The authors used a systems change approach to evaluate the implementation of the first three years of the Healthy and Equitable Futures (HEF) initiative, which was launched in 2021 by the Greater Rochester Health Foundation. HEF seeks to center racial equity in systems serving children and families and thereby improve health and well-being for Black and Latino children ages 0 to 8 in Monroe County, New York.

Shifting Systems Toward Racial Equity for Child Health

An Evaluation of Healthy and Equitable Futures

Dana Schultz, Anita Chandra, Lisa Sontag-Padilla, Sarah Weilant

ResearchPublished Sep 18, 2024

Evolving dialogue about racial equity and the importance of holistic child health and well-being led the Greater Rochester Health Foundation (GRHF) to launch the Healthy and Equitable Futures (HEF) initiative in 2021. HEF seeks to center racial equity in systems serving children and families and thereby improve health and well-being for Black and Latino children ages 0 to 8 in Monroe County, New York. The initiative focuses on transforming these systems to better serve children and their families and on emphasizing whole child health, which includes physical, cognitive, social, and emotional development. HEF uses three main levers to propel change: advancing family leadership, providing social-emotional supports, and creating representative and inclusive systems.

GRHF asked RAND to evaluate the implementation of the first three years of HEF operations and the progress of HEF toward its goals. In this report, the authors review the strategy and structure of HEF and its progress on the three main levers. The report identifies overarching lessons for transforming systems to achieve racial equity in the health and well-being of children. This report's findings will be of interest to those concerned with the Rochester area, as well as those concerned with efforts to improve racial equity in health and well-being of young children.

Key Findings

In its first three years, HEF focused on building organizational capacity and making progress toward systems change

  • HEF advanced family leadership by increasing the capacity of grantee organizations to partner with families, encouraging changes in organizational policies and practices for family partnership, and providing parents with training and supports to build leadership and advocacy skills.
  • HEF's grantmaking enhanced social-emotional well-being services for children ages 0 to 8 through increased culturally responsive services, trauma-informed care, and improved access to play spaces. It also enhanced training in early childhood mental health for providers.
  • HEF helped improve representation and inclusion within systems by strengthening training, policies, and practices to support equity and representation, promoting racial equity services and supports, and helping grantee organizations develop equity-focused recruitment strategies and change hiring practices to increase staff diversity.

Three learnings can help HEF as it moves forward with implementation

  • HEF has needed more careful planning than other initiatives because it aims to change not just organizations, but also systems grappling with historical racial inequities and established ways of serving children and families in Monroe County for years.
  • While HEF has made progress in involving parents in decisionmaking, there is still variation in how much families are involved in decisionmaking across organizations and systems.
  • Although HEF has led some community actions on equity and child health and well-being, its work is part of a broader community context that is still figuring out what equity-centered systems and policies mean, as well as the meaning of racial equity itself.

Recommendations

  • To advance family leadership in child health equity, HEF should promote consistent and innovative approaches to ensure meaningful parent engagement. Parents need more supports and opportunities to exercise their advocacy and advance in leadership roles.
  • For better social-emotional support services, HEF should improve coordination among local organizations, families, and social service agencies and increase awareness of family needs.
  • To build more representative and inclusive systems, HEF should address structural barriers and allocate resources to move effectively from dialogue to impact. This includes overcoming organizational fragmentation and aligning racial equity actions among local organizations.

Topics

Document Details

  • Copyright: Greater Rochester Health Foundation
  • Publisher: RAND Corporation
  • Availability: Web-Only
  • Year: 2024
  • Pages: 98
  • DOI: https://doi.org/10.7249/RRA3340-1
  • Document Number: RR-A3340-1

Citation

RAND Style Manual

Schultz, Dana, Anita Chandra, Lisa Sontag-Padilla, and Sarah Weilant, Shifting Systems Toward Racial Equity for Child Health: An Evaluation of Healthy and Equitable Futures, RAND Corporation, RR-A3340-1, 2024. As of May 1, 2025: https://www.rand.org/pubs/research_reports/RRA3340-1.html

Chicago Manual of Style

Schultz, Dana, Anita Chandra, Lisa Sontag-Padilla, and Sarah Weilant, Shifting Systems Toward Racial Equity for Child Health: An Evaluation of Healthy and Equitable Futures. Santa Monica, CA: RAND Corporation, 2024. https://www.rand.org/pubs/research_reports/RRA3340-1.html.
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The research described in this report was sponsored by the Greater Rochester Health Foundation (GRHF) and conducted by Community Health and Environmental Policy Program within RAND Social and Economic Well-Being.

This publication is part of the RAND research report series. Research reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND research reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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