Table 2 Building health system engagement case studies

(1) Los Angeles County Alternatives to Incarceration Workgroup

– Goal: Develop a roadmap of policy strategies to scale alternatives to incarceration and diversion through preventative health and social care

– Health Disparity: Before the COVID-19 pandemic, of the county’s ten million residents, 74% of arrestees were Black and Latinx. While only 9% of the county residents are Black and 49% are Latino, they comprise 29% and 52% of the jail population, respectively [58].

– Collaboration Team Role: Co-facilitators, organizers

– Partners: LAC DHS, LAC DPH, and other community and government stakeholders [58]. A Los Angeles County Board of Supervisors February 12, 2019 motion aided the official founding and funding

– Community engagement and power-sharing strategies: Developed six ad hoc committees compromising broad expertise (Community-Based System of Care, Community Engagement, Data, Research, Racial Equity, Funding, Gender, and Sexual Orientation, Justice System Reform) with voting privileges shared between government and community leaders

– Outcomes:

 o 70 public consensus-building meetings from 9/2019 to 3/2020

 o Meta-analysis of California policies for reducing incarceration (e.g., career services, reentry support, housing, legal aid, etc.) and diversion processes (e.g., collaborative community courts, specialized supportive housing programs, mental health full-service partnerships, and sobering centers) [59].

 o County reentry resources were compiled for a One Degree ommunity resource page [60].

 o Published the Care First, Jails Last: Health and Racial Justice Strategies for Safer Communities [58] report, including five strategies and 114 recommendations to expand services and promote continuous community engagement and consensus-building to inform government policy decisions. On 3/10/2020, the county Board of Supervisors adopted all five reported strategies

 o The workgroup has served on multiple countywide public policy initiatives, including the engagement plan to close LAC’s Men’s Central Jail [61],, the development of an alternative crisis response system [62], and Measure J development [63]; a county ballot initiative passed on 11/3/2020 redirecting 10% of net county costs towards incarceration alternatives and housing

(2) African American Infant and Maternal Mortality Prevention Initiative Community Action Team

– Goal: Address the unacceptably high rates of Black infant and maternal deaths countywide and ensure healthy and joyous births for Black families in LA County

– Health Disparity: Though local, state, and federal initiatives provide funds and programs to address African American maternal and infant health outcomes, such as doula programs, local community voices most impacted by perinatal disparities were often missing from decision-making spaces. County leadership also lacked African American representation in leadership positions. In 2017, the LA County Health Agency (LAC DHS, LAC DPH, and LAC DMH) reported racism as a leading cause of Black infant deaths setting a 5-year goal to reduce the black-white infant mortality gap by 30% [64].

– Collaboration Team Role: Co-facilitators, organizers

– Partners: LAC DHS, LAC DMH, LAC DPH, First 5 LA, community organizations, mental and health care providers, funders, and community members

– Community engagement and power sharing strategies: Developed five place-based cross-sector working groups and regional working groups focused on local resources for mothers and parents

– Outcomes:

 o From 11/2018 to 4/2020 the initiative led over 60 meetings focused on maternal and infant health equity with participation from over 500 community members and partners

 o The initiative worked to develop the “Birthing People’s Bill of Rights,” in July 2020 providing education for birthing moms during COVID-19 when doulas or family were not allowed in hospitals[65]. The initiative distributed the bill of rights to partner CBOs, birthing mothers, and regional hospitals

 o Targeted weekly newsletters with local resources for pregnancy and parenting to over 500 community stakeholders (e.g., breastfeeding week events, parenting resources, and food giveaways)