Coalition for a Healthier Community: Lessons learned and implications for future work

The Coalition for a Healthier Community (CHC) initiative was implemented to improve the health and well-being of women and girls. Underpinning CHC is a gender-based focus that uses a network of community partners working collaboratively to generate relevant behavior change and improved health outcomes. Ten programs are trying to determine whether gender-focused system approaches are cost-effective ways to address health disparities in women and girls. Programs implemented through coalitions made up of academic institutions, public health departments, community-based organizations, and local, regional, and national organizations, are addressing health issues such as domestic violence, cardiovascular disease prevention, physical activity, and healthy eating. Although these programs are ongoing, they have made significant progress. Key factors contributing to their early success include a comprehensive needs assessment, robust coalitions, the diversity of populations targeted, programs based on findings of the needs assessments, evaluations taking into consideration the effect of gender, and strong academic–community partnerships. A noteworthy impact of these programs has been their ability to shape and impact public, social, and health policies at the state and local levels. However, there have been challenges associated with the implementation of such a complex program. Lessons learned are discussed in this paper.     

Understanding the dynamic interinfluences of implementation processes: An illustration by multiple case studies

Many dropout prevention programs have been developed and validated in the past decades. Yet, little is known about the contextual factors influencing the implementation of these programs. Implementation processes, such as school principal leadership and governmental funding, have been identified for their influence on program implementation, but the mutual or dynamic influence of these processes is yet to be understood. This study examines the processes involved in the implementation of Check & Connect (C&C), a well-established targeted dropout prevention program validated in several countries that aims at promoting the development of a significant relationship between at-risk students and a mentor as a way to prevent school dropout.Semi-structured interviews were conducted with 12 mentors and coordinators directly involved in C&C implementation. Analyses were conducted in two subsequent steps: thematic analyses first helped identify implementation processes described by respondents, and then synthetic case studies allowed us to build the implementation stories of distinct sites. This last step was conducted using the Planned Change Framework.This framework helped us to understand the complex dynamics of implementation processes in each site, which were associated with previously identified program outcomes, beyond implementation fidelity. Implications for future implementations of evidence-based programs in the school setting are discussed.     

UPSTREAM! Together evaluation results from community efforts to prevent mental,emotional, and behavioral health problems

Mental, emotional, and behavioral (MEB) health problems are prevalent globally. Despite effective programs that can prevent MEB problems and promote mental health, there has not been widespread adoption. UPSTREAM! Together was a planning project in three Colorado communities. Communities partnered with academic and policy entities to 1) translate evidence about MEB problem prevention into locally-relevant messages and materials and 2) develop long-term plans for broad implementation of interventions to prevent high-priority MEB problems. Community members recognized the need to talk about MEB problems to prevent them. The UPSTREAM! communities localized messages designed to start conversations and sustain attention on preventing MEB problems. The communities understood that prevention takes sustained community attention and advocacy, knowing that important outcomes may be years away. Long-term implementation plans aimed to strengthen families and enhance social connections among youth. Despite community readiness and capacity to implement evidence-based programs, there were few funding opportunities, delaying program implementation and revealing gaps between funding policies and community readiness. This community-engaged experience suggests an achievable approach, acceptable to communities, and worthy of further development and testing. Policies that cultivate and support local expertise may help to increase wider community adoption of evidence-based programs that promote mental health among youth.     

A national evaluation of community-based youth cessation programs: design and implementation

Although widely available, little is known about the effectiveness of youth cessation treatments delivered in real-world settings. The authors recruited a nonprobability sample of 41 community-based group-format programs that treated at least 15 youth per year and included evidence-based treatment components. Data collection included longitudinal surveys of youth participants (n = 878); posttreatment surveys of program leaders (n = 77); and one-time surveys of organizational leaders (n = 64)and community leaders in education, health, and juvenile justice (n = 94). Information about smoking-related ordinances was collected at the state and local levels. The framework, evaluation design, and implementation strategies described in this article provide a template for large-scale real-world program evaluations.     

A Review of Multicomponent Interventions to Prevent and Control Tobacco Use Among College Students

Abstract

Objective: Multicomponent tobacco control programs have been implemented at the state and community levels and have led to a reduction in tobacco use. The purpose was to review the public health research literature on tobacco prevention and control programs on college campuses and derive evidence-based implications for comprehensive program implementation. Methods: MEDLINE, PsycINFO, ERIC, and PubMed databases were used to search the research literature concerning tobacco prevention and control programs conducted on college campuses published between 2000 and 2009. Results: No studies were found that implemented all 5 recommended components of a comprehensive program. Tobacco control programs containing policy and prevention education were used the most and promotion of tobacco-free environments and banning sales of tobacco products were used the least. Conclusion: The review suggests that despite the recommendation of comprehensive tobacco control programs to reduce tobacco use on college campuses, few institutions have implemented and evaluated programs consisting of multiple components.     

Toward a Horizontal Participatory Implementation Approach for Community Health Programs Serving Vulnerable Populations

Participatory implementation in three community health programs is examined using a 17 point assessment tool organized within a participatory framework made up of three conceptual elements: stakeholder participation in the program, cultural and structural relationships, and partnership synergy. The study results suggest that horizontal cultural relationships between frontline program implementers and beneficiaries, could lead to beneficiary satisfaction and empowerment even when structural relationships are vertical and beneficiary participation is not as robust as in complete participatory programs. The study's findings also suggest that partnership synergy can affect the success of program implementation and the growth of community social capital.     

Supporting systemic social and emotional learning with a schoolwide implementation model

A strong body of research indicates that evidence-based programs designed to promote social and emotional learning (SEL) can lead to positive developmental outcomes for children and youth. Although these evidence-based programs have demonstrated benefits for students, it is also well-established that programs must be implemented with quality and sustained to maximize positive outcomes. To support schools in implementing SEL that is integrated into all aspects of a school community, the CASEL School Guide implementation model was developed to guide school leadership teams in establishing a vision; selecting, implementing, and sustaining evidence-based programs; and integrating SEL schoolwide. The School Guide model is based on CASEL’s School Theory of Action which includes planning, implementing, and monitoring schoolwide SEL. This paper describes findings about the feasibility and degree of implementation of this model as carried out by 14 school leadership teams who were supported by SEL coaches. The participating schools implemented an evidence-based SEL program as the foundation of their efforts to promote schoolwide SEL. Findings demonstrate the feasibility of implementing this model in urban schools that primarily serve students of color, as all teams successfully carried out the implementation model and demonstrated increased levels of capacity related to supporting schoolwide SEL.     

Work-site health and fitness programs: Impact on the employee and employer

Physical fitness and health lifestyle habits have been reported to lower the risk of death from disease, foster healthy muscles, joints and bones, and enhance personal function and mental health. Given these benefits, many employers are implementing health and fitness programs into their workplace with the goals of improving and maintaining the health of their employees and increasing worker productivity. However, research is still being conducted to determine if these programs are an effective means of achieving these goals. OBJECTIVE: The purpose of this paper is to investigate the impact of these programs on employee physical and mental health, employee work performance, and the employer. This paper also investigates the effectiveness of the specific program structures and intervention procedures that were used in the employee health and fitness programs that have been implemented. STUDY DESIGN: This paper analyzed 15 previously conducted studies to investigate the impact and design of employee health and fitness programs. RESULTS: The reviewed literature suggests that the incorporation of an employee health and fitness program can have positive effects for both the employee and the employer. Programs that are structured using a variety of physical fitness programs, health education classes, outreach and one on one counseling with follow up contact have proven to be most beneficial in terms of employee and employer satisfaction. CONCLUSION: The implementation of an employee health and fitness program can have positive lasting effects on both the employee and employer. In addition to implementing programs that offer a variety of choices and one on one counseling, employers would benefit from targeting the at-risk population to ensure that the programs benefit the greatest number of employees possible.     

Challenges to Connecting Sociology and Service Learning

Service-learning programs are not free from challenges brought about by lack of financial support, lack of widespread commitment from professors, community agencies, and recipients of service, and lack of knowledge and insight in students directly involved in such programs. While service-learning initiatives and programs serve positive functions for organizations and individuals, rhetorical accolades for service learning can distort or omit the realities of program implementation and sustained delivery. This paper specifically explores the following challenges connected to service-learning programs: (1) pedagogical difficulties; (2) student limitations; (3) time constraints; and (4) community cooperation.     

Assessing local capacity for health intervention

Because of their location within the practice realm, participatory, community-based public health coalitions offer many lessons about implementing and sustaining local interventions. This paper presents a case study of capacity assessment at the local level. Capacity evaluation methods are presented, with emphasis on the theoretical framework used to guide the evaluation. The capacity evaluation framework presented herein was theoretically based and designed to generate practical information to facilitate the adoption of a locally tailored youth obesity prevention program, VERB Summer Scorecard (VSS). Using multiple methods, four aspects of community capacity were assessed, including community, knowledge and skills, resources, and power. Within each category, factors that facilitated or impeded program implementation were distinguished. The evaluation protocol was designed to generate information increasing community capacity to sustain a community-based obesity prevention program. Capacity tables were used as a program-planning tool and as a system for sharing implementation and sustainability requirements with potential adopters. This case study also explores how to use capacity assessment results to empower coalitions to serve as catalysts for development of local programs in other communities.     

Program analysis using the client oriented cost outcome system.

The client oriented cost outcome system has been under development in Pennsylvania community and hospital programs since 1972. The system builds upon the behavioral and decision data generated with or on behalf of consumers. Flexibility for local program system design is permitted if the procedures of consumer intake, review, and termination document each consumer's (a) problems, resources, and goals, (b) overall functioning level in their ordinary community, and (c) services intended and rendered as related to (a), above. While the system's primary application is in providing feedback for local program quality assurance and evaluation procedures, aggregation of data permits program planning and evaluation at county, state, and federal levels in terms of (a) client demographic or diagnostic characteristics, and (b) program service characteristics and objectives.     

Mentoring as a Bridge to Positive Outcomes for Teen Mothers and Their Children

This paper compares historical and psychosocial realities of teenage parenting to prevailing contemporary myths. The authors explore the negative consequences of current remedies based on these myths. Community volunteer mentoring programs are suggested as a cost-effective intervention that can benefit communities and promote positive outcomes for at-risk pregnant teenagers. The authors suggest strategies for implementation of a community volunteer mentoring program based on an existing program in an urban community health center. Detailed information for social workers in community agencies is provided with regard to community education, recruitment, training, and ongoing support and supervision of mentors; funding requirements; and program evaluation.     

Factors contributing to the subjective quality of life of the chronic mentally ill.

Although the deinstitutionalization of the seriously mentally ill has been severely criticized, the success of some model community programs shows that community care can enhance patients' quality of life. We lack specific knowledge, however, about the components that make these programs effective, and why. A theoretical framework for identifying these critical components is proposed. Services can enhance life satisfaction by increasing individuals' actual power through economic resources or status, thus enhancing their perceptions of mastery. An internal evaluation of a model program provides support for this hypothesis. One hundred and fifty-seven patients were interviewed about services, quality of life, and perceptions of mastery. Results show that services providing economic resources and an empowerment approach to service delivery are significantly related to overall quality of life. Furthermore, perceptions of mastery account for the impact of these components on life satisfaction. These findings suggest interventions that can be adopted by a wide range of mental health programs for the improvement of the quality of life of the chronic mentally ill.     

Teachers and health workers: partners in primary health care. Experiences from Papua New Guinea

Primary health care (PHC) involves community health education. When health priorities in rural communities are focused on the vulnerable under-5-years-of-age group then one has to examine who actually cares for this age group and what are the most appropriate means of reaching them through health education programs. In the context of rural communities in Papua New Guinea the linking of school and community health programs has been taking place. Examples and insights from programs where teachers and health workers attempted to find appropriate channels for integrating child and adult education in order to improve the health status of the very young child are described. The school programs used a child to child approach to develop in children a sense of shared responsibility with adults towards better health for themselves, younger children in their care and the environment of the community. The goal was a health program that applied to the whole community, where division between child and adult learning activities was not so sharply drawn, and where formal school programs and nonformal community education programs were to complement and contribute to each other. A campaign against infant diarrhea and death through dehydration was implemented. As a result of a 3-day planning workshop a program was drawn up for schools and communities. The workshop covered causes of diarrhea, fluid loss and dehydration, simple preventive and curative measures, essential hygiene habits and current community practices. Teachers, health workers and community leaders fashioned a program of activities for school children and adults. It was discovered that adults often feel a barrier between themselves and the child's school learning. Also, a gap often exists between what is taught in school and what is needed and can be applied to community health priorities. Thus, an effective community health education program that includes both children and adults in an integrated program will need to cover the varying ages and groups of community members who, with different degrees of responsibility, take care of themselves and others.     

Impacts of agency coordination on nonprofit domestic violence and sexual assault programs in communities with STOP formula grant funding

The goals of the current study are (a) to understand the community and state context in which STOP(Services* Training* Officers* Prosecutors)-funded victim service (VS) programs operate, (b) to assess the degree to which receipt of STOP funding for VS programs and the degree of state-level STOP agency support for collaboration among community agencies have led to improved program services and community interaction, and (c) to assess the degree to which improved interaction between community agencies leads to improvements for VS programs. The results show that community interaction between VS programs and other community agencies can improve VS program services as reported by service providers. In addition, the higher the pre-STOP levels of activity around violence against women issues in communities, the more agencies can enhance their service system with STOP funding. Also, STOP funding has facilitated greater levels of change for communities whose pre-STOP attention to violence against women was lower.     

The relationship between implementation fidelity and educational outcomes in a school-based family support program: development of a model for evaluating multidimensional full-service programs

There is increasing recognition of the need for evaluations that identify program processes or mediators and assess degree of program implementation rather than focusing solely on outcome evaluation. This paper describes the application of complementary qualitative and quantitative evaluation procedures to assess the degree of implementation of multi-component family support programs for improving educational outcomes for at risk youth, and to assess the relationship between program implementation and outcomes. The qualitative evaluation involved prolonged engagement to identify common program domains or mediators. Using a method called Innovation Configuration Analysis, levels of implementation of program domains were explicated as well as an overall Implementation Fidelity Index. Strong positive relationships were found between overall program implementation and program-level outcomes achieved by student participants.     

Developing Financial Management Training in Low-Income Communities

Abstract

As welfare policy contractions and declines in real wages have placed severe financial pressures on low-income families, programs to improve financial management practices and to help the poor accumulate assets have grown. This article examines the need for such programs and the implications associated with implementing two prominent training strategies-one that focuses solely on financial management training and another that combines such training with savings incentives.

Based on data from a large financial management training program, we find that knowledge deficits about basic financial issues are substantial, and that the type of financial training program offered has important implications with respect to the subgroups of low-income people likely to be served within a community. We discuss program issues critical to the implementation of such programs in low-income communities, with a focus upon more carefully attending to their participant empowerment and community development potential.     

Fostering CHANGE: Lessons from implementing a multi-country,multi-sector nutrition-sensitive agriculture project

Using agriculture to improve nutrition is an approach growing in popularity, with programs becoming increasingly complex and multisectoral. While there is an active line of research assessing the impacts of such programs, little has been written about the process of successfully implementing them. As such, this paper uses a multisectoral nutrition-sensitive agriculture program implemented in four African countries as a case study to address key challenges in and lessons learned from implementation. We highlight the overall flexibility of nutrition-sensitive agriculture but also the need to adapt certain aspects to the particular context, as well as the opportunities for cross-context learning (and the limits to this). Integrating rigorous evaluation into such complex programs and forging diverse cross-sectoral partnerships offer both rewards and challenges, upon which we reflect. Main lessons learned from the program include the importance of carefully sequencing interventions, retaining flexibility in implementation, allowing for considerable time for cross-sector integration and coordination, and considering community impacts when designing research.