Coalition Building In Real Communities Virginia Health Equity Conference, September 11, 2009 Amy Paulson Consortium for Infant & Child Health Eastern Virginia Medical School

Describe community-based participatory approaches & application in communities Differentiate between coalition approach & other types of partnership approaches Explain challenges & benefits of coalition building in real world Discuss impact of individual & community factors on coalition building

Describe community-based participatory approaches & application in communities

Differentiate between coalition approach & other types of partnership approaches

Explain challenges & benefits of coalition building in real world

Discuss impact of individual & community factors on coalition building

Sometimes…well, usually… Not every one will want the community to have an equal voice though Source: http://baloocartoons.files.wordpress.com/2008/09/1obama_community_organizer_243585.jpg

Sometimes…well, usually…

Not every one will want the community to have an equal voice though

Equal partnership b/t “trained experts” & members of community in working on community health problems Community-based participatory research is a "collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities." ~ WK Kellogg Foundation Community Health Scholars Program

Equal partnership b/t “trained experts” & members of community in working on community health problems

Community-based participatory research is a "collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities."

~ WK Kellogg Foundation Community Health Scholars Program

Recognizes community as unit of identity Builds on strengths & resources of community Facilitates collaborative, equitable partnerships, learning, & capacity building throughout process Emphasizes local relevance of public health problems and ecological perspectives that recognize the multiple determinants of health Disseminates and involves all partners in findings & knowledge gained Includes a long term process and focus on systems development Source: Israel, et al (2003), Community-Based Participatory Research for Health

Recognizes community as unit of identity

Builds on strengths & resources of community

Facilitates collaborative, equitable partnerships, learning, & capacity building throughout process

Emphasizes local relevance of public health problems and ecological perspectives that recognize the multiple determinants of health

Disseminates and involves all partners in findings & knowledge gained

Includes a long term process and focus on systems development

Involve the community in all phases Shared responsibility & ownership Action oriented Community-focused & relevant Tangible outcomes Development of knowledge linked to action, change, or advocacy Recognize that EVERYONE has something to give to the process

Involve the community in all phases

Shared responsibility & ownership

Action oriented

Community-focused & relevant

Tangible outcomes

Development of knowledge linked to action, change, or advocacy

Recognize that EVERYONE has something to give to the process

Parachute Research without action Research without involvement of priority populations Research without community benefit Hold power with researchers

Parachute

Research without action

Research without involvement of priority populations

Research without community benefit

Hold power with researchers

Enhances relevance & use of data, & quality/validity of research Strengthens intervention design & implementation Joins partners with diverse expertise to address complex problems Increases possibility of overcoming community’s distrust Knowledge & interventions benefit community

Enhances relevance & use of data, & quality/validity of research

Strengthens intervention design & implementation

Joins partners with diverse expertise to address complex problems

Increases possibility of overcoming community’s distrust

Knowledge & interventions benefit community

Increases trust & bridges cultural gaps Provides resources for involved communities Translation of findings to guide future interventions and policy change Source: Israel, et al (March 2006), Presentation on “ Community-Academic Partnerships: Principles, Rationale, Challenges & Facilitating Factors ” at Beyond Description: Addressing Health Disparities through Campus-Community Partnerships conference

Increases trust & bridges cultural gaps

Provides resources for involved communities

Translation of findings to guide future interventions and policy change

Historical context Cultural respect & trust building Identifying & overcoming obstacles Power exchange Differing agendas Personalities

Historical context

Cultural respect & trust building

Identifying & overcoming obstacles

Power exchange

Differing agendas

Personalities

Coalitions bring people together Coalitions negotiate through agendas, personalities, and competing interests Coalitions can be used to successfully move forward CBPA Coalitions respect & utilize the key principles of CPBA

Coalitions bring people together

Coalitions negotiate through agendas, personalities, and competing interests

Coalitions can be used to successfully move forward CBPA

Coalitions respect & utilize the key principles of CPBA

Union of people & organizations working to influence outcomes on specific problem “Organization of Organizations” united around common issue & clear goals Group of concerned citizens &/or organizations working together to facilitate community change

Union of people & organizations working to influence outcomes on specific problem

“Organization of Organizations” united around common issue & clear goals

Group of concerned citizens &/or organizations working together to facilitate community change

People with common interest Purpose is specific, yet inclusive It’s about systems change Diverse groups combining resources to create change Usually has formal structure, but doesn’t always start that way Has a lifecycle – like a business

People with common interest

Purpose is specific, yet inclusive

It’s about systems change

Diverse groups combining resources to create change

Usually has formal structure, but doesn’t always start that way

Has a lifecycle – like a business

Community investment creates action It’s about systems & policy change Diverse groups combining resource Usually impacts populations not “just individuals” Theory & literature supports coalition approaches! Best outcomes with evidence-based approaches

Community investment creates action

It’s about systems & policy change

Diverse groups combining resource

Usually impacts populations not “just individuals”

Theory & literature supports coalition approaches!

Best outcomes with evidence-based approaches

Are not usually coalitions Sometimes have unequal power More limited community involvement Predetermined agenda Limited shared decision making Appointed memberships as opposed to open Usually time limited & action oriented to detriment of community involvement Can accomplish many of same goals – often look & function a lot like coalitions

Are not usually coalitions

Sometimes have unequal power

More limited community involvement

Predetermined agenda

Limited shared decision making

Appointed memberships as opposed to open

Usually time limited & action oriented to detriment of community involvement

Can accomplish many of same goals – often look & function a lot like coalitions

Time involved Action directed – usually – by majority or consensus Success often tied to effective leadership Success can sometimes happen DESPITE ineffective leadership Members MUST be invested

Time involved

Action directed – usually – by majority or consensus

Success often tied to effective leadership

Success can sometimes happen DESPITE ineffective leadership

Members MUST be invested

Strength in numbers – unified voice Bigger reach Resources Increased variety Sharing conserves & increases Diversity in experience & expertise Credibility & trust "The achievements of an organization are the result of the combined effort of each individual." Vincent T. Lombardi

Strength in numbers – unified voice

Bigger reach

Resources

Increased variety

Sharing conserves & increases

Diversity in experience & expertise

Credibility & trust

"The achievements of an organization are the result of the combined effort of each individual." Vincent T. Lombardi

Lack of direction or focus Turf battles & competition History Failure to plan &/or act Dominance by professionals Poor links to the community Minimal organizational capacity

Lack of direction or focus

Turf battles & competition

History

Failure to plan &/or act

Dominance by professionals

Poor links to the community

Minimal organizational capacity

Funding - too much or too little Failure to develop, maintain, rotate leadership Unequal sharing of responsibility & decision-making Time & loyalty conflicts Lack of on-going staff/member training Burnout or unrealistic demands on members/staff Source: Butterfoss, 1995; Kaye & Wolfe, 1995 .

Funding - too much or too little

Failure to develop, maintain, rotate leadership

Unequal sharing of responsibility & decision-making

Time & loyalty conflicts

Lack of on-going staff/member training

Burnout or unrealistic demands on members/staff

Source: http://www.metacafe.com/watch/66347/cat_herding/

Don’t feel included Disagree with leadership style Group personality Group productivity Conflict with individuals within group

Don’t feel included

Disagree with leadership style

Group personality

Group productivity

Conflict with individuals within group

Feel included Are making contribution to group Feel comfortable with group personality, leadership, & members Feel group is accomplishing goals Group meets personal need

Feel included

Are making contribution to group

Feel comfortable with group personality, leadership, & members

Feel group is accomplishing goals

Group meets personal need

Competition Collaboration Individual change System change Owned Shared Institutional focus Community focus Paternalistic Consensus

Competition Collaboration

Individual change System change

Owned Shared

Institutional focus Community focus

Paternalistic Consensus

Change is uncomfortable People like status quo Change isn’t a priority/hot topic Multiple priorities Changing too little to impact Changing too much at once

Change is uncomfortable

People like status quo

Change isn’t a priority/hot topic

Multiple priorities

Changing too little to impact

Changing too much at once

Synergy – The “Right”…. Partners Leaders Resources Strength in numbers Approach – realistic & “doable” Topic (timely & relevant to community) Program/intervention Systems or behavior change OUTCOMES

Synergy – The “Right”….

Partners

Leaders

Resources

Strength in numbers

Approach – realistic & “doable”

Topic (timely & relevant to community)

Program/intervention

Systems or behavior change

OUTCOMES

Need a “rallying cry” Actions contrary to progress Community ready for change Problem is significant It’s the right thing to do

Need a “rallying cry”

Actions contrary to progress

Community ready for change

Problem is significant

It’s the right thing to do

Individuals Groups Organizations Systems/Policy

Individuals

Groups

Organizations

Systems/Policy

Personalities Behaviors Misunderstandings Different perspectives They don’t do what you want them to do! It really would be EASIER if we could do public health without PEOPLE! But, we can’t….so…

Personalities

Behaviors

Misunderstandings

Different perspectives

They don’t do what you want them to do!

It really would be EASIER if we could do public health without PEOPLE!

But, we can’t….so…

The member who wouldn’t shut up The member who was crazy The member who wanted to be in charge, but wasn’t The leader who wasn’t leading The member who never says anything The member who thinks all ideas are bad The member that wanted to get paid

The member who wouldn’t shut up

The member who was crazy

The member who wanted to be in charge, but wasn’t

The leader who wasn’t leading

The member who never says anything

The member who thinks all ideas are bad

The member that wanted to get paid

Coalition experiences are people intensive Personalities make or break coalitions People leave or stay based on dynamics Healthy dynamics promote good outcomes Healthy dynamics produce lasting partnerships

Coalition experiences are people intensive

Personalities make or break coalitions

People leave or stay based on dynamics

Healthy dynamics promote good outcomes

Healthy dynamics produce lasting partnerships

Members must understand role Members must understand mission Unfulfilled expectations can impact experience & dynamics Misunderstanding expectations can lead to disruptive group interactions

Members must understand role

Members must understand mission

Unfulfilled expectations can impact experience & dynamics

Misunderstanding expectations can lead to disruptive group interactions

Recruitment Referral Resource development, distribution & access Networking Collaboration for access to populations, funds, services, or resources

Recruitment

Referral

Resource development, distribution & access

Networking

Collaboration for access to populations, funds, services, or resources

Advocacy Systems Change Resource identification, development, dissemination Gaps in service/education Tasks needing collaboration or agreement among partners Communication campaigns – public awareness

Advocacy

Systems Change

Resource identification, development, dissemination

Gaps in service/education

Tasks needing collaboration or agreement among partners

Communication campaigns – public awareness

Understand all members will not participate at same level Individual participation may fluctuate Members with lower levels of participation may be specialists, gatekeepers, or people with influence or power who are helpful when asked Shifting membership WILL impact dynamics Goal: Move Members to “Core”

Understand all members will not participate at same level

Individual participation may fluctuate

Members with lower levels of participation may be specialists, gatekeepers, or people with influence or power who are helpful when asked

Shifting membership WILL impact dynamics

Goal: Move Members to “Core”

2nd Tier Members Attend “somewhat” regularly Variable level of participation Interested in group outcome Decreased sense of personal responsibility for group actions Less likely to volunteer for tasks Core Members Regular Attendance High level of participation Invested in Group outcome Feels personally responsible for group actions Likely to take on tasks Members enter group at different levels, many fluctuate between levels 3rd Tier Members Variable/ Unreliable attendance Low level of participation Low interest in outcome No sense of personal responsibility for group actions Unlikely to volunteer for tasks Sometimes Gatekeepers!

2nd Tier Members

Attend “somewhat” regularly

Variable level of participation

Interested in group outcome

Decreased sense of personal

responsibility for group actions

Less likely to volunteer for tasks

Core Members

Regular Attendance

High level of participation

Invested in Group outcome

Feels personally responsible

for group actions

Likely to take on tasks

3rd Tier Members

Variable/ Unreliable attendance

Low level of participation

Low interest in outcome

No sense of personal responsibility for group actions

Unlikely to volunteer for tasks

Sometimes Gatekeepers!

Find group whose “personality” does not run contrary to your own Be prepared to “shake things up” if you feel nothing is being accomplished Address group habits early, before problems arise “ I would never belong to a group that would accept someone like me as a member.” ~Groucho Marx

Find group whose “personality” does not run contrary to your own

Be prepared to “shake things up” if you feel nothing is being accomplished

Address group habits early, before problems arise

Are we all on the same page? Can we all come behind one agenda? Do we all agree with the mission? Are there ground rules? Can we follow them? What do we do when rules aren’t followed? Are leaders leading? Are members participating appropriately? Do we know who is responsible for what? Do we know our role?

Are we all on the same page?

Can we all come behind one agenda?

Do we all agree with the mission?

Are there ground rules?

Can we follow them?

What do we do when rules aren’t followed?

Are leaders leading?

Are members participating appropriately?

Do we know who is responsible for what?

Do we know our role?

Staff Elected leaders Informal leaders Lead agency Member organizations Members – Reps vs. Individuals Need balance of power for success “ You do not lead by hitting people over the head - that's assault, not leadership.” ~Dwight D. Eisenhower

Staff

Elected leaders

Informal leaders

Lead agency

Member organizations

Members – Reps vs. Individuals

Need balance of power for success

Leader Member Advisory Staff Trouble Maker Other?

Leader

Member

Advisory

Staff

Trouble Maker

Other?

Leaders Members Advisory Staff Other?

Leaders

Members

Advisory

Staff

Other?

Members Participate Influence Take on tasks Provide advice “ Do the work” Leaders Members Guide Keep people on task Adhere to agenda Provide feedback to staff Set the example Summarize Referee 

Members

Participate

Influence

Take on tasks

Provide advice

“ Do the work”

Leaders

Members

Guide

Keep people on task

Adhere to agenda

Provide feedback to staff

Set the example

Summarize

Referee 

Will attend coalition meetings Formally agree with coalition mission Put coalition issues on own agenda, if an organization Commit financial resources, time or other in-kind services

Will attend coalition meetings

Formally agree with coalition mission

Put coalition issues on own agenda, if an organization

Commit financial resources, time or other in-kind services

Organizations have responsibility in regard to experience of members Members also have responsibly in regard to their participation in organization

Organizations have responsibility in regard to experience of members

Members also have responsibly in regard to their participation in organization

Leave each meeting having contributed to group Follow basic etiquette in regards to participation Participating includes taking personal responsibility for outcomes of group

Leave each meeting having contributed to group

Follow basic etiquette in regards to participation

Participating includes taking personal responsibility for outcomes of group

If you want members & leaders – develop them Use retreats, fun events, & small tasks to bring members to action Share wealth & ask good leaders to mentor other members Offer formal membership & leadership development sessions

If you want members & leaders – develop them

Use retreats, fun events, & small tasks to bring members to action

Share wealth & ask good leaders to mentor other members

Offer formal membership & leadership development sessions

Remember – coalitions are only as effective as their members are willing to invest of themselves in the work “ A child of five would understand this. Send someone to fetch a child of five” ~Groucho Marx

Remember – coalitions are only as effective as their members are willing to invest of themselves in the work

“ A child of five would understand this.

Send someone to fetch a child of five” ~Groucho Marx

Members have rights – so do coalitions Encourage participation Defining membership & participation Individual & group personality types Sustainability (members & leaders) Conflict resolution

Members have rights – so do coalitions

Encourage participation

Defining membership & participation

Individual & group personality types

Sustainability (members & leaders)

Conflict resolution

Leading is more than showing up Leaders have increased responsibility as member in terms of attendance, task assignment, & setting examples Leaders can be hard to find Good leaders are even harder to find Some leaders are informal leaders

Leading is more than showing up

Leaders have increased responsibility as member in terms of attendance, task assignment, & setting examples

Leaders can be hard to find

Good leaders are even harder to find

Some leaders are informal leaders

Facilitate Meetings Set Agendas Review Minutes Mediate conflicts Keep group on task Identify big picture issues and next steps Summarize LONG discussion and verbal agreements for decisions

Facilitate Meetings

Set Agendas

Review Minutes

Mediate conflicts

Keep group on task

Identify big picture issues and next steps

Summarize LONG discussion and verbal agreements for decisions

Meeting management is VERY important Start on time/End on time ALWAYS Formal agenda with TIMES – stick to times! Send out agenda before meeting Rotate locations Minutes Review tasks from last meeting at start Review assignments before close Reminder to complete assignments sent before next meeting Elected leaders lead – not STAFF! Meeting effectiveness evaluations

Meeting management is VERY important

Start on time/End on time ALWAYS

Formal agenda with TIMES – stick to times!

Send out agenda before meeting

Rotate locations

Minutes

Review tasks from last meeting at start

Review assignments before close

Reminder to complete assignments sent before next meeting

Elected leaders lead – not STAFF!

Meeting effectiveness evaluations

Letting a member run away with your meeting Not starting/ending on time Too passive/dominating Avoids addressing “bad habits” Has bad habits & sets bad example Isn’t prepared for meeting “ I start with the premise that the function of leadership is to produce more leaders, not more followers.” ~Ralph Nader

Letting a member run away with your meeting

Not starting/ending on time

Too passive/dominating

Avoids addressing “bad habits”

Has bad habits & sets bad example

Isn’t prepared for meeting

Written guide for all reports required Leadership “job descriptions” Website with free guide to successful facilitation: http://www.thiagi.com/tips.html Website with free leadership development tools, materials, & guides http:// www.managementhelp.org / http://www.fullcirc.com/rlc/deveffectcoalitions.htm

Written guide for all reports required

Leadership “job descriptions”

Website with free guide to successful facilitation: http://www.thiagi.com/tips.html

Website with free leadership development tools, materials, & guides http:// www.managementhelp.org /

http://www.fullcirc.com/rlc/deveffectcoalitions.htm

Do you know your Mission/Goals? Do you understand your “rules”? Do people know what their role is? Is the group accomplishing anything? Has anyone asked the group what they like or dislike?

Do you know your Mission/Goals?

Do you understand your “rules”?

Do people know what their role is?

Is the group accomplishing anything?

Has anyone asked the group what they like or dislike?

Promoting organizations Promoting self or pushing their “ideas” Trying to get paid from coalition work Competing partners Different ideas/perspectives Coalition “ownership”

Promoting organizations

Promoting self or pushing their “ideas”

Trying to get paid from coalition work

Competing partners

Different ideas/perspectives

Coalition “ownership”

Have Mission/Goals everyone can “buy into” Revisit mission when conflict arises Be clear about coalition ownership BEFORE you develop things – including publicity and products Use your agenda - Table discussions not relevant to “off line” Have your leader talk to the person 1:1

Have Mission/Goals everyone can “buy into”

Revisit mission when conflict arises

Be clear about coalition ownership BEFORE you develop things – including publicity and products

Use your agenda - Table discussions not relevant to “off line”

Have your leader talk to the person 1:1

Member personalities play important role in “personality of group” All members are important, regardless of their strengths & weaknesses Identifying your member “type” may help to temper your more difficult attributes

Member personalities play important role in “personality of group”

All members are important, regardless of their strengths & weaknesses

Identifying your member “type” may help to temper your more difficult attributes

Wallflower Brainstormer Cynic Eternal Optimist Evaluator Volunteer Leader Dominator All Around

Wallflower

Brainstormer

Cynic

Eternal Optimist

Evaluator

Volunteer

Leader

Dominator

All Around

What are your challenges? How do you deal with difficult people?

What are your challenges?

How do you deal with difficult people?

Role plays! Discussion Ideas for dealing with “difficult people” “ Eventually we will find (mostly in retrospect, of course) that we can be very grateful to those people who have made life most difficult for us.” ~Ayya Khema

Role plays!

Discussion

Ideas for dealing with “difficult people”

(Retiring is not an option….) “ Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” ~Margaret Mead

Coalitions Work www.coalitionswork.com Community-Campus Partnerships for Health http:// depts.washington.edu/ccph/index.html Annotated listing of CBPR articles, reports and websites was prepared by Community-Campus Partnerships for Health for the Robert Wood Johnson Clinical Scholars Program http://depts.washington.edu/ccph/pdf_files/rwjcsp-cbpr-resources.pdf Speaking Truth, Creating Power: A Guide to Policy Work for Community-Based Participatory Research Practitioners http:// depts.washington.edu/ccph/pdf_files/ritas.pdf

Coalitions Work

www.coalitionswork.com

Community-Campus Partnerships for Health

http:// depts.washington.edu/ccph/index.html

Annotated listing of CBPR articles, reports and websites was prepared by Community-Campus Partnerships for Health for the Robert Wood Johnson Clinical Scholars Program

http://depts.washington.edu/ccph/pdf_files/rwjcsp-cbpr-resources.pdf

Speaking Truth, Creating Power: A Guide to Policy Work for Community-Based Participatory Research Practitioners

http:// depts.washington.edu/ccph/pdf_files/ritas.pdf

Amy Paulson Director, Consortium for Infant & Child Health Instructor, Department of Pediatrics Eastern Virginia Medical School [email_address] 757-668-6458

Amy Paulson

Director, Consortium for Infant & Child Health

Instructor, Department of Pediatrics

Eastern Virginia Medical School

[email_address]

757-668-6458