ECOR: Our SCALE Journey

This story was originally published through 100 Million Healthier Lives and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.

About Us

ECOR stands for Ethnic Community-based Organization for Immigrants and Refugees. Our vision is to improve the health and well-being of immigrant & refugee communities by addressing social determinants of health (the structural determinants and conditions in which people are born, grow, live, work and age). We seek to address a multiplicity of factors related to health disparities, including: (1) the physical environment, (2) access to health care (physical and mental health services), (3) education, (4) socioeconomic status/economic stability, and (5) Socio-cultural and community context.

From 2015 to present, with the generous support of Robert Wood Johnson Foundation, the 100 Million Healthier Lives initiative has helped us achieve unprecedented success in addressing social determinants of health, promoting health equity, and accelerating our journey toward a Culture of Health. Examples of social determinants addressed in SCALE 1.0 and 2.0 include: Access to health care and primary care services, availability of resources to meet daily needs (e.g., safe housing and local food markets), transportation options, education (high school graduation & language/literacy), social support, and social norms and attitudes (e.g., discrimination, racism, and distrust of government).

Using both the conceptual framework for health disparities (outlined below) and the Community of Solutions (CoS) framework, we seek to improve the health of refugee and immigrant populations and reduce longstanding disparities in health and health care in Salt Lake City, Utah (and the metropolitan area, including Weber, Ogden, and Provo) as well as the United States. In 2019, we expanded our initiatives to include refugee and immigrant communities in Franklin Township,  New Jersey.  Like Salt Lake City, Franklin Township is home to a large, and growing migrant population of African descent. 

Some of ECOR's work in transforming refugee and immigrant communities using CoS skills is highlighted below:

Leading Together

Leading Together (LT) skills are grounded in a perception of the community as a dynamic network of interacting people, organizations, structures, and systems that are related to a place.

Beginning of our Journey: We started our work by developing trust, stronger relationships, and interconnectedness. Some of the most effective ways to build positive relationships included organizing knitting circles (for women age 18 and over) and soccer tournaments for youth and adult men.

Youth soccer tournament

Soccer tournament for men age 18 and over

Engaging people with lived experience in SCALE

The picture above depicts a brainstorming session (part of a larger community needs assessment). By creating a safe space for teamwork and collaboration, we were able to determine community needs, determine capacity, and prioritize identified needs. This information was instrumental in guiding our SCALE work.

Owning our story and loving ourselves through that process is the bravest thing that we will ever do.

Leading from Within

Leading from Within (LW) skills involve one’s inner journey as a leader, including the ability to: know oneself and what brings one to leadership; reflect, “fail forward,” and change as needed and see and commit oneself to unlocking the leadership of others, especially those with lived experience of inequity.

Leadership event to empower refugees and immigrants with advocacy training, media training, and the tools to tell their own unique story.

Meeting to discuss housing issues (Summer, 2017)

Failing forward: Well being data was not collected from June-July 2019. This was a result of changing roles. Going forward, we have established a plan for data collection, which includes roles and responsibilities, dates and deadlines, as well as expected deliverables. We hold regular update meetings to ensure project deadlines are adhered to (we went from bi-weekly to weekly status meetings).

Secured housing for a single parent (through collaboration with housing services).

Leading for Outcomes

Leading for Outcomes (LO) skills support communities in applying design skills to co-create a theory of change, identify measures, test the theory, and plan for implementation and scaling up in a way that makes these tasks easier. Innovation/Design Thinking – Using stories and experience to understand the experience of people affected by a change; Improvement science – Developing aims, drivers, and measures, and running tests of changes; Implementation skills – Making implementation easier, more effective, and more joyful.

Community leaders were invited to a session on how to implement programs in the community

SCALE coaches taught us how to develop aims, drivers, and measurable outcomes. We also learned how to test changes on a small scale (PDSAs)

Co-designing ECOR's driver diagram with leaders.

SCALE Coaching at CHILA3 (developing driver diagrams)

Leading for Equity

Leading for Equity (LE) skills apply Leading from Within, Leading Together, and Leading for Outcomes skills to address equity at a population and structural level.

In Fall 2018, we held three house meetings in two cities to discuss topics related to health equity, including, racial justice, inequities by gender, and social-cultural norms & health behavior. Total number of participants = 27.

A House Meeting for Equity in the SCALE-Up Community of Franklin Township, NJ.

Notable Outcomes

People sustainability – cultivation of change leaders in a community. These leaders have gone on to train an additional 9 leaders (12 total) to provide mental health first aid.

Currently, over 80% of community members report being connected to a primary care physician. See employed strategies such as holding a large summer fair on world refugee day to orient refugees and immigrants to healthcare services, including providing contact information for providers who accept medicaid or provide charity care.

ECOR established a refugee welcome program. Among other things, the program provides orientation to the healthcare system and social services.

We secured buy-in from more stakeholders who are committed to supporting our community efforts and ensuring sustainability of projects beyond SCALE funding. 

First cohort of peer leaders- 3 per community (for a total of 12) received training in Mental Health First Aid

Established orientation program for new refugees.

Summer fare to promote access to healthcare and social services.

Stakeholders across sectors are coming together and stepping up to impact health outcomes outside of the clinical setting.

Reducing the Number of Ambulatory-sensitive ED visits has been a main focus of our work since 2015.  We have successfully reduced (and maintained) the number of non-emergency ED visits to 80%.  This is a significant achievement given that the baseline (in 2015) was around 10%. 

Call to Action

 Related Topics

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Social Determinants of Health