November 18, 2022
Alaska Department of Health and Social Services

Introduction

The report Public Health Forward: Modernizing the U.S. Public Health System calls on public health leaders to compensate community members and community-based organizations for their time and expertise provided to health departments. Authentic community engagement in public health program planning and implementation is a central practice for advancing health equity, but relying on community members to volunteer their time for this work — while everyone else in the room is being paid — perpetuates inequities. Residents deserve consistent monetary compensation for the expertise they provide to public health departments.

Context

The Youth Alliance for a Healthier Alaska (YAHA) is in its 14th year. YAHA advisors, youth between 14 to 21 years of age from across the state, are selected on a competitive basis for one-year, renewable terms to advise the Alaska Department of Health’s Adolescent Health Program. These youth advisors are compensated for their time to participate in an orientation and training sessions to kick-off their tenure and routine YAHA activities, including program strategy development and providing feedback for evaluation purposes. When the program started in the 2000s, the focus was on teen pregnancy prevention and violence prevention — the two priority issues at the time for Alaska’s youth. Over time, YAHA’s scope grew, so members now also advise on all youth programming in the health department and serve as a resource for other youth-serving agencies.

Key Actions

Provide compelling justification.

To promote decisionmaker buy-in, provide data that clearly describes the problem that this practice will address and supports the practice of compensating people with lived experience who inform public health programming.

YAHA’s initial efforts were directly tied to the Temporary Assistance for Needy Families’ (TANF) goal to reduce the portion of births among unmarried mothers. Compensating youth also supported TANF’s “Work-First” approach by providing job experience that could serve as a steppingstone to self-sufficiency.

In general:
  • This practice promotes equity.
  • Incentives may be necessary for people with some types of lived experience (e.g., those who are low income and/or facing transportation barriers, unstable housing, or food insecurity) to participate.
For adolescents, it can be helpful to note:
  • Equitable compensation can facilitate youth pursuit of higher education, since many youths cannot access the income needed for a college education or they secure loans that leave them steeped in debt upon graduation.
  • This practice provides good experience that will assist youth with obtaining a job in the future.
  • Youth may be more likely to enter the field of public health after participating in public health efforts.
  • Mental health among adolescents is a growing concern across the country, and this practice helps youth internalize their own value and self-esteem while they are getting paid for their time and expertise.
  • This is a best practice to promote equity.

Use updated data, program evaluation results, quotes from participants (e.g., responses to “How does compensation impact your ability to participate?”), and other information that supports the benefits of this practice.

  • Determine the nature and definition of the reimbursable and contractual relationship between the health department and the community member, e.g., advisors, partners, consultants.
    • YAHA’s youth advisors are categorized either as community partners or youth consultants, depending on the funding source and their program expertise.
  • Research allowable forms and limitations of compensation and be specific with the language, e.g., to pay, to incentivize, to stipend, to reimburse, to “make whole.”
  • Specify the processes involved with the compensation, e.g., pay or reimburse for travel, per diem, ground transportation to/from meetings.
  • With youth, work with the school for service-learning credit if available.
  • Decide the amounts of reimbursement.
    • YAHA members are paid a variable wage depending on the scope of work. Historically the range has been $13-$20/hour, and in 2022 it is $15/hour. The initial amount was determined after consulting with other adolescent health coordinators across the country. YAHA now refers to Partnering with Youth Families in Research: A Standard of Compensation for Youth and Family Partners, a body of work recognized by the Association of Maternal and Child Health as an emerging best practice.
  • Identify the level(s) of approval that these purchases require (i.e., division level, department level, or gubernatorial level).
  • Establish guiding principles to help steer decision making for the practice. For example, YAHA staff adopted “nothing about us without us” from the disability advocacy movement and committed to “adhering to national best practices on supporting, resourcing, and incentivizing constituents for their time and energy at a fair, equitable, and competitive rate.”

YAHA uses a formalized, competitive process that requires an application form and interview process and seeks representation from each Public Health region of Alaska.

  • Funding sources may change their expectations or limitations around what is permissible compensation.
  • State statutes and regulations revisions may affect compensation practices.

Recommendations

Workforce

Dedicate sufficient staff time.

Dedicate sufficient staff time to coordinating the work of compensated community members and ensuring that they receive compensation in a timely manner.

Financial

Thoroughly research funding specifications.

Available funds can vary widely in terms of whether they can be used for incentives, honoraria, stipends, or other forms of compensation and how they are tracked.

  • YAHA initially was funded by the Alaska Temporary Assistance Program (supported by TANF) in support of its goal to reduce the portion of births to unwed mothers. Other funding for incentives has come from Maternal Child Health Title Five Block Grant Funding and various partner agencies. The health department also has contracted with other youth entities to coordinate payments when internal governmental structures and leadership have not been supportive of youth compensation.

The allowable use of funds for compensation can change based on state statute as well as funder requirements. Therefore, it is critical to keep abreast of the impact of these issues on your compensation practices.

Policy

Develop an internal policy to institutionalize the practice.
  • Compensation for YAHA advisors is a long-term practice reflected in a health department internal policy to engage people from the target population in program planning.
  • Similarly, in Missouri, standard contract language of the Adolescent Health Program for contractors working with youth advisors states, “the contractor shall ensure youth are adequately compensated for sharing their time and expertise. Youth compensation should be comparable to compensation of other adults working in similar roles.”

Anticipated Impacts For Public Health Departments

Health

Including the perspective of people with lived experience in public health program design greatly increases the likelihood that program strategies will be effective and equitable at the outset.

Compensating community members for their time promotes health equity by incorporating the voices of community members in public health programming, building public health knowledge and power within communities, and ensuring that all community members — regardless of socioeconomic status — have the opportunity to participate. In some instances, this type of compensation also infuses much-needed financial support into historically marginalized and oppressed communities.

Potential Challenges To Implementation

Resistance to compensation as a practice.
  • In general, decisionmakers may be reluctant to adopt this practice, underscoring the impact and importance of time and effort spent on justification efforts such as those described above.
  • For adolescents in particular, potential challenges include the following:
    • Statutes limiting the incentivization and provision of stipends to minors or if they are under the age of 15 and not legally allowed to work.
    • Collection of private information needed for compensation, like a W-9, as it could impact their subsidized insurance or benefits.
    • Ageism and the belief that youth should “pay their dues” before they are income-earning adults.

Therefore, it is critical to communicate with new administrations about the importance of and best practices around providing stipends and incentives for community members’ support of public health programming if this practice is not backed by statute.

Availability of funding can also present a challenge, both with respect to having sufficient funds as well as limitations on the way they can be used. You may need to dedicate staff time to seeking grant opportunities that will specifically support this practice on an ongoing basis.

Sustainability

Embedding this practice in program plans year after year helps to solidify this strategy.

This is especially important in the early years to set expectations and generate momentum about the importance of this practice.

This not only minimizes your administrative burden but also can help attract community members who may otherwise be wary of providing personal information.

More evidence is likely to further support and yield improvements for this practice.

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