C4 Innovations

Together in Recovery: Facilitating Collective Action and Systems Change in Massachusetts

An episode of “Changing the Conversation” podcast

Julie Burns and host Livia Davis discuss the process of bringing diverse perspectives together, breaking down barriers, exploring solutions, and moving forward for collective action to end the opioid epidemic in Massachusetts.

July 19, 2021


Livia Davis, Host: [00:05] Hello, and welcome to Changing the Conversation. My name is Livia Davis. I am the Chief Learning Officer at C4 Innovations. Today, I am joined by Julie Burns. Julie is the Executive Director of RIZE Massachusetts. Julie, could you just start by introducing yourself and a little bit about what RIZE does before we launch into a conversation about facilitating systems change.

Julie Burns, Guest: [00:30] Sure, Livia, and thanks for having me today. RIZE is a statewide independent nonprofit foundation that is focused solely on ending the opioid crisis in Massachusetts. We do our work in primarily three ways. We invest in community programs and give grants. We try to build the knowledge base by funding research and evaluation. And then we have found a really great niche as a neutral convener of bringing people together from all parts of the care continuum to talk about solutions to ending the opioid crisis.

Livia: [1:06] Thank you, Julie. We are having this podcast just in the first day of July, 2021. It is during a time where much of our country is continuing to reopen after closing down for over a year due to COVID-19. And it’s also after an incredibly difficult year for our country in terms of racial injustice and political unrest. And as an outcome of some of the events of 2020, we have started to see many communities come together to look at how to change systems, to improve access and outcomes for people experiencing substance use mental health and housing challenges. And especially for those of us who experience structural racism, discrimination, and trauma. Now you were engaged at RIZE Massachusetts in a process for system change well before 2020. In fact, you in 2019, launched a project called Together in Recovery. And to get us started, could you tell us why RIZE decided to launch Together in Recovery?

Julie: [2:09} Thanks for that great setup and context setting, which really does sort of explain the basis of Together in Recovery. RIZE by its very nature set up to end the opioid overdose epidemic, created a board or put together a board of directors that had people from across the care continuum. So we had people with lived experience, we have medical professionals, we have the leader of a union who serves healthcare professionals, the lower wage healthcare professionals. So we had very diverse viewpoints on our board. Working with the board and then working with the community we realized that there was a deep divide or there was a perception of a deep divide about different approaches to solving the opioid overdose epidemic that related primarily to different treatment pathways. This isn’t to say people felt that one way was right or one way was wrong, they just sort of came to the table with a perspective, institutional historical ingrained perspective about what might be the best way to approach it.

Julie: [3:12] So we thought it would be a really interesting project to take it head on, really try to call out what the divide was, try to get people talking to each other, talking with each other, to each other not at each other about how we could come together to solve what really feels like an intractable problem that needs every single voice at the table in order to make progress. So that’s how we came to it. And we knew that we needed a really strong facilitator and were thrilled to partner with C4 on getting the project off the ground.

Livia: [3:44] Thank you, Julie. We were also very happy and thrilled to be able to work with you as a partner on this incredibly important project. Could you share with our listeners why you felt it was important to engage with an outside contractor and facilitator for this work?

Julie: [4:01] Yeah, this definitely wasn’t the type of project we had… even if we wanted to do it internally, we didn’t have the bandwidth or the internal capacity to handle it. And I think this type of work is better done by an outside facilitator. What we found in C4, which was what we really wanted was not only a facilitator, but a partner. So a planning partner, a thought partner, and then obviously, a skilled facilitation team that was able to manage the project with all of the support that it needed.

Livia: [4:33] Then as we started to talk early on about this, we also started to think about, what would be some hope for outcomes? Could you just talk a few minutes about what you’re hoping the outcomes would be for this process?

Julie: [4:48] Yeah. We had a number of objectives. As I said, bringing people together, really finding space for the patient, or the client, or the person with lived experience in the conversation. Again, I’m going to use another analogy a second time, talking with people instead of at people, and just making sure that all perspectives were heard. And we could come up with a network of people who really believed that the patient does belong in the driver’s seat and that that’s going to be the best approach. So that was objective number one. Objective number two was try to advance evidence-based practices, evidence-informed, evidence-based in all of the meaning that’s there so that people had accurate information about different pathways to treatment.

Livia: [5:37] Thank you. So, early on in our work together, Julie, we talked a little bit about the need to focus on the process of this work. And sometimes it can be hard to make a commitment to a process that takes time—a year or more—to really give people the chance to meet each other, to understand each other, to find common ground, to have a space where they can actually ask each other questions, where they can challenge each other, if they don’t understand a certain viewpoint. And for us, that was a big part of the process, but it also can be something that is hard for systems, or leaders, or decision-makers to invest in. And now I’m wondering if you could talk a little bit about your agreement to invest in taking the time to hold the space to be conveners as you pointed out earlier.

Julie: [6:46] Yes, that was definitely a challenge not only from the staff perspective, but also from the board perspective, because this is a long-term project that actually is still going on. It’s in its second phase, but it’s still going on. And working with you, Livia and others at C4, I think we did have an agreement that we were going to trust the process. I almost laugh at how many times you told me to trust the process when I was getting frustrated that I didn’t feel like things were moving fast enough or we weren’t making enough progress, but we really were. And letting it play out the way that it needed to, I think we ended up with a better set of priorities at the end, much more trust and understanding among the participants involved, and our board really respects the process.

Julie: [7:35] So I think it was a great learning experience for all of us in different ways to really say that, if we’re going to do this, we have to commit to it fully. This isn’t a one-off kind of investment. We’re not doing it for show. Parts of it may not be pretty, may not be bumpy, may not be great to talk about, but we were all in for the ride. And I think that was really important to have that agreement with you upfront and really understand what we were undertaking.

Livia: [8:02] I agree. And of course, I think a lot of the elements for this process, just to name a few, it was important for us as the outside consultant to work with you as the funder to really kind of say, “Okay, what works? What doesn’t work? Why is this element important? Why we may not be able to do it, or how can we support it?” Right? So the initial element in one of the facilitated dialogues we use, of course, is to get to know the people who will represent all the stakeholders in Massachusetts that are supporting people with a substance use disorder. And in part of that process, we got to have a lot of one-on-one calls with folks that ultimately became part of a change team. And this change team was another important element to really help to make sure that you got throughout the process from people who represented all stakeholders.

Livia: [9:00] And getting them together in a meeting on a regular basis to really understand each other and their constituencies was important, in addition to the hosting regional meetings and a statewide convening to really hear from all parts of Massachusetts, to gather the input from the community to really make sure that, like you said earlier, all the voices are at the table and heard, and that you’ll look at making sure that the information is not only captured, but is then also vetted and that you arrive through that process at some priorities, for recommendation to you as the funder.

Livia: [9:42] And through all those elements, building the trust and building some wins early on for the change team was important as they started to really make sure that all their concerns were heard as well. From your point as a funder, I’m wondering if you could talk a little bit about some of the pros and cons of having the funder at the table at some of these conversations.

Julie: [10:13] That’s a really great question, and it was something that we thought about a lot. I think we at RIZE thought a lot about it before we fully kicked off the project. And it’s something that you and I talked a lot about, about the best way for the funder to be involved. I think the beauty of what we were able to create together was there was just a real sense of equality in a level playing field. And in most cases, not all conversations and not at all times, it really felt like I was just me, you were just you, and everybody at the table was bringing their own perspective and information, and there was no hierarchy involved in the change team at all. And there are so many bright moments, but we had people who were very early in their career sitting next to people who have been at this for 30-35 years.

Julie: [11:08] And like I said, no hierarchy at all. Everybody was equal. Everybody had an opportunity to talk. And Livia, I think you always did a great job making sure that the power balance was not off kilter in any way. So I think that was really great. And then obviously, there were times that as the funder, we shouldn’t have been in the room. And that is something that you and I always agreed to, we discussed it. Because for people to be totally honest, somebody who’s holding the money and that sort of does create a little bit of a power imbalance shouldn’t be part of the conversation. And while that at times was hard for me, because I felt like I wanted to understand what was going on, I took your advice and stepped out when I needed to. And again, I think it made the project better at the end.

Livia: [11:54] Yeah. I just really appreciated your openness. And I think you’re right, I think such an important part of the success of Together in Recovery was yours and my ability to really form a relationship and understand how did we best work together for the greater good, really to support the process and the hoped for outcomes. And as facilitator, you’re right, it’s always about how do you support each group of people to become a team and then step back? How do you create that space? And sometimes it really certainly is addressing the power differential and making sure that elevating the voices of those who most often are not at the table to make decisions. And that can be hard for folks who are not used to being in those kinds of positions. So I know we also took time and care to say, “How do we support that? How do we support those folks?”

Livia: [12:54] I know additional kind of steps we’re taking to make sure that not only did we identify local champions, but we identified people who could really be a bridge between the project sometimes, and the constituency we are trying to involve in order to come up with not only defining the problem, but designing the solutions and co-creating them together. So I really appreciate that. And again, as the facilitator of this process, I want to make sure our listeners know that there was a lot of learning on my part as well, which is always what happens in these community processes, when you start from the community, you involve the community, you can’t help but learn because there’s so much wisdom. And the core of this work is actually evoking what’s already in the community, what’s in the minds and hearts of the stakeholders and helping them figuring out how do we take a collective action?

Livia: [13:50] How do we move ahead together? And remembering why you’re in this work. So we spent quite a bit of time on that as well. And I know for some of our participants, one of the criticism I got early on, they’re like, “Livia, you’re a social worker. There’s too much social work and touchy-feely stuff here. Can we just get to taking action?” And knowing the balance between needing to move forward and investing in the process was something you and I talked about all the time. And I think that’s just an important component for anyone else who wishes to undertake such a process. So talking about that just for a minute, I’m wondering also you and I talked about the dangers of reverse engineering. Could you talk a little bit about that?

Julie: [14:42] Yes. But before I do that, I just want to touch on what you just said about being a social worker and too touchy-feely. I think that was the secret sauce. And I don’t think you were too touchy-feely, and I think your skills as a facilitator and letting people sit in silence, which really sometimes stresses people out, including me. I’d be like, “Somebody say something,” but I think you allowed the silence to drive or to encourage, bring forward, lift up voices for people who had we moved at a faster pace would have definitely been left out of the conversation. So I think that was a benefit, a huge benefit of your facilitation in the project. And then in terms of reverse engineering, as a funder and also as somebody who comes out of government, having a process that doesn’t have a clear ending or a clear outcome is really kind of nerve-racking.

Julie: [15:47] And you and I discussed it as you said many times, probably more times than you care to, but for me it was good, just to say, “We had to trust the process.” This project is going to go where it’s going to go. It needs to be led by the people who are on the change team and the voices that we’re hearing from the community. It can’t be driven from the grass tops, funder, like I know everything, I know where this needs to end up. We really just had to let it unfold. And I think recognizing that in the beginning and then committing to it and having a partner who can keep reminding you that you committed to it along the way, it was just a huge piece of this project.

Livia: [16:27] I agree. Thank you. The other thing that I really appreciated early on was RIZE’s commitment to really center the lived experience of people who would be most impacted by any of the solutions or collective action coming out. And we led all our regional meetings and statewide convening with a panel of people with a lived experience who could really share with the audience how policies or funding impact their lives and how, of course, program and interventions, and harm reduction, prevention, recovery, and choices, and pathways really impact their lives, which was such an important part of this also for the change team and the stakeholders to remember their decisions and the impact of decisions and remembering the person at the center as you were talking about earlier. So I’m just wondering if you have anything you want to say around the commitment to that piece early on from RIZE’s point of view and how it shaped the outcome?

Julie: [17:36] One of our values that we agreed to when RIZE was being created, so when we were still on the drawing board, was an absolute commitment to having people with lived experience in all of our teams, in all of our projects. We have people on our board who have lived experience. Whenever we’re considering a project or an investment, we have grant review teams that include people with lived experience. So this is really in our DNA. So it was easy to bring it to this project, but I will say the folks who were involved in Together in Recovery are part of the RIZE family.

Julie: [18:17] I rely on them so much for things outside of this project, but we’ve really formed bonds, and I believe that we have a level of trust that we are an honest broker, that we do appreciate, listen to and value them. And like I said, we rely on them for just about everything. I feel like I call on the folks from the change team more than I talk to some members of my board of directors, because they’re on the ground, they know what’s happening. And I would never want to think that we would launch a grant program or any other type of intervention or commitment without having that level of expertise guide us.

Livia: [18:58] Agreed. I think also why you’re having such a profound impact in Massachusetts. So thank you for that. You know we share the same philosophy and value at C4. So I’m wondering also for other communities or states who may be interested or considering doing this kind of facilitated community process, why should they do it in your mind? What do you think would be good reasons, benefits and also what are some lessons learned?

Julie: [19:28] Well, I think in probably almost all situations, the benefit is going to outweigh the risk. Right? So even if you don’t get to if you have an objective or you have a desired outcome and you don’t get there, the process itself to me is as valuable as the outcome. So all of the relationships were built, all of the conversations that were had, all of the new shared understandings, as we said, the aha moments along the way, the opportunity for people to be at tables, in rooms, in conversations with people they might not normally get the chance to interface with. I think I would say, “Do it, no matter what, and then get a strong partner, a strong facilitator, really be clear upfront about what the process is going to look like and what you can commit to and what you can’t commit to.” And I would say, “Go for it,” because this process, I think this is probably the most impactful program that RIZE has done. It’s not the highest cost, it’s not the most influential maybe, but it’s the most impactful for sure.

Livia: [20:37] Well, that’s fantastic. Thank you, Julie. In terms of making sure that we can bring to light some of the benefits of this process, I wonder if we could share just a couple of examples of aha moments of sharing perspectives that really helped to build trust and gain understanding between the stakeholders on the change team.

Julie: [21:02] There are so many aha moments, I hate to even pick one. I’m going to give one, but Livia, I think you actually have the best one, and then I’m going to turn it to you. One moment that was particularly profound for me was at one of the regional meetings. I think it was in Southeast Massachusetts, where we were at work tables, work groups and there was a recovery coach who was working at a CBO and a nurse who was at a local hospital. And they started to talk about induction on medication for opioid use disorder. And the recovery coach was saying, “I can never get people in. I don’t know where to turn. I don’t know what to do.” And the nurse looks at her and says, “Are you kidding me? I can get people in same day.”

Julie: [21:44] Now, these two people were literally working less than a mile away from each other, and they didn’t know that the services that they both had and combined they can really provide tremendous care for people. And they both got so jazzed, they got so excited, they switched their emails, they switched their phones, they promised to keep in touch. So that was exciting, on the ground moment in the community. But I think at a higher level, Livia, I think you actually have a really good example of how perceptions were changed.

Livia: [22:16] We were in a smaller meeting, and this was between prescribers of medication and recovery housing operators in this instance where a recovery housing operator was saying to the prescriber, “There’s a reason we can’t always serve people in recovery housing who are on medications. And one of the reasons is that folks, they nod off sometimes in the living rooms, in the recovery homes and that really can be a trigger for other people in that recovery environment.” And the prescriber then kind of leaned back and then leaned in over at the table and said, “Well, wait a minute, we don’t want a person nodding off on medication either and that means that the person’s dose needs to be adjusted. Is there a way for us to connect because we want the same thing. We want that person to have the best shot, the best chance of being in recovery.

Livia: [23:16] And sometimes it takes a while for the medication to be adjusted accordingly.” And the recovery housing operator, you could see the light kind of go off and their eyes going, “Oh, so it really means we need to pick up the phone and call each other because we are concerned about that person in that situation the same way you are. We may come at it from different perspectives and reasons, but we are on the same page.” So that was a huge aha moment to really … it lets a community based organization have some insight into what goes on in the mind of a prescriber of medication and vice versa and finding some common ground.

Livia: [23:56] And then just as an example of the power of the process to break down barriers and give people an opportunity to actually explore conflict, to have it become constructive conflict rather than destructive conflict, getting people together who may publicly have not seen eye to eye and may have pushed each other either in the media, or in regards to the pathway or the setting that they’re working in, getting them together at a table and getting to know each other as persons and, really figuring out how can we work together and how can we commit to that?

Livia: [24:35] One of the quotes that came out of one of those meetings was, “It is hard to hate up close,” and that really speaks to the power of us connecting as human beings and remembering first, that we are humans, that we are in this field for a reason. And if we can remember our why and making those connections, then it can be much easier to figure out, where do we disagree? Where do we have common ground? And regardless, how do we move forward together for collective action for the purposes of supporting people that we all care about? Julie, it has been such a pleasure to get to know you and work with you and your team and with RIZE Massachusetts. I’ve learned so much, and I so very much appreciate you being on this podcast today.

Julie: [25:27] Thank you, Livia, and the feeling is mutual. I think we, myself and the team at RIZE, have learned so much from you and your team. It’s just been tremendously positive experience. And I hope that you and I will be working together for a very long time.

Livia: [25:41] Indeed. And to our listeners, please join us next time on Changing the Conversation.

Erika Simon, Producer: [25:47] Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact. Thank you for joining us. This episode was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.


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