Bridging the Gap Between Communities of Color and the Health Care System: A Q&A with UniteWI Founder and Executive Director Bria Grant November 16, 2021

Social determinants of health – like where we work, sleep, eat, and play – have a tremendous impact on our physical and mental wellbeing. While this is not a novel idea, it’s a concept that has become far more familiar to millions of Americans as the pandemic has reshaped our relationships with our environment and the people near us.

For Stronger Nonprofits Initiative alumna Bria Grant, executive director of UniteWI, the pandemic experience has been an affirmation of her work to address social determinants of health.

Grant founded UniteWI in 2016 to improve health outcomes in Milwaukee by training and deploying community health workers who bridge the gap between members of under-resourced communities and health care providers. They serve as frontline personnel who meet community members where they are, build trusting relationships with them, learn what external factors influence their health, and guide them toward resources that enable them to live healthier lives.

In a Nutshell

What: Q&A with Bria Grant, founder and executive director of UniteWI, about how her organization is bridging the gap between communities of color distrustful of the health care system and providers who make up that system, takeaways from the Stronger Nonprofits Initiative that have helped her lead UniteWI through the pandemic, an upcoming construction project, and more.
Sector: Health care
Location: Milwaukee, WI

In its first several years in existence, UniteWI has established partnerships with organizations working in the health care sector, expanded the reach of its community health workers, and embarked on a development project with financing from IFF to renovate a historic facility in Milwaukee.

With the organization continuing to play a vital role in pandemic response and its development project now underway, we recently caught up with Grant after last talking to her in 2020 about how UniteWI (then named UniteMKE) was leveraging the Paycheck Protection Program to navigate the pandemic.

IFF: What motivated you to found UniteWI and dedicate your career to improving public health at the community level?

Grant: Growing up, I wanted to be a lawyer. But when I got to college, I decided to focus on human services. After graduating, I got my start as a mental health and substance abuse counselor at an organization called Career Youth Development (CYD) here in Milwaukee, which was an amazing training ground. The motto there was “Love in Action,” and we really demonstrated that with our client base. We worked with whatever resources we had, and no one was turned away.

Although the organization was doing great work, I started to recognize that the funding for it was not at the level it should have been. One of the reasons for that is that we needed more evidence to demonstrate return on investment to funders to convince them to invest in the work, which stuck with me even after I moved on from the organization.

I worked at several other places after that and later transitioned into government as a staff member for a state senator, which helped me build relationships across Wisconsin and taught me the language of government. That’s been crucial at UniteWI because we have to translate between the language of government and the language of communities.

Communities that need resources often don’t “do data” very well because they’re so involved in the hard, day-to-day work of supporting community members.

One day I was representing the senator at a session where a proposal was being discussed to discontinue food assistance for working adults without disabilities because of purported fraud in the program. The data being used to make the case for that was abysmal, but it was what was being used to justify moving forward with this proposal that was going to cause lots of harm to communities in Wisconsin. I remember thinking that the state paid $300,000 for a private consulting firm to compile data and put together a report that told us absolutely nothing. That was another important lesson, because it reinforced the idea that data is what drives funding decisions. And, unfortunately, communities that need resources often don’t “do data” very well because they’re so involved in the hard, day-to-day work of supporting community members.

Years later, I wrote a proposal to the Department of Human Services with a suggestion for how to increase the state’s return on investment while funding health care for people with chronic health conditions and in communities of color. They ended up giving me $20,000 in seed money to demonstrate what I was proposing, and that’s what led to UniteWI. We’ve been able to secure a variety of grants since then by demonstrating with data the value of strong communities and the cost savings we can create for stakeholders like hospitals and state Medicaid when communities are healthy.

IFF: So much of UniteWI’s work is grounded in achieving more equitable outcomes in communities. How explicit is your focus on equity in the organization’s day-to-day work?

Grant: Community health workers are at the core of our work, and equity is built into the model itself. We compensate our community health workers with a living wage, which contributes to the rebuilding of the middle class in the communities where we work. About 10% of those we serve actually become community health workers themselves once they’re stable, which creates a ripple effect.

We’re very intentional about addressing equity imbalances and transferring authority to the community, because you can’t take ownership of your community if you don’t have the authority to make decisions that affect the community.

We’re very intentional about addressing equity imbalances and transferring authority to the community, because you can’t take ownership of your community if you don’t have the authority to make decisions that affect the community.

IFF: There’s also an important element of racial equity in your work, in that you’re trying to build bridges between communities of color that are distrustful of the health care system and the providers who make up that system. How have you gone about bridging the divide?

Grant: It comes down to building relationships in an intentional way. I’ll use COVID-19 as an example to illustrate my point.

When guidelines came down the public health pipeline last year from the CDC, the assumption was that, “We’re going to just tell people what they need to do, and they’ll do it. They’re going to wear masks, wash their hands, stay home as much as possible, and practice social distancing when they’re not at home.”

But there is a disconnect between systems and people that’s rooted in a lack of trust, and so that’s not actually what happened. And that was major challenge for an organization like UniteWI because we understand that the lack of trust is based on past medical trauma, but we still recognize that the guidance is important. It’s the equivalent of having an abuser and being told that you need to go back to the abuser because it’s the best place for you. That wouldn’t be an acceptable message in that situation, but that’s essentially the message that we needed to deliver to the community regarding the pandemic.

So, how do you overcome that? One of the ways was providing lots of training to the community health workers about what the CDC was asking for and working with them to translate that into a message that would resonate with the individuals and families we serve. It’s about understanding the barriers that exist for them to hear and act on what’s being communicated to them, and we’re very mindful of that.

It’s about understanding the barriers that exist for them to hear and act on what’s being communicated to them, and we’re very mindful of that.

If someone says they don’t want to get vaccinated against COVID-19, they’re not saying they won’t get vaccinated. Maybe they just don’t have enough information yet about what side effects are possible, or they’re uncomfortable about how quickly the vaccines were developed and need to learn more about the approval process. Education helps break down those barriers and provides them with the facts they need to make an informed decision. And when that education comes from a peer in the community, it’s far more effective than hearing the same thing from a medical professional they don’t have a relationship with.

Maybe that’s not always enough to convince them, and that’s okay. If someone still doesn’t want to be vaccinated after talking to the community health worker, we can still support them in better managing underlying conditions like diabetes or hypertension, which is going to put them in a better position to fight the virus if they happen to contract it.

IFF: We talked last year about how the pandemic was affecting UniteWI and how you expected a PPP loan to help the organization. PPP aside, are there any opportunities that have arisen for the organization in the past 12 months because of the pandemic?

Grant: We had a vision for how we could help address longstanding disparities in Milwaukee by acting as a bridge between the government or hospitals and community members. And what the pandemic has done is to create a real sense of urgency to cut through all of the layers of bureaucracy to move those relationships forward. There’s been a desire to put aside the typical differences in opinion and competing interests to find new ways to provide immediate relief to communities during the pandemic, and we’ve been able to leverage that to advance goals that we already had in mind before this started.

IFF: Have you found yourself leaning on lessons learned as a member of IFF’s Stronger Nonprofits Initiative (SNI) to lead UniteWI through a situation as unusual and demanding as the pandemic?

Grant: One of the things that SNI has helped with is managing the large funding opportunities that are coming our way right now. The program gave us the tools to set up systems that allow us to manage financials at a glance, which frees up time. It also helped me become more mindful about fundraising and what’s worth our time. Every little bit helps, but, realistically, we can’t chase lots of $20 opportunities when more substantial opportunities are out there. We’ve also been able to identify how to cover some of our operational costs more effectively, particularly when they’re not covered by grant funding. Overall, participating in SNI has really been invaluable for us as an organization.

IFF: Last question: In addition to ramping up UniteWI’s “normal” work during the pandemic, you’re also in the midst of the organization’s first real estate development project. Can give us a preview of what you have planned?

Grant: The concept is something that began in 2017 as a capstone project when I was enrolled in LISC Milwaukee’s Associates in Commercial Real Estate program. Working with one of my colleagues in the class, I studied the property and decided it presented a good opportunity for redevelopment. We launched UniteWI around the same time and ended up acquiring the property. It’s a historic facility that was built in 1914, but it has been vacant for more than 30 years. We’re going to do a complete gut rehab to save it from being demolished and to transform it into a community asset.

The space is around 5,000 square feet. Our vision is to have two residential units that can provide temporary housing for the populations we serve. We’re especially interested in housing for individuals who are pregnant while experiencing homelessness because we want to make sure they have healthy birth outcomes. Individuals with chronic health conditions will also be a target population for the apartments, as well as people who require wound care assistance after leaving the hospital. The units will provide a bridge so that the people living there have the support they need to recover fully before they go home.

The facility is also going to have commercial space and a restaurant, with the goal being to generate revenue for UniteWI and to provide workforce development opportunities for community members. And then the final component is new office space for UniteWI and several of our partners, which will make it possible for us to bring all of our administrative and programmatic processes into one space.

The pandemic delayed our plans because there just wasn’t enough time to respond to everything that needed to be done while our day-to-day work was increasing so quickly, so we’re just getting started with construction now. We have a wonderful team in place, and they’re well equipped to handle the challenges that may arise during construction. I’m also grateful to IFF for putting so much trust into a community organization that hasn’t done a project like this before and making a loan of more than half a million dollars without all of the requirements of traditional commercial lenders. The entire process to make this project happen has been a nice journey so far, and we’re excited to get the construction done and move in.

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