A M o d e l M e m o r a n d u m of Collaboration: A Proposal

The authors propose a mudel mtmuwndum of collaboration for u s e by
state and community partnerships, support organizations, and grantmakers in working together to build httalthler communities. Described as an idealized social contract, the model mcrnvrandum lays out interrelated rc.sponsibllities for the key parties.

The authors are with the Work Group on
Hcalth Promotion and Community

Development. Un~verslty Kansas. of
Lawrence. Dr. Fawcett is

the Director of the

Work Group and D~stlngu~shed Professor of

Community Leadersh~p.Drs. Francisco,
Pame-Andrew$, and Schultz are Assoc~ate

Directors of the Work Group

Address correspondence to: Dr. Fawcecc Work Group on Health Promotion a ~ d Cornm. Devpt, 4082 Dole Center, Unw. of Kansas, Lawrence KS 66045; tel. 785-8640533, f;lx 785-864-5381 e - ~ l l

ing vlulance, improving environmental quality, nr prornotlng child health. This process lnvolves altering social and ~nvirrmmentalcond~tions to effect wtdespread bzhavlor change and related population-le~eloutcomes :;uch as inlury or employment rates It promotes cwic engagement atnong people who share a common place, such as a rural comlnunlty or urban neighborhood, or experience, ~ncludingbeing an i~dolrscentOK a member of an ethnic minor~ty group Collaborative parrnershlps Eocus on bringlng abutlt comrnunrty and systems change, a n ~ntcrl-cd~ate nutcome In the long process of communlty hcalth improvernerit ( l a r n r n r ~ n ~ t ~ syst~>n'~sI (and c-rr~clude new &; m E r : l i ~ i $ @ unmple. after-school proernms. prevciitlo~~ serfLCL4,~+ (I'nr u.an1!k_ dressed fines t'nr - s 1lleg;ll !,roducrs tr, W + I bb d . d P T ~ C ~ I C L(for example, S


ullding hea1thit.r cnmmunities is the process of people working together to address what ~ n a t t ~tos them-whether that is reducr

irnpruved access co health services) related to communityde term~ned goals. A growing body of hteraturc documenis the lunctionLng oF collaborative partnerships for community health and development. Although the evidence r ~ eEfect~v~f ncss is limited and muted, researchers and practitioners are beginning to come to an agreement an some key features of community-based in~tiatives Of particular Interest are the components and elrments that: contr~bute to success.

(including with udiorn, by whom, and by when) may be the single most important pract~ce that can be implemented.
Who's doing what by when

3 . Leadershp. A change in

(or loss OF) key leadership can dramatically affect rates of community m d systerns change.

4. Resources for cornmunl~ymob~llzers,Hirlng corn-

rnunity mobilizers or organizers can aid in following up on action plans. Mobilizer = "Coordinator"



For mort. than a dccade, ocrr University of Kansas research team has used a common measurement systemM to document the unfolding of community and systems change, and related events, over tlme. In a muItiple case study design with 6 . Technical assistance. Techmore than 20 different communityTransforming the nical assistance. such as partnerships, we have looked for with action planning or helpdircontinuir~er in rile patrcrn of affect ing secure resources, is to be community and systems change s upporrive of change efforts. Coordination vs technical assistance and for events sssociatcd ~ l t h marked increases and dttcrcaszs ~n 7. Making outcomes matter. rates of change. For example, we development requires a Grantmakers can accelerate noted char following cumplctiw of rates OE community and sysaction plans, there is typically a terns change with incentives marked increasc in the rate of comand disincentives such as annuaI renewal uf multi-year munity change, a relationship that among awardsB or boilus g r a n t s was found ~n many different contexts. By using the logic OF multiple several L a s e d u n e v i d e n c e of progress or acco~~ipl~shrncnt. time series (quasi-experirnental) designs, we identified several types TO WARD A B R O A D of events that appear to affect rates of community change. C O L L A B O R A ~P~A~R TE E R S H I P V N Our overall analysis, consisterlt with the work of 0thTransforming the conditions that af k c t conimunl ty trs, suggests seven factul-s that facilitate the prucess of h e a l ~ hand dcvelopmcnt requires a broad cullaboratlve community change and ~inproverntli~t ' partnersll~yamong several key First. state and community partnerships doing the wurk uF ~ o m m u n l i y 1 Clear v~siunand mlssmn Initiatives with a clear and systrr~is charlge link people and organizations In COCUS (fur example, increasing chlldhoud vaccicornlnon yuryostl. For example, a cummunlty partnerslll~ natlull rales or ilnpruvlilg ernployrnen~ou~cor lies) tu reduce rac~alinequal~tiesIn hcaI111 o u t c o n ~ r smlght bring abuul rn;irkedly hlKher rates of cvmrnunity engage members o ethnrc lrunorlty groups and organitaC (and systcr~is)cll;zrlgt: than broad "healthy corndona1 representatives In trar-tsfurming local cummuni~ymunit iesV elforts lnckhng largeled m:sslons and bascd, health, and religious organl~a tions, businesses, objcc t ivcs Focus on specific change sct tools, government, and financial insriru~ions. Second, ~ ~ I p p oand lntermedlary organizations, s u c h rt 2 Action p l a n n ~ ~1dc.r~ti~i:ig ~g sPcclT!ccon~rnui-t~~y or as unlverslty-based research centers and communitysyste~nsC ~ ~ I I : R ~ S ([ha[ 15, new ur modifled probclscd argan~zations,help build t h c cepacrLy of cornnluP ~ ~ ~ grilnks. l ~ o l m~d ~ P ~ ~ L C I,I CtoS )bc sought

5. Docurncntatian and feedback on interrnedlate outcomes. Regular (at kast quartcriy) comrnunication about rates of community change, and events that affect it, is also corrclatcd wjth higher rates of success. quarterly communication re: rates of change

conditions that

community health and

broad collaborative

key players.

nrly pdrtners b y enhancing core cotnpetencles (for example, community assessmen[, slrateg~cy lann~ng, communlty actlon and advocacy, cornrn~~mty evaluat~on. securing resuurcrs to si~stairl effort) the 'Third, grantmakers and government agenclcs help crcare conditions €or success by using requests fur pr.0posals to convene people in common purpose. In add]tion, they broker connections a m m g those working in the same community, or un the same concern (for example., among grassroots community orgamzatrons and financial institutions) and can 1rvr:rage funding and resources through relationships with other grantmakets, Crantmakers can also help make outcomes matter (for example, through grant renewal or bonus grants contingent on evidence of accomplishment). How can these parties collaborate? What nsks, resources, and responsibilities can they share when engaged in the process of c o n ~ r n u n i(and systems) ~ change and improvement? How might research-based information be used to guide broad collaborative partnerships for community health? What follows is a model memorandum of collahoration o~~tlining complementary roles and responsibilities.

health and development [for example, children I~vingIn povr~tyj.) h ~ s 1 l help det'ine T ~ 1 and focus their common work to Inlprove the lives of local people. b. S~rpportorganizations. Support organlzatlons wrlI asslst the community partnership in establ~shing a broad-based vision and mission f w community health and development, focusing on speclflc locally detcrrn~ned issues or concerns and framing objectives as cl~allengin~ putentially achiev(but able) community-determined goals. (An example for education- by 2010, increase by 40% the hlgh schvol graduation rate). c. GrantmakerIs): Grantmakers wiII lay the groundwork for multi-year grant appIication(s) to be submitted to relevant funders. The grant(s) will outline coordinated investments in a long-term, comprrhensive, and community-determined development process.


2. Developing an action pIan fur bringing about community and systems change related to community-determirlcd goaIs for health a n d development {approximately right months and ongoing). a. Comrnu~~ity partnership: Building on earlier efforts, culIaborating partners, including people of influence (for example, appointed officials) and those most affected [for example, youth, low-income residents), will identify specific community and sysIn this complex work, any model rnll be adapled to ht the tems changes to bc effected to improve populationlocal context and adjusted to reflect emerging needs, barlevel outcomes for people in this community. riers, and opportunities. Based on ongoing dialogue, the Changes in programs, policies, and practices will particiyahng yartles-the community partnership, supbe sought in all relevant sectors of the community port organizations, and grantmaker(s)-agree to work (that is, schools, government, business, health and together for comrnu ni ty change and improvement in the human service organizations, the f a ~ t h community). follow~n~ ways. Detailed and interrelated action plans will be developed for cach Focal objccdve (for example, subRefining and targeting the vision, mission, and stance abuse, cducattul-r, vlolence or neighborhood objectives for community health a n d developsafety), Working comrnlttees ~ v t l l be organized ment (€our monchs) around each [ocal oblective, such as a Task Force a. Comrnun~ty partncrshrp Cons~stent ~ t h comw [he on Substance Abuse, to coordinate and focus colnmun~ty'svlsion and gnals, the curnrnunlty partnermun~ty change efforrs €or maximum impact. s hip, including lucal people arld cor~~~nunity-based b. Support organizations Support organlzat~onswill organlzatlons, will select a modest number of assist wlth actron ~lanning,i n c l u d ~ nidenlJylng ~ broad goals (ror e ~ a r n ~ l Iniprovlng education. e, community changes and best practices Tor each preventing vlolencc, reducing d ~ s ~ a r ~ Iln~ outes broad ob1ectlve (for example, employmrnr, l ~ h y s ~ c a l comes dssociatcd with "race" a n d poverty) (Note actlvlly) In each relevant srcror (for example, 'The v~siorland misslor rnay retlect a cantlnuum of schools, business, the Fa~thcolwnunity) They wrll outcomes, l n c l i r d ~ n ~d l cdteg~1ri~.11 ~ L I C S (for [ IS support the early stage3 OC ~ o n i ~ r r h e t ~ s ~ tv~cr j n d ~ u\,~rnp adole3cenl pregnancy) [I,] 1,rrjader intcrte, planr1i1-r~ example, by org~inizinga n d h ~ c i l ~ ~ ~ t (for rrl:~ted c o n c e r n s [ h r ex:lmlilc, yo~~tlh developlrlg plannrng relrrats) n l c n t ] , and/or [ c ] i7iorc t t l r ~ r l e ~ ~ l c~-O C t ~d~rIlt ~ r ~ ~ LLI

c ~ r a i ~ t ~ n a k z r Cran tmakcrs wrli brolccr cor-rnec(s) trons to other organlzatlons wl t h special c\j,ertlse in specific goal areas (for example, hnusinp. ~ n d e pendent Irving fur elders] relevanb to the j w r k In lucaI c o r n ~ ~ l u n l t ~G s e rantmakers w ~ l also ; ~ s s ~ 1x1i l s fac~litatln~ broader systems changes {lor esarnple, grant-mahng practices, regional planning polic~es that concentrate poverty in a tew urban ne~ghborhoods) to improve the coilditluns under whlch local efforts For cummun~tychange and improvement occur.
3 . Developing a n d supporting leadership within cumrnunities (ongoing). a. Community partncrship: The cummunity partn e r s h p will enhance and support existing leadcrship through mechanisms such as partnership ~neetingsand retreats. The partnership will also seek to develop ncw generations of leadership by creating nichcs of opportunity for leadership, seeking n a t u r a l leaders among those most affeccttd, mentoring newer leaders, and supporting local youth and other underrvpresented groups in leadership roles. b. Support organizations Support organizations will use courses, technical assistance, networks of support, and Internet-based resourccsg to cunnect pcople, ideas, and resourccs. They will help convene formal and informal (for exampIe, support networks among the parties) learning communiti~s. c. Grantmaker(s) : Grantmakers w~llsupport partners in securing suppIc.maniaI resources fur leadership development in local commun~ties. Using tradltional face-to-face gatherings and new communications techndogies (lor example, teleconferenc~ng. forums on the Internet), grarlt~nakers ~ 1 1 1help community cunncct local leadership and restdents to each other and to broader local and global resources and expertise

n~~y-lcvel rncllcators rclatud tn t h e (I bjec tmtis. Partners WII I I eview ciata o n I I I ~ C ~ I ~ ~uutconlesC (for C ~ I ~ L exan$e, co~nil-tunity and systems change) at least quarierl~ ;lnd d a on more distant outcomes (that ~ 1 5 , cornrnun~ty-level indicators), at Ieast annr~ally to help g u ~ d e irnl>rovm~eet~ts promole the celcbraand tion of a ~ c n t n ~ l ~ s l i r n e n t s b. Support organlzatlons Supporl organizations will help facil~tate a cunvt.rsatron about what the important markers or ~nd~calors success are for of the community. They mill establish, adapt (as needed), and maintam a system for documenting intermediate outcomes ([or example, community and systems change). They will also help the community partnership identify comrnunity+level indicators thar offer the best potential lur an accurate and sensltlve plcture from he community's perspective. They will support the work of Local documentars in obtaining, clarifying, interpreting, and communicatitrg evaluation information tv the cummunity, and to current and prospective funders. c. Grantmakcr(s): G r a n t m a k ~ r s will request a n d accept fanctional informauon on the process of cunlmuillty charlgtl and improvement and related naxrative information as evidence of progress for its grant status reports and grant applicat~ons. maxTo imize efhciency, they will work with other grantmakers and organizations to encourage the acccptance of common datasets for rePoits. If needed, they will hetp secure access to data on communitylevel indicators sensitive to community-defined goals. Grantrnakcrs will also asslst in d o c u r n e n t ~ n ~ their own contributions to local cfforts (For example, facllltat~ng sysrcms change, brokenng access to resources}.

5 . Securing and providing technical assistance r e l a t e d to the work i n local communities (ongoing) a. C o r n m u n ~ tpartnttrsh~p. - h e community partner~ ' s h ~ pwill seek assls tarre frotn reIevant support 4, Documenting the process of cornmunily change organizations with gt.neral~zt.d e~pt.rllse bulld[ng In and improvement, and using ctngoing feedback rapacity (for c x a n ~ ~ lFor planning, evaluation) and c, for improverneni ancl celebration [monthly and w~th syeclalued knnwl~rlge about relevan1 categorid ongoing) ci,l I S S U L . ~(tar cx;hrnpte, I-tlV/AIDS, child d ~ v r l o y a Uomlnun~t~ pcirttler\Iiiil Uslt~g C ~ J I I l l I I L l I ~ IrEl ~ > ~ u a r 111crit) I n i ~ r l r l lbun, the local part t~ershipwill t rnentat~ondntl evatu;~tlunsy,ctc.l-n,local I~t.opte w~ll Jevclol~ thc cdpaclty t r ~ 1,rovide tecl~nrcal a s s l s gather ~ntormat~on cornr~~un~tv-ru[cv;li~t OII ~ncl~cat ~ j ~ ~ i C U C I ~ L)\ : , 1 1 1 dctrun p1dr-tnillg or documen~dtors o auccrss ']'hey wrll ;11stl A \ ~ I \ I 111 u b t L i ~ l ~ ~ n g f t101i. tor otlhv~~ ) r p , a i ~ ~ ~ . ~ h ~ ~ ~ n \ ;UIC\ coinlllunit1e5 uther rclutr~l 117 ~ ' O ~ I ~ I ; ~ ~ 10 I [~I L>. I ~ p,~rtjr~l)allts I I nrganixations wdl 1 Sit[q){~rtI K;IIII/~I~ [) toil\ Su 13 ilnder31, ~ n d ,111tl I)c ;~cc.ri~~l-t~;lblct h y r v o r k , I r)r IICI I ~ C~lpilCIIVI(IC ICCII~I~C';LId ~ l \ ~ > t i l ~ l ~\ eC [ ~ >LCI l d ~nc.ludl I I : l~ ~ l r \ ~ *c, ~ ~ c c c c\~ r , r l c \ " .IIILI crjmlnutip " \

cornmr~nj {ongomg). ties a Community partnershi1 The community partnershlp agrees to submit annual status reports that include information on evidence of progress @rh intermediate (for examplt., communiq and s F t e m s 6 . Securing and providing financial resources for change) and more distant outcomes (for example, those doing the work in Iocal communities (micommunity-level indicators). Consisteni with tial 1 0 - y e a r c o m m i t m e n t , enhanced accountabiIity, the potentially renewable, includpartnership will also share eviing m ulti-ycar grants with dence of accomplishments and annual renewal contingent on needed adjustments with the evidence of progress). local community and uith outrecommend specific a. Community partnership: As side funders. appropriate, partners will interrelated roles b. Support organizations: Suppon organizations will assist the comseek and invest significant resources in d e v e l o p l n y munity partnership in collecting, analyzing, and communicating capacity for the work. In pardata o n the process of comrnutitular, this may involve hirnity change and improvement ing and supporting community Drganlrers responsible SUPpOrt CI~ganiZati~ns, for grant status reports. They will also help all parties use for helping bring about the community and systems ongoing fcedback (for example, rates of c o m r n ~ n i i y changc, satchanges, and implementing isfaction w t h support organizathe best practices, identified tions and funders) for continuin the action plan. In applious improvemcnr cations For grant funding, the partners will provide evidence o f the need for c. Grantmaker(5): Grantmakers wlll rtlqulre annuaI grant and value of con~rnunity investment, includtng status reports that include evidence of progress (far quantitative information on cornrnunlty and sysexampk, high rates OF cotnrnun~ change, improvety ment in community-level ind~cators) To maximize tems change and Improvement In comniun~ty-lcvei ~ndicators, and qur~litative informatton such as accountablllty to the cornrnunity and LO grantmakers, three Forrns of "malung outcomes matter" wijl be used success stories. F I C S annual renewal of multi-year awards will be ~, b. Support organlzatlons Support organizi~tlonswill cont~ngent evtdence of progress, I n i l ~ a l I ~ . on progrctss help identify ava~lable resources and support will be judged largely by evidence of Full rrn~lernentalocaI leadership in cornmunlcatlng data (for IIOIT of the proces5 (for example, cornniun~rytnvolveexample, comrnun~tyand systems chsl-tge, coinm e n t in plnnnrng) and i n t e r r n e d ~ a ~outcoines e municy-level indtcarors) For use 111 gl~lnt s t a i ~ l s (lor example, the mte and kind of community s11d S ~ S reports and pr~gr~sr;-to-<liltc scctionc of' grilnt terns change f=~cllttuted the community pi~rtnerIy al~pllcatlons.T h ~ s n d r c l t ~ ~ ecI~r;~ir~atlvc a d inl'orc.nvttonmcntal 5 1 1 1 ~ ) In Iatcr years, aftcr sufl'lcle~~t lnatlon (for tlxa~l-t~le, nilrnlilve success srorics) changes have occurred, ~ m p r o v e l ~ ~ e n tc o n ~ r ~ l~yu n on t v a n be used to hell> lcvorilge rcso~ircc., for C O I J J -

in community partnerships, as requested, In lmplsment~ngand documenting thtl prucess of community change and Improvement. Thts will include brokerlng linkages to othrrs and prowding t r a ~ n t n gmatznals and/or workshops 111 skills related to this work (for example, comrnunlty assessment. action planning, leadership dcvclopment, evaluation) c. Grantmakcr(5). Grantmakers will help fund and broker connections to support organizations that can provide needed technical assistance, They will aIso help build capar:iry, for example, by improving com~nunitypartnershipsMaccess to communicatiuns ttlchnuIogy.

mul-rity o r ~ ~ n r z e r s others to help do the onand going work c Grantmaker (5). Grantmakers wilt facilitate the development of grant praposals to support a longterm, comprehensive community change and ~mprovement effort. Grantmakers w111 ~ I S Obroker connections .to othcr f~rnders help generate the to resources estimated as needed for the ef1ort.

7. Making outcomes matter in the work in local



responsibilities among

community partnerships,

and grantmakers.



level indicators will serve


additional e v ~ d e n c e
Community health-ihe well-bemg of the people w he share a common place or experirnce-rcqu1rc.s cammun~ty engagement in changing the behawors of large nutnbers of indlv~dualsand the condition5 or soclal d e t e m l nants that affect hcalth and development. Although local people are best positioned to determine their priority concerns and strategies, transforniing cornmu nities requires other parcners to help w t technical support and fmanih cia1 and other needed resources. Rased on an emergirrg rvsearch base, we recommend specific in terrclated rolt:s and r e ~ ~ u n s i b i l i ~ i e s community partnrrships, supamong port organizations, and grantrnakers. The aim is, first, to build capacity for local people to address what matters to them and, over time, to build currcnc and future gcner:lrions of leadership. Perhaps m d c I s such as thls for a new social cuntract will enhance cdlaborative work toward more just, caring, and healthy communities.

of success Second, bonus grants (that i s , u p to anet h ~ r d the grant award) may be earned annually for of outstanding accamplrshmrtnts (For t.xamplc, ~mylcmentatlon of core conlponerrts, hlgh rates of change of importance to community members and experts in relatcd areas s u c h as adolescent pregnancy or education). Third. outcome divldtlnds wlll be available to enhance accountability and provide incentives fur irnprovlng mure distant community-level outcomes (for example, reduced adoIescent pregnancy, improvcd academic outcomesj. The uutcornc dlvldend will consist of a dollar bonus calculated based a n cost-benefit estjmates associated with improvements (for example, reduced adolescent pregnancy). ?'he outcume dihidend will be deposited in a Iocal "community trust account" and rernv~sted by the community ~ a r t n e r s h ifor work 1~1th ~ cornmunitydetermined goals.



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