From Plan to Action

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

Overview

Once the RC/EZ/EC has outlined a health plan, it is important to get it out in the community and not let it sit on a shelf. Two key steps can ensure a successful implementation phase. First, be sure to include strategies in the plan for addressing community needs. Simply identifying a problem does not lead to a solution. Second, build a marketing campaign into the planning process. This will help the plan resonate with the partners and the community and they will be more likely to use it and more likely to feel a sense of ownership. RC/EZ/ECs can tap into resources available from APHA and NCI to guide the marketing process.

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Stories and Models from the field

Citizen Involvement Leads to Successful Strategies
Charleston, South Carolina, EC

The City of Charleston utilized partnerships with the Greater Charleston Empowerment Corporation, the Medical University of South Carolina, the City of North Charleston, and EC residents to assess the communities health needs and move its health improvement plan into action.

Carolyn Jenkins, Associate Professor of Nursing at MUSC, serves as the liaison between community members, University officials, health professionals, and health systems persons to ascertain interests, meet with granting agencies, and network to find those who are interested in working on the identified issue or need. Rather than relying on public health data, this EC relied purely on community input to identify needs. To begin to involve the community, the Enterprise/MUSC Neighborhood Health Program held 19 focus groups and talking circles.

Citizen testimony was collected on videotape and shown to partners and potential sponsors. According to Jenkins, the need for an accessible health care clinic was quickly made apparent. With this need identified, a 3.5 year campaign resulted in the creation of a new healthcare center and access to health screening, referral, and dental care through two mobile vans.

Potential partners for this project were initially identified through brainstorming sessions that involved the Enterprise Board, community leaders, university officials, as well as state and regional leaders. The group first identified potential partners then worked to find a specific linkage or common interest between the identified partner and the proposed project. In some cases, the commonality was not a shared interest, but a common acquaintance that the potential partner trusted. This linkage created incentive for the potential partner to become involved in the project.

Potential partners were then approached. Among those asked to take part in the construction of the new health facility were neighborhood associations and leaders, the Franklin C. Fetter Community Health Center, the Trident Health Department, local businesses, health care providers, senior citizen leaders, church leaders and ministers, government leaders, the local supermarket, a building supply company, and even an architectural firm. The initial approach involved a presentation of success thus far, and ended with a statement of need.

Jenkins states that these potential partners were usually asked for something specific that they could give rather than simply being asked to be part of the larger initiative. This made it easier for the potential partner to respond and feel effective. The first request for aid was generally for something that is easy to honor, or for solutions to a common problem shared by the partners, while more difficult tasks are addressed after trust and relationships are built. For example, the Enterprise/MUSC Neighborhood Health Program identified diabetes and hypertension education and treatment as needs. The EC's initial efforts in this area resulted in diabetes and hypertension education becoming available through a REACH 2010 grant that was planned collaboratively by the University, community agencies, and community leaders. Now, with these relationships solidified, these groups are tackling the issue of obtaining medications for those unable to afford medications.

It also soon became clear that different audiences required that the community's message be translated in various versions appropriate for each audience. For example, the video of the community's needs assessment is used to educate future health professionals about the needs and desires, as well as the participatory process of improving community health. Another version of the video has been used by community leaders to obtain funds for needed activities. This has helped to show each partner about community needs and to help partners work collaboratively to address need.

In creating these partnerships, the EC discovered two valuable approaches. The first was to stress the concept that partnerships would not be created simply as a means to an end, but as an open relationship which the EC and the University would work to collaborate to create mutual gains. Collaboration, rather than duplication of services was stressed.

Jenkins also found that clearly identifying when support was appropriate and needed and in what format was a key strategy. Community leaders and members often can address their needs better than "outsiders," and working together for a common goal can enhance community empowerment. Often, community members only need guidance rather than someone to "do it for them."

As the process of building the clinic continued, marketing to partners became an ongoing process. Once partners were drawn into the project, the Enterprise/MUSC Neighborhood Health Program made certain that communication continued. Partners were thanked and recognized for their successes. Recognition often went beyond thanking the individual person or business to include a letter of recognition sent to their boss or parent organization.

Most importantly, the EC tries to always offer something in return for a partner's participation. In the case of the local grocery store, the EC is now doing educational grocery store tours related to healthy shopping in exchange for their support. Other examples included a letter of support for a grant, medicine for a community member, a talk for a group, or a letter to their boss regarding their contribution and collaboration.

With its citizens and sponsors behind the construction of the new clinic, Jenkins and supporters approached the Empowerment Corporation, the city of North Charleston, the city of Charleston and the MUSC to determine feasibility. Each organization looked at possibilities of what they could bring to the table and tried to come up with other community members that could help their cause. The working advisory board was then put together, consisting primarily of active community members. This board coordinated partners and oversaw the process of building the clinic to completion.

Since the creation of the clinic, Jenkins has worked with the community to identify and resolve other health issues including the improvement of disparities in diabetes care, the provision of clinics for diabetes and hypertension, and a program to administer end-of-life care to terminally ill patients. "Never give up," says Jenkins. "We had clear operational definitions about our goals and possibilities for collaboration for building better community health…and when one door closed, we would try to open another. Faith and work, along with clear documentation of need from community leaders was the key."

Prevention Strategies Result in a Healthier Community
Upper Kanawha Valley, WV (Round II EC)

After an outbreak of encephalitis, the Cabin Creek Health Clinic, the Chelyan Public Service District (PSD), and the residents of Cabin Creek West Virginia realized the need for effective prevention interventions. When a test of the sewer system revealed that raw sewage was being released into the water and a nearby community playground, the community began to develop strategies for prevention. A community forum was opened and eventually established as the Watershed Committee to ensure ongoing oversight of the community's water supply. Community education in the form of brochures, videos and newsletters were developed to inform and involve citizens. The local sewer treatment plant and lines leading into it were assessed and found to be insufficient.

Potential partners were then approached on an individual basis. These requests for aid were followed up with letters. The UKVEC cultivated partnerships with the Cabin Creek Health Clinic, the Rural Health Education Partnership, the Board of Education, local coal companies and active citizens as well as government agencies including the Department of Housing and Urban Development's (HUD) Charleston office, and the State of West Virginia. Personal satisfaction and recognition through the media were cited as incentives used to encourage partnerships. At this point the Cabin Creek Watershed Association and Chelyan PSD has not only educated the community to prevent encephalitis but has dredged the creek beds, replaced sewer lines and constructed a new sewer treatment plant. The new plant created two additional jobs for the community. Much of the money needed for infrastructure came from a block grant from HUD, written by the UKVEC.

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Tools

Worksheet I: Choosing Strategies
Worksheet II: Finding Potential Partners
Worksheet III: Conduct "Market Research"
Worksheet IV: How to Develop a Marketing Plan
Worksheet V: Uncovering Other Resources

Worksheet I: Choosing Strategies

In moving from the planning stages into action, the first thing that an EC or EZ should do is to determine what strategies it will use to accomplish the objectives that it set for itself. This worksheet can be used to make the transition from goal setting to strategizing.

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Worksheet II: Finding Potential Partners

Below is a partial listing of the many public, private, and voluntary sector partners that states have engaged in similar initiatives. Some of these may be good resources when developing EC/EC partnerships. Which are most important to you?

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Worksheet III: Conduct "Market Research"

To move from planning into action, it is necessary to "market" to potential partners. Learn what their needs, desires and preferences are and then tailor your message to attract their enthusiastic participation. Uncovering the best way to approach your partners does not need to be time consuming. Whether learning takes place at the water cooler or from a marketing consultant, the point is to know your potential partners. Below are some of the many ways to learn from and about the people and organizations considered partners in both the development and implementation of the RC/EZ/EC's plan.

Sample "Market Research" Questions

Carefully designed questions will help focus your research on the most important areas. The right questions will depend upon the audience, project goals, level of input desired and the stage in the RC/EZ/EC planning process. For example, if the steering committee and work groups were already formed, planners would focus questions on how to develop and implement the plan rather than how to engage key partners and the community in the planning process.

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Worksheet IV: How to Develop a Marketing Plan

A marketing plan clarifies how the RC/EZ/EC can share its vision with others (including its partners and the larger community), promote their benchmarks, and "make things happen." To develop marketing goals and objectives, planners must determine priority audiences, desired results, key messages, strategies and tactics, and marketing partners.

1. Priority audiences
Whose opinions or actions are most important to the success of the RC/EZ/EC's health planning process and the implementation of objectives? Identify potential target audiences and choose two to three of most importance.

Sample Target Audiences for RC/EZ/EC Marketing Plans: policymakers, including elected officials private sector health organizations, including managed care organizations private sector employers medical societies and other health professional associations school and education leaders state voluntary organizations with local affiliates public health leaders and program managers front-line public health staff grass roots groups with the capacity to address health objectives potential community advocates for priorities

2. Desired Results
What do you want each target audience to do or believe? Be specific! The final plan and marketing materials should, explicitly or subtly, be designed to achieve the desired outcome.

3. Key Messages
For each audience, what are the main messages to communicate? Perhaps your main message is that this is a "people's plan," a governor's plan, a call to action, or a measure of the current path to success. Whatever your message, be sure to identify key words and phrases that support it. If your market research has identified that your target population responds favorably to "milestones," "action plans," and "steps to success"–but turns off when they hear "objectives" or "benchmarks"–include the preferred words in your key messages. Remember to be consistent with vocabulary. Key messages should be reinforced in all communications about the plan, including slogans, conference presentations, press releases, and executive summaries.

4. Marketing Strategies and Tactics
How will you reach each audience?

Strategies describe your general marketing approach. For some audiences and purposes, the best strategy may be to blanket the audience with messages about the RC/EZ/EC's program in a short period of time. For others, your strategy might be to selectively promote the RC/EZ/EC's plans in connection with timely events (e.g., budget hearings) over several years.

Tactics are the methods of communication, such as:

Assess the communication environment of the target audience. The way to reach policy makers may be through their staff or targeted newsletters, whereas the way to reach public health program managers may be through an annual conference or posters at work.

List marketing strategies with a budget in mind. However, a longer menu of marketing options can help identify marketing opportunities and resources in the future.

5. Marketing Partners
General media, special interest media, advocacy organizations, public relations offices, health education units, graphics departments, private health care organizations, and professional organizations with newsletters or web sites may be excellent partners in promoting community health.

Exclusive arrangements with a few marketing partners who are committed (e.g., "Channel 12 Cares") may sometimes be more effective than multiple, less focused partners. Explore options with marketing professionals and check your agency policies.

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Worksheet V: Uncovering Other Resources

Sometimes after a marketing plan has been developed and the community is involved in carrying out the plan, it becomes obvious that further partnerships and assistance are needed to carry plans into action. This list should help your community come up with strategies to increase available resources.

Important to Explore ( ) Responsible Party Potential Strategies to Ensure Resources For Planning and/or Implementation     Request legislators to appropriate additional funds to implement priority activities based upon RC/EZ/EC health planning objectives.     Private and public partners create a non-profit organization to raise and distribute funds for RC/EZ/EC initiatives.     Ask public agencies to voluntarily adopt policies to focus their current human and financial resources on priorities or certain objectives.     Ask private groups to voluntarily redirect current program resources to address health objectives.     Encourage legislators to evaluate budgets against the plan's priorities.     Use policy and regulation to focus private sector and public sector efforts on priorities in the plan.     Ask private foundations to consider RC/EZ/EC public health priorities when developing grant making programs and awarding funds.     Request private organizations to provide technical assistance, leadership, administrative support, and donated services to planning efforts, programs, and policy initiatives.     Require community agencies to address health objectives as a condition of using certain public funds. (Recipients choose which objectives to address.)     Earmark state and/or local funding for particular RC/EZ/EC activities, objectives, or strategies in the plan, in order to ensure certain priorities are addressed.     Request local and state health agencies contribute in-kind resources such as personnel to planning efforts.     Set aside funding and technical assistance resources to help local neighborhoods with planning efforts.     Charge dues to organizational members of the RC/EZ/EC coalition.     Apply for private or public grants to support RC/EZ/EC efforts.

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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

• Plan for action.
• Be aware of potential barriers and have a plan to overcome the barriers.
• Ask for help when you need it.
• Have a clear plan for ensuring accountability.
• Assign RC/EZ/EC staff or staff support to follow-up on activities.
• Enlist support from other groups such as neighborhood associations.
• Implement an annual awards program to recognize people and their accomplishments, such as "RC/EZ/EC Heroes".
• Start an RC/EZ/EC newsletter to keep businesses and residents updated on activities.
• Use interns to help carry out plans.
• Develop a communication plan and publicize your plans - don't keep them a secret.
• Consider asking or hiring an outside group to gather your marketing information and help you develop a marketing plan.
• Develop communication kits for partners (e.g. - business, education, community-based organizations, and hospitals).
• Consider issuing periodic report cards or action updates what progress has been made.
• Hire a health planning coordinator.
• Share your plans with HHS regional officers and local public health agencies. They will be able to alert you to appropriate RFPs.
• Include the human-interest factors - quality of life improvements.

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Links

EZ/EC Health Benchmarking Demonstration Project - Lessons Learned

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

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. Useful sections include:

• The community vision and implementation section which "identifies alternative approaches and resources that can assist the visioning process."
• The civic engagement section which "provides resources for encouraging civil discourse and involvement."

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

The Consensus Organizing Model
which seeks to support communities in implementing their strategies through a series of "practical steps that rely on careful analysis and planning; by carefully crafting the relationships necessary to make progress on important issues; by seeking pragmatic solutions based on the common self interest of the people and institutions connected with a community; by forming surprising, dynamic partnerships between private and public sector leaders and community groups; by providing effective ways for individuals to use and develop their own skills and creativity on behalf of their communities; and by repeatedly succeeding at positioning people to make genuine, beneficial change on important issues."

The Dudley Street Neighborhood Initiative: A Story and Case Study
This section includes the 25-page executive summary of the plan for the Dudley Street urban village. It lays out comprehensive strategies for the physical, economic, and human development of a vibrant, diverse, empowered community. A 1996 update of this report is also available and can be used as an example for other RC/EZ/ECs seeking to implement their goals.

Community Meetings Shape Oregon Health Plan
The story and case study for the development of the highly publicized Oregon Health Plan and how a nonpartisan grassroots organization called Oregon Health Decisions developed the broad based support it needed to implement its goals through citizen input.

The Guide to Ethnic Minority Outreach
which is "aimed at uncovering strategies for including diverse ethnic groups in a range of community-based initiatives. In this guide, you will find recommendations for reaching out to and communicating with diverse groups, engaging leaders within distinct populations, establishing credibility, and developing shared goals and objectives" that communities can then work to implement.

Organizing for Effective Advocacy

Promoting Interest and Participation in Initiatives

Selecting, Designing and Adapting Community Interventions

Social Marketing of Successful Components of the Initiative

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