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A Model Memorandum of

Collaboration: A Proposal

The authors propose a mudel mtmuwndum of collaboration for use 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~versltyof Kansas.

Lawrence. Dr. Fawcett is the Director of the

Work Group and D~stlngu~shedProfessor of

Community Leadersh~p.Drs. Francisco,

Pame-Andrew$, and Schultz are Assoc~ate

Directors of the Work Group

Address correspondenceto: Dr. Fawcecc

Work Group on Health Promotion a~d

Cornm. Devpt, 4082 Dole Center, Unw. of

Kansas, Lawrence KS 66045; tel. 785-864- 0533, f;lx 785-864-5381 e-~ll

<sfawce@hlcon.cc.ukans.edu~

B ullding hea1thit.r cnmmunities is the process of people working together to address what ~natt~rsto them-whether that is reduc- 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~elout- comes :;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~tygroup

Collaborative parrnershlps Eocus on bringlng abutlt comrnunrty and

systems change, an ~ntcrl-cd~atenutcome In the long process of commu-

nlty hcalth improvernerit (larnrnr~n~t~(and syst~>n'~sIc-rr~clude new

& ;mEr:li~i$ @ unmple. after-school proernms. prevciitlo~~ser-

fLCL4,~+(I'nr u.an1!k_ dressed fines t'nr- s 1lleg;ll !,roducrs tr,

W+I b bd. d PT~C~ICLS(for example,

irnpruved access co health services) related to community- determ~nedgoals. A growing body of hteraturc documenis the lunction-

(including with udiorn, by whom, and by when) may be the single most important pract~cethat can be implemented.

Lng oF collaborative partnerships for community health and development. Although the evidence r~feEfect~v~- 3. Leadershp. A change in (or loss OF) key leadership

ncss is limited and muted, researchers

are beginning to come to an agreement an some key fea- tures of community-based in~tiatives Of particular Inter-

est are the components and elrments that: contr~buteto success.

4. Resources for cornmunl~ymob~llzers,Hirlng corn- rnunity mobilizers or organizers can aid in following

and practitioners

can dramatically affect rates of community md sys- terns change.

up on action plans.

SUMEFACTORS AFFECTING

COMMUNITYCHANGE 5. Docurncntatian and feedback on interrnedlate outcomes. Regular (at kast quartcriy) comrnunica-

For mort. than a dccade, ocrr University of Kansas research

team has used a common measurement systemM to docu- ment the unfolding of community and systems change, and related events, over tlme. In a

muItiple case study design

more than 20 different community- Transforming the nical assistance. such as

with action planning or help- ing secure resources, is to be supporrive of change efforts.

dircontinuir~erin rile

6. Technical assistance. Tech-

tion about rates of community change, and events that affect it, is also corrclatcd wjth higher rates of success.

with

partnerships, we have looked for

patrcrn

of

conditions that affect

community and systems change and for events sssociatcd ~lth community health and marked increases and dttcrcaszs ~n

rates of change. For example, we

noted char following cumplctiw of

action plans, there is

7. Making outcomes matter. Grantmakers can accelerate rates OE community and sys- terns change with incentives and disincentives such as

annuaI renewal uf multi-year

awardsB or boilus

grants

of

Lased

un

evidence

development requires a

broad collaborative

partnership among

several key players.

typically a

increasc in the rate of com-

munity

was found ~n many different con- texts. By using the logic OF multiple

series (quasi-experirnental)

time

marked

change, a relationship that

progress or acco~~ipl~shrncnt.

designs, we identified several types

of

events

that

appear

to affect rates

of

community

change.

Our overall analysis, consisterlt with the work of 0th-

facilitate the prucess of

trs, suggests seven factul-s that

community change and ~inproverntli~t'

T O WARD

A

B R O A D

COLLABORA~~~VEPARTNERSHIP

Transforming the conditions that af kc t conimunl ty heal~hand dcvelopmcnt requires a broad cullaboratlve partnersll~yamong several key First. state and

1 Clear v~siunand mlssmn Initiatives with a clear community partnerships doing the wurk uF ~ommunliy

and systrr~is charlge link people and organizations In cornlnon yuryostl. For example, a cummunlty partnerslll~ tu reduce rac~alinequal~tiesIn hcaI111 outcon~rsmlght

COCUS (fur example, increasing chlldhoud vacci-

natlull rales or ilnpruvlilg ernployrnen~ou~corlies)

bring abuul

rn;irkedly hlKher rates of cvmrnunity

(and systcr~is)cll;zrlgt: than broad "healthy corn- engage members oC ethnrc lrunorlty groups and organita-

munitiesV elforts lnckhng largeled m:sslons and dona1 representatives In trar-tsfurming local cummuni~y-

objcc t ivcs

bascd, health, and religious organl~ations, businesses,

sct tools, government, and financial insriru~ions.

2 Action plann~~~g1dc.r~ti~i:igsPcclT!ccon~rnui-t~~yor Second, ~~Ipportand lntermedlary organizations, such syste~nsC~~II:R~S([ha[ 15, new ur modifled pro- as unlverslty-based research centers and community-

grilnks. l~ol~~~~,md PP~~LCIIC~S)to bc sought bclscd argan~zations,help build thc cepacrLy of cornnlu-

nrly pdrtners by enhancing core cotnpetencles (for exam- ple, community assessmen[, slrateg~cylann~ng,commu- nlty actlon and advocacy, cornrn~~mtyevaluat~on.securing resuurcrs to si~stairlthe effort) 'Third, grantmakers and government agenclcs help crcare conditions €orsuccess by using requests fur pr.0- posals to convene people in common purpose. In add]- tion, they broker connections ammg 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, Crantmak- ers can also help make outcomes matter (for example, through grant renewal or bonus grants contingent on evi- dence of accomplishment).

collaborate? What nsks,

resources, and responsibilities can they share when engaged in the process of con~rnuni~(and systems) change and improvement? How might research-based information be used to guide broad collaborative partner- ships for community health? What follows is a model memorandum of collahoration o~~tliningcomplementary roles and responsibilities.

How

can

these parties

In this complex work, any model rnll be adapled to ht the

local context and adjusted to reflect emerging needs, bar- riers, and opportunities. Based on ongoing dialogue, the

particiyahng yartles-the

port

to work

community partnership, sup-

organizations, and grantmaker(s)-agree

2.

together for comrnu ni ty change and improvement in the follow~n~ways.

Refining and targeting the vision, mission, and objectives for community health and develop- ment (€ourmonchs) a. Comrnun~typartncrshrp Cons~stentw~th[he com- mun~ty'svlsion and gnals, the curnrnunlty partner- ship, including lucal people arld cor~~~nunity-based organlzatlons, will select a modest number of broad goals (ror e~arn~le,Iniprovlng education. preventing vlolencc, reducing d~s~ar~l~esIn out- comes dssociatcd with "race" and poverty) (Note 'The v~siorland misslor rnay retlect a cantlnuum of outcomes, lnclird~n~[dl cdteg~1ri~.11IS~LICS (for u\,~rnpte, adole3cenl pregnancy) [I,] 1,rrjader intcr- rrl:~ted concerns [hr ex:lmlilc, yo~~tlhdevelop-

nlcnt],

and/or [c] i7iorc ttlr~rle~~lc-~~t~~l~OCLLIIdrt~r-

nllnants OF health and development [for example, children I~vingIn povr~tyj.)Th~s~1l1help det'ine and focus their common work to Inlprove the lives of local people. b. S~rpportorganizations. Support organlzatlons wrlI asslst the community partnership in establ~shinga broad-based vision and mission fw community health and development, focusing on speclflc locally detcrrn~nedissues or concerns and framing objectives as cl~allengin~(but putentially achiev- able) community-determined goals. (An example for education- by 2010, increase by 40% the hlgh schvol graduation rate). c. GrantmakerIs): Grantmakers wiII lay the ground- work for multi-year grant appIication(s) to be sub- mitted to relevant funders. The grant(s) will outline coordinated investments in a long-term, comprr- hensive, and community-determined development process.

Developing an action pIan fur bringing about

community and systems change related to com-

munity-determirlcd goaIs for health and devel- opment {approximately right months and ongoing). a. Comrnu~~itypartnership: Building on earlier efforts, culIaborating partners, including people of influ- ence (for example, appointed officials) and those most affected [for example, youth, low-income resi-

dents), will identify specific community and sys- tems changes to bc effected to improve population-

level outcomes for people in this community. Changes in programs, policies, and practices will be sought in all relevant sectors of the community (that is, schools, government, business, health and human service organizations, the fa~thcommunity). Detailed and interrelated action plans will be devel- oped for cach Focal objccdve (for example, sub- stance abuse, cducattul-r, vlolence or neighborhood safety), Working comrnlttees ~vtllbe organized around each [ocal oblective, such as a Task Force on Substance Abuse, to coordinate and focus coln- mun~tychange efforrs €ormaximum impact.

Support organlzat~onswill

b. Support organizations

assist wlth actron ~lanning,includ~n~idenlJylng community changes and best practices Tor each broad ob1ectlve (for example, employmrnr, l~hys~cal actlvlly) In each relevant srcror (for example, schools, business, the Fa~thcolwnunity) They wrll support the early stage3 OC ~oni~rrhet~s~vcd~t~rjn planr1i1-r~(for example, by org~inizingand h~cil~~~t- lrlg plannrng relrrats)

c ~rai~t~nakzr(s)Cran tmakcrs wrli brolccr cor-rnec- trons to other organlzatlons wl t h special c\j,ertlse in specific goal areas (for example, hnusinp. ~nde- pendent Irving fur elders] relevanb to the jwrk In lucaI corn~~lunlt~esGrantmakers w~llalso ;~ss~si1x1 fac~litatln~broader systems changes {lor esarnple, grant-mahng practices, regional planning polic~es that concentrate poverty in a tew urban ne~ghbor- hoods) to improve the coilditluns under whlch local efforts For cummun~tychange and improvement

3.

occur.

Developing

and

supporting leadership within

cumrnunities (ongoing).

a. Community partncrship: The cummunity part- nershp will enhance and support existing leadcr- ship 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 natural leaders among those most affeccttd, mentoring newer leaders, and support- ing local youth and other underrvpresented groups in leadership roles. b. Support organizations Support organizations will use courses, technical assistance, networks of sup- port, and Internet-based resourccsg to cunnect pco- ple, ideas, and resourccs. They will help convene formal and informal (for exampIe, support net- works 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 tradl- tional face-to-face gatherings and new communica- tions techndogies (lor example, teleconferenc~ng. forums on the Internet), grarlt~nakers~111help community cunncct local leadership and restdents to each other and to broader local and global resources and expertise

4, Documenting the process of cornmunily change

and improvement, and using ctngoing feedback for improverneni ancl celebration [monthly and ongoing)

a Uomlnun~t~pcirttler\Iiiil Uslt~ga C~JIIllIILlI~IE~rlr>~u-

rnentat~ondntl evatu;~tlunsy,ctc.l-n,local I~t.optew~ll gather ~ntormat~onOII cornr~~un~tv-ru[cv;li~t~ncl~ca- tors of auccrss ']'hey wrll ;11stl A\~I\I 111 ubtLi~l~~ng

uther rclutr~l 117 ~'O~I~I;~~III~>10 [IL.I~ p,~rtjr~l)allts ilnder31,~nd ,111tl I)c ;~cc.ri~~l-t~;lblcI r)r thy rvork,

~nc.ludltip II:~l~lr\~c"*,~~ccc\\c~r,rlc\".IIILI

crjmlnu-

n~~y-lcvelrncllcators rclatud tn the (I bjectmtis. Part-

ners WII I I eview ciata on III~C~I~~C~I~LCuutconles (for

exan$e, co~nil-tunityand systems change) at least quarierl~;lnd da~on more distant outcomes (that 15, cornrnun~ty-levelindicators), at Ieast annr~allyto help gu~deirnl>rovm~eet~tsand promole the celcbra- tion of a~cntn~l~slirnents b. Support organlzatlons Supporl organizations will help facil~tatea cunvt.rsatron about what the important markers or ~nd~calorsof success are for 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 com- munity partnership identify comrnunity+level indi- cators thar offer the best potential lur an accurate and sensltlve plcture from he community's per- spective. They will support the work of Local docu- mentars in obtaining, clarifying, interpreting, and communicatitrg evaluation information tv the cum- munity, and to current and prospective funders.

c. Grantmakcr(s): Grantmak~rswill request and 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.To max- imize efhciency, they will work with other grant- makers and organizations to encourage the acccp- tance of common datasets for rePoits. If needed, they will hetp secure access to data on community- level indicators sensitive to community-defined goals. Grantrnakcrs will also asslst in docurnent~n~

their own contributions to local cfforts (For exam-

ple, facllltat~ngsysrcms change, brokenng access to resources}.

5. Securing

and

providing

technical

assistance

related

to

the

work

in

local

communities

(ongoing)

a. Cornmun~t~partnttrsh~p.'-he community partner- sh~pwill seek asslstarre frotn reIevant support organizations with gt.neral~zt.de~pt.rllseIn bulld[ng rapacity (for cxan~~lc,For planning, evaluation) and w~thsyeclalued knnwl~rlgeabout relevan1 categorid ci,l ISSUL.~(tar cx;hrnpte, I-tlV/AIDS, child d~vrloy- 111crit) In i~rlrlltbun, the local part t~ershipwill Jevclol~ thc cdpaclty tr~1,rovide tecl~nrcal assls- t~j~~i:,CUCI~ L)\ 111 dctrun p1dr-tnillg or documen~d- t101i. tor otlhv~~)rp,ai~~~.~h~~~n\;UIC\ coinlllunit1e5

11 Sit[q){~rt[)I K;IIII/~I~toil\ Su 13 nrganixations wdl IIVI(ICICCII~I~C';LId~l\~>til~l~eIICI \IC[~>LCI~ldC~lpilC-

it) in community partnerships, as requested, In

lmplsment~ngand

community change and Improvement. Thts will c Grantmaker (5). Grantmakers wilt facilitate the include brokerlng linkages to othrrs and prowding development of grant praposals to support a long-

tra~ntngmatznals and/or workshops 111 skills related to this work (for example, comrnunlty

assessment. action planning, leadership dcvclop-

ment, evaluation) resources estimated as needed for the ef1ort.

mul-rity or~~nrzersand others to help do the on- going work

term, comprehensive community change and ~mprovementeffort. Grantmakers w111 ~ISObroker

connections .to othcr f~rndersto help generate the

documenting

thtl

prucess

of

c. Grantmakcr(5). Grantmakers will help

fund and

broker connections to support organizations that 7. Making outcomes matter in the work in local

can provide needed technical assistance, They will

aIso help build capar:iry, for example, by improving

com~nunitypartnershipsMaccess to communica-

tiuns ttlchnuIogy.

cornmr~njties {ongomg).

a Community partnershi1 The community partner- shlp agrees to submit annual status reports that include information on evidence of progress @rh intermediate (for examplt., communiq and sFtems change) and more distant outcomes (for example,

Consisteni with

6. Securing and providing financial resources for

those doing the work in Iocal communities (mi- tial 10-year commitment,

community-level indicators).

enhanced accountabiIity, the

potentially

ing

partnership will also share evi-

dence of accomplishments and

the

local community and uith out- side funders.

appropriate, partners will interrelated roles and b. Support organizations: Suppon

seek and invest significant

resources in developlny responsibilities among munity partnership in collecting,

analyzing, and communicating data on the process of comrnu- nity change and improvement

ing and supporting

nity Drganlrers responsible SUPpOrt CI~ganiZati~ns, for grant status reports. They

for helping bring about the

community

changes, and implementing the best practices, identified in the action plan. In appli- cations For grant funding, the partners will provide evidence of the need for and value of con~rnunityinvestment, includtng quantitative information on cornrnunlty and sys- tems change and Improvement In comniun~ty-lcvei ~ndicators,and qur~litativeinformatton such as

organizations will assist the com-

renewable,

includ-

with

m ulti-ycar

grants

annual renewal contingent on

evidence of progress).

a. Community partnership:

As

needed

adjustments

with

We recommend specific

capacity for the work. In par-

titular, this may involve

commu-

and

systems

hir- community partnerships,

and grantmakers.

will also help all parties use ongoing fcedback (for example, rates of comrn~niiychangc, sat- isfaction wth support organiza- tions and funders) for continu-

ous improvemcnr c. Grantmaker(5): Grantmakers wlll rtlqulre annuaI grant status reports that include evidence of progress (far exampk, high rates OF cotnrnun~ty change, improve- ment in community-level ind~cators) To maximize accountablllty to the cornrnunity and LO grantmakers,

success stories. b. Support organlzatlons Support organizi~tlonswill help identify ava~lableresources and support locaI leadership in cornmunlcatlng data (for

three Forrns of

"malung outcomes matter" wijl be used

FICS~,annual renewal of multi-year awards will be cont~ngenton evtdence of progress, Inil~alI~.progrctss will be judged largely by evidence of Full rrn~lernenta-

example, comrnun~tyand systems chsl-tge, coin- IIOIT of the proces5 (for example, cornniun~rytnvolve-

municy-level indtcarors) For use 111 gl~lntstai~ls reports and pr~gr~sr;-to-<liltcscctionc of' grilnt

al~pllcatlons.Th~sand rclt~~edcI~r;~ir~atlvcinl'or-

lnatlon

van be used to hell> lcvorilge rcso~ircc.,for COIJJ-

ment in plnnnrng) and interrned~a~eoutcoines (lor example, the mte and kind of community s11d S~S-

terns change f=~cllttutedIy

the community

pi~rtner-

5111~)

In

Iatcr years,

aftcr sufl'lcle~~tc.nvttonmcntal

changes have occurred, ~mprovel~~enton con~r~~unlty-

(for tlxa~l-t~le,nilrnlilve

success

srorics)

level indicators will serve as additional ev~dence of success Second, bonus grants (that is, up to ane- th~rdof the grant award) may be earned annually for

outstanding accamplrshmrtnts

(For t.xamplc,

~mylcmentatlonof core conlponerrts, hlgh rates of change of importance to community members and experts in relatcd areas such as adolescent pregnancy or education). Third. outcome divldtlnds wlll be avail- able to enhance accountability and provide incentives

fur irnprovlng mure distant community-level out- comes (for example, reduced adoIescent pregnancy, improvcd academic outcomesj. The uutcornc dlvl- dend will consist of a dollar bonus calculated based an cost-benefit estjmates associated with improve- ments (for example, reduced adolescent pregnancy). ?'he outcume dihidend will be deposited in a Iocal "community trust account" and rernv~sted by the community ~artnershi~for work 1~1thcornmunity-

determined goals.

References

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I. hfferfoss FD, Goodman RM, Wandersmarl k Commun~tycoalitlons for prevention and health promotion Health Educ Res 1?93;8;315-

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2, Scharr LB. Common purpcxe: strengthening families and neighbor- hoods to rebuild America. New York. Anchor Books; 1997

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Green LW, Kreuter MW. Health promoti~nplanning; an educational and ecological approach. 3rd ed, Bounta~nView {LA): Mayfield Pub- lishing; 1999.

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Ftandsco VT, Paine AL, Fawcen SR (1973). A methodcslogy for manl-

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Fawcett SB,Stetllng TD, Parns-Andrews A, Harris

KJ, Franctlco VT,

Rlchter KP, ~t al. Evaluating comrn~nit~efforts to prevent cardiamscu-

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FAWCE'I'T ET

AL.

Community health-ihe well-bemg of the people w he share a common place or experirnce-rcqu1rc.s cammu- n~tyengagement in changing the behawors of large nutn- bers of indlv~dualsand the condition5 or soclal deteml- nants that affect hcalth and development. Although local people are best positioned to determine their priority con-

cerns and strategies, transforniing cornmu nities requires

other parcners to help with technical support and fman- cia1 and other needed resources. Rased on an emergirrg rvsearch base, we recommend specific interrclated rolt:s and re~~unsibili~iesamong community partnrrships, sup- 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:l- rions of leadership. Perhaps mdcIs such as thls for a new social cuntract will enhance cdlaborative work toward more just, caring, and healthy communities.

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hwcutt SB, kine-Arrdrewa A, Franctsco VT: Schultz 1, Richter KP,

Berkley-Patton J, ec al Evatuatjng community ~nittativelfor health and

development. In; Rootman I, McQlreen Dmet al

editors. Evaluating

hedth promodon approaches, Copenhagen: World Health Otganim-

tion-Europe. In press 2000.

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Fawce~SB. Francisco VT, Hyra D, Pal fie- Andrews A, Schultz JA Rus- sos S, et al. Burldtng healthy communittes. In: Tarlor A, editor. Society and populauan health reader: state and commdnity appllcatlonr, New 'fork: New Pros. lo press 2000.

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Fawcett $5, Lew~sRK. Palne-Andrew' A, Fanclsca V, R~chtsrKP, Willlams El ~opple5. Evaluacng carnrnun\ry coalitlons for the pre- vention of substance abuse: the case of Praject Freedom. Health Edu~

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Fawcett SO, Franc~scaVT. Schul~jA, Barkowiu 8. Wolff

TJ, Nagy C.

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rer commun~t~esPubl~cHealth Rep 2000: 1 I 5274-8.

I