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Preventing Chronic Disease

Working with Health Coalitions

Local health departments can provide the impetus for a variety of coalitions to work together on chronic disease prevention. As staff to many networks, advisory boards, commissions and task forces, they are in a good position to help these groups collaborate.

Coalitions have flourished in recent years as a way for communities to advocate for a broad array of interests. In California, health coalitions have proliferated since the advent of Proposition 13, a 1978 reform of the property tax. That measure resulted in a huge loss of state revenue, severely impairing funding for public programs. Coalitions formed to make the most of limited resources and reduce duplication of services.

Many health departments have a long history of working with coalitions to garner community support, solicit resources, plan programs, and advocate policies. Usually these health coalitions have focused on a single issue or population. In fact, passion for a particular issue often is what drives volunteers to commit. Among the most successful examples are coalitions that address tobacco, substance abuse and AIDS prevention.

In Contra Costa County...

While single-issue coalitions have scored many successes, they have sometimes been at odds with one another-in competition for members or funds, or in conflict over proposed policies or legislation. A few years ago the county's Breast Cancer Partnership found itself pitted against the local Tobacco Prevention Coalition as the state legislature debated whether to divert tobacco prevention dollars to breast cancer screening and treatment. Luckily, the groups shared members in common, so the two coalitions decided to reinforce one another. Their message to the legislature: Both initiatives are critical and both should be adequately funded. We shouldn't have to choose one over the other.

This kind of coordination would happen more routinely if coalitions had mechanisms in place to work together. Collaboration among coalitions increases the likelihood of success in accomplishing shared goals and minimizing conflict. It offers the potential for a broader constituency, more access to skills and expertise, and greater credibility.

When it comes to chronic disease prevention, there are likely to be a number of groups working independently to address particular risk factors or diseases. To foster collaboration among them, emphasize how risk factors are related, and how they play a joint role in promoting a host of diseases. Help each community see how collaboration can advance its particular interest. At the same time, acknowledge that collaborative planning involves some uncertainty, as organizations may have to confront conflicting priorities. Be aware that you will need a strong commitment from coalition leadership and staff.

Step One: Identify potential partners


Conduct an assessment

As in any planning effort, assess the resources at hand. Take an inventory of existing coalitions, advisory groups and task forces addressing issues related to chronic disease. Keep in mind that environmental health and justice groups are often allies in chronic disease prevention efforts. For each organization, collect the following information:

  • Mission and vision statement
  • Communities served
  • Priority issues
  • Primary strategies
  • Major accomplishments
  • Experience collaborating with other groups
  • Mandates and constraints set by the organization or its funders
  • List of active members

There are various means to do an assessment of existing coalitions. These can include interviews with staff and community leaders, written surveys, group meetings, and review of written materials solicited from each group.

View/Print

Coalition Survey (8k PDF, 2pp.)
Coalition Map (6k PDF, 1p.)

If you conduct individual interviews or surveys, distribute a summary of the results to each organization that participated and to the leadership of each coalition. Invite feedback on the findings. You may wish to review the membership lists you've collected from each coalition to see whether there is any overlap. Shared members could indicate opportunities to strengthen ties.

If you arrange a group meeting, people will have a chance to network and identify areas of common interest. In preparation, make personal contact with the lead staff person of each prospective partner coalition to describe the initiative and the purpose of the meeting. Invite him or her to participate. Also contact at least one community representative from each group. Then send written follow-up invitations. Ask participants to come prepared to describe their coalition. Invite them to bring any written materials they want to pass out, such as sample bylaws, mission statements, committee descriptions, or recruitment and orientation materials.

The format for the meeting will depend on the number of people attending. If the meeting is relatively small, consider a 'round robin' approach, in which you ask each person around the table to briefly share information about his or her group. If the meeting is large, perhaps have people pair up to introduce themselves, then reconvene as a group to recount the highlights. Depending on the numbers, you may need one or two introductory meetings.

Other suggestions for the meeting facilitator:

  • Record ideas on a large wall grid that everyone can see.
  • Make and post a list of issues that will require further discussion or action.
  • After the meeting, distribute notes to all participants.

Choose representatives from each organization

Each participating coalition will need to designate one or more representatives to take part in the next phase of the discussions about collaborative planning. These representatives should have skills in group planning and should understand the potential role that their coalition might play in the collaborative. They should be familiar with the risk factors for chronic disease and with prevention approaches that focus on the community.

Plan for natural fluctuations in participation. People may not be able to attend meetings consistently, and there may even be turnover in staff and community leaders during the planning period. Develop strategies for keeping people informed and bringing new members up to speed, so that the flow of meetings is not continually disrupted. For example, consider using a flip chart at the beginning of each meeting that summarizes the project's purpose, agreements to date and steps to be accomplished. Another option is to have group members agree to pair up with newcomers to orient them.

In Contra Costa County...

In Contra Costa, much of the leadership for collaboration came from the Public and Environmental Health Advisory Board (PEHAB), a citizen advisory board to the county board of supervisors and the health department. A number of the PEHAB members participated in various single-issue groups and urged these groups to look at their common concerns. A networking meeting was convened with staff from PEHAB, the Breast Cancer Partnership, the Tobacco Prevention Coalition, the West County Food Security Council, the Food & Nutrition Policy Consortium and the Childhood Injury Prevention Coalition.

Staff worried that collaboration would mean more work and could dilute the efforts of their individual groups. Nonetheless, they dentified some areas to explore for cooperation: exchanging information such as legislative updates, sharing recruitment and retention strategies, and training staff and community members. PEHAB suggested that at a minimum, the coalitions share their priorities and planned activities with one another on a annual basis. Members agreed to take these ideas back to their coalition memberships via their newsletters and oral reports at meetings.

Step Two: Assess readiness to collaborate

Once the inventory from Step One is complete, compile the findings and analyze them. Look for common ground among the organizations. Look also for potential obstacles to collaboration. Share the analysis with those who participated in the inventory. Invite clarification or new ideas.

If you held a large group meeting and some key coalitions were unable to attend, you may want to present the findings to the governing body of such groups. Solicit their feedback by asking, for example:

  • Are the conclusions accurate and complete?
  • Could your group benefit from collaborating with other chronic disease coalitions?
  • What efforts would your group most like to pursue?
  • What role could your group play?
  • What resources can you offer?
  • Is there anything else we should consider in deciding whether to proceed?

To move forward with collaboration, you need to know that prospective participants have enough in common. Shared ground could include the following:

  • Target population
  • Goals and strategies to promote health
  • Goals or activities for internal development (such as member orientation or training)
  • A commitment of time and effort from staff and members

Communicate your findings and decisions

If there is sufficient shared interest and enthusiasm for working together, this can be communicated to the groups. It is important to outline next steps, a timeframe, and how people can get more involved.

If the common ground is not sufficient, share the findings of the assessment with the full membership of all prospective partners, through their monthly newsletters or a report at their regular meeting. Suggest they consider revisiting the issue next year when they do their annual planning. Work with staff to see if a specific area for collaboration can be made to fit into future plans.

In either case, include a review of the list of issues identified during the assessment process that require follow-up. Decide what actions to take and communicate your plans back to the participants.

In Contra Costa County...

The health department chose to work initially with the lead staff person for each coalition. In appealing to them to consider collaborating, we assured them that any joint efforts would fit into their current scope of work and would not add new projects. An assessment identified three common interests that fit this requirement:

  • Helping community members be better advocates with policy makers and the media.
  • Training staff to work more effectively with their coalitions.
  • Sharing information, resources and expertise among the collaborating groups.

A survey of staff identified specific training needs. In response, we compiled a resource packet on working with coalitions and conducted a training on media advocacy entitled, Media Advocacy: Getting Out Your Message, Making a Change. (To learn more about the training program, see Other Resources (13k PDF 2pp.).

It proved difficult to design one training that addressed the diverse health concerns of the coalitions. Two chronic disease groups ran their own training sessions but invited the other coalitions to participate. In addition, health department staff realized they needed more experience developing cooperation among programs within the department before they were ready to collaborate with external groups.

Step Three: Build vision and commitment

If you are ready to move forward with collaboration, you may want to begin with a series of small steps. Coalitions are unlikely to consider an ambitious agenda until they have had a chance to work on smaller-scale efforts, such as developing shared recruitment or orientation materials, coordinating an annual training calendar, or co-hosting community events.

As the groups get to know one another and enjoy some successes, they might tackle something more difficult. Perhaps they might identify a common skill-building need and develop a training session in response. Or they might plan a yearly get-together for all the participating organizations. Of course, the more complex the joint initiative, the more planning it will require. For example, if the groups want to coordinate their annual training calendars, staff can simply get together to set the dates. If the groups are ready to sponsor joint activities, they will need to plan more extensively and include leaders among the coalition staff and membership.

Levels of Working Together

  • Level I - Exchanging information about what we do. Participants offer mutual support, relationships are informal, and there are few decisions to make.
  • Level II - Doing together what we are already doing alone. Participants merge tasks they are already doing independently, and perhaps begin some new, short-term projects together. Relationships are somewhat formalized, with some sharing of resources and joint decision-making.
  • Level III - Deciding what to do and how to do it together. The partners pursue a long-term collaboration. They forge a common mission, pursue joint funding, and have formal roles and governance.

See Levels of Working Together (10k PDF, 1p.) for examples.

Coalitions that are ready for advanced collaboration should consider articulating a common vision. Hold a series of meetings with community leaders and health department staff to cover the following:

  • Review the findings of your earlier assessment and invite any revisions.
  • Draw on common themes from each coalition's statement of vision and mission.
  • Ask the group to imagine what the collaborative might accomplish in the next three to five years, and how the community might look different as a result.
  • Ask each participating organization to consider how it will benefit from the partnership.
  • Once you have articulated a vision, allow participants to review it and refine it accordingly.

Step Four: Plan and carry out joint activities

Agree on how the collaborative will function

In addition to articulating a vision, the group must agree on ground rules for how the collaborative will function. These issues are important to discuss no matter how simple or complex the collaboration is:

  • Decide on a process for decision-making.
  • Agree on a process for resolving conflict within the group.
  • Clarify roles and expectations for each coalition and its staff.
  • Choose a point-person for each coalition.
  • Decide how you will convey information and decisions to the memberships.

Identify potential additional partners

As you prepare for action, you may need to invite additional partners to the table. Leaders from the staff and membership of each group should be represented. Before you start planning, find out whether participants need any advance training. In Contra Costa, we found that participants needed training in chronic disease prevention and in collaboration before tackling any new projects.

View/Print

Survey of Training Needs (8k PDF, 2pp.)

Establish criteria for selecting initial activities

It will be important to building trust in your collaborative to have discussions and agreements on how you will jointly rank possible actions. This will also be helpful as the group begins to identify new issues or problems to address. (See Appendix C: Criteria for Collaborative Projects.) For instance:

  • Does the action further our collective vision?
  • Does each coalition see a potential role for itself?
  • Is the timing right? Are there opportunities to capemize on?

Develop a written action plan

Your action plan should be as complete as possible. Anyone with specific responsibilities should review the plan and agree to it. Write a memorandum of understanding for each participating organization that states the roles and responsibilities of health department staff, coalition leaders and other participants. Identify the following:

  • Goals, objectives, and activities. Assign resources to each task. You may need the whole group to sketch this out initially, or you may form a work group to do this.
  • Leaders for each activity and for overall coordination.
  • Timelines, including short-term, intermediate and long-term benchmarks.
  • Mechanisms for accountability, who will monitor the accomplishment of tasks?

View/Print

Action Form E (6k PDF, 2pp.)
Action Form F (6k PDF, 2pp.)

Step Five: Evaluate the impact

In deciding how to evaluate your success, it is important to ask the other participants what areas of the project they would like to examine. The health department and its partners are likely to want to use a combination of member surveys, interviews with key staff and coalition leadership, and perhaps case studies. You might also consider analyzing the content of minutes from project meetings to see if agenda topics, quality of discussion and decisions change as a result of the collaborative effort.

Some questions the group may want to ask are:

  • Can coalition members describe a broad framework for chronic disease prevention and explain how their issues relate to other risk factors and diseases?
  • Have they learned about the activities of the other coalitions? At meetings and else where, are participants citing more links among issues or referring concerns to other coalitions with a shared interest?
  • Have coalitions specifically inserted collaborative efforts into their scope of work? Has collaboration infused the missions of participating coalitions?
  • What problems or obstacles arose working together? How were they addressed?
  • What seemed to help the group move forward in working together?
  • What benefits did people see in the collaborative process?
  • What opportunities are there for future collaboration? Are there ways to establish some other links among coalitions?
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Content provided by the The Community Wellness & Prevention Program of Contra Costa Health Services.

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