Dialogue as a core MAPP Philosophy

1. Dialogue as a core MAPP Philosophy Stephanie Welch, MS-MPH, RD, LDN Strategic Planning Coordinator East Tennessee Regional Health Office stephanie.welch@state.tn.us

2. Section Overview • Background and Context • Dialogue Defined • Dialogue in Practice • Benefits and Lessons Learned

3. Setting: East Tennessee Region • One of 13 regions under the Tennessee Department of Health (7 rural, 6 metro) • 15 mostly rural, Appalachian counties surrounding Knox County • Population nearly 700,000 • Local Health Depts. in each county focusing primarily on disease prevention and health promotion services to women and children. 69 34 82 14 74 13 81 63 83 56 46 76 37 07 66 90 85 48 10 44 67 25 92 40 87 29 42 32 11 80 30 19 95 65 01 86 22 71 23 45 03 43 47 27 09 21 18 15 94 93 73 75 78 17 49 41 08 53 88 05 68 89 39 04 57 38 60 72 20 84 51 02 16 12 59 54 62 31 61 77 64 24 35 91 50 79 55 36 28 33 06 26 58 70 52

4. History: Community Diagnosis • State-developed community health planning process initiated in mid-1990’s • Led to the formation of Local Health Councils (LHCs) in each county • Local citizen volunteers • Process • Assessment • Prioritization • Implementation • By 2000, several LHCs were prepared for another round of planning

5. Transition to MAPP: East TN Challenges • More comprehensive than Community Diagnosis • Balancing current activities with strategic planning process • Role of staff, community members • Issue of scale • Regional vs. local implementation • Paradigm shift to a “New Way…” • Discomfort with not knowing

6. Transition to MAPP:East TN Opportunities • Health council structure in place • Previous experience with community health planning • Health councils asking “What’s Next?” • Partnership with University of Tennessee • Introduction of Dialogue in East Tennessee Region

7. Structure of MAPP in East TN • Regional MAPP Steering Committee • Subcommittee of regional health council • Staff facilitated • Community and staff representation • Resource and catalyst for local MAPP implementation • Familiarization with MAPP process to provide guidance for local implementation • Local MAPP Committees • Subcommittee of local health council • Staff facilitated; Chaired by community member • Decisions made at local level: • Whether to implement MAPP • Implementation details: Subcommittee membership, tailoring the MAPP model

8. Dialogue in Theory • Skills • Listening • Community engagement • Facilitation • Building trust, safety, sense of team • Principles • Comprehensive • Inclusive • Locally Owned • Attitudes and Intentions • Openness • Equality • Empathy

9. Dialogue in Practice • Physical set up • Circle • Comfortable chairs and no tables preferred • Meetings – agenda and skills • Clear desired outcomes • “Check in” and connect • Good question(s) • Small group breakouts • Reflective listening • Next steps • Respectful closure

10. Dialogue in East Tennessee • Cross River Connections • Danny Martin and Leonadi Ward • Facilitated MAPP Steering Committee retreat • Provided statewide Basic Dialogue Training for Community Services staff • Provided statewide Training for Dialogue Facilitation • 4 East Tennessee Region staff trained (TDFs) • East Tennessee Region public health leadership received Basic Dialogue Training as a result

11. Examples of Dialogue in Action • MAPP Steering Committee Initial Retreat • Half day of Appreciative Inquiry • Values, Peak Experiences, Future • Half day of Team Building • “Ropes course” activities • Half day of Visioning • Model for Regional Visioning

12. Examples of Dialogue in Action • Regional Visioning Event • Modeled after the MAPP Steering Committee retreat • 45 participants representing 13 ETN counties • Small group breakouts facilitated by Basic Dialogue trained staff • Large group reports • Following event, MAPP Steering Committee and Regional Health Council representatives: • Developed themes • Composed draft vision statement • Vision statement adopted by MAPP Steering Committee and Regional Health Council

13. Vision for East Tennessee “All stakeholders in East Tennessee will be engaged in creating conditions for improved health and quality of life.”

14. Examples of Dialogue in Action • Monroe County: • MAPP Kickoff Event • Approximately 50 community leaders attended • Presentation followed by small group breakouts • Facilitated by Health Council members • Hybrid between Organizing for Success and Visioning • Community Health Status Assessment Follow- up Dialogue • Meeting focused on bringing meaning to data • Outcomes informing development of the other assessment phases

15. Lessons Learned from Dialogue • Transition from public health directing the process to community directing the process challenging and uncomfortable • Creating a space for trust and safety controversial • Skills are a piece of Dialogue…Intention is just as important for achieving MAPP desired outcomes • It takes time, but it’s worth it!

16. Dialogue Benefits • Move from “I” to “We” • A team connected by values, stories, experience • Shared vision • Commitment to process • Clarification and shared understanding of roles (public health, community organizations, etc.) • Increased awareness and emphasis placed on community engagement and local ownership • Meetings are enjoyable!