Since its inception, Human Options has worked to ensure that Orange County's most marginalized, under-served, high-risk populations have access to domestic violence services. Last year, the Board and CEO launched a new cycle of strategic planning, using an evidence-based strategic planning process called Theory of Change (TOC). TOC is highly compatible with a health equity approach to domestic violence because it grounds problem analysis and solution building in an understanding of the social determinants and contextual factors that either contribute to a social problem or prevent it. The TOC also requires planners to understand and center the complexity of the lived experiences of people impacted by domestic violence. Solutions and strategies generated from centering those most impacted, especially our most marginalized families and communities, are more likely to be socially relevant, valued, and impactful. The TOC process also involves re-examining assumptions. For instance, many approaches to domestic violence are built on an assumption that most victims of domestic violence want to separate from their abusive partner. Additionally, service providers often assume that domestic violence can be addressed independently from other issues, such as substance abuse, homelessness, child abuse, community violence, poverty, and discrimination. Listening to communities and families most impacted by domestic violence, it becomes clear that not all families want to separate. Furthermore, typically families struggle with multiple problems at the same time, and community factors, such as violent crime and discrimination, greatly impact their ability to thrive. Therefore, comprehensive support requires developing whole-family solutions and effective treatment for people who harm family members. A family-centered, community-centered approach also requires us to address intersecting issues, structural inequality, and community-level healing.

To date, the work we have done is highly compatible with a health equity approach. Yet the expansiveness of an equity framework opens additional opportunities for increased cross-sector work to collectively impact intersecting issues that adversely affect marginalized communities and increase their vulnerability to family violence. For instance, the six community-level determinants of health and safety outcomes identified by the World Health Organization—harmful norms and culture, weak social networks and trust, weak community sanctions against domestic violence, harmful media and marketing practices, housing insecurity, and income insecurity—represent actionable places where we can promote equity in health and safety outcomes in Orange County. To more fully implement a health equity approach, last year we embarked on an intensive strategic planning process that included the development of a “theory of change. " Our theory of change identifies root causes of domestic violence and proposes strategies to address them. The strategies in our theory of change are informed by local and national contextual factors, community assets, and evidence; they are designed to achieve positive outcomes for individuals, families, communities, and networks. Using our theory of change as a foundation, we will continue to refine our approach to more effectively achieve our mission. In addition, changing client needs continually influence our programs. For instance, last year, two deaf clients presented for services at the Santa Ana family resource center. This catalyzed a partnership with LifeSigns, an agency that provides ASL interpretation, which resulted in the provision of legal advocacy and PEP groups being provided in ASL through an interpreter. Similarly, our partnership with Cambodian Family, an organization that provides services to a largely monolingual Cambodian community, allows us to provide PEP classes in Cambodian through a translator, on location at Cambodian Family. Currently, plans are in the works to develop a counseling group curriculum for male victims of domestic violence and a second level of Parenting classes, again based on needs brought forth from clients.

Framing domestic violence within a health equity model is new and unfamiliar to some of our stakeholders. To build our capacity to apply a health equity framework, we need to fully understand it, articulate it, and engage in constructive discourse about it with other people to engage them and inspire them to be a part of this work. For example, many of our stakeholders view of domestic violence as an individual-level problem with a single solution—helping victims escape. As our TOC framework leads us to expand our approach to include strategies such as whole family services and community healing, we need to be able to persuade stakeholders to understand the benefits of these new strategies. Our Board and CEO are also accessing additional resources to improve agency capacity to apply an equity lens. Our CEO and our Board President recently completed the Annenberg Alchemy Leadership seminar. They both plan to attend the second phase of this program, Alchemy Plus, which includes a focus on diversity, equity and inclusion. In addition, Human Options uses a variety of formal and informal methods to involve clients and constituents in our work. The Residential Program has Resident Councils made up of current clients who share their experiences, perceptions, and suggestions to improve our shelter and transitional housing programs. Human Options' family resource center-based programs in Santa Ana and Costa Mesa use Community Engagement Advisory Committees comprised of former clients, community members, and local business representatives who want to give back to their community. Similarly, our Teen Ambassador Program provides teens with leadership skills training and mentoring to equip them to serve their communities as active bystanders against dating violence.

Each of our direct service programs uses program-specific pre and post measures to assess impact. Our counseling program assesses anxiety and depression, our children's program measures parenting skills and parent observations of child progress, our youth program measures knowledge of teen dating violence and healthy relationship skills, and our legal advocacy program assesses participants' knowledge of legal rights and ability to use the legal system to protect themselves from abuse. Satisfaction surveys are provided to all clients. For people exiting residential programs, their next living situation (e. g. , transitional housing, permanent housing) is tracked. For community-level projects such as awareness campaigns, the number of schools and communities that participate in elements of the campaign is tracked. We also track client demographics, such as race/ethnicity, gender identity, and income level, to ensure that those who most need assistance are accessing our services.

In order to more effectively break the cycle of domestic violence, Human Options must continue to remove the barriers that Orange County's most marginalized, under-served victims face, including poverty, discrimination, unemployment, and lack of affordable healthcare, mental health services, childcare, and educational opportunities. In doing this work, it will be important to explore new territory, including collective impact strategies, cross-sector partnerships, and community-level healing strategies. We are mid-way through a five-phase strategic planning process that will help us map out the best ways to engage in this work. To date, we have: 1) completed a strategic planning project management plan; 2) created a TOC framework that describes the problem to be solved, contextual factors that contribute to the problem, and strategies to address the problem; and 3) begun the process of assessing the health of the organization and its programs while exploring contextual factors and current program capacity. Support is needed to complete the remaining two planning phases, which involve developing draft work plans around each prioritized strategy, creating management and monitoring tools, and devoting time annually to reviewing progress and adjusting the planning process as needed.