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Community-Based Participatory Approaches: Coalition Building in Real Communities


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Presentation by Amy Paulson at the 2009 Virginia Health Equity Conference. Explores and explains the community-based participatory approach with focus on application of theory in “real communities with real people”. The use of coalitions in community-based participatory approaches will be discussed. Explains the challenges and benefits of coalition building was they relate to moving from theory to practice, as well as the impact of individual and community factors on coalition building.

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Community-Based Participatory Approaches: Coalition Building in Real Communities

  1. 1. Coalition Building In Real Communities Virginia Health Equity Conference, September 11, 2009 Amy Paulson Consortium for Infant & Child Health Eastern Virginia Medical School
  2. 2. <ul><li>Describe community-based participatory approaches & application in communities </li></ul><ul><li>Differentiate between coalition approach & other types of partnership approaches </li></ul><ul><li>Explain challenges & benefits of coalition building in real world </li></ul><ul><li>Discuss impact of individual & community factors on coalition building </li></ul>
  3. 6. <ul><li>Sometimes…well, usually… </li></ul><ul><li>Not every one will want the community to have an equal voice though </li></ul>Source:
  4. 7. <ul><li>Equal partnership b/t “trained experts” & members of community in working on community health problems </li></ul><ul><li>Community-based participatory research is a &quot;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.&quot; </li></ul><ul><li>~ WK Kellogg Foundation Community Health Scholars Program </li></ul>
  5. 8. <ul><li>Recognizes community as unit of identity </li></ul><ul><li>Builds on strengths & resources of community </li></ul><ul><li>Facilitates collaborative, equitable partnerships, learning, & capacity building throughout process </li></ul><ul><li>Emphasizes local relevance of public health problems and ecological perspectives that recognize the multiple determinants of health </li></ul><ul><li>Disseminates and involves all partners in findings & knowledge gained </li></ul><ul><li>Includes a long term process and focus on systems development </li></ul>Source: Israel, et al (2003), Community-Based Participatory Research for Health
  6. 9. <ul><li>Involve the community in all phases </li></ul><ul><li>Shared responsibility & ownership </li></ul><ul><li>Action oriented </li></ul><ul><li>Community-focused & relevant </li></ul><ul><li>Tangible outcomes </li></ul><ul><li>Development of knowledge linked to action, change, or advocacy </li></ul><ul><li>Recognize that EVERYONE has something to give to the process </li></ul>
  7. 10. <ul><li>Parachute </li></ul><ul><li>Research without action </li></ul><ul><li>Research without involvement of priority populations </li></ul><ul><li>Research without community benefit </li></ul><ul><li>Hold power with researchers </li></ul>
  8. 11. <ul><li>Enhances relevance & use of data, & quality/validity of research </li></ul><ul><li>Strengthens intervention design & implementation </li></ul><ul><li>Joins partners with diverse expertise to address complex problems </li></ul><ul><li>Increases possibility of overcoming community’s distrust </li></ul><ul><li>Knowledge & interventions benefit community </li></ul>
  9. 12. <ul><li>Increases trust & bridges cultural gaps </li></ul><ul><li>Provides resources for involved communities </li></ul><ul><li>Translation of findings to guide future interventions and policy change </li></ul>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
  10. 13. <ul><li>Historical context </li></ul><ul><li>Cultural respect & trust building </li></ul><ul><li>Identifying & overcoming obstacles </li></ul><ul><li>Power exchange </li></ul><ul><li>Differing agendas </li></ul><ul><li>Personalities </li></ul>
  11. 16. <ul><li>Coalitions bring people together </li></ul><ul><li>Coalitions negotiate through agendas, personalities, and competing interests </li></ul><ul><li>Coalitions can be used to successfully move forward CBPA </li></ul><ul><li>Coalitions respect & utilize the key principles of CPBA </li></ul>
  12. 18. <ul><li>Union of people & organizations working to influence outcomes on specific problem </li></ul><ul><li>“Organization of Organizations” united around common issue & clear goals </li></ul><ul><li>Group of concerned citizens &/or organizations working together to facilitate community change </li></ul>
  13. 19. <ul><li>People with common interest </li></ul><ul><li>Purpose is specific, yet inclusive </li></ul><ul><li>It’s about systems change </li></ul><ul><li>Diverse groups combining resources to create change </li></ul><ul><li>Usually has formal structure, but doesn’t always start that way </li></ul><ul><li>Has a lifecycle – like a business </li></ul>
  14. 20. <ul><li>Community investment creates action </li></ul><ul><li>It’s about systems & policy change </li></ul><ul><li>Diverse groups combining resource </li></ul><ul><li>Usually impacts populations not “just individuals” </li></ul><ul><li>Theory & literature supports coalition approaches! </li></ul><ul><li>Best outcomes with evidence-based approaches </li></ul>
  15. 21. <ul><li>Are not usually coalitions </li></ul><ul><li>Sometimes have unequal power </li></ul><ul><li>More limited community involvement </li></ul><ul><li>Predetermined agenda </li></ul><ul><li>Limited shared decision making </li></ul><ul><li>Appointed memberships as opposed to open </li></ul><ul><li>Usually time limited & action oriented to detriment of community involvement </li></ul><ul><li>Can accomplish many of same goals – often look & function a lot like coalitions </li></ul>
  16. 22. <ul><li>Time involved </li></ul><ul><li>Action directed – usually – by majority or consensus </li></ul><ul><li>Success often tied to effective leadership </li></ul><ul><li>Success can sometimes happen DESPITE ineffective leadership </li></ul><ul><li>Members MUST be invested </li></ul>
  17. 23. <ul><li>Strength in numbers – unified voice </li></ul><ul><li>Bigger reach </li></ul><ul><li>Resources </li></ul><ul><ul><li>Increased variety </li></ul></ul><ul><ul><li>Sharing conserves & increases </li></ul></ul><ul><li>Diversity in experience & expertise </li></ul><ul><li>Credibility & trust </li></ul><ul><li>&quot;The achievements of an organization are the result of the combined effort of each individual.&quot; Vincent T. Lombardi </li></ul>
  18. 24. <ul><li>Lack of direction or focus </li></ul><ul><li>Turf battles & competition </li></ul><ul><li>History </li></ul><ul><li>Failure to plan &/or act </li></ul><ul><li>Dominance by professionals </li></ul><ul><li>Poor links to the community </li></ul><ul><li>Minimal organizational capacity </li></ul>
  19. 25. <ul><li>Funding - too much or too little </li></ul><ul><li>Failure to develop, maintain, rotate leadership </li></ul><ul><li>Unequal sharing of responsibility & decision-making </li></ul><ul><li>Time & loyalty conflicts </li></ul><ul><li>Lack of on-going staff/member training </li></ul><ul><li>Burnout or unrealistic demands on members/staff </li></ul>Source: Butterfoss, 1995; Kaye & Wolfe, 1995 .
  20. 26. Source:
  21. 27. <ul><li>Don’t feel included </li></ul><ul><li>Disagree with leadership style </li></ul><ul><li>Group personality </li></ul><ul><li>Group productivity </li></ul><ul><li>Conflict with individuals within group </li></ul>
  22. 28. <ul><li>Feel included </li></ul><ul><li>Are making contribution to group </li></ul><ul><li>Feel comfortable with group personality, leadership, & members </li></ul><ul><li>Feel group is accomplishing goals </li></ul><ul><li>Group meets personal need </li></ul>
  23. 29. <ul><li>Competition Collaboration </li></ul><ul><li>Individual change System change </li></ul><ul><li>Owned Shared </li></ul><ul><li>Institutional focus Community focus </li></ul><ul><li>Paternalistic Consensus </li></ul>
  24. 30. <ul><li>Change is uncomfortable </li></ul><ul><li>People like status quo </li></ul><ul><li>Change isn’t a priority/hot topic </li></ul><ul><li>Multiple priorities </li></ul><ul><li>Changing too little to impact </li></ul><ul><li>Changing too much at once </li></ul>
  25. 31. <ul><li>Synergy – The “Right”…. </li></ul><ul><ul><li>Partners </li></ul></ul><ul><ul><li>Leaders </li></ul></ul><ul><ul><li>Resources </li></ul></ul><ul><ul><li>Strength in numbers </li></ul></ul><ul><ul><li>Approach – realistic & “doable” </li></ul></ul><ul><ul><li>Topic (timely & relevant to community) </li></ul></ul><ul><ul><li>Program/intervention </li></ul></ul><ul><ul><li>Systems or behavior change </li></ul></ul><ul><ul><li>OUTCOMES </li></ul></ul>
  26. 32. <ul><li>Need a “rallying cry” </li></ul><ul><ul><li>Actions contrary to progress </li></ul></ul><ul><ul><li>Community ready for change </li></ul></ul><ul><ul><li>Problem is significant </li></ul></ul><ul><ul><li>It’s the right thing to do </li></ul></ul>
  27. 33. <ul><li>Individuals </li></ul><ul><li>Groups </li></ul><ul><li>Organizations </li></ul><ul><li>Systems/Policy </li></ul>
  28. 35. <ul><li>Personalities </li></ul><ul><li>Behaviors </li></ul><ul><li>Misunderstandings </li></ul><ul><li>Different perspectives </li></ul><ul><li>They don’t do what you want them to do! </li></ul><ul><li>It really would be EASIER if we could do public health without PEOPLE! </li></ul><ul><li>But, we can’t….so… </li></ul>
  29. 38. <ul><li>The member who wouldn’t shut up </li></ul><ul><li>The member who was crazy </li></ul><ul><li>The member who wanted to be in charge, but wasn’t </li></ul><ul><li>The leader who wasn’t leading </li></ul><ul><li>The member who never says anything </li></ul><ul><li>The member who thinks all ideas are bad </li></ul><ul><li>The member that wanted to get paid </li></ul>
  30. 39. <ul><li>Coalition experiences are people intensive </li></ul><ul><li>Personalities make or break coalitions </li></ul><ul><li>People leave or stay based on dynamics </li></ul><ul><li>Healthy dynamics promote good outcomes </li></ul><ul><li>Healthy dynamics produce lasting partnerships </li></ul>
  31. 40. <ul><li>Members must understand role </li></ul><ul><li>Members must understand mission </li></ul><ul><li>Unfulfilled expectations can impact experience & dynamics </li></ul><ul><li>Misunderstanding expectations can lead to disruptive group interactions </li></ul>
  32. 41. <ul><li>Recruitment </li></ul><ul><li>Referral </li></ul><ul><li>Resource development, distribution & access </li></ul><ul><li>Networking </li></ul><ul><li>Collaboration for access to populations, funds, services, or resources </li></ul>
  33. 42. <ul><li>Advocacy </li></ul><ul><li>Systems Change </li></ul><ul><li>Resource identification, development, dissemination </li></ul><ul><li>Gaps in service/education </li></ul><ul><li>Tasks needing collaboration or agreement among partners </li></ul><ul><li>Communication campaigns – public awareness </li></ul>
  34. 43. <ul><li>Understand all members will not participate at same level </li></ul><ul><li>Individual participation may fluctuate </li></ul><ul><li>Members with lower levels of participation may be specialists, gatekeepers, or people with influence or power who are helpful when asked </li></ul><ul><li>Shifting membership WILL impact dynamics </li></ul><ul><ul><ul><ul><ul><li>Goal: Move Members to “Core” </li></ul></ul></ul></ul></ul>
  35. 44. <ul><li>2nd Tier Members </li></ul><ul><li>Attend “somewhat” regularly </li></ul><ul><li>Variable level of participation </li></ul><ul><li>Interested in group outcome </li></ul><ul><li>Decreased sense of personal </li></ul><ul><li>responsibility for group actions </li></ul><ul><li>Less likely to volunteer for tasks </li></ul><ul><li>Core Members </li></ul><ul><li>Regular Attendance </li></ul><ul><li>High level of participation </li></ul><ul><li>Invested in Group outcome </li></ul><ul><li>Feels personally responsible </li></ul><ul><li>for group actions </li></ul><ul><li>Likely to take on tasks </li></ul>Members enter group at different levels, many fluctuate between levels <ul><li>3rd Tier Members </li></ul><ul><li>Variable/ Unreliable attendance </li></ul><ul><li>Low level of participation </li></ul><ul><li>Low interest in outcome </li></ul><ul><li>No sense of personal responsibility for group actions </li></ul><ul><li>Unlikely to volunteer for tasks </li></ul><ul><li>Sometimes Gatekeepers! </li></ul>
  36. 45. <ul><li>Find group whose “personality” does not run contrary to your own </li></ul><ul><li>Be prepared to “shake things up” if you feel nothing is being accomplished </li></ul><ul><li>Address group habits early, before problems arise </li></ul>“ I would never belong to a group that would accept someone like me as a member.” ~Groucho Marx
  37. 46. <ul><li>Are we all on the same page? </li></ul><ul><li>Can we all come behind one agenda? </li></ul><ul><li>Do we all agree with the mission? </li></ul><ul><li>Are there ground rules? </li></ul><ul><ul><li>Can we follow them? </li></ul></ul><ul><ul><li>What do we do when rules aren’t followed? </li></ul></ul><ul><li>Are leaders leading? </li></ul><ul><li>Are members participating appropriately? </li></ul><ul><li>Do we know who is responsible for what? </li></ul><ul><li>Do we know our role? </li></ul>
  38. 47. <ul><li>Staff </li></ul><ul><li>Elected leaders </li></ul><ul><li>Informal leaders </li></ul><ul><li>Lead agency </li></ul><ul><li>Member organizations </li></ul><ul><li>Members – Reps vs. Individuals </li></ul><ul><li>Need balance of power for success </li></ul>“ You do not lead by hitting people over the head - that's assault, not leadership.” ~Dwight D. Eisenhower
  39. 48. <ul><li>Leader </li></ul><ul><li>Member </li></ul><ul><li>Advisory </li></ul><ul><li>Staff </li></ul><ul><li>Trouble Maker </li></ul><ul><li>Other? </li></ul>
  40. 49. <ul><li>Leaders </li></ul><ul><li>Members </li></ul><ul><li>Advisory </li></ul><ul><li>Staff </li></ul><ul><li>Other? </li></ul>
  41. 50. <ul><li>Members </li></ul><ul><li>Participate </li></ul><ul><li>Influence </li></ul><ul><li>Take on tasks </li></ul><ul><li>Provide advice </li></ul><ul><li>“ Do the work” </li></ul><ul><li>Leaders </li></ul><ul><li>Members </li></ul><ul><li>Guide </li></ul><ul><li>Keep people on task </li></ul><ul><li>Adhere to agenda </li></ul><ul><li>Provide feedback to staff </li></ul><ul><li>Set the example </li></ul><ul><li>Summarize </li></ul><ul><li>Referee  </li></ul>
  42. 51. <ul><li>Will attend coalition meetings </li></ul><ul><li>Formally agree with coalition mission </li></ul><ul><li>Put coalition issues on own agenda, if an organization </li></ul><ul><li>Commit financial resources, time or other in-kind services </li></ul>
  43. 52. <ul><li>Organizations have responsibility in regard to experience of members </li></ul><ul><li>Members also have responsibly in regard to their participation in organization </li></ul>
  44. 53. <ul><li>Leave each meeting having contributed to group </li></ul><ul><li>Follow basic etiquette in regards to participation </li></ul><ul><li>Participating includes taking personal responsibility for outcomes of group </li></ul>
  45. 54. <ul><li>If you want members & leaders – develop them </li></ul><ul><ul><li>Use retreats, fun events, & small tasks to bring members to action </li></ul></ul><ul><ul><li>Share wealth & ask good leaders to mentor other members </li></ul></ul><ul><ul><li>Offer formal membership & leadership development sessions </li></ul></ul>
  46. 55. <ul><li>Remember – coalitions are only as effective as their members are willing to invest of themselves in the work </li></ul><ul><li>“ A child of five would understand this. </li></ul><ul><li>Send someone to fetch a child of five” ~Groucho Marx </li></ul>
  47. 56. <ul><li>Members have rights – so do coalitions </li></ul><ul><li>Encourage participation </li></ul><ul><li>Defining membership & participation </li></ul><ul><li>Individual & group personality types </li></ul><ul><li>Sustainability (members & leaders) </li></ul><ul><li>Conflict resolution </li></ul>
  48. 57. <ul><li>Leading is more than showing up </li></ul><ul><li>Leaders have increased responsibility as member in terms of attendance, task assignment, & setting examples </li></ul><ul><li>Leaders can be hard to find </li></ul><ul><li>Good leaders are even harder to find </li></ul><ul><li>Some leaders are informal leaders </li></ul>
  49. 58. <ul><li>Facilitate Meetings </li></ul><ul><li>Set Agendas </li></ul><ul><li>Review Minutes </li></ul><ul><li>Mediate conflicts </li></ul><ul><li>Keep group on task </li></ul><ul><li>Identify big picture issues and next steps </li></ul><ul><li>Summarize LONG discussion and verbal agreements for decisions </li></ul>
  50. 59. <ul><li>Meeting management is VERY important </li></ul><ul><li>Start on time/End on time ALWAYS </li></ul><ul><li>Formal agenda with TIMES – stick to times! </li></ul><ul><li>Send out agenda before meeting </li></ul><ul><li>Rotate locations </li></ul><ul><li>Minutes </li></ul><ul><li>Review tasks from last meeting at start </li></ul><ul><li>Review assignments before close </li></ul><ul><li>Reminder to complete assignments sent before next meeting </li></ul><ul><ul><ul><ul><li>Elected leaders lead – not STAFF! </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Meeting effectiveness evaluations </li></ul></ul></ul></ul>
  51. 60. <ul><li>Letting a member run away with your meeting </li></ul><ul><li>Not starting/ending on time </li></ul><ul><li>Too passive/dominating </li></ul><ul><li>Avoids addressing “bad habits” </li></ul><ul><li>Has bad habits & sets bad example </li></ul><ul><li>Isn’t prepared for meeting </li></ul>“ I start with the premise that the function of leadership is to produce more leaders, not more followers.” ~Ralph Nader
  52. 61. <ul><li>Written guide for all reports required </li></ul><ul><li>Leadership “job descriptions” </li></ul><ul><li>Website with free guide to successful facilitation: </li></ul><ul><li>Website with free leadership development tools, materials, & guides http:// / </li></ul><ul><li> </li></ul>
  53. 62. <ul><li>Do you know your Mission/Goals? </li></ul><ul><li>Do you understand your “rules”? </li></ul><ul><li>Do people know what their role is? </li></ul><ul><li>Is the group accomplishing anything? </li></ul><ul><li>Has anyone asked the group what they like or dislike? </li></ul>
  54. 63. <ul><li>Promoting organizations </li></ul><ul><li>Promoting self or pushing their “ideas” </li></ul><ul><li>Trying to get paid from coalition work </li></ul><ul><li>Competing partners </li></ul><ul><li>Different ideas/perspectives </li></ul><ul><li>Coalition “ownership” </li></ul>
  55. 64. <ul><li>Have Mission/Goals everyone can “buy into” </li></ul><ul><li>Revisit mission when conflict arises </li></ul><ul><li>Be clear about coalition ownership BEFORE you develop things – including publicity and products </li></ul><ul><li>Use your agenda - Table discussions not relevant to “off line” </li></ul><ul><li>Have your leader talk to the person 1:1 </li></ul>
  56. 65. <ul><li>Member personalities play important role in “personality of group” </li></ul><ul><li>All members are important, regardless of their strengths & weaknesses </li></ul><ul><li>Identifying your member “type” may help to temper your more difficult attributes </li></ul>
  57. 66. <ul><li>Wallflower </li></ul><ul><li>Brainstormer </li></ul><ul><li>Cynic </li></ul><ul><li>Eternal Optimist </li></ul><ul><li>Evaluator </li></ul><ul><li>Volunteer </li></ul><ul><li>Leader </li></ul><ul><li>Dominator </li></ul><ul><li>All Around </li></ul>
  58. 67. <ul><li>What are your challenges? </li></ul><ul><li>How do you deal with difficult people? </li></ul>
  59. 68. <ul><li>Role plays! </li></ul><ul><li>Discussion </li></ul><ul><li>Ideas for dealing with “difficult people” </li></ul>“ 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
  60. 69. (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
  61. 71. <ul><li>Coalitions Work </li></ul><ul><li> </li></ul><ul><li>Community-Campus Partnerships for Health </li></ul><ul><li>http:// </li></ul><ul><li>Annotated listing of CBPR articles, reports and websites was prepared by Community-Campus Partnerships for Health for the Robert Wood Johnson Clinical Scholars Program </li></ul><ul><ul><li> </li></ul></ul><ul><li>Speaking Truth, Creating Power: A Guide to Policy Work for Community-Based Participatory Research Practitioners </li></ul><ul><ul><li>http:// </li></ul></ul>
  62. 72. <ul><li>Amy Paulson </li></ul><ul><li>Director, Consortium for Infant & Child Health </li></ul><ul><li>Instructor, Department of Pediatrics </li></ul><ul><li>Eastern Virginia Medical School </li></ul><ul><li>[email_address] </li></ul><ul><li>757-668-6458 </li></ul>