coalition-building training

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Florida Public Health Institute (FPHI)

Mission: “To advance the knowledge and practice of public health to promote, protect and improve the health of all.”

• FPHI works with local, state and national leaders to develop policy recommendations and program solutions to health-related issues for the citizens of the state of Florida.

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Purpose

To provide customized training and coalition-building tools and resources to emerging or existing oral health coalitions.

To promote the development of highly effective oral health coalitions throughout the state of Florida.

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Training Topics:

1. Basics of forming a coalition2. Expanding your coalition3. Strategic Planning4. Messaging5. Ideas for Action6. Available Resources

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Forming a Coalition

• Why?– Increase power or leverage– Form a working collaborative– Define and implement

results-based strategies for change

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Coalition Leadership

• Natural allies– Local FDA members– Local FDHA members– Local colleges and universities with dental-related curriculum– Local health department directors or dental directors

• Credible• Committed to collaborative effort• Loyalty to the coalition must be strong enough to cope

with pressure from the organization/interest they represent

Tip: Strive to include a local foundation with a healthcare focus

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Recipe for Success(Winter 2011, “Collective Impact,” by John Kania and Mark Kramer)

The Stanford Social Innovation Review identifies five types of collaborations:

• Groups of funders pooling resources to support the same issue

Funder Collaboratives

• Formed between government and private-sector organizations to deliver specific services or benefits

Public-Private Partnerships

• Voluntary activities by stakeholders from different sectors around a common themeMulti-Stakeholder Initiatives

• Ad hoc collaboration among groups of individuals or organizations fluidly connected with the emphasis placed on information sharing and targeting short-term actions

Social-Sector

• Long term commitments by a group of important actors from different sectors to a common agenda for solving a specific social problem

Collective Impact Initiatives

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Collective-Impact vs Multi-Stakeholder Initiatives(Winter 2011, “Collective Impact,” by John Kania and Mark Kramer)

Collective Impact

Shared measurement system

Mutually reinforcing activities

Ongoing communications

Staffed by an independent backbone organization

Multi-Stakeholder

Lack shared measurement of impact

Lack the supporting infrastructure to forge true alignment of efforts or accountability for results

Subject to having their coalition’s agenda superseded by the agenda of a member organization or individual

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Keys to Success

Strive to involve all key players/perspectives – Operating

principles

Choose a realistic strategy – Mission

Establish a shared vision - Vision

Make promises that can be kept - Bite-sized pieces

Build ownership at all levels – Strategic plan with milestones &

accountability

Publicize successes – Internally and externally

Tip: Free guides, links and resources are available at

www.oralhealthflorida.com

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The Five Conditions of Collective Success(Winter 2011, “Collective Impact,” by John Kania and Mark Kramer)

1. Common Agenda – Shared Vision for Change

A common understanding of the problem• Different definitions of the problem

and the ultimate goal can splinter the efforts and undermine the impact

• Differences must be discussed and resolved

A joint approach to solving it through agreed upon actions• Draw on each other’s strengths• No hidden agendas• Recognize everyone for their

involvement

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2. Shared Measurement Systems

Agreement on a common agenda includes an agreement

on the ways success will be measured and reported

Collect data and measure results consistently on a short list of indicators• Helps ensure all efforts remain aligned• Enables participants to hold each other

accountable• Helps participants learn from each

other’s successes and failures

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3. Mutually Reinforcing Activities

Encourage each participant to undertake the specific set of activities at which he or she excels in a way that supports and is coordinated with the

actions of others

Coordinate differentiated activities through a mutually

reinforcing plan of action

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4. Continuous Communications

Developing trust among coalition members is a challenge• It takes time and lots of

interaction• Set realistic timetables and

manage expectations

Regular meetings• Recognize and appreciate

members’ common motivation• Over time partners see their

interests will be treated fairly• Develop a common vocabulary• CEO-level leaders must

participate• External facilitator and

structured agenda

Consider web-based tools to keep communication flowing among and within the coalition

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5. Backbone Support Organization

Collaborations fail with a supporting infrastructure

Requires a separate, dedicated staff who can• Focus people’s attention and create a

sense of urgency• Apply pressure without overwhelming

stakeholders• Present opportunities as well as

difficulties• Strength to mediate conflict

A highly structured decision-making process

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EXPANDING YOUR COALITION BEYOND THE ORAL HEALTH COMMUNITY

Coming together is a beginning; keeping together is progress; working together is success – Henry Ford

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Potential Community Partners

• Federally Qualified Health Centers • School District

• Local Hospitals • Local Foundations

• University/College • Local senior organizations

• ARC • Health Department

• Children’s Services Council • Community Health Center

• WIC • Head Start/Early Head Start

• Area Agency on Aging • United Way

• Local legislators and local city, county and school board officials

• General manager of local television station(s)

• Local medical association • Publisher of local newspaper(s)/ magazine(s)

• Faith-based organizations • March of Dimes

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Sustaining Your Coalition

• The expectation that collaboration can occur without a supporting infrastructure is one of the most frequent reasons for failure

• Start with local foundations• May need a sponsoring organization to act as fiscal agent • Some established coalitions may consider forming a

nonprofit organization to accept tax-deductible donations– Great deal of time and effort involved– Reporting requirements– Limits advocacy capability

• Resources available through www.oralhealthflorida.com

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STRATEGIC PLANNING

If you don't know where you are going, you will wind up somewhere else. -Yogi Bera

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Strategic Planning

• Write it down!

Group Goals

Needs AssessmentList of PrioritiesIdentify needs being addressed by member or other organizationsIdentify group goals

Long-Term Goals

What does victory look like?What will the headlines read?

Intermediate Goals

What programs, policies, activities, etc., move the coalition toward the long-term goals

Short-Term goals

Individual, specific action itemsSet deadlinesCelebrate successes

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Action Planning

Goal

• What is it and what constitutes success• Deadline for completion

Targets

• Primary decision maker(s)• Secondary targets

Resources

• What do you have• What do you need• What can you bring to bear

Audiences• Are there other audiences who influence the target

Messaging• What do you want the target to do

Messenger

• Who is delivering the message• Is there a process for getting feedback/response from the target

Tactics

• Short-term action items• Who will do what and when will it happen

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MESSAGING: HOW TO TALK ABOUT ORAL HEALTH SO PEOPLE WILL LISTEN

Words should be used as tools of communication and not as a substitute for action – Mae West

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Messaging

Effective messaging is consistent whether

educating or advocating

Effective messaging is consistent over time:

The public must hear it multiple times before

it starts to register

Effective messaging incorporates a unified

message – Healthy Mouth, Healthy Body

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Framing the issue

• An overview of the FrameWorks Institute training provided to Oral Health Florida through a grant from DentaQuest

• HIGHLY recommend visiting www.oralhealthflorida.com ➝ local coalitions ➝ Messaging Media Campaign ➝ FrameWorks Institute Toolkit

www.frameworksinstitute.org/toolkits/oralhealth

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FrameWorks Institute Research:

• Reveals people organize new information into their existing frames of reference, i.e. “mental shortcuts”

• Shows people typically think of oral health as a personal responsibility and a parent’s responsibility

• Finds people perceive the consequences of poor oral health as relatively benign – cosmetic beauty and self-esteem issues.

“Family Bubble”

“Health Individualism” “Cosmetics”

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Advocates Say The Public Thinks

Early childhood tooth decay is on the rise.

Poor oral health in children is a symptom of bad parenting.

Public or private, all kids need access to dental insurance coverage.

This can only be “fixed” through parent education.

To prevent cavities, kids need access to preventive treatments like dental sealants and fluoride protection.

Kids need to be more responsible about brushing and flossing.

Low-income and minority children are at greater risk of developing dental disease.

Poor kids have lots of (more important) problems.

Increase dental workforce and include non-dentist providers.

Don’t listen to dentists (they’re self-interested)

FrameWorks Institute Research:

What advocates say and the public hears don’t line up

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Less Dominant Cultural Models

• FrameWorks Institute research found other public perceptions that may lead to policy change but require intentional triggers to overcome the major bubbles:– People expect schools to be involved in systemic solutions to

children’s oral health problems

– When prompted, people believe oral health is part of overall health and well-being

– When prompted, people understand children’s oral health is a community responsibility

The goal is to trigger the more promising beliefs through proper message framing

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FrameWorks Institute: Anatomy of a Frame

Values

Issue Explanation

Solutions

Visuals

Metaphors

MessengersEvery frame has several elements advocates should carefully consider when constructing messages for the public

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FrameWorks Institute Training

• Values– Anchor your message in

the proper frame by stating a shared value. Effective:

• Ingenuity• Opportunity• Inter-dependence• Future• Stewardship

(Responsible Manager)

“As an elementary school teacher, I see the promise of our future every day. I can also see clearly the responsibility adults have to guide the next generation toward healthy and prosperous future. So when something is getting in the way of learning that can be easily solved, I want to do something about it. That is why my school has joined the effort to prevent childhood dental decay.”

〜 “ Watch Your Mouth: A FrameWorks Eworkshop on children’s oral health”

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• Issue Explanation– The structure of our health system disconnects the mouth from body– E.g. The doctors and insurance for our mouths is different than for the

rest of our bodies– Reunite the Mouth with the Body: Remove the issue from the dominant

family and individual responsibility bubbles

Oral Health Check-ups

Vision and Hearing

Screening

Vaccination Programs

Overall Health

For example, promote children’s oral health policies by linking the issue to other aspects of kids’ health for which we have accepted societal responsibility to overcome dominant cultural models (parental responsibility, individual failure to brush teeth, etc.)

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FrameWorks Institute Training• Explaining the issues – Examples that work

It’s a real disease• Reminder that dental decay

is a serious, chronic disease• Reinforces the idea of

community responsibility to safeguard citizens

• Medical professionals reinforce point

An Ounce of Prevention• Works well for childhood

oral health• Must explain what

prevention means• Educators are good

messengers

The Most Common Chronic Childhood Disease• Five times more common

than childhood asthma• Children miss more than 51

million school hours due to dental disease

• Kids with dental disease are more likely to have other health problems and do poorly in school

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• Explaining the Issues-Don’t call it a CRISIS• Unintended consequences

– Reminds people of all of the other crises we’re facing; some they may find more compelling(child poverty, obesity, climate change)

– Make solutions seem inadequate

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• Keep Solutions Front and Center– School-based dental screenings– Medicaid dental coverage expansion– Fluoridated water access– Support finding ways to help dental professionals

work in underserved areasLead with a shared value to prevent unwanted frames of reference filtering your message

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Of all of our inventions for mass communication, pictures still speak the most universally understood language 〜 Walt Disney

• Happy teeth and tooth fairy images undermine issue’s import• Visuals should support the connections between

– Oral health– Overall health– School achievement– Living in a healthy community


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Incorporate Metaphors and Models• Important cognitive tools that help people grasp complex issues and ideas

– The mouth as a gateway to the body• Connects dental health to overall health• Conveys the science of dental caries accurately and clearly

– Social math• Breaks mind-numbing data into visual images

False Start Reframe“Greater numbers of children in 14 of Maine’s 16 counties were living in low-income families in the past year. Today 37% of all children live in low-income families.”

“A state’s economic stability is threatened when large numbers of families work but can’t earn enough to meet basic needs. Over 100,000 Maine children – more than the entire populations of Portland and Bangor combined – live in such working families.”

“Americans throw away 35 billion plastic bottles every year”

“Enough plastic is thrown away each year to circle the Earth four times”

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Messengers Matter: A Good Argument for a Broad-based Coalition

Choose messengers carefully to ensure they reinforce your key messages

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FrameWorks Institute TrainingMessengers Matter:

Doctors – Reinforce overall health connection. Underscore the severity of the problem.

Educators – Collective impact on learning and success. Show support for school-based solutions.

Business Community – Speak about financial impacts. Support investing now to avoid future costs.

Faith Community and Other Community Leaders – Establish the issue is the public interest. Exhort others

to get involved.

Use dentists and dental hygienists cautiously – Public may perceive a vested interest

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Focus on Systems and Structures• The goal is to make the

systems and structures more visible to the public, not less so

Avoid Vivid Personal Stories• There is a danger these

stories will stoke a debate over the character, behavior and choices of the people profiled

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Episodic Frames Thematic Frames

Individuals Issues

Events Trends

Psychological Political Environmental

Private Public

Appeal to Consumers Appeal to Citizens

Better Information Better Policies

Fix the Person Fix the Condition

FrameWorks Institute Training• Two types of Frames: Episodic and Thematic

Different Frames Set Up Different Policy Solutions

Tip: FrameWorks toolkit “Wide Angle Lens”.Embedded at www.frameworksinstitute.org/workshops/wym/

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A Message Template for Oral Health

Level OneValues

Level TwoIssue Category

Explaining the Issue

Level ThreeSpecific Policy Solutions

FrameWorks Institute Training: Putting It All Together

fFuture, Prevention, Opportunity, Ingenuity

Mouth as a Gateway to the BodyIt’s a Real Disease

School-based dental screenings; Medicaid dental coverage expansion;

Fluoridated water; Access to care

Oral Health = Overall Health

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IDEAS FOR ACTION

Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not. 〜 Dr. Seuss

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• Oral Health Literacy• Public Policy Advocacy• Data Collection• Medical-Dental Collaboration

Ideas for Action

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Ideas for Action: Oral Health Literacy

• Traditional Media– Press releases– Op-Eds– Columnists– Events– Letters to the editor

Downloadable press kit available at


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Ideas for Action: Oral Health Literacy

• Speak directly to the public– Social Media

• Websites can wait• Facebook• Twitter• YouTube• LinkedIn• Reddit, Tumblr, Google+,

Instagram, etc.

– Small Group Outreach• Civic group luncheons and

breakfasts• School clubs and associations• Social and support groups

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Ideas for Action: Public Policy Advocacy

Pursuing policy change drives what we do as coalitions

Policy-change manual available for download at www.oralhealthflorida.com

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Ideas for Action: Oral Health Surveillance

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Ideas for Action: Medical-Dental Collaboration

• Reunite the mouth with the body• A top priority of the US National

Oral Health Alliance • “Summary of the First Leadership

Colloquium – Medical and Dental Collaboration” (www.usalliancefororalhealth.org)

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RESOURCES

I not only use all the brains that I have, but all that I can borrow. 〜 Woodrow Wilson

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• Chair, Dr. Frank Catalanotto, Professor and Chair, Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry

• Facilitated by the Florida Public Health Institute www.flphi.org

• Majority Funder: the DentaQuest Foundation www.dentaquestfoundation.org

Oral Health Florida www.oralhealthflorida.com

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Local Oral Health Coalitions

• Oral Health Coalition of Alachua

• Palm Beach County Oral Health Coalition

• Hillsborough & Pinellas County Oral Health Coalitions

• Miami Oral Health Coalition

• Smiles for Lake County Oral Health Coalition

• Greater Tampa Bay Oral Health Coalition

• Bay County Health

• Rural Oral Health Coalition of North Central Florida

• St. Lucie County Oral Health Coalition

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Emergency Room DataKey Findings:

In 2010, more than 115,000 emergency room visits with dental charges exceeding $88 million

Florida Medicaid was billed $29.7 million in 2010 for preventable oral health emergency room visits

Tip: Don’t forget to message with social math

ER Data Sheets for each of Florida’s 67 counties available

on OHF website


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Access to Oral HealthKey Findings:

Less than 8 percent of Florida dentists accept Medicaid patients.

Just 15 percent of Medicaid-eligible Floridians receive dental services

Tip: Don’t forget to message with social math

Access to Oral Health data sheets for each of Florida’s 67

counties available on OHF website


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County Data Sheet Examples

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Pew Center Reports

2012 2011

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Pew Center Annual State Grades• 2012 Grades:

– Florida received a D

– 40 percent of all states received a D or F

– 5 states earned an A (AK, ME, ND, NH, WI)

– 5 states and the District of Columbia received F’s (DC, HI, MT, NJ, NC, WY)

– Maine and New Hampshire received maximum number of points

• Pew Talking Points:

– Every $1 spent on sealants saves $2 in treatments

– Sealants cost 1/3 of a filling and prevent 60% of cavities

– Water fluoridation saves $38 in treatment cost for every $1 invested

– 5.3 million children will gain coverage by 2014 under ACA (this number will remain consistent whether the coverage mandate is ruled unconstitutional)

Tip: Good data and downloads available at www.pewstates.org

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• Oral Health Florida www.oralhealthflorida.com

• The DentaQuest Foundation www.dentaquestfoundation.org

• The US National Oral Health Alliance www.usalliancefororalhealth.org

• Pew’s Children’s Dental Campaign www.pewstates.org

www.Resources

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ANOHC

The American Network of Oral Health Coalitionshttp://www.facebook.com/AmericanNetworkofOralHealthCoalitions/info

ANOHC is a group of state oral health coalitions that actively share information, ask questions, and leverage time and resources.

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Florida Public Health Institute (FPHI)

Executive Director, Dr. Roderick King [email protected]

Chief Operating Officer, Debora [email protected]

Project Manager, Cristy Kovach [email protected]

Administrative Assistant, Fay [email protected]

www.flphi.org (561) 533 – 7909

mailto:[email protected]




http://www.flphi.org/

coalition-building training

Health & Medicine

john kania

common indicators agenda

common vocabulary

mark kramer2

shared vision vision

local foundation

reinforcing activities

common theme socialsector