Keeping it Going

• Overview
• Stories and Models from the field
• Tools
• Tips for RC/EZ/ECs
• Links

Overview

Sustaining partnerships is a key ingredient to successful health planning. However, sustaining partnerships can be a major challenge. Over the course of your programs you may see a shift in leadership, policy makers, administration, and priorities. Recognizing these challenges up front and planning for them can make a world of difference. Use the expertise of your partners to solve problems as they arise. Also, use the partnerships to show the importance of the common agenda you have convened around. Most important though, remain sensitive to your partnerships' needs: continuously receive feedback from those involved and show how their feedback was considered; remember the multitude of viewpoints represented in the group; and establish a sense of ownership for the partners.

(back to top)

Stories and Models from the field

Burlington Public Safety Project
Burlington, Vermont EC

Recognizing the importance of partnerships and the need to keep its members involved and energized, The City of Burlington, Vermont, EC's Public Safety Project emphasizes leadership development and problem solving.

The Public Safety Project (PSP) helps neighborhood residents identify issues and solutions and build on the existing strengths and resources in their community. AmeriCorps*VISTA Members work to foster valuable relationships among residents and develop leadership that will improve the security and quality of life in Burlington's Neighborhoods.

Currently the project is a collaborative effort of the City of Burlington's Community and Economic Development Office and the Police Department. The Advisory Board includes Neighborhood Residents, a Code Enforcement Officer, a University of Vermont Representative, Neighborhood Planning Assembly Representatives, and a Tenants' Rights Agency Representative.

Serving approximately 2,000 EC residents, the PSP supports the following specific activities which serve to keep the EC and its partners involved:

• Neighborhood Association and Neighborhood Watch Development and Support: Technical advice, assistance and encouragement for resident groups working to improve their neighborhoods.
• Leadership Development Series and People's Institute for Civic Engagement: Year round trainings aimed at increasing the capacity of neighbors to achieve their goals and learn about the issues that affect their lives
• Public Safety Project Grant Program: funds neighborhood projects and encourages resident activity
• Special Initiatives: Support to the Mayor's Community Based Action Team and the Neighborhood Action Project

The PSP has had a tremendous impact on the Old North End in the past year. Twelve neighborhood associations were able to carry out community improvement projects through the Grant program including: a bike safety day and helmet distribution, street parties, greenbelt gardening, and clean-ups. Each workshop of the Leadership Development Series was attended by an average of 20 residents. Topics included Code Enforcement, History of Your Street, Fire Safety, and Self Defense. A newsletter that provides valuable information and resources to neighborhood leaders is developed and being published three times per year. A Community Organizing Handbook will be available by March 2001. In addition, calls for service to the Burlington Police Department decreased 26.6% over the past two years while arrests and juvenile petitions increased 56%.

For more information contact Cara Gleason, 802 865-7185, cgleason@cedoburlington.org.

Greater Portsmouth Enterprise Community
Scioto County, Ohio EC (Round I)

The Greater Portsmouth EC, located in Scioto County Ohio has succeeded in keeping its initiatives going despite the fact that their EC's operational funds were exhausted in 1999. Its partners have not only helped the Greater Portsmouth EC to successfully meet its benchmarks but have worked to find methods of sustaining its initiatives. Partners including the Southern Ohio Medical Center, the county and Portsmouth City Health Departments, the local medical society and the local Department of Jobs and Family Services have worked with the EC's Community Action Organization (CAO) to meet its health goals. These goals included expanding CAO clinic hours to include evening clinics during the week and a new clinic on Saturdays. Other health-related benchmarks were the development and implementation of a health education and outreach plan and the provision of family planning services to low-income residents.

The CAO succeeded in expanding clinic hours into the evenings and now opens the facility on alternating Saturdays. In addition, the EC reached its benchmarks regarding pregnancy prevention education and outreach and is now offering direct services through the CAO clinic. Despite the fact that their EC designation has expired, the CAO has succeeded in leveraging $115,000 to keep the clinic's expanded services. With 40% of its clients on Medicaid, Medicaid reimbursement makes up 65% of the clinic's overall budget. The additional funds needed to keep the clinic's expanded hours available have been leveraged with Medicaid surpluses generated by the Temporary Assistance to Need Families (TANF) program. Ohio state government encourages communities to use these funds (that have been created by TANF's resulting reduction in the number of Medicaid enrollees) to create contracts with private and nonprofit organizations willing to provide health and job-related outreach programs to their needy populations.

More recently, the CAO has implemented a new benchmark. Benchmark #43 targets the creation of a comprehensive dental plan. The budget for this program, supported by the Anthem of Ohio Foundation and community development block grants from both the Scioto County Commissioners and the city of Portsmouth, is $360,000. This program is currently focusing on providing dental services to children. Any children 18 years of age or younger are eligible for dental coverage under the state's Medicaid plan. Due to the large volume of children served, the dental program's budget is heavily reliant on Medicaid reimbursement. As the program beings to target adults, the percentage of Medicaid patients is expected to drop from 60% to 45%. To keep the initiative running, the CAO is working towards securing funding from the Appalachian Regional Commission for 2002. The CAO is also attempting to secure a more permanent funding source by integrating their initiative into the state's Oral Health Safety Net Clinics, a program sponsored by the Ohio Department of Health. This would result in the allocation of state money to ensure that the CAO's oral health program is sustained.

(back to top)

Tools

Tool 1: Finding Partners that will sustain the effort
Tool 2: Developing Trusting Relationships Between Partners

Tool 3: Cultivating Commitment
Tool 4: How to Build and Sustain Commitment for Your Health Planning Process
Tool 5: How to Sustain Your Partnerships

Tool 1: Finding Partners that will sustain the effort

The key to keeping community initiatives alive lies in keeping your partners involved and active. Too often, partners are asked to participate in the beginning stages of an initiative but are not kept actively involved as it progresses. This tool will help you find partners that will be involved and interested in the initiative long after the initial fanfare has died down. The best partners are those that have something to offer, share a common goal and have built up trust with the other members of the initiative.

Ask yourselves these questions:

1. What kind of relationships do you need to meet your health planning goals?

Every RC/EZ/EC will have different goals. The key to attaining those goals is to find partners that have something that will help you meet those goals. Your goals might include the creation of a mobile screening program or the development of a community exercise group. What assets will you need? Transportation requires not only a vehicle, but also maintenance. Where will you get the instruments that you need to conduct the screenings? Who do you need to staff the program? How will you get the word out into the community about your program? Where will you get the materials you need for advertising or office supplies? Determining what kind of relationships you will need helps you to find partners that will have what your program needs.

2. Who can best provide these services?

Once you have identified what types of partners you will need, consider who is best equipped to provide you with what you need. A large car dealership in the next town might seem like the logical place to start searching for a van for your mobile screening program, but a local car dealership may have a greater interest in investing in his or her own community. Choose partners who not only have the services you want, but are likely to be interested in the well-being of the community and in following the progress of their investment. Their interest in your success will make them more likely to want to participate in future initiatives.

3. What partners can help you get permission or funding needed to implement your plans?

Sometimes RC/EZ/ECs will have to navigate legal matters or find funding from other organizations. Finding partners that have personal experience in these areas may help to alleviate some of the headaches involved in these processes. Of course, finding partners that have a personal stake in the community's well being is important. However, personal relationships with members of the RC/EZ/EC may also help to convince potential partners to become involved. The RC/EZ/EC advisory board may have a member whose neighbor works for a granting organization. Or perhaps a nurse that has already committed to working on the mobile screening clinic has a son or daughter that is married to a car dealer. Take advantage of the trusting personal relationships that already exist. Your partners are more likely to say yes to your requests and to have a personal stake in the outcome.

It is also especially important for RC/EZ/ECs to evaluate the political climate in which they work. Align your goals with those that have been set by local and state governments. This will help in generating political support for your goals and may increase your chances of getting funding. When a shift occurs within government, take the time to reevaluate how your RC/EZ/EC's goals match up with the priorities of the new administration or elected official. Take the time to meet with these individuals; the development of good relationships with these people may give the RC/EZ/EC the political support it needs to stay active in difficult times.

4. Who might be able to supplement your planning goals in special, individual ways?

Sometimes potential partners are overlooked because they don't have exactly what the RC/EZ/EC's health objectives say they need. This does not mean that these organizations or individuals should be left out of the partnership equation. Look for groups that have traditionally taken part in community outreach, fundraising activities or have an interest in the local community. Your local historical society might be willing to help with a lead paint removal project by signing up volunteers to work on repainting a neighborhood block of historical significance. Your local grocer might be wiling to provide bottled water for the RC/EZ/EC's Saturday morning exercise program. Partners that have something unique to contribute will appreciate being part of a successful initiative that might not otherwise involve them.

5. Who is your target population?

In all of the above examples, we have stressed the importance of finding partners that have an interest in the well being of the community. Involving community members is the obvious solution. But looking beyond the general population to those that are targeted by your health programs may help you find individuals that have a greater commitment to its success. For example, using the mobile screening unit again, someone whose mother or uncle has diabetes - or who has it themselves - may have a personal interest in seeing that the program succeeds. If your objective is to encourage women in the community to increase the frequency with which they exercise, outside motivation may not be enough. Instead, offer to train women in the community to lead these programs themselves. Their success will fuel their desire to involve their friends and family - and lead to an initiative that they can truly claim as their own.

6. Who can lend stability and permanence to your initiative?

Planning ahead can help your EZ develop health programs that will be sustained long after your RC/EZ/EC funding has run out. By including key partners in the planning process, you may be able to ensure that your program survives. For example, if your RC/EZ/EC is beginning a neighborhood-based exercise program, involve the local fitness center. If and when funds begin to become less available or other partners begin to lose interest in the program, this business may be willing to take over the program as a permanent part of its community outreach. Likewise, involving local politicians and citizen action groups may enable your RC/EZ/EC to cultivate the skills it needs for political advocacy or to build RC/EZ/EC initiatives permanently into your government's budget.

These tips adapted from the Community Toolbox.

(Tool Menu | Top of Page)

Tool 2: Developing Trusting Relationships Between Partners

When you plan a project, you need to include the time that it takes to build relationships into your plan. This means not only recruiting potential partners, but also giving those partners the time and the means to develop trust. Whenever people work together, they need to have trusting relationships as a foundation in order to function well. When that trust is missing, people usually have a difficult time functioning cooperatively. This tool provides a series of suggested steps for developing trusting relationships between partners while working towards your RC/EZ/EC's health objectives.

Step 1: Establish relationships before you need them.

It is always better to establish relationships before you need them or before conflict arises. If you already have a good relationship with the hospital in your town or city, you will be in a better position to approach it for help in creating a neighborhood clinic for those citizens that lack access to care.

Step 2: Come to a consensus about how your partners will help you reach your objectives.

Hold discussions about your objectives and each partner's role (See Defining Roles). Establish an initial goal that each partner is comfortable with. Building a new health clinic to increase access might seem like too large a challenge and too risky an investment to begin with. Instead, find out just how much risk each partner is willing to take and how you can find other ways to fulfill your goal of increasing access to health care.

Step 3: Begin with smaller projects.

There is nothing wrong with reevaluating your strategy or starting with smaller goals. Your ultimate goal may be to build a health clinic in your neighborhood, but why have you chosen that goal? Chances are that your objective is to increase access to care. One your partners have reached a consensus as to what they are willing to contribute, choose a small, easy-to-manage strategy that they can work on. For example, perhaps you want to focus on children's access to vaccinations and sponsor a series of clinics around the RC/EZ/EC. Partners may be willing to provide the vaccinations or the human resources necessary to make this strategy successful. By waiting to initiate larger This strategy allows your partners to begin to develop relationships with one another and with you, the RC/EZ/EC. As their trust grows, so will their willingness to commit to larger, more complex projects.

Step 4: Highlight both the project's success and the partners' contributions.

Your partners will want to see some kind of return on their investment in your initiative. They will want to know how their efforts paid off and how the project benefited the community. Evaluating and sharing your outcomes will let your partners know that you are not only interested in what you can get from them, but in making sure that they see results. At the same time, be sure to thank your partners for their involvement. Find a way to let the community know what role your partners have had in increasing their access to care (or whatever your objective may be). Appreciation goes a long way. When partners are publicly and privately recognized for their efforts, they are more likely to commit to future endeavors. The trusting relationships they have developed make them more willing to take risks. This helps you, the RC/EZ/EC, sustain your efforts!

These tips adapted from the Community Toolbox.

(Tool Menu | Top of Page)

Tool 3: Cultivating Commitment

Building and sustaining commitment grows within people over time. RC/EZ/ECs can foster commitment in their organizational culture. People commit to a group or organization because they gain something important from their involvement. RC/EZ/ECs should seek to offer their community members opportunities to grow whether it is because they are working on an issue that is important to them, expanding their skills, doing work that helps others or learning how to be part of a team.

These tips adapted from the Community Toolbox.

(Tool Menu | Top of Page)

Tool 4: How to Build and Sustain Commitment for Your Health Planning Process

1. Welcome people into your organization.

Sometimes all people need in order to become involved is to feel genuinely welcome - and if people don't feel welcome they leave before you can blink an eye. People will be impressed with you as a leader if you personally welcome them when they show up. Ask them questions and get to know them. Teach everyone involved in RC/EZ/EC planning to welcome new people. Make it part of your organizational culture. You can also set up a Welcoming Committee for open meetings or special events or set up a buddy system. People involved in the planning process will understand that welcoming is a job to be taken seriously.

2. Be open and clear about the mission, principles and goals of your organization.

People have to know what they are committing to. They want to join a planning group if they share its principles and goals. Make sure that everyone in your health planning committee is familiar with its mission, principles and goals. As a leader, talk openly about why you care about these things.

3. Model commitment yourself.

Everyone looks to the leader or leaders of a group or project to see if they are committed. If you care about the work, it will show in your attitudes and actions. People will watch to see how you act and they will follow your lead. If they can count on you, it is more likely that you can count on them. If you stay late to send out a mailing, others will be willing to do so. Commitment is contagious.

4. Make people accountable for health planning efforts.

If someone shows interest in becoming involved in your RC/EZ/EC's planning initiative, don't wait too long to give them something to do. People need to feel that they are making a significant contribution in order to feel committed. Find out what they are interested in doing and see if you can match their interests to some work that needs to be done. Make them personally accountable for some aspect of the planning process. This not only encourages their involvement–assigning responsibility also increases the probability that the project will get done.

5. Pick out the right level of challenge for people.

People need to feel successful and they also need to stretch their abilities. Both are important. When you are first getting to know someone, try to match him or her with work in which you think they can achieve some success. This will help people feel good about themselves and encourage them to stay. As you get to know them better, give them gradually increasing challenges. Being challenged helps keep people excited about the work that they are doing. Sometimes people will need encouragement to try things they have never done before. Sit down and talk to your members to find out what jobs they would like to try. It is a worthwhile investment of time because they will know that you care about them and their development, not just about what they can produce for you.

Be careful about giving them too much to do though. Remember, these are volunteers.

6. Build an organizational culture in which RC/EZ/EC staff, planning group volunteers and community members appreciate and respect each other.

People need to feel respected and appreciated in order to stay connected and committed to any group or organization. Model appreciation and respect by taking time to think about the people with whom you are working and openly appreciate them and their work. Teach people in your RC/EZ/EC planning group to notice what is going well, rather than just noticing what needs to be improved. For example, you can have open meetings by having each person talk about what they have done well since you last met. You can also have people appreciate one another as a way to end meetings. If people have personal conflicts, mediate the conflict or bring in a mediator. Do not allow personal attacks.

7. Listen, listen and listen. Listening is a powerful tool.

Everyone could use someone to listen to them. When you listen to others with respect, they sense that you have confidence in them and are interested in what they think. In turn, your interest and confidence helps them to think clearly and creatively.

Taking action on what is heard is also important. Demonstrate that you have listened and will take action.

8. Support people's leadership.

To help sustain commitment in your group's initiatives, think about each person as a potential leader and train them to lead. If people view themselves as a leader, they will view the group as their own. They will have a feeling of ownership and will be more likely to take initiative to make sure that things work well.

Expand your definition of leadership. For example, you can view the event organizer as one of the key leaders. The person that informally resolves conflict is a leader too. Even the person who gets everyone in the room laughing when energy bogs down is performing an important leadership function. Help people to recognize their leadership talents and encourage them to try out different roles. Invite them to speak in public, to chair a meeting or to take on a titled leadership role.

9. Celebrate.

Don't forget to celebrate. Any excuse will do. A victory, your RC/EZ/EC's anniversary, a time to give out prizes or certificates to volunteers or workers or a cultural sharing time are all reasons for people to get together, relax and just enjoy each other's company. Remember, commitment grows when people have fun and play together too!

These tips adapted from the Community Toolbox.

(Tool Menu | Top of Page)

Tool 5: How to Sustain Your Partnerships

1. Pay attention to people.

Check in with your partners when you need to. This may take only a few minutes a week, but those few minutes can make the difference in helping your partner remember the importance of the work you are doing together. An occasional phone call to check in with a partner can also motivate that partner to take action on something that has been assigned to him. Partners are more likely to remain accountable and fulfill their responsibilities if they know that other partners are paying attention to the work that is being done.

2. Communicate openly.

People need to communicate. It is a good idea to set aside some time just to talk about the way things are going. When partners don't have a chance to talk about important issues, misunderstandings can blossom. Tensions often build up. Communication is a discipline that has to be practiced regularly; it is like taking vitamins or exercising.

3. Appreciate each other.

Everyone needs appreciation to keep relationships going. If you notice that someone did a stellar job of collecting the necessary data for a committee's evaluation, say so. If you enjoy working with a particular partner, let them know. Appreciation helps us thrive.

4. Extend Yourself.

Go a little out of your way, at least once in a while. If one of your more active citizen volunteers needs to take some extra time with his daughter, you might tell him to go home early and you will finish his grant proposal.

5. Volunteer to do some work for their organization.

If you lend their organization a hand, they are likely to think well of you and give something back in return.

6. Challenge each other to do better.

We all need a buddy to help us stretch ourselves beyond what we think we can do. We can also build stronger relationships by challenging our partners to take on bigger challenges.

7. Back each other when things get tough.

Loyalty is essential in keeping relationships healthy. We may not agree with a partner's position, but we can stand by them when they are in a jam.

8. Invite people and organizations to get involved.

People want to become part of something bigger than themselves or their organization. Many groups are looking for an opportunity to meet others with common goals. At the worst, people will be flattered that you invited them to join.

9. Enjoy people.

If you genuinely enjoy people, others will be attracted to your attitude. People will more likely want to be around you and partners will be more willing to work with you.

These tips adapted from the Community Toolbox.

(Tool Menu | Top of Page)

These technical assistance resources for RC/EZ/ECs were funded by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services (HHS), through a cooperative agreement administered by the Health Resources and Services Administration (HRSA), and prepared by the Public Health Foundation. Duplication and adaptation, with credit, are encouraged.

(back to top)

Tips for RC/EZ/ECs

• Assign or create a committee to sustain efforts, outreach, and partnerships.
• Develop a timeline and assign responsibility and accountability.
• Call people to task when things are not done.
• Display the relevant time line tasks at each meeting and make sure major partners see tasks on the time line for them.
• Celebrate victories, accomplishments, and milestones. This is a good time to involve the media!
• Implement an annual awards program to recognize accomplishments, such as RC/EZ/EC Heroes.
• Use kick-off events to showcase community, government, and business partners and their commitments.
• Recruit marketing partners to find the best "selling points" for different audiences.
• Create a logo for your RC/EZ/EC health planning initiative and make it available for partners to use.
• Re-group and reassess needs with changing administrations. Stay in tune with political realities.
• Connect to the WELCOA program by using their standards for a healthy worksite.
• Consider developing a newsletter to update the RC/EZ/EC residents and businesses on new developments and ongoing efforts.
• Establish a means of continuous communication to report progress among those involved (consider electronic possibilities).
• Recognize groups and individuals for their efforts.
• Integrate your health plan into other ongoing activities such as strategic and annual plans of agencies, agency policies and legislative initiatives, or funding proposals and allocations.
• Schedule reviews of the RC/EZ/EC health plan and use these reviews to revitalize or redirect the initiative.
• Plan activities to follow the "labor and delivery" of the plan. Redefine roles of the advisory groups and bring in new partners for a boost of energy.  

(back to top)

Links

Change Project

From this main page, follow the link to Healthy Communities, then to "How to create one," then to "Sustaining the Effort." This will take you to the article, "Sustaining The Effort: Building a Learning Community" from the healthcare forum. The table of contents includes areas such as governance, structure, and leadership; process; maintaining participation and inclusion; resources; staff support; measurement; and celebration.

Revisiting the Critical Elements of Comprehensive Community Initiatives

The study focuses on lessons and insights gained through the experience of Comprehensive Community Initiatives. The study defines the characteristics of a good leader and staff, how to develop and maintain a sense of hope and momentum, and how planning and action can be blended and balance.

The Sustainable Communities Network

This site offers resources to support communities in developing safe, livable, healthy communities using "integrative, inclusive, and participatory" methods. Their goal is to foster "innovative strategies that can produce communities that are more environmentally sound, economically prosperous, and socially equitable."

The site includes case studies and information about the principles of sustainability and visioning, community indicators, planning in neighborhoods, and what tools are available to help. Groups are also able to locate their local community network and civic engagement opportunities.

Idealist.org: Action Without Borders

This is a network of 22,000 nonprofit and community organizations in 150 countries. Organizations can: post job openings, volunteer opportunities, events, internships and resources, and find volunteers that want to work with them by looking through the Volunteer Profiles. Organization staff and volunteers are able to register for email updates about new events and resources in their field.

(back to top)