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

06/01/2012

The literature review demonstrated that coalitions have different memberships, patterns of formation, functions, goals, activities, and organizational structures. As such, it was important to clearly define the term "community coalition." A commonly used definition of community coalitions, developed by Feighery and Rogers (as cited in Butterfoss, 2007, p. 31), defines a community coalition as "a group of individuals representing diverse organizations, factions, or constituencies within the community who agree to work together to achieve a common goal." To add specificity to the conceptual framework, the Feighery and Rogers definition is expanded to define the number of organizations. Thus, for this study, a community coalition is defined as an alliance of three or more organizations who agree to come together to achieve a common goal. Adding the requirement of at least three organizations to the definition excludes direct partnerships between two entities from qualifying as a coalition, while ensuring the inclusion of coalitions of all sizes. This definition serves two purposes. First, by building on the well-accepted Feighery and Rogers definition, findings about the sustainability of community coalitions generated with this definition can be compared to other findings in the literature. Second, this definition is broad and will therefore be inclusive of community coalitions even if their form or function changed over time. Furthermore, it is necessary to define what is meant by the sustainability of a community coalition.

Post initial federal funding, some community coalitions continue to function exactly as they did previously—with the same membership, goals, activities, managerial structures, intensity of collaboration, community buy-in, and vision. Others are sustained with a different composition of members, although the coalition still continues to address its original goals. Some community coalitions have the same composition of members, but have scaled back their work by addressing only one (rather than all) of their original goals. Other community coalitions continue to evolve since they were initially federally funded, addressing their original goals and expanding to work toward new goals. Some coalitions adopt entirely new goals as a result of a shift in the economic or political environment or in response to a change in the community’s needs. In addition, some coalitions dissolve because of internal problems, or actively disband because they have found new homes for their activities within the community (e.g., institutionalization of the benefits within the community) or because they have achieved their original goals. A definition of sustainability in the context of community coalitions must recognize these different scenarios.

In the conceptual framework, a sustained community coalition is defined as an alliance of three or more organizations that is addressing one or more of the original goals of the coalition. There is an important distinction between the community coalition’s "goals" and its "activities." For example, the original goals of the HCAP community coalitions were connected to the vision of the coalition. Within HCAP, common goals were to increase insurance coverage and access to services for the uninsured and underserved; increase coordination and integration of services in the community; improve the quality of health care for the uninsured and underserved; and reduce the cost of care for the uninsured and underserved. The activities are the ways in which each coalition works toward its goals. Activities are unique to each coalition and may be refined over time to reflect the economy, funding priorities, population demographics, evaluation results, or other factors.

Definition of a Sustained Community Coalition
A sustained community coalition is an alliance of three or more organizations that is addressing one or more of the original goals of the coalition.

This model assumes that there will be membership turnover in the community coalition, and therefore, the alliance of three or more organizations does not need to be the same one that was part of the community coalition when it was initially federally funded. The decision to define a sustained coalition in terms of the presence of an alliance of three or more organizations that is addressing one or more of the original goals—rather than the continuation of the coalition’s activities post-initial federal funding—was based on the literature, and made in collaboration with ASPE.

Furthermore, of the sustained community coalitions (i.e., those that have satisfied both conditions), some may have been partially sustained. A coalition is considered partially sustained if it satisfies both conditions of sustainability but is not addressing all of its original goals. Similarly, some community coalitions may be continuing to work toward all of their original goals while also addressing a new goal or goals. This community coalition would be considered expanded. Community coalitions may also be partially sustained and expanded. These coalitions are partially sustained because they are addressing at least one of their original goals. However, they have also expanded because they have taken on at least one new goal. The new goal may or may not be synergistic to the original goals of the coalition. Rather, the new goal is reflective of the evolving needs of the community. Partially sustained and expanded coalitions have an important adaptive capacity, given that they have responded to community conditions over time.

Post initial federal funding, some community coalitions will not be sustained. The coalitions that do not have an alliance of three or more organizations, may have either dissolved because of a lack of resources, conflicts, or other reasons, or actively disbanded because they have achieved their original goal(s), and/or were no longer needed in the community. Additionally, in some cases, the coalition may have an alliance of three or more organizations that is no longer addressing at least one of the coalition’s original goals. This coalition is addressing a new goal, perhaps as a result of a shift in the economic or political environment or in response to a change in the community’s needs. Additionally, a coalition may address a new goal to meet the requirements of a new funder. Regardless of whether the coalition dissolved, actively disbanded, or is addressing a new goal to meet the needs of the community, the coalition is considered not sustained. Thus, even coalitions that have an active membership and/or were successful in institutionalizing the activities in the community may not necessarily be considered sustained.

In order to provide a foundation for the definition of a sustained community coalition, Exhibit 1 displays a sustainability decision tree that was used to guide our study.


Exhibit 1: Sustainability of the Community Coalition

Exhibit 1: Sustainability of the Community Coalition

Notes:

  1. The alliance of two or more organizations does notneed to be the same alliance that was part of the community coalition when it was initially federally funded.
  2. The original goals are those goals that the coalition was addressing when the coalition was initially federally funded. The coalition’s original goals should not be confused with its activities. The coalition’s activities are the ways in which the coalition works towards its goals. These activities may change over time to reflect the economy, funding priorities, population demographics, evaluation results, or other factors.

Coalitions that are "sustained" in Exhibit 1 are composed of an alliance of three or more organizations that are working toward one or more of the coalition’s original goals. However, these coalitions are not necessarily pursuing their original activities, i.e., the same activities that they did when they were initially federally funded. Activities are the ways in which each coalition addresses its goals, and may include programs or services, systems, policies, health behavior interventions, dissemination of products, and community capacity building. Therefore, upon determining whether the coalition itself has been sustained, it is necessary to explore whether the coalition has been able to sustain all, some, or none of its original activities. Given that coalitions evolve over time, it is possible that activities will also change to reflect the needs of the community or the requirements of a funder.

Exhibit 2 demonstrates that all, some, or none of the original activities of the coalition may have been sustained, regardless of whether the coalition itself has been sustained. Additionally, the coalition may take on new activities to reflect the economy, funding priorities, population demographics, evaluation results, or other factors. Below are three hypothetical cases of community coalitions whose activities have been sustained after their initial federal funding has ended. In the first case, all of a sustained coalition’s original activities have been sustained. In the second case, some of a sustained coalition’s original activities have been sustained. In the third case, none of a sustained coalition’s original activities have been sustained.

  • All of a sustained community coalition’s original activities are sustained. For example, suppose a community coalition’s original goal was the improvement of coordination and integration of services. The coalition decided to implement an electronic medical record (EMR) application at 15 different clinics in its service area. The coalition’s funds were used to conduct several activities: to integrate clinic messaging standards, train providers in the county clinics about how to use the EMR, and purchase some of the needed hardware for the rollout. After the initial federal funding ended, the coalition was able to continue all of these activities because it found a suitable benefactor to continue the project.

  • Some of a community coalition’s original activities are sustained. For example, suppose a community coalition’s original goal was the improvement of access to health care services for the uninsured. The coalition conducted a variety of activities to meet this goal when it was initially federally funded. First, the coalition expanded the network of providers in the community that would serve the uninsured at a reduced cost. Second, the coalition implemented patient navigation services to expand access to rural members of the community. Finally, the coalition disseminated health education materials throughout the community. After initial federal funding expired, the coalition has been sustained because it has an alliance of three or more organizations that continues to meet the original goal of improving access for the uninsured. However, after the initial funding ended, the coalition also had to discontinue several original activities because of budgetary constraints, and it now only focuses on expanding the network of providers that serve the uninsured.

  • None of a sustained community coalition’s original activities are sustained. For example, suppose a community coalition’s original goal was to increase access to primary care and prevention services. The coalition’s original activities were related to health education and community outreach. Post initial federal funding, the coalition was sustained because it received a large grant from a foundation. As part of this grant, the coalition conducted a needs assessment that found that transportation was the largest barrier to accessing services in the coalition’s catchment area. In response to this new information, the coalition discontinued its original activities, and conducted new activities that address transportation needs in rural areas.

In addition to these examples, there may be many other variations (e.g., a partially sustained coalition that has sustained some/all of its activities, an expanded coalition that sustained none of its original activities but conducts several new activities, a coalition that was not sustained even though some or all of its activities live on in the community, etc.).


Exhibit 2: Sustainability of the Community Coalition’s Activities

Exhibit 2: Sustainability of the Community Coalition’s Activities

Notes:

  1. The alliance of three or more organizations does notneed to be the same alliance that was part of the community coalition when it was initially federally funded.
  2. The original goals are those goals that the coalition was addressing when the coalition was initially federally funded. The coalition’s original goals should not be confused with its activities.
  3. The coalition’s original activities are the ways in which the coalition works towards its original goals. Coalitions may sustain some, all, or none of their original activities. Additionally, the coalition may take on new activities to reflect the economy, funding priorities, population demographics, evaluation results, or other factors.

View full report

Preview
Download

"rpt.pdf" (pdf, 942.2Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®