Organizing and Managing the NW Ohio Strategic Alliance for Tobacco Control

1. Organizing and Managing the NW Ohio Strategic Alliance for Tobacco Control Jan L. Ruma, CFRE, MEd Kathy S. Silvestri, MPH Stuart O. Kerr, BA James Price, MPH PhD Timothy Jordan, MEd PhD Sadik Khuder, MPH PhD

2. The Alliance programming is funded in large part by: The Ohio Tobacco Use Prevention and Control Foundation (OTUPCF)

3. The Problem • In the U.S., more than 2,000 youth under the age of 18 start smoking daily. Source: MMWR Surveillance Summary 2002;51(SS04) • In Ohio, 11.5% of high school youth reported having smoked their first whole cigarette before the age of 11. Source: Ohio Youth Tobacco Survey, 2002 • In Ohio, 68.5% of middle school and 78.3% of high school students are exposed to second hand smoke while indoors or riding in cars. Source: Ohio Youth Tobacco Survey, 2002

4. The Problem • In NW Ohio 32% of high school students in grades 9-12 have used tobacco in the past 30 days. • 46% of NW Ohio youth in grades 4-12 live in a household with a smoker. • 58% of students surveyed were in a room with someone smoking in the past week. • 13% will definitely or probably smoke a cigarette in the next 3 months. Source: NW Alliance Tobacco Use Survey, 2003

5. Alliance Vision • Established in 2001 • The NW Ohio Strategic Alliance for Tobacco Control will significantly reduce tobacco use through community-based partnership, and implementation of a comprehensive research-based tobacco control plan.

6. Alliance Mission • To develop a tobacco control plan for Northwest Ohio, request funding for the plan from the Ohio Tobacco Use Prevention and Control Foundation, and to implement the plan to measurably reduce tobacco use in the targeted populations.

7. Alliance Service Area Lucas Fulton Williams Ottawa Defiance Sandusky Erie Wood Henry Huron Seneca Paulding Putnam Hancock Wyandot Allen Auglaize

8. Alliance Programs • Youth Prevention Programs • LifeSkills • Word of Mouth • STAMP • TATU • Project Alert • Youth Cessation Programs • TAP • TEG • Reduce Smoking During Pregnancy • 5 A’s Counseling Intervention

9. Foundation The Alliance tobacco control plan is based on: • Best Practices for Comprehensive Tobacco Control Programs, the U.S. Centers for Disease Control and Prevention (CDC, 1999) • Program and Funding Guidelines for Comprehensive Local Tobacco Control Programs, The National Association of County and City Health Officials (NACCHO) • The Strategic Plan of the Ohio Tobacco Use Prevention and Control Foundation

10. Session Outcomes • Discuss the nine elements of developing a collaborative approach to implementing a comprehensive tobacco control plan. • Identify management strategies for the successful implementation and evaluation of a coordinated regional approach to tobacco control. • Define the role of local coalitions in the implementation of a regional, comprehensive tobacco control plan.

11. Why Collaborate to Reduce Tobacco Use? Jan L. Ruma, CFRE, MEd Project Director, Northwest Ohio Strategic Alliance for Tobacco Control Vice President, Hospital Council of NW Ohio

12. Why Collaborate? • Commitment to mission of significantly reducing tobacco use • To develop a comprehensive approach • To put the community’s needs first • To bring the greatest possible resources to NW Ohio in a coordinated fashion & improve our ability to work together as a region

13. Alliance Early Wins • Regional, Voluntary Governance Structure • Representative Steering Committee with diverse backgrounds • Member input and communication system • Weighted funding allocation formula • Development and implementation of a comprehensive research-based tobacco control plan

14. Alliance Early Wins Secured Funding For: • 30 subcontractors in 16 NW Ohio counties • Tobacco use surveillance system • Key indicator program evaluation system • Evidence-based youth prevention and cessation programs • Best practice guidelines to reduce tobacco use by women during pregnancy in various hospital and clinic settings. • Enhancement of local coalitions

15. Alliance Early Wins • 5,283 youth in grades 4-12 surveyed for tobacco use opinions • In the past 4-6 months: • 2,291 youth reached through prevention programs • 635 youth through cessation programs • 693 pregnant women and health providers through 5As counseling intervention • Changing Community Norms (clean indoor air--Cities of Toledo and Bowling Green)

16. Nine Elements of a Collaborative Approach to Tobacco Control Jan L. Ruma, CFRE, MEd Project Director, Northwest Ohio Strategic Alliance for Tobacco Control Vice President, Hospital Council of NW Ohio

17. 1. External Catalyst An external force is required for change. • Master Tobacco Settlement Agreement 11/1998 • Formation of Ohio Tobacco Use Prevention & Control Foundation 2/2000

18. 2. Neutral Leadership Mission-minded, community leadership is needed. “A great hunger for community and collaboration exists everywhere . . . despite profound mistrust, alienation, and skepticism. People want to come together. They simply do not know how.” • E. Schindler-Rainman & R. Lippitt

19. 2. Neutral Leadership Mission-minded, community leadership is needed. • NW Ohio Coalition (founded in 1994) met with local member of Foundation Board 3/2001 • Healthy Communities Foundation (HCF) of the Hospital Council of NW Ohio (HCNO) was asked by the Coalition to lead a regional effort.

20. 2. Neutral Leadership • HCF secured a planning grant 7/2001 • Hired strategic planning consultant (Catherine Kinney, PhD) • Appointed project director • Experienced collaborative leader • Political savvy • Servant leadership philosophy • Unwavering enthusiasm and dedication to the mission

21. 3. Regional Readiness Organizations must delegate authority for successful collaboration. • Conducted Regional Readiness Survey 8/2001 • Analyzed and Disseminated Results • Nominations and Appointment of Steering Committee 9/2001

22. Components of the RegionalReadiness Survey • Sent to Organizational Leadership in the Region • Hospital CEOs, Health Commissioners, Non-Profit Executive Directors, Government Agency Heads • 44 Organizations Responded

23. Regional ReadinessSurvey Mission/Structure/Planning • 95.5% agree with the mission of the Alliance • 72% agree with the proposed structure • 91% give the Alliance the authority to develop a tobacco control plan

24. Regional Readiness Survey Implementation • 93% are comfortable with the Alliance coordinating the implementation of the plan • 86% are comfortable with the Alliance identifying service providers to implement the plan • 88% are comfortable with the Alliance evaluating the performance of the service providers 

25. Regional Readiness Survey Fiscal Responsibility • 95.5% are comfortable giving the Alliance authority to apply for funds  • 84% are comfortable giving the Alliance the authority to allocate funds Administration • 95% are comfortable with the Healthy Communities Foundation administering the Alliance

26. Regional Readiness Survey Alliance Authority • Do you agree with the proposed: • Mission 95.5% • Structure 72% • Lead Agency (Healthy Communities Foundation of the Hospital Council of NW Ohio) 95%

27. 4. Process for Action You can’t lead people where they are not ready to go. • If you bring a diverse and appropriate group of people together, give them good information and an effective process, they will create effective strategies and take responsibility to implement them.

28. 4. Process for Action • Start Where People Are • Listen • Educate • Accommodate • Build Consensus to Accomplish the Mission • Movement from Silo to Collaborative Perspective • Focus on the target of reducing tobacco use . . . allowing organizational roles to fall into place.

29. Decision-Making Model Decisions must be based on research and made through consensus to build trust. • Research-Based Tobacco Control Plan • Planning Template To: • Prioritize strategies, indicators, leverage points, and activities

30. NW Ohio Tobacco Control Plan Components Vision Strategies Indicators Activities Prevent youth tobacco use initiation Implement prevention programs To measurably reduce tobacco use in NW Ohio % youth 12-18 who have tried tobacco Recruit youth advocates for tobacco control Voluntary youth cessation programs Reduce youth tobacco consumption % youth reporting use in last 30 days Involuntary youth cessation programs Reduce tobacco use among pregnant women and diverse, underserved populations Culturally specific programming Implement 5As Counseling Intervention for Prenatal Clients %of tobacco use within the targeted population All indicators stratified by ethnic group, age, gender, economic status, county

31. Decision-Making Model Decisions must be based on research and made through consensus to build trust. • Weighted Funding Formula • Increased allocation to rural and diverse counties • Implementation Plan • Alliance Structure • Role • Operating Procedures • Strategies to monitor progress and quality

32. 6. Secure Funding No money, no mission. • Funding should flow through collaborative table • Request for Implementation Plans 4/2002 • Plans required to address one or more goals • Evidenced-based programs • Steering Committee Selected Plan Implementers 5/2002 • OTUPCF Released RFP 6/2002 • Proposal Submitted 7/2002 • $835,000 Grant Awarded 10/2002 • Renewable for Three Years

33. 6. Secure Funding

34. 7. Implement the Plan Ongoing care, feeding, hand-holding and conflict resolution required. • Experienced professional to coordinate plan implementation • Content knowledge • Interpersonal skills • Ability to problem-solve • Provide technical assistance • Bridge the gap between practice and theory • Steering Committee guides decision-making

35. 8. Engage Grassroots Coalitions Harness the passion to reduce tobacco use. • Re-energize existing or form new tobacco control coalitions • Encourage local coalitions to coordinate tobacco control efforts within their service area • Encourage local coalitions to lead policy initiatives

36. 9. Continuous Improvement Cycle Be prepared to expand what is working and change what is not. • Experienced professionals to design an indicator-based evaluation strategy • Program evaluation content knowledge • Knowledge of latest research-based tobacco control strategies • Flexibility

37. 9. Continuous Improvement Cycle Be prepared to expand what is working and change what is not. • Experienced professionals must: • Maintain an interest in building evaluation capacity of subcontractors • Communicate complex program evaluation results in subcontractor language • Regular Progress Reports to the Alliance and OTUPCF

38. Nine Elements of a Collaborative Approach to Tobacco Control • External Catalyst • Neutral Leadership • Regional Readiness • Process for Action • Decision-Making Model • Secure Funding • Implement the Plan • Engage grassroots coalitions • Continuous Improvement Cycle

39. Alliance Challenges • Relying on one grant to create a system to reduce tobacco use • Traveling Upstream: Silos Rule! • Coordination with tobacco control efforts in NW Ohio funded independently of the Alliance • Expand programs that are proven effective • Improve or eliminate ineffective programs • Financial Sustainability

40. Alliance Opportunities • Demonstrate effectiveness of Alliance Model compared to independent grantees • Apply Alliance Model to other public health challenges • Organizational shift to viewing their role in tobacco control in the context of the Alliance system as a whole • Learn how to use our community resources effectively • Change NW Ohio community norms regardingtobacco use

41. Managing Program Implementation and Evaluation Kathy S. Silvestri, MPH Project Coordinator, Northwest Ohio Strategic Alliance for Tobacco Control Director of Health Planning for Hospital Council of Northwest Ohio

42. Key Program Components to Manage • Building Trust and Respect • Multi-Layered Communication System • Evaluation Strategy Components • Youth Tobacco Use Surveillance System • Program Subcontractors • Alliance Outcomes

43. Building Trust and Respect • Listen to problem-solve, trouble-shoot, and support • Pay attention to the needs and concerns of individual subcontractors • Be flexible • Maintain sense of humor

44. Multi-Layered Communication System • TUPCF • Program Director • Program Coordinator • Steering Committee • e-mail list serve “Tobacco Control” • Monthly meetings • Alliance Subcontractors • e-mail list serve “Tobacco Talk” • personal phone and conference calls • visits • General Alliance Membership • WinFax messages • General Alliance meetings and trainings

45. Youth Tobacco Use Surveillance System • Contracted with outside vendor (Great Lakes Marketing) for: • Survey development • Data collection and analysis plan • Coordination with local school districts through coalitions and subcontractors • Development of individual county report format • Executive summary of NW Ohio youth tobacco use opinions • Comparison with national and state figures • Report distribution

46. Alliance Surveillance Procedures • GLM pilot tested the survey instrument with 5 classrooms. Conducted “logic check” for readability, acceptability, and reliability. • Great Lakes Marketing (GLM) and Alliance subcontractors contacted school administrators for permission so conduct survey. • Employees of GLM administered surveys to students. Data analysis completed by GLM.

47. Alliance Surveillance Survey Instrument • Based on National Youth Tobacco Survey (NYTS) 2001-2002 Core Questionnaire • Modified for Alliance use • Affords comparison of NW Ohio data to state and national data (CDC) • Used CDC guidelines for school-based tobacco programs as basis for items regarding the role of schools • Total of 77 items: Likert-type response formats or multiple choice formats

48. Alliance Surveillance Survey Subjects • Cluster sampling methods of grades 4-12 • Grade levels & number of students were proportional to school district populations • Random selection of grades and classrooms from all 16 NW Ohio counties in the Alliance • 124 schools were included in the sample • Final sample size = 5,283 • 5,000 students completed the survey • Completion rate = 95%

49. Characteristics of Respondents

50. Components of the Alliance Evaluation Strategy Evaluation Team Contract for: • Youth Tobacco Use Surveys • Grades 7-12 • Excel and ScanTron formats • Elementary School Youth Tobacco Use Survey • Grades 4-6 • Tobacco Use During Pregnancy Survey • Translation of surveys to Spanish • Program implementation logs • Ongoing data analysis • Continuous feedback and training