In 2002 Catholic Charities USA and the Catholic Health Association sponsored
a study assessing the state of collaboration in Catholic ministries across the
United States. This assessment, called Greater than the Parts: A Study of
Collaboration between Catholic Charities and Catholic Health Care, was released
during the semiannual meeting in June of the U.S. Conference of Catholic Bishops.
The study was conducted by Health Systems Research, Inc., and was funded
in part by a grant from SC Ministry Foundation, Cincinnati. As part of the study,
researchers visited five sites (St. Petersburg/Tampa, FL; Cleveland; Wichita,
KS; Orange County, CA; and Albany, NY) to learn what makes for successful collaboration.
What follows is the fourth in a series of articles for Health Progress
highlighting the study's findings. Greater than the Parts is available
on compact disk from CHA.
Orange County, CA, is an affluent area that also has less well-to-do, pocket-sized
communities whose residents primarily originate in Mexico. Many families in
these latter communities struggle with an array of economic, language, housing,
education, social, and health issues associated with starting and sustaining
life in a new country. The mission of Orange County Community Health Enrichment
Collaborative (CHEC) is to create a neighborhood-based health and social service
system guided by community residents and stakeholders. The collaborative's goal
is to weave together services provided by local institutions in ways that will
support the physical, spiritual, emotional, and economic health of Orange County's
low-income residents.
These are complex communities with wide-ranging needs. Seeing this, each of
CHEC's founding partner organizations realized that it could not address these
needs alone. The partners also recognized that, under New Covenant, their
collective mission was in fact to address these needs. As part of New Covenant,
California's Catholic bishops convened a statewide meeting during which members
of Catholic Charities, hospitals, and dioceses were challenged to find ways
to work together. After this meeting, the Orange County partners came together
and recognized that each organization possessed skills, relationships, experiences,
and resources that were unique, allowing all to make their own special contributions
to the overall approach needed to effectively address community issues.
The partners see collaboration as a better way to leverage assets and resources.
As one partner said, "We need to think about time spent in collaboration as
an investment, the way business does. They don't expect immediate results from
investments, and neither should we."
CHEC's founding partners are:
- Catholic Charities of Orange County, Santa Ana, CA
- Mission Hospital Regional Medical Center, Mission Viejo, CA
- Mission Basilica, San Juan Capistrano, CA
Collaboration
For CHEC's founding partners, working together started with talking together.
Each was aware of community issues, accepted some level of responsibility for
addressing those issues, and was ready to consider the possibility of using
a collaborative approach to bring about change. New Covenant acted as
motivation to engage in systemwide discussions of the Catholic mission. A representative
of one of the partner organizations described the collaboration as a "rare opportunity
to make a difference."
CHEC's partners developed and agreed to a formal memorandum of understanding
that facilitated and institutionalized the collaboration process. This memorandum
carefully described the responsibilities of each partner in the collaboration
effort. Using a small grant, the founders formed the CHEC Advisory Council,
which was composed by representatives from 12 other agencies, including a Neighborhood
Health Committee made up of representatives from the target neighborhoods. Members
of the Neighborhood Health Committee were charged with empowering residents
to improve their health and that of their families.
Partners and advisory council members participated in leadership training
sessions to help everyone learn how to discuss and make decisions collaboratively
rather than unilaterally by organization. CHEC partners at all levels stressed
the importance and usefulness of leadership training to facilitate and support
the collaboration work. Collaboration, they realized, is a different way of
doing business, one that requires leadership skills different from those used
in more traditional, hierarchical organizational structures.
Results
A number of successful initiatives have resulted from the work of the collaborative.
Stone Field Project A needs assessment conducted in collaboration with
California State University in Fullerton revealed that neighborhood residents
especially needed a safe place for their children to play. CHEC therefore developed
what it called the "Stone Field Project," in collaboration with yet another
partner, the city of San Juan Capistrano. This project involved the mobilization
of the community to create a soccer field in the center of town. The funds needed
to build it came from St. Joseph's Health System and the city. Residents of
the targeted community are actively involved in the project, as evidenced by
their participation in city council meetings, at which issues related to this
project and other community problems are discussed.
Diabetes Collaborative Diabetes is a significant problem among residents
in these communities. CHEC, in collaboration with a range of county agencies,
accordingly formed the Diabetes Collaborative to provide education, prevention,
detection, and referral services to Latino residents who are at high risk for
the disease.
Leer es Poder The "Leer es Poder/Reading Is Power" program
is a partnership comprising CHEC; Saddleback College, Mission Viejo; and the
Capistrano Unified School District Adult School. Its aim is to help Spanish-speaking
people learn to read in their own language and then learn to speak and read
English. Additional partners are the Children's Hospital of Orange County at
Mission, Mission Viejo, and other members of the broader community.
CHEC Family Resource Center The center, working with a range of partners,
offers a wide array of services, including health and parent education, counseling,
health screening, information and referral, child development, and community
outreach to link residents with services. The center uses a service model in
which community residents choose what services they need when they need them.
This contrasts with a program model which essentially says to residents, "Here
are the set programs available; take what we have."
Community-Based Events The partners also work together on an array
of ad hoc community projects. These include health fairs, where residents have
an opportunity to engage in health screening and health education activities,
immunization drives, and various health- and social service-related activities
for senior citizens. Particularly important, given the demographic composition
of the southern part of Orange County, are the events organized by the partners
to bring the Anglo and Hispanic communities together. Among these are the annual
Cinco de Mayo Fiesta and education fairs conducted by the English and Spanish
Parent/Teachers Associations.
Lessons Learned
There was a remarkable consistency of responses from founding partners, new
partners, and staff at all levels of CHEC regarding the lessons learned and
advice offered.
There Is Much to Learn about Each Other Though all involved identified
the importance of shared mission and values in jump-starting collaboration work,
they were also aware of the limitations of this in putting the collaboration
concept into operation. Even when potential partners shared the same mission
and value system, significant differences in institutional and organizational
cultures still existed; each partner organization had to realize that it had
much to learn about each other. This included working through an array of both
conscious and unconscious misconceptions and assumptions, as well as learning
each others' languages.
A Community Needs Assessment Helps the Partners Stay Focused Conducting
and actually using a community needs assessment to determine what residents
indicate they need—versus what the providers assume the community needs—is
essential. Input from the community was obtained and used to determine the collaborative's
first project, and input is still sought on a regular basis and used to drive
CHEC's ongoing work.
Pace the Work of the Collaboration Trying to do too much too quickly
can result in failure and disenchantment with collaboration as an approach to
addressing community problems. A representative of one partner organization
said, "Don't take too big a bite. You must have staying power while relationships
mature." It is impossible to be effective if the collaboration efforts are "all
over the place," as the phrase goes. One successful project will naturally lead
to another and, over time, an array of community issues can be effectively addressed.
Decision Makers Need to Be Involved Requiring the "at-the-table" presence
of those invested with the authority to make decisions is another lesson learned
by CHEC. As one partner's representative noted, "This [collaboration] is not
a spectator sport." But he also cautioned that it was important to accept partners
as they are, understanding that differences as well as similarities bring strength
and creativity to collaboration.
Include the Diocesan and Parish Partners CHEC partners also stressed
the importance of early and ongoing involvement of the diocese and local parish
in the collaboration. This, they said, helps to keep the work focused on mission
and gives credibility to the project and project activities.
Trust Takes Work Although trust among individuals and organizations
involved in collaboration work is routinely cited as essential to collaboration,
CHEC partners identified the importance of understanding that trust doesn't
just happen. Rather, trust-building is a process that is fragile in the beginning
and grows stronger as partners continue to work together. Patience is needed
as partners learn to trust by taking chances through the sharing of ideas, information,
and resources. It is important to let go of previously held attitudes as well
as some measure of institutional pride. The growth of trust can be assessed
by the level of candor displayed by those involved in collaboration.
The Future
One of CHEC's goals is to develop a collaborative, neighborhood-based, participatory
approach to the organization and to the delivery of services that might be replicated
in other communities. Having developed the model through the work in San Juan
Capistrano, CHEC is now working to replicate the model in two neighborhoods
in northern Orange County. The lead partner in this effort is the Catholic Charities
agency, which is working to engage local parish and hospital partners in the
new collaborative venture. The original CHEC partners and the CHEC Advisory
Council, guided by an updated needs assessment, continue to develop other projects
in the San Juan Capistrano community. These projects will help spread collaboration
as an approach to the organization and delivery of services. CHEC has developed
a collaboration manual that includes policies and procedures useful for starting
and sustaining collaborative efforts.
To help it determine what to do next, CHEC is assessing and measuring what
it has done. Evaluation is viewed as vital in determining if—as the representative
of a CHEC agency put it—"we are actually walking the talk." On the program and
service levels, success is primarily measured by the number of clients referred
to or receiving services. At the collaboration level, the strength and growth
of the collaboration is being measured through a variety of strategies, including
surveys and key informant interviews. Using several different assessment tools,
CHEC examines the effectiveness of the collaboration itself using leadership,
communication, and shared decision making as indicators to be rated as high,
medium, or low.
CHEC has also assessed the effect of the collaboration on the overall system
of care, employing as outcome indicators the reduction in the use of the hospital
emergency room as a primary site for care and the level of empowerment of community
residents as measured by participation in city government.
One CHEC partner representative said, in an interesting perspective on evaluation,
"A community can measure its own health by the health of its collaboratives."
A community in which there is a shared vision and mission about health and human
services, in which individual agencies and organizations in partnership with
community residents work together in new ways within a framework of mutual respect
and understanding, is indeed a "healthy community."
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.