An Assessment of the Sustainability and Impact of Community Coalitions once Federal Funding has Expired. Coalition Activities

06/01/2012

espondents provided information on the types of activities that the coalition has conducted since receiving the HCAP grant. Activities were defined as the projects, programs, products, and services the coalition worked on to serve the community.

Types of activities. Overall, a majority of sustained and not sustained coalitions conducted each type of activity. As shown in Exhibit 22, "Programs and Services" was the most commonly cited activity by both sustained (92%) and not sustained coalitions (86%). Sustained coalitions cited health behavior change activities least often (63%) while not sustained coalitions cited policy advocacy and change least often (51%). Sustained coalitions were significantly more likely to conduct several different types of activities compared to not sustained coalitions including systems change, policy and advocacy, and information dissemination.

Exhibit 22: Types of Coalition Activities
Activities Conducted Since HCAP Grant Received Sustained Coalitions (n=112) Not Sustained Coalitions (n=49)
*p<.10; **p<.05; ***p<.01, two-tailed difference of proportions test
Programs and services (e.g., enrollment assistance for entitlement programs or patient navigation) 92% 86%
Systems change (e.g., integrating data systems or pro bono provider systems)** 82% 65%
Health behavior change (e.g., wellness programs or training peer educators) 63% 53%
Capacity building (e.g., providing technical assistance to other organizations or community leader development programs) 71% 59%
Policy advocacy and change (e.g., informing local leaders and elected officials or collaborating with local institutions like school systems)*** 72% 51%
Dissemination of information and products (e.g., health fairs or community newsletters)* 79% 67%

Additionally, coalitions were asked to provide the three types of activities that made up the largest portion of their work during the HCAP grant, with sustained coalitions also being asked to provide the three types of activities that made up the largest portion of their work after the HCAP grant ended. When asked to narrow their activities down to the top three during the HCAP period, the responses of the sustained and not sustained coalitions were statistically equivalent, as shown by the blue and green bars in Exhibit 23. Among sustained coalitions, the coalitions were less likely to cite capacity building as a main activity after the HCAP grant (41% down from 50%) and more likely to cite policy and advocacy change activities (32%, up from 27%), as shown by the blue and red bars in Exhibit 23.


Exhibit 23: Activities that Made Up the Largest Portion of Coalitions’ HCAP Projects

Exhibit 23: Activities that Made Up the Largest Portion of Coalitions’ HCAP Projects

Exhibit 23: Activities that Made Up the Largest Portion of Coalitions' HCAP Projects
Main Activities Sustained Coalitions during HCAP Period (n=111) Sutained Coalitions after HCAP (n=110) Not Sustained Coalitions during HCAP Period (n=49)
Capacity Building 50 41 45
Dissemination of Information and Products 32 31 33
Health Behavior Change 32 36 33
Policy Advocacy and Change 27 32 35
Programs and Services 90 88 82
Systems Change 59 58 59

Of the 113 sustained coalitions who provided responses to the survey’s coalition activities sections, four (4%) reported that the coalition was not conducting any of the same activities it did during the HCAP grant. Fifty-nine of the coalitions (52%) reported conducting at least one of the original activities; 21 (19%) reported conducting all of the same activities; and 29 (26%) reported conducting all of the same activities plus new ones. All of the 92 sustained coalitions that have dropped or added activities since the HCAP grant period reported that the activities they conducted at the time of the survey were consistent with at least one of the coalition’s HCAP goals.

Changes in coalition activities. Sustained coalitions also reported on why they changed or added new activities. The three most common reasons for changing or adding new activities were qualifying for (or as a result of) new funding; reacting to changes in the demographics or needs of the target population; and expanding reach to a new population. An example of changing or adding new activities due to one of these reasons was seen when a sustained coalition realized that the mentally ill were not receiving adequate services, the coalition increased outreach and services provided. This activity expanded to helping the mentally ill find permanent housing when the coalition received funding through a grant specifically related to housing. Another coalition began targeting in-patients, realizing that enrolling them in a program for the under insured or uninsured was more effective. Additional reasons provided for adding or changing activities included funders’ priorities changing, evaluation results suggesting changes were needed, exogenous influences (e.g., Hurricane Ike), structural influences (e.g., all volunteer organization, so need to conduct activities people are willing to do), and more nuanced resource issues (e.g., decreases in funding resulted in scale-backs to all activities rather than eliminating a few activities). Some sustained coalitions described experiences of learning how to keep processes efficient and effective, thus changing some of the activites conducted under HCAP. For example, one coalition realized that a nursing component originally designed for the program was not valuable because those activites were already being conducted by the hospitals and clinics. As such, they made the programmatic decision to eliminate that activity, while continuing to meet the needs of their population in other ways.

Of the not sustained coalitions responding to the activities questions (51), ten (20%) reported that none of the coalition’s original activities were being conducted by the coalition/organization or another coalition/organization at the time of the survey. Twenty-six (51%) reported that at least one activity was still being conducted and 15 (29%) reported that all of the original activities were still being conducted. In some cases, some services that not sustained coalitions were providing under HCAP were transferred to another entity within the community. For example, a free care program launched by one not sustained coalition was absorbed by the hospital where it was being implemented. A key informant from another not sustained coalition said that the dollars it received through HCAP had a domino effect and "continue to bear fruit."

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