Building and Sustaining Community Partnerships for Teen Pregnancy Prevention: A Working Paper

Sharon Lovick Edwards
Renee Freedman Stern
Cornerstone Consulting Group, Inc.

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I. Introduction

The National Strategy to Prevent Teen Pregnancy, begun in January 1997, was formulated in response to a call from the Congress for a strategy to reduce teen pregnancies and to a directive to assure that at least 25 percent of U. S. communities have teen pregnancy prevention programs in place. Toward that end, HHS initiated a multi-year partnership-building process to solicit a nationwide commitment to the goal of preventing teen pregnancies.

In the fall of 1997, The Cornerstone Consulting Group, Inc., began a year-long inquiry in partnership with the Urban Institute, to examine the potential benefits that community partnerships might hold for communities attempting to effectively reduce unintended teenage childbearing.

For this working paper, Cornerstone completed an extensive literature review of various partnership relationships designed to produce change in a range of topical areas. Many of the problems addressed were associated with teenage risk-taking behaviors. Our examination considered research in the fields of violence prevention, substance abuse prevention, teenage pregnancy prevention, youth development, community development, environmental protection, and general business enterprises. The discussion that follows is intended to provide the reader with an overview of the literature on partnerships and to help inform the development of future community partnerships to prevent teen pregnancy.

II. Community Partnerships: A Promising Strategy for Teen Pregnancy Prevention?

Before approaching the question of the advantages of community partnerships as a strategy for adolescent pregnancy prevention, it is useful to review what is known about the causes of teen pregnancy and approaches to preventing it.

A. Adolescent Pregnancy

Factors that Underlie Adolescent Pregnancy

A large body of research has identified a number of factors that underlie adolescent sexual and contraceptive behavior, pregnancy, and childbearing. Several recent reports summarize these studies.⁽¹⁾ Moore and colleagues consider five types of influences that contribute to these behaviors: biological; family, peer, partner and sibling; community; policy; and media. Among the many factors in each of these categories, they identify four that are most predictive of early pregnancy and childbearing: poverty, early school failure, early behavior problems, and family problems.⁽²⁾

Kirby provides a three-part framework for organizing factors underlying teen pregnancy and childbearing. There are biological antecedents, including gender, age, testosterone level, and timing of puberty. Research has shown that these factors are causally related to adolescent sexual and contraceptive behavior and pregnancy, and they have moderate effects. A second group of antecedents can be viewed as manifestations of social disorganization or disadvantage. These include factors in the community and the family: violent crime, poverty, unemployment, family marital disruption, parents' lack of education, mother's and/or sister's being an adolescent mother, poor child rearing practice, lack of parental support and/or supervision, and inappropriate sexual pressure or abuse. The second group also includes factors in the individual teen: lack of religious affiliation, drug and alcohol use, aggressiveness, engaging in other problem behaviors and deviance, delinquency, poor educational performance, low educational expectations, low expectations for the future, and external locus of control. Research has shown that these factors are associated with adolescent sexual behavior and pregnancy-some strongly, some weakly, some in varying degree depending on the study. A third group of antecedents are attitudes and beliefs about sexual behavior, pregnancy and childbearing; these include beliefs, personal values, and perceived norms and intentions. Research has shown that most of these factors are weakly or moderately associated with sexual behavior and pregnancy, with some variation from study to study.

This large, complicated, and interrelated accumulation of factors suggests that the course that leads to adolescent sexual activity, contraceptive use, pregnancy, and childbearing is complex. Kirby concludes that "not merely one or two, but a multitude of antecedents are related to one or more sexual or contraceptive behaviors, pregnancy and childbearing, including characteristics of the teens themselves, their peers and sexual partners, their families and their communities and states. No single one of these antecedents is highly related to behavior; rather, each of many antecedents is weakly (or, in some instances, moderately) related to behavior."⁽³⁾

Programs Designed to Prevent Teen Pregnancy

A vast array of programs have been launched over the past 30 years in an effort to affect one or another of the factors underlying teen pregnancy and thus reduce the problem. These have included educational programs, programs that improve access to contraception, and multi-component programs. Educational programs include those that teach only abstinence and those that teach abstinence plus effective contraceptive practice. Among them are those that include skill development, such as Postponing Sexual Involvement and Reducing the Risk. Programs designed to improve access to contraception include the development of school-based or school-linked clinics and adaptations of family planning services to increase their accessibility and appeal to youth. Multi-component programs may include some combination of job readiness training, academic tutoring, recreation, mentoring, sexuality education, life skills training, and health and mental health care. Most emphasize one aspect of this array. For example, Summer Training and Education Program and Youth Incentive Entitlement Employment Program focus on job training and employment opportunities, and the Teen Outreach Program utilizes mentoring and service learning. A few programs have included a community component-for example, Project ACTION and the School/Community Program for Sexual Risk Reduction. A few programs, among them the Children's Aid Society's Teen Pregnancy Prevention Program, have offered a comprehensive array of services and activities.

Recent reviews of the literature⁽⁴⁾ find serious shortcomings in most of the studies of teen pregnancy prevention programs. Many studies lacked sufficient sample size. Few included long-term follow up. Many programs were conducted as demonstration projects, with a maximum of resources and support; very few have been replicated in less ideal circumstances. A number of studies lacked an experimental design or independent evaluators, or they utilized improper statistical analysis. In addition, difficulty measuring behaviors and a publishing bias toward positive outcomes limited what was known. The accumulation of limitations makes conclusions about programs difficult.

However, a few cautions judgments can be mentioned. None of the programs have been shown to have large, sustained effects on adolescent sexual behavior, contraceptive use, pregnancy, and childbearing rates. Only a few have been shown to have moderate effects. Some educational programs have shown modest positive effects on delay of sexual initiation and less effect on contraceptive use or pregnancy rates. State level data indicate that funding for family planning services can reduce adolescent pregnancies; however, it is not clear how the use of clinic services by adolescents is best encouraged or sustained. Among the multi-component programs, some have shown an effect in reducing sexual risk taking, some have not. The most intensive programs were usually the most effective. Effects tended to disappear when programs were stopped.

The Need for Comprehensive Programs

Most investigators concerned with adolescent pregnancy have concluded that broad-based, comprehensive prevention efforts are the best approach to intervention in this complex problem.⁽⁵⁾ Kirby notes that because the factors underlying adolescent sexual and contraceptive behavior, pregnancy, and childbearing are numerous and complex, each with a small effect, it will be difficult to reduce adolescent pregnancy a great deal. Biological antecedents cannot be changed. Many other factors are related to social conditions that will be difficult to affect. Thus, he concludes that effective programs must focus on multiple factors, including beliefs, perceived norms, skills and intentions, and environmental factors that interfere with intentions to be abstinent or use contraception. However, to have a greater effect programs must address antecedents related to poverty and social disorganization.⁽⁶⁾ Many current programs have serious shortcomings: they do not address many of the risk factors, they focus on a single aspect of prevention, they are brief and superficial, and they are often too late to have a large effect, especially on high-risk groups.

While more research and evaluation is certainly needed, some programs have shown promise. Increasingly, programs serving youth recognize that meaningful strategies require community- wide, coherent, and comprehensive intervention strategies in order to be effective.

Partnerships are most appropriate

• when they address social problems that have multi-faceted causes, and
• when the most promising strategies require influence and resources beyond the scope of any single organization or sector.

Teen pregnancy prevention, it has often been suggested, is such a complex phenomenon, with so many, varied factors underlying it and an array of risky behaviors associated with it, that only a concerted effort on behalf of entire communities is likely to have a significant impact. Because the problem is so complex and no one intervention or sector can "solve" this problem alone, strategic alliances and/or partnerships among multiple sectors are seen by many as essential.

B. The Advantages of Community Partnerships

Beyond teen pregnancy prevention, those working on other complex social problems with multiple, interrelated causes - violence, alcohol and other drug use, youth development - have also come to the conclusion that individual, single shot solutions are inadequate.⁽⁷⁾ As a result, efforts to address all of these problems have increasingly focused on the need to involve a variety of community institutions and mobilize resources community-wide through creative partnerships.

Partnerships, coalitions, and collaborations (see Appendix A for definitions) have been a strategy for promoting health and for delivering social services since the early decades of this century. It wasn't until 1990, however, that "Inter-organizational and Interdisciplinary Collaboration" was given an entry in the Encyclopedia of Social Work. Professional interest in cooperative approaches increased in the 1960s because of decentralization, specialization, and categorization of services and growing acknowledgment of the complexity of the social and economic conditions that these services attempt to ameliorate. Shrinking resources, increasing competition, and administrative and technical innovations also contributed to interest in collaboration.

Many government and private funders-interested in eliminating duplication, increasing cooperation and leveraging resources-have mandated collaborative approaches to programs in health and human services, housing, justice, and the environment. Somewhat later the for-profit sector moved in this direction, as well. The forces favoring partnerships intensified in the 1980s, spurred by federal policies that reduced traditional sources of funding for local programs. Approaches have included comprehensive community planning, functional specialization among organizations, joint programs and collocation, and task integration. Since the 1980s, inter-organizational collaborations "are rapidly becoming a common method of producing goods and services."⁽⁸⁾

If broad-based, comprehensive prevention efforts are a beneficial method of addressing the issue of high rates of adolescent pregnancy, are community partnerships a meaningful approach for delivering these interventions? Reviews of literature on partnerships suggest that these associations do have some significant advantages over individual organizations or agencies.⁽⁹⁾

Partnerships Pool Resources, Share Risks, Increase Efficiency

In partnerships the expertise of different individuals, professions, and groups can be pooled, allowing a more complete understanding of issues, needs, and resources, improving the capacity to plan and evaluate, and allowing for the development of more comprehensive strategies. Further, division of responsibility allows each partner to specialize, doing what it does best. Because partners share responsibility and risk, they are more willing and likely to be creative, becoming involved in new and broader issues. Partnerships, through efficiencies of scale and elimination of duplication, allow maximum use of resources. They also provide access to and permit development of more talents, resources, and approaches than any single organization could. Partnerships bring together larger and more diverse constituencies than single organizations. By including diverse perspectives, partnerships can develop a more comprehensive vision, increase accountability, and achieve a wider base of support for their efforts. By demonstrating widespread support and taking joint action, partnerships can maximize their members' power and increase access to policy makers, the media and the public.

Partnerships Integrate and Coordinate Services

Another rationale for the preference for partnerships comes from the perspective of service integration and coordination. The proliferation of categorical services, often motivated by federal and state funding directives, created complex and fragmented systems that were frequently difficult to access, as well as inflexible and redundant. By coordinating service providers, partnerships can develop comprehensive plans, eliminate duplication, allow members to specialize in their functions, link and integrate partners' activities, and ensure consistency. These benefits improve efficiency, making better use of more limited resources, increase flexibility, and enhance the ability to leverage resources.

Partnerships Build Communities

Partnerships thus have various advantages over independently operating organizations. However, the notion of community partnerships requires its own justification. This rationale comes in part from an emerging public health promotion model⁽¹⁰⁾ that claims a strong relationship among health, life style and social norms: while individuals are still considered to have a role and some responsibility, environmental factors are viewed as crucial in supporting or preventing individual health promoting behavior. Organized community support programs and environmental changes can reinforce individual life style changes. In other words, many chronic health conditions, such as violence, alcohol and other drug use, heart disease, and adolescent pregnancy, "are rooted in a larger social, cultural, political and economic fabric."⁽¹¹⁾ The social ecological approach to health promotion maintains that prevention efforts must affect both personal and environmental factors because of the "interactive and transactional nature of behavior-environment relationships."⁽¹²⁾

By strengthening the environment, community partnerships can affect these chronic health conditions. Without changes in the social and cultural environment, however, interventions that affect individuals are likely to have little success. In the late 1970s the World Health Organization endorsed community development, with emphasis on self-help, citizen participation, and community control, as an approach to health promotion.⁽¹³⁾

Those who study the factors that underlie adolescent sexual behavior, pregnancy and childbearing have noted the relationship between these health concerns and a variety of factors in the family and the community. Some have concluded that "to reduce pregnancy markedly, [programs] must have multiple effective components that address both the more proximal antecedents of adolescent sexual behavior as well as the more distal antecedents involving one or more aspects of poverty, lack of opportunity, and family dysfunction, as well as social disorganization more generally."⁽¹⁴⁾

Those who study other complex social problems have reached similar conclusions. Examining the issue of violence prevention, Cohen and Lang conclude that there is no single or simple solution to violence because the behavior is the result of a complex of environmental, political, cultural, educational, and behavioral factors. They find that effective community-based strategies must be coordinated, including a variety of interventions to reach specific risk groups in multiple settings and provide social support for individual behavior change.⁽¹⁵⁾ Various branches of the Department of Health and Human Services recommend community-based, multi-strategy approaches to a variety of problems. The National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention (CDC) makes this recommendation: "no single action in isolation is likely to solve the problem of youth violence. There are too many types and too many causes to be solved by one strategy. The most effective programs include several types of activities."⁽¹⁶⁾

Similarly, the Office of Substance Abuse Prevention (OSAP) of the Substance Abuse and Mental Health Services Administration notes the complexity of the problem of substance abuse, its multiple, interrelated causes, and the interaction of the individual, drugs and the environment. OSAP establishes a framework guided by the principle "that no one system, agency, or organization can prevent alcohol and other drug problems in communities."⁽¹⁷⁾ The Family and Youth Services Bureau of the Administration for Children and Families advises communities interested in creating youth development programs that "the complexity and interrelatedness of factors contributing to crime, violence, and other social problems...require a commitment to looking beyond superficial solutions."⁽¹⁸⁾

Community partnership is referred to in journals of education, public health, and social work, in the fields of housing, substance abuse, and violence prevention, and it is becoming part of a new type of public-private business approach. It is mentioned in conjunction with collaboration, empowerment, and initiatives. And yet, in spite of its prevalence in the literature and in practice, there is no single, clear definition, framework, or application. Community partnerships seem, instead, to reflect the motivations and purposes of those who are involved, and they are greatly affected by the availability of financial resources, commitment of the members, and the host of macro social, economic, political, and cultural factors that influence change. In spite of this ambiguity, there does seem to be some agreement that community partnerships, although difficult, can be invaluable components of a community's attempt to effect change.

C. The Difficulties Associated with Community Partnerships

While the advantages noted above to community partnerships can be considerable, so too is the difficulty in forming and sustaining such arrangements.⁽¹⁹⁾ Individuals and organizations with experience in complex, multi-year partnership enterprises frequently note that:

• partnerships take a long time to establish and considerable energy to maintain,
• skilled staffing and support are frequently needed to manage a successful partnership,
• it is difficult, and takes time, to establish true community consensus on controversial issues,
• collaboration is particularly challenging when the partners come from different racial, ethnic, linguistic, class and/or educational backgrounds-yet it is exactly this cross-sector involvement that is seen as most desirable.

Given the sheer organizational issues involved, projects built on complex partnership structure will rarely have a short term impact on the problems they seek to address. Instead, most energy in the early stages of the partnership will be devoted to building the partnership itself. Consequently, many would suggest that strategies employing partnerships be reserved for projects and initiatives with the intention and the resources to exist over an extended period of time.

III. Understanding the Process of Partnership Development

Many researchers have noted the "lack of empirical research to guide the development and maintenance of coalitions."⁽²⁰⁾ Some have concluded that "the literature on coalitions is mainly 'wisdom literature,'" anecdotal and based on experiences and impressions.⁽²¹⁾ Nevertheless, various typologies have been proposed on the basis of descriptive evidence.

Classification of Partnership Types

The term "partnership" (as well as related terms such as "collaboration," "coalition," and others) can be used to describe a wide variety of relationships and structures. Coalitions have been categorized by membership characteristics-grassroots volunteers or professionals or community-based combinations of professionals and grassroots leaders. Coalitions have also been typed according to their reason for formation, their functions, their stage of development, and their organizational structures.⁽²²⁾ Others have categorized partnerships according to their products: planning products, services, community actions, and community changes.⁽²³⁾ In terms of organizational structure, there are organization-set coalitions, which are groups of cooperating organizations that provide resources or services under an umbrella organization, for example, the United Way. There are network coalitions, which are loosely coupled groups of organizations that provide services to a particular client population and come together for a specific purpose. There are action-set coalitions, which bring together agencies and individuals that may not have been in the same network to achieve a particular purpose, planning, implementing, coordinating, and advocating for their communities.⁽²⁴⁾ Appendix C contains a review of several theoretical models of partnerships.

The relationship of differences in partnership type to their success has hardly been studied in a systematic way. One study that compared a partnership initiated within the community with one developed in response to an external funder's mandate found little difference.⁽²⁵⁾ Another examined state level adolescent pregnancy prevention coalitions that varied widely in their environments, structures, activities, and underlying philosophies and found no systematic differences in their effectiveness.⁽²⁶⁾ Some suggest that there are probably different combinations that are best in various circumstances and to achieve particular outcomes.⁽²⁷⁾

Stages of Partnership Development

One of the most common ways of looking at partnerships is by identifying their stages of development and the main activities associated with each phase. (One such framework is presented in Appendix B, the representation of a community coalition organized to prevent alcohol and other substance abuse.) The most complete descriptions of partnership formation, implementation and maintenance are found in implementation manuals designed to guide communities and organizations as they create and manage partnerships.⁽²⁸⁾ By combining the advice presented in these manuals, we have identified a series of steps that are important to partnership-building efforts. We have used these steps to organize factors that were observed to contribute to or obstruct the development of partnerships in the literature on the functioning of actual partnerships in teen pregnancy prevention and other fields. The processes involved in forming and sustaining partnerships frequently do not occur in sequence but occur simultaneously and repeatedly over the lifespan of the partnership.⁽²⁹⁾ However, for the purposes of exposition, we present them as a series of sequential steps.

A. Mobilizing the Community

Community partnerships usually begin when factors in the environment bring together a group that identifies and describes the community, the issue(s), and the community's needs and resources related to the issue(s); involves the community; recruits members; and prepares for resistance. These activities together comprise the community mobilization or engagement stage of partnership development.

1. Characteristics of the Environment

Several characteristics of the environment in which the partnership takes shape help bring together partners. Some number of these factors are necessary for the formation of a partnership, but they might not be sufficient.⁽³⁰⁾ The most frequently noted factors include:

• the history of collaboration within the community,⁽³¹⁾
• the recognition of mutual need or purpose and shared responsibility for the problem as well as the solution,⁽³²⁾
• scarcity of resources, economic insecurity among members, and competition for clients,⁽³³⁾
• external mandates,⁽³⁴⁾ for example, the opportunity to compete for public or private funding and/or the need to comply with applicable statutes, regulations, or funding guidelines, although these were not sufficient where other conditions were absent,⁽³⁵⁾
• problem complexity and the need to reduce costs and increase profits in for-profit partnerships, ⁽³⁶⁾
• the failure of existing efforts to address the problem-in other words, the need for innovation,⁽³⁷⁾
• viewing the prospect of collaboration as compelling⁽³⁸⁾ and attaching positive attitudes, expectations and value to collaboration,⁽³⁹⁾
• the level of power and security of members⁽⁴⁰⁾ and the legitimacy of the group to address the issue.⁽⁴¹⁾

The issue of teen pregnancy in many communities presents a powerful convergence of several of these environmental factors. This may explain why efforts to address the issue have tended to increasingly rely on mobilizing partnerships at the community or state level.

2. Community Mapping

Community mapping⁽⁴²⁾ or needs assessment⁽⁴³⁾ or social reconnaissance⁽⁴⁴⁾ is identified in many studies as a crucial step in the process of forming community partnerships.⁽⁴⁵⁾ One element of community mapping is defining the community in terms of its location, general characteristics, and relevant demographic features of residents.⁽⁴⁶⁾ Several studies noted the value of starting within a relatively small area or an area that contained a small number of residents in order to create more breadth of action, a more manageable scale of relationships, and increased motivation, flexibility, and adaptiveness.⁽⁴⁷⁾

Gathering data on the incidence and prevalence of health concerns and risk factors is another element of community mapping. There are three components of this information: epidemiology-the extent, distribution, and nature of the problem; etiology-the origins of the problem; and assessment-the effectiveness of various solutions.⁽⁴⁸⁾ Surveying the attitudes, beliefs, and behaviors of various sectors of the community and partnership members relevant to the group's mission is a third element of community mapping. Awareness of community politics is also important.⁽⁴⁹⁾ This process also includes documenting community resources and services currently available; inventorying assets and resources that might be useful; and documenting needs, barriers and alternatives. The perspective of community residents on service delivery, barriers to service, community resources and needs is important. Once all of this information is gathered, it is essential to disseminate it to community residents and leaders.

Community mapping has obvious value in establishing a base of information for creating and adjusting implementation strategies and for measuring success. In addition, the process has other important effects: it can facilitate recruiting and involving residents actively in planning; provide information that mobilizes residents and agencies; and provide a place to test and refine delivery strategies.⁽⁵⁰⁾ Several sources noted the difficulty and complexity of this information-gathering effort and recommended technical assistance to achieve the best results.⁽⁵¹⁾

3. Community Involvement & Membership Recruitment

Community involvement is another essential, and particularly challenging, part of the mobilization process. Several studies of partnerships noted that skills in community organizing and development are essential,⁽⁵²⁾ especially among the conveners of the partnership.⁽⁵³⁾ Most emphasize inclusion of those most affected by the problem, including youth-at-risk, parents, and traditionally disenfranchised groups.⁽⁵⁴⁾ Yet involving youth and males and sustaining residents' involvement are among the greatest challenges, requiring expertise, resources, time and energy.⁽⁵⁵⁾ In the Annie E. Casey Foundation supported Plain Talk partnerships, community members were involved through their participation, often paid, in the community assessment process.⁽⁵⁶⁾ Stipends, home health meetings, door-to-door canvassing, and addressing other needs identified by residents as more pressing are useful in recruitment.⁽⁵⁷⁾ Grassroots organizations are also helpful in this regard.⁽⁵⁸⁾ A number of studies of partnerships found that technical assistance⁽⁵⁹⁾ or the hiring of a community organizer⁽⁶⁰⁾ is important in successfully involving the community.

Beyond involving community residents, membership recruitment includes attracting a broadly representative group of individuals and organizations both within and outside the community with a role to play in the issue. Diversity of membership is considered essential in partnership success.⁽⁶¹⁾ The evaluators of the Community Partnership Demonstration Program funded by the Center for Substance Abuse Prevention (in the Substance Abuse and Mental Health Services Administration) hypothesize that "successful partnerships will reflect their target community characteristics."⁽⁶²⁾

Most studies found benefits to including prominent citizens and political leaders, and representatives of business, education, and health and human services sectors, faith communities, youth serving organizations, the media, professional organizations and service organizations.⁽⁶³⁾ Less expected partners include sectors such as housing, transportation, justice, welfare, child welfare and foster care, sports and recreation, managed care, shelters, drug companies, and organizations that are concerned with birth defects and disabilities.⁽⁶⁴⁾ Some suggest a balance between public and private sectors.⁽⁶⁵⁾ In general, involving various sectors from the beginning is an advantage. In the Plain Talk partnerships, this was particularly true of health care providers.⁽⁶⁶⁾

Partnerships tend to grow as they develop, often beginning with a small group with common needs and interests and broadening to include diverse constituents.⁽⁶⁷⁾ Some partnerships have found it useful to limit new members based on geography, on programmatic novelty, philosophical approach, and interpersonal style.⁽⁶⁸⁾ While diversity is considered important, large, diverse partnerships are more difficult to manage.⁽⁶⁹⁾ Because of the variety of partnership types and structures, no absolute or even approximate number of partners can be identified as optimal.⁽⁷⁰⁾

4. Preparing for Potential Resistance

Preparing for potential resistance is another important step in community mobilization. Studies of partnerships found resistance in community politics⁽⁷¹⁾ and in community distrust and suspicion of outsiders, especially official bodies and their representatives⁽⁷²⁾ and especially when the partnership mission is imposed from outside.⁽⁷³⁾ There were also unexpected barriers to partnerships from those who might be adversely affected by the effort⁽⁷⁴⁾ and in well organized opposition groups without popular, local support.⁽⁷⁵⁾ Including potential opponents in planning is advocated by some.⁽⁷⁶⁾ Several studies noted that the climate continues to change over the life of the partnership, so monitoring the environment and adjusting to new conditions is an on-going part of maintaining the association.⁽⁷⁷⁾

B. Organizing the Partnership

Once the community is mobilized, the partnership creates itself in a formal sense, developing a structure for governance; establishing processes for decision-making, conflict resolution, and communication; establishing its mission, goals and objectives; and creating an action plan.

1. Administrative Structure & Governance Processes

Establishing internal administrative structures and governance processes is essential in partnership development⁽⁷⁸⁾ and typically occurs in the first three to six months,⁽⁷⁹⁾ although in some cases these efforts take up to two years to accomplish.⁽⁸⁰⁾ Some have noted that community partnerships are often in a constant state of development, even years after formation.⁽⁸¹⁾ The forms the organization takes are variable; the crucial element is that there are formally defined structures and processes.⁽⁸²⁾ Where public and private organizations or diverse organizations come together, structures and processes should reflect all participants.⁽⁸³⁾ Members' rights, roles and responsibilities should be clearly defined.⁽⁸⁴⁾ Contracts,⁽⁸⁵⁾ memoranda of understanding,⁽⁸⁶⁾ or letters of agreement⁽⁸⁷⁾ are suggested as methods of formalizing relationships. Failure to clearly establish these can lead to conflict.⁽⁸⁸⁾ Further, the degree of members' participation is related to their sense of satisfaction; formalizing members' commitments and assessing their compliance with these partnership obligations increases their commitment.⁽⁸⁹⁾

Other clearly defined structures are also essential in partnership development; yet the structure should be flexible and adaptable to changing conditions.⁽⁹⁰⁾ Many partnerships utilize a committee or task force structure organized around community sectors identified for change-for example, schools, criminal justice system, health care providers.⁽⁹¹⁾ However, committees should include members from a variety of disciplines and perspectives, and committee leadership should reflect partnership diversity.⁽⁹²⁾ There should be regular and frequent meetings of all participants.⁽⁹³⁾ Meetings should be orderly and clearly directed, with minutes, agendas, and the like.⁽⁹⁴⁾

In many partnerships, one or more of the members assume the role of "lead agency" or project manager, with responsibility for monitoring and coordinating group activities and maintaining accountability.⁽⁹⁵⁾ This centralized authority contributes to the successful development of some partnerships.⁽⁹⁶⁾

Organizational processes must also be formally developed and clearly defined. Decision-making procedures are vitally important. Decisions should be made in a nonhierarchical and participatory manner, in which no one group or member dominates.⁽⁹⁷⁾ Non-hierarchical decision-making and problem solving are a defining element of inter-organizational networks.⁽⁹⁸⁾ Smaller and single issue coalitions tend to have more consensual decision-making; larger, multi-issue groups tend to use a working consensus method-for example, two-thirds of members.⁽⁹⁹⁾ By distributing decision-making equally among members, "members develop ownership of the process and its outcomes."⁽¹⁰⁰⁾ Member-led decision-making reduces obstacles and facilitates agreement in some partnerships.⁽¹⁰¹⁾

Because partnerships involve members from different disciplines, of different races, genders, and cultures, and with different levels of status or position within their own organizational hierarchy, creating equality and satisfactory working relationships among them is often difficult. "Managing people (or in our case, organizations) with different views of the world is the major inter-organizational problem of our day."⁽¹⁰²⁾ Partners need to develop mutual respect, understanding, and trust in order for the association to develop.⁽¹⁰³⁾ Allowing time at the start for members to learn about each other, including cultural and communication differences and agendas, to test boundaries, to evaluate others, to develop relationships, and to forge new alliances is helpful.⁽¹⁰⁴⁾ Cultivating patience and a willingness to learn and compromise are also important.⁽¹⁰⁵⁾ In partnerships involving schools, which are frequently the site of interventions suggested by researchers or funding sources, it is particularly important for school staff at all levels to support the program. This is facilitated by involving all of the school community, from the beginning, in developing the program and training those who will deliver the intervention.⁽¹⁰⁶⁾ In partnerships involving governmental and non-governmental agencies, differences in the complexity of organizational structure and the timing of decision-making can create problems in collaboration.⁽¹⁰⁷⁾

2. Relationship between Residents & Professionals

Creating relationships of equality between residents and professionals is particularly challenging. Residents' inexperience may make them reluctant to assume leadership roles.⁽¹⁰⁸⁾ In other cases, the disparity between individuals members of partnerships and those who are representatives of organizations creates problems.⁽¹⁰⁹⁾ Establishing separate resident groups, conducting training workshops, and providing on-going mentoring and support to residents are helpful in building their capacity to plan and govern.⁽¹¹⁰⁾ Involving all participants from the beginning in creation of the partnership is also noted as important.⁽¹¹¹⁾ Residents need opportunities for authentic input.⁽¹¹²⁾ Over time in many partnerships, professionals shift from a leadership to a support role in relation to residents.⁽¹¹³⁾ This shift is seldom fully realized and appears to be facilitated by extensive community development efforts in the neighborhood.⁽¹¹⁴⁾ However, this shift-viewing residents as potential partners with assets and expertise rather than as clients with problems to be solved-is the essence of community empowerment and a goal in many partnerships.⁽¹¹⁵⁾

3. Communication

Established procedures for communication among members and between members and staff are also essential. Communication has to be open and frequent and both formal-through established protocols and well-developed systems-and informal or personal.⁽¹¹⁶⁾ As the frequency and intensity of communication increases, the level of cooperation tends to increase.⁽¹¹⁷⁾ Evaluators of the Community Partnership Demonstration Program of the Centers for Disease Control and Prevention found that frequency of interaction between members is related to members' satisfaction with the partnership.⁽¹¹⁸⁾ Open lines of communication and feedback to and from the community are also a key component in the success of partnerships.⁽¹¹⁹⁾ Information often needs to be presented in different ways, at different levels of complexity, and more than once, with time for processing to accommodate different cultural and individual styles and capacities.⁽¹²⁰⁾ Direct communication among all participants, including leaders is important.⁽¹²¹⁾ Butterfoss and colleagues conclude that communication might be the most important ingredient in creating a positive climate within the partnership.⁽¹²²⁾

4. Defining the Mission, Goals & Objectives

There appears to be unanimity in the literature on the need to create a formal statement of the partnership's mission and its goals and objectives.⁽¹²³⁾ Butterfoss and colleagues see this as the most important element in organizing a partnership.⁽¹²⁴⁾ Failure to clearly define the mission, goals and objectives is among the most commonly reported obstacles to partnership development among substance abuse prevention groups.⁽¹²⁵⁾ These formal documents not only clarify the purpose of the partnership and provide guidelines against which to measure success, they also provide a mechanism for the individual members to come to a common mission and shared view of the group's role.⁽¹²⁶⁾ The importance of citizen participation in defining the problem, establishing priorities, and shaping the mission, as well as implementing activities and retaining control over what happens in the community is emphasized by many.⁽¹²⁷⁾

Some studies suggest that the mission be unique to the partnership, not identical with the mission of any of the member organizations.⁽¹²⁸⁾ Some find that more targeted missions rather than more global ones lead to higher levels of action and change in the community.⁽¹²⁹⁾ Goals and objectives need to be understood by all partners;⁽¹³⁰⁾ they have to be realistic.⁽¹³¹⁾ Several studies suggest defining some short-term goals to allow for early successes that will lend credibility to the partnership and help sustain effort.⁽¹³²⁾ Others caution against tackling goals that are too large.⁽¹³³⁾ The partnership's sense of purpose needs to be reestablished periodically to revitalize and refocus the group.⁽¹³⁴⁾

In many cases, the mission, goals, and objectives are, to some extent at least, imposed on the community and the partnership from outside. In the case of the Public/Private Ventures-led Community Change for Youth Development partnerships, the evaluator felt that the "focused but flexible" framework established by the funder expedited the move toward consensus and reduced conflict; however, the effect on community ownership of the issue and its solution are not yet known.⁽¹³⁵⁾ In another case, in which a model developed elsewhere was replicated in new communities, the process of shaping and adapting the intervention to the needs, resources, and constraints in the local context helped establish local ownership.⁽¹³⁶⁾

5. Building Consensus

Crucial to the adoption of a shared mission and common goals and objectives is the process of building consensus, an "on-going challenge" in developing and sustaining partnerships.⁽¹³⁷⁾ The more diverse the group, the greater the challenge.⁽¹³⁸⁾ In the literature on partnerships, several techniques are identified as useful in building consensus. In the early stages, focusing on the importance of the problem rather than specific solutions increases consensus.⁽¹³⁹⁾ Respecting differences and building on similarities are also important in consensus building.⁽¹⁴⁰⁾ Having staff who reflect the diversity of the community and extensive early outreach to all sectors and to "values' shapers," for example, media, clergy, and community leaders, help in building consensus.⁽¹⁴¹⁾

On-going discussions, in which all points of view are heard and respected, allow those whose personal values conflict with the initiative's approach to support the group's position.⁽¹⁴²⁾ Sometimes members have to agree to disagree. This is particularly true for "single issue" members and for those who represent organizations strongly opposed to the group's position. Acknowledging differences in writing sometimes allows partners to move beyond their differences; in other cases, dissenting partners must leave the group.⁽¹⁴³⁾ Partners need to fully explore alternatives and avoid agreeing simply to maintain harmony.⁽¹⁴⁴⁾

6. Managing Conflict

Conflict is seen as inherent in partnerships: in the tension between members' individual agendas and their shared mission; in members' divided loyalties to their own organization and to the group; between the coalition and the targets of change; and among members and staff.⁽¹⁴⁵⁾ Conflict and cooperation are simultaneous processes within inter-organizational relationships.⁽¹⁴⁶⁾ Conflict is likely to develop when "(1) participants have a history of adversarial relations; (2) the collaboration includes ideologically diverse participants or those with different professional or organizational cultures; (3) the outcome has the potential to shift dominance from those in power; (4) the parties hold differing interests regarding desired outcome; or (5) new issues or players emerge."⁽¹⁴⁷⁾ In many partnerships, conflicts tend to diminish over time.⁽¹⁴⁸⁾

The best advice for managing these inevitable differences is to acknowledge that they will occur, address them openly, and apply techniques of consensus building-open communication and expression of misgivings, agreeing to disagree, respect for others' point of view, and a willingness to work together and make compromises.⁽¹⁴⁹⁾ Training in conflict resolution can help partnerships manage their differences.⁽¹⁵⁰⁾ Conflict can present opportunities to develop new options and ways of working together. By resolving conflicts positively, partnerships can improve the climate, facilitate future interaction, and increase cooperation among members.⁽¹⁵¹⁾ Abramson and Rosenthal cite the inability to deal directly with conflict as one of the most serious obstacles to coalition success.⁽¹⁵²⁾ Alter and Hage find excessive conflict to be an indicator of partnership imbalance.⁽¹⁵³⁾

In managing the tensions between members' loyalties to their own organizations and to the partnership, the literature provides some specific suggestions. Representatives of organizations need authority and credibility within their own group⁽¹⁵⁴⁾ and latitude to act within the partnership.⁽¹⁵⁵⁾ Representatives' responsibilities within their own organizations may need to be reduced to allow them time to devote to the partnership; stable representation from partner organizations is also important to partnership success.⁽¹⁵⁶⁾ Recognizing the complexity of the various roles of partnership members and discussing strategies for managing them are useful in assuring success.⁽¹⁵⁷⁾

7. Creation of an Action Plan

The creation of a satisfactory action plan (or strategic plan or implementation plan) is essential to effective partnership development.⁽¹⁵⁸⁾ In the model developed by the Work Group on Health Promotion and Community Development at the University of Kansas, such a plan includes specific objectives for community changes to be sought in achieving the group's mission, the action steps that will effect these changes, and evidence that members support the plan. Focusing on specific community changes in the action plan leads to greater success than identifying issues and clarifying the mission.⁽¹⁵⁹⁾ It is beneficial if funders require an action plan.⁽¹⁶⁰⁾ Priorities should be established by members with elected officials, funders and experts⁽¹⁶¹⁾ and should fit the unique needs of the community.⁽¹⁶²⁾ Elements of plans originate in individual committees, but the whole membership reviews and approves the plan. This approach "maximized ownership at the committee level with buy in and coordination at the larger level."⁽¹⁶³⁾ In the Plain Talk partnerships, residents created messages and defined broad objectives and the general shape of the implementation plan; then staff took these ideas and organized them into a formal action plan.⁽¹⁶⁴⁾

C. Implementing & Sustaining the Partnership

Once internal structures and processes are developed and an action plan completed, community partnerships begin to provide services and/or take action in the community. Related to the partnership's ability to implement its plan and sustain itself are the availability of resources and support. Evaluation also becomes an important concern.

1. Services & Community Actions

As partnerships develop, their focus shifts from internal concerns-how to form and keep the organization going-to external concerns-how to affect the environment and achieve the mission.⁽¹⁶⁵⁾ Most partnerships provide services for members and for the larger community. These might include conferences, training workshops, newsletters, resource directories, reports on the nature and extent of identified problems, position papers, and draft legislation. Services can be distinguished from community actions, which are the activities undertaken by members of the partnership in the community in order to create changes in community programs, policies, and practices.⁽¹⁶⁶⁾ Community actions can be both universal, for example, for all adolescents, and targeted, for example, for high-risk youth.⁽¹⁶⁷⁾ Implementation of specific activities that derive from the action plan is a characteristic of a mature partnership.⁽¹⁶⁸⁾ Actions need to be of sufficient intensity, scope and duration to have an effect.⁽¹⁶⁹⁾ In at least one partnership, focus on production of services reduced the group's ability to take action in the community.⁽¹⁷⁰⁾ One type of community action that has a strong positive effect is a program of mini-grants, providing funds to small, new programs in the community.⁽¹⁷¹⁾

2. Resources/Support

The need for sufficient resources and support is critical in partnership implementation and maintenance. Various types of resources have been identified as important. Several studies find that paid staff is important because staff insure consistency in organizing, communication, and follow-through.⁽¹⁷²⁾ A full-time project director can be key to building external support and developing internal programs.⁽¹⁷³⁾ Partnerships with a project manager who assumes a central leadership and coordination role tend to be the most effective.⁽¹⁷⁴⁾ The value of a community organizer was noted previously.⁽¹⁷⁵⁾ Having staff who are from and accepted by the community⁽¹⁷⁶⁾ and have appropriate training and experience⁽¹⁷⁷⁾ are important to success.

The necessity of adequate, consistent, and sustained resources is noted in many studies.⁽¹⁷⁸⁾ Existing resources are inventoried and additional ones identified in the first six months.⁽¹⁷⁹⁾ Some advocate diversity in funding for achieving broad goals and increasing chances of survival.⁽¹⁸⁰⁾ Using local resources and focusing on sustainability and institutionalization are also advised.⁽¹⁸¹⁾ Firm commitments for continued in-kind support are important.⁽¹⁸²⁾ In the case of one partnership, a large grant tied to services development early in the life of the association reduced the ability of the coalition to develop a comprehensive plan and then take actions necessary for community change. The evaluators speculate that if early resources are focused on the development of the coalition they will not create so great a problem.⁽¹⁸³⁾

"Environmental linkages," relationships between members of the partnership and organizations and individuals in the environment but outside the partnership, are also important. These links, especially those to elected officials, government agencies, religious and civic groups, and community development associations, are often a vital source of resources.⁽¹⁸⁴⁾ Such links vary in formalization, standardization, intensity, and reciprocity, but the more links there are the greater the satisfaction of members.⁽¹⁸⁵⁾ Such links can also contribute to conflict.⁽¹⁸⁶⁾ There is benefit to establishing environmental links early in the partnership.⁽¹⁸⁷⁾ Formal links with other coalitions, which tend to develop later, are also beneficial in achieving goals.⁽¹⁸⁸⁾

Leadership is a critical resource, and several partnerships have foundered because of a loss of leaders.⁽¹⁸⁹⁾ Development and dispersion of leadership throughout the association are important to sustaining the coalition.⁽¹⁹⁰⁾ It is also important that the leader be recognized as such within the partnership⁽¹⁹¹⁾ and be respected by key influentials and by disenfranchised groups and communities of color.⁽¹⁹²⁾ Having leadership who have immersed themselves in the neighborhood improves cooperation.⁽¹⁹³⁾ Effective leadership is assertive and responsive,⁽¹⁹⁴⁾ fair,⁽¹⁹⁵⁾ attentive to and supportive of individual member concerns, and skilled in negotiation, problem solving, conflict resolution, and garnering resources.⁽¹⁹⁶⁾

Technical assistance is a vital resource, especially useful in community mapping,⁽¹⁹⁷⁾ in community mobilization and involving residents,⁽¹⁹⁸⁾ and in involving key influentials.⁽¹⁹⁹⁾ Technical assistance is also valuable in forming the mission, goals and objectives,⁽²⁰⁰⁾ in creating an action plan, identifying changes to be sought, and strategies and tactics for achieving change,⁽²⁰¹⁾ in annual planning sessions,⁽²⁰²⁾ and in developing financial sustainability.⁽²⁰³⁾ Perhaps most frequently, technical assistance is mentioned in connection with designing and implementing program evaluation.⁽²⁰⁴⁾ It is important that the intensity of the technical assistance match the complexity of the partnership.⁽²⁰⁵⁾

Technical assistance falls into a set number of categories: enhancing experience and competence; enhancing group structure and capacity; removing social and environmental barriers; and enhancing environmental support and resources.⁽²⁰⁶⁾ To be most useful technical assistance needs to respond to the needs expressed and identified by the community.⁽²⁰⁷⁾ Some propose establishing "enabling systems" for community partnerships that would provide training programs for skills development; telephone and on-site consultation on organizational development; information and referral services; mechanisms for creating linkages among key community institutions and individuals; incentive grants and methods of recognizing achievements; and publications to promote partnerships.⁽²⁰⁸⁾

3. Monitoring & Evaluation

Most studies noted the importance of monitoring and evaluation. These activities should begin early in the partnership.⁽²⁰⁹⁾ The impartiality of independent, external evaluation is the standard for scientific study.⁽²¹⁰⁾ There is value as well in evaluation efforts that are integrated into the system and collaboratively developed with partnership members.⁽²¹¹⁾ Members of the partnership should be involved in setting evaluation goals, identifying data needed, and collecting and interpreting data.⁽²¹²⁾ The monitoring system should be dynamic, changing with developments in the coalition.⁽²¹³⁾ Whether internally or externally conducted, evaluation results should be reported at regular intervals, more frequently in early stages of development, and should be openly communicated to coalition members, the community and funders.⁽²¹⁴⁾ These recommendations reflect the view that monitoring and evaluation should not be one-time, after-the-fact judgments of partnership effectiveness but rather on-going feedback that can be used for improving the association.⁽²¹⁵⁾ In other words, evaluation should encourage creativity and innovation, not penalize failure.⁽²¹⁶⁾ Several types of evaluation are important in community partnerships.

Process or formative evaluation measures whether the community has been mobilized to address the problem by assessing the number of members and volunteers recruited; by-laws, goals and objectives, mission statements, committees, and reports created; financial resources generated; member satisfaction; and other measures internal to the partnership. In a variety of partnerships, these measures appear as the group takes form, usually within the first three to six months. They continue to be produced over the life of the partnership and are produced in greater numbers than other types of measures.⁽²¹⁷⁾ In the Plain Talk initiative, those partnerships that successfully moved from planning into the implementation phase completed a number of process measures defined by the funder and identified as "milestones" in the planning process.⁽²¹⁸⁾ In the CSAP Community Partnership programs evaluated on the FORECAST model, "markers" were used to verify that the program was implemented according to plan. If markers were not achieved, the plan might need review or the program might need "mid-course correction."⁽²¹⁹⁾ Many noted the importance of frequent feedback on these measures to assess fidelity to plans, to detect and communicate early successes to coalition members, the community, and current and potential funders, and to assess and consider the partnership course and needed adjustments.⁽²²⁰⁾ Where resources are not available to conduct extensive evaluator-administered surveys and the like, self-administered checklists have been found to be useful.⁽²²¹⁾

Partnerships also conduct outcome evaluation to assess whether partnership actions resulted in changes in the community. Outcome evaluation measures immediate results, such as services provided, actions taken in the community, and changes in community programs, policies and practices. These measures, which appear regularly after eight to 12 months of partnership existence and continue at fairly high and steady rates in successful partnerships, help sustain momentum, focus efforts, and justify activities to members, the community, and funders.⁽²²²⁾ Regular feedback on immediate outcomes prompts discussion among members of partnership activities, focuses attention on the mission and objectives, communicates progress, and indicates where adjustments are needed in partnership functioning.⁽²²³⁾ Feedback also leads to an increased number of changes in the community.⁽²²⁴⁾

Services, community actions, and community changes tend to increase at about the same rate in partnerships that are functioning well.⁽²²⁵⁾ Community changes appear after community actions, and increases in community actions tend to produce community changes.⁽²²⁶⁾

Finally, it is necessary to document the connection between various partnership activities and the achievement of the partnership's mission, in other words, whether the partnership has had community-level impact. As one review noted "a well formed and maintained coalition is not necessarily effective in accomplishing its mission, even if it is effective in generating programs and activities or member satisfaction and commitment."⁽²²⁷⁾ Impact or summative evaluation measures the effect of the partnership on intermediate and ultimate outcomes. Intermediate outcomes are behavioral objectives, such as increased abstinence and use of contraception, connected by research and theory to the ultimate health concern; and ultimate outcomes are the partnership's mission, for example, a reduction in the rate of teen pregnancy.

Measuring long term effects and system change is difficult; thus, impact evaluation demands skill, time, and resources, often requiring technical assistance to implement successfully.⁽²²⁸⁾ For these reasons, some suggest limiting impact evaluation to the most promising strategies.⁽²²⁹⁾ Others hypothesize that the greater the number of important changes in the community, the greater the likelihood of achieving a positive impact. They propose tracking process and activity outcomes with relevant risk factors and health indicators to establish links.⁽²³⁰⁾ In the evaluation of a partnership to prevent alcohol and other substance abuse among youth, preliminary results indicate such a link.⁽²³¹⁾

The long delay between the implementation of partnerships and measurable impacts creates problems for groups that need to justify their expenses, if not their existence, to the community, to policy makers, and to funding organizations. Large scale initiatives have been abruptly ended because they failed to show impact.⁽²³²⁾ This situation is not easy to remedy; however, educating others about these delays, building short term goals into program design, and measuring process and intermediate outcomes can help indicate progress on the way to impact.⁽²³³⁾

4. On-going Planning

Although the creation of an action plan is typically accomplished within the first year, planning is an on-going part of partnership development, and its continuation appears necessary for partnership success.⁽²³⁴⁾ Butterfoss and colleagues note the need for regular reorientation to the purposes, goals, roles and procedures of the partnership.⁽²³⁵⁾ Plans need to be reevaluated and changed as community conditions change, new funding becomes available, new opportunities arise, and the partnership matures.⁽²³⁶⁾ At the least, plans should be ratified annually by the whole membership.⁽²³⁷⁾ Planning retreats⁽²³⁸⁾ and annual planning meetings⁽²³⁹⁾ are important for reflection and problem solving and have a large positive effect on coalition growth. These sessions are also an opportunity to celebrate accomplishments.⁽²⁴⁰⁾ Technical assistance is useful in these sessions.⁽²⁴¹⁾

IV. Conclusions & Observations

As we have seen, establishing "partnerships" is a widespread practice in addressing social problems and is commonly seen as a useful strategic tool to bring together the resources, expertise, and will of a community. Partnerships are most useful when the problem to be solved is complex and multi-faceted and rooted in both the individual and the environment and when the efforts of a single agency or institution, no matter how dedicated to the cause, are believed to be insufficient to produce significant, positive outcomes.

Partnerships come in a huge variety of forms and sizes. (Appendix D contains descriptions of several partnerships at both the state and local levels.) They range from informal, non-binding agreements that are not written or not written in detail. The continuation of such partnerships depends on the participants' continuing to see that the arrangement is producing results or shows promise. Other partnerships are highly structured, formal arrangements with written, legally-binding agreements among members. Often these partnerships continue as long as their funding lasts, with continued support determined by formal evaluation results or political considerations. In some instances, the creation of the partnership itself is seen as a valued product, by participants and funders alike. Smoother working relationships, increased trust, and reductions in tension can be potential by-products of working together in partnership, even if the effort fails to achieve its original ends.

Partnerships have a wide range of aspirations for their work. Some loosely structured coalitions, including coalitions to address teen pregnancy, are satisfied that their periodic meetings produce increased communication and coordination. Members learn what others are doing and on occasion can be helpful to one another. At the other end of the spectrum, some partnerships set their goals at the level of producing substantial social change-reducing teen pregnancy rates, the incidence of drug abuse or the school drop-out rate-and are supported by large public or private financial resources, formal third-party evaluations, and considerable public attention.

The challenge of preventing teen pregnancy is good candidate for a partnership intervention strategy. The literature suggests that teen pregnancy has a wide variety of antecedents that include factors related to teens' biology and personality, their families, partners, friends and communities. Most experts in the field suggest that there is a need for multi-pronged services, far beyond the authority and resources of any one institution to provide. Meaningful strategies need to be community-wide, coherent, and comprehensive. The services often suggested to create a "comprehensive" approach to reducing teen pregnancy include health education, contraception, educational supports, job training and employment counseling, self-esteem building activities, recreational activities, and a wide range of social supports. Partnerships are created out of a desire and need to pool resources, share risks, increase creativity, increase efficiency, integrate and coordinate services, maximize power, and build community. Supporting all of these motives is a strong commitment to the value of working together to achieve a common goal.

A large literature describes the work of partnerships in teen pregnancy prevention, substance abuse prevention, violence prevention, community and youth development, as well as other fields, such as business and environmental protection. Much of this is "wisdom literature," descriptions based on experience and impressions. A number of models have been used to describe partnerships, and a variety of studies have attempted to examine scientifically the relationship between aspects of partnership structure or composition or development and outcomes and impacts. These links are just beginning to emerge.

However, the literature contains a wealth of practical advice on creating and sustaining partnerships. From the environment that gives rise to partnership efforts to the development of group structures and processes, these documents provide useful guidance as they describe a number of challenges. Among them are:

• attracting members from among community adults and youth and a broad range of institutions and service sectors, including religious and political leaders, representatives of business, youth serving agencies and organizations, schools, and many others;
• fashioning this diverse mix of professions, races, classes, languages, and levels of education and experience into a working partnership that can set goals, make decisions, attract resources, develop and implement a plan of action;
• developing the skill to establish an environment of trust, build consensus, expand leadership capacity, resolve conflict, and communicate effectively; and
• documenting accomplishments to sustain support.

Consequently, while the establishment of partnerships to combat teen pregnancy is a wise strategic choice, it is not a choice that should be taken lightly. The most effective partnerships typically do not happen easily or overnight. Instead, they are most frequently long-term efforts that require unusually skilled and dedicated staff, sustained financial support, and clear and consistent goals. In the case examples, the partnership often took years to develop and even longer to become recognized as successful. As a result, those with limited resources or a short time frame for intervention should probably consider less complex, more direct strategies.

A promising option, however, rather than the creation of new partnerships, would be a strategy designed to enlist already existing partnerships-those established to work to improve housing or combat crime, for example-in efforts to combat teen pregnancy. While such groups would have to re-commit to working together on a new project and would have to learn together about new issues, their prior experience would in many cases shorten the time needed to get beyond partnership-building and on to addressing teen pregnancy.

Finally, while partnerships are, in general, a promising way to address community problems, it needs to be said that in some ways teen pregnancy prevention is a uniquely complex issue. Nearly everyone has an opinion about what should be done about teen pregnancy, and the range of opinions is unusually wide. Furthermore, feelings and beliefs about sexuality are strongly held and often deeply rooted in culture and religion. Strategies that value inclusiveness and that seek to bring everyone to the table will often face a difficult challenge in forging community consensus around these highly charged issues.

Nonetheless, utilizing a "partnership" strategy to undergird any long-term and ambitious effort to address teen pregnancy is extremely valuable. There is no practical way, without a partnership strategy, to pull together the forces needed to address this critical problem with the strength and power it takes to produce significant results.

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ENDNOTES

1. Dryfoos, 1990; Kirby, 1997; Miller, 1995; Moore, Miller, et al., 1995.

2. Moore, Miller, et al., 1995.

3. 1997, p.12.

4. Kirby, 1997; Moore, Sugland, et al., 1995; Santelli and Beilenson, 1992; Brindis, 1991.

5. Brindis, 1991; Carnegie Corp., 1989; Dryfoos, 1990; Moore, Sugland, et al., 1995; Santelli and Beilenson, 1992.

6. Kirby, 1997.

7. Executive Office for Weed and Seed, n.d.; OSAP, 1991; National Clearinghouse on Families and Youth, 1996.

8. Alter and Hage, 1993, p. 259.

9. Abramson & Rosenthal, 1995; Butterfoss, et al., 1993; Alter and Hage, 1993; Chavis, 1995; Cornerstone Consulting Group, 1997; CSAP, 1995; Mattessich & Monsey, 1992; Nezlek & Galano, 1993; Rabin, 1992; U.S. Environmental Protection Agency, 1990; Weiss, 1987.

10. Bracht, 1995.

11. Butterfoss, et al., 1993, p. 315.

12. Paine-Andrews, et al., 1996, p. 16.

13. WHO, 1978.

14. Kirby, 1997, p. 46; see also Santelli & Beilenson, 1992; Brindis, 1991; Carnegie Corp., 1989; Dryfoos, 1990.

15. Cohen & Lang, 1990.

16. NCIPC, 1993, p. 4.

17. OSAP, 1991, p. 3.

18. National Clearinghouse on Families and Youth, 1996, p. 19.

19. Annie E. Casey Foundation, n.d.; Cornerstone Consulting Group, n.d.

20. Nezlek & Galano, 1993, p. 434; see also Francisco, et al., 1993; Chavis, 1995.

21. Butterfoss, et al., 1993, p. 318.

22. Butterfoss, et al., 1993.

23. Francisco, et al., 1996.

24. Butterfoss, et al., 1993.

25. Mansergh, et al., 1996.

26. Nezlek & Galano, 1993.

27. Alter & Hage, 1993.

28. Allensworth, 1994; Brindis, 1991; Annie E. Casey Foundation, 1993b; Colorado Dept. of Health, n.d.; Cornerstone & Philliber, 1997; The Community Toolbox, 1997; Executive Office for Weed and Seed, n.d.; Fawcett, et al., 1993; National Assembly of National Voluntary Health and Social Welfare Organizations, 1991; OSAP, 1991.

29. Bailey & McNally Koney, 1995a, 1995b.

30. Weiss, 1987; Alter & Hage, 1993.

31. Abramson & Rosenthal, 1995; Butterfoss, et al., 1993; Francisco, et al., 1996; Mattessich & Monsey, 1992; Fawcett, et al., 1993.

32. Carbine & Lee, 1988; CDC, 1995; CSAP, 1995; Fawcett, et al., 1995; Ferraro, 1994; Kracke, 1996; NCIPC, 1993; Scarlett et al., 1991; Williams, et al., 1991; Weiss, 1987.

33. Abramson & Rosenthal, 1995; Alter & Hage, 1993; Butterfoss, et al., 1993; Weiss, 1987.

34. Abramson & Rosenthal, 1995; Butterfoss, et al., 1993; Weiss, 1987; see also the section on the history of partnerships, above, which notes various government and foundation initiatives that contributed to the creation of partnerships.

35. Weiss, 1987.

36. American Leadership Forum, 1993; Anderson, 1996; Rabin, 1992.

37. American Leadership Forum, 1993; Alter & Hage, 1993; Anderson, 1996; Butterfoss, et al., 1993; Rabin, 1992; Weiss, 1987.

38. Abramson & Rosenthal, 1995; Butterfoss, et al., 1993; Francisco, et al., 1996.

39. Abramson & Rosenthal, 1995; Alter & Hage, 1993; Butterfoss, et al., 1993; Mattessich and Monsey, 1992; Weiss, 1987.

40. Abramson & Rosenthal, 1995.

41. Mattessich & Monsey, 1995; Weiss, 1987.

42. Annie E. Casey, 1993a.

43. Brindis, 1991; Executive Office for Weed and Seed, n.d.; Colorado Dept. of Health, n.d.

44. Fawcett, et al., 1993; Fawcett, Paine Andrews, et al., 1995; Fawcett, et al., 1994.

45. Center for the Study of Social Policy, 1995; Cohen & Lang, 1990; Copple, et al., n.d.; Mulroy, 1997; Nadel, et al., 1996; Nezlek & Galano, 1993; NIJ, 1995.

46. Annie E. Casey, 1993a, b.

47. Annie E. Casey, 1993b; ISA Associates, 1994; Mulroy, 1997.

48. Nezlek & Galano, 1993.

49. Nadel, et al., 1996.

50. Kotloff, et al., 1995.

51. Kotloff, et al., 1995; Nezlek & Galano, 1993; see Cornerstone & Philliber, 1997 and Annie E. Casey, 1993a for examples of manuals designed to guide communities through this process.

52. Nezlek & Galano, 1993; OSAP, 1991.

53. Abramson & Rosenthal, 1995; Mattessich & Monsey, 1992.

54. Cohen & Lange, 1990: Fawcett, Paine Andrews, et al., 1995; Harrison, 1996; Kotloff, et al., 1995; Mattessich & Monsey, 1992; Mulroy, 1997; NCIPC, 1993; Rabin, 1992; Wolff & Foster, 1993.

55. Copple, et al., n.d.; Gambone, 1997; Kotloff, et al., 1995; NIJ, 1995.

56. Kotloff, et al., 1995.

57. Gambone, 1997; Kotloff, et al., 1995; Mulroy, 1997; Mattessich & Monsey, 1992; U.S. Dept. of Health and Human Services, 1997b, Group 3..

58. Copple, et al., n.d..

59. Fawcett, Paine Andrews, et al., 1995; Kotloff, et al, 1995; NIJ, 1995; Paine-Andrews, et al., 1996.

60. Gambone, 1997.

61. Butterfoss, et al., 1993; CSAP, 1995; Center for the Study of Social Policy, 1995; Copple, et al., n.d.; Kotloff, et al., 1995; Mattessich & Monsey, 1992; Nezlek & Galano, 1993; OSAP, 1991; Willaims, et al., 1991.

62. Motter, et al., 1993, page 263.

63. Butterfoss, et al., 1993; Copple, et al., n.d.; Fawcett, Paine Andrews, et al., 1995; Mattessich & Monsey, 1992; Mulroy, 1997; Nezlek & Galano, 1993; U.S. Dept. of Health and Human Services, 1997b, Group 1 and 3; Wolff & Foster, 1993.

64. U.S. Dept. of Health and Human Services, 1997b, Group 3.

65. Nezlek & Galano, 1993.

66. Kotloff, et al., 1995.

67. Nezlek & Galano, 1993.

68. Mulroy, 1997.

69. Alter & Hage, 1993; ISA Associates, 1994.

70. Mattessich & Monsey, 1992.

71. Abramson & Rosenthal, 1995; Nadel, et al., 1996.

72. Mulroy, 1997; NIJ, 1995; Wiist, et al., 1996.

73. Bailey & McNally Koney, 1995a.

74. Copple, et al., n.d..

75. Nezlek & Galano, 1993.

76. Fawcett, Paine Andrews, 1995.

77. Chavis, 1993; Mattessich & Monsey, 1992; Nezlek & Galano, 1993.

78. Bailey & Koney, 1995a, 1995b; Kotloff, et al., 1995; Mulroy, 1997; Wolff & Foster, 1993.

79. Fawcett, Paine Andrews, et al., 1995; Francisco, et al., 1996.

80. Center for the Study of Social Policy, 1995; National Evaluation of the Community Partnership Program, 1994.

81. Butterfoss, et al., 1993.

82. CSAP, 1995; ISA Associates, 1994; Nezlek & Galano, 1993; OSAP, 1991b.

83. Harrison, 1996.

84. Mattessich & Monsey, 1992; National Evaluation of the Community Partnership Program, 1994; Rabin, 1992; Ringwalt, et al., 1996.

85. Abramson & Rosenthal, 1995.

86. Butterfoss, et al., 1993.

87. Mattessich & Monsey, 1992; Ringwalt, et al.,1996.

88. Abramson & Rosenthal, 1995; Ringwalt, et al., 1996.

89. Butterfoss, et al., 1993.

90. Mattessich & Monsey, 1992.

91. Copple, et al., n.d.; Kotloff, et al., 1995.

92. Copple, et al., n.d..

93. Wiist, et al., 1996.

94. Butterfoss, et al., 1993; Ringwalt, et al., 1996.

95. Bailey & McNally Koney, 1995a; Butterfoss, et al., 1993; Kotloff, et al., 1995.

96. Kotloff, et al., 1995.

97. Abramson & Rosenthal, 1995; Alter & Hage, 1993; Butterfoss, et al., 1993; Copple, et al., n.d.; Francisco, et al., 1996; ISA Associates, 1994; Mattessich & Monsey, 1992; Mulroy, 1997; Schatz, et al., 1993; Williams, et al. 1991; Wolff & Foster, 1993.

98. Alter & Hage, 1993.

99. Butterfoss, et al., 1993.

100. Mattessich & Monsey, 1992.

101. ISA Associates, 1992, 1994.

102. Alter & Hage, 1993, p. 242.

103. Abramson & Rosenthal, 1995; Alter & Hage, 1993; Mattessich & Monsey, 1992; Mulroy, 1997; Ringwalt, et al., 1996.

104. Butterfoss, et al., 1993; Gambone, 1997; Harrison, 1996; Mattessich & Monsey, 1992; Nadel, et al., 1996; Ringwalt, et al., 1996.

105. Bailey & Koney, 1995a, 1995b; Mattessich & Monsey, 1992; Ringwalt, et al., 1996.

106. Aber, et al., 1996; Farrell, et al., 1996; Nadel, et al., 1996.

107. U.S. Dept. of Health and Human Services, 1997b, Group 7.

108. Kotloff, et al., 1995.

109. Bailey & McNally Koney, 1995a.

110. Butterfoss, et al., 1993; Gambone, 1997; Kotloff, et al., 1995; see also CSAP, 1995; Motter, et al., 1993; National Evaluation of the Community Partnership program, 1994; and OSAP, 1991; for discussion of the community capacity-building efforts of the CSAP Community Partnership Program.

111. Aber, et al., 1996; Schatz, et al., 1996.

112. Nadel, et al., 1996.

113. Kotloff, et al., 1995; Mansergh, et al., 1996.

114. Kotloff, et al., 1995.

115. Fawcett, Paine Andrews, et al., 1995; Mulroy, 1997; OSAP, 1991; and see section IIB above.

116. Butterfoss, et al., 1993; Harrison, 1996; Mattessich & Monsey, 1992; Rabin, 1992.

117. Alter & Hage, 1993.

118. ISA Associates, 1994.

119. Center for the Study of Social Policy, 1995; Kleiner, 1994; Schneider, 1994; Schatz, et al., 1993.

120. Butterfoss, et al., 1993; Gambone, 1997; Mattessich & Monsey, 1992; U.S. Dept. of Health and Human Services, 1997b, Group 3.

121. Gambone, 1997; Mulroy, 1997.

122. Butterfoss, et al., 1993.

123. Butterfoss, et al., 1993; Cohen & Lang, 1990; Gambone, 1997; Harrison, 1996; Kotloff, et al. 1995; Mattessich & Monsey, 1992.

124. Butterfoss, et al., 1993.

125. National Evaluation of the Community Partnership Program, 1994.

126. Abramson & Rosenthal, 1995; Francisco, et al., 1996.

127. Bailey & McNally Koney, 1995a; Cohen & Lang, 1990; Copple, et al., n.d.; Fawcett, et al., 1993; Fawcett, Paine Andrews, et al., 1995; ISA Associates, 1994; Kotloff, et al., 1995; Schatz, et al., 1993; Williams, et al., 1991.

128. Mattessich & Monsey, 1992.

129. Francisco, et al., 1996.

130. Mattessich & Monsey, 1992.

131. Copple, et al., n.d.; Mattessich & Monsey, 1992.

132. Butterfoss, et al., 1993; Center for the Study of Social Policy, 1995; Fawcett, Paine Andrews, et al., 1995; Mattessich & Monsey, 1992.

133. Schneider, 1994; U.S. Dept. of Health and Human Services, 1997b, Group 3.

134. Bailey & McNally Koney, 1995a.

135. Gambone, 1997.

136. Paine-Andrews, et al., 1996.

137. Kotloff, et al., 1995; ISA Associates, 1994; Schatz, et al., 1993; Willaims, et al., 1991.

138. Alter & Hage, 1993; ISA Associates, 1994; Kotloff, et al., 1995; Nezlek & Galano, 1993.

139. Nezlek & Galano, 1993.

140. Andersen, 1996; Ferraro, 1994; Israel, 1995; Rabin, 1992.

141. Kotloff, et al., 1995.

142. Bailey & McNally Koney, 1995a; Kotloff, et al., 1995.

143. Kotloff, et al., 1995; Nezlek & Galano, 1993.

144. Bailey & McNally Koney, 1995a.

145. Mizrahi & Rosenthal, 1992.

146. Alter & Hage, 1993.

147. Abramson & Rosenthal, 1995, p. 1483; see also ISA Associates, 1994.

148. ISA Associates, 1992.

149. Alter & Hage, 1993; Butterfoss, et al., 1993; Kotloff, et al., 1995; Mattessich & Monsey, 1992; Nezlek & Galano, 1993.

150. Fawcett, Paine Andrews, et al., 1995.

151. Abramson & Rosenthal, 1995; Butterfoss, et al., 1993.

152. Abramson & Rosenthal, 1995.

153. Alter & Hage, 1993.

154. Bailey & Koney, 1995a.

155. Mattessich & Monsey, 1992.

156. Ibid.

157. Bailey & Koney, 1995a.

158. Copple, et al., n.d.; ISA Associates, 1992; Kotloff, et al., 1995.

159. Francisco, et al., 1996.

160. Copple, et al., n.d.; Kotloff, et al., 1995; Paine-Andrews, et al., 1996.

161. Copple, et al., n.d..

162. Cohen & Lang, 1990.

163. Copple, et al., n.d., p..

164. Kotloff, et al., 1995.

165. Nezlek & Galano, 1993.

166. Fawcett, et al., 1993; Fawcett, Paine Andrews, et al., 1995; Francisco, et al., 1993, 1996.

167. Paine-Andrews, et al., 1996.

168. ISA Associates, 1992.

169. Copple, et al., n.d.

170. Wolff & Foster, 1993.

171. Fawcett, Lewis, et al., 1995, Fawcett, Paine Andrews, et al., 1995.

172. Bardach, 1993; Center for the Study of Social Policy, 1995; Fawcett, Lewis, et al., 1995; Francisco, et al., 1996; NIJ, 1995.

173. Mulroy, 1997.

174. Butterfoss, et al., 1993; Kotloff, et. al., 1995.

175. Fawcett, Lewis, et al, 1995; Gambone, 1997.

176. Schatz, et al., 1993.

177. Cohen & Lang, 1990; NIJ, 1995.

178. Center for the Study of Social Policy, 1995; Cohen & Lang, 1990; Gambone, 1997; ISA Associates, 1992; Mattessich & Monsey, 1992; Nezlek & Galano, 1993; Weiss, 1987.

179. Fawcett,

180. Copple, et al., n.d.

181. Copple, et al., n.d.

182. Nezlek & Galano, 1993.

183. Wolff & Foster, 1993.

184. Bailey & Koney, 1996; Butterfoss, et al., 1993; NCIPC, 1993; Schatz, et al., 1993.

185. Butterfoss, et al., 1993.

186. Ibid.

187. Mattessich & Monsey, 1992.

188. Fawcett, Paine Andrews, et al., 1995; Nezlek & Galano, 1993.

189. Bailey & Koney, 1995b; Copple, et al., n.d.; Fawcett, Lewis, et al., 1995; Francisco, et al., 1996; Gambone, 1997; Wolff & Foster, 1993.

190. Nezlek & Galano, 1993; Schneider, 1994; Wolff & Foster, 1993.

191. Gambone, 1997; Mattessich & Monsey, 1992.

192. Copple, et al., n.d.; U.S. Dept. of Health and Human Services, 1997b, Group 1.

193. Mulroy, 1997.

194. Bailey & McNally Koney, 1996.

195. Bailey & McNally Koney, 1995a, Mattessich & Monsey, 1992.

196. Butterfoss, et al., 1993.

197. Kotloff, et al., 1995.

198. Fawcett, Paine Andrews, et al., 1995; Gambone, 1997; NIJ, 1995.

199. Paine-Andrews, et al., 1996.

200. Fawcett, Paine Andrews, et al., 1995; Mattessich & Monsey, 1992.

201. Fawcett, Paine Andrews, et al., 1995; Paine-Andrews, et al., 1996.

202. Francisco, et al., 1996; Paine-Andrews, et al., 1996; Wolff & Foster, 1993.

203. Fawcett, Paine Andrews, et al., 1995.

204. Nezlek & Galano, 1993; Paine Andrews, et al., 1996.

205. Wolff & Foster, 1993.

206. Fawcett, Paine Andrews, et al., 1995.

207. Francisco, et al., 1996.

208. Florin, et al., 1992.

209. Copple, et al., n.d.

210. Ibid.

211. Bailey & McNally Koney, 1995b; Chavis, et al., 1993.

212. Copple, et al., n.d.; Fawcett, Lewis, et al., 1995; Wolff & Foster, 1993.

213. Bailey & McNally Koney, 1995b; Fawcett, Lewis, et al., 1995; Francisco, et al., 1993, 1996.

214. Bailey & McNally Koney, 1995b; Copple, et al., n.d.; Fawcett, Lewis, et al., 1995.

215. Bailey & McNally Koney, 1995b; Cook, et al., 1994; Fawcett, et al., 1993.

216. U.S. Dept. of Health and Human Services, 1997b, Group 1.

217. Fawcett, et al., 1993; Fawcett, Paine Andrews, et al., 1995; Francisco, et al., 1996; Wolff & Foster, 1993.

218. Kotloff, et al., 1995.

219. Goodman & Wandersman, 1994.

220. Cohen & Lange, 1990; Fawcett, Lewis, et al., 1995; Florin, et al., 1992; NIJ, 1995; Ringwalt, et al., 1996; Schatz, et al., 1993.

221. Florin, et al., 1992.

222. Francisco, et al., 1993, 1996; Fawcett, Paine, et al., 1993.

223. Copple, et al., n.d.; Wolff & Foster, 1993.

224. Fawcett, Lewis, et al. 1995.

225. Wolff & Foster, 1993.

226. Fawcett, Lewis, et al., 1995.

227. Butterfoss, et al., 1993, p. 327.

228. Chavis, 1995; Cohen & Lange, 1990; Francisco, et al., 1993; Wolff & Foster, 1993.

229. Copple, et al., n.d.; Fawcett, Lewis, et al., 1995.

230. Fawcett, et al., 1993; Cook, et al., 1994.

231. Fawcett, Lewis, et al., 1995.

232. Cagampang, et al., 1997.

233. Cagampang, et al., 1997; Cook, et al., 1994; Fawcett, Lewis, et al., 1995; Fawcett, Paine, et al., 1993.

234. Center for the Study of Social Policy, 1005; Francisco, et al., 1996.

235. Butterfoss, et al., 1993; see also Schneider, 1994.

236. Abramson & Rosenthal, 1995; Cohen & Lang, 1990; Copple, et al, n.d.; National Evaluation of the Community Partnership Program.

237. Copple, et al., n.d..

238. Bailey & McNally Koney, 1995a; Francisco, et al., 1996.

239. Wolff & Foster, 1993.

240. Bailey & McNally Koney, 1995a.

241. Paine-Andrews, et al., 1996.

242. Butterfoss, 1993, p. 316.

243. Ibid., p. 317.

244. Abramson & Rosenthal, 1995, p. 1479.

245. Chavis, 1995, p. 235.

246. Bailey & McNally Koney, 1995a, p.22.

247. Alter & Hage, 1993, p. 46.

248. Mattessich & Monsey, 1992, p. 4.

249. Gray & Wood, 1991.

250. Chavis, 1993; Chavis, et al., 1993; Florin, et al., 1992.

251. Fawcett, et al., 1993; Fawcett, Paine Andrews, et al., 1995; Francisco, et al., 1993, 1996; Wolff & Foster, 1993.

252. Bailey & McNally Koney, 1995a, 1995b, 1996.

253. Mizrahi & Rosenthal, 1992; Roberts-DeGennaro, 1986.

254. Alter & Hage, 1993.

255. Ibid., p. 265.

256. Ibid., p. 103.

Appendix A-Definitions

Definitions

The terms community partnership, coalition, and collaboration have been used interchangeably by some authors and have been differentiated by others. Frequently their parameters are assumed or implied. Some definitions have, however, been offered.

Early definitions of coalitions saw these groupings as relatively short-term, loosely structured alliances. In more current usage, coalitions are "inter-organizational, cooperative and synergistic working alliances....[that] unite individuals and groups [representing diverse factions or constituencies] in a shared purpose."⁽²⁴²⁾ In contrast to other types of groups, they are "formal, multi-purpose and long-term alliances."⁽²⁴³⁾ Coalition members advocate for both the organization they represent and for the coalition itself; they exchange mutually beneficial resources; and they direct interventions at various levels.

Abramson and Rosenthal provide a similar definition of collaboration, in which autonomous partners, diverse individuals, as well as organizations, work toward common goals. "Ideally, collaboration entails a common vision, a jointly developed structure; and the sharing of work, resources, and rewards."⁽²⁴⁴⁾

According to Chavis, the term partnership reflects "their multi-sectoral (e.g., spiritual, business, government, grassroots citizens, schools) make up...[and] implies the shared and long-term commitment of effective community coalitions; everybody brings something of value to the table."⁽²⁴⁵⁾

Bailey and McNally Koney use the term community-based consortium and define it as "a partnership of organizations and individuals representing consumers, service providers, and local agencies or groups who (1) identify themselves with a particular community, neighborhood or locale, and (2) unite in an effort to apply collectively their resources toward the implementation of a common strategy for the achievement of a common goal."⁽²⁴⁶⁾ The consortium is similar to the participatory federation in that members have an active role in decision- and policy-making; however, the federation may be issue-based rather than community-based, and the central office retains significant control over the resources and activities. They distinguish coalition from consortium in that the latter can include individuals as members while the former consists only of organizational members. In addition, the community is identified by the consortium/coalition members.

Another, related concept is the network, which Alter and Hage define as "the basic social form that permits inter-organizational interactions of exchange, concerted action, and joint production. Networks are... clusters of organizations that are nonhierarchical collectives of legally separate units."⁽²⁴⁷⁾ They have four characteristics: 1) a shared conceptual framework with common goals and methods; 2) nonhierarchical structure and joint decision making and equal status among members; 3) division of labor, each member contributing compatible competence to the whole; and 4) self-regulation in the production of a new service. The forms of networks vary with their degree of cooperation, the number of member organizations, and the competitive or symbiotic relationship of member organizations. They also vary in their purposes, structure, operations, and outcomes. Obligational networks, like ad hoc committees, are loosely knit groups. Promotional networks, like coalitions, are associations of organizations that pool resources to accomplish a common goal. Systemic production networks contain multi-organizational units that create a community-based service delivery system through division of labor. They usually pursue a larger societal goal. (See Appendix C, "Models of Community Partnerships," for further discussion of this framework.)

Mattessich and Monsey differentiate among the terms collaboration, coordination, and cooperation. Collaboration is "a mutually beneficial and well-defined relationship entered into by two or more organizations to achieve common goals. The relationship includes a commitment to mutual relationships and goals; a jointly developed structure and shared responsibility; mutual authority and accountability for success; and sharing of resources and rewards."⁽²⁴⁸⁾ Communication channels are well defined and operate on many levels. Authority is determined by the collaboration structure. Cooperation, in contrast, is an informal relationship without a commonly defined mission, structure, or planning effort. Information is shared as needed, and authority is retained by each organization. Risks, resources and rewards are not shared. Coordination falls in between the other two. It involves somewhat formal relationships, with some planning, division of roles and understanding of compatible missions. Formal channels of communication are established. Individual organizations retain authority but share risk, resources, and rewards to an extent.

These definitions suggest the elements of a working definition of community partnership. Such an alliance

• is composed of two or more legally separate units, which may include individuals as well as organizations, agencies, or other entities;
• shares a commonly defined mission and goals;
• develops a nonhierarchical structure that makes decisions and policy and has well defined channels of communication;
• shares responsibility and resources and rewards and risks; and
• includes citizens of the local community and representatives of local community groups and organizations.

Appendix B-Overview of the Development of a Community Coalition

Overview of the Development of a Community Coalition*

*Butterfoss, Goodman, and Wandersman, 1993, "Community Coalitions for Prevention and Health Promotion." in Health Education Research: Theory and Practice, Vol. 8, No. 3, page 320.

Appendix C-Models of Community Development

Models of Community Partnerships

Models of partnerships tend to focus on one of three questions: (1) what are the preconditions that lead to partnership formation; (2) what is the process of collaboration within the partnership; and (3) what are the outcomes when organizations join in partnerships.⁽²⁴⁹⁾ Models of partnerships in teen pregnancy prevention and other health promotion efforts have looked primarily at the process of interaction within the partnership, viewing the group over time and looking at internal and external factors and their relation to each other. They typically see partnerships as evolving through a series of stages, with certain issues or tasks assuming prominence in each phase. The rate at which the partnership moves through these stages and the direction of change is affected by internal and external factors. Some of the more well developed models are described below.

The Open Systems Model⁽²⁵⁰⁾

Florin, Chavis and associates develop a model of partnerships using systems theory. In this view, pictured in Figure 1, community organizations are open systems that receive various input from the environment, which is transformed within the organization by organizational components and processes and becomes throughput. Within the throughput the organization performs activities that use energy or resources to either maintain the organization or produce the organization's goals. Once they leave the organization, its activities result in output, either intended or unintended. These become part of the environment, which can serve as further input to the organization. Like all systems, community partnerships tend toward disorganization and "death" or entropy. The organization resists entropy by using energy, first collecting inputs or resources-for example, members and money-then transforming them to maintain the organization, and then using them to produce output.

This model highlights the importance of access to information on the environment, both from community assessment and from feedback, including criticism, on organization activities. The community partnership must make constant adjustments to the environment. The organization also needs information on its own functioning; again monitoring and feedback are important to maintaining the organization.

The Health Promotion through Community Change Model⁽²⁵¹⁾

The Work Group on Health Promotion and Community Development adopts a health promotion approach in which responsibility for supporting health and preventing disease is shared by individuals and the environment. The Work Group shares the view of the World Health Organization that a community development approach emphasizing self-help, citizen participation, and community control fits well with the health promotion framework. Their model posits community partnerships as catalysts for community change. Community change is, narrowly, new and adjusted programs, policies, and practices related to the partnership's mission. Ultimately, community change is the achievement of the health outcomes that are the partnership's mission, along with empowerment of the community.

The model is presented in Figure 2, an adaptation and simplification of Community partnerships plan for and implement preventive interventions designed to change the targets of change, for example, youth and parents, and agents of change, for example, peers and adults, in various channels of influence, or community sectors, such as schools, courts, and the like. Collaborative planning, the first element in the process, involves the community in identifying community health goals and specific changes to be sought in the community. Health goals are specific levels of intermediate and ultimate outcomes, for example, a 50 percent reduction in sexual activity among young adolescents and a 25 percent reduction in rates of teen pregnancy. Community leaders and outside support may assist in planning by providing training to community members, assisting with needs/strengths assessment, developing group structure, and assisting in strategic planning. Planning is both a first step and a continuing activity throughout the life of the partnership.

Community actions are the second element in the process. They begin to occur regularly in the first eight to twelve months of the partnership. These are actions taken within the community by the partnership to create community change. For example, meeting with the school principal about new after-school programs is a community action. Community changes, the third element, are new or transformed programs, policies, and practices, such as an after-school program for latch-key youth, enhanced enforcement of truancy regulations, and the like. They begin to occur regularly in the first 10 to 14 months of the partnership. These actions and changes are seen, within a public health model, as affecting risk and protective factors associated with particular health outcomes. Both community actions and changes are among the more immediate outcomes of the partnership.

Community capacity and intermediate and ultimate outcomes, the fourth element, are the ultimate goals of the partnership. These include the community's ability to pursue its chosen purposes both now and in the future and the evidence of the impact of the partnership's activities on intermediate outcomes, such as behavioral factors linked to its purpose, and on ultimate outcomes. The fifth element is adaptation, renewal, and institutionalization. This is the partnership's ability to adjust to new conditions and build long-term, sustainable capacities. Each element of the partnership framework affects the others. And outcomes can provide feedback that will affect future planning, implementation, and outcome.

Because ultimate and even intermediate outcomes often take many years to appear and are difficult to document, it may be hard for partnerships to sustain their efforts and retain support. The Work Group advocates that evaluators and partnership members together develop a system of evaluation that suits local conditions and answers questions identified by the members. Using a variety of sources of data, including
    a monitoring and feedback system,
    event logs,
    a goal attainment report,
    constituent surveys,
    interviews with key participants,
    surveys of satisfaction,
    written documents,
    behavioral surveys,
    community level indicators of impact, and
    other sources,
evaluators assess four process variables-members recruited or participating, planning products, financial resources generated, and dollars obtained-and three outcome measures-services provided, community actions, and community changes. These variables may change, depending on the particulars of a given group; in one partnership evaluation, instances of media coverage were included among process measures. The results of this monitoring are regularly communicated to partnership members, the community, and current and potential funders. This information guides partnership development and allows the recognition of early success. The Work Group has used this system to evaluate eight health and human services coalitions in Massachusetts, cardiovascular disease prevention coalitions in Kansas, a CSAP Community Partnership Program in New Mexico, a substance abuse prevention program in Kansas, and three replications of the South Carolina School/Community Program to Prevent Teen Pregnancy.

In these various partnerships, evaluators found that process measures developed first, usually in the first three to six months, and continued to increase throughout the life of the group. Groups that only produced high levels of planning products, which the Work Group called "Planning Coalitions," tended to be productive and have satisfied members during the first year, but then both production and satisfaction decreased. Services and community actions developed in the first six to eight months. Community changes followed. Groups that largely produced services for members and providers, with few community actions or changes, tended to have high degrees of member satisfaction. Groups providing services to the community without many community actions or changes tended to be newer and still developing. The Work Group called these "Support Networks." "Coalitions as Catalysts for Change" produced planning products and then community actions and changes in steadily increasing numbers. Services provided grew steadily but more slowly. "Hybrid Coalitions" had high numbers of both planning products and community actions and somewhat lower numbers of community changes and services. Satisfaction of members in these groups was high.

Analyzing the data from these partnerships, the Work Group concludes that planning products do not lead to community change; community actions are necessary for change, and in most cases the actions do produce changes. They hypothesize that community changes are early evidence of the partnership's success. There was evidence for this relationship in the analysis of Project Freedom, a partnership to prevent alcohol and other drug abuse, which successfully changed its community in many ways and documented a reduction in single car accidents, a measure of community level impact, that appears related to these changes. Further research is needed to establish this causal link.

The empowerment framework advocated by the Work Group includes grant makers, outside evaluators, and technical support providers within the partnership. They and local partnership members are interconnected, each requiring the cooperation of the others to function successfully. More reciprocal relationships among partners, with communities defining priorities, directing missions, determining assistance activities, and influencing evaluation methods and goals, should lead to both empowerment and the achievement of community-determined outcomes.

Community Based Consortium Development⁽²⁵²⁾

In a series of articles, Bailey and McNally Koney review the literature on the development of organizations, inter-organizational collaboration, and community organizing and find that, despite differences, the models have three elements in common: 1) they view development as an evolutionary process from start up to mature system; however, they do not see this progression as always proceeding smoothly from one stage to the next-various factors both within the system and outside it can affect how quickly the system moves from stage to stage and whether it moves forward or backward. 2) They view the chronological age of the partnership and its stage of development as independent. 3) Each developmental stage has specific issues and characteristics associated with it.

From the literature, they isolate eight key components that together characterize partnership development:

• leadership that is inspirational & either participatory or authoritative; it may be one or more organizations or individuals
• membership representing diverse constituencies
• environmental linkages-the type, strength, and continuity of connections between the partnership and external organizations, including the level of community involvement
• purpose-or mission and whether it is voluntary or mandated
• strategy-the ideology and proposed means to achieve the purpose
• task(s)-the number of issues to be addressed and specific activities that will lead to accomplishing the purpose
• structure-the size, geographic scope, centrality of decision making, complexity of function and services, formality of rules and policies
• systems-the mechanisms for decision making, communication, budgeting, planning, administration, and the like

Leadership has an overarching role in creating effective relationships among all the components. Others of these components have primary or secondary importance in one or more of the four stages of partnership development. Their four-stage model is adapted from earlier three-stage models-formation, maintenance, and termination.⁽²⁵³⁾ They call their framework Community Based Consortium Development (CBCD).

Assembling is the first phase. During this period a leader is identified, either through self selection, mandate, or by community choice; members are recruited based on resources needed to achieve the mission; roles, responsibilities and relationships are determined and understood; the mission of the group is understood; a structure is initiated; funding and other resources are identified.

Ordering is the next phase. In it processes and structures for building consensus and managing conflict are established as are systems for distribution of resources, communication, decision making, and evaluation; member recruitment continues as turnover occurs; leaders emerge among members.

Performing is the third phase. It involves the operation of all the systems that were established and performing the activities necessary to accomplish the group's purpose.

Ending is the final phase. The focus in it is on evaluation of the partnership, making adjustments and improvements, and ultimately disbanding or renewing the association by reforming or creating a new group.

The eight partnership components are process variables to be measured in formative evaluation that assesses the processes used by the group in its development and their strengths and weaknesses. This information is regularly communicated by evaluators to partnership members to allow for continuous improvement and to monitor the development of the partnership through the four stages. Summative evaluation measures the achievement of the partnership's goals and objectives.

Bailey and McNally Koney note that their model is based on a social psychological approach that emphasizes socio-emotional characteristics, for example, interpersonal relationships, influence, power, control, and satisfaction of the members and leader. In addition, their examples are all partnerships that were formed as a condition of external funding mandates. They conclude that the model should be used as a general guide rather than a detailed blueprint for partnership development.

Systemic Inter-organizational Networks⁽²⁵⁴⁾

One of the most highly developed models of inter-organizational groups is proposed by Alter and Hage in their book-length study of a variety of "network" arrangements in both the public and private sectors.

Alter and Hage suggest that four conditions are each necessary for inter-organizational relationships to develop: there must be a need for financial resources and sharing of risk; a need for expertise; a need for adaptive efficiency, i.e., speed, flexibility, and quality in the development of new products and services; and finally, a willingness to cooperate. They propose that the willingness to cooperate is the most basic condition and that it shapes analysis of costs and benefits. In other words, both ethics and economics lead to cooperation: increasingly, among cognitively and technologically advanced groups, solving complex problems is seen as the joint good. A culture of trust, created by a history of collaborative behavior, such as professional associations and friendship networks, is necessary for there to be a willingness to cooperate. The complexity of the task is the critical determinant of greater inter-organizational collaboration because it increases willingness to collaborate, need for expertise and need for funds and sharing of risks. The interaction of these conditions is pictured in Figure 3.⁽²⁵⁵⁾

Alter and Hage describe a 12-type system of inter-organizational forms of collaboration based on variation along three dimensions. The first dimension is whether the organizations are in competitive or symbiotic relationships, in other words, whether they occupy the same sector or different sectors. The second dimension is the number of organizations involved: two and three organization associations are distinguished from multi-organization networks. The final dimension is the extent of cooperation among the organizations: limited, moderate, and broad. The authors suggest that inter-organizational collaborations tend to evolve, going from exchange relationships to action or promotional networks and finally to joint ventures and systemic networks, which are non-competitive associations of many organizations that cooperate broadly. This sequence is not rigid; a network may begin as a systemic production system. However, more developed forms have to include the collective activities of the less developed forms. Alter and Hage note that they might have included other dimensions in their taxonomy, for example, duration of the group, location of the membership, and others. They suggest that their taxonomy is not exhaustive but is a beginning.

Synthesizing organizational theory, population ecology theory, and institutional governance theory, they suggest a system of 19 variables grouped into categories. Their model is shown in Figure 4.⁽²⁵⁶⁾

External controls on the network include three factors:

• resource dependency-the degree to which the network relies on external resources, for example, state funding
• network autonomy-the degree to which the network is governed by external mandates
• work status-the degree to which clients receive services voluntarily or involuntarily

Technologies, what we know and how we use this knowledge, can be defined along five dimensions:

• task scope-the complexity of the task, for example, the number of categories used to diagnose or the number of intervention roles used in service delivery
• task intensity-the degree to which services are concentrated, for example, the average minutes spent with or on behalf of each client
• task duration-the degree to which services are long lasting, for example, the average months case remains open
• task volume-the size of the work load, for example, the average number of cases at one time
• task uncertainty-the extent to which outcomes of the process or intervention are knowable.

External controls and technologies together comprise the environment of the network. These to a large extent determine the network's structure and operations. The five dimensions of network structure are:

• size-the number of participating organizations
• centrality-the extent to which one or a small number of organizations dominates the network
• complexity-the extent to which a variety of services are available to clients within the network
• differentiation-the extent to which there is division of function among organizations in a network
• communication/connectivity-the number of communication linkages between organizations in the network.

The choice of coordination methods, called operational processes, are the operations of the network that are most important for outcomes. These processes occur at two levels:

• administrative coordination-the extent to which decisions are made jointly and with mutual adjustment and feedback. Coordination at the administrative or policy level can be impersonal-achieved through formal plans, contracts, and rules, either written or unwritten. Coordination can be achieved through personal methods, involving a staff person who acts as coordinator and informal, direct communication between administrators and staff. And coordination can be through group methods in which standing and ad hoc interagency committees meet regularly to plan and coordinate.
• task integration or operational coordination-the extent to which staff members work together interdependently across organizational boundaries. Task integration can be sequential, in which one agency treats a client, terminates service, and refers to the next agency. Task integration can be reciprocal, in which more than one agency treats the client at the same time. Or it can be collective, in which staff from several agencies develop treatment plans together and systematically share the tasks of treating the client.

Networks employ some combination of the three levels of administrative coordination and task integration. When environmental factors, structural characteristics of networks, and internal coordination are in balance, networks operate effectively, with two outcomes kept in check:

• conflict-the amount of disharmony and strife between organizations in a network, and
• performance gap-the difference between expectations of the network's effectiveness and its actual effectiveness.

A network is in balance when its technology, structure, and coordination develop "in tandem." In other words, as dependency on external resources, complexity of tasks, and complexity and differentiation of structure increase, higher levels of personal and group coordination are required. When impersonal coordination is used in dependent and complex networks, there is greater conflict and performance gap. There is a tendency for networks to be pushed out of balance by controls from outside funding sources that emphasize impersonal methods of coordination through regulation, formal operating procedures, and structural differentiation. This sort of network experiences the most conflict and performance gap.

In contrast with administrative coordination, task integration through team methods increases as networks become more complex and more dependent on outside resources. Alter and Hage suggest that task integration may compensate to some extent for lack of administrative coordination. Inter-organization direct service teams are easier to establish than joint administrative decision-making groups. They are also harder for outsiders to control.

The theory and its application to a variety of social service networks lead Alter and Hage to make several recommendations for inter-organizational groupings:

• Power within large organizations should be decentralized.
• If there are many exchanges of clients between agencies, a boundary spanner should be created to help move the relationship toward joint service development.
• Partners with complementary competencies are better suited to develop solutions to complex problems.
• In promotional linkages and networks it is better if all organizations are of about the same size in personnel and revenues.
• Support networks of all professionals working in a network should be formed at the same time as the network to build trust, by creating social bonds through information sharing, collective learning and other interdependencies.
• As tasks get more complex in promotional and systemic production networks, coordination through teamwork involving all member organizations becomes essential. In simpler systems, like promotional linkages and production ventures, boundary spanners must provide a steady flow of information to member organizations about developments and difficulties. Problems should be solved jointly.
• In systemic production networks and joint ventures, successes and failures, profits and losses must be shared. This is necessary for joint problem solving.
• In systemic production networks and joint ventures there should be coordinating councils at the administration and production levels. Coordination requires active participation of members in joint problem solving.
• In any collaborative effort, structural differentiation leads to a lack of a common frame of reference, or definition of the problem, which is a major cause of conflict. This can only be overcome by understanding of the partner organizations' culture and model, which is best accomplished by transferring personnel, both staff and administrators, to the other agencies.
• Partners and the government need to measure adaptive efficiencies, time to market, and the time cost of development, so that managers do not continue to focus exclusively on production efficiencies.

FIGURE 1

The Open Systems Model*

*Chavis, Florin & Felix, 1993, "Nurturing grassroots initiatives for community development: the role of enabling systems," in Community Organization and Social Administration: Advances, Trends and Emerging Principles, edited by T. Mizrahi and J. Morrison, New York: The Haworth Press, page 45.

FIGURE 2

The Health Promotion through Community Change Model*

*Francisco, Paine, & Fawcett, 1993, "A methodology for monitoring and evaluating community health coalitions," Health Education Research: Theory and Practice, Vol. 8, No. 3, page 405.

FIGURE 3

The Environmental Forces that Promote

Systemic Inter-Organizational Networks*

FIGURE 4

The Systemic Inter-Organizational Network Model**

*Alter & Hage, 1993, Organizations Working Together, Thousand Oaks, CA: Sage Publishers, page 265.
**Ibid., p. 103.

Appendix D-State and Community Partnerships: Case Studies

A. Kansas

The School/Community Sexual Risk Reduction Replication program is a comprehensive community-wide strategy for preventing adolescent pregnancy first developed in South Carolina in 1982. The Kansas replication, funded by the Kansas Health Foundation, began in 1993 with four-year grants to three sites: Geary County-with the Fort Riley military base, Franklin County-primarily a rural community, and Wichita-an urban area. The Foundation is currently establishing phase 2 of this initiative with four years of funding to three new sites in the state.

Developed and initially implemented in Bamberg County, South Carolina, the School/Community Sexual Risk Reduction Model (the Model) is based on the hypothesis that the greater the number of important changes in school and community contexts related to reducing adolescent pregnancies, the greater the likelihood of achieving this outcome. The ultimate mission of the initiative is "to improve social and health status in the community through long-term change in environmental factors and personal behavior related to health."

Objectives include:

• Reduction of unintended pregnancy among never-married teens and preteens,
• Promotion of abstinence and postponement of the age of first intercourse, and
• Promotion of effective contraceptive use among teens who choose to be sexually active.

The program included components designed to: 1) enhance sexuality education; 2) implement age-appropriate comprehensive K-12 sexuality education; 3) increase access to health services and contraceptives; 4) collaborate with school administrators; 5) use the mass media to increase awareness and involvement; 6) provide peer support and education; 7) provide alternative activities for youth; 8) establish community linkages; and 9) establish programs in religious organizations. It is the combination of these multiple components that is hypothesized to change the environment and impact teen pregnancy.

The Kansas sites replicated the Model, including the program time frame and key components. However, each community defined specific project objectives for reducing pregnancies, increasing abstinence, and increasing contraceptive use by 1996. Evaluation was key to the replication and included both process and impact measures, measuring integrity of the replication and changes in estimated pregnancy rates. Teen pregnancy rates were successfully reduced in both counties and in one zip code in Wichita.

The program director feels that several lessons learned in these sites will be of value in phase 2. Essential to all was the development and support of alliances among community members across a broad spectrum of sectors. A key first step in this process was involving these sectors as partners in the agenda-setting process. In support of this, the leadership of the project on both the lead agency level and the community level was critical. Lead agency staff had to be ready to be vocal and strategic in their agency alliances and in the allocation of resources to support the goals of the project. In addition, both levels had to be ready to make hard decisions in the community and at meetings about strategies, interventions, resources, and the direction of the project.

Each site had an advisory board or steering committee that guided the development of the action plan. The composition of each board was to be as reflective of the community as possible and to include sectors of the community that could be instrumental in meeting the goals and implementing the strategies laid out by the foundation. It was suggested that sites seek out and recruit those in the community who opposed the project. This was particularly important because there was organized opposition to the project in all three communities, primarily in the faith communities and around the issue of access to contraceptives. Questions remain open: who should be involved and how and what expectations for their involvement in the project might be reasonable. Given the importance of its work, the board/steering committee needs orientation and capacity building assistance on expectations, tasks, and the process of implementation.

With regard to community commitment, there is a need for increased evidence of a broad range of sectors involved in the planning and the implementation of the action plan. Often partners who were included in the initial proposal were not at the table when implementation began. In phase 2, Letters of Intent submitted as part of the application process by the partners will help to formally bind all to the project and its implementation. In addition, the action plan, which in the original replication was part of the application, will now be a product of the first quarter of funding and must reflect the inclusion of the broad sectors who committed in the application process.

Evaluation will continue to be a key component of Phase 2. Summative and formative evaluation processes allowed the sites and oversight staff to analyze the effectiveness of the partnership in addressing the needs of its members and in meeting project goals. Satisfaction surveys distributed semi-annually monitored the community collaboration process. These were also helpful in identifying technical assistance and training needs for the sites. The evaluators are in the process of analyzing the data, including behavioral changes associated with sexual activity and contraceptive use and estimated pregnancy rates. They hope to publish their findings in the coming year.

More than 100 documented changes occurred in these communities, creating an environment that is more conducive to addressing teen pregnancy. Curriculum changes and increased access to condoms have become part of the system in some of the communities. All three communities continue the teen pregnancy prevention efforts begun during the replication project, to a greater or lesser extent, depending largely on their success in fundraising. All of the sites are currently in transition, since the replication project ended in the summer of 1997. The extensive evaluation component ended with the replication.

In Geary County, the program is receiving unspent funds from the original Kansas Health Foundation grant and, as a condition of funding, maintains its commitment to the original mandates of the grant. The County Health Department has assumed leadership of the program, with the school district remaining as fiscal agent responsible for management and supervision of the grant. The program has retained the previous staff, including a director, on-site coordinator, administrative assistant, and three interns from Kansas State University. For the most part, programs from the replication project remain intact. They are currently looking for additional funding and considering broadening their scope to youth development.

In Franklin County, teen pregnancy prevention efforts continue among agencies and community-based organizations that were partners in the initial project, which is still known as the Phase Program. Parent education classes, youth groups in the schools, and limited teacher education opportunities are on-going. In addition, Phase Program staff still provide community presentations to promote awareness of teen pregnancy and provide sexuality education information. After-school mentoring, recreation, and employment programs were developed during the demonstration project by Phase staff and other youth serving agencies working collaboratively. These agencies have now taken the lead in supporting and staffing these programs, which continue much as they did before. The Phase staff is working on increasing access to health services provided by the County health clinic. They hope to develop links between the school district and the clinic eventually. Staff are working to increase youth development efforts and to seek out other partners and funding opportunities. They are also considering focusing their efforts on a more targeted population of teens at high risk for pregnancy.

The Wichita City program continues with support from various state and local funding sources, providing youth workshops, teacher education opportunities, health education classes, and after-school programming. The community advisory board, which was an essential element of the initial project, is in the midst of transition, moving toward a membership that can support the teen pregnancy prevention effort with human and material resources. The need for funds has assumed primary importance for this community.

B. Minnesota

Started in 1991, the Teen Pregnancy Prevention Project of Minnesota (TPPPM) developed out of an interagency team into a public-private partnership housed in Minnesota Planning, a state agency. It was governed by a steering committee of representatives of state agencies and local and private agencies. Before 1991, the state had numerous programs and task forces working to reduce teen pregnancy rates; however, there was no comprehensive, coordinated strategy at the local and state levels and no funding mechanism to support community-based programs and form a coherent and effective public policy.

TPPPM was a demonstration project with the mission of reducing teen pregnancies in Minnesota. There were four specific project goals: increasing collaboration at the community and state levels on teen pregnancy prevention issues; increasing effective and replicable teen pregnancy prevention programming; increasing leadership on the state level for the prevention of teen pregnancy and the support of teen parents; and strengthening policies in Minnesota related to adolescent pregnancy prevention and parenting.

TPPPM employed four strategies intended to develop a comprehensive system of support, resources, programming, advocacy, and public policy to reduce teen pregnancy in Minnesota:

1) Six community-based collaboratives (pilot projects): 1. Cross Cultural Pregnancy Prevention Peer Education Program in St. Paul; 2. Project SIGHT in Northfield and Fairbault; 3. the Tri County Coalition on Adolescent Pregnancy Prevention in Cook, Lake and Carlton counties; 4. the Red Lake Teen Pregnancy Prevention Coalition on the Red Lake Reservation; 5. the Youth Health Collaborative in St. Louis Park; and 6. the Youth Issues Network in Park Rapids.

2) A statewide professional membership organization: Minnesota Organization on Adolescent Pregnancy Prevention and Parenting (MOAPPP), whose membership included private, nonprofit, and public service organizations joined to strengthen polices and programming related to adolescent pregnancy prevention and parenting. Services included service provider trainings, an annual conference, a quarterly newsletter (MOAPPP Monitor) and public policy, public education, and awareness efforts.

3) Research and information activities: The Teen Pregnancy Prevention Clearinghouse collected and disseminated statistics and objective information on adolescent health and teen pregnancy. Its goals were to increase the efficacy of prevention programing and encourage the exchange of information among local programs and between state government and communities.

4) A technical assistance service: A variety of training and consultation services were provided to pilot projects, communities, and task forces over the life of the TPPPM. The TA service shared the same goals as the Clearinghouse.

Wilder Research Center evaluated TPPPM through telephone surveys, a written survey of pilot project collaborative members, in-person interviews, and analysis of data from the 1992 and 1995 rounds of the Minnesota Student Survey. The evaluators concluded that TPPPM had achieved a number of its goals:

• Increased collaboration on teen pregnancy issues among staff at both the state and local levels occurred. Collaboration was more successful within communities than between communities.
• Depth and coherence were added to existing adolescent pregnancy prevention programming in the pilot project sites, as evidenced in youth development measures and enhanced sexuality communication among youth. Five of the six developed new programs, strategies, and curricula, and promotional and educational materials. All of the pilot projects supplemented their TPPPM programming with funding from community-based efforts and/or other public and private funds.
• Leadership and advocacy at the state level for teen pregnancy prevention was enhanced though MOAPPP, which had a comprehensive public awareness campaign, including interviews with the media, statewide presentations, testimony to the Legislature, and a briefing at the White House in connection with the National Strategy to Prevent Teen Pregnancy.
• TPPPM's efforts directly contributed to the passage of two key pieces of legislation since 1991: Male Responsibility and Fathering Grants and Minnesota Education Now And Babies Later (MN ENABL).

Although funding for the overall project concluded in 1996, three of the four strategies are still in operation through MOAPPP, which is now the lead agency in Minnesota in providing both technical assistance and research and information to health professionals and agencies involved in reducing teen pregnancy in the state. Thus, MOAPPP has absorbed the roles of the clearinghouse and the technical assistance service. The only thing that has changed is that there is no state-level administrative supervision of the community-based pilot projects. MOAPPP now receives funding from public and private sources and membership dues. It currently has an active membership of 350. The MOAPPP Monitor reaches 800 to 1000, and the mailing list is close to 6,000. In fiscal year 1997-98, MOAPPP was awarded a contract to train grantees of MN ENABL. The organization is now applying for fiscal year 1998-99 funding to work with the 24 additional communities that have just received MN ENABL funding.

Although the community pilot projects are no longer funded by TPPPM, Project Sight and the Youth Health Collaborative have received funding from MN ENABL and have continued some of their adolescent pregnancy prevention efforts under that umbrella. Some community activities that were developed as a result of TPPPM continue in the other pilot project sites, but they do not function in the collaborative that was originally funded by TPPPM.

In July 1996 TPPPM released Investing in Teen Pregnancy Prevention: Lessons Learned from Minnesota, which identifies 11 key elements that contribute to the success of a teen pregnancy prevention collaborative. Of particular importance to the development and maintenance of collaboratives are two activities. First is the dual challenge of keeping members involved and of recruiting new collaborative members when turnover occurs. These are on-going processes for which new strategies are always needed.

Anticipation of conflict and the skills to work through differences were also challenges, especially at the community level. The use of consensus for collaborative decision-making may have led communities to make decisions that pleased the majority rather than fully explore the range of solutions and strategies. To avoid risking the ire of fellow community members, some sites chose intervention strategies, which, although somewhat effective, may not have been the most appropriate for their community. Conflict over the causes of and solutions to teen pregnancy produced an environment in which the communities chose methods that were not consistent with proven strategies in reducing adolescent pregnancy.

The structure of the collaborative was important to its viability. TPPPM's steering committee was composed of a diverse and committed membership who supported and monitored the project. Those involved felt that although reflective of the community and the professional organizations involved in teen pregnancy prevention and parenting in Minnesota, the board also needed to include members who had contacts with both public and private funding sources. They also noted that orientation and training for board members is vital to their effectiveness in directing policy and allocating resources. Another factor in TPPPM's effectiveness was the neutrality of Minnesota Planning and the professional commitment it had to the mission and the goals of the project. At no time did Minnesota Planning interfere in the operations and management of TPPPM.

TPPPM, through MOAPPP, has been very successful in developing and advocating for changes in Minnesota public policy related to adolescent pregnancy prevention and parenting. As a result of their efforts, $1.3 million in general funds was allocated for Adolescent Parenting Grants. These funds are available in fiscal years 1998-2000, in a competitive process, to schools interested in implementing or expanding programs in grades K-12 for adolescent parents and their children. Programs include efforts to reduce additional pregnancies among teen parents and to reduce pregnancies among their siblings. This advocacy success led to a more structured and informed advocacy group, as well as to more insight into the legislative process.

There is some frustration among those involved at the loss of focus on teen pregnancy prevention at the state level. The coordinated state policy gave importance to the issue in the public eye and provided more secure funding for various efforts. Loss of these advantages has led to more time spent raising funds and greater efforts made to develop advocacy activities.

C. New Jersey
The Network For Family Life Education
Susan Wilson, Executive Coordinator

School Based Youth Services Program
New Jersey Department of Human Services
Roberta Knowlton, Executive Coordinator

New Jersey Network on Adolescent Programs
Phillip Benson, Project Director

New Jersey does not have a single entity that oversees a comprehensive statewide strategy to prevent teen pregnancy; it has three separate organizations that combine to form an informal and successful statewide coalition. Although the three are funded and managed independently of one another, senior staff work closely in developing resources and engaging different sectors of the community to support healthy youth development. The following describes each organization and some of the challenges and successes they have had in terms of collaboration, partnership development, and the reduction of teen pregnancy.

The Network for Family Life Education (Network)
Founded in 1981 after the State Board of Education adopted a requirement for family life/sexuality education in public schools, the Network's mission is to 1) support age-appropriate, balanced family life/sexuality education in schools and communities through the delivery of training and technical assistance to New Jersey teachers, policy makers, and local governments and 2) coordinate advocacy of effective implementation of family life education in New Jersey public schools.

Directed by Susan Wilson, former Board of Education member and author of the 1981 education requirement, the Network is in the unique position of having staff who were instrumental in its own development and who have an intimate knowledge of the players and issues related to family life/sexuality education in New Jersey. The Network dominates the state with regard to this issue, and its long history of commitment and effectiveness has yet to produce a competitor. Often working in alliance with Planned Parenthood and other agencies, the Network has an informally defined territory of advocacy, resource development, and trainings related to family life/sexuality education in public schools.

The coordinator attributes most of the success of the Network to its focus: during its 16 years, it has concentrated on implementing the policy that was the impetus for its origin. The Network is a membership organization, the only state-level one of its kind in New Jersey. There are no membership dues and very few expectations of members, who include statewide youth and family planning associations, various state departments (e.g., education, health, human services), and other associations/councils that have an interest in maternal, child, and adolescent health and reproductive rights. Part of the process by which the Network stays in touch with the membership is through informal evaluations about expectations and needs and most of all by re-visiting the mission and goals of the Network every year. The Network continuously re-evaluates its effectiveness and usefulness in implementing the family life/sexuality education standards.

Members have full access to the range of services and resources that the Network provides. These include regional trainings and conferences throughout the state and statewide seminars to discuss teen pregnancy prevention across communities and disciplines. Statewide activities include four annual meetings that revolve around a variety of issues, most of which are skills-based and reflect the needs of constituents. Attendance at these meetings remains high after 16 years because members know that the information delivered will be rich in content and relevance. On the national level, the Network provides staff trainings and publishes newsletters for adolescents and teachers.

The Network's clients are the catalysts for the materials and documents it develops. SEX, etc, a newsletter developed and written by youth, is received in 85 percent of the high schools in the state, which has 600 school districts. Another publication, Family Life Matters, is sent to almost 2,000 educators and health-related staff in 49 states. The Network's membership has continued to grow over the past 10 years.

The Network is housed at Rutgers University, a publicly funded institution. There have been ongoing internal discussions about whether to remain affiliated with the University. The director believes that the Network's long history of affiliation with the University adds credibility and integrity to its work. It is seen as an objective and research-based entity dedicated to implementing the State Board of Education's policy. On the other hand, as a publicly funded body, it cannot lobby the legislature, a key strategy in insuring the allocation of funds and the adoption of policies that support the Network's goals.

The Network notes several major accomplishments: 1) establishing core curriculum standards across the New Jersey Unified Public School District; 2) creating resources and materials that support the implementation of state policy and respond directly to the needs of members; and 3) continuing to support the will of the people of New Jersey and to reflect and address the changing needs of the membership. In 1993, the Network received the Best Statewide Coalition Award from the National Organization on Adolescent Pregnancy, Parenting and Prevention, which recognized their focus and commitment to their goal.

School Based Youth Services Program (SBYSP)
SBYSP was established in 1987 to provide services to children and adolescents in New Jersey by linking education, social services, employment, and health services in or near school sites. The program was introduced by Governor Tom Kean during his 1987 State of the State speech and received the support of business, education, and parent leaders across the state. These forces were instrumental in its passage by the legislature and the appropriation of $6 million for the 1988 program year. Focus groups held with youth to determine their opinions and suggestions for program components elicited a strong message for "caring adults who would listen to them, be non-judgmental, and help them with decision making-not make decisions for them."

There is at least one SBYSP site in each of the State's 29 counties, in elementary, middle and/or high schools. The overall program is supervised by the Department of Health and Human Services, with management at the local level by public and non-profit entities and schools. The local project director works closely with all members of the school staff in order to integrate SBYSP into the school and increase its accessibility to students. All local sites have an advisory council that includes school, business, parent, and faith community representatives.

Each community determines the array of programs and services that will be offered locally. These may include tutoring, mentoring, recreation, employment, educational enrichment, peer counseling, pregnancy prevention programs, and the like. Over time, sites add and enrich components or eliminate them. Because of the differences among the sites, there are in fact many models of the SBYSP. However, the preliminary findings of the analysis conducted by Academy for Educational Development indicated that the types of collaborative relationships that contributed to the programs' ability to meet SBYSP objectives were those that integrated the school and SBYSP programs and staff most completely. In well-integrated programs SBYSP staff took over school functions, played roles usually played by school staff, served on school committees, conducted workshops and classes, and provided technical assistance to school personnel. SBYSP activities that were incorporated into school procedures were most successful.

The longevity of the program is another contributing factor to its success. In many of the initial 29 sites, SBYSP has become an invaluable part of the school system, yet it remains independent and not associated with the school district bureaucracy. In addition, funding for SBYSP has been consistent (part of the Governor's line item). This contributes to staff's ability to focus on the students and program development rather than on funding issues.

Many staff have been with sites since their inception, and they are fully integrated into the daily operations of the school and extremely accessible and visible to the students. They are seen as trusted and supportive adults who provide information and guidance. They do not preach and judge, a direct result of the youth focus groups that helped shape the SBYSP.

There have been challenges along with these successes. The strong family life education and comprehensive sexuality education component of the program was often contrary to messages supported by the local faith community. In one site, Pinelands High School, a rural, predominantly Anglo community, opposition from the faith community was strong. In a compromise "agreement to disagree," for the last 10 years a guest speaker has discussed abstinence before the family life education curriculum is introduced to classes.

There have also been turf issues between school staff and SBYSP staff concerning access to students and the "rewards" of the job. School staff have often tried to have SBYSP become more involved in crisis management, substance abuse counseling, and suicide and abuse intervention, functions that actually fell under the purview of school administration. At times maintaining confidentiality was an issue between school staff, SBYSP staff, and students at some of the sites, particularly around mental health, parental consent, and health related issues.

Evaluation of SBYSP is on-going. Six of the 29 sites have been selected for intensive study, including quantitative and qualitative measures, such as grades, employment, school retention, suspension, and absence rates. The baseline evaluation report will be available in mid-1998. However, evaluators and staff note that small daily changes are the most rewarding and long lasting and the hardest to capture as hard data.

With regard to reductions in teen pregnancy, Pinelands, New Jersey, has seen a dramatic decrease from an estimated 20 full term adolescent pregnancies per year for a population of 1500, to an average of two per year. The project director attributes the drop to SBYSP's provision of in-school comprehensive sexuality education, a broad spectrum of recreational and employment programs, and staff that is fully integrated into the school. Its efforts are being replicated at sites in Camden, Phillipsburg, Planfield, and Longbridge. Informal findings at the Camden site have revealed a large drop in teen pregnancies since the inception of its teen pregnancy prevention program a year ago. Formal results of an evaluation of the Pinelands High School program and its replication at Plainfield will be available in early 1999.

New Jersey Network on Adolescent Programs (NJNAP)
Founded in 1979, the NJNAP is based at the Center for Social and Community Development at Rutgers University's School of Social Work. It targets adolescents who are at risk for engaging in behaviors that are detrimental to their health and well-being. NJNAP's goal is to increase the capacity of community-based and local organizations to develop programs, policies, and services that impact youth in a variety of areas, including teen pregnancy. Its objectives are:

• To insure youth input and involvement;
• To establish linkages between public and voluntary agencies;
• To identify funding sources and pertinent current legislation regarding potential funding;
• To identify existing resources, programs, and partnerships in New Jersey and to establish new programs where gaps exist in the system;
• To develop an understanding of the political implications of youth development;
• To establish a system for information-sharing on a state and regional level in order to maximize information dissemination; and
• To educate youth-serving professionals and other interested adults in the implications (i.e., health, education, psychosocial and socioeconomic) of high risk adolescent behaviors.

In order to meet its objectives, NJNAP uses various techniques/resources: 1) technical assistance and counseling; 2) a quarterly newsletter, EXCHANGES; 3) seminars, conference and trainings; 4) a resource center including print and audio-visual materials; and 5) statewide clearinghouse services on adolescent health issues, including teen pregnancy prevention. By providing linkages among existing organizations, often through county networks that implement local policy and activities, NJNAP seeks to create an environment in which youth-serving organizations can share information and resources that pertain to healthy youth development.

D. Austin, Texas
East Austin Youth Charter
Dennis Campa, formerly Director of the Community Services Division of Austin/Travis County Health & Human Services Dept., currently Neighborhood and Community Initiatives Officer of the City of Austin
Robert Penn, Vanguard Management
Kit Abney, Program Coordinator

East Austin Youth Charter began when Public/Private Ventures, a national nonprofit organization, approached the city about participating in a new initiative. This initiative, Community Change for Youth Development (CCYD) involves five "core concepts" of positive youth development-supportive relationships with adults, constructive work experiences, activities for non-school periods, involvement in decision making, and support through transitions-and a process for implementing them. CCYD leaves the specific program model to be developed by the community. Further, the CCYD approach is based on the hypothesis that community mobilization is necessary for lasting community change.

The Community Services Division of Austin/Travis County Health and Human Services Department (CSD) had been working with others in the community to develop a proposal for an Empowerment Zone grant for a group of three adjacent neighborhoods in the East Austin area. Over 80 percent of the residents of this area are Latino, and 37 percent are poor. Although the group did not receive the grant, the process generated enthusiasm and a commitment to working together to benefit the community. Recognizing the limits of their ability, as a government agency, to involve community residents, CSD joined with Austin Interfaith (AI) as co-lead agency. AI is a part of the Industrial Areas Foundation, a nonprofit membership organization whose mission is to organize community institutions and residents for political action. AI had been working for 12 years in the community.

Between March and October 1995, the two agencies' staffs and residents worked to develop a plan. Several elements were important to their success: for the most part, the partners knew each other from their previous work on the EZ grant; they had a shared interest in seeing their earlier work take strategic shape; and they had a shared commitment to the process of creating a community that supports healthy youth development. It was important that they were "not chasing money." Early in the planning, one of the partners questioned whether the group even needed P/PV. CSD committed half of the small amount P/PV offered for planning, if partners would commit to the process. The group was prepared to work with or without P/PV funding.

Much of the planning time was spent mobilizing the community, informing them about CCYD, and determining the concerns and priorities of adult and youth residents. AI used neighborhood walks, house meetings, and community meetings in different locations around the neighborhoods to involve residents. They formed "action teams" led by residents to plan programs related to each of the core concepts. A leadership team of three CSD staff, two AI staff and two or three residents had overall responsibility for planning strategies and developing ideas for the plan; thus leadership was shared among the city, AI and the community. Service providers were organized into a separate group to prevent the loss of community control. Community churches and schools were involved through their association with AI. An outside expert conducted a household survey that provided information on risk factors and community attitudes. This information helped to mobilize all sectors of the community, including churches. CSD drafted the formal implementation plan based on the ideas developed and agreed on by the community.

Obstacles to planning included maneuvering for position and power, especially by some of the neighborhood associations, which tended to be negative about partnership activities that were not part of their agenda. When others did not adopt their agenda and they did not gain the power and resources they had hoped for, they left the group. The formation of a permanent Neighborhood Steering Committee (NSC) to direct the implementation of the CCYD plan has been a source of continuing controversy, and the group has had several configurations. The NSC has recently been restructured and now includes one youth and one adult community member nominated from each of three local churches, one high school teacher and a student, two community parents who are active in their children's elementary schools, a school district representative, a representative from Communities in Schools and one from Capital 4-H, the director of the local recreation center, a member of the UT Urban Issues Program, and the head of prevention programs of the Texas Youth Commission. The NSC has pushed the schools to be more active partners. The relationship of the NSC to the Service and Support Partnership of 24 local service providers and neighborhood associations is still being worked out.

Another roadblock was the need to overcome the usual way of doing things, that is, the City making decisions about programs and services rather than building communities by sharing power with residents. On the other hand, residents have had to learn to trust agencies and to fully participate in the development and implementation of the plan. These are continuing challenges. Building residents' capacity has been and continues to be a primary concern of P/PV, which has conducted workshops and retreats on defining roles and responsibilities, consensus building, decision making, conflict resolution, team and trust building, budgeting and the like. Residents were trained to make quarterly presentations to the funders. As residents have assumed new responsibilities, for example, for fiscal oversight and leadership, new capacities have to be developed. Redefining roles and responsibilities is an ongoing process. P/PV reviews the partnership's operation monthly, asking questions and pushing the group to evaluate and solve problems.

Youth Charter now operates with three separate grants: one from P/PV, one federal Title V juvenile delinquency prevention grant through the governor's office, and one Strategic Intervention for High Risk Youth grant. Additional city and county money comes from CSD. The effort is staffed by one adult organizer, one youth organizer, and, until very recently, one coordinator for each of the grants. The coordinators for the first two grants have now been merged. The NSC makes policy and planning decisions for the P/PV programs, and a Prevention Policy Board performs these roles for the Title V grant. These groups meet regularly. Coordinating these efforts is a work in progress and led to the appointment of the Texas Youth Commission representative, who serves on the Prevention Policy Board, to the NSC. The boards have standing and ad hoc committees, organized by sectors, that meet regularly and report back to the larger group. Residents lead the committees and boards.

Those involved in Youth Charter consider the partnership a success in a number of ways. It has established a conversation in the community among key institutions, residents, and youth. It has raised the level of awareness of the issues facing youth and the strengths of the community and outside institutions and has increased accountability. At the end of its second year Youth Charter has begun to change the system of supports for children and families in an enduring way: involving adults in several programs, linking youth to existing enrichment activities, creating new programs for non-school times, providing job training, career awareness opportunities and jobs, developing programs for youth moving into middle and high school. More youth are involved, and preliminary results indicate that more youth are remaining in school. P/PV collected baseline data on various behavioral measures, including arrests, sexual experience, gang membership, alcohol and marijuana use, carrying of weapons, use of force, and participation in protective activities, such as sports, recreation, religious activities, and job training. They have been tracking participation in Youth Charter programs and will survey youth behaviors again at the end of the third year. Until then, impact remains conjecture. Youth Charter staff have begun tracking participation themselves in order to have more immediate feedback.

While rates of teen pregnancy are high in the East Austin area and the community is concerned about the issue, Youth Charter has not done direct prevention programming for two reasons. First, the youth development philosophy supports programs that emphasize assets and provide opportunities for youth rather than those that provide specific intervthe PRECEDE model. Comm perhaps, is the fact that two large Catholic churches in the area are very involved in Youth Charter efforts and only support teen pregnancy prevention activities within very limited parameters. The city's Family Health Unit operates a multi-component teen pregnancy prevention effort in the area, loosely patterned after the South Carolina school-community program. It includes education of parents and other youth leaders on how to talk to youth about sexuality and a family life education program that reaches all seventh grade students in the local middle school. Youth Charter staff maintain close relations with these programs; both are housed in the same city department, and staff communicate regularly and cooperate whenever possible without any formal, written relationship. Youth Charter participants are referred to these programs. Youth Charter also plans to develop Family Learning Centers, which will provide various educational activities, including pregnancy and drug and alcohol prevention, in the near future.

E. Roanoke, Virginia
Teen Outreach Program
Cheri Hartman, Ph.D., TOP Director

The Teen Outreach Program (TOP) began as a project of the Association of Junior Leagues International (AJLI), sponsored and operated by local Junior Leagues (JL) in cities across the country. In 1990, TOP was in place in one school in Salem, Virginia, where a lack of support from the principal and staff was creating roadblocks to every activity. When the principal of a Roanoke high school heard TOP described at a JL board meeting and advocated for the program, the TOP coordinator began a pilot program in one class of 20 students at the Roanoke school.

From that beginning, the program has gradually developed and evolved in Roanoke under the constant leadership of the TOP coordinator. In 1994 TOP began a transition from JL sponsorship to a community-based project. The coordinator assembled a community advisory committee that included the local General Assembly representative, the principal of the high school, representatives of agencies with similar missions, health care providers, and others who might be partners in the program. The coordinator and board undertook a process of determining TOP goals and objectives, establishing criteria for a new sponsoring agency, identifying possible matches, and interviewing agency directors and boards. TOP eventually found a home within Family Service of the Roanoke Valley, a private, nonprofit human services organization that wanted to expand its prevention services to youth. The JL TOP coordinator became the TOP director.

Technical assistance from AJLI helped the local TOP staff make effective presentations to the community. In addition, the availability of data from the national evaluation of TOP, which documented its impact, added to the program's appeal. Strong advocates in the school, who knew the program in operation, increased the case for TOP. With funding from United Way, TOP made a first step toward self-sufficiency. A series of powerful articles in the Roanoke Times on the impact of teen pregnancy on the community and a subsequent editorial were also important in attracting support. TOP now receives funding from the State Departments of Health and Education, the city through Community Development Block Grant funds, United Way, the March of Dimes, several foundations, and service organizations.

Relationships with service learning sites, which include a program for handicapped preschoolers, nursing homes, and businesses, are developed by mini planning teams. The teams work out mutual commitments and expectations, as well as logistics. There are no written contracts. Coordination, supervision, and problem solving are managed through planning meetings, personal contact, and open and frequent communication. According to the director, if lines of communication are not open frustration mounts and service learning sites may leave the program.

Other partners include the City of Roanoke school system, which works with TOP in many ways-providing teachers to help implement the curriculum and coordinate service learning, monitoring grading, integrating TOP into English classes, managing school administrative requirements, providing referrals to TOP through the counselors, and planning and staging special events. Prevention Plus, a division of the local mental health department, provides two prevention specialists who help implement the curriculum. Roanoke Adolescent Health Partnership provides Teen Health Clinics and two health educators who help implement the curriculum. The Voluntary Action Center helps identify new volunteers for TOP's tutoring and mentoring programs and provides information on summer youth volunteer opportunities.

These partnership relationships are conducted without written contracts. Personal relationships and open communication are key. However, the full commitment of partners, particularly the schools, from the district administration down, is essential. TOP's director suggests that her long personal history with the program facilitates the trusting nature of these arrangements. However, each of the partners is committed to the program because each gains from its involvement. The program gains credibility from evaluation, and the organizational goals the partners attain through TOP cement these relationships without formal agreements.

The TOP director makes day-to-day decisions in compliance with the policies of Family Service of the Roanoke Valley and of the schools, which host the programs. The Board of Directors of Family Service and a committee of a local youth development coalition provide input on goals, objectives, and the evaluation process. The advisory committee continues to guide strategic planning. Student participants and their families are surveyed at the end of each year for input on TOP content and activities; however, these groups have not been attracted to service on the board.

The TOP director attributes TOP's success in part to networking that she does in two coalitions committed to youth development. Networking has made her aware of grants and funding opportunities and has connected TOP with new partners for the service learning component. Through these coalitions, as well, she hopes to develop a comprehensive plan for coordinating local youth development activities and to remove barriers to partnering with other organizations that share TOP's turf.

TOP in Roanoke has grown from a single class to sites in a school for students with court connections, a school for pregnant and parenting teens, a special education program, a program for educable mentally retarded students, and a church-based project, as well as two high schools. These programs reach about 120 active participants each month. Each year for the period between 1993 to 1997 TOP has shown consistently positive impact, reducing rates of absenteeism, suspension, school drop out, and class failure by substantial amounts. Teen pregnancy rates have also been reduced, but the numbers are so small that significance cannot be assessed. A survey that measured sexual knowledge and resiliency showed significant improvement among TOP students after their TOP experience. All students rated their TOP experience favorably.

Sustaining TOP over the long term has depended on evidence of positive outcomes from the local evaluation, as well as national data. In addition, technical assistance has given the program self-sufficiency in training facilitators, the most costly and uncertain element of program operation. The director is now working to integrate TOP into the English curriculum, which will strengthen the partnership with the school system and make TOP more than an add-on program that can be easily eliminated. She is also working with the Virginia Department of Health, which is TOP's major funder, and a local foundation to spur replication and expansion in other communities through partnerships at the state level.

F. Seattle, Washington
Partners in Action for Teen Health
Sharon Brew, Program Coordinator
Steve Daschle, Director, Southwest Youth and Family Services
Cynthia Goodwin, Associate Director for Community Based Services,
Ruth Dykeman Children's Center

Seattle Partners in Action for Teen Health (PATH) began in 1993, when new statistics revealed that the White Center neighborhood had the second highest rate of teen pregnancy in the State. The White Center community is diverse and includes 40 percent Southeast Asians, who are themselves a very diverse group. Many teens in the area live at or below the poverty level and have four or five risk factors for negative outcomes. The Southwest Teen Pregnancy Prevention Alliance, part of a larger coalition of social service providers who met (and still meet) monthly to share information and support, wanted to do something about the problem. They did not want to create new programs but wanted to coordinate services and identify gaps.

This group spent much of the early years learning "how to be a collaboration." For some time, program development was neglected as the partnership was created. They hired a facilitator to help identify issues and define the collaboration partners' roles. They worked on crossing professional and jurisdictional boundaries. And they worked on creating a flat, non-hierarchical structure. At first, two of the partners assumed fiscal responsibility and managed the hiring and supervision of staff. However, without coordination at the partnership level, staff worked at cross purposes, and there was a great deal of frustration and dissatisfaction.

Eventually, the collaboration hired a program coordinator. Although technically staff are still hired through the two agencies that have fiscal responsibility, the program coordinator is intimately involved in hiring and supervises the staff, which includes one community organizer, one health educator, and one employment/mentorship development specialist, one intern, and a group of regular translators. The coordinator makes day-to-day decisions. The 12 collaborative partners, who include agency representatives and individuals, provide guidance on policy, programming, fundraising, and community awareness issues. There is no lead agency; the partnership calls itself "nonhierarchical." Decisions are made by consensus and cooperation. Responsibility is shared. Possible new members are interviewed to determine their philosophical fit with the group.

Partners in PATH attribute their successful organizing effort to the members' genuine sense of goodwill, commitment to the collaboration, and willingness to set aside personal and organizational biases to achieve their common goals. They spoke openly about their competing agendas and their concerns. They worked around different personal and communication skills. They agreed not to micro-manage the daily operation of the program.

Early in the program's development, PATH struggled to involve parents and other residents. Now, after five years, the program has become a fixture in the community, a long-term endeavor that residents view as committed to the area. Community adults and teens value PATH's presence, and youth especially seek to be involved. At the end of 1997, when members of the Christian Coalition attacked PATH, the community rallied to its defense. Part of PATH's acceptance is due to the staff, who share the philosophy of the program and reflect the community ethnically.

In addition to community acceptance, other measures of PATH's success include the remarkable stability of the group, which retains all except one of its original members. The staff has grown from one to five. This past year PATH received a grant from the Children's Aid Society and is a replication site for the Carrera model. In conjunction with this grant, participants have increased from 30 to 100. PATH's program has changed somewhat as a result of the grant; it will soon be a six-part, comprehensive program that includes academic assessment and tutoring, life time sports, self-expression/arts, employment and career awareness and training, family life/sexuality education, comprehensive health services, and mental health care. Parents of participants are involved in Plain Talk for Parents, in family meetings, and in assisting in programs in various ways.

A state evaluation that ended in July 1997 called PATH a "promising approach," although problems with the control communities prevented clear comparisons. The Children's Aid Society program is being evaluated using an experimental design. Students are surveyed every six months on behavior and risk indicators. First year results will be available in late 1998. Participants report a great deal of satisfaction with the program, attend activities regularly, have helped recruit new participants, and have stayed connected to the program through the changes.

The partners see the Children's Aid Society grant as an opportunity to gain credibility from the name and the national reputation of the Carrera model. The evaluation of their program, funded by the grant, should assist PATH in securing the resources for long-term sustainability.

D. Austin, Texas

East Austin Youth Charter began when Public/Private Ventures, a national nonprofit organization, approached the city about participating in a new initiative. This initiative, Community Change for Youth Development (CCYD) involves five "core concepts" of positive youth development-supportive relationships with adults, constructive work experiences, activities for non-school periods, involvement in decision making, and support through transitions-and a process for implementing them. CCYD leaves the specific program model to be developed by the community. Further, the CCYD approach is based on the hypothesis that community mobilization is necessary for lasting community change.

The Community Services Division of Austin/Travis County Health and Human Services Department (CSD) had been working with others in the community to develop a proposal for an Empowerment Zone grant for a group of three adjacent neighborhoods in the East Austin area. Over 80 percent of the residents of this area are Latino, and 37 percent are poor. Although the group did not receive the grant, the process generated enthusiasm and a commitment to working together to benefit the community. Recognizing the limits of their ability, as a government agency, to involve community residents, CSD joined with Austin Interfaith (AI) as co-lead agency. AI is a part of the Industrial Areas Foundation, a nonprofit membership organization whose mission is to organize community institutions and residents for political action. AI had been working for 12 years in the community.

Between March and October 1995, the two agencies' staffs and residents worked to develop a plan. Several elements were important to their success: for the most part, the partners knew each other from their previous work on the EZ grant; they had a shared interest in seeing their earlier work take strategic shape; and they had a shared commitment to the process of creating a community that supports healthy youth development. It was important that they were "not chasing money." Early in the planning, one of the partners questioned whether the group even needed P/PV. CSD committed half of the small amount P/PV offered for planning, if partners would commit to the process. The group was prepared to work with or without P/PV funding.

Much of the planning time was spent mobilizing the community, informing them about CCYD, and determining the concerns and priorities of adult and youth residents. AI used neighborhood walks, house meetings, and community meetings in different locations around the neighborhoods to involve residents. They formed "action teams" led by residents to plan programs related to each of the core concepts. A leadership team of three CSD staff, two AI staff and two or three residents had overall responsibility for planning strategies and developing ideas for the plan; thus leadership was shared among the city, AI and the community. Service providers were organized into a separate group to prevent the loss of community control. Community churches and schools were involved through their association with AI. An outside expert conducted a household survey that provided information on risk factors and community attitudes. This information helped to mobilize all sectors of the community, including churches. CSD drafted the formal implementation plan based on the ideas developed and agreed on by the community.

Obstacles to planning included maneuvering for position and power, especially by some of the neighborhood associations, which tended to be negative about partnership activities that were not part of their agenda. When others did not adopt their agenda and they did not gain the power and resources they had hoped for, they left the group. The formation of a permanent Neighborhood Steering Committee (NSC) to direct the implementation of the CCYD plan has been a source of continuing controversy, and the group has had several configurations. The NSC has recently been restructured and now includes one youth and one adult community member nominated from each of three local churches, one high school teacher and a student, two community parents who are active in their children's elementary schools, a school district representative, a representative from Communities in Schools and one from Capital 4-H, the director of the local recreation center, a member of the UT Urban Issues Program, and the head of prevention programs of the Texas Youth Commission. The NSC has pushed the schools to be more active partners. The relationship of the NSC to the Service and Support Partnership of 24 local service providers and neighborhood associations is still being worked out.

Another roadblock was the need to overcome the usual way of doing things, that is, the City making decisions about programs and services rather than building communities by sharing power with residents. On the other hand, residents have had to learn to trust agencies and to fully participate in the development and implementation of the plan. These are continuing challenges. Building residents' capacity has been and continues to be a primary concern of P/PV, which has conducted workshops and retreats on defining roles and responsibilities, consensus building, decision making, conflict resolution, team and trust building, budgeting and the like. Residents were trained to make quarterly presentations to the funders. As residents have assumed new responsibilities, for example, for fiscal oversight and leadership, new capacities have to be developed. Redefining roles and responsibilities is an ongoing process. P/PV reviews the partnership's operation monthly, asking questions and pushing the group to evaluate and solve problems.

Youth Charter now operates with three separate grants: one from P/PV, one federal Title V juvenile delinquency prevention grant through the governor's office, and one Strategic Intervention for High Risk Youth grant. Additional city and county money comes from CSD. The effort is staffed by one adult organizer, one youth organizer, and, until very recently, one coordinator for each of the grants. The coordinators for the first two grants have now been merged. The NSC makes policy and planning decisions for the P/PV programs, and a Prevention Policy Board performs these roles for the Title V grant. These groups meet regularly. Coordinating these efforts is a work in progress and led to the appointment of the Texas Youth Commission representative, who serves on the Prevention Policy Board, to the NSC. The boards have standing and ad hoc committees, organized by sectors, that meet regularly and report back to the larger group. Residents lead the committees and boards.

Those involved in Youth Charter consider the partnership a success in a number of ways. It has established a conversation in the community among key institutions, residents, and youth. It has raised the level of awareness of the issues facing youth and the strengths of the community and outside institutions and has increased accountability. At the end of its second year Youth Charter has begun to change the system of supports for children and families in an enduring way: involving adults in several programs, linking youth to existing enrichment activities, creating new programs for non-school times, providing job training, career awareness opportunities and jobs, developing programs for youth moving into middle and high school. More youth are involved, and preliminary results indicate that more youth are remaining in school. P/PV collected baseline data on various behavioral measures, including arrests, sexual experience, gang membership, alcohol and marijuana use, carrying of weapons, use of force, and participation in protective activities, such as sports, recreation, religious activities, and job training. They have been tracking participation in Youth Charter programs and will survey youth behaviors again at the end of the third year. Until then, impact remains conjecture. Youth Charter staff have begun tracking participation themselves in order to have more immediate feedback.

While rates of teen pregnancy are high in the East Austin area and the community is concerned about the issue, Youth Charter has not done direct prevention programming for two reasons. First, the youth development philosophy supports programs that emphasize assets and provide opportunities for youth rather than those that provide specific intervthe PRECEDE model. Comm perhaps, is the fact that two large Catholic churches in the area are very involved in Youth Charter efforts and only support teen pregnancy prevention activities within very limited parameters. The city's Family Health Unit operates a multi-component teen pregnancy prevention effort in the area, loosely patterned after the South Carolina school-community program. It includes education of parents and other youth leaders on how to talk to youth about sexuality and a family life education program that reaches all seventh grade students in the local middle school. Youth Charter staff maintain close relations with these programs; both are housed in the same city department, and staff communicate regularly and cooperate whenever possible without any formal, written relationship. Youth Charter participants are referred to these programs. Youth Charter also plans to develop Family Learning Centers, which will provide various educational activities, including pregnancy and drug and alcohol prevention, in the near future.

E. Roanoke, Virginia

The Teen Outreach Program (TOP) began as a project of the Association of Junior Leagues International (AJLI), sponsored and operated by local Junior Leagues (JL) in cities across the country. In 1990, TOP was in place in one school in Salem, Virginia, where a lack of support from the principal and staff was creating roadblocks to every activity. When the principal of a Roanoke high school heard TOP described at a JL board meeting and advocated for the program, the TOP coordinator began a pilot program in one class of 20 students at the Roanoke school.

From that beginning, the program has gradually developed and evolved in Roanoke under the constant leadership of the TOP coordinator. In 1994 TOP began a transition from JL sponsorship to a community-based project. The coordinator assembled a community advisory committee that included the local General Assembly representative, the principal of the high school, representatives of agencies with similar missions, health care providers, and others who might be partners in the program. The coordinator and board undertook a process of determining TOP goals and objectives, establishing criteria for a new sponsoring agency, identifying possible matches, and interviewing agency directors and boards. TOP eventually found a home within Family Service of the Roanoke Valley, a private, nonprofit human services organization that wanted to expand its prevention services to youth. The JL TOP coordinator became the TOP director.

Technical assistance from AJLI helped the local TOP staff make effective presentations to the community. In addition, the availability of data from the national evaluation of TOP, which documented its impact, added to the program's appeal. Strong advocates in the school, who knew the program in operation, increased the case for TOP. With funding from United Way, TOP made a first step toward self-sufficiency. A series of powerful articles in the Roanoke Times on the impact of teen pregnancy on the community and a subsequent editorial were also important in attracting support. TOP now receives funding from the State Departments of Health and Education, the city through Community Development Block Grant funds, United Way, the March of Dimes, several foundations, and service organizations.

Relationships with service learning sites, which include a program for handicapped preschoolers, nursing homes, and businesses, are developed by mini planning teams. The teams work out mutual commitments and expectations, as well as logistics. There are no written contracts. Coordination, supervision, and problem solving are managed through planning meetings, personal contact, and open and frequent communication. According to the director, if lines of communication are not open frustration mounts and service learning sites may leave the program.

Other partners include the City of Roanoke school system, which works with TOP in many ways-providing teachers to help implement the curriculum and coordinate service learning, monitoring grading, integrating TOP into English classes, managing school administrative requirements, providing referrals to TOP through the counselors, and planning and staging special events. Prevention Plus, a division of the local mental health department, provides two prevention specialists who help implement the curriculum. Roanoke Adolescent Health Partnership provides Teen Health Clinics and two health educators who help implement the curriculum. The Voluntary Action Center helps identify new volunteers for TOP's tutoring and mentoring programs and provides information on summer youth volunteer opportunities.

These partnership relationships are conducted without written contracts. Personal relationships and open communication are key. However, the full commitment of partners, particularly the schools, from the district administration down, is essential. TOP's director suggests that her long personal history with the program facilitates the trusting nature of these arrangements. However, each of the partners is committed to the program because each gains from its involvement. The program gains credibility from evaluation, and the organizational goals the partners attain through TOP cement these relationships without formal agreements.

The TOP director makes day-to-day decisions in compliance with the policies of Family Service of the Roanoke Valley and of the schools, which host the programs. The Board of Directors of Family Service and a committee of a local youth development coalition provide input on goals, objectives, and the evaluation process. The advisory committee continues to guide strategic planning. Student participants and their families are surveyed at the end of each year for input on TOP content and activities; however, these groups have not been attracted to service on the board.

The TOP director attributes TOP's success in part to networking that she does in two coalitions committed to youth development. Networking has made her aware of grants and funding opportunities and has connected TOP with new partners for the service learning component. Through these coalitions, as well, she hopes to develop a comprehensive plan for coordinating local youth development activities and to remove barriers to partnering with other organizations that share TOP's turf.

TOP in Roanoke has grown from a single class to sites in a school for students with court connections, a school for pregnant and parenting teens, a special education program, a program for educable mentally retarded students, and a church-based project, as well as two high schools. These programs reach about 120 active participants each month. Each year for the period between 1993 to 1997 TOP has shown consistently positive impact, reducing rates of absenteeism, suspension, school drop out, and class failure by substantial amounts. Teen pregnancy rates have also been reduced, but the numbers are so small that significance cannot be assessed. A survey that measured sexual knowledge and resiliency showed significant improvement among TOP students after their TOP experience. All students rated their TOP experience favorably.

Sustaining TOP over the long term has depended on evidence of positive outcomes from the local evaluation, as well as national data. In addition, technical assistance has given the program self-sufficiency in training facilitators, the most costly and uncertain element of program operation. The director is now working to integrate TOP into the English curriculum, which will strengthen the partnership with the school system and make TOP more than an add-on program that can be easily eliminated. She is also working with the Virginia Department of Health, which is TOP's major funder, and a local foundation to spur replication and expansion in other communities through partnerships at the state level.

F. Seattle, Washington

Seattle Partners in Action for Teen Health (PATH) began in 1993, when new statistics revealed that the White Center neighborhood had the second highest rate of teen pregnancy in the State. The White Center community is diverse and includes 40 percent Southeast Asians, who are themselves a very diverse group. Many teens in the area live at or below the poverty level and have four or five risk factors for negative outcomes. The Southwest Teen Pregnancy Prevention Alliance, part of a larger coalition of social service providers who met (and still meet) monthly to share information and support, wanted to do something about the problem. They did not want to create new programs but wanted to coordinate services and identify gaps.

This group spent much of the early years learning "how to be a collaboration." For some time, program development was neglected as the partnership was created. They hired a facilitator to help identify issues and define the collaboration partners' roles. They worked on crossing professional and jurisdictional boundaries. And they worked on creating a flat, non-hierarchical structure. At first, two of the partners assumed fiscal responsibility and managed the hiring and supervision of staff. However, without coordination at the partnership level, staff worked at cross purposes, and there was a great deal of frustration and dissatisfaction.

Eventually, the collaboration hired a program coordinator. Although technically staff are still hired through the two agencies that have fiscal responsibility, the program coordinator is intimately involved in hiring and supervises the staff, which includes one community organizer, one health educator, and one employment/mentorship development specialist, one intern, and a group of regular translators. The coordinator makes day-to-day decisions. The 12 collaborative partners, who include agency representatives and individuals, provide guidance on policy, programming, fundraising, and community awareness issues. There is no lead agency; the partnership calls itself "nonhierarchical." Decisions are made by consensus and cooperation. Responsibility is shared. Possible new members are interviewed to determine their philosophical fit with the group.

Partners in PATH attribute their successful organizing effort to the members' genuine sense of goodwill, commitment to the collaboration, and willingness to set aside personal and organizational biases to achieve their common goals. They spoke openly about their competing agendas and their concerns. They worked around different personal and communication skills. They agreed not to micro-manage the daily operation of the program.

Early in the program's development, PATH struggled to involve parents and other residents. Now, after five years, the program has become a fixture in the community, a long-term endeavor that residents view as committed to the area. Community adults and teens value PATH's presence, and youth especially seek to be involved. At the end of 1997, when members of the Christian Coalition attacked PATH, the community rallied to its defense. Part of PATH's acceptance is due to the staff, who share the philosophy of the program and reflect the community ethnically.

In addition to community acceptance, other measures of PATH's success include the remarkable stability of the group, which retains all except one of its original members. The staff has grown from one to five. This past year PATH received a grant from the Children's Aid Society and is a replication site for the Carrera model. In conjunction with this grant, participants have increased from 30 to 100. PATH's program has changed somewhat as a result of the grant; it will soon be a six-part, comprehensive program that includes academic assessment and tutoring, life time sports, self-expression/arts, employment and career awareness and training, family life/sexuality education, comprehensive health services, and mental health care. Parents of participants are involved in Plain Talk for Parents, in family meetings, and in assisting in programs in various ways.

A state evaluation that ended in July 1997 called PATH a "promising approach," although problems with the control communities prevented clear comparisons. The Children's Aid Society program is being evaluated using an experimental design. Students are surveyed every six months on behavior and risk indicators. First year results will be available in late 1998. Participants report a great deal of satisfaction with the program, attend activities regularly, have helped recruit new participants, and have stayed connected to the program through the changes.

The partners see the Children's Aid Society grant as an opportunity to gain credibility from the name and the national reputation of the Carrera model. The evaluation of their program, funded by the grant, should assist PATH in securing the resources for long-term sustainability.

Appendix E-Case Study Questions

Case study interviews will begin with a set of overview questions and proceed to more detailed questions from among those listed below.

Overview Questions
Identify interviewee: name, title, tenure with partnership, what do you see as your role?
Is the group a "community partnership"? What does that mean?
What brought the members together & enabled them to overcome differences?
Is the group "successful"? What do you think you are accomplishing? What is working well?
What have been the major barriers to creating the partnership? To its success?
What keeps the group together?

Specific Questions
What was the genesis or impetus for the development of this partnership? What brought people/organizations together in the first place? When did it begin? If applicable, what was the historical relationship between/among the founding partners or the community in which this partnership was founded? Describe any particular alliances that were new as a result of this partnership (i.e., public/private, historically opposing view points). What motivated them to overcome their differences? What made it easier to create the partnership? What made it more difficult? How was the project area/community defined? Was a community assessment/mapping done? How were the origin and scope of the problem determined? How were needs and resources identified? What barriers/sources of resistance were identified? How was the mapping information used? ORIGIN AND HISTORY

Does the group have a formal statement of mission, goals and objectives?* Who developed this statement? How? How was consensus developed around the issue and the partnership's goals? What difficulties had to be overcome? Does the group have a formal action plan?* How did the group identify the community sectors to be involved in the partnership's activities? How did the group identify activities that would lead to accomplishment of the mission? How were priorities set? Were attempts made to include a representative sample of those parties affected by the goals and objectives in the agenda-setting process and subsequent action plan development? MISSION

What was the initial membership composition of the partnership and why? What if any attempts were made to broaden the spectrum of the partnership? What was the process by which the partnership identified potential new partners who were critical to the partnership success? How were they recruited and retained? Were any groups excluded? Why? Were community residents involved? If not, why? How? What helped in their recruitment and retention? What made it difficult? Were all segments of the community represented? Were youth involved? If not, why? What helped in their recruitment and retention? What made it difficult? MEMBERSHIP

How was the partnership staffed initially and what changes occurred in that staffing as the partnership matured? Who led the partnership? How was the leader selected? How was the partnership organized? Committees? Task forces? How formally were structures defined (e.g. by-laws, etc)? How were decisions made? By whom? How did members of the partnership communicate? How often? What elements of the structure or process were important to the success of the partnership? What elements presented obstacles? How was the capacity of the members to participate in and lead the partnership increased? STRUCTURE

What resources were available to the partnership? From partners? From the community? From outside? How were new resources developed? Was technical assistance used? For what? What type of support did the partnership need or receive (i.e., fiscal, human, skills development) and how was this support elicited? Did other entities (government, public, media) contribute to the goals of the partnership via policy changes, awareness days, etc.? RESOURCES & SUPPORT

What services did the partnership provide? What actions did the group take? What changes did the group make in practices, policies, or programs related to the partnership's mission? Was the partnership evaluated? Was the process of partnership formation, organization and function evaluated? Were outcomes measured? How? ACTIVITIES & EVALUATION

How has the partnership changed during its existence? What has been important in sustaining it? SUSTAINING THE PARTNERSHIP

Documents Requested

Action/Implementation Plan
Goals/Mission/Purpose
Partnership Membership List
PR Materials (brochures, pamphlets, websites, etc.)

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Endnotes

1. Dryfoos, 1990; Kirby, 1997; Miller, 1995; Moore, Miller, et al., 1995.

2. Moore, Miller, et al., 1995.

3. 1997, p.12.

4. Kirby, 1997; Moore, Sugland, et al., 1995; Santelli and Beilenson, 1992; Brindis, 1991.

5. Brindis, 1991; Carnegie Corp., 1989; Dryfoos, 1990; Moore, Sugland, et al., 1995; Santelli and Beilenson, 1992.

6. Kirby, 1997.

7. Executive Office for Weed and Seed, n.d.; OSAP, 1991; National Clearinghouse on Families and Youth, 1996.

8. Alter and Hage, 1993, p. 259.

9. Abramson & Rosenthal, 1995; Butterfoss, et al., 1993; Alter and Hage, 1993; Chavis, 1995; Cornerstone Consulting Group, 1997; CSAP, 1995; Mattessich & Monsey, 1992; Nezlek & Galano, 1993; Rabin, 1992; U.S. Environmental Protection Agency, 1990; Weiss, 1987.

10. Bracht, 1995.

11. Butterfoss, et al., 1993, p. 315.

12. Paine-Andrews, et al., 1996, p. 16.

13. WHO, 1978.

14. Kirby, 1997, p. 46; see also Santelli & Beilenson, 1992; Brindis, 1991; Carnegie Corp., 1989; Dryfoos, 1990.

15. Cohen & Lang, 1990.

16. NCIPC, 1993, p. 4.

17. OSAP, 1991, p. 3.

18. National Clearinghouse on Families and Youth, 1996, p. 19.

19. Annie E. Casey Foundation, n.d.; Cornerstone Consulting Group, n.d.

20. Nezlek & Galano, 1993, p. 434; see also Francisco, et al., 1993; Chavis, 1995.

21. Butterfoss, et al., 1993, p. 318.

22. Butterfoss, et al., 1993.

23. Francisco, et al., 1996.

24. Butterfoss, et al., 1993.

25. Mansergh, et al., 1996.

26. Nezlek & Galano, 1993.

27. Alter & Hage, 1993.

28. Allensworth, 1994; Brindis, 1991; Annie E. Casey Foundation, 1993b; Colorado Dept. of Health, n.d.; Cornerstone & Philliber, 1997; The Community Toolbox, 1997; Executive Office for Weed and Seed, n.d.; Fawcett, et al., 1993; National Assembly of National Voluntary Health and Social Welfare Organizations, 1991; OSAP, 1991.

29. Bailey & McNally Koney, 1995a, 1995b.

30. Weiss, 1987; Alter & Hage, 1993.

31. Abramson & Rosenthal, 1995; Butterfoss, et al., 1993; Francisco, et al., 1996; Mattessich & Monsey, 1992; Fawcett, et al., 1993.

32. Carbine & Lee, 1988; CDC, 1995; CSAP, 1995; Fawcett, et al., 1995; Ferraro, 1994; Kracke, 1996; NCIPC, 1993; Scarlett et al., 1991; Williams, et al., 1991; Weiss, 1987.

33. Abramson & Rosenthal, 1995; Alter & Hage, 1993; Butterfoss, et al., 1993; Weiss, 1987.

34. Abramson & Rosenthal, 1995; Butterfoss, et al., 1993; Weiss, 1987; see also the section on the history of partnerships, above, which notes various government and foundation initiatives that contributed to the creation of partnerships.

35. Weiss, 1987.

36. American Leadership Forum, 1993; Anderson, 1996; Rabin, 1992.

37. American Leadership Forum, 1993; Alter & Hage, 1993; Anderson, 1996; Butterfoss, et al., 1993; Rabin, 1992; Weiss, 1987.

38. Abramson & Rosenthal, 1995; Butterfoss, et al., 1993; Francisco, et al., 1996.

39. Abramson & Rosenthal, 1995; Alter & Hage, 1993; Butterfoss, et al., 1993; Mattessich and Monsey, 1992; Weiss, 1987.

40. Abramson & Rosenthal, 1995.

41. Mattessich & Monsey, 1995; Weiss, 1987.

42. Annie E. Casey, 1993a.

43. Brindis, 1991; Executive Office for Weed and Seed, n.d.; Colorado Dept. of Health, n.d.

44. Fawcett, et al., 1993; Fawcett, Paine Andrews, et al., 1995; Fawcett, et al., 1994.

45. Center for the Study of Social Policy, 1995; Cohen & Lang, 1990; Copple, et al., n.d.; Mulroy, 1997; Nadel, et al., 1996; Nezlek & Galano, 1993; NIJ, 1995.

46. Annie E. Casey, 1993a, b.

47. Annie E. Casey, 1993b; ISA Associates, 1994; Mulroy, 1997.

48. Nezlek & Galano, 1993.

49. Nadel, et al., 1996.

50. Kotloff, et al., 1995.

51. Kotloff, et al., 1995; Nezlek & Galano, 1993; see Cornerstone & Philliber, 1997 and Annie E. Casey, 1993a for examples of manuals designed to guide communities through this process.

52. Nezlek & Galano, 1993; OSAP, 1991.

53. Abramson & Rosenthal, 1995; Mattessich & Monsey, 1992.

54. Cohen & Lange, 1990: Fawcett, Paine Andrews, et al., 1995; Harrison, 1996; Kotloff, et al., 1995; Mattessich & Monsey, 1992; Mulroy, 1997; NCIPC, 1993; Rabin, 1992; Wolff & Foster, 1993.

55. Copple, et al., n.d.; Gambone, 1997; Kotloff, et al., 1995; NIJ, 1995.

56. Kotloff, et al., 1995.

57. Gambone, 1997; Kotloff, et al., 1995; Mulroy, 1997; Mattessich & Monsey, 1992; U.S. Dept. of Health and Human Services, 1997b, Group 3..

58. Copple, et al., n.d..

59. Fawcett, Paine Andrews, et al., 1995; Kotloff, et al, 1995; NIJ, 1995; Paine-Andrews, et al., 1996.

60. Gambone, 1997.

61. Butterfoss, et al., 1993; CSAP, 1995; Center for the Study of Social Policy, 1995; Copple, et al., n.d.; Kotloff, et al., 1995; Mattessich & Monsey, 1992; Nezlek & Galano, 1993; OSAP, 1991; Willaims, et al., 1991.

62. Motter, et al., 1993, page 263.

63. Butterfoss, et al., 1993; Copple, et al., n.d.; Fawcett, Paine Andrews, et al., 1995; Mattessich & Monsey, 1992; Mulroy, 1997; Nezlek & Galano, 1993; U.S. Dept. of Health and Human Services, 1997b, Group 1 and 3; Wolff & Foster, 1993.

64. U.S. Dept. of Health and Human Services, 1997b, Group 3.

65. Nezlek & Galano, 1993.

66. Kotloff, et al., 1995.

67. Nezlek & Galano, 1993.

68. Mulroy, 1997.

69. Alter & Hage, 1993; ISA Associates, 1994.

70. Mattessich & Monsey, 1992.

71. Abramson & Rosenthal, 1995; Nadel, et al., 1996.

72. Mulroy, 1997; NIJ, 1995; Wiist, et al., 1996.

73. Bailey & McNally Koney, 1995a.

74. Copple, et al., n.d..

75. Nezlek & Galano, 1993.

76. Fawcett, Paine Andrews, 1995.

77. Chavis, 1993; Mattessich & Monsey, 1992; Nezlek & Galano, 1993.

78. Bailey & Koney, 1995a, 1995b; Kotloff, et al., 1995; Mulroy, 1997; Wolff & Foster, 1993.

79. Fawcett, Paine Andrews, et al., 1995; Francisco, et al., 1996.

80. Center for the Study of Social Policy, 1995; National Evaluation of the Community Partnership Program, 1994.

81. Butterfoss, et al., 1993.

82. CSAP, 1995; ISA Associates, 1994; Nezlek & Galano, 1993; OSAP, 1991b.

83. Harrison, 1996.

84. Mattessich & Monsey, 1992; National Evaluation of the Community Partnership Program, 1994; Rabin, 1992; Ringwalt, et al., 1996.

85. Abramson & Rosenthal, 1995.

86. Butterfoss, et al., 1993.

87. Mattessich & Monsey, 1992; Ringwalt, et al.,1996.

88. Abramson & Rosenthal, 1995; Ringwalt, et al., 1996.

89. Butterfoss, et al., 1993.

90. Mattessich & Monsey, 1992.

91. Copple, et al., n.d.; Kotloff, et al., 1995.

92. Copple, et al., n.d..

93. Wiist, et al., 1996.

94. Butterfoss, et al., 1993; Ringwalt, et al., 1996.

95. Bailey & McNally Koney, 1995a; Butterfoss, et al., 1993; Kotloff, et al., 1995.

96. Kotloff, et al., 1995.

97. Abramson & Rosenthal, 1995; Alter & Hage, 1993; Butterfoss, et al., 1993; Copple, et al., n.d.; Francisco, et al., 1996; ISA Associates, 1994; Mattessich & Monsey, 1992; Mulroy, 1997; Schatz, et al., 1993; Williams, et al. 1991; Wolff & Foster, 1993.

98. Alter & Hage, 1993.

99. Butterfoss, et al., 1993.

100. Mattessich & Monsey, 1992.

101. ISA Associates, 1992, 1994.

102. Alter & Hage, 1993, p. 242.

103. Abramson & Rosenthal, 1995; Alter & Hage, 1993; Mattessich & Monsey, 1992; Mulroy, 1997; Ringwalt, et al., 1996.

104. Butterfoss, et al., 1993; Gambone, 1997; Harrison, 1996; Mattessich & Monsey, 1992; Nadel, et al., 1996; Ringwalt, et al., 1996.

105. Bailey & Koney, 1995a, 1995b; Mattessich & Monsey, 1992; Ringwalt, et al., 1996.

106. Aber, et al., 1996; Farrell, et al., 1996; Nadel, et al., 1996.

107. U.S. Dept. of Health and Human Services, 1997b, Group 7.

108. Kotloff, et al., 1995.

109. Bailey & McNally Koney, 1995a.

110. Butterfoss, et al., 1993; Gambone, 1997; Kotloff, et al., 1995; see also CSAP, 1995; Motter, et al., 1993; National Evaluation of the Community Partnership program, 1994; and OSAP, 1991; for discussion of the community capacity-building efforts of the CSAP Community Partnership Program.

111. Aber, et al., 1996; Schatz, et al., 1996.

112. Nadel, et al., 1996.

113. Kotloff, et al., 1995; Mansergh, et al., 1996.

114. Kotloff, et al., 1995.

115. Fawcett, Paine Andrews, et al., 1995; Mulroy, 1997; OSAP, 1991; and see section IIB above.

116. Butterfoss, et al., 1993; Harrison, 1996; Mattessich & Monsey, 1992; Rabin, 1992.

117. Alter & Hage, 1993.

118. ISA Associates, 1994.

119. Center for the Study of Social Policy, 1995; Kleiner, 1994; Schneider, 1994; Schatz, et al., 1993.

120. Butterfoss, et al., 1993; Gambone, 1997; Mattessich & Monsey, 1992; U.S. Dept. of Health and Human Services, 1997b, Group 3.

121. Gambone, 1997; Mulroy, 1997.

122. Butterfoss, et al., 1993.

123. Butterfoss, et al., 1993; Cohen & Lang, 1990; Gambone, 1997; Harrison, 1996; Kotloff, et al. 1995; Mattessich & Monsey, 1992.

124. Butterfoss, et al., 1993.

125. National Evaluation of the Community Partnership Program, 1994.

126. Abramson & Rosenthal, 1995; Francisco, et al., 1996.

127. Bailey & McNally Koney, 1995a; Cohen & Lang, 1990; Copple, et al., n.d.; Fawcett, et al., 1993; Fawcett, Paine Andrews, et al., 1995; ISA Associates, 1994; Kotloff, et al., 1995; Schatz, et al., 1993; Williams, et al., 1991.

128. Mattessich & Monsey, 1992.

129. Francisco, et al., 1996.

130. Mattessich & Monsey, 1992.

131. Copple, et al., n.d.; Mattessich & Monsey, 1992.

132. Butterfoss, et al., 1993; Center for the Study of Social Policy, 1995; Fawcett, Paine Andrews, et al., 1995; Mattessich & Monsey, 1992.

133. Schneider, 1994; U.S. Dept. of Health and Human Services, 1997b, Group 3.

134. Bailey & McNally Koney, 1995a.

135. Gambone, 1997.

136. Paine-Andrews, et al., 1996.

137. Kotloff, et al., 1995; ISA Associates, 1994; Schatz, et al., 1993; Willaims, et al., 1991.

138. Alter & Hage, 1993; ISA Associates, 1994; Kotloff, et al., 1995; Nezlek & Galano, 1993.

139. Nezlek & Galano, 1993.

140. Andersen, 1996; Ferraro, 1994; Israel, 1995; Rabin, 1992.

141. Kotloff, et al., 1995.

142. Bailey & McNally Koney, 1995a; Kotloff, et al., 1995.

143. Kotloff, et al., 1995; Nezlek & Galano, 1993.

144. Bailey & McNally Koney, 1995a.

145. Mizrahi & Rosenthal, 1992.

146. Alter & Hage, 1993.

147. Abramson & Rosenthal, 1995, p. 1483; see also ISA Associates, 1994.

148. ISA Associates, 1992.

149. Alter & Hage, 1993; Butterfoss, et al., 1993; Kotloff, et al., 1995; Mattessich & Monsey, 1992; Nezlek & Galano, 1993.

150. Fawcett, Paine Andrews, et al., 1995.

151. Abramson & Rosenthal, 1995; Butterfoss, et al., 1993.

152. Abramson & Rosenthal, 1995.

153. Alter & Hage, 1993.

154. Bailey & Koney, 1995a.

155. Mattessich & Monsey, 1992.

156. Ibid.

157. Bailey & Koney, 1995a.

158. Copple, et al., n.d.; ISA Associates, 1992; Kotloff, et al., 1995.

159. Francisco, et al., 1996.

160. Copple, et al., n.d.; Kotloff, et al., 1995; Paine-Andrews, et al., 1996.

161. Copple, et al., n.d..

162. Cohen & Lang, 1990.

163. Copple, et al., n.d., p..

164. Kotloff, et al., 1995.

165. Nezlek & Galano, 1993.

166. Fawcett, et al., 1993; Fawcett, Paine Andrews, et al., 1995; Francisco, et al., 1993, 1996.

167. Paine-Andrews, et al., 1996.

168. ISA Associates, 1992.

169. Copple, et al., n.d.

170. Wolff & Foster, 1993.

171. Fawcett, Lewis, et al., 1995, Fawcett, Paine Andrews, et al., 1995.

172. Bardach, 1993; Center for the Study of Social Policy, 1995; Fawcett, Lewis, et al., 1995; Francisco, et al., 1996; NIJ, 1995.

173. Mulroy, 1997.

174. Butterfoss, et al., 1993; Kotloff, et. al., 1995.

175. Fawcett, Lewis, et al, 1995; Gambone, 1997.

176. Schatz, et al., 1993.

177. Cohen & Lang, 1990; NIJ, 1995.

178. Center for the Study of Social Policy, 1995; Cohen & Lang, 1990; Gambone, 1997; ISA Associates, 1992; Mattessich & Monsey, 1992; Nezlek & Galano, 1993; Weiss, 1987.

179. Fawcett,

180. Copple, et al., n.d.

181. Copple, et al., n.d.

182. Nezlek & Galano, 1993.

183. Wolff & Foster, 1993.

184. Bailey & Koney, 1996; Butterfoss, et al., 1993; NCIPC, 1993; Schatz, et al., 1993.

185. Butterfoss, et al., 1993.

186. Ibid.

187. Mattessich & Monsey, 1992.

188. Fawcett, Paine Andrews, et al., 1995; Nezlek & Galano, 1993.

189. Bailey & Koney, 1995b; Copple, et al., n.d.; Fawcett, Lewis, et al., 1995; Francisco, et al., 1996; Gambone, 1997; Wolff & Foster, 1993.

190. Nezlek & Galano, 1993; Schneider, 1994; Wolff & Foster, 1993.

191. Gambone, 1997; Mattessich & Monsey, 1992.

192. Copple, et al., n.d.; U.S. Dept. of Health and Human Services, 1997b, Group 1.

193. Mulroy, 1997.

194. Bailey & McNally Koney, 1996.

195. Bailey & McNally Koney, 1995a, Mattessich & Monsey, 1992.

196. Butterfoss, et al., 1993.

197. Kotloff, et al., 1995.

198. Fawcett, Paine Andrews, et al., 1995; Gambone, 1997; NIJ, 1995.

199. Paine-Andrews, et al., 1996.

200. Fawcett, Paine Andrews, et al., 1995; Mattessich & Monsey, 1992.

201. Fawcett, Paine Andrews, et al., 1995; Paine-Andrews, et al., 1996.

202. Francisco, et al., 1996; Paine-Andrews, et al., 1996; Wolff & Foster, 1993.

203. Fawcett, Paine Andrews, et al., 1995.

204. Nezlek & Galano, 1993; Paine Andrews, et al., 1996.

205. Wolff & Foster, 1993.

206. Fawcett, Paine Andrews, et al., 1995.

207. Francisco, et al., 1996.

208. Florin, et al., 1992.

209. Copple, et al., n.d.

210. Ibid.

211. Bailey & McNally Koney, 1995b; Chavis, et al., 1993.

212. Copple, et al., n.d.; Fawcett, Lewis, et al., 1995; Wolff & Foster, 1993.

213. Bailey & McNally Koney, 1995b; Fawcett, Lewis, et al., 1995; Francisco, et al., 1993, 1996.

214. Bailey & McNally Koney, 1995b; Copple, et al., n.d.; Fawcett, Lewis, et al., 1995.

215. Bailey & McNally Koney, 1995b; Cook, et al., 1994; Fawcett, et al., 1993.

216. U.S. Dept. of Health and Human Services, 1997b, Group 1.

217. Fawcett, et al., 1993; Fawcett, Paine Andrews, et al., 1995; Francisco, et al., 1996; Wolff & Foster, 1993.

218. Kotloff, et al., 1995.

219. Goodman & Wandersman, 1994.

220. Cohen & Lange, 1990; Fawcett, Lewis, et al., 1995; Florin, et al., 1992; NIJ, 1995; Ringwalt, et al., 1996; Schatz, et al., 1993.

221. Florin, et al., 1992.

222. Francisco, et al., 1993, 1996; Fawcett, Paine, et al., 1993.

223. Copple, et al., n.d.; Wolff & Foster, 1993.

224. Fawcett, Lewis, et al. 1995.

225. Wolff & Foster, 1993.

226. Fawcett, Lewis, et al., 1995.

227. Butterfoss, et al., 1993, p. 327.

228. Chavis, 1995; Cohen & Lange, 1990; Francisco, et al., 1993; Wolff & Foster, 1993.

229. Copple, et al., n.d.; Fawcett, Lewis, et al., 1995.

230. Fawcett, et al., 1993; Cook, et al., 1994.

231. Fawcett, Lewis, et al., 1995.

232. Cagampang, et al., 1997.

233. Cagampang, et al., 1997; Cook, et al., 1994; Fawcett, Lewis, et al., 1995; Fawcett, Paine, et al., 1993.

234. Center for the Study of Social Policy, 1005; Francisco, et al., 1996.

235. Butterfoss, et al., 1993; see also Schneider, 1994.

236. Abramson & Rosenthal, 1995; Cohen & Lang, 1990; Copple, et al, n.d.; National Evaluation of the Community Partnership Program.

237. Copple, et al., n.d..

238. Bailey & McNally Koney, 1995a; Francisco, et al., 1996.

239. Wolff & Foster, 1993.

240. Bailey & McNally Koney, 1995a.

241. Paine-Andrews, et al., 1996.

242. Butterfoss, 1993, p. 316.

243. Ibid., p. 317.

244. Abramson & Rosenthal, 1995, p. 1479.

245. Chavis, 1995, p. 235.

246. Bailey & McNally Koney, 1995a, p.22.

247. Alter & Hage, 1993, p. 46.

248. Mattessich & Monsey, 1992, p. 4.

249. Gray & Wood, 1991.

250. Chavis, 1993; Chavis, et al., 1993; Florin, et al., 1992.

251. Fawcett, et al., 1993; Fawcett, Paine Andrews, et al., 1995; Francisco, et al., 1993, 1996; Wolff & Foster, 1993.

252. Bailey & McNally Koney, 1995a, 1995b, 1996.

253. Mizrahi & Rosenthal, 1992; Roberts-DeGennaro, 1986.

254. Alter & Hage, 1993.

255. Ibid., p. 265.

256. Ibid., p. 103.