Creating Space for Change

Advocates connect through a shared commitment to improve health outcomes.

Dec 4, 2023

Outcomes from Mid-Iowa Health Foundation’s HealthConnect Fellowship

Cohort 3 | Published December 2023


When children and families can access what they need to live healthy lives, our entire community thrives. While the essential elements for a healthy life are available to some, opportunities are significantly limited for others. Systems, shaped by policies and practices, determine people’s ability to access housing, food, physical and mental health care, and other essential elements that influence how long and how well we live.

The HealthConnect Fellowship supports central Iowa professionals who are advocating for system changes that address the social determinants of children’s and families’ health. By building individuals’ capacity to lead efforts that encourage decision makers to shift policies and practices, Mid-Iowa Health Foundation aims to have a greater impact in improving community health outcomes.

In April 2022, Mid-Iowa Health Foundation welcomed a third cohort of HealthConnect Fellows. Eight advocates joined a network including 20 fellows from previous cohorts. While nearly all fellows work within nonprofit organizations, the Foundation also supported its first public sector fellow, recognizing the importance of engaging system-change thinkers within government entities.

The eight fellows joined at a time of transition. The post-pandemic period brought shifts in funding, leadership, and government structures. The Fellowship offered a space for fellows to talk openly about challenges, consider new strategies, celebrate wins, and maintain the energy and hope needed for system change. The experience also fostered intentional connections across issues, organizations, and sectors as fellows learned about each other’s work, met other stakeholders, and shared insights with colleagues and decision makers.

This report is an invitation to our community to learn about the work central Iowa system-change leaders are engaged in and to support opportunities that can have a long-term impact on community health and well-being.

Mid-Iowa Health Foundation thanks everyone who has been engaged in this 18-month journey with us:

  • To the HealthConnect Fellows who have made an incredible commitment to advancing system changes that will have a tremendous impact on children, families, and communities.
  • To the organizations that allowed the fellows time and space to lead advocacy efforts.
  • To the partners who have provided guidance and support.
  • To our Board of Directors for believing in the HealthConnect Fellowship and the fellows’ work.

As the network of system-change advocates continues to grow and expand throughout our region, we are hopeful that together we can create conditions where people can thrive.

Cohort 3 Fellows Share Their Work

*Left position with Iowa Migrant Movement for Justice in 2022; system-change work continued by the organization.

Explore the history and structure of the Health Connect Fellowship and previous fellows’ work: Cohorts 1 & 2 and Cohort 1

Overview of the HealthConnect Fellowship Cohort 3 Journey

Levels of Fellowship Support

Recognizing that system change requires a multi-year commitment, the HealthConnect Fellowship was developed to support individuals in building their capacity to lead work long-term. Resources are provided with a focus on meeting individual needs for learning and growth as each fellow advances a system-change goal. The fellowship also fosters connections with others who are addressing social determinants of health in central Iowa to encourage support for each other’s work and collaboration across issues.

“We understand this type of advocacy work cannot occur in isolation. Building a network of resources to connect to and consult with strengthens the ability of our local experts to support change that fosters better health outcomes in our community.” — Dr. Nalo Johnson, President and CEO, Mid-Iowa Health Foundation

The fellowship launched with eight individuals in 2017 and expanded to 20 fellows in 2019. The third cohort that began an 18-month journey in April 2022 included eight members, an intentionally smaller group to encourage deeper connections. Fellows from previous cohorts also had opportunities to share their work with Cohort 3 Fellows and to continue to learn and network as a fellowship community.

Mid-Iowa Health Foundation provided support to Cohort 3 Fellows on three levels:


A survey of all cohort fellows in fall 2022 highlighted that fellows have unique needs in building their capacity to lead system-change work, especially based on their positions within their organizations. As a result, the Foundation has increasingly offered multiple options for learning and support as well as flexibility in how resources are used.

Cohort 3 Fellows received the following:

GRANT AWARD: Each fellow was given a modest grant which allowed them to dedicate time and resources to work toward a specific system-change goal and to participate in group learning.

CAPACITY-BUILDING GRANT: For the first time, Mid-Iowa Health Foundation offered a separate grant to allow fellows and other key staff within their coalitions or organizations to build specific skills. This grant was offered with the understanding that most organizations do not have the budget to support significant learning opportunities and that fellows were each seeking different kinds of professional development. The fellows appreciated the flexibility and autonomy to use the funds as needed to grow their capacity.

TIME AND SPACE TO GATHER: The opportunity to meet regularly with others leading advocacy and policy change efforts allowed fellows to talk about what they were working on and offer support, as well as discuss other relevant topics. Despite busy schedules and pressing tasks, many fellows prioritized these gatherings because they felt re-energized by the conversations. Several mentioned this opportunity as the most impactful part of the fellowship experience and that it led to deeper connections among the cohort.  

“I have learned a great deal from the experiences of the other fellows. I was particularly encouraged by their stories of perseverance as they navigated their particular campaigns. I always left our meetings encouraged, inspired and more resolute. So much of the change we are endeavoring to realize as part of our individual campaigns is to help heal the human condition in some measure.” — Alyson Simmons, HealthConnect Fellow
“The ability to share challenges … in a confidential space free of judgment or concerns about retaliation is a very freeing experience and extremely therapeutic. Working for system-level change can be an isolating experience if you do not have these types of connections. Recognizing some of the common struggles we all face can help put things in context, and it encouraged me that I was on the right track.” — Luke Elzinga, HealthConnect Fellow

MENTORSHIP: The fellowship offered access to two mentors to facilitate discussions and provide one-on-one guidance as needed. Rick Kozin served as lead mentor and brought experience from leading the Polk County Health Department, as well as insights from a career in community organizing and advocacy. Sarah Welch offered messaging and communications strategy support, drawing from a career in nonprofit communications with a focus on system-change issues.

While one fellow found benefit in meeting weekly with Kozin, other fellows relied on mentors as they were facing challenging decisions, strategizing approaches to their campaigns or seeking other resources.

“The opportunity to work with Rick — someone I’ve long admired — was invaluable,” shared Simmons. “His counsel, support and strategic guidance were instrumental in my being able to engage stakeholders with a greater sense of confidence.”

“Mid-Iowa Health Foundation provided a supportive platform to discuss my challenges and receive advice from Rick and Sarah,” said Keshia Fields, HealthConnect Fellow. “Sarah connected me with [human resource] professionals to guide me in navigating the field. … Rick's extensive career history at Polk County also proved invaluable in providing historical knowledge and connecting me with current leaders.”

TOOLS AND FRAMEWORKS: An onboarding experience of five sessions at the start of the fellowship offered questions, tools, and frameworks that expanded fellows’ understanding of the strategies they could utilize as they approached system-change work. After the initial experience, fellows continued to participate in formal and informal training on topics, including framing, negotiation, and empathy in system-change work. Conversations on these topics reflected the unique role fellows were playing within their organizations to advance policy and system-change work; many noted that these discussions were unlike others they were having with their colleagues.

A mapping exercise that looked at who are the influencers to decision makers and a presentation on developing a 27-9-3 statement (27 words, 9 seconds, 3 key points) were useful tools that fellows used in a variety of ways. “I try to utilize and share both of these techniques frequently,” said Greg Bellville, HealthConnect Fellow.

“There were several moments when the fellowship changed my ideas and my thinking. I appreciated learning and expanding on how to craft our ideas more straightforwardly to share with others, especially with those not in this work daily. I also benefited greatly in realizing how systemic change is a long-haul achievement that occurs through incremental change. It gave me hope.” — Gabby Guerra Ceron, HealthConnect Fellow

Quarterly training engaged all cohort fellows, and occasionally other colleagues, to build skills in specific areas, such as communicating with confidence and building a grassroots advocacy strategy. These sessions met specific areas of need that fellows identified.

ELEVATING LEADERSHIP: The Foundation featured the fellows’ work through social media posts, in its newsletter, and with leaders and partners in the community. Fellows also received opportunities to present to groups, positioning them as leaders in their work and their community.

For example, a group of fellows shared insights on system-change work with students at Iowa & Minnesota Campus Compact’s Civic Action Academy. Fellows also led learning sessions with Iowa funders to help them see opportunities to support policy advocacy work as part of the Iowa Council of Foundations’ Rural Health Equity series, developed in collaboration with Mid-Iowa Health Foundation.

These opportunities supported fellows in acknowledging the expertise they could offer and to celebrate the work they were achieving. In the process, they began to be recognized by other entities and their peers for their work.

“Requests for training and presentations are happening much more often since the beginning of the fellowship,” said Emily Ehlers, HealthConnect Fellow, “and I directly credit the impact the fellowship and related opportunities have had on my leadership and advocacy skills that has resulted in such requests.”


In preparation of inviting a third cohort of fellows, previous cohorts provided input into the issues and expertise they felt would be helpful to include within the fellowship network. Based on that feedback, the Foundation invited its first fellow from the public sector as an opportunity to support system-change advocates working within government and to encourage stronger connections between public and nonprofit entities.

This is just one example of how the Foundation has intentionally nurtured a network of system-change advocates in the region. Here are other points of connection throughout the past 18 months:

11 previous cohort fellows participated in onboarding Cohort 3.
  • Eleven previous cohort fellows participated in the Cohort 3 onboarding experience, offering insights from their system-change efforts, including how to measure success, how to authentically engage community and how to creatively use resources to advance campaigns. Inviting one or two fellows to meet with Cohort 3 at a time allowed for meaningful relationships to develop from the start of Cohort 3’s experience and positioned the fellowship network as experts which the Cohort 3 Fellows could call upon for guidance.
  • Opportunities for all cohorts to gather regularly — at first monthly and then quarterly — fostered connections as fellows discussed topics of shared interest. Most meetings took place at Mid-Iowa Health Foundation’s new Collaboration Space, a meeting room added to its offices to encourage these kinds of gatherings.
  • Based on a fellow’s recommendation, Cohort 3 Fellows began to host monthly gatherings at each other’s organizations. This allowed fellows to learn about other organizations and meet other community leaders.

Through these gatherings, fellows identified ways to support each other’s work. Guerra Ceron noted how connections with other fellows helped her work at Al Éxito. She was able to secure event space, connect families with resources, advocate against legislation that would harm Latinos and access opportunities that supported her growth as a leader. “These connections have been one of the fellowship’s best and most expansive benefits,” she said.

According to Fields, “It was comforting to connect with other fellows who, despite having different focuses, shared a common goal of helping people.” In particular, she appreciated how after reaching out to fellow Dr. Daniel Zinnel for support with one of her first community events, he showed up to support her as a newcomer to the central Iowa community.

Through fellowship gatherings, fellows not only identified opportunities to support each other, but also to collaborate to have greater influence with decision makers. Mentors facilitated initial conversations with a group of fellows so they could identify shared values and a messaging frame that could help decision makers see their work as interconnected and working toward a greater vision.

“It is our job to look for ways to continue to improve the lives of the people around us. There are lots of different ways to do that. We are all working on different things, with the common goal of improving lives.” — Greg Bellville, HealthConnect Fellow


Mid-Iowa Health Foundation also provided intentional opportunities for the fellows to build connections with others outside of the HealthConnect Fellowship network who could help advance their campaigns.

  • Fellows had opportunities to meet with various stakeholders who could provide resources, support and new insights. Dr. Paul Gilbert, University of Iowa College of Public Health Associate Professor, shared a perspective of how universities could help with fellows’ research needs, while a presentation from Kayla Powell and Bri Deason with the Iowa Department of Human Rights encouraged fellows to think about how to authentically engage youth in system-change work.
Fellows were invited to a reception focusing on philanthropy and advocacy with Dr. Cara James, President and CEO of Grantmakers In Health, along with other philanthropic leaders.
  • Each fellow produced two blog posts that shared insights into the issues they were working on and their approaches to system-change work. This opportunity was designed to inform the community about what fellows were learning and working on to inspire greater engagement in their efforts and to expand thinking about how to improve community health and well-being.
  • Some trainings allowed fellows to identify additional colleagues and community partners to attend, including an advocacy training with Bethany Snyder of Snyder Strategies as well as a communications training with Wixted & Company.

Outcomes from the Work

Since the HealthConnect Fellowship began in 2017, the political and social climate has experienced tremendous shifts. Cohort 3 especially navigated changes in state government structure, increasing partisan politics, a decreasing number of advocates working on policy change, and increasing pressures on funding.

While this environment made system-change work more challenging, the fellows were able to have impact over the 18-month period through small, intentional steps often outside of state legislative work. They built strategic relationships with decision makers, advanced grassroots advocacy tactics, and demonstrated the effectiveness of new models. They focused on internal changes within institutions and through local, community-based efforts.

“There’s still a lot of room to do good work and this group of fellows has demonstrated that clearly,” said Rick Kozin, HealthConnect Fellowship Mentor.

Collectively, the Cohort 3 Fellows achieved the following impacts:

Commitment to the work

The experience helped reinforce many fellows’ energy to lead system-change work and solidified the role they want to play going forward even when they switched positions during the fellowship.

“The fellows are doing a lifetime’s worth of work, and we have a brief window to reinforce people’s decision that doing this work was the right decision,” said Kozin.  

“This achievement goes back to the genesis of the fellowship: How do we support individuals who are doing this work to help them keep doing this work, so we don’t lose them from the field,” — Denise Swartz, Senior Program Officer at Mid-Iowa Health Foundation

Elzinga, for example, moved into a full-time advocacy position at DMARC, allowing him to lead the Iowa Hunger Coalition in growing its capacity to more strongly advocate on policies that influence food security. Guerra Ceron has continued her efforts to support and engage youth in advocating for changes that improve their mental well-being even while leaving a position to return to Al Éxito. Ehlers transitioned from staff attorney into the newly created position of system change and equity attorney at Disability Rights Iowa.

“My goal is to help foster and facilitate a professional environment where my colleagues can identify an issue and then find the support they need to help make the system-level change we know creates the biggest, long-term impact,” said Ehlers. “The fellowship has given me the skills and confidence needed to assume this new role and I am forever grateful.”

New partnerships

The connections fellows made with each other and through the fellowship experience helped increase their capacity to lead system-change work and opened new avenues for creating change.

Fellow Tinika Roland, for example, met several public health and health care stakeholders at the Iowa Public Health Association Conference that then opened new doors to sharing her preventive heart health message. Bellville helped form a connection between two organizations that had never partnered to advance training for community health workers. Simmons’ efforts to build a stronger relationship with the Iowa Attorney General’s Crime Victim Assistance Division led to an invitation to participate in leadership convenings to discuss high-level issues regarding victim services in Iowa.

Cohort 3 also decided to initiate regular bi-monthly gatherings past the formal fellowship period to continue to support one another and strengthen their network — the first time a cohort has made this a priority. They are identifying topics and locations of interest to continue to learn together and will utilize the Collaboration Space at Mid-Iowa Health Foundation as a home base.

Challenging approaches

Fellows seized opportunities to encourage leaders and other stakeholders to consider policies, practices and approaches that could have greater impact on addressing community needs.

For example, five fellows among all the fellowship cohorts presented to Iowa funders to encourage investment in policy advocacy opportunities that could advance health equity in rural communities. Fields is working to establish a process for Polk County leadership to hear feedback from employees and to build trust as the foundation for internal policy and practice changes, while Simmons is challenging the state to take a more holistic approach to supporting survivors of violent crimes.

While system-change goals can take many years to achieve, many fellows used the tools and resources they received through the fellowship to lay the foundation for long-term change.

Themes and Lessons Learned from the Experience

Many of the lessons learned from the previous two cohorts remain, while the past 18 months has also demonstrated that each cohort experience is unique — shaped by those who come together and the conditions in which they are working to make an impact. Here are specific lessons and themes that stood out about the Cohort 3 experience:

Space to be together matters.

Creating a space for system thinkers to talk strategically about complex issues and what to do about those issues is critical. As seen with other cohorts, the time to talk — without putting together a specific strategy or identifying tactics — is important. As fellows experienced challenges in their work or considered different paths to achieving their goals, they found the fellowship allowed them to connect with others holding similar roles in other organizations and they no longer felt alone in their efforts. Through conversation and connection specific strategy and tactical opportunities emerged.  

emily ehlers headshot
“If I am ever feeling disappointed by a case or situation, or approaching burnout, all I need to do is hold on until the next fellowship meeting. I know that the fellows have all experienced similar frustrations or setbacks and often have advice or helpful guidance. Even just having someone to commiserate with is helpful. I also love celebrating the successes of my other fellows, because all our work impacts each other in unexpected ways. When a colleague has a success or professional win, I know that our community also benefits.”— Emily Ehlers, HealthConnect Fellow

Creating change takes many forms.

Cohort 3 challenged what system-change work can look like and where to target efforts. While previous cohorts especially focused on building relationships with specific decision makers at the state level to influence policy change, many fellows in this cohort invested in building grassroots advocacy efforts with those most impacted by issues and in creating shifts within institutions that could ripple into the community.

Guerra Ceron and Elzinga, for example, focused on building the capacity of those impacted by issues to advocate for changes that could improve their well-being. Fields focused on internal changes within Polk County that could ripple into how the County serves the community. Simmons is using outcomes data from a pilot model to make a case for changing the way survivors of violent crimes receive support.

System-change work is fluid.

The fellowship encouraged fellows to see multiple pathways for reaching their goal and that strategies and tactics could shift as the environment shifted — all with a continued focus on influencing long-term sustainable change. Campaign plans asked fellows to set a goal and then identify the next three steps they would take to work toward that goal. About every six months, fellows were asked to identify the next three steps they planned to take. This approach recognized that after taking three steps, the fellows would likely see paths that would no longer work and newly available opportunities.

“An ‘Aha!’ moment was recognizing that overthinking a plan can be counterproductive. Instead, focusing on goals and remaining flexible can help. I learned that communication was the foundation for change in my organization and began prioritizing it. This shift in focus helped to rebuild trust and empower employees to become changemakers.” —Keshia Fields, HealthConnect Fellow

The fellows made shifts based on what they were learning and discussing as well. For example, Simmons shifted her communications tactics from focusing on the conditions of survivors of violent crimes to sharing what is possible for survivors and their families through the Central Iowa Trauma Recovery Center model.

Influence has limitations depending on your role.

Many fellows understood what they could accomplish based on their professional roles. When Bellville left his position as Executive Director of Prevent Child Abuse Iowa, for example, he was no longer connected with the same committees and decision makers because those relationships were with the position where he previously served.

“This added an additional degree of difficulty to the work as I was no longer present at many of the tables I previously was,” he said, “and most of my interactions were now one of a concerned citizen rather than an organization partner.”

Guerra Ceron’s focus for her fellowship campaign shifted as she assumed different positions, however she remained committed to efforts that support and engage youth in advocacy. As a consultant outside of an organization, Roland has worked to build champions to add credibility to her efforts.

Building relationships is necessary for change, but is not always enough.

While Ehlers had a strong relationship with a health care institution, the process of agreeing to a memorandum of understanding to launch a Medical-Legal Partnership has taken more than a year to move forward. With a model of care that is new to Iowa, Simmons met roadblocks locally that made it difficult to work collaboratively to get referrals. “We decided to focus on partners who wanted to work with us,” she said, “and bring our services directly to survivors that we knew were in need.”

Fellows need different kinds of support.

Some fellows needed space to reflect and sought guidance with a mentor, others needed funding to attend a specific conference or training, and others valued meeting once a month with other fellows and to share what they were experiencing. The Foundation also offered many kinds of options for learning, support and flexibility in using resources to meet individual fellows’ needs.

Cross-cohort connections are valuable.

All Cohort 3 Fellows developed fruitful connections with previous cohorts. For example, Ehlers partnered with another fellow to move the Medical-Legal Partnership idea forward and Roland’s work was hosted by another fellow's organization.

The work involves becoming comfortable being seen as a leader.

The Cohort 3 Fellows were nominated to participate in the fellowship as a recognition by their peers of their leadership in system-change work. However, many Cohort 3 Fellows noted that they did not see themselves as leaders until later in the fellowship experience. As fellows received requests to present their work, as they identified incremental steps toward their goal, and as they celebrated wins in their campaigns, they began to build confidence in themselves as leaders.

“The nomination from the American Heart Association to serve as one of their Leaders of Impact for 2023 was unexpected. I had never heard of the AHA Leaders of Impact. It's a great opportunity to continue bringing heart health awareness and also inform additional people about cardiovascular genetic testing. Bringing more attention to a broader audience is a win/win.” — Tinika Roland, HealthConnect Fellow

“I feel that I grew in my self-confidence considerably over the course of the fellowship,” said Elzinga. “This work can feel really hard and isolating, and the fellowship was an amazing source of support and encouragement during some really rough organizational times.”

Hope for a Thriving Community

The long-term nature of system-change work, the barriers that exist to creating system change, and the lack of understanding among colleagues of what system change means are among some factors that make the work incredibly difficult. And yet, fellows continue to express hope that change is possible. For many, doing this work is necessary to create the world they envision for the future — a world where everyone has the opportunity for positive health and well-being outcomes.  

At a celebration luncheon to honor Cohort 3 Fellows’ work in fall 2023, Kozin shared:

“I think all of us would agree you have to be an optimist if you are going to work to create social change. You have to believe in a better future. That optimism is sustained in hope — the possibility to make that belief a reality. And our hope is grounded in the dreams of what it could look like.”

Advocates connect through a shared commitment to improve health outcomes.

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