Phase 1: East Tennessee Region Vignette
Organize for Success/Partnership Development
The East Tennessee Region of the Tennessee Department of Health serves a population of more than 660,000 in 15 mostly rural counties. In the mid-1990s, the community development division facilitated a state-developed community health planning process in each of the counties. This process, Community Diagnosis, led to the formation of health councils in counties in which none had existed. The county health councils, in turn, conducted community assessments to identify key health issues and health priorities for their communities. In subsequent years, the health councils have implemented a variety of projects, activities, and programs to address their priorities.
A key consideration in preparing to engage in MAPP was recognizing the success of the health councils. To do this, they melded an unlikely pair—evaluation and celebration—into a process to assist health councils in measuring and reflecting on their accomplishments. The process was developed using the MAPP evaluation model, the Centers for Disease Control and Prevention''s Framework for Program Evaluation. Each health council held a five-hour retreat to identify accomplishments and develop a plan to measure its significance. The resulting data, which were mostly qualitative, were compiled into a brochure for the health council to promote their work and recruit additional members and resources.
Initially, community development staff facilitated the retreats. An ongoing collaboration with the University of Tennessee, Knoxville, provided the capacity necessary to conduct the process across the region. By first observing a staff-facilitated retreat and then replicating the process (with staff supervision), students from the Master of Public Health and Graduate Public Health Nutrition Programs were able to experience the application of health planning theory and contribute to the evaluation.
The response to the evaluation retreat was outstanding. The process of recognizing their accomplishments energized the health councils. Several councils developed new subcommittees and recruited new stakeholders to refocus their efforts on unaddressed needs that emerged from the evaluation. Through the process many health council members experienced the difficulty of retrospective data collection, and thus gained appreciation of the importance of incorporating evaluation components throughout the planning and implementation phases of the health improvement cycle.
Following the health council evaluation process, the regional office collaborated with the University of Tennessee faculty to submit an abstract to the Council on Linkages between Academia and Public Health Practice. The abstract, A Public Health Academic and Practice Collaborative in Community-based Strategic Planning, was selected as the second place Linkage Award winner. Building on the success of this evaluation project, the $500 Linkage award was used to sponsor an organizing, team building and visioning retreat for the East Tennessee regional MAPP steering committee, which is gearing up to re-engage the health councils in the community health planning process.
After engaging the health councils in an evaluation process in 2001–2002 (see East Tennessee Organizing Vignette Part 1), many were asking, "What''s next?" MAPP''s framework set the stage for communities to bring their health improvement planning to a deeper and broader level. At the same time, the comprehensive nature of MAPP posed implementation challenges in such a large and diverse region. Overcoming these challenges required a strong emphasis on engaging communities in organizing for successful MAPP implementation.
Initial organizing efforts involved a regional MAPP steering committee, formed to gain community input on MAPP implementation. One challenge in forming the committee was determining appropriate involvement of the local and regional staff providing support for MAPP implementation. Learning from past experience as stakeholders in the process, staff members were engaged from the start. This enabled staff to assume new roles as participants and supporters, rather than drivers, of the process. The risk in this approach was an overrepresentation of staff in the process, a tension that has not yet been resolved as staff members outnumber community representatives 2 to 1 on the 15-member steering committee.
Throughout the process, the committee used a dialogue approach to explore its function and the community''s role in implementing MAPP. At the same time, staff and community members struggled with their traditional roles and explored potential new roles to take on in the MAPP process. Ultimately, the committee identified community engagement as the key factor in successful and sustainable MAPP implementation, though the issue of "roles" remains part of an ongoing conversation.
The committee developed an inventory of resources that it could offer to counties interested in implementing MAPP, and it co-sponsored an event that convened community members from across the region in an Expedition to a Healthier Community (see East Tennessee Visioning Vignette). In June 2003, the first of the 15 counties volunteered to pilot MAPP in the East Tennessee region. The MAPP steering committee plans to provide support with its collective resources and organizing experience as Monroe County begins its plans for community health improvement.