While system change initiatives can take years to accomplish, identifying successes along the way helps advocates sustain their commitment, as well as keep partners engaged, organizations involved, and funding secured.
HealthConnect Fellow Mary Nelle Trefz, Advocacy Network Director at Iowa ACEs 360, describes system-change progress like a squiggly line with ups and downs, and at times, backward steps. But reflecting on what is being accomplished along that path allows her to remain present in the work, strategize next steps, and to see forward movement over time.
Here are four ways she’s viewed success in her work to advocate with state leaders for policies that improve the health and well-being of Iowa’s children and families.
Sometimes advocacy requires playing defense to preserve what is already in place. Most recently, Iowa advocates have pushed to maintain programs and initiatives that support children and families as funding has been reduced in state budgets.
For example, several years of advocacy led to an expansion of 1st Five, a children’s mental health early intervention initiative, to 88 counties in Iowa with a significant increase in state funding for the program. Then the climate at the Iowa Legislature shifted. While advocates continue to push for expansion to all counties, they also consider a win being that 1st Five remains in its current state while other programs have been cut.
Getting key data measured and shared publicly can be an important step in building an advocacy strategy. When Iowa privatized Medicaid, for example, advocates heard how children and families were struggling to get the care they needed through the system. Trefz and her colleagues successfully advocated with state leaders to publish a dashboard specifically focused on children’s health data. While more can be done to disaggregate and validate the data Medicaid Managed Care Organizations provide, the dashboard has been an important step to help Trefz advocate with leaders on targeted ways to better support kids and families.
Some policies proposed by lawmakers could place significant barriers to Iowans accessing public support for health care, food, and other essential needs. While advocates have worked to ensure none of these bills are passed, they also have had to shift tactics at times to focus on killing the worst bills, so lawmakers focus on bills that would ensure most participants continue to receive consistent program support. One effective strategy has been to give members of the majority party the talking points and resources to explain to their constituents and colleagues why they aren’t advancing a particular bill that the other chamber supports.
Building strong relationships with state agency leaders is a notable achievement, allowing advocates to become trusted partners and advisors. This achievement has allowed Trefz to align with state officials around shared priorities and to help advocate with lawmakers on policies that support agencies in best serving kids and families. It also has allowed her to be invited to help inform staff regarding administrative rules for the laws that are passed, thus impacting how legislation is operationalized and implemented.
Success in Trefz work is often based on relationships built over time. After years of meeting with leaders to explain policies that would promote maternal health, for example, she began to hear her talking points repeated back to her, a sign that leaders were hearing her message and were interested. Eventually, this session, the majority party introduced a bill that would extend Medicaid coverage. While the end goal of having the bill signed into law has still not been accomplished, the points of success along the way demonstrate that the end goal is still possible.
System-change work is often messy, difficult, and takes longer than we expect. But knowing you are at the table, are being heard, and are seeing helpful decisions being made can remind you that you are doing meaningful work.
Teenagers in jumpsuits lying on yoga mats, their eyes closed, their bodies still. This is the image Megan Hoxhalli describes as remarkable for juvenile detention, a place where youth arrive shaken, dysregulated, and scared about their future.