The Brain Architects Podcast: COVID-19 Special Edition: Building from Strengths: Post-Pandemic Partnerships in Health Care

Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host Sally Pfitzer. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. You may remember we discussed the importance of self-care for caregivers, and the importance of physical distancing, not social distancing.  And now a year later, we wanted to continue those conversations and discuss what we’ve learned, what needs to change, and where we go from here. On today’s podcast, we have Dr. Renée Boynton-Jarrett, who is the founding Director of Vital Village Networks at Boston Medical Center and an Associate Professor of Pediatrics at Boston University School of Medicine. So good to have you with us, Renée. Dr. Boynton-Jarrett: Delighted to be here. Thank you, Sally. Sally: Renée, in March of 2020, we spoke with Dr. David Williams, who explained that many of the disparities that we saw in the early stages of the pandemic were predictable and the result of longstanding social policies and systemic racism. From your perspective, as an expert in the field, in the past year, what have we learned about these disparities? Dr. Boynton-Jarrett: I think what Dr. Williams shared is absolutely correct. What we saw happen with the COVID-19 pandemic is it took advantage of the existing inequities and just widened those. So actually, our existing structural racism created a broader opportunity for the pandemic to disparately impact the lives, the well-being, and the health of communities of color and communities that are disproportionately impacted by structural racism. And so, I think one of the things that we have learned or relearned is the tremendous cost of failing to truly address structural inequities with sustainable and comprehensive policy changes. And as importantly, because we know structural racism is around these interconnected systems and institutions, but there are also these ideologies, mindsets, ways of thinking and being. And if we think about it, those ideologies and mindsets about who’s okay just to remain at risk, to not have the luxury of physical distancing, to not have the luxury of having water to wash hands and do the hygienic practices. We’ve learned that we also have mindsets that truly impact the way in which we view humanity and human dignity and human rights, and that this pandemic has completely taken advantage of the ways in which those mindsets, ideologies, and systems create structures of inequities. Sally: Could you give us some examples of what changes you think need to happen in the field, particularly how communities and neighborhoods could help? Dr. Boynton-Jarrett: Yeah. I think your question actually hits on where I see the biggest opportunity for change. So, one of the things we saw happen over and over during the pandemic is in the absence of plans. Strategic plans and responses are being created in real time, and often those decisions—whether they were decisions being made about how vaccines would roll out, whether they were decisions being made about what economic supports and resources will come to families, or what will happen with early care and education, childcare, school—we saw time and time again decisions being made that were not being made with true engagement. Not just engagement of communities, but engagement of community leadership. So really, in partnership with, in conversation with. Those who were closest to the inequities—experiencing them most directly—were not being engaged or brought to the table. And time and time again, we also saw that the ideas, the wisdom, the strategies that were actually happening within communities were thoughtful, were creative, were real-time responsive. And actually, when we begin to get behind them, we see more protection happening for communities. So, we also saw tremendous community leadership, and in the absence of that leadership, I think that we would have all fared much worse in this pandemic. Sally: Just anecdotally, I’ve seen that even in some of the work we’ve done at the Center too, and often finding that bringing in members of the community actively from the beginning of projects has been the thing that has made those projects so much more successful. Could you tell us more about your work at Vital Village Networks? Dr. Boynton-Jarrett: So, Vital Village Networks is based at Boston Medical Center. We promote child well-being and address structural and systemic inequities and systems of care and education in early childhood by doing a couple of things. We really work around establishing sustainable, authentic, and equitable partnerships between caregivers, parents, and community residents and community-based organizations and cross sector institutions—health care, education, advocacy, social service. In this work, we all really focus on expanding leadership trajectories and pathways for community leaders, and that can be through trainings and certifications and expanded opportunities. But we also really think about how do we work to build capacity and enhance existing community-driven solutions? So, how do we build capacity within a community to promote well-being? And often, that involves helping institutions and organizations within the community work with community leaders in a different way and we use a model called co-design. So, how do we create and design things together? We really work to think about what builds equitable partnerships. What creates a table for truly equitable participation? A lot of approaches to community engagement and community work begin with the deficit lens. They begin with the idea that there’s a problem in the community, and we have a solution, we want to bring the solution. Well, that starting point actually makes it very hard to partner equitably with communities. Because if you think about—even if you were going to pick someone for a team, would you pick someone or something that you had only framed in terms of their weaknesses? Parents don’t do that with their children, right? We all have our strengths and weaknesses. Parents are really good at framing the strengths and uplifting the strengths and building upon the strengths of their children, but we don’t do that with community engagement. We often view a problem and that’s our primary way of understanding a community, and that really creates an imbalance in power from the very beginning. Also, who gets to ask the questions? Who gets to design the evaluation? What type of technology do you need to participate virtually? So, all of these things create barriers for equitable partnerships. With co-design, we really begin first by understanding that there are solutions that already exist within communities and if we’re not aware of those solutions, it’s because we’re not seeing them, not because they don’t exist. So really beginning by recognizing, appreciating, and valuing the strengths and the wisdom and solutions within communities, which creates a much more level playing field for partnership. The second piece is how do we plan? How do we design together? So, how can we disrupt tools and strategies that bias someone based on their training or education? And how do we create opportunities to design things together that are centered around the diversity of people in the room? And that’s also a particular invitation that no one is at the table only as an expert, but everyone is at the table, both with their expertise and their gifts, as well as as learners. And so, creating that mutuality, that ability for us to be in both roles, all of those factors really lead to the ability to partner with communities and not on behalf of. Sally: Why do you think there’s a disconnect between health systems and the families they’re supposed to serve? I’m thinking particularly here about the COVID vaccine in relation to this. Dr. Boynton-Jarrett: What I would share is I think we’ve had a disproportionate focus on distrust about the vaccine. So, when we think about it, when we actually look at the real data that we have, actually the vast majority of people who have been surveyed or interviewed in communities of color are along a continuum of interest in the vaccine, and/or very interested in getting the vaccine or have already received it. So, a very, very small percentage that has said, you know an absolute no. So, that is a strong signal that people are seeking an opportunity to have their questions answered, to have a conversation, and to engage around the vaccine. Also, what I think we haven’t focused on enough is how do health care institutions demonstrate trustworthiness? So, we want people to trust the vaccine, and that it’s good for their health. And we have like this, I think an overemphasis or an over expectation that what we’re hearing from people is that they don’t trust the vaccine. What we may be hearing from people that we haven’t focused on enough is how do institutions demonstrate that they are trustworthy—that they’re going to share updated information about concerns, or warnings, or emerging complications, or side effects? That they are going to offer the vaccine in settings where you will be able to get your questions answered. That you will have opportunities to hear from other people who have received the vaccine. And so, what I think that we need to really focus on is also taking a hard look from a lot of current and historical lessons at the ways in which, you know, despite what might be well intentioned efforts, systemic racism truly exists within our institutions, including our health care institution. And how that is experienced for people is sometimes that the institution does not appear to be trustworthy, because time and time again needs are not being heard or listened to or responded to with dignity. If we are expecting that we can change people’s minds to make them do what it is we’d like them to do, again, that only serves to reinforce, “I’m not wanting to hear your concern. I’m wanting you to follow my guidance, my advice in a system that you have not been invited to help design what this experience would look like.” So, that’s why we’re seeing so much success of vaccines that are being administered at faith-based institutions in partnerships with the faith-based community. That’s why we’re seeing so much success with providers of color that are creating safe and brave spaces for people to learn about, talk about, and discuss the vaccine. And in our work with Vital Village Networks, we’ve had what I would just consider—led by community members—we’ve had love conversations. Conversations that aren’t so much about all of the details, but are just creating a space for people to be honest about any fears they may have, or anxieties that they may have. And time and time again, they connect to what you have learned throughout your life around untrustworthy medical institutions that have demonstrated that time and time again. So, we must do a better job and a different job of demonstrating trustworthiness. Sally: I really appreciate that response. I’m your host Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, Instagram @developingchildharvard, and LinkedIn: Center on the Developing Child at Harvard University. Brandi Thomas is our producer. Dominic Mathurin is our audio editor. Our music is Brain Power by Mila from freemusicarchive.org. This podcast was recorded at my dining room table.

Header photo by Christina Morillo from Pexels