This transcript is auto-generated and may contain inaccuracies.

Eliza Daly:
Help in having us be able to do this work efficiently and in an impactful way. We also really want to highlight that there are many opportunities between A3 and the other big strategies. So A1 is the workforce, and A2 is for foundational capabilities. I think oftentimes, A3 kind of gets sent off to be its own island. Data modernization can be very intimidating, but there is so much opportunity to have connections between all three strategies, so that’s why, as Sarah mentioned, we are kind of using our data modernization context for this presentation, but it really weaves in and out of all of our PHIG strategies. And then we’re going to be talking about our organizational learning in the Iowa context. But our hope is that you can really take away how to adapt some of these kinds of organizational learning frameworks to your own jurisdictions. We’re all going through a lot of change and adaptation right now, and we’re still able to get our work done by using some of these organizational learning strategies. So it doesn’t necessarily matter what your own jurisdiction is going through if you have this sort of framework to work through some of those issues.

So our first act is our original vision. As you see, we’re going to be using a kind of roller coaster motif throughout these slides. When we first had or heard of PHIG, you know, we were on board this roller coaster. We’re in Act One. We’re kind of rolling up the hill, very excited for what’s to come ahead, not necessarily knowing what’s at the top of the hill or what’s at the bottom of the hill.

So I will just kind of ground us in some of our data modernization outcomes, especially if there are folks in the audience who are not as familiar with what some of the data modernization focus areas are supposed to be. We’re really trying to invest in a more modern and efficient data infrastructure. So this is building a lot off of previous ELC data modernization funding and keeping that work moving forward. We’re also trying to increase data interoperability.

So for Iowa, specifically, we’re doing this by building a data lake, which is just kind of a central platform that houses different data systems and data sets so that they can be able to speak to one another, for our epidemiologists, to be able to kind of integrate more for analysis work, and it’s just a common storage area that will support this interoperability element, and then just increasing the availability and the use of all of our public health data. It’s one thing to collect data, but then actually being able to use it not only serves our agency, but also Iowans and anyone in our jurisdiction by giving back that kind of data-informed decision-making. And so to do this, we’re really trying to invest in upgrading our processes for things like data sharing, data privacy for some of our A3 work that involves bringing on new staff. Sarah, I’m sure, will talk about some of the incredible team members that we’ve been able to bring on in positions and job descriptions that we’ve never been able to have as a department before.

This funding, and then a lot of A3, is focused on upgrading our technology. So that does look like investing in different data structures or systems, but also making sure we can maintain them, so these outcomes all kind of support some of Iowa’s overarching fit goals. A lot of this data infrastructure supports the idea that Iowa, in general, is also attempting to assess our public health system and identify opportunities to improve it overall, as well as supporting our local public health workforce through capacity building and training.

So I will turn it over to Sarah for the next stage of our roller coaster ride.

Sarah Brooks:
As you can see, our roller coaster has changed. It is now the loops and the upside down and the round and round, because that is how it has been since they put out the call for people to come give presentations at this conference. I said, okay, but only if we can, like, be really honest about what’s been. Happening, because a lot of times we come and we hear about the great things, but we don’t always hear about the hard, and implementing change, even in blue sky days, is very hard. I mean, we’re looking at completely overhauling our public health system, and there’s a lot that goes along with that.

So, just a show of hands, have you been able to implement PHIG exactly as you originally proposed in your grant application? Anyone?

Anyone? No, no, yes.

We want to talk a little bit about why that has been, because we have had some unique experiences, but we feel like they probably translate to a lot of other places. So we’re here to talk about the hard decisions we have to make, and how we get from A to B and then to C.

So, in act two, we’re going to talk about rapid evolution and systemic shifts. That includes agency mergers, consolidation of IT services, and delays in hiring. PHIG-funded positions, funding shifts, you know, supplemental funds came in later than originally, a one and a two funding came in. We’re still trying to braid funds with ELC. Money has been, you know, rescinded. So there’s, there’s just been a whole lot, not to mention we also were kicked out of our building for a year for renovations, so we had that piece as well.

So the slides you’ll see are not meant to be a full organizational chart or necessarily indicative of hierarchy. But I do want to kind of illustrate how the people in the work associated with PHIG have changed since PHIG was awarded in 2022. Public health in Iowa was its own department. We were the Iowa Department of Public Health. So when PHIG was awarded, we were an agency of 500 people, and it was spread across the deputy director’s office, which had the PHIG PI. They were going to build out a new public health surveillance office under there as well, and then the data, data strategy, and data sharing also kind of fell under that. As the DMI director in 2022, I was not the DMI director, but the DMI director lived in information management under administration and professional licensure, and then a lot of the work would be done in the acute disease prevention, emergency response, and environmental health.

But as we were coming off of COVID and trying to, you know, get our bearings and find a way forward, the state said, I have a great idea. Let’s merge the public health agency with the Department of Human Services and five others. So, in July of 2023, we officially became the Iowa Department of Health and Human Services. With this, there was a great amount of shifting of people. People previously kind of committed to PHIG took new roles. People got moved the PI no longer lived in the Division of Public Health. She moved to strategic operations. That’s where the grant coordinator also lives, and the data strategy at that time was located within strategic operations. Public Health has the public health surveillance program that falls under our health statistics program. Those positions were all vacant at the time, and compliance, we created a bureau called data sharing, privacy, and open records.

So that’s where the compliance officers lived, and the attorney specifically designated to privacy, HIPAA, and data sharing, and then under administration, we have information technology, public health was a bureau, kind of under there, and then that’s where I fell. And I was the DMI director at that time. We did not have an actual tool for information. Information Technology, at this point, as a merged agency, we also started to have some competition, because we went from 500 employees to 5000 employees and a fully established IT shop within legacy DHS. They were a Microsoft shop. We were a Google shop. I had four email addresses over about 15 months. Everyone had to move off of Google for email and, you know, documents, to Microsoft. So there was just a lot of churn underneath that. And when we worked in our, you know, original agency. We knew how to submit a request for a new employee, go through the process to get them hired, onboard them, and get them a computer. And now all of this is different. It’s all changed. And so we did experience a fair amount of delay in hiring people, just because, I mean, everything was different.

So then, between the fall of 2023 and 2024, we changed again, and information technology completely moved out of the state agencies, and they created a consolidated information technology for the state. Additionally, performance moved again to the administration, public health still has the public health surveillance with vacant positions, and we did hire Jeneane as the workforce director. Compliance remained the same with data sharing, privacy, and open records, but I no longer worked at HHS. I was in a completely different agency. Initially, when that was announced, the Deputy Director for HHS did call me and ask, What do you think, and primarily about the HIE, because that’s that was really my connection with her, and if we were going to embed staff and agencies, I’m like, this could totally work. I don’t know that this won’t work. I don’t know that we need to worry about this or change anything. I think we should see what happens.

So off to the Department of Management I went but at the time, the public health building was being renovated, so we were actually co located in a little in one little building, and I was on the second floor, and then PHIG people were on the first floor and the third floor, so it was still somewhat cohesive, but I wasn’t fully, you know, integrated with the team. And then in the spring of 2024, Eliza brought us together to do a RACI because we were starting to get some staff we needed to identify, you know, who was doing what, and what the responsibilities were, and to bring clarity at that point, I had never even met Jeneane. She’s part of the PHIG team and PHIG leadership. I’ve never even met her. They all know each other really well. And I don’t know if anyone in this room knows Jeneane, but a lot of people know Jeneane. If you travel anywhere, Jeneane knows people. People know her. I didn’t know her, and I was on her team that day. Was kind of sitting through that the A3 component was clearly not integrated with A1 and A2. I was on my own, with some help from Eliza to submit things, but everything was me, and then where there were multiple things, I wasn’t involved, or I wasn’t included.

So that was kind of the first hint that, okay, this might not be great. We need to do some work here. So there came a point in July, end of June, early July, where we finally got the new organizational chart for Information Technology, and they were not going to embed people in agencies. They moved to a completely different structure and where I was going to be placed. There was no way for me to do this work. So when the deputy director called me again after that chart kind of came out, and she’s like so and I said, bring me home, bring me back. This isn’t going to work for us to be successful. ASTHO, I need to be back in your agency. And while we have changed rapidly over the last three years, change is also very slow. So it took a little bit. I do tell the story of the day I went to training for the new position they wanted to put me in, and I walked into a conference room and called our operations deputy and said, Get the truck and come get me. It’s time to go.

So here we are today with our data modernization and our current structure for people who are kind of involved in the A3 components of data modernization, compliance and administration now has performance and operations. So the PHIG PI has also moved again. This is not just me; that team has also undergone a great amount of change over the last couple of years. The data sharing privacy and open Records Bureau is now called data privacy and strategy, and that’s where I moved back to. So we are co-located with the compliance officers and our attorney, with the DMI director, a data scientist, a data strategy coordinator, and a health economist, who all fit in this one area.

So when we’re having data modernization conversations, when we’re talking about a data lake, when we’re talking about data sharing, when we’re talking about how to do all of that, compliance is at the table. Our attorney is there. It has streamlined those discussions significantly, because I know that’s always kind of a catch point for people, right where you have to have your idea, and you have to send it back over, get approval, have these discussions. We’re kind of all working in the same space within public health. We have public health surveillance, the data scientists’ one. We have two data scientists. We have a specific syndromic surveillance epi, and we have four new epidemiologists as well. We work very closely with them, especially the two data scientists. I mentor both of them and help them work with the data scientist, too, that I mean, we just hired him two weeks ago, and then Jeneane is still under public health. We also have a new state epidemiologist in the last 15 months. So here we are today with our data modernization and our current structure, for people who are kind of involved in the A3 components of data modernization, compliance, and administration, now have performance and operations.

I mean, we’ve really, in the last year, and especially six months, we’ve really been able to ramp up hiring our new positions and what we’re doing and where we’re going with with our work. So it took a lot of I think this can work. I don’t think this can work. We need to move this back. I mean, there’s been a lot of organizational shift, and I do have to acknowledge that a lot of times in state government, when they put out a table of Organization. This is it, and this is how it’s going to be, and we’re just going to make it work. And we have changed and shifted multiple times since the merger. And so I think it’s a credit to our agency that they’re willing to sometimes out of necessity, because people come and go, but also to recognize where the work needs to live, to ensure that the work gets done. So with that, we will move on to Act Three.

Jeneane McDonald:
Okay, so here’s our metaphor with the roller coaster. It’s not as topsy-turvy anymore. So poll, because Danielle said we could do just show hand polls and please online, how many of you are the kind of person at the top of the roller coaster who does the “woo hoo? Here we go.” And how many of you are like, “I am holding on for dear life.” Okay, that’s all right, and you’re all in the car together. So just pause. We’ve been as Sarah was talking, I was thinking about that term VUCA environment. Are you familiar with those environments that are volatile, they’re uncertain, they’re complex, they’re ambiguous? So even if all this book report is about like our experience regarding a three, do you see yourself and the story and your implementation of PHIG, if you have nothing to do with data modernization, have you been living in a VUCA environment while you’ve been implementing? Okay? All right, so we’ll talk a little bit about organizational learning.

So organizational learning requires leaders, as you can see at the top of the model, to concentrate. Debate on changes and collective knowledge, organizational structures, and behaviors to instill adaptive practices. And oh my gosh, Sarah was talking about some adaptive practices, and I bet you can think of your own, and it is essential to decision making by requiring feedback loops in both stable and dynamic conditions, thereby highlighting the strategic role of continuous learning to organizational success.

So Sarah was talking about the experimentation that was happening in real time, some things that might be smaller bets that you’re taking as an organization, and some things that are really large decisions for the organization, but the process is about improving over time. So you can see that across the bottom there. So leadership and time are moving across the model, and it is about gaining experience, acquiring knowledge, and adapting behavior.

But the point is, the point of this story is it’s not about individual learning, it’s about collective learning, and then how we institutionalize that learning and use it intentionally to adapt. So this is the interview portion, and so I’m asking my colleagues here. So we’re going to talk about, start with you, Sarah. Think of a time when you had that first insight, and you thought, Oh, we’re having some collective learning happening here. And you remember clocking and registering that.

Sarah Brooks:
Sure, so as I mentioned before, I think it really became apparent during that RACI meeting. I mean, having been to other…you know, some of the webinars, online, some of the different meetings that we attend for DMI, we’re really always just focused on the A3 things. And I don’t think I really fully recognize the depth and breadth of what we were trying to accomplish with PHIG until, until we had that RACI session, and seeing all of the different things that people were working on and what needed to be done, and then how we really needed to start to consider A3 a partner with A1 and A2, and how A3 can serve A1 and A2.

Jeneane McDonald:
Okay, and I remember that was the first time we met as well. I could read your body language during that facilitated session that this was not connecting, and you were experiencing it differently than others, and then to the adaptive practices. So then what would you point to in the story as adaptive practices? Because that’s the point of learning, as we adapt our practice, right?

Sarah Brooks:
So I think, like at that time, we were all in the building on East Grand, trying to go downstairs more, go upstairs more. I was never required to be in the building at that time, but I made sure to come in two days a week so that I could physically connect with other people who were working on PHIG to try to start creating more of that team. We hired Manuela. I had, you know, I spent a lot of time with her. We spent time together, just trying to reach out and establish relationships and connections to see where, where we might be able to bring it together.

Jeneane McDonald:
Okay, and in the interest of time, Eliza, I’m going to ask you just briefly, so as the PHIG coordinator, you have that balcony view, right, and you can see the pieces across. So, where were you seeing the adaptations through this organization?

Eliza Daly:
Learning? Yeah, I think that there was so much change in just the communication and regular check-ins with you that have really helped. I’m just thinking in between the first when I started and working on annual reporting, the jump between the breadth and depth of information that we were able to report to where we are now, so much success has happened, and it’s really all due to the kind of that interconnection piece that’s been developed over the last, however, many months.

Sarah Brooks:
Okay, so to finish up, we do kind of want to come back to the three primary outcomes and report on them, because in the midst of all the turmoil, we have actually been successful in some areas. We are developing new data systems for disease surveillance, immunization, and Family Health. We have enhancements to our ELR and ECR programs, and we have established a syndromic surveillance program. We were one of the last states to do syndromic surveillance. We do not have legal authority to hold that data, so we utilize our HIE to send the data to the CDC work to come; we have to reprocure the HIE, and the scope and breadth of infrastructure work will be determined by some of our funding. Increase in data interoperability, we have built a data lake, and it currently holds 11 data sets, disparate data sets, a data inventory has been completed, and next week, we will be meeting with our team and AWS to implement the governance features, how we want to implement governance within the lake so that we can assure you know, good data access controls.

We need further granularity on the data inventory. We want to build that into the lake and then modernize the public health tracking portal. We have hired a lot of staff in the last few months related to data, and it’s been really exciting for us to see that we’re updating our internal data sharing process, and we continue to evolve in how we work with our IT partners at DOM do it, things can take quite a long time. Yeah, and then do you want to talk about this?

Jeneane McDonald:
Okay, we want to hand it over to our colleagues here. And just so, what were the facilitators to success? It was about our mindset and about changing how we were going to be adaptive. And so, mental models are the things in the iceberg model below the waterline. And really, having that approach about being learners and learning collectively was important. But if we pointed to our facilitators for success, much like you, they would probably have flexibility and support adaptation.

Our CDC program officer has been very accommodating with that deliberate restructuring. This wasn’t just moving boxes around for the sake of moving boxes around, because form follows function. It was about the function of where Sarah and people were located, and those connectivity points shared and clarified vision, which is an ongoing, iterative thing, and the inter-team collaboration, of course, and Sarah has said many times, it was about building those relationships for those points of connectivity. So now we will hold the questions for the full group, and we will turn it over and ask you to please give a warm welcome to our colleagues from Harris County, Texas, as they take the stage.

Regina Dennis:
All right, good morning. My name is Regina Dennis. I’m the Grants Manager in the Office of Planning and Innovation at Harris County Public Health. Harris County is where Houston is located, FYI. And you know, some of what the Iowa team shared today really resonated with us, that idea of being in constant flux and having to shift and make changes from where you originally started to where you are in the present day, whereas theirs was more about an organizational shift. Our challenges were related to programmatic changes.

When we launched our capacity-strengthening program, we invested in community-based organizations in Harris County, providing them with funding and technical assistance to increase their capacity to serve residents and address non-medical drivers of health. But we started out with a plan, and then along the way, encountered a lot of different roadblocks, roadblocks that forced us to reassess and pivot in order to come up with a stronger and more sound program. So we will talk about that experience today to kind of help you all understand how to better engage with stakeholders and partners to enhance new program delivery and development, recognize and take advantage of opportunities to make adjustments throughout the design phase, the launch and implementation phases, and also how to embrace a community-centric approach to guide program development.

So again, I wanted to introduce my colleagues here. We’re from the Office of Planning and Innovation at Harris County Public Health. I have Brandon Maddox with me, our director, and Hannah Easton, a project coordinator who handles the day-to-day management of our capacity-strengthening program. So with that, I will turn it over to Brandon to talk about Harris County.

Brandon Maddox:
Thank you, Regina. Hi everybody. My name is Brandon Maddox. I am the Director of Planning and Innovation for Harris County Public Health. And it’s important to know that Harris County is big. It’s diverse, and it is a complex jurisdiction. It is the third largest county in the United States, home to over 4.8 million people across 34 cities, which includes the city of Houston, one of the most diverse cities in the US to kind of show and give a perspective of how big, diverse and complex we are, if I were to get in my car At 4 pm on a Wednesday, so typical rush hour traffic and I was sitting at the northwestern corner of Harris County, we call that Waller, and I drive to the southeast corner of Harris County or Baytown, I would be driving anywhere from an hour and a half to two hours and 40 minutes. And that might seem like a silly example, but for some programs like our food safety investigators or our alternative 911 response teams, these are things that they do have to keep in mind as they plan their program operations.

And so, you know, Harris County Public Health, and in service of this area, we provide comprehensive health services through approximately 900 public health professionals, and our primary jurisdiction includes the two and a half million community members in unincorporated Harris County. But for some services, like Mosquito and Vector Control, refugee health screening, and Ryan White Part A HIV funding, our jurisdiction actually includes all 4.8 million members, including those in the city of Houston.

And on the map, you see we’re broken up into four Commissioner precincts, and these four precincts are represented by four commissioners alongside our county judge who oversees the entire county and so at Harris County Public Health, our mission is to protect health, prevent disease and injury and promote health and well being for everyone in Harris County by advancing equity, building partnerships and establishing culturally responsive systems, we have our vision and values up here as well, but in the interest of time, what I really want to focus on is that our mission says that we’re going to protect, prevent, promote right by advancing equity, building partnerships and establishing culturally responsive system.

And so the capacity-strengthening program, our topic for today, is really just one of the ways we do just that. So the vision for the capacity strengthening program is ultimately to strengthen community partnerships that we have in Harris County, we learned through the COVID-19 pandemic that certain communities, when advised to wear a mask or to get vaccinated, were more likely to listen to a trusted community partner than their local, large health organization, governmental health department, and oftentimes, the organizations that we worked with in the pandemic were those trusted most by the community. They had less institutional organizational capacity, and are what we would refer to as those small but mighty voices of Harris County. And so, through these observations and learnings, we developed the capacity-strengthening program as a unique partnership model that gives these small and emerging community-based organizations the opportunity to contract with a large governmental organization while preparing them for future partnerships and funding opportunities.

And so I want to talk a little bit about how it works. Our hypothesis is that there are three interventions that we provide to eligible grantees during the program, and that through these three interventions that organizational capacity can grow. The first is funding resources, right? Funding is needed to make the world run, and it’s through this funding of up to 100,000 per organization that is used in support of their capacity, strengthening plan, and objectives that they grow during this program.

Additionally, these organizations partner with a personal TA provider, so they are offered custom technical assistance throughout the program. They’re assigned a custom capacity strengthening coach that meets with them monthly, works with them on their capacity strengthening plans and ensures that they’re making progress against the goals and objectives that they. Set at the beginning of the program. And then lastly, these organizations, they engage in a series of peer learning opportunities, networking opportunities and training sessions, kind of similar to what we’re doing here today, right? That is all aimed at enhancing organizational capacity and effectiveness. And so it’s really through these three things that we think we can help community-based organizations grow in Harris County.

As you can imagine, we’re targeting a very specific type of organization, and so we do have very specific eligibility criteria. First, the organization must be based in Harris County and conduct its proposed work in Harris County. Second, they must be categorized as a 501 (c) (3), or fiscally sponsored. And third, they have programs or services that address non-medical terminologies of health. And this is pretty broad, but we also are aware that there is a multitude of things that affect health and well-being, like housing quality, financial security, social and community context, all of these things, which are drivers of health.

And so, you know, since we’re looking to support those small and emerging organizations, we actually prioritize applications from orgs who have fewer than 25 paid employees and limited organizational infrastructure, and this can be hard to hard to evaluate, but but the reason that this is not an eligibility criteria, it’s more of a prioritization, is that there might be an organization with more than 25 paid employees but does not yet have the organizational capacity, the strategic planning, the board development, the fundraising development, all of those that an organization with fewer than 25 paid employees, but does have those things do.

And so our plan is to have three cohorts of 10 organizations over our period of performance for a total of 30 community-based organizations benefiting from this program. And so we’re actually just now a little bit over halfway through our first cohort. We’re seeing some great engagement and results thus far. I’m incredibly excited to see out the remainder of this first cohort and then kind of report out on those results, perhaps at a future PHIG conference. But with that, I’m actually going to turn it back over to Regina.

Regina Dennis:
All right, so we’ve covered the why and the what of the capacity strengthening program, which, from here on out, I’m just going to call the CSP. But before we get into the how, I wanted to kind of do a temp check in the room to get to gauge everyone else’s experience with program design. So raise your hands if you’ve ever led a program from idea to launch. Okay. Okay, good number there. If you’ve supported program development as a team member, okay, if you’ve adapted or revamped an existing program, never developed a program, but here to learn, none of those. I’ll raise my hand on that, because that was absolutely my experience coming into this, this role, and the CSP program. Hannah had some experience with seeing a program from start to finish, with our Safe Routes to Schools initiative, but neither of us had anything to do with capacity strengthening. So this was definitely something where we had a steep learning curve as we were implementing things, but again, we had a plan.

So this was our plan. And you’ll see at the bottom of the screen, there’s the timeline for, you know, launch to implementation for us. It is critical to note that we use the consultant to help us design the CSP and draft the request for applications (RFA) we would use to recruit potential applicant organizations to participate in the program. So our idea was to launch that RFA in October of 2023, with applications due just before the Thanksgiving holiday in November, and in December, we would evaluate all the candidates and make our selections by January.

In January, we would contract with the organizations to sign their subrecipient agreements so they could receive the awards. And then in February, we would be good to go to launch all the content and programming. During the same timeframe, we would simultaneously be developing the learning opportunities, content, and workshops that we would deliver to the organizations over the course of the 16-month capacity-strengthening cohort. Spoiler alert, only the first two of those steps actually happened according to the plan. So. Sure, yeah, we had an idea, and we realized we were going to have to make some shifts.

So I’m going to introduce Hannah to bring up the next one.

Hannah Easton:
Regina walked us through the plan we had for the CSP, outlining what we envisioned from conceptualization through implementation for our first cohort. But as we all know, in this room, things don’t always go as we plan, and there are a lot of different factors that can affect that. But before we get into the specific challenges we experienced, we kind of wanted to pull the room, and in the theme of this session, we’re pivoting away from the word cloud, so just kind of call things out, maybe experiences you’ve had, or challenges you would anticipate facing if you were implementing a program. Maybe that’s funding, but we all have that, right? We’re here. What other kind of challenges maybe have you experienced in program planning? What criteria did CBOs have to meet to be sub-awardees? Exactly, right? So we’re going to get into that.

So, like I figured, some of these challenges are challenges that we experienced, and so we’re going to kind of outline those challenges for you in the rest of our session today, but we did consolidate our strategic shifts or changes into five categories. So that is the recruitment process. How do we reach out to these community-based organizations that we want to partner with? How do we evaluate the applications that they submit to select the community-based organizations we’ll work with? How do we contract with them? So how do we make sure their insurance and the contract we have in place, that sub-recipient agreement, is going to be efficient for the rest of the program? And then how do we plan that content that we want to deliver throughout the cohort? And then using all of that to decide how we outline the cohort to redesign, to launch for the second cohort of the program.

So in the rest of this session, we’re going to walk through each of these areas, sharing our original plan, the challenges we faced, and then the strategic shifts we made to ensure that the program aligned with our goal of supporting these developing CBOs in serving Harris County residents.

Regina Dennis:
All right, the first area where we made a strategic shift was recruitment. We had a 30-day application period planned for the RFA. And during that application period we had two information sessions, one virtual and one in person to really explain the requirements, the eligibility requirements, the application process itself, the program benefits and encourage, you know, garner some more interest in the program and get applicants so but when we were doing the info sessions, one of the first challenges we encountered was with technology. Raise your hand if you have been victimized by Microsoft Teams.

And so, during our virtual information session, we had a lot of technical issues and realized we weren’t getting the information out in a way that was really clear and effective. We also had a lot of organizations. To your point to the gentleman who spoke earlier, who didn’t quite understand if they were eligible. They had some unique circumstances about, hey, we serve Harris County and another county. Do we qualify? Our headquarters are outside of Harris County, but we also provide services in Harris County. Do we qualify?

We had a lot of really unique questions that we hadn’t anticipated, and we just felt like, you know what, we should spend some more time to make sure we’re delivering the content, and we give time for Q and A so people can have that clarity. So we added another virtual session, like I say, just walk through the information more thoroughly and make sure that you know there is as much information and clarity as possible about how to take advantage of this opportunity.

Another technical issue we encountered was overestimating the applicants’ technological skills. With our application process, we provided a Word doc template that everyone had to fill out and then convert into a PDF and email it to us along with the other required attachments. Some people and organizations had issues with the conversion process of the PDF. Some of them had issues with their Word documents. Some had to send the application materials in multiple emails because of the size or other constraints they were dealing with. And so we realized we were going to have to be a little more flexible and adaptable.

So, we ended up doing a lot of individual support. Hannah ended up doing a lot of individual support to walk people through the application process, and just making some exceptions, or just creating some more flexibility to get more applications, which led to the next shift we had to make regarding the evaluation period.

Now, if you recall our timeline. This is kind of where things went off the rails. We had planned to do a one-month evaluation period in December to review all the applications. This will be done by a three-person committee of Harris County Public Health staff who will review and score the applications, identify the top 20, and then select the 10 awardees.

So the challenge we really encountered, though, which was a blessing and a curse, was that we had a huge turnout. We had a huge swell of applications: 96 organizations applied, which was double what we had hoped for. But this required a lot more time commitment than we were anticipating.

We also had to do quite a bit of work with the applications, as I mentioned. Some pieces came piecemeal, so we had to search through the email box, consolidate all the application materials they submitted into one packet, and then distribute it to the evaluation committee. So that also took longer than we anticipated. So we ultimately had to extend the application review period to about 2 months. And you know, we wanted to make decisions by the end of December. We ended up making those decisions in February to select 10 organizations for the CSP.

Another factor contributing to that slowdown was our evaluation rubric. So we had a 60-point scale with six categories, each worth 10 points, which, admittedly, is odd. And what that meant was there wasn’t much differentiation in the scores, which also made it tougher for the evaluation committee to come up with their final recommendations on who to include in the CSP, since everyone was so close together. So again, with that additional time, they had more time to discuss and make those kinds of decisions about who should be in the cohort.

Hannah Easton:
Then our next strategic shift, and I’m willing to debate, but I personally think our most complicated one came during the contracting phase. Our original plan was to continue to do all of the contracting in one month, from January to February of 2024 however, that didn’t happen the 10 recommended awardees that the evaluation committee put forward for us, they had to remain confidential during the entire contracting phase, which meant we couldn’t provide direct updates to the rest of the applicant pool, letting them know, kind of where we were at in the process, which obviously is very frustrating for these organizations who have just applied and are eager to partner with us and receive this funding. And so we ended up having to send general evaluations, which are still ongoing.

We had a lot of applications, and we’re excited. We’re really trying to be efficient with this and just keep these communications going so they know the program is still happening, and we still want to put it forth for the community. We didn’t receive our draft subrecipient agreement from our county attorney’s office until May 2024, so this is several months later than anticipated. This was due, in part, to the county attorney’s office also drafting subrecipient agreements for a maternal health program that was launching at the same time.

But once we received these draft agreements, each of the 10 organizations had to review, negotiate, and sign, and then, as mentioned earlier, we needed to make sure each organization met the Harris County insurance requirements and provided that documentation to us. And that proved very challenging.

Many of these organizations, this was the first time they were navigating a contracting process like this. We had varying levels of technical proficiency, and we really struggled in the middle of this point to get communication back from our emails. We had planned to do everything over email. We had a program-specific email, and we were sending things and just not hearing back.

And so, to address these challenges and get things moving, we shifted from contacting the selected or tentatively selected organizations by email to making phone calls and then conducting one-on-one check-ins. And this approach really did help finalize the contracts and then confirm those insurance coverages more efficiently. So in the end, all 10 subrecipient agreements were submitted to the Commissioners Court by December of 2024, preparing us to launch the program’s implementation phase. Which brings us to our fourth strategic shift around content planning.

So we had originally thought that we would have a fully developed learning schedule for engaging with the cohort, ready to go for the second they onboarded, so that we could quickly roll out the program and stay on course.

However, due to the delays in the contracting process, we actually had the opportunity to bring on our contracted technical assistance provider a couple of months before we launched the cohort, and it was in these initial meetings with the TA provider that we learned a lot about these organizations that we were hoping to partner with from the subject matter experts in the TA team.

And so what we learned was that each organization was going to come to us with very different capacity levels, different experiences, different priorities, different needs, and that a standard set schedule with strict dates and content areas wasn’t going to be the most helpful thing for them. We needed to adapt to where they were and then the changing both internal environments that they were experiencing as an organization, and then the external factors that we know have very deeply impacted not only us as public health institutions, but the nonprofit organization sector as well in the last year or so. And so what we decided to do is to make our learning schedule a living document. We worked with our TA provider to help engage the cohort around prioritization and selection of content areas that we would eventually roll out for the program.

You can see here on the left are the planned content areas we had envisioned and thought that we would be rolling out. And on the right is a brief snapshot of the actual learning content that we put forth. So you can see that in November, when we hosted our orientation, we had our TA provider lead some prioritization and brainstorming activities with the cohort to get an initial list of the areas and the things that they wanted to focus on throughout their 16-month tenure in the program. We then, after that orientation, started hosting monthly one-hour virtual learning opportunities over Zoom learning opportunities. And then once a quarter, we would host longer in-person, what we called quarterly learning opportunities. And you’ll see a lot of primers there. That’s because we often introduce a topic in that virtual format, then dig in deeper over a quarterly in-person session, and include some notes about the different kinds of sessions we offered. So we have speakers from our TA provider and their coaches who work with these organizations, who will lead certain sessions. We have external subject matter experts who lead sessions, and we also partner with Harris County Public Health facilitators.

So you can see in our February foundations for optimal health, we actually had our Office of Public Health advancement lead that to start making connections between these community based organizations and our different departments and offices at Harris County Public Health, and then we started to really lean into what our TA provider calls responsive rescheduling, which essentially means listening to the cohort, seeing what’s happening with their capacity, strengthening plans areas that they’re needing additional support, support, things that they’re bringing up on their one on one, coaching calls and implementing those into the learning schedule.

Our June session on individual giving that actually took place or was changed that the topic only about a month beforehand because we had organizations saying, Hey, we really want to know how to better interact with donors and how to connect one on one to help with our fundraising revenue, but we offer peer networking events, so that is when the cohort is leading and sharing amongst each other, and then again, those topics, or the topic specific workshops and trainings.

Regina Dennis:
All right, I know we’re coming up against time, so I’ll try to get through these last few slides quickly. Our last strategic shift area was regarding Cohort Two, and having to redesign it. Essentially, we plan to do three CSP cohorts. And originally, we thought we would do them, kind of staggered back to back, but with our experiences with Cohort One and the challenges we face, we realized we couldn’t just, you know, rinse and repeat, and that we were going to have to do something different when it came to this next cohort. And as Hannah mentioned, you know, all the cohorts are coming, all those CBOs are coming in with different levels of readiness and experience, and they’re going to need different support than something that’s just more generic or cookie-cutter. So some of those key changes we made were with the application process. We have an online application portal this time.

So we just launched the RFA for Cohort Two in June, and we used the form with this case, and we had a lot fewer technical difficulties. The applications came in more complete. We had more applications that were eligible for review. And we also updated the app with the evaluation rubric, so that we have a 100-point scale for even this, but also gives some greater flexibility, so we still have six categories, but things are weighted differently depending on certain factors that we have found to be more important in determining readiness for the cohort. We also have the readiness issue. We ask questions about that with the application. So do you have dedicated staff who can participate in the cohort and commit 15 to 20 hours to the activities we’re providing each month? We incorporated those questions into the organizational assessment and pre-implementation survey we’ll do throughout the course of the cohort, and we will also cover them more thoroughly at orientation to ensure there’s a commitment to the CSP.

So, on your tables, you’ll see a copy of our community commitment. This is just the document we have organizations review and sign to help establish the culture we want to put in place through the CSP, encouraging learning and growth for all participants. And finally, the largest change we made was with the timeline. So, because the contracting process took so long last time, we’ve actually incorporated that into the start of the programming. So it’s a contracting slash onboarding period in the first two months. So at the same time that we’re finalizing those contracts and getting them through Commissioners Court, we’re also doing orientation, we’re doing those intro coaching calls, we’re doing the pre implementation survey and assessment so that we’re starting to build that foundation of the things that will happen over the course of that 16 months together, this also allows us to more quickly, you know, establish priorities with the cohort, so that we can develop out that responsive scheduling and learning opportunities that we’ll do.

Eliza Daly:
So, really quickly, what did we learn from this? And what do we want you to take away today as you consider implementing different programs for your department?

So first starting technical assistance early is invaluable, having that initial conversation to make sure we were on the same page and we could really learn from the subject matter expertise that our TA consultant has to offer, because they know specifically about what it means to build capacity in nonprofit, community based organizations, and have really been drivers of this work and a great partnership to us.

Starting any partnerships or contracts early, good win, offering multiple information sessions and application support to increase submission quality, so making sure that we’re available, we’re having plenty of opportunities for people to both learn about the program, ask their questions and then receive support if they need it, to ensure that they can submit an application and get a chance to potentially participate in the program.

Third is using that neutral and consistent communication, so people took the time to send in their applications. We want to make sure we keep them abreast of what’s going on and when they can expect to hear from us.

Hannah Easton:
We were concerned that, because of the delays experienced with Cohort One, we might see a drop in applications for Cohort Two. But excitingly, we did not. We actually received more applications, and more of them were complete and eligible for a review with fewer technical difficulties, even though we moved to an online platform, so we just continued to be communicative and open throughout any evaluation processes. And then, number four, we learned that developing CBOs and organizations requires support to meet the contracting and insurance documentation requirements. So extending timelines, offering that customized, one-on-one support, and not just relying on email communications were really integral to getting those contracts ready. And then finally, co-designed content results in more relevant and timely engagement. We need to be working together and really extending the partnership part of the program to ensure that we are listening to the CBOs and that we are giving them tools and training that are going to really be put into practice and help them. Achieve their goals, but also our goals of serving Harris County residents and protecting their health.

So with that, I know we’re going to have a Q and A session for both of the presentations today, but we have our contact information here if you have additional questions or interest after that Q and A and you can scan the QR code on the bottom left to pull up the capacity strengthening program web page to get more information there. Thank you.

Tatiana Lin:
Thank you so much to both our great presenter groups. Now we’ll take some questions.

Audience Member #1:
Hi, I’m Louisa from Minneapolis, and not so much a question. But we have something very similar. We call it our public health community Institute, and so we took a little different approach.

We have a fiscal agent that we work with, and they’re going to do the contracting with the community organizations, so that the whole role is to avoid some of the city bureaucracy, and they still have to meet the requirements, but we the fiscal agent, works with them to make sure that they get all of those pieces in place, with the idea that then they will build that capacity to then apply for funding, both whether from the city or elsewhere, and in terms of we developed the curriculum and invited the organizations to come, and we had four required courses or sessions they needed to attend.

We also recorded all of those, so if someone missed, they were all after hours. But if someone had to miss, they could do the one, you know, watch it, and then take a knowledge check to make sure that at the end, and then they had to attend two additional sessions to be eligible. Not only did they have to be working in Minneapolis and all of that stuff. But they had to complete those six sessions, and then they could apply. And then the application, we work with them to really develop their goals and objectives, make sure they have everything so we have right now.

I mean, this is our first cohort. It took a lot longer to get it all in place because the RFP for the fiscal agent also took a long time, and the city felt we were trying to subvert the processes they have in place and didn’t understand the idea of capacity building for these small organizations. So took us, like, a year to just even be able to release the RFP for the fiscal agent.

But I’d love to have more conversations about the so we have six agencies now that have applied, and we’re getting applications in regularly, and so we’ll be funding them for a small implementation project, and the idea is that this will be something that they can then use if they’re applying for bigger funding. But yeah, it’s just interesting to see the different approaches, and some of the same issues with all the pieces we put in. You know that the government puts in place things that are not, you know, for small CBOs, which becomes a barrier to actually applying for the funds and doing the work. So great that you guys are doing it in Harris County, and I just wanted to share our experience in Minneapolis. One of my colleagues will be presenting on it…tomorrow. But it’s a very, you know, similar idea. So thank you.

Brandon Maddox:
I’d love to connect with you. Love to connect with you afterwards, because just from what you shared, I have a bunch of questions.

Tatiana Lin:
Wonderful. Any other questions from the audience or online? Any questions?

Audience Member #2:
Okay, first question is, for Iowa, you caught my attention when you said one of your goals was to move beyond just disease reporting in your data modernization. You didn’t cover that in the presentation. Where did you get to, or what are you trying to measure besides disease reporting, because we’re trying to do the same?

Sarah Brooks:
Right, so we’re kind of, we’re working to expand beyond just our disease surveillance system, and having that data available to us as now, HHS, and having data scientists and a health economist, we’re looking at, trying to link data across the agency, Medicaid, foster care, like all of those additional data when we reorganized some traditional public health programs, moved outside of the Public Health Division, behavioral health, some of the maternal health, maternal health has moved back under public health like there’s just a movement and shift, but being able to look at a person holistically, and not just by incident, but kind of everything that’s happening with them, so that we can be able to evaluate where we might be missing with people in terms of services that we that we provide if something still isn’t going well for them, where did we miss? Where are they all located within our system? And how can we serve them more effectively and efficiently? So kind of moving beyond just this is, you know, they have a foodborne illness. I mean, yes, that’s a specific instance, and, you know, has its own reasoning, but we’re trying to expand the work.

Eliza Daly:
I was gonna add one quick thing to that. Sarah neglected to say that historically in the legacy Iowa Department of Public Health, we focus on most of our epi support in infectious disease. And so there was a strong capacity there. And when we wrote the original PHIG application, we did not necessarily have consistent epi capacity for chronic disease, for maternal health, or for other public health. Call it some of the soft epi science work. And so that was the other thing. When Sarah mentioned we have hired epidemiologists. It is for that focus, so a non-infectious disease focus as well.

Audience Member #3:
Thank you. Quick question for Harris County, sounds like you said 30 different CBOs over three cohorts of 10 each. So it’s like $3 million you’re investing. How are you tracking the impact of the 100k microgrants that you’re giving? Or mini grants, whatever you want to call them.

Brandon Maddox:
So this program is actually the subject of our targeted evaluation plan, and it is what we’re trying to measure everything out of PHIG, right? But this is the one thing that we want to say, if nothing else, we’re going to be able to report on the growth of these organizations over time, and so we are tracking engagement both at our sessions as well as engagement with those monthly coaching calls. We’re tracking how they’re spending the funds and what they’re spending those funds on. We’re tracking their progress against the capacity-strengthening plan they developed at the beginning of the program, including how far they are today and how much they have left to go.

And we’re also doing some baseline and post surveys with these groups to understand where they are in what our technical assistance calls the TA vendor calls the stems and seeds. And the stems broadly relate to different areas of organizational capacity around, I think, their strategy, technology, engagement, money, and what’s the last s? There’s one more, but in either case, they have a structured way of achieving sustainability and measuring organizational capacity. And we’re looking at that, and it changes over time.

Tatiana Lin:
Wonderful. Well, unfortunately, we are on time, so it’s 12:30 please join me to thank both great teams for working on those important projects. And I’m sure they will be able to hang out for a couple of minutes to answer any additional questions, and you can connect with them through their contact information in the app. Thanks again for joining us, both online and in person. Thank you.