Strengthening Collaboration Between Community-Based Organizations, State Title V Agencies, and Funders by Uplifting Community-Rooted Evidence: A Qualitative Research Study

What is considered ‘evidence’ in maternal and child health (MCH) has major implications for which organizations and initiatives receive funding. Despite growing recognition of the importance of community-rooted work, state and jurisdictional MCH agencies, (Title V) operate from an evidence framework that typically prioritizes empirical research and large-scale evaluations over community-rooted evidence (CRE). This study sought to examine how CRE informs decision-making within Title V agencies, understand capacity-building needs of community-based organizations (CBOs), and explore strengthening relationships between CBOs and Title V. This qualitative study interviewed Title V and CBO staff to explore current CRE perceptions and funder/CBO relationships. 16 CBO and 11 Title V staff participated in compensated interviews from February to July 2024. Interviews were conducted, transcribed, coded, and analyzed using a thematic analysis approach. CBO interviewees stressed the need to reimagine misaligned funder and CBO relationships to be rooted in trust, allow CBOs agency to define metrics of success for their work, recognize the credibility of CRE including qualitative data and storytelling, and introduce more flexibility into funding opportunities and reporting structures. Title V respondents expressed capacity building needs around how to operationalize CRE in their work and decision-making practices, as well as build CBO capacity. Funders including Title V can support tailored, innovative, and community-driven solutions to MCH challenges through uplifting CRE in evidence frameworks, investing in trust-based relationships with CBOs, and supporting CBO capacity building. Recommendations for how Title V can operationalize CRE in their work are also provided. The findings of this study reinforce trends in the behavioral health, child welfare, and tribal health fields that have recognized the validity and importance of CRE in demonstrating an initiative’s impact, cultural appropriateness, and alignment with community preferences. State agencies, like Title V, can uplift and value CRE when considering the evidence informing funding decisions to create opportunities for state and federal investments in community-rooted solutions. This work also emphasizes the opportunity for Title V to reimagine relationships with funded CBOs in accordance with trust-based accountability principles to establish more symbiotic, collaborative, and innovative partnerships.