4 ways to measure system-change progress

May 31, 2022

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.

1. Maintaining the status quo

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.

2. Ensuring data is shared

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.

3. Reducing harm

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.

4. Being invited to the table

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.

Relationships are key

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.

Related Issues & Ideas

White Paper

Strengths of Latinx Immigrants Despite Legal Violence

View Strengths of Latinx Immigrants Despite Legal Violence
Article

Why building community power is vital for philanthropy

View Why building community power is vital for philanthropy
Report

A Caring, Connected Community: How Greater Des Moines nonprofits met our needs during the pandemic

View A Caring, Connected Community: How Greater Des Moines nonprofits met our needs during the pandemic
Report

Why aren't kids a policy priority?

View Why aren't kids a policy priority?
Guide

Prenatal-to-3 State Policy Roadmap

View Prenatal-to-3 State Policy Roadmap
Website

Frameworks Institute: Changing the conversation on social issues

View Frameworks Institute: Changing the conversation on social issues
Website

Framing best practices with Topos Partnership

View Framing best practices with Topos Partnership
Website

Iowa Public Health Association

View Iowa Public Health Association
Report

Cultivating Change: How the HealthConnect Fellowship lifted a network of advocates to improve children's health in central Iowa

View Cultivating Change: How the HealthConnect Fellowship lifted a network of advocates to improve children's health in central Iowa
Report

Shifting the Lens: How The ACE Study sparked action to collectively improve our community's health

View Shifting the Lens: How The ACE Study sparked action to collectively improve our community's health
Website

National Academy of Medicine

View National Academy of Medicine
Website

Grant Makers in Health

View Grant Makers in Health
Website

ACEs Connection

View ACEs Connection
White Paper

Prenatal Strategies to Support Families

View Prenatal Strategies to Support Families
Report

1st Five Healthy Mental Development Initiative 2020 Report

View 1st Five Healthy Mental Development Initiative 2020 Report
Report

Human Trafficking Awareness for Youth

View Human Trafficking Awareness for Youth
Policy Brief

Strengthening Medicaid

View Strengthening Medicaid
Website

CAMHI4Kids Children's Mental Health System

View CAMHI4Kids Children's Mental Health System
Policy Brief

Transforming Iowa's Foster Care System to Support Kinship Caregiving

View Transforming Iowa's Foster Care System to Support Kinship Caregiving

Latinx Project tells story of strength and opportunity

New report highlights central Iowa Latinos contributions and disparities and elevates Latinx leaders

View Story
View Story

Improving Health through Social Supports

MercyOne's community health worker model improves outcomes for families.

View Story
View Story

Re-Imagining How Iowa's Systems Work Together to Best Serve Families

The Vision Council has led conversations on how Iowa's families and children can be safe, secure, healthy, and well in our communities.

View Story
View Story

Champions for Change: A Collective Commitment to Children's Health

Outcomes from Mid-Iowa Health Foundation's HealthConnect Fellowship, October 2019-June 2021

View Story
View Story

Elevating the Latinx Community

How nonprofit leaders brought attention to the Latinx community and built new systems of support during the pandemic

View Story
View Story

Protecting Those Who Protect Our Kids

Iowa ACEs 360 shares this story about how supervisors in the Polk County Dept. of Human Services’ Child Welfare Division are addressing trauma in their workforce.

View Story
View Story

A New Approach to Supporting Youth in Juvenile Detention

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.

View Story
View Story

Health disparities for Black pregnant Iowans: What you should know

View Post

5 reasons why youth should lead systems-change work

View Post

What we mean by 'system change'

System change
Apr 6, 2022
View Post

4 insights from researching housing instability in central Iowa

View Post

Iowa youth aging out of foster care: How are they doing?

View Post

7 lessons learned from Sesame Street partnership

Foundation grants
Jan 31, 2022
View Post

A closer look at mental health in schools during the pandemic

Community response
Nov 29, 2021
View Post

Get to Know Dr. Nalo Johnson

Foundation news
Nov 24, 2021
View Post

4 questions for nonprofit and community leaders

View Post

5 questions for leaders in philanthropy

Funder practices
Nov 5, 2021
View Post

5 ways to think about your personal brand as a part of your work

Leadership
Nov 1, 2021
View Post

4 issues impacting children’s health during the pandemic

View Post

7 lessons learned about systems change work

System change
Sep 9, 2021
View Post

The Foundation's role in the HealthConnect Fellowship

Funder practices
Sep 8, 2021
View Post

Go ahead: Brag a little

Leadership
Aug 5, 2021
View Post

Planning from strength: questions to ask your team

Advocacy
Apr 26, 2021
View Post

Preparing yourself to center the voices of those impacted by issues

View Post

Vision vs. Tactics: How we can achieve the change we want to see

Action planning
Feb 22, 2021
View Post

System-change achievements advocates are making for central Iowa’s kids

View Post

How we can begin to find peace in 2021

View Post