Grant Program: Community Impact Grant

This project is designed to make a substantial and long-lasting impact on the social emotional health of African American/Black students enrolled in the McFarland School District both now and into the future. While McFarland consistently ranks high among districts academically, their African American/Black students are not meeting critical health indicators as compared to their White counterparts. To address these disparities, this initiative will implement and expand the Natural Circles of Support program, in close partnership with student, school leaders, teachers, and families to change the conditions that perpetuate racial disparities and create a learning environment that ensures equity. The project, with plans to expand beyond McFarland, will work to increase engagement and belonging, expand equity and improve teacher support and relationships with Black students to create conditions that support all students’ ability to reach their full potential.

Through the creation of the Well Black Women Institute (WBWI), the Foundation for Black Women’s Wellness will connect, train and empower Black women to reshape the conditions in which they live, work and play. Through this Institute, the Foundation will prepare women as health equity leaders to address the persistent health and birth outcome disparities plaguing Black women in Wisconsin. In Wisconsin, Black women face higher death rates, lower life expectancy and some of the highest rates of infant mortality. Black families experience chronic stress caused by systemic racism and economic instability. These health challenges have been further exacerbated by COVID-19 and racial unrest. The WBWI will harness the talent and experience of Black women and provide them with the tools and training to become systems change leaders who can inform and promote policies and solutions to change how Black women experience health and well-being.

This project, led by Marshfield Clinic, aimed to change the way clinics, campuses and communities interact to advance health equity by refining and expanding the Community Connections Team (CCT) model to screen for and address unmet social needs. The CCT model recruits, trains and supervises volunteers to connect patients with unmet social needs to community agencies for assistance. Traditional health care systems excel in treating illnesses through medication, therapy or procedures but often fall short in addressing upstream social factors that significantly influence health outcomes. Systematic screening for social needs is rarely part of routine care, leading to many patients not receiving the necessary referrals and support. This project successfully advanced health equity by screening over 54,300 individuals for social determinants of health (SDOH) needs and facilitating 11,361 referrals to community agencies, connecting patients with baby needs, dental care, housing and more. The integration of Findhelp into Marshfield Clinic Health System’s electronic health record system expanded access to a directory of social care programs via a ZIP code search. Additionally, the project trained and supported 154 volunteer navigators who collectively contributed over 15,500 hours to bridge health care gaps and promote health equity through community resource navigation.

The goal of this initiative is to improve population health by reducing health problems that are fueled by civil legal injustices. The initiative’s approach combines technology and community-based programming to address legal problems that are barriers to employment, economic stability and health and well-being. Civic legal issues like child support, consumer and medical debt and evictions, influence economic and employment stability, housing access and poverty, and chronic stress, and impact families and individuals who often don’t have the resources to address these issues effectively. This grant team aims to transform the legal aid system, court procedures and the policy environment through community-driven policy and a technology response to make legal services more accessible to Black, Indigenous and People of Color in Dane County (LIFT Dane), Racine County (LIFT Racine) and statewide (LIFT Wisconsin). By addressing issues that can be resolved with a legal intervention, through a system that is modern and accessible, this initiative will work to improve health and well-being for people throughout the state.

This grant awarded to the Nehamiah Community Development Corporation aimed to reduce racial health disparities by strengthening social connectedness and community leadership among African Americans in Madison. Grounded in the understanding that racism – not individual behavior – is a primary driver of poor health outcomes, the project focused on addressing Racial Battle Fatigue (RBF), the chronic stress caused by daily experiences of discrimination and microaggressions.

This project, led by the Dane County Health Council and the Foundation for Black Women’s Wellness, aims to reduce racial inequities in birth outcomes through care coordination. Wisconsin has the highest Black infant mortality rate in the country, and Black infants born in Dane County are two times more likely to die in their first year of life than white infants. Factors contributing to racial disparities in birth outcomes are attributable to social and economic challenges in Dane County, including inadequate housing, food insecurity, lower educational attainment, fewer economic opportunities, poverty and structural racism. The project has made significant progress toward its goals in the first three years. ConnectRx is a closed-loop referral system developed in partnership with Epic Systems and UW Health and launched in April 2022. ConnectRx allows providers to make social prescriptions and integrates over 1,200 unique resources into patients’ electronic health records. Six Black female community health workers were hired to enhance maternal care teams, and a partnership with the Foundation for Black Women’s Wellness provided doula support. These efforts have resulted in assistance for over 200 Black birthing persons and their families, addressing needs such as rental assistance, homelessness prevention, mental health support, job-related assistance and food pantry referrals.

This project, led by Community Advocates, Inc., aimed to improve health and reduce the inequities within Wisconsin that are driven and reinforced by poor housing conditions. In Milwaukee, over 28,000 rental units were deemed moderately to severely inadequate to live in and nearly 16,000 adults and children face eviction each year. Disparities exist as women and people of color are over 50 percent more likely to be evicted than men or white individuals. The lack of quality, stable and affordable housing leads to poor health outcomes. In collaboration with Human Impact Partners, the project conducted a modified Health Impact Assessment (HIA), leading to the publication of the “Home Is Where Our Health Is” report with policy recommendations. The formation of the Healthy Housing Initiative’s Housing Advisory Council facilitated stakeholder engagement and contributed to the establishment of the Milwaukee Rental Housing Resource Center. The center’s triage team provided diverse services and resources to over 2,300 households in six months. Finally, a website was launched and garnered substantial engagement, with over 158,000 visitors since its launch in December 2020.

Oneida Nation will develop a model of programming that promotes food sovereignty and cultural identity among Indigenous communities as a comprehensive approach to reducing health disparities and improving health and healthcare. Dr. Bret Benally Thompson, a clinical assistant professor in the SMPH Department of Medicine and advisory council member of the SMPH’s Native American Center for Health Professions, serves at the academic partner.

Farmers are an occupational group with one of the highest rates of death by suicide- as much as two and half times the rate of the general population. To impact the number of farmers experiencing mental health distress and prevent farmer suicides, this project, Farm Well Wisconsin, aims to develop a comprehensive range of upstream interventions to create an ecosystem of support to foster farmer resilience. In its two first years, Farm Well has trained more than 700 rural community members and agribusiness professionals in peer support and suicide prevention, expanded their social media reach 10-fold and conducted training for more than 75 health providers, residents and medical students. Farm Well staff members have also been asked to join statewide coalitions and steering committees related to farmer mental health and rural suicide prevention.

The FREE Campaign seeks to improve health outcomes for formerly incarcerated women and their families by increasing access to safe, stable and supportive housing and resources to support successful recovery and reentry. The team will employ various approaches including transitional and reentry housing coordination in Milwaukee, Madison and the Chippewa Valley to achieve its goals. The FREE Campaign is an initiative within EXPO (Ex-incarcerated People Organizing), led by criminal justice-impacted women; EXPO is an affiliate of WISDOM, a faith-based community organization in Wisconsin. Lori DiPrete Brown, UW–Madison School of Human Ecology serves as the academic partner.