EvidenceBased Practices for Organizing FamilyCentered, CommunityBased Services

1

• Evidence-Based Practices for Organizing
  Family-Centered, Community-Based Services
• Diane Behl, Champions for Inclusive Communities
• Deborah Allen, MA Consortium for Children with
  Special Needs
• Kathy Watters Eileen Florenza, CO Health Care
  Program for CSHCN
• MODERATOR Diana Denboba, DSCSHN Integrated
  Services Branch
• March 3, 2008
• Alexandria, VA

2
Workshop Purpose

• Share findings from the literature on effective
  coalitions
• Present examples of how these practices are
  applied in the MCH world

3
Community Coalitions
Why Did You Choose This session? I Came to
this Session Because (Audience Participation)
4
What are Evidence-Based Practices in Coalition
Building?Diane Behl and Cora PriceChampions
for Inclusive Communities
5
What is a Coalition?

• AKA
• Collaborative partnership
• Community forum
• Task force
• Consortium
• Coordinating council
• A mutually beneficial relationship between
  individuals, governmental agencies, private
  and/or public sector organizations based on
  achieving common goals.

6
Levels of Evidence

• Researchstudies subject to peer review
• Expert Opinionprofessional/expert groups
• Promising Practices/Field Lessonsimplemented in
  the field but lack conclusive evaluation data
• Theoretical Rationalestrong causal reasoning

7
How Were EBPs Identified?

• Synthesized 8 published literature reviews
  (1996-2006) reflecting 18-80 studies each.
• All were community-based coalitions
• All had a health focus
• Target populations varied

8
Outcomes Achieved by Coalitions

• Reduced risky behaviors
• Improved access to services
• Reduced lead poisoning among children
• Reduced infant mortality rate
• Reduced adolescent pregnancy rate

9
EBPs can be Tied to the CQI Process

• Building partnerships
• Developing plans
• Implementing in communities
• Measuring and monitoring

10
Key Ingredients for Building Partnerships

• Mutual respect, understanding and trust among
  members Typically member self-report
• Include persons representing all levels of
  position power in decision-making, service
  provision, and service customers
• Clearly-established roles for coalition members
  and coalition staff to prevent confusion/conflict
  
• Clear rules about how to handle
  conflict/differences
• Building skills, knowledge, and positive
  attitudes of their members
• Selecting partners with links to resources and
  represent broad sectors
• Diverse membership re ethnicity, age, SES, and
  citizens impacted
• Benefits of involvement are clear and outweigh
  the costs to members
• CO Leveraging assets of community partners
• MA Ensure understanding of goal/mission

11
Building Partnerships (continued)

• Strong leadership
• Using incentives to reward/motivate
• Tasks directly linked to accomplished goals
• Shared leadership that emphasizes exchange of
  ideas, voices
• Collective leadership based on democratic
  principles

12
Key Ingredients for Developing Plans

• A concrete, clear mission combined with quality
  plans and attainable goals is essential.
• Keep focus on the coalitions priorities and
  reasons for coming together
• Develop short-term goals with high chance of
  success
• Include a range of sectors from the community
  when appropriate (government, faith based,
  private providers, business)
• Use open, frequent, predictable communication
  methods
• Establish fair problem-solving and conflict
  resolution procedures
• Plan actions that build on the strengths within
  the community
• Develop actions for change that fit within the
  communitys culture
• CO Use of logic model
• CO Utilize family leaders in all aspects
• MA Developed clear functions to guide efforts

13
Key Ingredients for Implementation (Taking
Action!)

• First step is often changing community attitudes
• Access training opportunities, technical
  assistance, and support for the coalition
• Allocated/paid staff, materials, work space to
  support the work of the coalition
• Secure financial resources for program
  activities, staff pay, and future needs
• Skilled leadership to deal with conflict
  management
• Plan for set backs and be flexible about changing
  specific implementation plans
• CO Implementing care coordination
• MA Recognizing role of government, legislators
  in implementation

14
Key Ingredients for Measuring and Monitoring

• Work with community to identify meaningful
  indicators of change
• Establish measurement plan that is based on these
  recommended indicators
• Hold members accountable for creating change
  Even if they do not change the policies
  themselves, they are responsible for getting the
  public opinion behind them to convince
  legislators or agency heads to change the
  policies. Even if they are not teenagers, if
  their campaign reduces teenage pregnancies, they
  can feel responsible and celebrate that.
• Celebrate coalition accomplishments frequently.
• Keep records of the work accomplished, ranging
  from meeting attendance and minutes to
  documentation of policy changes 
• CO ?
• MA Data are collected based on multiple sources.

15
EBP Limitations

• Inconsistent use of dependent vs. independent
  variables
• Lack of controlled studies
• Paucity of treatment information
• Lack of outcomes demonstrating increased system
  efficiency/integration

16
and we are making a difference.
17
Questions?
18
The Mass Consortium for CSHCNAn Organization in
Transition to AdulthoodDeborah Allen,
ScDBoston University SPH
19
Infancy1998-1999

• 11 projects all doing research on CSHCN
• State agencies
• Academic groups
• Parent organizations
• Non-profits
• Came together to avoid duplication and mutual
  interference

20
Starting with parallel play

• What we found
• Shared interests
• Shared needs
• Value of mutual support
• A strong sense that this could be the foundation
  for collaborative improvement efforts

21
Childhood 1999-2003

• Phase 1 Clearinghouse Who is doing what
• Phase 2 Collaboration Who is doing something
  someone else could help with
• Phase 3 Coordination What could some or all of
  us do together
• Phase 4 Consensus Can we define a shared
  mission
• ?Phase 5 Crafting a 2010 action agenda
• ?Phase 6 Constructing our organization

22
The tasks of our adolescence

• Mission
• Structure
• Leadership
• Workgroups
• Membership
• Projects

23
Mission
Together we are committed to promoting and
realizing the Healthy People 2010 national
objectives of building a more responsive and
family centered system of care for children with
special health care needs. (June 2001)
24
Member Views on Structure

• Maintain and enhance diversity of participants
• Special focus on family participation
• Leave room for disagreement- different
  perspectives
• Leave room for many levels of participation
• Maintain non-judgmental atmosphere
• Share leadership responsibilities
• Permit efficient decision-making
• Dont get too bureaucratic

25
Structural Units

• Steering Committee
• 12 members
• 5 parents
• 2 parent organizations
• 3 MDs
• 1 health plan
• 1 large clinic system
• 1 tertiary hospital
• 2 state agencies
• 2 public health researchers

• Work Groups
• At various times
• Medical home
• CBSC/Care coordination
• Transition
• Financing/Medical necessity
• Family participation
• Ad hoc work/advisory groups

26
Membership

• Individuals
• Organizations
• Seek broad participation, but
• Focus on commitment of participant, rather than
  organizational representation
• Membership completion of form
• Offers multiple levels of participation
• No dues at present

27
Projects
28
Moving to Adult Autonomy

• Prerequisites
• Stable funding base
• Rock solid public-private partnership
• Deep shared understanding of mission and mandate
• Strong mutual trust
• Realistic program expectations
• Willingness to take risks

29
Mission and Mandate

• Mission
• Continues to be the national agenda
• Mandate
• We must assure
• Diverse leadership team
• Broad constituency
• Visibility
• Program and policy innovation
• Recognition and support for government role
• Improved collection and use of CYSHCN and
  disability data

30
and we are making a difference.
31
Questions?
32
Colorado Community Coalition BuildingKathy
Watters Eileen FlorenzaCO Health Care Program
for CSHCN
33
Todays Information

• Respite Care Coalition Building Steps
• Other Examples of Local Coalitions
• Action Guide

34
Considerations
1. Do you Have a Champion in Your Title V Program
that Promotes Local Coalition Building?
35
Considerations Continued

• 2. Does Your State Culture Involve Strong Central
  or Local Control?
• The Culture of Colorado is Strong Local Control.
  We Support our Local Communities.

36
Considerations Continued

• 3. What is Your Structure or Mechanism for
  Implementing Local Coalitions?
• Colorado Title V/CSHCN Contracts With All Local
  Public Health Agencies. This is the Mechanism for
  Coalition Building for CSHCN.

37
Respite Coalitions 8 Steps
38
Respite Care Coalition Building Steps

• EBP Building Partnerships
• State champion encourages/inspires a shared
  vision, provides consultation, and technical
  assistance.
• State champion connects with the pulse of the
  community-utilizing relationships with family
  agencies to know the buzz of what gaps exist.
  Principle 2 Constituency.

39
Respite Care Steps Continued

• 3. Local champions are identified--state champion
  leads with a can do approach providing steps or
  PPs, with other community stakeholders sharing
  the vision and responsibilities. Principle 1
  Collaborative Leadership, Principle 5 Role of
  Government

40
Respite Care Steps Continued

• 4. Convening diverse perspectives-community call
  to action! Inclusive approach to leadership
  Principles 2 Constituency, 3 Visibility of
  CSHCN

41
Steps Continued

• EBP Developing Plans
• Develop implementation plan-timelines,
  responsible parties, sustainable funding.
  Principle 4 Strategic thinking, 5 Role of
  Government, 6 Data Collection

42
Steps Continued

• EBP Implementing in Communities
• 6. Program implementation and development
  principles, whats working (keep it). Value
  statements (Respite extended time for families,
  community involvement, student/youth involvement)
  Maintaining and being accountable to the shared
  vision. Principle 1 , 6

43
Steps Continued

• EBP Measuring and Monitoring
• 7. Identify outcomes for the community, family,
  child.
• 8. Measure outcomes for community, family , child

44
(No Transcript)
45
Community OutcomesFamily OutcomesChild Outcomes
46
Other Coalition Examples

• Faith Communities Coalitions
• Coalitions for Screening, Assessment and Referral
  for CSHCN
• Early Intervention and Public Health Coalitions

47
Proposed Coalitions

• Newborn Hearing Screening and Follow-Up
  Coalitions
• Medical Home Quality Improvement Coalitions

48
Colorado MCH Action Guide HandoutNational
Adolescent Health Leaders
49
and we are making a difference.
50
Questions?
51
(No Transcript)