Coalition development

for fall prevention

Local Coalition Development for Fall PreventionWisconsin Fall Prevention Initiative

Webinar hosted bythe Healthy Wisconsin Leadership Institute

and Mary Michaud, Health Forward ConsultingJanuary 12, 2011

“Coalitions can affect change in communities and broader systems…

when they link local people to resources and situations, at the

multiple levels in which change should occur, to address common

interests.” Steven Fawcett

Today

What are the characteristics of effective coalitions?What do coalitions do best?

What they did:• Assessed needs/gaps in services• Looked at the data for their county• Looked at the data for the large medical center in their

county• Posed the question: Who pays for care?• Developed county-wide network of resources• Core members signed formal letters of commitment to

service• Recruited executive management of the three major

hospitals• Recruited extensive network of volunteers

What they did:• Integrated efforts with the Napa Healthy Aging

Population Initiative• Outlined and publicized costs of falls for their county• Found that Napa City ranked high (#30 out of 308 cities)

compared to other municipalities in the nation for rate of hospitalizations due to hip fracture among Medicare enrollees• Secured technical support from the team of experts in

multi-factorial areas of expertise• Leveraged existing programs who had contact with

homebound older adults or people with limited mobility

Focus is on elevating awareness, creating relationships, identifying opportunities for collaboration, and influencing policy change.

What is not evident: How they identify incentives for healthcare delivery organizations to change practices, improve quality, increase referral to/ coordination with community services

Sustainability: What happens when the grant runs out?

According to the Falls Center of Excellence, Napa Fall Prevention:

• Used a resolution or proclamation as an advocacy and educational tool

• Collaborated with community partners and groups who advise county board of supervisors

• Reached community and homebound individuals through televised Board of Supervisor’s meetings (local access cable TV station)

• Achieved visibility, resulting in funding to establish Napa County’s first Fall Prevention Program

Environment• History of collaboration or cooperation in the

community• Collaborative group seen as a legitimate

leader in the community • Favorable political and social climateProcess/structure• Members share a stake in both process and

outcome • Multiple layers of decision-making • Flexibility • Development of clear roles and policy

guidelines • Adaptability • Appropriate pace of development Membership characteristics• Mutual respect, understanding, and trust • Appropriate cross section of members • Members see collaboration as in their self-

interest• Ability to compromise

Communication• Open and frequent

communication • Established informal relationships

and communications links Resources• Sufficient funds, staff, materials,

and time • Skilled leadershipPurpose• Concrete, attainable goals and

objectives • Shared vision • Unique purpose

Characteristics adapted from Mattessich PW, Murray-Close M, Monsey B. Collaboration: What Makes It Work, 2nd Ed. Fieldstone Alliance, 2001.

Characteristics of effective coalitions

Coalition development:Building blocks

Start from the bottom and work your way up. What questions have you already answered? How do your answers changeover time? Youcan also use these questions to guide discussion about how your group envisionsthe future.

History

What’s the history of collaboration in this

community? What’s the history of collaboration

around this or other issues?

Trust

What is the level of trust among potential members of this

collaborative?

Structure and Process

How can we ensure commitment and participation? Are expectations clear? Are tasks reasonable? Are

deadlines realistic?

Personal connections

Is the “right” person is inviting members? Delegating the work?

Community Context

How does this initiative dovetail with others in the community? Do our initiatives compete for

time and resources, or are they complementary?

Sustainability planning

Can we “institutionalize” collaboration around this issue in the community? For example, are there planning or

policy initiatives currently underway where this might fit as a priority?

Laying relational groundwork

Whom should we approach first within a community? Is

there groundwork to do before inviting people to

collaborate?

Participants’ interests

What are members’ individual self-interests? What are their organizational interests?

Understanding collaboration in context

This diagram offers a look at some elements of successful coalitions. Too often, we dive into collaborative work with structural and process questions: Who does what, when? In our action-oriented approach, we often miss the more fundamental questions of collaborative history, existing relationships, levels of trust, and the current community context. All of these factors require attention and understanding.

For further reading:Tom Wolff, Finding the Balance Between Community Organizing and Community Building - a tipsheet for the future (PDF, 8K)

PowerWhen thinking about the issue you’re working on, where does power exist in this community?

How is power perceived by participants? By people who the problem affects most?Explore questions of whether your approach should lean toward community “organizing” or community “building.”

Key lessons from veterans in coalition development:

• Acknowledge self-interest of parties, then identify and help frame common interests

• Less can be more: You may not need all organizations or all stakeholders at the table

• Individuals matter: Organizations are made up of individuals, and they are who make the relationships happen

• Planning counts: Being ready to “strike while the iron is hot” is key to advancing systems change issues

Five Principles for building Powerful Coalitions.

Amanda Tattersall,Power in Coalition, 2010.

Key lessons from veterans in coalition development:

• Work is necessary at multiple levels to effect system change: Local coalitions have functions that broader ones do not, and vice versa

• Organizing structure and action depends on goals

• Interventions should include systems changes that reflect “root causes” of the problem. (Do not use coalitions to change the behavior of those with limited power who are most affected by the “problem.” Rather, change systems to enhance support for health interventions or lifestyle changes.) Fawcett, S.B. (1999). Some lessons on

community organization and change. In J. Rothman (Ed.), Reflections on community organizations: Enduring themes and critical issues (pp.314-334). Itasca, Illinois: F.E. Peacock Publishers.

Coalitions can affect change in

communities and broader systems…

when they link local people to resources

and situations, at the multiple levels in

which change should occur, to address

common interests.Fawcett, S.B. (1999). Some lessons on community organization and change. In J. Rothman (Ed.), Reflections on community organizations: Enduring themes and critical issues (pp.314-334). Itasca, Illinois: F.E. Peacock Publishers.

“Community organizations should

seek changes commensurate with

their power.”

Fawcett, S.B. (1999). Some lessons on community organization and change. In J. Rothman (Ed.), Reflections on community organizations: Enduring themes and critical issues (pp.314-334). Itasca, Illinois: F.E. Peacock Publishers.