This document provides an evaluation of the Connecticut Health Foundation's efforts to expand health equity. It analyzes data from 29 grantees and interviews with stakeholders. Key findings include: - Grantees made progress coordinating care, holding systems accountable, and building advocacy capacity. - CT Health influenced policies through participation on governing bodies and convening stakeholders. - Challenges included a lack of disaggregated data and organizational changes. The evaluation concludes CT Health has strengthened leadership for health equity and recommends continuing its multi-pronged strategic approach while improving data and communication with grantees.

1. Annual Evaluation of the
Connecticut Health
Foundation’s New Focus to
Expand Health Equity
Kien Lee and Sinead Younge
Community Science
June, 2015

2. CT HEALTH STRATEGIC FRAMEWORK

3. PURPOSE OF EVALUATION
o Assess the degree to which CT Health was making progress towards
its goal to expand health equity for all of Connecticut’s residents
through its grantmaking, policy work, and communications strategy
o Synthesize grantees’ accomplishments and how the
accomplishments support CT Health’s strategic plan
o Identify avenues through which CT Health influenced policies,
procedures, and practices to promote health equity
o Make recommendations for CT Health based on the evaluation
findings

4. CONTEXT TO KEEP IN MIND
o The evaluation included grantees that were funded before the
revised 2013-2017 strategic plan was final. As such, these grantees
did not implement strategies or have desired outcomes that aligned
perfectly with the framework
o Some grantees did not describe their progress or outcomes in the
same manner described in CT Health’s strategic plan

5. EVALUATION METHOD
o Reviewed grantee reports and “mapped” their activities and results
against the strategic framework to the extent possible
o Tailored interview protocols for grantees based on their alignment
with the strategies and outcomes in the strategic framework
o Interviewed grantee representatives and, for three grantees that
functioned like an intermediary, representatives from organizations
that benefited from their technical assistance and other services
o Worked with foundation staff to identify a list of key stakeholders
who are familiar with CT Health’s work to influence policies,
procedures, and practices, and interviewed a sample of these
stakeholders
o Interviewed foundation staff and selected board members

6. DATA SOURCES
o Analysis of grant progress and final reports from 29 grantees
o Interviews with:
o 26 grantees
o 4 CT Health staff members
o 3 board members
o 5 people familiar with CT Health’s influence activities
(community advisory committee members, fellows, and
leaders of key agencies and organizations)
o 6 organizations who received capacity building assistance
from 3 grantees
o Data also used to populate scorecard

7. ACRONYMS USED
AHCT Access Health Connecticut
BCAC Bridgeport Child Advocacy Coalition
CASBHC Connecticut Association of School Based Health Centers
CCA Christian Community Action
CDHP Children’s Dental Health Project
CECA Connecticut Early Childhood Alliance
CLRP Connecticut Legal Rights Project
CLS Connecticut Legal Services
CNP Connecticut News Project
COHI CT Oral Health Initiative
CPB Connecticut Public Broadcasting
CTCMCF Connecticut Children’s Medical Center Foundation
CTCPS Connecticut Center for Patient Safety
CTJJA Connecticut Juvenile Justice Alliance
CT Voices Connecticut Voices for Children
DMHAS Department of Mental Health and Addiction Services
HES Health Equity Solutions
HFPG Hartford Foundation for Public Giving
IRIS Integrated Refugee and Immigrant Services
KTP Keep the Promise
NAMI National Alliance on Mental Illness
NHLAA New Haven Legal Assistance Association
OHA Office of Health Advocate
PPSNE Planned Parenthood of Southern New England
PSC Partnership for Strong Communities
SNCR Society for New Communications Research
UCAN United Connecticut Action for Neighborhoods
UHCFCT Universal Health Care Foundation of Connecticut

8. OUTREACH, EDUCATION, AND ENROLLMENT
IN HEALTH INSURANCE PLANS
o 3 of 6 grantees reached (e.g., flyers, brochures) 6,144 people,
educated (e.g., informational sessions) 5,883 people, and
enrolled approximately 4,379 individuals
o Bridgeport Child Advocacy Coalition successfully advocated
for a webpage in Spanish on the Access Health CT website
o Universal Health Care Foundation of Connecticut in
collaboration with Community Alliance for Research
Engagement (CARE), conducted a study to examine
enrollment experiences to inform the next enrollment period
o Grantees mentioned challenges related to enrolling mixed-
status families in healthcare insurance plans

9. COORDINATION OF INTEGRATED CARE
o CT Oral Health Initiative’s participation in
the SIM’s Practice and Transformation
Taskforce helped integrate oral
health into discussions about the state model
o 3 grantees developed screening protocols
to better identify needs and provide
comprehensive services (e.g., the homeless, oral
health for pregnant women)
o 3 grantees established practices that brought
together professionals who used to work independently
to improve the coordination of care (Dept. of Mental Health
and Addiction Services’ care teams, Partnership for Strong
Communities’ community care teams)
o 2 grantees worked to improve service coordination and
provision within their organizations
Coordination & integration
of physical, oral, &
behavioral health services,
and dental & obstetric
practices.
 St. Francis Hospital
 CDHP  NHLAA
 CTCMCF  CASBHC
 DMHAS  COHI
 NAMI PSC
 Wheeler Clinic
 COHI PPSNE

10. HOLDING OF SYSTEMS ACCOUNTABLE TO
HEALTH EQUITY
o Infusion of health equity into the State
Innovation Model (SIM) plan
o United CT Action for Neighborhoods assisted
in making Dept. of Social Services more
responsive to consumer needs and to decrease
insurance rates
o National Alliance on Mental Illness ensured that
underrepresented persons with mental illness
were represented on various task forces
o CT Juvenile Justice Alliance was appointed to the Public Act 12-
178 Advisory Board and used data to address racial disparities in
juvenile justice
o Primary Care Access/Univ. of Mass. implemented a statewide
survey on enrollment and access, to collect data that can be
used to influence state policy
Holding of systems
accountable
to health equity
through the
development and
integration of:
 CCJA  NAMI 
UCAN
 UMASS

11. LEADERSHIP AND ADVOCACY CAPACITY
o 5 grantees organized events that convened
state and national stakeholders to discuss issues,
including best practices for insurance enrollment;
budgeting for healthcare coverage; and advocating
for oral health (e.g., CT Center for Patient Safety, CT
Voices)
o 5 grantees demonstrated leadership in generating
solutions and ideas to advance health equity
(e.g., CT Association of School-based Health Centers)
o 4 grantees helped shape legislation and budgeting of healthcare
services (e.g., PA 13-208 provision about mental health services in
outpatient clinics, blocking of the waiver that would have lowered
level of coverage for low-income adults)
o 3 grantees, through various types of assistance, helped to build the
capacity of nonprofit organizations, community groups, and
advocates that promote health equity
o CT Legal Services established Health Equity Solutions (HES), the first
healthcare advocacy organization of its kind and prompted by CT
Health
Stronger leadership
and advocacy
capacity:
AHCT  BCAC
 CASBHC COHI
CTCPS  CLS 
CT Voices  NAMI
NHLAA
 St. Francis Hospital
UCAN

12. DATA-DRIVEN DECISION-MAKING
o CT Health has contributed and helped cultivate a culture of
data-driven decision-making among grantees
o 13 grantees used data to inform policies, procedures, and
practices in their efforts to improve health care for
underserved populations
o The Univ. of Mass. Office of Survey Research used the data
collected through the CT Health Care Survey and collaborated
with other stakeholders to publish policy briefs
o CT Juvenile Justice Alliance used data about mental health
disparities to engage stakeholders in discussions about racial
disparities in juvenile justice due to implicit bias

13. LEVERAGE RELATIONSHIPS AND OTHER
CAPACITIES TO INFLUENCE CHANGE
CT Health was well positioned
to influence systems change by
intentionally enabling its staff,
board members, grantees, and
fellows to serve on a wide
range of governing and
decision-making bodies
Leverage relationships and
other capacities to influence change
AHCT  BCAC  CASBHC  CLRP  CLS
 COHI CTCMC  CTCPS  CT Voices
 DHMAS  NAMI  NHLAA  OHA
 PSC  St. Francis Hospital  UCAN
 UHFCT  CT Legal Rights Project
 Fellows*

14. PARTICIPATION OF CT HEALTH AND GRANTEE
REPRESENTATIVES ON SIM GOVERNING BODIES
CT Health staff led effort
to convene members to
establish operating
principles for the Cabinet
and ensure that health
equity was part of the
principles.
CT Health engaged a
consultant to help write
language about medical
homes and health equity.
COHI’s participation,
encouraged by CT Health,
helped ensure the inclusion
of oral health in the SIM.
CT Health nominated
many of the members
who serve on the
board.
CT Health provided
input on the
evaluation
requirements for
the SIM.
CT Health hired
national experts to
inform the health
equity work group,
also led by a CT Health
staff person.

15. PARTICIPATION OF CT HEALTH AND GRANTEE
REPRESENTATIVES ON ACCESS HEALTH CT
GOVERNING BODIES
AHCT Board
Dept. Of Mental
Health &
Addiction
Services
Office of
Healthcare
Advocate
AHCT Race &
Ethnicity Data
Collection
CT Health
Healthcare
Innovation
Steering
Committee
United
Connecticut
Action for
Neighborhoods
AHCT Navigator
and In-Person
Assistor
Training
CT Health

16. PARTICIPATION OF CT HEALTH AND GRANTEE
REPRESENTATIVES ON OTHER HEALTHCARE AND
HEALTH EQUITY COMMITTEES

17. FOSTER ALLIANCES AND CROSS-SECTOR
COLLABORATION
o Grantees and other stakeholders frequently
cited CT Health’s “mini think tanks”
convenings as a useful and inclusive process
for cross-sector information exchange and
relationship building
o CT Health funding and brokering enabled
grantees to develop partnerships that led to
greater understanding of the current
healthcare system and relationships that laid
the groundwork for integrated care (e.g.,
Partnership for Strong Communities
collaborated with hospitals and Community
Care Teams to promote patient-centered
care)
Foster alliances
and cross sector
and cross-system
collaboration
 AHCT  BCAC
 CBP  CLS 
CT Voices
 DHMAS  OHA
 NHLAA  PSC
 SNCR
 St. Francis
Hospital

18. GENERATE, SYNTHESIZE, AND DISSEMINATE
KNOWLEDGE TO INFORM DECISIONS, STRATEGIES,
AND PROGRAMMING
o CT Health-funded research and products that
informed decision- and policy-makers’ thinking
and planning (e.g., the work of the
Comprehensive Behavioral Health Planning Group
of the Keep the Promise Coalition, study by
National Alliance for Mental Illness to examine
youth aging out of youth services and into the
Dept. of Mental Health and Addiction Services
system, analysis of HUSKY Health enrollment)
o CT Health used the media in different ways to both disseminate
information and maintain focus on health equity (e.g., CT Health
President co-authored an op-ed about the lack of a public plan for
linking consumer with in-person assistance for the 2014-2015
enrollment period, CT Health helped convene a group of 20
reporters to discuss reporting about health disparities and equity)

19. PROVIDE FUNDING AND OTHER SUPPORTS
o CT Health engaged and contracted directly with experts to
inform planning and decision-making (e.g., national experts
to inform the work of the SIM Practice Transformation Task
Force and SIM Quality Council’s health equity design work
group)
o CT Health helped strengthen key nonprofits in the state and
contributed to their ability to attract investments from
additional funders (e.g., CT News Project received funding
from The Seedlings Foundation and the Universal Health Care
Foundation, along with support from CT Health, was able to
dedicate nearly 20% of its overall budget to healthcare
issues)

20. o The lack of available data disaggregated by race and
ethnicity
o Difficulty in working with navigators and assisters primarily due
to the newness of the program
o Internal organizational changes, from staff turnover to
delayed startup of efforts for various reasons (e.g., unrealistic
timeline, staff recruitment)
GRANTEE CHALLENGES

21. CONCLUSIONS
o CT Health was perceived as a leader in promoting and infusing health equity
into policies, procedures, and practices
o CT Health has helped strengthen the leadership and capacity to advocate
for health equity
o Grantees have laid the groundwork for coordinated and integrated care
o Grantees have laid the groundwork for developing and integrating mental
health policies and programs as well as oral healthcare practices by
statewide maternal and child health programs
o Further work is needed before outcomes related to safety net and the
development and integration of primary care models are evident
o CT Health has helped foster a culture of data-driven decision-making
o More people were reached, educated, and enrolled due to CT Health’s
support

22. CT HEALTH’S ENABLING ROLE
o Connected people to opportunities (e.g., CT Oral Health Initiative
and SIM Practice Transformation Task Force and Access Health CT)
o Provided funds for building and strengthening organizational
infrastructure (e.g., CT Association of School-based Health Centers,
Health Justice CT, CT Voices)
o Provided funds for hiring staff and consultants (e.g., policy
advocacy, strategic communications, data analyst)
o Provided expertise – technical assistance, coaching, sounding
board for ideas, knowledge about systems and policies (e.g., Health
Justice CT)
o Helped grantees attract other funders
o Was flexible and allowed for mid-course corrections

23. RECOMMENDATIONS
o Continue to simultaneously focus on all the strategies – policy,
grantmaking, and communications – to maximize their
synergistic effect
o Develop a strategy and plan for continuing to cultivate, expand,
and sustain a shared sense of responsibility for effecting systems
change among grantees and other nonprofits in Connecticut
o Develop more “go-to-resources” besides CT Health for policy
advice and relationship brokering (e.g., Health Equity Solutions)
o Consider what role the foundation can play to help improve the
availability and adequacy of data and integration of data
systems in order to continue to foster a data-driven decision-
making culture

24. RECOMMENDATIONS
o Develop process to help staff continuously reflect on the
investments being considered before making them to maximize
the potential of systems change and the “balance” desired
o Use the framework diagram to check the number of grants and
policy and communications efforts in each “slice”
o Align strategies with short- and long-term outcomes
o Revise progress-reporting template to use the same measures as
in scorecard
o Convene fellows, grantees, and partners annually to
continuously foster a sense of community, common purpose,
knowledge exchange, and knowledge generation

25. RECOMMENDATIONS
o Provide technical assistance to grantees before grant
application and immediately after grant award
o Understand systems change in CT Health’s terms
o Clarify CT Health’s expectations in terms of progress
(implementation and outputs) and outcomes
o Completion of reporting forms
o Communicate to current grantees about its expectations for the
future including the strategic plan
o Design an evaluation for the upcoming year that focuses on the
outcomes experienced by external stakeholders who are
impacted by CT Health’s grantmaking, policy, and
communications work