Extrapreneurship and Systems Thinking

Teresa Chahine: Welcome to Impact & Innovation. I’m Teresa Chahine, and I’m inviting you inside my classroom, at Yale School of Management, as we grapple with questions on social entrepreneurship and impact.

Welcome back, everyone. We are discussing something really interesting today, which is not your usual startup, that is launched by an entrepreneur in the form of a new venture, but actually something super innovative that has all the same elements of a startup, but that is launched by someone working within the Yale system who I like to call an “intrapreneur.” Dr. Brita Roy, thank you so much for being here with us today, Brita.

Brita Roy: My pleasure. Thanks for having me.

Teresa Chahine: I thought it was so important for my students to meet you, because many of them may go on to have jobs like yours. You’re a clinician, you’re a researcher, you have a full-time job in an academic medical system, and yet you’re doing the work of a social entrepreneur. I know you don’t think of yourself as a social entrepreneur, but it’s interesting to apply that lens to your work, because you basically came up with this new model about how to apply systems thinking to a social problem, which is gun violence, and how to bring together different stakeholders to test a new innovation, which is housing as an intervention to gun violence. Those are all the things that a social entrepreneur does.

So I’m going to break it down through this social entrepreneurship framework and ask you all the same questions that I would ask a social entrepreneur. Basically, first, I know that your work, your intervention and your innovation, which I’ll ask you about in a moment, is underpinned by a framework that you came up with, which is called the Collective Wellbeing Model. Can you tell us a little bit about that?

Brita Roy: Sure. The Collective Wellbeing Model is an actionable community-level theoretical framework that describes how a community is one, more than the sum of its parts, and two, adapts individual-level wellbeing theory to the community level. There is a fair amount of literature and psychology, positive psychology primarily, talking about different domains of wellbeing, the reasons that people want to be alive. They generally have to do with having good health, having positive social relationships, having meaning and purpose in life. Experiencing what’s called a state of flow is actually also really important. So kind of being immersed in an activity that you kind of lose yourself in is actually really important for psychologic health and belonging, a sense of belonging to a group or to a community. We looked at what the evidence was for existing wellbeing theory as well as how wellbeing is both shaped by community factors and how wellbeing influences health outcomes and other outcomes like productivity, for example, and created this framework of collective wellbeing, which has five domains. kind of parallel to individual-level wellbeing.

The first domain is vitality, so that includes rates of physical, mental, emotional health and higher rates of positive functioning. The second domain is opportunity, so that has to do with income equality as well as opportunities for social mobility. The third domain is connectedness, so that’s kind of the social networks and social connections. The fourth is contribution, so feeling of meaning and purpose from giving back to one’s community. Finally, inspiration, which is opportunities and rates of involvement in those kind of immersive types of activities.

So just as a single example to help frame why it’s useful to think of these at the community level and think about how communities can foster those types of outcomes, if you even just think about physical health or physical activity, for example, I now live in Brooklyn, New York, and while I am a person that thinks it is healthy, for example, to cycle to work, I don’t really want to, because I’m scared of all the cars. But same person who’s not biking to work at all, if I moved, for example, to somewhere like Portland, Oregon where they have a lot of really safe, protected bike lanes, and a lot more people actually do use cycling as a mode of commuting and transportation. The drivers are more used to looking for them. So there’s many fewer accidents and a lot more infrastructure for it. That’s how the properties of a place can influence even something like health behaviors like physical activity and downstream effects like obesity.

Teresa Chahine: I asked that question to set the framework for your innovation and how you ended up working on housing as an intervention for gun violence. Your intervention is called True Haven, right? I’m not going to try to say what it stands for. Can you tell me what it stands for? I never get it right.

Brita Roy: I don’t even know if I can get it right!

Teresa Chahine: It’s here in New Haven, and you called it True Haven because it’s...

Brita Roy: It’s “trusted messengers and housing assistance to reduce violence in New Haven.”

Teresa Chahine: Okay.

Brita Roy: Something close to that.

Teresa Chahine: I love acronyms, but True Haven is basically a startup, except it’s just existing organizations working together in a different way. You had been working in the community for 10 years, you developed this collective wellbeing framework, which is just like we think about the wellbeing of an individual being multifaceted, how can we look at a group of individuals and think about their collective wellbeing as being greater than the sum of its parts? When you look at gun violence, a lot of the traditional public health interventions, a lot of them look at policy and gun ownership and gun use, et cetera. But then a lot of them also look at the individuals who either perpetrate gun violence or are victims of gun violence and how can we support them.

But you applied the system’s thinking model to understand the root causes of gun violence, and then that really tied in with your collective wellbeing model, because you were thinking about how can we strengthen this community and build social cohesion in order to reduce gun violence. It turned out that you really have to address the root causes of what makes a community lose its social fabric, which is basically just structural racism. When you address those factors, that’s how you reduce gun violence. Can you tell us more about that process of bringing the community together and applying that systems thinking to figure out how you’re going to tackle gun violence? How did you go from gun violence to housing?

Brita Roy: Actually, I’m glad you even just brought up the term “structural racism,” which is a systemic oppressive structural force at the community and societal level. So if we are to undo that and dismantle that, I think we can’t just dismantle in parts. It’s actually thinking about utilizing and opposing positively framed systematic societal framework to be able to combat it. That’s where the collective wellbeing framework comes in. I mentioned the five domains of collective wellbeing, but antecedent to that, or upstream or determinants of wellbeing, are the community-level programs and policies and infrastructure that lead to specific behaviors or social connections that result in certain levels of wellbeing. So it was looking at those systems factors that led us to this eventual approach. And which system’s factors, I didn’t know. I didn’t think I or anyone else in the community, a single person was going to have that solution.

This is really kind of the culmination of years of relationship building among multiple stakeholders in New Haven that were concerned about the high rates of violence and understood we don’t want that in our community, but no one knows exactly how to tackle it. So we got everyone together in a room and asked the question, what community factors do you think foster or undermine race/gun violence in this community? Of course, everyone has a different perspective. Everyone has different ideas and everyone’s right. There is a really systematic process called group model building that I used with this really diverse group of stakeholders in the room, to elicit those ideas in a very equitable way, where everyone contributes and participates. Everyone contributes their ideas as to what they think influences gun violence. Then we literally map them on the board, not just like themes, but we draw arrows to say, “Okay, factor A causes factor B, and factor B causes factor C.”

In the end, you get this literal map called a causal loop diagram that shows how all of these different community factors relate to each other, to result in the outcomes that we see. From that kind of qualitative process, we can create a computer simulation model, literally a mathematical model, and test things in silico to see what types of interventions may or may not work combined with talking with our community partners about what’s feasible in our community. Where do we have leverage? Where do we have connections to be able to influence, to actually implement such an intervention? From that process, we came up with two major components of our intervention. The first is increasing housing stability, really paired with comprehensive financial education. The second is training a cadre of trusted laypeople community members in trauma-informed counseling and care, so they themselves can provide a base level of support. For those that need a higher level of care, can really destigmatize receiving that care and connect people into mental health care when needed.

Teresa Chahine: That really is the social entrepreneurship process. You had a social challenge you were facing, incidents of gun violence, and then you map the system around it. What’s causing these incidents of gun violence? I saw the map, it kind of looked like the solar system. There were so many different parts and—no, not even the solar system—all the galaxies that there were many systems inside it. There were many systems within the system. There was the criminal justice system; there was mental health; there was social cohesion. There are a couple of others, I don’t even remember what they were. Substance use maybe, other things that will lead to all the upstream factors leading to gun violence incidents. Then it’s like once you mapped that out, it sounds like you stepped back with the community and you were like, okay, there’s a lot of ways this could go.

So where are we best positioned, in terms of this partnership, the local nonprofit and one of the local universities and other community partners? Where can we make a difference? You landed on these three points that you mentioned, providing housing stability and financial training, trauma-informed counseling, and then working with the city and state. Which of course, you have to do your direct interventions, but then you have to advocate for policy changes at the city and state level. All these things are meant to address structural racism. That’s why this happens. Tell us more about, what do you provide in terms of the housing interventions, and who’s paying for this?

Brita Roy: Yes. With the housing intervention, a few things. One, we’re focused on recruiting people who either were recently incarcerated or are family members of people who are currently incarcerated. Because many of them would have lost an income-earning member of their family. Also, this group collectively is at higher risk of being involved in gun violence. Second is this financial education program that’s being delivered primarily through the Urban League of Southern Connecticut, which really importantly in all of this, this has been a fully partnered approach. The CEO of Urban League is actually the co-principal investigator on the research study. So this organization’s getting money from NIH to be able to support personnel to do this work. They are providing very comprehensive financial education that’s milestone-based, where they have a curriculum and people go at their own pace. When they achieve a milestone, like understanding a certain concept, like understanding how credit scores work or how to maintain a budget, for example, then they move on to the next.

They complete this course and then have access to financial support, in the form of either rental assistance, down payment assistance, or low-interest home loans. That money is coming from a variety of sources, both public and private. On the public side, we are tapping into existing programs that many people in our communities can gain access to for rental assistance. There was a lot more during the COVID pandemic, but there still are a lot of programs out there, as well as for down payment assistance. Then we have access to low-interest home loans through local banks and credit unions and also through the state as well. We’re working with partners to make sure all of those programs do not have any limitations placed on them because someone was recently incarcerated or because they have a family member incarcerated. So we’re trying to lower barriers to entry as well as facilitate entry into these programs.

We also want to make sure that some of these programs that are short-term, it might be rental assistance for six months, want to make sure that they’re in a situation that when it ends, they’re still able to maintain their housing. That’s really key. There is some private funding provided as well from Yale School of Medicine. We’re approaching other philanthropic organizations as well, thinking that there are systems that have benefited from structural racism over the years. So it is sort of a reparations process to think about ways that they too can actually give back and be part of the process of now reducing the racial wealth gap in these communities.

Teresa Chahine: it sounds like it could actually be sustained over time once your intervention is done. Right now, you mentioned this is an experiment, a scientific experiment. It’s registered as a clinical trial. It’s funded by the NIH, the National Institute of Health. The idea is to show does this work? You have a theory of change. If we address structural racism, the root causes and its manifestations, like housing inequities, then we can reduce the symptoms of structural racism like gun violence. So if this works and if you get results, then it no longer needs to be a project that’s implemented by the same people, but rather the process that you’ve used, the systems mapping, bringing together community stakeholders, can be replicated in so many other locations. The existing stakeholders, like the state housing authority, maybe local banks, universities, philanthropists, et cetera, could finance it.

It could actually be sustainable once we know if it works. I think that’s the role of social entrepreneurs, is generating new innovations and testing if they work, and then other people can adapt them. That’s what my students seem to think was really unique about what you’re doing, because you’re not starting a new organization, where you then have to figure out how are you going to sustain that organization or how are you going to get funding to support yourself, but you’re just doing the work and then thinking about how you can help existing stakeholders replicate it. It’s a different definition of scale, I think, and that’s really important. This is what we call a collective impact model, right?, when you’re bringing together existing stakeholders and getting them to work on a shared agenda. I think it goes back to your notion of collective wellbeing also.

You mentioned that underpinning the characteristics of wellbeing in a community are the community programs and capacities and all those things. So you’re actually changing those. Hopefully by the time you’re done with this intervention, it’s not just the housing you’re doing or just the financial training or trauma counseling you’ve provided, but the community itself will be healthier. It will have different capacities and programs and everything. So now, sounds like you’re already replicating this process at a different site and doing this in New York. Are you up for telling us a little bit about that as well? Is it similar as True Haven? Is it called True Brooklyn or something?

Brita Roy: No. Yes, I recently transitioned, moved to Brooklyn, New York, where I’m working with the Sunset Park community, which is a primarily low-income, very diverse immigrant community with multiple languages and ethnicities and working with them collaboratively to improve health outcomes. Gun violence is not a specific issue there, but health outcomes of interest include cancer, kind of the whole continuum, preventive screening, as well as reducing morbidity and mortality, prevention of heart disease and risk factors, improving maternal and child health and improving behavioral health. The program is called Beyond Bridges, and it’s really multi-component. Certainly we’re trying to improve health and health disparities, but also recognizing that NYU Langone, which is the institution I’m at now at, is also a leader in research and medical education and program evaluation and medical technology. We’re also utilizing those aspects to improve equity in Sunset Park as well.

One of the major initiatives we are launching is to develop what’s called a community clinic linkage model, where we are working to create a digital health and social needs screening and referral tool across clinical and community-based social service organizations. So if a person, a patient or client, either in a clinical setting or in a community-based social service setting enters, they’ll be screened for these needs and be able to be referred electronically to the right place, which will be supported by a network of community health workers. Community health workers are laypeople trained in general preventive health approaches and health behavior counseling, who can help make sure that people are able to get to these referrals, reduce barriers to getting there, and also understands how these things are important to improve their own health and wellbeing and their family’s health and wellbeing and can create connections among these organizations.

That’s one major component. Then in addition, we’re working to increase research infrastructure in the community as well as increase diversity of participants in research and create pipeline programs, so high school students growing up in this community are able to gain experiences to understand what science and research and healthcare can look like, and offer programs for them to be able to get into these fields to diversify them. Those are some of the things that we’re working on now, but I am kind of taking a systems approach to it, and also I’m planning to start using that type of group model building approach across clinical and community partners to be able to better understand how we can implement this type of intervention well within this complex community context in Sunset Park.

Teresa Chahine: It’s what you were saying earlier, like a strengths-based approach. What are the different assets in a community and who are the different stakeholders and how can you bring them together to strengthen the health of the collective? That’s part of systems thinking is understanding who the players are, what the assets are, and how you can make them play together differently. So this is a really great example and how anyone, no matter what institution you’re working in, you could ask yourself the questions a social entrepreneur asks themselves, like what is the problem that I want to solve for? What is the system around it and how am I best positioned to work with others to tackle that collectively?

Thank you so much, Brita, for taking the time to share your work with us today.

Brita Roy: My pleasure. Thank you.

Teresa Chahine: I am Teresa Chahine and you’ve been listening to Impact & Innovation. Subscribe to stay tuned and follow us at Teresa Chahine and SOM Ventures. Special thanks to the broadcast center at Yale School of Management.