Community Health Workers, a key lever in the Sustainable Community System Change Model pushing forward a structural change approach

Founded in 1998, First 5 Marin Children and Families Commission (F5M) works to assure that all children 0 – 5 years of age in Marin County, California thrive in supportive, nurturing and loving families, are healthy and enter school ready to succeed. F5M implements its Strategic Plan through a platform of four integrated initiatives: 1) school readiness (place-based efforts in 5 communities); 2) health (physical, oral, developmental, and social-emotional); 3) public policy ; and, 4) health advocacy/health literacy. The latter, referred to as HAHLI, implements F5M's emphasis on health promotion and education, preventive care, and community capacity building. It supports integration and coordination among organizations, programs and systems around health messages, understanding of health services and how and why to use them and reducing barriers to access for families Using a promotores/community conductor model, the community's capacity to care for/support its own members is multiplied.

As F5M's efforts mature, the focus on the participation of those often marginalized in the public policy discourse has increased. The Sustainable Community System Change (SCSC) model provides a framework for F5M to move deliberately through stages of system development and to identify critical levels of change (i.e., human capacity building, communication/networking /leadership) and indicators of progress moving along the continuum. HAHLI is expanding its role to include more upstream Public Health approaches engaging those most affected by the state of the current health care system. This will include relationships and connections with other issues reflecting a transition towards movement building and structural change.