To date, LBDHHS has applied the Framework in the development of one Request for Proposal (RFP) opportunity for community partners. Aspects of the Framework’s core tenants in simplifying procurements, using data to identify priority populations, and increasing access to funding through technical assistance have also been applied to other funding opportunities. The evaluation and plans outlined below include early findings from these efforts as well as plans for future measurement.

Central to the evaluation of the Framework are the two primary goals: 1) creating a tool which aligns investments with existing planning documents and 2) improving short and long-term population health and life outcomes in the city. The evaluation plan is therefore divided into two areas:

1. Connectedness of the Framework to LBDHHS’ strategic plan.

2. Efficacy of the Framework as a tool to improve health outcomes.

Goal #1 – Evidence of connectedness to LBDHHS’ strategic plans and assessments.

LBDHHS holds a strategic vision that “Everyone within our diverse communities is safe, healthy, and has the resources to thrive.” Established pillars toward achieving this vision include building a strong internal infrastructure, building a healthier population, and fostering equity.

There is close alignment between the equity objectives of the 2021-2026 LBDHHS Strategic Plan (https://www.longbeach.gov/globalassets/health/media-library/documents/planning-and-research/plans/strategic-plan/2021-2026-dhhs-strategic-plan) and the goals and outcomes achieved thus far with the development and application of the Framework. The creation of the Framework meets several of the department’s equity objectives including objective 1.1 to “Utilize an equity lens in planning and implementing programs, policies and practices, and to effectively design health and race equity initiatives,” and objective 3.1 to “Utilize disaggregated data to inform and influence all new and expanded policies or programs.”

The investment strategies likewise connect to strategic objectives related to decreasing chronic diseases, including objective 5.3 which seeks to “Reduce the incidence of chronic diseases (asthma, hypertension, cardiovascular disease, and diabetes) among Black residents in Long Beach.” Objective 16.1 of the strategic plan is to “Prevent and reduce mental illness and trauma in communities with the highest rates.” The Framework identifies mental health supports and trauma-informed responses as a category for investment. This funding category received significant response, with 21 projects proposed by community partners to address the current community need. Use of the Framework both allowed LBDHHS to direct significant investment toward achieving this objective and made it easier for organizations best suited to drive this work to access the funding.

Through a methodical, data-driven, and community-centered process, the Framework guided LBDHHS to achieve objective 13.1 to “Further build collaborative partnerships and mobilize resources to promote health, equity and safety.” This is also a component in evaluating the effectiveness of the Framework as a tool to address health inequities. Initial process metrics and future evaluation plans are outlined below.

Further evidence of the Framework’s connectedness within the work of the organization and City of Long Beach include alignment with goal four of the Racial Equity and Reconciliation Initiative: “Improve health and wellness in the city by eliminating social and economic disparities in the communities most impacted by racism.”

A second evaluation component in determining connectedness of the Framework to the department’s work is ensuring that it is translatable and durable for use with other conditions. This objective will be realized as teams throughout the department and across other City Departments begin using the Framework to set budget priorities and outline investment strategies. The first two areas for which the department has further explored application of the Framework are the Advancing Peace program and Early Childhood Education (ECE) efforts.

Initial results from application of the Framework to the advancing peace efforts offered insights into the potential of grounding the Framework in a positive, asset-based approach. Instead of centering on an adverse condition like incidence of violence, in this application, the “condition” is advancing peace. The Framework then identifies the root elements necessary to support safety and to promote peace for community residents as well as the impacts of increased peace on short- and long-term health and life outcomes.

The department’s ECE leaders have also started to apply the Framework to guide investment strategies and create synergy with community partners to achieve population level improvements. Team members have received training on the Framework and discussed how its application will be useful in collaborating with the CLB’s public school representatives and ECE providers to organize and identify investment strategies for multi-stakeholder, place-based resiliency projects. The Framework has laid the foundation for translating the analysis of forthcoming data related to the developmental skills of CLB kindergartners into ECE investments. In this case, the Framework will be used to define investment strategies and priorities using school readiness as the “condition” of focus.

After learning of its success in application to COVID-19 hospitalizations and the related Health Equity Community Projects RFP, team members across LBDHHS are eager to apply the Framework to their work. Plans are in place for a phased roll-out across the department, including utilization of the Framework as a tool for improving organizational infrastructure to support equity. Over the next year, focus will be placed on providing training to management and supervisory staff, providing example materials, templates, and early process outcome data for use and replication. LBDHHS’s Collective Impact Bureau will continue to engage the Racial and Health Equity Team to oversee ongoing institutionalization of the Framework. Finally, LBDHHS is looking to apply the Framework not only in consideration of funding to external community groups, but, working together with the City’s Office of Equity, as a model for prioritizing budget decisions locally and across the region.

Goal #2 – Efficacy at achieving its goals in improving health outcomes:

There are two categories by which LBDHHS is interested in evaluating the Framework’s effectiveness at improving health outcomes and reducing inequities. Through application of the Framework in 2022, initial data have been collected and reviewed to understand impact. Future plans to dive deeper and monitor consistency have additionally been outlined.

As mentioned, the Framework was utilized in the design of the Health Equity Community Projects RFP in 2022. Several of the strategies identified through the Framework application related to other existing programs under the LBRA. This included investments in Economic Inclusion and Resiliency, Nutrition Security, and Health Education and Outreach. As these were already identified and separate program investments, LBDHHS sought to share the Framework with program teams across the department and City who were engaged in these efforts to inform their work. This included sharing data and community input, encouraging greater provision of technical assistance, discussing neighborhood prioritization based on the HPI Quartile 1, and sharing the anticipated scope of investments within the Health Equity Community Projects RFP.

Most notably, the information from the Framework’s application also informed the design of investments in a Promotora/Community Health Champion program. Although the scope of work expectations and objectives were more specific in this case, LBDHHS replicated efforts to add technical assistance services for the RFP application process, simplify the RFP template, narrow the priority population based on the HPI Quartile 1 neighborhoods, and conduct greater outreach to organizations best suited to conduct these services. Results from this RFP and the Health Equity Community Projects RFP are discussed in the sections below.

The first objective in evaluating progress toward Goal 2 is to increase access to funding for organizations who are centered in communities, historically excluded from City procurements, and best equipped to carry forward transformative work in neighborhoods. This objective will be achieved by increasing new partnerships, increasing access to technical assistance, and designing funding opportunities that are relevant to the work of local organizations. Initial results from application to the Health Equity Community Projects (HECP) and the Promotora/Community Health Champions (P/CHC) RFPs are summarized below.

For the HECP RFP there were 114 prospective bidders who downloaded the RFP materials from the City’s procurement platform and 63 submissions. This equates to 55% conversion from prospective to actual bidder, with the city-wide historical average being closer to 10%. Twenty percent of proposers in response to the RFP had never applied to the City before and 93 project designs were submitted by these 63 organizations.

Twenty-seven organizations sought technical assistance from a contracted provider and 37% of those had never applied to the city for funding before. Even more, at least 55% of those organizations were small community-based organizations with up to a maximum of just five paid staff. Of the 29 contracts awarded, 6 organizations had not previously contracted with the City (or 20.6% of awards) and 13 organizations receiving contracts had engaged with the technical assistance provider (44.8% of awards).

For the P/CHC RFP, there were 25 prospective bidders who downloaded the RFP and this resulted in 13 organizations or 52% of prospective bidders following through and submitting a proposal. Thirteen organizations sought technical assistance from a contracted provider. Of the 6 contracts awarded through this RFP, 1 organization had not previously contracted with the City (or 16.7% of awards).

As LBDHHS scales the Framework, continued evaluation goals include the following:

Strategy 1 (short term): Ensure robust technical assistance. 90% of organizations who are connected with a technical assistance provider through the Health Equity Community Projects RFP report the trainings as having a positive impact in organizational development and that it will help them apply to future grants.

Strategy 2 (long term): LBDHHS will increase new partnerships, with 10% of awards going to new organizations per funding opportunity crafted using the Framework.

Strategy 3 (long term): LBDHHS will maintain greater than 20% conversion percentage from prospective bidder to proposal submission for funding opportunities designed using the Framework.

The second objective in evaluating progress toward Goal 2 is to reduce health inequities through strategic investments in contributing factors and outcomes of the condition of focus. This objective will be achieved by ensuring that work is happening in neighborhoods with greatest need, and that the menu of services or programs categories offered have a positive health impact for those most affected by inequities.

Initial results observed from implementation through the Health Equity Community Projects RFP demonstrated that funding from the RFP was nearly equally awarded to projects across the three geographic regions prioritized. Twenty-one projects were awarded through the RFP in the amount of $3 million and these equity-driven projects align explicitly with the investment strategy areas outlined with application of the Framework to COVID-19 hospitalizations.

Continued evaluation plans to measure progress include the following:

Strategy 1 (short term): Demographic data on program beneficiaries through vendor final reports in December 2024 will indicate that greater than 75% of beneficiaries live in central, west, or north Long Beach zip codes.

Strategy 2 (short term): Demographic data on program beneficiaries through vendor final reports in December 2024 will indicate that greater than 75% of beneficiaries identify as persons of color or other prioritized identity (LGBTQIA, older adults, low-income, etc.)

Strategy 3 (short term): Data from vendor final reports in December 2024 will indicate positive impact on health as measured through reporting metrics such as increased understanding of health information, increased access to resources, and improved perception of health or interest in engaging in health promoting behaviors.

Strategy 4 (long term): Health inequities in the City of Long Beach are reduced and LBDHHS is reaching goals outlined within strategic plans.

Health Equity Investment Framework

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