​Principle 4

Focus on policy, systems and structural change.

McAfee et al. 2014 note that “Systems and policy change are integral to advancing racial equity. Without changing policies and systems, transformation at scale cannot be achieved.” Policy offers the most direct route to measureable progress. But all too often, Collective Impact practice stops at the programmatic level. As McAfee and his colleagues go on to say, “Collective Impact partnerships should plan to amplify the possibilities inherent in local successes and translate the lessons and insights into the systems, policy and structural change needed to have sustained impact for whole populations.”  

Books and Articles:
  • Berkowitz, B., Wolff, T. (1998). Rethinking social action and community empowerment: A dialogue. In M. Brinton Lykes, et al. (Eds.), Unmasking social inequalities: Victims, voice and resistance, 296–317. Philadelphia, PA: Temple University Press.
  • Butterfoss, F.D. (2007). Coalitions and Partnerships for Community Health. San Francisco, CA: Jossey-Bass.
  • Butterfoss, F.D. (2013). Ignite: Getting Your Community Coalition Fired Up for Change. Bloomington, IN: Author House.
  • Butterfoss, F.D., Malveaux, F.J., Guest Co-Editors. (2011). Translating Evidence-based Interventions into Practice. Merck Childhood Asthma Network, Inc. Initiative. Health Promotion Practice, 12 (6) S1, 5-8.
  • Butterfoss F.D., Kegler, M.C., Francisco, V.T. (2009). Mobilizing organizations for health enhancement: Theories of Organizational and Systems Change. In K. Glanz, B. K. Rimer, K. Viswanath (Eds). Health Education and Health Behavior: Theory, Research and Practice, 4th Ed. San Francisco, CA: JosseyBass.
  • Francisco V.T., Butterfoss, F.D. (2003). How do we know if we are making a difference with our program or community initiative? Health Promotion Practice, 4(4), 367-70.
  • Frieden, T. R. (2010). A framework for public health action: The Health Impact Pyramid. American Journal of Public Health, 100(4), 590-595.
  • Jasuja, G., Chou, C., Bernstein, K., Wang, E., McClure, M., & Pentz, M. ( 2005). Using structural characteristics of community coalitions to predict progress in adopting evidence-based prevention programs. Evaluation and Program Planning, 28, 173-184.
  • Kegler, M., Norton, B., Aronson, R. ( 2008). Achieving organizational change: Findings from case studies of 20 California Healthy Cities and Communities coalitions. Health Promotion International, 23, 109-118.
  • Kegler, M., Twiss, J., Look, V. ( 2000). Assessing community change at multiple levels: The genesis of an evaluation framework for the California Healthy Cities and Communities project. Health Education & Behavior, 27, 760-779.
  • Lasker, R., Weiss, E., Miller R. ( 2001). Partnership synergy: A practical framework for studying and strengthening the collaborative advantage. Milbank Quarterly, 79, 179-205.
  • Schultz, J.A., Pandya, S., Sims, M., Jones, J.A., Fischer, S. (2013). Participatory Monitoring and Evaluation Within a Statewide Support System to Prevent Adolescent Substance Abuse, Journal of Prevention & Intervention in the Community, 41(3), 188-200.
  • Frieden, T.R. (2010). A Framework for Public Health Action: The Health Impact Pyramid, American Journal of Public Health, 100(4), 590–595.
  • Wandersman A., Goodman, R.M., Butterfoss, F.D. (2005). Understanding coalitions and how they operate: An “Open Systems” framework. In M. Minkler (Ed.) Community Organizing and Community Building for Health, 2nd Edition. Rutgers University Press.
  • Wolff, T. (2010). The Power of Collaborative Solutions. San Francisco, CA: Jossey-Bass.

Image result for Jicarilla Apache Tribe photos

Case Study: Decade of Hope Coalition, Jicarilla Apache Tribe, Dulce NM USA

Several members of the Jicarilla Apache Tribe, along with other community members who worked on the reservation but were not tribal members, developed the Decade of Hope Coalition. Many of the residents struggled with alcohol abuse some time in their lives. Many of the tribal elders died from neglect and alcoholism, often dying of exposure during the long mountain winters. The coalition began in 1989, following a string of suicides among young tribal members. Mothers of these teens and young adults decided that something needed to be done about the problem beyond the limited efforts of the Tribal Council. The authors and collaborators began our involvement with this coalition near the end of 1991, when we were asked to help with evaluation of a successful grant proposal to the Community Partnership Program of the U. S. Center for Substance Abuse Prevention (CSAP).

A community action planning guide for substance abuse prevention provided a framework with which to create and adapt a vision for a healthy community and statement of what the community will do and why (vision and mission statement). The process also facilitates making that vision concrete through the development of a culturally-appropriate blueprint for action (objectives, strategies, and action plans). Unlike many other strategic planning processes, the Action Planning Guide provides a group with specific prompts for potential community changes (i.e., new or modified programs, policies and practices) that could be sought to reduce risk and enhance protection for substance abuse. Tribal members developed their own unique action plan to reflect local strengths, culture, needs and resources.

One result of the strategic planning process was the identification of sectors of the community targeted for change by the Decade of Hope Coalition. These sectors included tribal and non-tribal businesses, religious organizations, public schools and tribal education, tribal government, cultural organizations, tribal police and courts, youth organizations, media, as well as health and service organizations and native healing. During action planning, tribal members identified specific community changes to be sought (i.e., new or modified programs, policies and practices related to substance abuse) for each sector. For example, there were a number of changes identified for tribal and non-tribal businesses, such as a ban on people fighting in the local bars. A total of 85 objectives for community change were identified. It remained the task of coalition members to further specify who would do what by when to bring about the changes in the action plan. Coalition members and staff reviewed the objectives and related accomplishments during monthly coalition meetings and informally in the coalition office.

This coalition was instrumental in bringing about changes in the community relative to substance abuse prevention. The total of 69 documented changes included new programs, such as the establishment of a micro-grants program to create alternative activities for youth and address health-related problems in the community, the coordination of services among human service agencies, and policy changes such as requiring the local public radio station to air substance abuse prevention Public Service Announcements in Jicarilla as well as English.

The local evaluation coordinator (a tribal member) reviewed the records of the local Indian Health Service clinic to collect these data. Data were available from January 1985 through June 1993. There was a steady increase in the number of alcohol-related transports through January of 1992. The patterns were somewhat cyclical, with a series of peaks occurring in the summer months when tribal festivals are held. Although data for 1993 are not complete (because we only had data for 6 months), alcohol related transports decreased sharply when those months are compared to the same time period from the previous years. When viewed alongside data from the documentation system, the results show an association between decreased alcohol-related transports and changes facilitated by the coalition in 1992 and 1993. Although limited by data availability, this association is suggestive of coalition impact.

This presentation provides additional background, including graphs of accomplishments over time, critical events, and a list of example accomplishments.