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Programs & Organizations > Chronic Disease Prevention > A Guide For Local Health Departments > Working with Community-Based Organizations
Preventing Chronic Disease
Working with Community-Based Organizations
Health Departments and community groups jointly identify concerns set priorities and plan for action.
Community-based organizations (CBOs) are natural partners in preventing chronic disease. Local agencies often have a track record of working effectively with under-served, low-income and ethnically diverse communities.
Local health departments have a long history of working with these groups on issues such as AIDS and smoking. Traditionally, departments have taken the lead in identifying public health problems, provided public funds to community organizations, and directed their activities. Community agencies may have had contracts to conduct outreach, education, referral or other activities specified by the health department.
While this approach has succeeded in accomplishing certain goals, the relationship also has limitations. Community groups have generally not had an opportunity to exercise their own judgment about the challenges facing residents and the best way to address them. Competition for funding has hindered cooperation and resulted in tension, mistrust and inequities of power. Funding has often limited programs to a year or two of planning and implementation. Communities were not able to develop the internal capacity to continue providing services on their own.
This chapter proposes a new approach, where health department and community groups jointly identify concerns, set priorities and plan for action. Local agencies can build skills in preventing chronic disease and advocating for their community's interests. The health department gains increased understanding of the community's perceptions of the issues, and can tap more effectively into existing community networks.
As you prepare to contact key community-based organizations, here are some considerations to keep in mind:
Be aware of history.
Recognize that this approach is ambitious.
Build on current efforts.
Be flexible in setting priorities. The health department must be willing to respond to community concerns. While the goal is to apply the broadest possible definition to chronic disease, communities and agencies may need to focus first on something specific, such as a single disease or risk factor. You may need to be creative in demonstrating links between specific risk factors and chronic disease in general. The department can also help link organizations to programs of interest that address health issues other than chronic disease.
In Contra Costa County...
When the Chronic Disease Organizing Project (CDPOP) first approached community-based organizations in one community, the groups suspected that the health department had a hidden agenda. They were convinced that the department had a particular problem in mind. Some members even asked that the department just identify a health concern and come back with a request for proposals. Department staff convened several meetings and delivered their message repeatedly before they could convince the community of a genuine interest in defining the issues and solutions together.
Once group member trusted that they were equal partners in defining the issues, they quickly began talking about how to reduce the number of emergency room visits for asthmatic children. The health department gathered information about the impact of asthma in the community and catalogued prevention efforts that were already underway. At the same time, staff facilitated an inventory of each organization's mission, clientele and services, to identify other areas of common interest.
After a series of discussions, the group developed a broad vision. They devised a plan to improve nutrition and physical activity, and to reduce chronic stress among pre-school children and their families. Separately, two of the agencies began working with the health department on a proposal for a community-based asthma prevention program.
Following are the major steps involved in working with community organizations to develop a shared chronic disease prevention agenda.
Step One: Choose an initial focus
The health department may want to start by focusing on a limited geographic area or population. In deciding this, staff will need to weigh a number of criteria: the incidence of chronic disease, the level of community interest, and any efforts already underway that can be used as a foundation. Research the following:
If possible, draw a county map that highlights results of your research. Ideally, the work you do with local community-based organizations will coincide with and reinforce other efforts to mobilize residents in the same communities as described below. (For more on working with residents, see Mobilizing Neighborhoods.)
In Contra Costa County...
When Contra Costa Health Services prepared to launch CDPOP, we examined hospem discharge and demographic data and identified five zip code areas where residents were at greatest risk for chronic disease. The department had already established neighborhood organizing efforts in four of those areas through our Healthy Neighborhoods Project (HNP).
Health department staff and the community advisory board reviewed the research and chose to pilot the project in the city of Pittsburg, in the eastern part of the county. The department had already designated the city for increased prevention efforts, and community organizations there were interested in working together on chronic disease. In addition, two neighborhoods in Pittsburg were already participating in the county's Healthy Neighborhoods Project (HNP). HNP had accomplished resident-identified goals for community improvement and appeared ready to move on to other health issues.
Step Two: Identify potential partners
Build on the research described in Step One to identify potential partners. Ask for candidates from health department staff, health outreach workers and educators in the community, and other local leaders. Make an effort to include faith groups, neighborhood associations, and local, non-profit community groups.
These queries are likely to turn up a handful of prospects repeatedly. Meet with staff from these organizations to introduce them to the project and ask if they are interested in getting involved. Ask for the name of someone in the agency who might take the lead. Ask also for other organizations you should contact. Make a list of contacts, noting their level of interest and any follow-up you need to do.
Assessing Readiness to Collaborate (7k PDF, 1p.)
Assess whether agencies are interested in working together or prefer to work individually with the health department. While this chapter describes steps to work with a network of community groups, the process can be adapted to work with single organizations as well.
Step Three: Build vision and commitment
Develop a common understanding of the issues
Once the health department has identified interested agencies, invite them all to meet. Let participants know who else is expected to attend. Ask them to come prepared to describe their agency's mission, major programs and clientele. State the purpose of the meeting: to help the group reach a mutual understanding of chronic disease prevention, and to explore what each organization might bring to a collaborative effort and how the group might benefit.
Start the meeting by introducing a broad framework for chronic disease prevention and the factors that place communities at risk. Present findings from the interviews you held to help people to see how their own work fits into the bigger picture.
Share the results of your localized research on disease, risks and demographics. Be as specific as possible about data on particular neighborhoods or populations represented at the meeting. Acknowledge any limits of available information that make it difficult to get a complete picture for the community. Present the research succinctly and clearly, so that a lay person can readily understand. If possible, make the data come to life with stories, photographs or other visuals. Allow plenty of time for people to ask questions and contribute their own knowledge and experience.
Give the agencies time to network, particularly if they have not worked together before. Set aside time for the groups to describe their programs, interests, and perceptions of chronic disease in their communities. Document the information on a large wall chart. Afterwards, put the material on paper and distribute it to everyone. This assessment will help catalogue current services and identify possible roles for the various groups.
Current Efforts of Collaborative Members (7k PDF, 1p.)
As the meeting proceeds, record recurrent themes. Be on the lookout for common issues, population groups, or strategies. Steer away from issues or activities that seem likely to stir conflict. At the end, evaluate the meeting, gauge interest in continuing, and outline next steps.
In Contra Costa County...
At our first meeting with local CBOs, we showed our video on chronic disease prevention, "Together We Can Make a Change." The video gives an overview of chronic disease, risk factors and county statistics. It uses personal examples to represent groups most affected by chronic disease and presents communities that are mobilizing to reduce risks. The video led to a spirited discussion. Agencies examined trends in their own communities and envisioned how their communities might look different if they all worked together.
If the group wants to move forward, plan a series of meetings to talk about how everyone will work together. The following topics will need to be addressed, whether the health department is working with just one community group or as a member of a network:
The group may want to write a memorandum of understanding for each participating organization that states its roles and responsibilities as well as its relationship to other participants, including the health department.
Governing a Collaborative (8k PDF, 1p.)
Create a vision
A shared vision and purpose sets a foundation for the group. Start by reviewing earlier discussions about how chronic disease affects the community and how a collaborative of groups might change the picture. The health department may want to set the discussion in a broader context of public health. This may be a good time to introduce the Spectrum of Prevention model presented in the introduction to this Guide. It describes a range of interventions and strategies that promote health. It may help people keep the big picture in mind as they consider specific collaborative efforts.
To create a vision, ask people to put aside for the moment concerns about budgets, resources and other logistical constraints. Ask them to dream of the best possible results. If you choose to brainstorm, remind people to welcome all voices without criticism. Invite people to imagine: How would we like our community to look in three to five years? How would residents be different? How would our agencies be different?
Then draft a vision and test it with the group. It should inspire all of them. It should reflect their experience and understanding of the community's hopes and dreams. It should also fit with each agency's independent mission and priorities. Perhaps ask the group to consider whether they think collaboration will help them work toward this vision.
Set goals and priorities
Once the group has articulated a vision, the next step is to list goals to fulfill that vision. Your earlier research and discussions should provide a foundation. In discussing possible goals, make sure everyone understands the ideas and terms being used. As participants make proposals, encourage them to tell the story of the problem they seek to address.
As participants consider goals, some questions may arise. For example, does this goal really fit with our vision? Is the goal already being addressed elsewhere in the community? Is a preventive approach likely to help solve the problem? Do the partners have the necessary skills and client base? If more information is needed, the health department may be able to do some research and bring results for the next discussion.
If the goals listed are numerous, the group will have to set priorities and agree on a process for doing so. Some criteria to consider in ranking goals are whether they:
Criteria for Collaborative Projects (8k PDF, 1p.)
In Contra Costa County...
In considering possible joint goals, partners in the collaborative described challenges in their communities, as well as past strategies that had helped solve problems and engage residents. Asthma, nutrition, physical activity and parental stress surfaced as major community health concerns. Participants realized they needed more information about health initiatives already underway,including who was working on them and what interventions were being used. The partners looked at the chart they had made earlier to see how each organization could help respond to these issues. They realized that they were not in a position to address asthma effectively, and that there were already others in the community who were working on this condition. The focus shifted to a broader goal of addressing risk factors for chronic disease among pre-school children and their families. Ultimately, the group decided to work with pre-school families in Pittsburg to improve nutrition and physical activity and to reduce family stress.
Step Four: Create and carry out your action plan
Once goals are in place, the group can move on to develop an action plan that spells out specific objectives, strategies, and a timeline for completion. The plan should also assign responsibility for tasks.
Assess what resources each agency can contribute, including staffing and materials. If agency staff have no experience with a broad approach to chronic disease prevention, they may require some training. If staff already have experience, they may be ready to build on an existing program. Design an action plan that addresses the chief interests of staff, so as to foster their commitment to the project.
In Contra Costa County...
The collaborative leaders decided that their staff needed to know more about a comprehensive approach to chronic disease prevention before they could introduce that approach to clients. The group developed a grant proposal for staff training, relying on expertise within the collaborative.
They planned an initiative to follow the training that would help families identify risk factors for chronic disease. The group would invite interested parents to help design an education program.
Unfortunately, the group had to drop the proposal after the prospective funder changed priorities and two of the collaborating agencies lost their directors. The gap in leadership stalled a search for alternative funding. Nonetheless, the agencies continued to work with the health department to develop a comprehensive asthma program. The group also worked to develop the region's concept for another initiative, the Partnership for the Public's Health. This four-year effort was later funded to help Contra Costa as well as other local health departments and communities around the state learn how to work together more effectively.
Step Five: Evaluate the impact
As described in previous chapters, chronic disease prevention presents a special challenge to evaluators. It may take years before the impact of an effort can be seen through health data, such as incidence of disease or hospemization. So you will need to be creative in identifying more immediate measures of progress. Here are some possible evaluation measures:
In sum, evaluate your efforts for both quantity and quality. Look for improvements in the community and in the capacity of the collaborating agencies. Document the challenges you have faced and what you have done to overcome them. Also document your successes. This information could prove useful to your group as you move on to address other community needs, or to another group trying to address similar issues.
[next section: Launching A Media Advocacy Campaign]
Content provided by the The Community Wellness & Prevention Program of Contra Costa Health Services.