Addressing Disparities Through Strategic Planning and Community Engagement

Addressing Disparities Through Strategic Planning and Community Engagement CDC Pilot Project September 2001 – May 2003

Arkansas Department of Health Tamika Walls twalls@healthyarkansas.com Smokefree Indiana Coalition Cecilia Williams cwilliams@smokefreeindiana.org Washington State Department of Health David Harrelson david.harrelson@doh.wa.gov CDC/OSH Sharon Kohout sek2@cdc.gov Panelists & Moderator

Rationale • Lack of science and understanding around the concepts of identifying and eliminating disparities • Healthy People 2010 focus on disparities • Need for tools and proven strategies • Confusion between “disparities” and “diversity”

Arkansas Idaho Indiana Iowa Maine Michigan Minnesota Nebraska North Carolina Oregon Utah Washington Wisconsin Virgin Islands Participating States

Project Summary • Each grantee convened a diverse and inclusive workgroup • Workgroup reviewed data and developed a strategic plan to address identified disparities • Recommendations were incorporated into their annual action plans • Project was evaluated to determine the effectiveness of the strategic planning process

Expectations/Requirements • Develop a strategic plan specifically addressing tobacco-related disparities • Incorporate this plan into the statewide comprehensive tobacco control plan • Develop a case study outlining the planning process • Share experiences

Planning Steps/Process • Get organized (form advisory group) • Take Stock (gather and analyze data) • Set Direction (Identify critical issues and develop plan) • Adopt and Refine the Plan • Get Ready for Action

"I may not have gone where I intended to go, but I think I have ended up where I intended to be." Douglas Adams

Get Organized(form an advisory group) • Arkansas • Brainstorming session with key representatives from various organizations, hospitals, AR. Dept. of Health (ADH), and other entities with ties to diverse populations and communities. • Key representatives nominated individuals throughout the state. • Letters of invitation were mailed and upon acceptance, the workgroup was formed. • The workgroup (22 initial members) agreed to continue recruitment for the next 3 months.

Get Organized(form an advisory group) • Indiana • Sought nominations from tobacco-control partners statewide, prior recipients of mini-grants, and organizations representing diverse populations in Indiana. • Nominations reviewed; invitations made to individuals representing diverse communities, and geographic regions of the state]. • Nominees received an invitation to join the workgroup, and each accepted the invitation. • Commitments were made by each member to actively participate in monthly meetings and the strategic planning process.

Get Organized (form an advisory group) • Washington • Recruited workgroup based on racial/ethnic diversity, not all disparities, prior to CDC grant • Networked in communities to identify organizations/leaders who were skilled in working on statewide issues and willing to work cross culturally • Attempted to recruit 2-3 organizations/community to ensure support and differing perspectives • Once members recruited, asked members to do additional recruitment

Take Stock(gather and analyze data) • Arkansas • ADH Tobacco Prevention and Education Program Epidemiologist presented state data. • Guest Speakers were invited to speak to the workgroup about particular communities, interests, and population census. • Environmental Scan performed by Workgroup Members • Critical Issues Developed

Take Stock(Gather and analyze data) • Indiana • Available state-specific data were collected to identify and describe tobacco-related disparities. • Insufficient state-specific data existed to adequately identify populations disparately affected by tobacco use or have indicators identifying them as a possible risk. • Gaps in data were identified and qualitative and national data were collected to make constructive correlations in identifying populations

Take Stock(Gather and analyze data) • Washington • Epidemiologist gathered existing state and national data and presented it to the workgroup • DOH contracted with members of the workgroup from 6 communities to conduct community assessments and summarize findings • Contracting agencies presented findings and identified 6-8 critical issues

Set Direction(Identify critical issues & develop plan) • Arkansas • Six questions lead to development of 5 critical issues that later became the final 7 goal areas. (open forum lead by facilitator) • Afterwards group was asked to group issues. The following 5 groups emerged: • Partnerships • Funding • Data • Capacity and Infrastructure • Politics

Set Direction (Identify critical issues & develop plan) • Indiana • The workgroup identified five key findings, or critical issues, which significantly affect the ability to identify and eliminate tobacco-related disparities in Indiana. • The workgroup developed a long-term goal to address each critical issue. • For each goal statement, the workgroup identified strategies for accomplishing the goal

Set Direction(Identify critical issues & develop plan) • Washington • Contractors presented community assessment findings and 6-8 critical issues for their communities • Critical issues posted and workgroup instructed to answer the question: What are the 6 most critical issues that must be addressed to eliminate tobacco-related health disparities in WA state?

Adopt and Refine the Plan • Arkansas • Critical Issues redefined into 7 goal areas with strategies and actions. Seven areas include: • Funding * Partnerships • Data & Research * Capacity & Infrastructure • Policy & Advocacy * Materials and Resources • Media/Counter Marketing • Workgroup collectively defined goals and strategies during meeting. • Evaluator developed the plan in draft and submitted to workgroup for review. • Coordinators and Evaluator reviewed workgroup suggestions and final plan was drafted and submitted to ADH Strategic Planning Subcommittee.

Adopt and Refine the Plan • Indiana • The facilitator and staff compiled information to write the strategic plan document. • Draft was sent out to members between meetings and reviewed at the subsequent meeting. • Plan had gone through a number of revisions (always with consensus of the group) • Final document was presented for approval to the Indiana state health commissioner

Adopt and Refine the Plan • Washington • Workgroup developed goals, strategies, two year, measurable objectives and 1- year action plan • Workgroup developed draft at one meeting, then review and finalize at the next) • Workgroup developed and finalized their recommendations; DOH staff reviewed and requested amendments based on DOH needs • All issues/differences between the workgroup’s plan and DOH amendments were negotiated before the plan was approved and sent to CDC

Get Ready for Action • Arkansas • Plan discussed to the ADH leadership team (summer 2003). • Began working with other program areas to understand tobacco related disparities, determine common goals and population groups, and combine efforts to accomplish plan goals. • Marketing and Media, • Cessation, and • Secondhand Smoke • ADH Campaign for Healthier Babies (Fall 2003) • AR Summit on Cancer and Health Disparities (Fall 2003) • Disparities Strategic Plan was incorporated into the overall Tobacco Prevention and Education Program’s (TPEP) 5 year strategic plan.

Get Ready for Action • Indiana • Indiana Tobacco Prevention Cessation Agency (MSA administrative org.) incorporated disparities piece in application process; • Key stakeholders have shown interest in integrating plan with their AAP • Presentations on addressing disparities will be given to potential partners of theplan and local tobacco control programs

Get Ready for Action • Washington • Integrated the 1-year action plan into the plan for SFY 2004 • Assigned activities from the 1-year action plan to tobacco program staff working on components of the state tobacco plan (cessation, public awareness, secondhand smoke, etc) • Began to implement the plan (contracted with CBO’s in five communities • Began to develop strategies to market the plan internally and externally

Lessons Learned • General Tips for Successful Planning • Preparing for Strategic Planning • Forming a Diverse and Inclusive Workgroup • Ensure Workgroup Meetings Advance Your Planning Process • Keep Workgroup Members Engaged in the Planning Process • Getting Good Information on Disparities in Your State • Getting Your Plan Endorsed by Your Workgroup, the State, and Others

Lessons Learned • General tips for successful planning • Laying the Groundwork To Implement Your PlanRecognize that planning takes considerable time and effort. • Hire a facilitator experienced in working with communities before convening your workgroup. • Foster good working relationships between your State project team and workgroup and among workgroup members. • Collaborate with workgroup members as a team, respect their views, and acknowledge their important contribution.

Lessons Learned • General tips for successful planning • Communicate effectively with workgroup members: truly listening to them and responding to their input. • Use an epidemiologist to compile, analyze, and present the data on disparities. • Recruit an evaluator to document and assess your planning process and help you resolve any problems that may occur.

Lessons Learned • Preparing for strategic planning • Allocate sufficient time and money for developing and marketing the plan. • Identify resources to implement the strategic plan before you accept funding to develop one. • Determine how your disparities strategic plan will fit into the SHD’s overall tobacco control plan.

Lessons Learned • Preparing for strategic planning • Review the SHD’s planning process for health-related disparities to see where your plan will fit in. • Build relationships with key stakeholders and potential partners before starting the planning process.

Lessons Learned • Forming a diverse and inclusive workgroup • Allow sufficient time for recruitment to ensure that workgroup members are qualified to represent their communities. • Ask your epidemiologist to compile and analyze surveillance data on disparities in population groups to help you recruit members from these groups. • Consider ideal number of workgroup members and invite more people to ensure an adequate number of participants.

Lessons Learned • Forming a diverse and inclusive workgroup • Use the findings to help you select and recruit workgroup members qualified to represent these population groups. • Build on good relationships with prominent members of communities affected by tobacco-related disparities by inviting them to participate. • Ask workgroup members from communities affected by disparities for referrals. • Limit the number of members from each State agency to ensure greater community representation

Lessons Learned • Ensuring workgroup meetings advance your planning process • Have a skilled facilitator run the meetings to prevent dominant groups and interests from taking control. • Plan the agenda and discuss work products for every meeting with your facilitator so that he/she can keep the proceedings on track. • Distribute agendas and other meeting materials before each meeting so workgroup members will be better prepared to participate.

Lessons Learned • Ensuring workgroup meetings advance your planning process • Give workgroup members clear and concise descriptions of the strategic planning process and their roles/responsibilities. • Clearly define tobacco-related disparities and emphasize the differences between disparities and diversity. • Make workgroup meetings interactive, including the use of small-group breakout sessions to increase the power and efficiency of the workgroup.

Lessons Learned • Keeping workgroup members engaged in the planning process • Avoid long periods between workgroup meetings. • Keep in contact with members between meetings. • Distribute relevant materials to members between meetings. • Call members who are absent to keep them involved. • Rotate workgroup meeting sites around the State to make it easier for geographically peripheral members to attend.

Lessons Learned • Keeping workgroup members engaged in the planning process • Encourage members to bring issues to the table and voice their opinions. • Be responsive to workgroup members’ questions, requests, and concerns. • Base planning decision-making on consensus. • Give workgroup members specific tasks during and between meetings. • Celebrate accomplishments or noticeable progress in the planning process

Lessons Learned • Keeping workgroup members engaged in the planning process • Provide stipends and travel/lodging reimbursement, especially for community-based members. • Offer meals, beverages, and snacks.

Lessons Learned • Getting good information on disparities in your State • To minimize delay in planning, present the data on disparities at your first meeting so additional data can be collected and shared at the second meeting. • Present data to the workgroup in a visually interesting and interactive way. • Collaborate with workgroup members to identify and address gaps in the data.

Lessons Learned • Getting good information on disparities in your State • Work with members to gather qualitative data from their communities for the population assessment; they know where best to get this information. • Conduct additional surveys to get more accurate information on populations affected by disparities. • Accept the fact that some data may not be available and make one of your planning goals the elimination of this data gap.

Lessons Learned • Getting good information on disparities in your State • Develop a clear understanding and consensus with workgroup members about the time, resources, and effort needed to conduct these population assessments.

Lessons Learned • Getting your plan endorsed by your workgroup, the State, and others • Give workgroup members enough time to check that the plan includes all the issues it should and to reach consensus on the wording. • Clearly explain the planning process and goals to SHD agency leaders. • Ensure that all key players and decision-makers are involved from the start.

Lessons Learned • Getting your plan endorsed by your workgroup, the State, and others • Make sure your plan is a genuine collaborative product for community and State organizations to own and implement in order to sustain diverse community-based organizations.

Lessons Learned • Laying the groundwork to implement your plan • Get a strong commitment to the plan from your SHD administration. • Include someone in your workgroup with decision-making and fiscal power to support implementation of the plan. • Seek up-front support for the plan from other individuals with leadership roles. • Garner support from key political leaders for particular planning goals.

Lessons Learned • Laying the groundwork to implement your plan • Get help from your workgroup to contact potential partners to implement specific planning goals. • Use media and social marketing to raise public awareness about disparities and their adverse effects on everyone.

Q & A

Thanks for Coming! “Go to the people, Live among them, Learn from them, Love them, start with what they know, build on what they have, But the best leaders, when their task is accomplished, Their work is done, the people will all remark WE HAVE DONE IT OURSELVES” -Chinese Proverb

Addressing Disparities Through Strategic Planning and Community Engagement