Coalition development for fall prevention

1. Local Coalition Development for Fall PreventionWisconsin Fall Prevention Initiative Webinar hosted bythe Healthy Wisconsin Leadership Institute and Mary Michaud, Health Forward Consulting January 12, 2011 Coalition development for fall prevention

2. Today What are the characteristics of effective coalitions? What do coalitions do best? “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

11. 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

12. 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

13. 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?

14. 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

15. Characteristics of effective coalitions • Environment • History of collaboration or cooperation in the community • Collaborative group seen as a legitimate leader in the community  • Favorable political and social climate • Process/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 leadership • Purpose • 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.

17. 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. Structure and Process How can we ensure commitment and participation? Are expectations clear? Are tasks reasonable? Are deadlines realistic? 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) Personal connections Is the “right” person is inviting members? Delegating the work? Participants’ interests What are members’ individual self-interests? What are their organizational interests? Trust What is the level of trust among potential members of this collaborative? Community Context How does this initiative dovetail with others in the community? Do our initiatives compete for time and resources, or are they complementary? History What’s the history of collaboration in this community? What’s the history of collaboration around this or other issues? Laying relational groundwork Whom should we approach first within a community? Is there groundwork to do before inviting people to collaborate? 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? 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.”

18. 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.

19. 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.

20. 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.

21. “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.