Community Partnerships

Building partnerships with the community: lessons from the Camden Health Improvement Learning Collaborative.

Weech-Maldonado R, Merrill SB.
Department of Health Policy & Administration, Pennsylvania State University, University Park, USA. rxw25@psu.edu
J Healthc Manag. 2000 May-Jun;45(3):189-205.

This case study describes the Camden City Health Improvement Learning Collaborative (the Collaborative), a community care network initiative formed in 1993. The organization is composed of representatives from local healthcare providers, public agencies, religious organizations, and neighborhoods. The major goal of this initiative is to improve the health status of the community by involving and empowering residents in the solution of their needs. The Collaborative represents a grassroots strategic model of community inclusion in the formulation of goals and programs to improve community health status. The case study describes the dynamics of the Collaborative by examining the following: historical development; political, institutional, and social context; planning process; organization and structure; and performance evaluation. The article concludes with a discussion of the strategic and operational lessons learned from the Collaborative.

Early intervention screening for family caregivers of older relatives in primary care practices: establishing a community health service alliance in rural America.

Kaye LW. Turner W. Butler SS. Downey R. Cotton A.
Center on Aging, University of Maine, Orono, ME 04469-5770, USA.
Family & Community Health. 26(4):319-28, 2003 Oct-Dec.

The Maine Primary Partners in Caregiving project provides a prime example of how disparate community health, social service, and higher education institutions can build a successful rural service alliance for the purposes of screening for family members experiencing stress during the provision of care to impaired older relatives. Community primary care practices are featured as prime sites for the early identification of elder caregivers experiencing stress and burden. Initial project results and implementation challenges as well as recommended strategies for nurturing such community partnerships are presented.

MDON: a network of community partnerships.

Constance A. Crawford K. Hare J. Parker S. Scott A. Stys A. May-Aldrich G.
U.P. Diabetes Outreach Network, Marquette, Michigan, USA.
Family & Community Health. 25(3):52-60, 2002 Oct.

This model for strengthening diabetes care in communities teams the public health system with the professional and lay community to address prevention, early detection, and treatment of diabetes. This article describes how the Michigan Diabetes Outreach Network (MDON) develops local, regional, and statewide partnerships to increase professional and public knowledge and to improve care delivery for this chronic and complex disease.

The costs and benefits to participants in community partnerships: a paradox?

El Ansari W. Phillips CJ.
Postgraduate Public Health Program, Oxford Brookes University, Oxford, United Kingdom. walid.ansari@brookes.ac.uk
Health Promotion Practice. 5(1):35-48, 2004 Jan.

This article examines the degree of stakeholder participation in health and social partnership schemes in relation to their perceptions of benefits, costs, satisfaction, commitment, and ownership. The findings suggest that (a) involvement, commitment, and sense of ownership were invariably associated with high benefits and mostly with low costs; (b) benefits, commitment, and ownership might be more sensitive monitors of involvement than costs and satisfaction; © an increase in involvement was initially associated with decreased costs and increased satisfaction up to a point beyond which costs increased and satisfaction decreased despite increasing benefits; and (d) favorable cost-benefit ratios were perceived when the benefits were at least 1.6 times the costs. Partnership initiatives need to explore the involvement “cut-off” point at which the costs (and satisfaction) might change direction. For favorable cost-benefit ratios, benefits need to be at least 60% more than costs (Ansari’s paradox).

A review of collaborative partnerships as a strategy for improving community health.

Roussos ST, Fawcett SB.
University of Kansas, Lawrence 66045, USA. tsai_roussos@mindspring.com
Annu Rev Public Health. 2000;21:369-402.

Collaborative partnerships (people and organizations from multiple sectors working together in common purpose) are a prominent strategy for community health improvement. This review examines evidence about the effects of collaborative partnerships on (a) community and systems change (environmental changes), (b) community-wide behavior change, and © more distant population-level health outcomes. We also consider the conditions and factors that may determine whether collaborative partnerships are effective. The review concludes with specific recommendations designed to enhance research and practice and to set conditions for promoting community health.

Academic-community partnerships as a strategy for positive change in the sexual behavior of rural college-aged students.

Anderko L. Uscian M.
School of Nursing, Northern Illinois University, 1240 Normal Road, DeKalb, IL 60115, USA. landerko@uwm.edu
Nursing Clinics of North America. 37(2):341-9, 2002 Jun.

Students who completed the pre-intervention survey were asked to complete the 74-item questionnaire again to determine if risky behavior had changed over time. Substantial reductions in risky behaviors were reported. Students reporting five or more sex partners in the previous year decreased from 13% to 4%. Students reporting “always” or “mostly” using a condom increased from 51% to 61%. Other positive findings indicated that students who had contracted a STD decreased from 8% to 2%, and students who experienced an unwanted pregnancy decreased from 12% to 4% [21]. However, despite the positive behavior changes reported, student’s perceptions of sexual norms remained inaccurate. For example, although 72% of students reported having zero to one sex partner(s) in the past year, students perceived that only 5% of the student population had zero to one sex partner(s). The effectiveness of specific efforts to change perceptions (e.g., newsletters, interactive booths) requires more intensive evaluation so that successful strategies can be reinforced and/or developed [21]. Positive findings from this academic-community partnership underscore the need for nurses to acknowledge the influence of the community on impacting an individual’s behavior, and integrate interventions that modify the social context of at-risk behavior. The results of this study also suggest that nursing centers can successfully establish effective academic-community partnerships and design innovative primary prevention programs that can positively modify the social environment for positive changes in health behavior of at-risk populations. Limited health care resources in rural communities demand innovative approaches to reduce the continually increasing incidence of these diseases. Since limited resources for HIV/STD prevention existed in this rural community, collaboration with community agencies that had available resources was essential to developing effective prevention efforts. Academic-community partnerships can increase the number of persons at risk that are reached and, ultimately, help prevent further increases in HIV/STD cases in rural areas.

Evaluating community partnerships and coalitions with practitioners in mind.

Butterfoss FD. Francisco VT.
Health Promotion and Disease Prevention Section, Center for Pediatric Research, Norfolk, Virginia, USA.
Health Promotion Practice. 5(2):108-14, 2004 Apr.

Evaluation plays a key role in developing and sustaining community partnerships and coalitions. We recommend focusing on three levels of coalition evaluation that measure (a) processes that sustain and renew coalition infrastructure and function; (b) programs intended to meet target activities, or those that work directly toward the partnership’s goals; and © changes in health status or the community. A tendency to focus on quick wins and short-term effects of programs may explain why some coalitions are not able to achieve systems and/or health outcomes change. Although measuring community-level or system changes (e.g., improving environmental quality or changing insurance coverage policies) is much more difficult than evaluating program outcomes, it is essential. This article presents challenges that coalition practitioners and evaluators face and concludes with practical resources for evaluation.

Local newspapers, community partnerships, and health improvement projects: their roles in a comprehensive community initiative.

Hubbell AP. Dearing JW.
Department of Communication Studies, New Mexico State University, Las Cruces 88003, USA. ahubbell@nmsu.edu
Journal of Community Health. 28(5):363-76, 2003 Oct.

To understand local media’s role in a community health initiative, a content analysis of 1,709 paragraphs from 173 news articles and editorials was undertaken. The articles were from three local newspapers, one in each of three communities. Analyses focused on article content combined with reflective personal interviews with local campaign directors. Results suggest that local campaign staff can be successful using commercial media to achieve objectives. Surprisingly, most coverage was not about projects with observable and easily identifiable benefits for local residents, but rather partnerships among influential residents engaged in decision-making about such projects. We conclude that the politics of resource distribution is more newsworthy to local journalists than tangible topics like access to health information, insurance coverage, and service provision.

Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research. [Review]

Lasker RD. Weiss ES.
Center for the Advancement of Collaborative Strategies in Health, Division of Public Health, The New York Academy of Medicine, New York, New York 10029, USA. rlasker@nyam.org
Journal of Urban Health. 80(1):14-47; discussion 48-60, 2003 Mar.

Over the last 40 years, thousands of communities-in the United States and internationally-have been working to broaden the involvement of people and organizations in addressing community-level problems related to health and other areas. Yet, in spite of this experience, many communities are having substantial difficulty achieving their collaborative objective, and many funders of community partnerships and participation initiatives are looking for ways to get more out of their investment. One of the reasons we are in this predicament is that the practitioners and researchers who are interested in community collaboration come from a variety of contexts, initiatives, and academic disciplines, and few of them have integrated their work with experiences or literatures beyond their own domain. In this article, we seek to overcome some of this fragmentation of effort by presenting a multidisciplinary model that lays out the pathways by which broadly participatory processes lead to more effective community problem solving and to improvements in community health. The model, which builds on a broad array of practical experience as well as conceptual and empirical work in multiple fields, is an outgrowth of a joint-learning work group that was organized to support nine communities in the Turning Point initiative. Following a detailed explication of the model, the article focuses on the implications of the model for research, practice, and policy. It describes how the model can help researchers answer the fundamental effectiveness and “how-to” questions related to community collaboration. In addition, the article explores differences between the model and current practice, suggesting strategies that can help the participants in, and funders of, community collaborations strengthen their efforts.

Fighting childhood obesity with university-community partnerships.

Thompson LS. Grey M.

Center for Community Partnerships for Children and Families, University of Maryland, 655 West Lombard, Room 516, Baltimore, MD 21201, USA. thompson@son.umaryland.edu
Nursing Leadership Forum. 7(1):20-4, 2002 Fall.

This article describes how two Robert Wood Johnson (RWJ) Executive Nurse Fellows used their leadership competencies to inspire and lead change within the community to fight the growing problem of childhood obesity. A model of University-Community partnership is proposed which incorporated the core leadership competencies of the RWJ program—interpersonal and communication effectiveness; risk-taking and creativity; self-knowledge; skills in creating change; and, strategic vision. Leadership lessons learned are provided for nurses interested in leading efforts to improve the health status of communities.

Building community capacity in public health: the role of action-oriented partnerships.

Veazie MA, Teufel-Shone NI, Silverman GS, Connolly AM, Warne S, King BF, Lebowitz MD, Meister JS.
Southwest Center for Community Health Promotion, College of Public Health, University of Arizona, Tucson, Arizona, USA.
J Public Health Manag Pract. 2001 Mar;7(2):21-32.

Public health practice increasingly is concerned with the capacity and performance of communities to identify, implement, strengthen, and sustain collective efforts to improve health. The authors developed ways to assist local Turning Point partnerships to improve their community public health system as a secondary outcome of their work on the expressed needs of the community. Using focus groups, meeting minutes, attendance records, and meeting observation, the authors fed information back to the partnerships on systems change. A public health systems improvement plan supportive of local partnerships’ work on specific health issues was funded and the collaborative research agenda was further refined.

Collaboration for health improvement: models for state, community, and academic partnerships.

Berkowitz B.
Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, USA.
J Public Health Manag Pract. 2000 Jan;6(1):67-72.

The value of approaching health improvement through collaborative models seems self-evident, especially at the community level. A review of the literature, however, reveals a number of challenges in terms of helping us understand precisely what it is that makes collaborative models effective in influencing health. The purpose of this article is to describe important elements of collaboration that state, local, and academic partners may wish to consider when developing models for health improvement. The author will provide examples of collaborative strategies that are emerging from the Turning Point: Collaborating for a New Century in Public Health initiative.

Collaborative partnerships at the state level: promoting systems changes in public health infrastructure.

Padget SM, Bekemeier B, Berkowitz B.
School of Nursing, Turning Point National Program Office University of Washington, Seattle 98109, USA.
Public Health Manag Pract. 2004 May-Jun;10(3):251-7.

Reforms in the public health infrastructure such as those called for in recent Institute of Medicine reports require stakeholder engagement on different levels than traditional grass-roots community work. The Turning Point Initiative, funded by The Robert Wood Johnson Foundation, involves 21 state-wide partnerships established for systems change and focused in specific areas of public health innovation and policy development. These partnerships represent a different model of strategic alliances and relationship-building than has been previously described in the literature on community-level and health-promotion collaborations. This article utilizes qualitative data to illustrate the ways in which state-level partnerships for systems change both confirm and extend previous models. Findings indicate that state-level public health partnerships share many of the challenges and opportunities of locally-based and health-promotion-oriented partnerships. Collaboration at the state level, however, involves more attention to organizational alliances, coordination of institutional change, and strategic responses to political changes. These partnerships depend on a combination of interpersonal skills, material resources, and organizational savvy to manage complex planning and implementation processes. Influencing policy development and organizational redesign in public health systems requires nuanced understanding of the opportunities provided by various kinds of organizational partners.

Innovations in collaboration for the public's health through the Turning Point Initiative: the W.K. Kellogg Foundation perspective.

Sabol B.
Health Department, W.K. Kellogg Foundation, Battle Creek, Michigan, USA.
J Public Health Manag Pract. 2002 Jan;8(1):6-12.

The need for a more integrated public health system led the W. K. Kellogg Foundation (WKKF) to establish Turning Point (TP): Collaborating for a New Century in Public Health, with a goal of transforming and strengthening the current public health infrastructure. WKKF partners with the Robert Wood Johnson Foundation (RWJF), the National Association of County and City Health Officials, the University of Washington, the Lewin Group, and the New York Academy of Medicine to support activities of 41 community and tribal jurisdiction grantee partnerships in 14 states. Preliminary evaluation of partnerships participation indicate: (1) most have accomplished breadth; (2) many did not achieve depth prior to the end of initial recruitment and (3) when the mission was internalized, penetration occurred. Strengthening public health systems requires redevelopment of human, organizational, financial, educational and information resources, and as in the past, WKKF will work to this end.

Managing complex systems: performance management in public health.

Landrum LB, Baker SL.
Illinois Public Health Futures Institute, Coordinator, Turning Point’s Performance Management Collaborative, Chicago, Illinois 60601, USA.
J Public Health Manag Pract. 2004 Jan-Feb;10(1):13-8.

The complexity of mobilizing and managing systems-wide public health responses has prompted Turning Point’s Performance Management National Excellence Collaborative, funded by the Robert Wood Johnson Foundation, to develop a conceptual framework for performance management in public health. The framework has four integrated parts: (1) performance standards, (2) performance measures, (3) reporting of progress, and (4) a quality improvement process. The Collaborative based its framework on evidence gathered through a survey of current state performance management practices, a literature review, and its investigation of current practice models. This balanced and cohesive management model can be constructively used by public health programs, organizations, and community and state public health systems.

Public health infrastructure system change: outcomes from the turning point initiative.

Berkowitz B, Nicola RM.
Department of Psychosocial and Community Health, Turning Point National Program Office, University of Washington, Seattle, USA.
J Public Health Manag Pract. 2003 May-Jun;9(3):224-7.

The Robert Wood Johnson and W.K. Kellogg Foundations created the Turning Point initiative to transform and strengthen the public health infrastructure. This study examined 135 public health system changes for their links to multiple sector collaborative engagement, essential public health services, health outcomes, and infrastructure building strategies. An on-line documentation system developed by the University of Kansas was used to record and analyze these linkages. The results showed that each state accomplished notable system changes; the majority involved more than one sector and primarily related to increasing local public health system capacity and organizational change.