Community coalitions have increasingly been used as a vehicle to foster improvements in community health. When they function well, they offer a powerful means of mobilizing individuals, raising the visibility of issues that are of concern to the community, minimizing duplication of effort and services, making efficient use of new resources, and convening diverse organizations that have a common goal or concern in order to develop comprehensive solutions. Funders, including the U.S. Department of Health and Human Services (HHS), have often provided grants to community coalitions to promote health, and have encouraged partners to work together at the community level to achieve common aims. Further, many initiatives have required grantees to form coalitions because they offer a means of coordinating multi-faceted approaches to address complex problems that are rooted in the social and physical environment of a community.
While research has shown that coalitions can successfully address health concerns and support improved health behavior, less is known about the sustainability of coalitions and their outcomes once their initial funding ends. Further, there is significant ambiguity around the meaning and assessment of coalition sustainability. There are no standard guidelines for evaluating sustainability, and no common definition of sustainability currently exists. Some studies have operationalized the concept of sustainability as the continuation of all or part of the coalition and its structure after initial external funding ends. Others have focused less on the idea that a coalition must maintain the membership and structure to be considered sustainable, and more on the idea that it continues to meet its initial goals and objectives to provide benefits to the community. Furthermore, many HHS initiatives provide seed money to community coalitions to promote their sustainability, but very little research has been done to examine the impact of community coalitions that have continued to exist after the initial funding has ceased.
To fill this important research gap, and to learn more about what happens to the dynamics of collaborations that have been built around grant funding once that funding is no longer present, the Office of the Assistant Secretary for Planning and Evaluation (ASPE), within HHS, contracted with NORC at the University of Chicago (NORC) to examine the long-term sustainability and impact of community coalitions that were funded by the Community Access Program (CAP) and its successor, the Healthy Communities Access Program (HCAP).1 HCAP was one of the largest federal investments to strengthen local safety nets through community coalitions providing $525 million in grants from 2000 to 2006 to 260 coalitions across 45 states, the District of Columbia, and the U.S. Virgin Islands. Many grantees within the initial cohorts of the HCAP program had a track record of building partnerships, having been recipients of earlier national foundation funding from the W.K. Kellogg and Robert Wood Johnson Foundations, or having received support from other contributors such as health systems, corporations, or non-profit organizations.
The conclusion of the HCAP funding posed a number of problems for grantees that lacked other funding sources, and the sustainability of several programs was threatened at the end of the funding stream. As such, exploring what has happened to the HCAP coalitions during the intervening years since they stopped receiving initial federal funding can provide important information—not only on the effectiveness of the HCAP coalitions, but also on the post funding experiences of coalitions that successfully competed for grant funding from HHS. This project sought to use the experience of HCAP to learn about the long-term sustainability of federally-funded coalitions and had several research questions:
- How many community coalitions funded under HCAP are still in existence?
- What coalition characteristics are associated with sustainability and what factors promote or hinder community coalition sustainability?
- What are the impacts of HCAP coalitions post-federal funding and what are the types of outcomes achieved? To what extent have the coalitions evolved to address the needs in the community?
To examine these important issues, NORC conducted a multi-method assessment using qualitative and quantitative research methods, including a review of literature on coalition sustainability; a survey of the 260 former HCAP grantees; key informant interviews with sustained and not sustained HCAP coalitions; and case studies involving site visits with sustained coalitions.
This report examines the long-term sustainability and impact of community coalitions that were funded by HCAP. It synthesizes the findings from our study of the sustainability, evolution, and impact of the HCAP coalitions since the expiration of HCAP funding.