Judith Hager Belfiori, MPH, MA 1 Virginia Smyly, MPH, CHES 2

1. Evaluating the Effectiveness of Community Action Teams in Promoting Community Unity and Improving the Community Environment: Methods and Results Judith Hager Belfiori, MPH, MA1 Virginia Smyly, MPH, CHES 2 Linda Mack Burch, MPH1 Sandra Johnson, BS 2 Jennifer Rienks PhD (c)1 Wanda L. Johnson, BA 2 Geraldine Oliva, MD, MPH1 • University of California, San Francisco, Family Health Outcomes Project, 3333 California Street, Suite 365, San Francisco, CA 94118 • San Francisco Department of Public Health Community Health Education Section 30 Van Ness Avenue, Suite 2300, San Francisco, CA 94102

2. CATS Community Gardening Project 03-04

3. Background Community Action Teams (CATS) are an intervention of the Seven Principles Project (7Ps) in San Francisco. 7Ps is funded by the Centers for Disease Control and Prevention (CDC) Reach 2010 Initiative. The San Francisco Department of Public Health is the lead agency working in partnership with Community Based Organizations (CBOs) and the UCSF Family Health Outcomes Project (FHOP). 7Ps Goal is to eliminate the disparity between African American and Caucasian infant mortality rates in San Francisco and to improve the health of African American infants and their families and communities by increasing community protective factors and educating and supporting community members.

4. Community Action Teams(CATS) • The 7Ps project asserts thatpeople must work together and accept responsibility to make positive changes happen in the community.CATS are developed to unite community members, strengthen their capacity to achieve desired changes in their community environment. • The 7Ps project funds CBOs to form CATS in four African American neighborhoods to promote collective action to address community identified economic, social or physical issues that contribute to the poor health of their community. • CATS recruit and train members, identify the local health related issue they will work on, conduct an assessment, analyze the assessment data, select an action, implement the action, and evaluate and maintain the action.

5. Community Action Teams (CATS) • CATS use a Community Action Model (CAM) approach to address neighborhood issues: nutrition/food security, violence, or lack of community unity/leadership. • The CAM is an organizing method based on the work of Paulo Freire, John McKnight and others emphasizing the assets of the community and its capacity to change. • The 7Ps project provides CAM trainings and technical assistance to the CATS. The CATS use their training and energy to make a selected change in their community. • The anticipated outcome for a CAT is the successful completion of the team’s chosen community action, such as a community garden or a good neighbor policy. • Anticipated outcomes for CAT members are increased: sense of community unity, sense of self efficacy, leadership skills, and problem identification and solution development skills.

6. Evaluation of CATS • The Family Health Outcomes Project (FHOP) of the University of San Francisco, California is a Project Partner and the evaluator of the project’s interventions. • The evaluation provides formative, monitoring and outcome data for the purposeof • improving how the CATS function • assessing the effectiveness of the CATS • documenting, for possible replication, the process and results of this approach and lessons learned • Using the CDC Logic Model framework, quantitative and qualitative evaluation methods include • outcome measures (pre and post questionnaires, documented completed actions) • process measures (staff and team coordinator reports, CAM training/meeting evaluations) • case study of selected CATS (pre and post interviews and evaluator observation of trainings, meetings, events) • input of participative evaluation workgroup

7. CDC’s Reach 2010 Evaluation Logic Model • The CAT evaluation is designed to assess: • CAT capacity building • Targeted action • Community & system change / change agents change Adapted from CDC Reach 2010 Initiative

8. Preliminary CAT Member Capacity Building Findings • There were more than 20 participants that attended 1 or more of 3 CAM trainings. Coordinators were required to attend, others encouraged. • The 34 participant evaluations from these sessions rated the CAM presentation by staff as excellent or good, 2 as useful (N=38, 2 missing). • In every category of skill development over 50% (50- 80%) indicated ability to describe and/or use the information provided during the training.

9. Preliminary Findings for Change Agents Change Measures were selected to assess Change in Change Agents. Data was collected using Pre/Post CAT Questionnaires. Below are examples of measures/questions and results for the two case study CATS. In # 1, Group A’s and Group B’s belief in collective action appears to have remained the same pre and post CATS participation. In # 2, Group A’s sense of belonging to the CAT was weak, while in Group B the sense of belonging was strong. Additional information was needed to augment and help to explain findings. Qualitative information was collected through interviews, evaluator observation, and monitors (staff) reports. These data showed that conflicts in Group A were undermining group unity.

10. Preliminary Case Study Findings The descriptive data collected was rich in information. The following key findings were drawn from this data and changes are being made accordingly in next year’s CATS: • Teams need access to more technical assistance (TA) • Fund fewer teams / more funding for each team • Increase length of CATS activity time to 9 months • Increase required number of team members • Establish a system of check-ins and one for TA requests. • Need consultation on conflict management and approaches that promote a participative process • Increase staff involvement in monitoring and providing guidance and problem-solving • Clearly define roles and responsibilities within the group. • Need to expand influence to more community members • Outreach to increase membership will be built into CAT as a team objective • Develop links to and outreach at other project activities and events.

11. Results • In Year 2003-04, there were 8 CATS, 56 CAT members. Activities and events often affected larger groups of 30-200 people. • Each CAT chose a Targeted Action, addressing one of the Community Systems Change issues: Nutrition, Violence, or Lack of Community Unity and Leadership. • Examples of completed or ongoing CAT actions: • CATS members were trained in healthy food preparation by a Professional Chef. They received new funding to hold cooking classes for day care staff and parents at CBO sites. Obtained commitment of local store to carry fresh produce. • Surveyed youth and wrote article about their beliefs on health issues. Collaborating on planning for a Teen Healing Arts Center with intent of seeking additional funding. • Had a holiday gathering, identified safe place for youth, met with city official and local police to discuss strategies. • Involved youth in a community garden. Events included produce giveaway and cooking demo days (continuing), earth day and a community clean-up & BBQ.

12. Contact Us Family Health Outcomes Project University of California, San Francisco 3333 California Street, Suite 365 San Francisco, CA 94118 Telephone: (415) 476-5283 Email: fhop@itsa.ucsf.edu Website: http://www.ucsf.edu/fhop