Heather Lusk, MSW: Executive Director, CHOW Project hlusk@chowproject

1. Creating and Sustaining a “Learning Organization”: Community Health Outreach Work (CHOW) Project Case Study Heather Lusk, MSW: Executive Director, CHOW Project hlusk@chowproject.org Lorraine C. Marais, Ed.D., MSW: CEO Ubuntu Generative Mentoring and OD Consultancy Services ubuntunonprofitconsultancy@gmail.com www.ubuntunonprofitconsultancy.com

2. Overview of Presentation • Introducing the speakers • Intent and outcomes for the presentation • Theory of Change (TOC): What is a “learning organization”? • Model for presentation: 5 Learning Disciplines (LD) applied to CHOW • Mental Models (LD 1) • Shared Vision (LD 2) • Team Learning (LD 3) • Systems Thinking (LD 4) • Personal Mastery (LD 5) • CHOW: The Story of CHOW • The context: Hawaii • Historical/Timeline CHOW change process • Application of 5 Learning Disciplines

3. Intent and Outcomes of Presentation After this presentation, participants are able to: • Understand and apply the LDs to own organization based on the lessons from CHOW • Committed to bring about positive change to own organization based on an explicit and conscious theory of change (TOC) • Recognition of the value of LO and the 5 LDs

4. Theory of Change (TOC): What is a “Learning Organization”? • Theoretical underpinnings • Senge (1997, 2003) • Generative and adaptive learning • Multi-layered learning • Inter-dependent and interconnected Individual Group Agency

5. Five Learning Disciplines • Mental Models (LD 1) • Shared Vision (LD 2) • Team Learning (LD 3) • Systems Thinking (LD 4) • Personal Mastery (LD 5) Shared Vision Team Learning Mental Model Personal Mastery Systems Thinking

6. The Story of the CHOW Project • Context: Hawaii • Overview of CHOW: Video and Pictures • CHOW Historical and Timeline of the Change Process • Application of the 5 LDs to CHOW’s change process

7. Contextual factors: Hawaii • Most remote archipelago in the world • Urban and rural with water between counties and therefore resource scarcity • 1.4 million residents with 80% on Oahu • Diverse population • 37.7% Asian • 22.7% White • 9.4% Native Hawaiian and other Pacific Islander • 8.9% Latino • 1.5% African American • Tourism drives Hawaii economy and impacts social issues • 3.4 million visitors a year – 14 billion dollar tourist industry

8. Contextual factors: Hawaii • 7,777 non-profits in Hawaii in 2008 • 57% of residents volunteer • 93% of households give cash, goods or services in contributions • Strong military presence • Honolulu has highest rate of homelessness in U.S. • Very high cost of living, affordable housing shortage • New study found need to make over $34 an hour to afford 2 bedroom • Highest in US • Hawaii has highest rate of liver cancer in U.S. (hepatitis B and C) • Also high rates of TB, MRSA and other infectious diseases (even dengue) • Youth in Hawaii: • Latest age of initiation for sex but also lowest condom use rate in U.S. • High rate of suicide attempts • Strong connections to family (ohana)

9. The (Not so) Hidden Side of Paradise VS

10. History and Timeline of Change Process of CHOW • 1989 – pilot syringe exchange pilot • 1992 – Act 152 passed to allow syringe exchange (SEP) • 1993 – CHOW awarded Hawaii’s first SEP grant • 38,000 syringes exchanged statewide • 1999 – CHOW incorporated as 501c3 • 1999 – 2009 offered syringe services only with small (3 member) management-oriented Board of Directors • 500,000 syringes exchanged statewide in 2009 • Through 2009 only ONE funding source (DOH) • CHOW notified that DOH expects 300,000+ funding cut

11. History and timeline of change process of CHOW (continue) • 2010 Lorraine joins CHOW Board as President • 2011 Heather joins CHOW and CHOW • 2012 Strategic planning process with Richard Male • DOH follows through with 350K funding cut (1/3 of grant) • CHOW annual budget 668,000 • 2013-2015 implementation of SP* www.chowproject.org • Expanded services, enhanced visibility, increased funding, strategic collaborations • 2015 just under 1 million syringes exchanged statewide • 2015 CHOW budget 2.8 million • 2013 -2015 External community collaboration • 2016 Repeat the strategic cycle

12. CHOW Organizational Chart

13. Current CHOW Services • Syringe exchange • HIV and hepatitis C counseling, testing and referral • Hepatitis and HIV care coordination • Health education • Housing navigation and case management • Wound care • Overdose prevention • Hygiene kits, safer sex supplies, other harm reduction supplies • Referrals and Outreach • Training, outreach and education in community

14. CHOW Services

15. CHOW and 5 LDs LD 1: Mental Models • Perception of consumers and community stigma • Past & current OD culture • “Being in the shadows” • Limiting our own potential • Understanding who we are and our own potential (changing the way we thought of ourselves) • Challenge to translate it into action • Current Mental Model

16. LD 1: Mental ModelsCHOW Organizational Culture Before • One funding source/service • Traditional hierarchal structure • ED made all decisions alone • Staff never met Board • Lack of transparency • Fear • If CHOW was visible would be shut down • What happens here stays here • Initiative penalized • Services done in isolation After • Diverse funding • Data-driven programming • Embody values of agency within org structure and culture • Board/staff integration • Innovation encouraged • Visibility enhanced • Continuum of services • Internal and external to CHOW

17. LD 1: Mental ModelCurrent Mental Model Challenge to Action • CHOW is out and proud! • Evidence-based services • CHOW is part of the solution and active in coalition-building • Homelessness, substance use, mental health • CHOW participants and staff are our greatest resource • Change is now the status quo

18. LD 2: Shared Vision and CHOW • Role of creating a common understanding of who we are, who we want to be and how do we get there (identity) • Planning content and process (role of strategic, assessment and resource development planning) • Changing the hearts and minds of staff, board, consumers & community • How to keep the vision alive

19. LD 2: Shared Vision Creating a Common Understanding of Identity CHOW’s old mission: To prevent the transmission of HIV/AIDS and other blood-borne pathogens among high-risk drug users, especially injection drug users (IDUs) in the State of Hawaii.

20. LD 2: Shared Vision CHOW’s New Mission Statement The Community Health Outreach Work (CHOW) Project is dedicated to serving individuals, families and communities adversely affected by drug use, especially people who inject drugs, through a participant-centered harm reduction approach. CHOW works to reduce drug-related harms such as but not limited to HIV, hepatitis B/C, homelessness and overdose. CHOW supports the optimal health and well-being of people affected by drug use throughout the State of Hawaiʿi.

21. LD 2: Shared VisionPlanning Content and Process • Evolved Program Profile • Enhance and expand our services to our participants, expand research, get involved in advocacy, enhance collaborations • Ensured Infrastructure and Systems • Enhance effectiveness in meeting mission and vision • Strategic plan was separated into activities with current funding and those which need additional funding

22. LD 2: Shared VisionCHOW Values • Participant-centered: listen to and honor peoples’ needs • Non-judgmental: care without judgment and with respect • Accessibility: eliminate barriers to access services based on peoples’ circumstances • The self-determination rights of each person: respect and honor individual privacy, freedom, and choice • Empowerment: provide opportunities for empowering participants to make positive changes in their health and well-being • Positive change: support positive incremental change through options, not directives • Centrality of relationships: recognize the importance of trust and relationships as the building blocks for successful service provision and positive change • Holistic and strength-based approach: belief in the resiliencies of people to enhance the well-being of family and community

23. LD 2: Shared VisionCurrent CHOW Vision • promote the overall health and well-being of people and communities affected by drug use, •  foster collaborative prevention strategies and reduce the risks of hepatitis B/C, HIV and overdose, •  empower individuals and communities to make positive incremental change in health and well-being • eliminate the stigma of drug use through community education and outreach, and  • advocate on behalf of people and families whose quality of life has been disrupted by the broader impacts of drug use.

24. LD 2: Shared VisionChanging the hearts and minds Strategic Planning Capacity Building and Training Resource Development Evaluation Capacity Building and Training

25. LD 2: Shared VisionHow to keep the vision alive? • Visioning exercise • SP/mission vision/values at every staff meeting • Board/staff retreats

26. LD 3: Team Learning and CHOW • Role of Board Leadership in change process • External OD Consultant comments • Role of staff and Consumers • How to continuously bring it together?

27. LD 3: Team LearningCHOW Leadership: Board Members https://youtu.be/-WSfzrFIYvI

28. LD 3: Team LearningRole of Staff and Consumers Staff evaluations and staff development plans linked to vision and strategic plan Consumer feedback integrated through annual evaluation and focus groups

29. LD 3: Team LearningExternal OD consultant www.richardmale.com https://www.youtube.com/watch?v=QG9rZYv4mhY

30. LD 4: Systems Thinking and CHOW • Seeing the connection between internal and external systems (then, now and future) • Creating a picture of the whole and its parts

31. LD 4: Systems ThinkingSystems Connections Systems within CHOW Training and Capacity Building Job description Staff evaluation and development plan Policies and Procedures Systems affecting CHOW Participants Stigma Access to healthcare and other services Addiction Housing and Basic Needs

32. LD 4: Systems ThinkingBig Picture/Small Picture Individual Group Agency

33. LD 5: Personal Mastery and CHOW • Moving from consciousness reflection understanding identifying competencies skills development implementation • Resistance to change and how to motivate staff/board • Role of leadership (ED and managers) • ED’s own journey

34. LD 5: Personal MasteryCommitment to Continuous Learning • Case Study: Kavika: Data Entry Clerk to Finance Manager • Externalized accounting and auditing • Partnership with Board Treasurer and outside accountant to assess capacity • Training and capacity building • Now – all accounting internal (with external audit) Individual Group Agency

35. LD 5: Personal MasteryMoving beyond consciousness Daily log example

36. LD 5: Personal MasteryDealing with Resistance to Change Parallel of behavior change and harm reduction values with participants and CHOW organizational change Making change explicit and discussing fears and challenges without consequences

37. LD 5: Personal MasteryRole of Leadership • Shift from ED-centered to leadership team-centered decision making • Increased communication, autonomy, responsibilities • Move from supervision to coaching • AT LEAST one hour per week with each • Building on strengths/redistributing tasks • Balance of amnesty and accountability

38. LD 5: Personal MasteryED’s journey

39. Lets practice In groups of three reflect on the following: • To what extent are you practicing the LO philosophy without know it? • Which of the LDs do you already have in place? • What should you do next when you return home in regard to LO and LDs Which ones we do well and which need improvement? • Discussion and Q & A Shared Vision Team Learning Mental Model Personal Mastery Systems Thinking

40. Mahalo! For more information: • Heather Lusk, MSW: Executive Director, CHOW Project • hlusk@chowproject.org • www.chowproject.org • Lorraine C. Marais, Ed.D., MSW: CEO Ubuntu Generative Mentoring and OD Consultancy Services • ubuntunonprofitconsultancy@gmail.com