Choosing the Right Approach for Health

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

Overview

Plan for your planning. Before EZ/ECs begin health planning activities, decide on the approach they will take. Who are the leaders and stakeholders that need to be involved? What sort of planning structure will they work with? Who will be held accountable? What is the time line? These are the important questions that should be answered before convening steering committees or advisory groups. Thinking through the questions and answers up front will lead to an organized process and smooth transition from plan to action.

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Stories and Models from the field

Healthy Boston is an initiative that focuses on making things happen in communities in an inclusive manner. The vision for Healthy Boston was to use a 6 million dollar fund to help self-identified communities within the city to establish coalitions, define their own needs, use their own resources in a more efficient manner and be in a stronger position to negotiate with the city government and other outside agencies regarding resources and services. To begin this initiative, the Boston Commissioner of the Department of Health and Hospitals, Judith Kurland, convened a "visioning group" consisting of the Department of Health and Hospital's (DHH) staff and asked that they draft a blueprint that would:

1. Facilitate collaboration and integration of human services at the local and neighborhood levels
2. Encourage communities to partner with local government to define and work on addressing their own priorities
3. Restore some of the social and civic infrastructure that makes communities strong, viable and healthy and ultimately;
4. Lead to an improved quality of life for Boston residents.

With the basic framework in place, Kurland convened an advisory committee of city department heads and community leaders. They worked to gain support for the initiative in city hall and from community leaders. The group was successful enough to generate city government interest in their ideas that it became the focus of the city department heads' December 1990 retreat. This retreat led to the establishment of the Human Services Cabinet, which was designed to coordinate the development and implementation of the program among the various city departments. Eventually, the name "Healthy Boston" was coined for the initiative and a formal link was established with the international healthy cities movement . Through this connection, Healthy Boston staff were able to visit Cali, Columbia in the winter of 1993 to see what kinds of initiatives were possible.

Shortly after the conference, the Boston City Hospital became eligible for enhanced funding from the US Department of Human Service's Medicaid Program. This was due to the disproportionately high number of hospital patients with incomes below the poverty level. DHH began to design a comprehensive plan using the $18 million in available federal aid. A team from DHH and other city departments was assembled and assigned the responsibility of managing and coordinating Healthy Boston Functions. The staff worked with city and neighborhood residents to define the scope and requirements for Healthy Boston.

With this groundwork in place, the Healthy Boston initiative was announced in 1991. Within three month, DHH hosted a series of community meetings about the program. These meetings involved potential applicants and helped the Healthy Boston staff to determine what requirements would be set in place for potential partners. In order to get funding as a part of this initiative, potential partners would have to meet these minimum requirements:

1. Establish themselves as coalition with representation from at least five sectors of the community including health education, economic development, housing and human services.
2. Identify a community-based organization or agency to serve as a fiscal agent to the coalition
3. Conduct a community assessment identifying important community needs
4. Hire a coalition coordinator
5. Develop an action plan that outlined the coalition strategies, models and plans for development
6. Articulate a special project that demonstrated the ability to draw on all their coalition partners to implement.

This way, the grant supported not only health communities but required coalescence as well. Technical assistance grants were used to help neighborhoods in forming coalitions. Planning grants were offered to establish and develop coalitions. Continuation grants were provided once coalitions had formed and carried out their identified planning activities and implementation funds were used to support programs that advanced coalitions sought to create. All coalitions are assessed for funding eligibility based on their level of development. That level is determined by a community review panel.

The Healthy Boston initiative determined and created its approach with the establishment of a "blueprint," the creation of an advisory committee, the linkage with the international Healthy Cities Movement and the creation of criteria for partners and funding. This successful approach has allowed them to weather political turbulence while continuing to strengthen the links between community members.

This case study taken from the Civic Practices Network: Healthy Boston Builds Strong Communities case study.

National School Health Strategies
National Center for Chronic Disease Prevention and Health Promotion a division of the CDC provides steps, strategies, examples and links for effectively planning and implementing a successful school health program.

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Tools

SWOT Worksheet

SWOT is an examination of a group's internal strengths and weaknesses, as well as the environment's opportunities and threats. It should be used in the beginning stages of decision making and strategic planning.

Strengths

What are your RC/EZ/EC's particular strengths? Do you do something particularly unique? What could be an asset in developing objectives for your health plan?

Weaknesses

Where is your RC/EZ/EC lacking? What do others seem to accomplish that you cannot? What could limit your planning efforts

Opportunities

What is happening in your RC/EZ/EC that could provide opportunities?

Threats

What is happening that could pose threats to the process or your goals?

Adapted from: Balamuralikrishna R., Dugger J.C. "SWOT Analysis: A Management Tool for Initiating New Programs in Vocational Schools." Scholarly Communications Project, University Libraries, Virginia Tech. http://borg.lib.vt.edu/ejournals/JVTE/v12n1/Balamuralikrishna.html

Forming a group to create and run your activity or initiative

Assembling a group to guide the organization or initiative in its beginning stages has some distinct advantages over trying to do the same thing as an individual:

• It lends credibility and community support to the effort. Especially if the group is diverse, and represents a number of different organizations, interests, and parts of the community, it gives the community a sense of ownership of the organization or initiative. This makes it much more likely that it will continue to have the community's enthusiastic support, long after the group has been disbanded.
• It allows more ideas to come into play. Two heads are often better than one, and ten are better than two, although sometimes harder to reconcile. While it can be a lot of work to sort out the different ideas of many group members, the consensus you come to is likely to be more interesting and effective than what you could have developed alone.
• It affords an opportunity to educate the community about the issue. Everyone's in favor of adult literacy, for instance, but very few - including staff people of health and human service agencies - understand how many adults need literacy services. As members of an oversight group for a community literacy initiative, however, they'll have the opportunity to learn a great deal about the issue and the actual potential for addressing it. And they'll spread the word as they learn.
• It gives new organizations and initiatives the benefit of others' experience. Even if the oversight group is largely made up of individuals from the community rather than agencies and organizations, many of those people may have founded their own businesses, started other organizations, been on community boards, etc. Both these individuals and those who work for other organizations will have valuable knowledge and experience that can save your organization or initiative enormous amounts of time and trouble.
• It provides a base for membership, fundraising, and other support. Each of the people in the group will know literally hundreds of others - far more than you would have any chance of contacting on your own - and many of those others will be only too willing to help if only they are asked. The networking possibilities are endless.
• It provides personal support to its members and to the people who started the initiative in the first place. This kind of support can be extremely important when things look bleak - and they will, at least occasionally, in any community initiative.

When starting a new project or initiative, you'll often find that the people involved don't know each other well enough yet to really know who might make the best leaders. Yet there is still a lot of work to be done in laying the groundwork for this new entity. Forming a group is a way to get some of these important things done before figuring out what the ultimate governing structure will be:

• Deciding the initial direction of the initiative
• Forming a vision and mission for the initiative
• Determining and recruiting potential partners
• Creating an action plan
• Choosing people to head individual committees and be in charge of specific tasks

A group is also useful when your project or initiative has started working on many tasks, but doesn't yet have - or will never have - a staff. The group may act as a substitute for an individual coordinator or director, either of an organization or initiative, or of an event or particular area of an initiative's functioning.

Adapted from: Chris Hampton and Phil Rabinowitz, "Choosing a Group to Run Your Initiative," Community Tool Box http://ctb.lsi.ukans.edu/tools/EN/sub_section_main_1093.htm

Creating a Structure for Success

1. Preparation
A carefully organized and well-defined planning structure will position the planning process for success. There are several options for developing steering committees, advisory committees, and other structures to carry out planning work and involve people in the process.

This tool can be used to structure government leadership or community involvement. This tool will give you ideas on how to structure your process, identify participants, and delineate participant roles and responsibilities. A small group, or preparation team, can help make structural decisions before the official steering group is formed. In just one or two meetings, this team can ensure that invitations are sent to the right people and their charge is clear from the beginning.

An existing health advisory group or management team can serve as a preparation team.

2. Align the planning structure with project goals
Consider first what the desired results of the project or initiative are, then build a planning structure around those goals. For example, if the goal is for policy makers to use the plan to propose legislation, a planning structure involving the legislative branch or the governor's office may be desirable. If goals emphasize local use of the plan, a planning structure with local involvement would be ideal.

3. Write down what the RC/EZ/EC wants to achieve, then consider the structural issues and options on the following pages by asking, "Which option will give us these results?"

In any planning structure, participants should know:

Who has an advisory role? Persons in an advisory role may provide informed input on topics such as the planning process, priority or focal areas, target populations, scope of objectives, marketing, and other aspects of the initiative.

Who has a steering role? Persons in a steering role navigate the course of the planning process, establish work groups, determine input processes, and make decisions about the content of the state plan.

Who makes final decisions, weighing all input?

Who will be held accountable for the plan and see the plan through?

Advisory Structure Options

• Single, RC/EZ/EC-wide advisory group that meets throughout the process
• Two or more advisory groups to ensure input from specific constituencies (e.g., geographic areas, racial and ethnic populations, or local health officers), periodically convened
• Consortium of various advisory groups, (e.g., maternal and child health, mental health, substance abuse)
• No formal advisory group, but planned events or activities to gain input from key constituencies

Steering Structure Options

• Steering group with full authority to develop and adopt the RC/EZ/EC plan
• Steering group with significant authority to develop the RC/EZ/EC plan, subject to the final approval of the governor, RC/EZ/EC Director, or others
• Steering group with specific authority over certain tasks (such as the development of objectives), with other tasks (such as marketing and publication of the plan) under the authority of the RC/EZ/EC office or mayor's office

Leadership Options

• Chaired by the mayor or his/her designee
• Chaired by an official or appointed by the town council
• Chair elected by the group
• Chaired or co-chaired by local public health, mental health, substance abuse, or environmental health director(s)
• Co-chaired by the local health officer and a community representative (appointed or elected)
• Rotating chair
• No chair– group received direction and guidance from staff

Membership Options

• RC/EZ/EC staff only
• Members of the private, public, and voluntary sectors– e.g., academia, community health and social organizations, business, legislatures, etc.
• Community members excluding local agencies and academia

The options below may apply to distributing the work of advisory groups, as well as steering groups, according to the planning structure in your state.

Delegation Options

• The steering group does all the work in steering group meetings
• The steering group divides its members into work groups or subcommittees
• The steering group establishes work groups to be chaired by a steering group member, with work group membership open to non-steering group members who have expertise or interest
• The steering group charges the local health agency with forming work groups as needed

Work Group Options

• Number
  • Limited number of work groups
  • Unlimited number of work groups
• Organization
  • By focal areas (e.g., tobacco, infectious diseases, infrastructure), so that work groups are responsible for all aspects of developing the plan for their areas of expertise
  • By functions (e.g., objectives, strategies, marketing, public input), so that work groups oversee one aspect of the process for all focal areas
  • By populations (e.g., grouped by life stage, gender, race/ethnicity, people with disabilities)
  • By target audience (e.g., business, government, community organizations)
  • Combination of work group types
• Communication
  • Work groups operate independently, reporting only to the steering group
  • All work groups are periodically convened with steering and advisory groups, sharing progress and discussing priorities of common concern
  • Certain, related work groups periodically meet
  • Staff, materials, web site, or electronic newsletters facilitate communication among groups

Staffing Options

• Members, or their respective staffs, do all the work
• Public agencies jointly support the process
• RC/EZ/EC office shares technical support and administrative support responsibilities with members.
• RC/EZ/EC office provides unlimited technical and administrative support, as delegated by the group
• RC/EZ/EC hires contractual staff for administrative or technical support, funded by RC/EZ/EC or private grants

Options

• Public meetings with formal testimony
• Public meetings with informal discussion with steering committee members
• Public meetings with break out rooms for structured input or activities
• Dissemination (via e-mail, web site, fax, or mail) of requests for specific input or comment
• Surveys
• Focus groups
• Internet discussion group

Scheduling public input

• One location (meeting in county office building)
• Multiple locations (meeting in different neighborhoods)
• Single point in the process
• Multiple points in the process (see options below)

Adapted from: Healthy Delaware 2010 Project. Public Health Foundation, 1999.

Minnesota Department of Health - Community Engagement (How Clear is Your Mission?)
Provides steps and explanations for successfully accomplishing an organizations mission.

Minnesota Department of Health - Community Engagement (We Need to Make A Decision!)
Provides a list of tested methods for making group decisions.

PATCH Chapter 2 - Mobilizing the Community
The Planned Approach to Community Health (PATCH) - Chapter 2 (Mobilizing the Community) outlines steps for gaining the appropriate level of involvement from the community for developing a successful health program. Additionally, this site provides sample sheets for developing a community health profile.

PATCH Chapter 4 - Choosing Health Priorities
The Planned Approach to Community Health (PATCH) - Chapter 4 (Choosing Health Priorities) outlines steps for a community to determine which health problem or problems to address first. Additionally, this site provides an example of a matrix to use for outlining existing community programs and policies.

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.

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Tips for RC/EZ/ECs

• Choose an approach that is not time-intensive
  • Offer options other than in-person meetings - audioconferences, chat rooms, phone interviews
• Be prepared before pulling people together
• Don't bite off more than you can chew. It's better to do a few small things well
• Assure commitment up front from the people most important to the planning process
• Timing is everything
  • Aim for having your health plan complete before RC/EZ/EC benchmarks are due
  • See that the release of you plan coincides with funding cycles
  • Define time commitments for volunteers up fron
• Balance community voices, data, and information on what works when deciding on priorities.
• Don't be afraid to work on what you already know is a priority
• Look at plans and programs that already exist through your local health department, local board of health, state Healthy People efforts, hospitals, and local colleges and universities
  • Start with the planning office at the local public health agency responsible for health in your area
• Decide if you want to use a national health planning tools such as Mobilizing for Action through Planning and Partnerships or the Protocol for Assessing Community Excellence in Environmental Health

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Links

Improving Health in Empowerment Zones and Enterprise Communities: Lessons Learned from the EZ/EC Health Benchmarking Demonstration Project
This report highlights 12 lessons learned, opportunities, and challenges of undertaking a community health improvement process in three EZ/ECs. RC/EZ/ECs can utilize the lessons learned, tips, examples, and resources from this project as they choose the right approach for implementing their own health improvement plan.

Tools and Resources From the EZ/EC Health Benchmarking Demonstration Project

A Strategy for Creating a Healthy Community: MAP-IT
To begin to achieve the goal of improving health, a community must develop a strategy. RC/EZ/ECs can use the MAP-IT technique to 'map out' the path toward the change you want to see in your community. This MAP-IT approach will help you understand and remember the specific steps you will need to take and the order in which you should take them.

Health Policy Coach
RC/EZ/ECs might decide to utilize policy as an approach to protecting and improving health in the community. This web site provides tools, strategies, and information on how to create policy change in your community.

Civic Practices Network - Community Section
Provides information on community building through "community organizing, social capital, and urban democracy." It also provides information on the Consensus Organizing Model, which explains ways one can bring together all the players in a community.

PATCH (Planned Approach to Community Health): Mobilizing the Community
This section of PATCH contains information on beginning phases of health planning, including establishing structures and procedures needed to manage the health planning process.

Community Tool Box: Developing a Strategic Plan
This section of the Community Tool Box provides and outline for developing a strategic plan, examples, how-to information, and other links for developing a strategic plan.

American Health Planning Association (AHPA)
Provides links to research articles containing information on effective health planning practices (including trends and standards).

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