March 11-14 2013 | The Fairfax at Embassy Row

March 11-14 2013 | The Fairfax at Embassy Row

Adopting

Healthy Habits

Leveraging

EFNEP to

Promote

Environmental

Change

Jamie Dollahite

Cornell University

Nutrition Education

Information Behavioral supports Environmental

dissemination strategies change

ldquoAny combination of educational strategies accompanied by

environmental supports designed to facilitate voluntary adoption

of food choices and other food- and nutrition-related behaviors

conductive to health and well-being and delivered through multiple

venuesrdquo Contento Nutrition Education Linking Research Theory and Practice 2nd ed 2010 p 14

Socio-ecological Framework

Adapted from Story M et al Annu Rev Public Health 200829253-272

CHANCE

Collaboration for Health Activity and

Nutrition in Childrenrsquos Environments

CHANCE Goal To prevent unhealthy weight gain and to

promote healthy eating and activity habits

among low-income children through dialogue

and collaborative action

with parents and other

influential adults who

shape the environments

where children live

learn and play

CHANCE Program Model

Children

Healthy eating amp active play

Parenting amp Home Environment

Agencies that influence

children

Parents

Workshops for parents

(HCHF)

Collaborations to change

environments

Policypractice

Goal

Initiate a participatory formative project to understand ifhow CE nutrition educators can broaden their roles to include environmental changes at the organizational and community level

ndash Is it feasible for EFNEP staff to do this

ndash What training and technical assistance are needed

ndash What other supports are needed

Initial Assessment Predicting Use of Environmental Strategies

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Initial Assessment Conclusion

1 Agents are using environmental strategies but at

a low moderate level

2 Networking program size perception of othersrsquo

expectations and perceptions of community

readiness appear to facilitate agentsrsquo use of

environmental strategies

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

March 11-14 2013 | The Fairfax at Embassy Row

Adopting

Healthy Habits

Leveraging

EFNEP to

Promote

Environmental

Change

Jamie Dollahite

Cornell University

Nutrition Education

Information Behavioral supports Environmental

dissemination strategies change

ldquoAny combination of educational strategies accompanied by

environmental supports designed to facilitate voluntary adoption

of food choices and other food- and nutrition-related behaviors

conductive to health and well-being and delivered through multiple

venuesrdquo Contento Nutrition Education Linking Research Theory and Practice 2nd ed 2010 p 14

Socio-ecological Framework

Adapted from Story M et al Annu Rev Public Health 200829253-272

CHANCE

Collaboration for Health Activity and

Nutrition in Childrenrsquos Environments

CHANCE Goal To prevent unhealthy weight gain and to

promote healthy eating and activity habits

among low-income children through dialogue

and collaborative action

with parents and other

influential adults who

shape the environments

where children live

learn and play

CHANCE Program Model

Children

Healthy eating amp active play

Parenting amp Home Environment

Agencies that influence

children

Parents

Workshops for parents

(HCHF)

Collaborations to change

environments

Policypractice

Goal

Initiate a participatory formative project to understand ifhow CE nutrition educators can broaden their roles to include environmental changes at the organizational and community level

ndash Is it feasible for EFNEP staff to do this

ndash What training and technical assistance are needed

ndash What other supports are needed

Initial Assessment Predicting Use of Environmental Strategies

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Initial Assessment Conclusion

1 Agents are using environmental strategies but at

a low moderate level

2 Networking program size perception of othersrsquo

expectations and perceptions of community

readiness appear to facilitate agentsrsquo use of

environmental strategies

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Nutrition Education

Information Behavioral supports Environmental

dissemination strategies change

ldquoAny combination of educational strategies accompanied by

environmental supports designed to facilitate voluntary adoption

of food choices and other food- and nutrition-related behaviors

conductive to health and well-being and delivered through multiple

venuesrdquo Contento Nutrition Education Linking Research Theory and Practice 2nd ed 2010 p 14

Socio-ecological Framework

Adapted from Story M et al Annu Rev Public Health 200829253-272

CHANCE

Collaboration for Health Activity and

Nutrition in Childrenrsquos Environments

CHANCE Goal To prevent unhealthy weight gain and to

promote healthy eating and activity habits

among low-income children through dialogue

and collaborative action

with parents and other

influential adults who

shape the environments

where children live

learn and play

CHANCE Program Model

Children

Healthy eating amp active play

Parenting amp Home Environment

Agencies that influence

children

Parents

Workshops for parents

(HCHF)

Collaborations to change

environments

Policypractice

Goal

Initiate a participatory formative project to understand ifhow CE nutrition educators can broaden their roles to include environmental changes at the organizational and community level

ndash Is it feasible for EFNEP staff to do this

ndash What training and technical assistance are needed

ndash What other supports are needed

Initial Assessment Predicting Use of Environmental Strategies

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Initial Assessment Conclusion

1 Agents are using environmental strategies but at

a low moderate level

2 Networking program size perception of othersrsquo

expectations and perceptions of community

readiness appear to facilitate agentsrsquo use of

environmental strategies

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Socio-ecological Framework

Adapted from Story M et al Annu Rev Public Health 200829253-272

CHANCE

Collaboration for Health Activity and

Nutrition in Childrenrsquos Environments

CHANCE Goal To prevent unhealthy weight gain and to

promote healthy eating and activity habits

among low-income children through dialogue

and collaborative action

with parents and other

influential adults who

shape the environments

where children live

learn and play

CHANCE Program Model

Children

Healthy eating amp active play

Parenting amp Home Environment

Agencies that influence

children

Parents

Workshops for parents

(HCHF)

Collaborations to change

environments

Policypractice

Goal

Initiate a participatory formative project to understand ifhow CE nutrition educators can broaden their roles to include environmental changes at the organizational and community level

ndash Is it feasible for EFNEP staff to do this

ndash What training and technical assistance are needed

ndash What other supports are needed

Initial Assessment Predicting Use of Environmental Strategies

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Initial Assessment Conclusion

1 Agents are using environmental strategies but at

a low moderate level

2 Networking program size perception of othersrsquo

expectations and perceptions of community

readiness appear to facilitate agentsrsquo use of

environmental strategies

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

CHANCE

Collaboration for Health Activity and

Nutrition in Childrenrsquos Environments

CHANCE Goal To prevent unhealthy weight gain and to

promote healthy eating and activity habits

among low-income children through dialogue

and collaborative action

with parents and other

influential adults who

shape the environments

where children live

learn and play

CHANCE Program Model

Children

Healthy eating amp active play

Parenting amp Home Environment

Agencies that influence

children

Parents

Workshops for parents

(HCHF)

Collaborations to change

environments

Policypractice

Goal

Initiate a participatory formative project to understand ifhow CE nutrition educators can broaden their roles to include environmental changes at the organizational and community level

ndash Is it feasible for EFNEP staff to do this

ndash What training and technical assistance are needed

ndash What other supports are needed

Initial Assessment Predicting Use of Environmental Strategies

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Initial Assessment Conclusion

1 Agents are using environmental strategies but at

a low moderate level

2 Networking program size perception of othersrsquo

expectations and perceptions of community

readiness appear to facilitate agentsrsquo use of

environmental strategies

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

CHANCE Goal To prevent unhealthy weight gain and to

promote healthy eating and activity habits

among low-income children through dialogue

and collaborative action

with parents and other

influential adults who

shape the environments

where children live

learn and play

CHANCE Program Model

Children

Healthy eating amp active play

Parenting amp Home Environment

Agencies that influence

children

Parents

Workshops for parents

(HCHF)

Collaborations to change

environments

Policypractice

Goal

Initiate a participatory formative project to understand ifhow CE nutrition educators can broaden their roles to include environmental changes at the organizational and community level

ndash Is it feasible for EFNEP staff to do this

ndash What training and technical assistance are needed

ndash What other supports are needed

Initial Assessment Predicting Use of Environmental Strategies

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Initial Assessment Conclusion

1 Agents are using environmental strategies but at

a low moderate level

2 Networking program size perception of othersrsquo

expectations and perceptions of community

readiness appear to facilitate agentsrsquo use of

environmental strategies

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

CHANCE Program Model

Children

Healthy eating amp active play

Parenting amp Home Environment

Agencies that influence

children

Parents

Workshops for parents

(HCHF)

Collaborations to change

environments

Policypractice

Goal

Initiate a participatory formative project to understand ifhow CE nutrition educators can broaden their roles to include environmental changes at the organizational and community level

ndash Is it feasible for EFNEP staff to do this

ndash What training and technical assistance are needed

ndash What other supports are needed

Initial Assessment Predicting Use of Environmental Strategies

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Initial Assessment Conclusion

1 Agents are using environmental strategies but at

a low moderate level

2 Networking program size perception of othersrsquo

expectations and perceptions of community

readiness appear to facilitate agentsrsquo use of

environmental strategies

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Goal

Initiate a participatory formative project to understand ifhow CE nutrition educators can broaden their roles to include environmental changes at the organizational and community level

ndash Is it feasible for EFNEP staff to do this

ndash What training and technical assistance are needed

ndash What other supports are needed

Initial Assessment Predicting Use of Environmental Strategies

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Initial Assessment Conclusion

1 Agents are using environmental strategies but at

a low moderate level

2 Networking program size perception of othersrsquo

expectations and perceptions of community

readiness appear to facilitate agentsrsquo use of

environmental strategies

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Initial Assessment Predicting Use of Environmental Strategies

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Initial Assessment Conclusion

1 Agents are using environmental strategies but at

a low moderate level

2 Networking program size perception of othersrsquo

expectations and perceptions of community

readiness appear to facilitate agentsrsquo use of

environmental strategies

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Initial Assessment Conclusion

1 Agents are using environmental strategies but at

a low moderate level

2 Networking program size perception of othersrsquo

expectations and perceptions of community

readiness appear to facilitate agentsrsquo use of

environmental strategies

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Approach

1 7 diverse counties with some collaborative experience

2 Participatory approach

3 Strategies developed covering spectrum home environment community level

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Approach

4 Support provided

Fiscal and human resources

$30K per year per site

05 FTE paraprofessional (pp)

pp salary= gt 60 of budget

05 FTE state-level extension associate to coordinate and provide leadership

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Approach 5 Support provided

Multidirectional learning collaborative

ndash Monthly bull Group phone calls

bull Activity logs follow-up amp feedback

bull Frequent individual calls for technical assistance

ndash Annual bull Proposal activities amp budget

bull 2-3 site visits

bull All-project meetings

ndash Continued funding dependent on involvement and commitment to process

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Intervention Points

Othersrsquo expectations

Perceived community readiness

Individual causes

Manage env program

Program size

Networking

Use of env strategies

Coordination Collaboration

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Core Strategies

bull Identify and support nutrition staff development strategies that increase skills and effectiveness in environmental change efforts

bull Develop and implement worksite wellness guidelines and practices

bull Extend EFNEPrsquos reach through collaboration with partner agencies and larger communities to make environmental change

bull Engage in site-specific environmental change initiatives with partner agencies and larger communities that make healthy habits easier for low-income families

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Implementation

1 Training for and delivery of parent workshops that include environmental change ndash Increased communication btw

agent amp pp

ndash Home + non-home environment

influences on food and activity

ndash Skill building

ldquoFinding Solutions with Othersrdquo

2 Cornell NutritionWorks online course Preventing Childhood Obesity an Ecological Approach

team with local partners

3 Worksite wellness activities in local CE

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Implementation

4 Supporting changes in partner agencies ndash Community mapping exercise

to consider partnership

expansiondevelopment

beyond recruiting

ndash Local discussions about

goalsplans with partners

networking

scheduling conversations to assess needs

maintaining frequent contact

ndash Mentoring of PPs by agents amp CHANCE Coordinator

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Implementation

5 Building coalitionsupporting community change ndash Coordination with agency

partners

ndash Alignment with local coalition

working on changes supporting

healthy choices in children

OR initiation of a local coalition

ndash Community Readiness assessment to assist with development of action plans

6 On-going participation in learning collaborative

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Results

bull Last 3 yearsrsquo experience

ndash 7 diverse sites different contexts

ndash Examples

ndash 2 of the longest running sitesmdash

divergent contexts

bull Lessons learned 1

2

3

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Context

bull 1268 sq miles bull Population 118000 bull 1 micropolitan area bull Close partnerships

CCE

Nutrition

Rural County

Staff

History Funding

Community-level environmental work for over a decade

1996-1998 Local food systems collabor project 2004-2009 Eat Well Play Hard (NYS Health Dept)

2011-present Creating Healthy Commun (State Health Dept)

Com Readiness = 5 8

Agent long term high level connections with community committees and coalitions track record with grants commitment to env chg amp mentoring

PP HCHF development lead CE worksite wellness new roles with partner agencies amp in community

- Relatively stable CE county funding provides some flexibility

- Contracts and close collaboration with County Health Dept

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

bull Leadership ndash Committee organized and chaired by PP ndash Leadership transitioned over time to other staff

bull PP skill development building collaboration facilitative leadership

bull Activity examples ndash staff health survey ndash signage with messages ndash vegetablefruit vending ndash walking maps with distances inside and outside

bull Organization-wide policy ndash healthy food at meetings with food reimbursement policy ndash physical activity break for long meetings

bull Model for local organizations

Rural Site Worksite Wellness

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Rural Site Partnerships

2010 n = 15

Community Action Planning Council

Council of Social Agencies

Dept of Social Services

Library

School

Head Start

Food Policy Council

Health Dept

Faith-based organizations

Neighborhood association

2011 n = 21

New partnerships

VA

3 with government

hospital

New work in school

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Rural Site Shifts in Focus

ldquoIn the last couple of monthshellip Irsquom not sure what happenedhellip but the group Irsquove been working with made just this ideological shift The language they are using is totally differenthellip we went from this group who was all focused on doing this [one] event to really looking at the environmenthellip I am very very excited about it

So we are creating a charter for this group They are looking at a vending machine policy for their buildinghellip They are changing how they celebrate birthdays they are really thinking about their environment and what environment they are portraying to children and families who come inhelliprdquo

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

ldquoI think what we find is they donrsquot get [environmental level approaches] and you have to use that language You have to challenge them a little bit at a time You have to be elbow to elbow with them for a while and then all of a sudden theyrsquoll catch the concepthelliprdquo

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Rural Site Initiatives in Partner Agencies

bull Community gardens in several agency sites

bull Salad bar in school cafeteria

bull Trail improvement clean-up signage

bull Healthy foods offered at many meetingsevents

policy implementation in several agencies

community level ripple effect

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Rural Site Building Coalitions Supporting Community Change

CHANCE initiated coalition

bull Begun with multiple long-standing partners

bull Originally facilitated by agent transitioned to facilitation by PP with mentoring agent still involved

bull Activities overlap with and build on those with partners

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Rural Site Building Coalitions Supporting Community Change

Current Activities

bull School wellness policy develop amp distribute list of healthy affordable snacks for classrooms

bull Increase number of community gardens

bull Plans for community kitchen

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Context

bull 2373 sq miles bull Population 15 mil bull 32 incorporated

communities bull Dispersed diverse

population and leadership

CCE

Nutrition

Suburban County

Staff

History Funding

Community level environmental work bull State Health Dept Creating Healthy

Places grant bull No evidence of past active

collaboration promoting healthy eating or activity

Com Readiness = 35 8

Agent long term connections with various agency partners recruitment amp advisory

PP HCHF development cooperates CE worksite wellness activities new roles with partner agencies amp in community

2 other PPs specific agencies

- County funding for human ecology programs in CE specifically targeted for elimination

- History of contracts with county Health Dept but number declining

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

bull Team approach leadership by PP

bull Activity examples

ndash Focus on education

signage staff newsletter

ndash Walking club

ndash Breast-feeding room

ndash Healthy snack options in

reception area

bull Organization-wide policy

Suburban Site Worksite Wellness

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Suburban Site Partnerships

2010 n = 13

County Health Dept DSS Hospital Faith-based organization Mothersrsquo group Hispanic outreach organization Schools School age child care center Family service agency Area restaurants amp healthy bodega group

(Creating Healthy Places grant)

2011 n = 20

New partnerships

Latino Advisory Board

Housing Alliance

Additional schools

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Suburban Site Initiatives in Partner Agencies

bull School wellness councils changes in food available development of wellness policy

Wrap-around approach admin teachers parents kids

bull Community garden at child care center

bull Wellness policy for childrenrsquos food implemented at child care center

bull Worksite wellness policy in one site

bull Trainings on environmental influences

partner agency public presentations

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Suburban Site Building Coalitions Supporting Community Change

CHANCE initiated coalition focusing on healthy food and activity for low-income children

bull Facilitated by agent

bull Focus on networking information dissemination

bull Difficulty moving beyond this to community action

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

ldquohellippeople arenrsquot gonna do a community level action plan They canrsquot commit to ithellip Everybody is working in individual programs and the people who are working in individual programs may not be motivated presently to put inhellip Everybody is stretched and they have so much on their plate that they are not going to stress themselves and say lsquook wersquoll do this and wersquoll do an action [plan]rsquohellipbecause they already have things in place that they need to take care of ldquo

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Suburban Site Building Coalitions Supporting Community Change

Current Activities

bull Large public presentations

bull State amp county legislative initiatives banning sale of energy drinks to minors buried in committee

bull Marketing campaign promoting water availability no movement to increase public water fountains

bull Health Dept Creating Healthy Places grant ndash Healthy bodega initiative

ndash Restaurant initiative $5 healthy meals subsidized by grant

bull County vending machines coalition member changed contract to include healthy choices

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Lessons Learned from 7 Sites

2 urban

1 suburban

2 with mid-sized cities

2 rural)

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Lessons Learned

1 Essential supports to develop skills amp move from networking to collaborative relationships conducive to environmental change ndash Dedicated time

ndash mentoring

ndash technical assistance

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Lessons Learned

2 ldquoHealthy Children Healthy Families

Parents Making a Differencerdquo

translated into ndash Understanding role of environment

ndash Using facilitation skills to ldquofind solutions with othersrdquo

ndashTool to use with partners

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Lessons Learned

3 Worksite Wellness

translated into skillseffective work with community partners ndash Trying new activities and directions

new understanding of role of the environment

ndash Facilitating discussions and change efforts with different stakeholders

ndash Dealing with resistance

ndash Developing credibility and passion

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Lessons Learned

4 Environmental change requires

bull on-going long-term commitment

bull dedicated time

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Lessons Learned

5 PPs and agents can form a complementary team in-depth collaborative environmental change work ndash PPs need continued time and guidance

ndash Agents provide overall leadership assist PPs in making connections

ndash PPs often more successful in identifying spark-plugs amp accomplishing change

ndash Both PPs and agents can move initiatives forward as opportunities arise

ndash Community coalitions require agent leadership but PPs can play a role

PP ldquoSometimes the manager is better at getting things set up Irsquom better at going in and getting things donerdquo

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Challenges bull Move from direct education to environmental change

bull Programs expected to meet education ldquonumbersrdquo ndash difficult to prioritize this ldquoimportantrdquo work in light of that ldquourgentrdquo need

bull Long-term commitment ndash few short-term outcomes

bull Community buy-in takes time multiple iterative steps dedicated staff

bull ldquoSpark-plugrdquo identification in each environment difficult

bull Staff turnover in partner agencies frequent

bull Effective skill-building activities not fully identified

bull Need feasible productive evaluation methods

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Conclusions bull Feasible for staff ndash not easy or straightforward

bull Requires financial and human resources at the local level

bull Requires financial and human resources at state level

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Resources

1 Edwards R W Jumper-Thurman P Plested B A Oetting E R amp Swanson L (2000) Community readiness Research to practice Journal of Community Psychology 28(3) 291-307

2 Plested B A Edwards R W amp Jumper-Thurman P (2006) Community readiness A handbook for successful change Fort Collins CO Tri-Ethnic Center for Prevention Research

3 Findholt N (2007) Application of the community readiness model for childhood obesity prevention Public Health Nursing 24(6) 265-270

4 Johnson K Grossman W amp Cassidy A (Eds) (1996) Collaborating to Improve Community Health Workbook and guide to best practices in creating healthier communities and populations httpwwwjosseybasscomJossey-Bass

Acknowledgements

Tisa Hill CHANCE Coordinator

Kate Dickin Research Associate

CHANCE Team

Angela Lu John Tung Foundation Taipei