’s going on.”

Being humble and listening, that’s one of our values. To listen and really listen. And, we’re putting our kids first in the work that we do, and our kids show up with all different walks of life. So, we have to be flexible and equitable. Equality is the foundation of the work. So, we all want access. We all want healthcare. But, equity means that we are providing access and health care based on the need of that family. It’s ownership for that particular human. It’s not just, “Oh, we’re giving everybody the same access.” That’s equality. Equity is, we’re giving them the access based on their language, based in a way that they understand, based in a person who looks like them and share their lived experience so that they may feel comfortable opening up.

And also, we’re not just coming in and we’re taking from them and then we don’t leave them hanging. We’re partnering together to see what is the opportunity that we need to work together on to meet a need to improve the health and wellbeing of the people that live in those spaces and work in those spaces.

Adriene Thornton: I’m excited for our departments to partner together, because we’re working on health disparities. We know that the health disparity is discovered within our building, but we can’t really improve that disparity unless we move outside of our building. And so, having your team working through the social determinants of health and collaborating with us on the community engagement piece so that we’re making sure that when we’re looking at health disparities, we’re actually serving the community’s needs and not just the needs of our metrics that we have determined to be important. I think that’s going to be really important going forward.

Cindy Kaigama: Yes. And, I also want to add, too, as a hospital system and as a healthcare organization, we have requirements that we have to fulfill in creating a community health needs assessment. And, I’m excited having that experience and working with our team, that we are going to evaluate what is the needs assessment saying? What is the community, the people who live and play and work in the areas outside of our doors say that they need? And, what should happen is you take in the recommendations of that needs assessment and then create a strategy that, for the next three years, we’re required every three years to conduct an assessment to find out what it is, but not just also being a need, but what are the assets that are currently available in the communities, in our surrounding areas and our service areas that we have?

And, not just focus on the needs. Because, there are also assets there, as well. And, taking those recommendations that the people say that we need to do. And, that’s, sometimes, where true community engagement comes in. Because, it may be uncomfortable for us as a organization, it may be within our scope, but like, “Oh, we’re uncomfortable. We don’t want to do that.” But, true community engagement is coming in and we’re getting our hands dirty together, and to be able to work together.

So, I remember when I worked at a different organization going into community and providing mobile health care was very different than what the organizations may have done. Or, being able to have mental health access that you’re calling, you have somebody to talk to, and not because you’re in a crisis situation. Well, people are asking for this now, to say, “Okay, I want you to come to me instead of me having to come to you.”

What does that look like from an organization like Children’s, to be able to provide mobile care for the families that we’re serving that’s outside of our walls? So, I would love to see that happen in community, because that’s what, from a mental health and from the needs of the people that’s being served, can we pull up in a parking lot and have a mobile bus and say, okay, this is the services we’re providing. We would love for y’all to come in and then, we’re doing things differently. And, that true, authentic community engagement.

Adriene Thornton: Well, Cindy, as usual, I have enjoyed talking to you. We talk often, and it is never a dull conversation. So, I appreciate you taking time to speak with me today, and I really do look forward to working with you more in the future. This is exciting work. It’s hard work, but together, I know we can get it done.

Cindy Kaigama: Thank you, Adriene, for having me. I really appreciate it, and I’m excited about the work that we’re going to do together.

Dr. Angela Kade Goepferd: Thank you for joining us for Talking Pediatrics. Come back each week for a new episode with our caregivers and experts in pediatric health. Our executive producer and showrunner is Ilze Vogel. Episodes are engineered, produced, and edited by Jake Beaver. Amie Juba is our marketing representative. For more information and additional episodes, visit us at childrensmn.org/talkingpediatrics, and to rate and review our show, please go to childrensmn.org/survey.