The California Wellness Foundation
THE CHILDREN AND YOUTH COMMUNITY INITIATIVE:
Challenges, Accomplishments and Lessons Learned

By Frances Jemmott and Fatima Angeles

TABLE OF CONTENTS

1 The Children and Youth Community Initiative
2 Wellness Village Program
3 Community Health Projects
4 Community Mentoring
5 Academic Support
6 Community Wellness Enhancement Projects
7 Technical Assistance Program
8 The Initiative Support Program
9 Evaluation/Dissemination Program
10 CYCHI Advisory Committee
11 Conclusion

Accomplishments, Challenges and Lessons Learned

In June 1996, The California Wellness Foundation’s (TCWF) board of directors approved a five-year $20 million grantmaking program titled the Children and Youth Community Health Initiative (CYCHI).

The overall goal of the CYCHI was to improve the health of several communities in California by engaging children and youth in the transformation of their social, physical and chemical environments. Components of the Initiative included the Wellness Village Program, Community Wellness Enhancement Projects, the Technical Assistance Program, the Initiative Support Program and the Evaluation/Dissemination Program.

The CYCHI focused on youth development and capacity building to improve community health, and required the involvement of adult and youth residents in the planning, implementation and evaluation of projects and activities. Youth development, defined by the National Youth Development Information Center, is a process to prepare young people to meet the challenges of adolescence and adulthood through a coordinated, progressive series of activities and experiences that help them to become socially, morally, emotionally, physically and cognitively competent. A growing body of literature on youth development suggests that many young people who participate in youth development activities have better health outcomes than those who do not. In response to the emerging youth development movement, CYCHI emphasized a youth development approach that acknowledged youth as resources in communities and encouraged youth development in community-based, action-oriented projects. CYCHI grantees were encouraged to look to young people as partners, rather than as clients, and involve youth in planning, implementing and evaluating wellness village efforts. Through participation in advisory committees and Initiative-related programs, young people developed substantive knowledge, practical skills and personal capacity in organizational development.

The Initiative promoted involvement in local advisory committees composed of adult and youth residents, community-based organizations, local colleges and universities. These committees established mechanisms for ongoing dialogues and decisionmaking, and served as a means to design and implement wellness village plans that included community health projects, mentoring programs and academic support programs. Using the World Health Organization’s definition of community health, wellness villages were encouraged to identify the factors that most influenced the overall health of their communities. Grantees were encouraged to look at community-driven efforts that focused on health for the whole community rather than at efforts that sought to change individual health behavior. Successful Wellness Villages understood the difference between active engagement of residents as stakeholders versus viewing residents as passive recipients of services.

There were two phases in the Initiative: planning and implementation. For the planning phase, the Initiative provided grants to 16 communities throughout California, which started on October 1, 1997, and continued for 18 months until March 31, 1999. During the planning phase, each community grantee had three objectives: 1) convene a representative advisory group of residents and stakeholders to plan the wellness village; 2) conduct an asset-based community development plan to improve wellness in a specific geographic area; and 3) prepare a proposal to submit to TCWF for its wellness village plan. The 18-month planning grants involved almost 1,900 local residents in examining local conditions and planning changes that would improve and enhance health. The communities were assisted in their efforts by the grantees for the Initiative Support, Technical Assistance and Evaluation/Dissemination Programs. Over the 18-month planning phase, each planning site completed a community visioning exercise and a plan to improve community health through youth action.

Staff and consultants reviewed the 16 wellness village grant applications, and three-person site visit teams spent a full day in each applicant community meeting with the local planning committee. Of the 16 communities, 10 were subsequently awarded grants to implement their wellness village designs over 3 ½ years; and six communities received grants to continue capacity building over another 18 months.

This report outlines the accomplishments, challenges and lessons learned during the CYCHI’s five-year period that ended in September 2002. Goals and objectives are presented for each portion of the Initiative followed by staff analysis of what was actually accomplished. This report is organized according to the goals and objectives of the Children and Youth Community Health Initiative. At the conclusion of the three components, we reflect upon the accomplishments, challenges and lessons learned about the Initiative as a whole.

Frances Jemmott and Fatima Angeles, Program Directors
The California Wellness Foundation

Grants to organizations in the Wellness Village Program provided resources for projects to transform the physical, chemical and social environments to improve community health. These projects were planned and led by residents, of which a majority were youth. Using techniques of youth development, community organizing and asset-based community development, residents learned how to address environmental concerns and how to evaluate progress in achieving goals.

The program had three components: 1) Community Health Projects, which engaged community residents in activities aimed at transforming their environments; 2) Community Mentoring, which connected middle-school-age youth with adults in the community to increase social capital in the wellness villages; and 3) Academic Support, which promoted partnerships between local colleges and universities and wellness villages to maximize and share resources in their communities.

Goal:

To improve the health of several communities in California by engaging children and youth in the transformation of their social, physical and chemical environments.

Objectives:

Planning Phase

• Support the development of local planning efforts that enable communities to invest resources in making environmental improvements that influence the health and wellness of children and youth.
• Encourage new models of collaboration that build on community assets.
• Conduct health education, peer support, and other programs necessary to engage youth in designing a wellness village.

Implementation Phase

• Implement a community-level advisory group consisting of residents, 50 percent of whom are youth, including civic and business leaders as well as public-sector representatives.
• Follow an approved logic model to implement a minimum of three community health projects that engage representative numbers of residents, especially children and youth, in activities that lead to measurable improvements in environmental conditions that influence health.
• Link support services of a local college or university to complement the community health projects through specific activities that are observable and measurable.
• Conduct a mentoring program for middle-school-age youth.

Accomplishments:

• Sixteen groups completed the planning phase of the Initiative. All 16 sites developed, through active community participation, action plans to improve community health.
• Wellness villages created substantive advisory groups. Each wellness village maintained an active advisory group that consisted of youth and adult residents who were involved throughout the course of the five years in all phases of the planning, implementation and evaluation of projects and activities.
• The Initiative encouraged a paradigm shift in the planning and implementation of community health programs. With an emphasis on enhancing the contributions or assets of youth in communities, the wellness villages provided youth development opportunities for their youth by engaging them in policy issues and ongoing dialogues about common concerns. In a number of wellness villages, city councils and other decisionmaking bodies created youth advisory boards and committees to help guide decisions affecting communities and young people.
• Wellness villages encouraged communities to view youth as positive assets capable of planning, implementing and evaluating projects that addressed community health needs. Youth developed into leaders as a result of opportunities to participate in training workshops and public speaking, and with responsibility as mentors, role models and staff within lead agencies. Youth from wellness villages were trained as evaluators and “village techies.” “Techies” became computer proficient and had responsibility for maintaining electronic contact with peers in other villages.
• Diversity and cultural competence were embodied by TCWF staff, CYCHI advisory committee, CYCHI support grantees, wellness villages, and wellness village advisory groups. Participants at all levels of the Initiative addressed issues and tensions associated with diversity and modeled respectful and just approaches to incorporating and reflecting different perspectives.
• High levels of resident involvement were achieved. There were deep and significant levels of involvement and participation of youth, families and kinship groups at the community level. Parents and other adults were involved alongside children and youth.

Challenges:

• Fostering adult and youth partnerships is a challenging task. Adult and youth partnerships require time, energy, technical assistance, and deliberate and facilitated discussions. In many of the communities, equitable roles for adult and youth in collective decisionmaking, planning, and implementation of activities were new concepts that challenged convention, tradition, cultural and community norms, and capacity among youth and adults.
• Involving residents in planning and programs required significant changes on the part of the lead agencies. Not only did the lead agencies have to relinquish control, they also had to mentor and teach new skills to the youth and adult residents. These notions of reciprocity and equity among traditionally unequal partners highlighted the tensions that members of each wellness village had to identify and work through. Along with power and control issues, time commitment, outreach efforts, data collection and language were barriers to consistent resident involvement.
• The rate of staff and volunteer turnover at all levels of the wellness villages was high. The turnover affected organizational memory and capacity to deliver outcomes according to established timelines. Mid-course corrections, organizational and leadership flexibility, and a quest to understand this phenomenon as inherent in community and organizational transformation were pivotal.
• The importance of community-organizing interventions to promote community health was recognized but the potential development of these skills was not realized. Community organizing as a tool that helps communities identify problems, resources and strategies to solve problems cannot be taught in short periods of time.
• Change in the social health environment precedes change in the overall community health environment. It was challenging for lead agencies to undertake the social engineering required for cooperative, sustained implementation of projects. Tensions among adults, youth, ethnic groups, community organizations and other stakeholders required time and energy to resolve before real work could begin.
• The process of selecting 10 wellness villages from an initial group of 16 planning sites was widely perceived as unfair. The level and intensity of competition between grantees gave way to mutual support and appreciation toward the end of the planning period. The encouragement of democratic processes at the wellness village level led to organized efforts to challenge the Foundation’s authority in selecting grantees.

Lessons Learned:

• Youth can be key stakeholders in determining effective approaches to the promotion of community health. Engaging youth to address community conditions that profoundly affect their health may influence how they will live as adults. Over the five years of the Initiative, many young participants completed school, obtained employment, began families and became active participants in the life of their community.
• The same opportunities for training, coaching and encouragement given to youth are also necessary for adults. It was anticipated that youth would need certain supports to effectively participate. It was a mistake to believe that adults did not need similar supports.
• Many youth, given the opportunity, will choose positive involvement in their communities. The focus on youth in this process ensured their involvement and engagement in the community and decreased their sense of social isolation. Youth became credible and valued leaders in their neighborhoods.
• The Foundation’s five-year commitment to 10 communities was valuable to the residents of these communities. During that time frame, the wellness villages had the time to plan, implement, evaluate and learn from their efforts. Participation in, and acknowledgment of, the accomplishments of the wellness villages cultivated community pride among the residents and transformed communities. Perceptions of the wellness villages, by those external to the communities, also improved.
• Grants of $1,050,000 over five years provided significant support to accomplish objectives. Wellness village grants were larger than community action grants in other initiatives. Increased resources allowed more work to be accomplished in a shorter time frame.
• The lead agency model made the grantmaking more efficient. Lead agencies, rather than collaboratives, were funded to implement all aspects of the program in the local community. Contracts for academic support and mentoring programs with the lead agency, rather than grants from the Foundation for those programs, led to greater accountability to the community.
• The local neighborhood was an effective center for organizing efforts to promote health and behavior change. Communities must be challenged to continually adopt resident driven community health improvements. Community organizing is necessary in community building because it stresses the identification, development and celebration of community assets.
• Neighborhoods have many assets that contribute to community health. Existing structures and facilities, such as churches, housing projects, schools and recreational centers, are all potential health resource centers. Such structures provide safe spaces for residents to meet, plan and host events that will contribute to improvement of health outcomes.
• Recognizing communities’ assets is an important step to improve the health of communities. The Initiative acknowledged the communities’ ability to define and solve broadly defined health problems at their place of origin, building on shared values and social relationships that inspired trust and strengthened social capital.
• Increasing the capacity for health promotion of individuals and organizations at the neighborhood level can result in community actions aimed at health improvement. Investing in and valuing individuals created a deep level of involvement in community health projects and a sense of community ownership of the work.
• A healthy respect for multicultural and cross cultural understanding is essential in community building efforts. It is critical to forge alliances among communities, learn to speak in common terms, and reach consensus around values and goals rather than foster competition at the community level. The shared understanding that developed among residents greatly contributed to the success of the Initiative.

Accomplishments:

• Community health projects successfully engaged residents in addressing improvements in their communities. Residents took actions such as converting vacant lots into gardens and play areas, helping non-English-speaking families understand the hazards of fishing in contaminated waters, establishing fitness programs, conducting lead prevention programs and providing sports and recreation activities.
• Community health projects strengthened community capacity for addressing health needs in communities. Through youth and adult partnerships as well as the utilization of a community-building model, networks within the community were strengthened.
• Community health projects increased the number of community-based organizations that integrated health improvements into their goals and objectives and developed programs to foster healthier lifestyles among community residents.

Challenges:

• Communities were challenged to understand community health as a concept. Early in the planning, there was interest in focusing on violence prevention, teenage pregnancy prevention and employment programs for youth. Community health did not have widespread appeal to residents.
• The technical assistance grantee was not successful in engaging planners around community health projects. Though they had broad public health experience, particularly around public education and media, working with community residents on asset-based community development was a major challenge.
• The Foundation language in early documents was confusing to grantees. Subtle changes in language caused frustration and setbacks in planning.
• Evaluators became de facto technical assistance providers given their greater understanding of community health and community psychology. Separation and distinction in roles and responsibilities of various support grantees was confusing and frustrating.
• The literature on community health was not readily available to community residents. The field was in formative stages and not readily distinguished from broader public health efforts.

Lessons Learned:

• Be clear. The language of public health and philanthropy combined may exceed the comprehension of those who work at the grassroots level in communities.
• Neighborhoods are significant points of entry for community health activities. They have underutilized resources and have potential for engaging residents around community health.
• Youth can be community leaders. Youth respond favorably to the invitation to plan, implement, evaluate and lead community projects.
• Resident-led projects can be effective. Resident-led community health projects can build social capital and social cohesion and can transform environments to improve community health.
• Health improvement via resident engagement is a complex process. Resident-driven community health projects deserve long-term study to fully understand processes such as empowerment and connection to health benefits.

This component connected middle-school-age youth with adults in the community to increase social capital in the wellness villages. The mentoring program had the potential to tap underutilized community resources and strengthen social networks for children, youth and adults. It was intended to foster the concept of “village elders” by organizing and rewarding residents to serve as mentors to young people working to improve community health.

Accomplishments:

• Young people engaged in mentoring programs learned about cultural traditions and values, received guidance and support, improved social and academic skills, and engaged in positive community activities.
• Lead agencies were able to successfully operate their own mentoring programs based on community norms acceptable to community residents.
• Some mentoring models offered alternatives to traditional mentoring and used formats such as peer-led, group mentoring and staff-supervised mentoring.
• Mentoring programs in some wellness villages involved younger children in elementary and middle schools in community health projects.

Challenges:

• The level of sustained commitment required of mentors was a barrier to many community adults who wanted to spend time with youth but did not have enough time to spare from their busy lives. However, a number of wellness villages capitalized on the time that these adults had available and created short-term activities for youth and adults.
• Mentoring models that required criminal searches, fingerprinting and extensive training were barriers to a number of wellness villages. Smaller lead agencies had difficulty executing these activities because of limited budgets and unfamiliarity with the processes.
• Providing funding to the lead agencies to manage the mentoring model did not result in sub-contracts with established mentoring programs. Traditional organizations such as the YMCA, Big Brothers/Big Sisters and the Boy Scouts were engaged in some wellness villages where lead agencies had more experience in monitoring subcontracts. However, most wellness villages used nontraditional resources.
• The concept of mentoring is not widely embraced in ethnic communities. Residents, especially parents, may feel devalued and displaced by a concept that can suggest that they are not capable of raising their children. Culturally appropriate models of mentoring engaged such parents in group mentoring projects based on a premise that everyone has a gift they can share.

Lessons Learned:

• The Foundation’s flexibility with accepting a variety of mentoring models helped wellness villages identify and implement mentoring programs that were suited to the unique needs of each community.
• Better methods of recruiting, training and certifying mentors are needed to serve diverse communities.
• Structured mentoring programs that address community health issues need to be identified and made known to grantees working on community health issues.

This component encouraged active participation of a local college or university in working with the wellness villages on community health issues. This collaboration provided community participants with necessary expertise, better access and understanding of the ways in which academicians can support community efforts. Academic support activities included a lecture series at a community college on Native American health issues, research and data collection training for youth, and internship positions in community-based organizations for college students.

Accomplishments:

• Wellness Villages established and retained several partnerships with local colleges and universities that brought in resources to the communities.
• Academic institutions were able to work at the community level and successfully implemented programs addressing grassroots needs. These included: nutrition and fitness programs, computer education, science and math exposure projects, research on community issues and agricultural techniques.
• Hundreds of young people became familiar with academic institutions, their locations, role in community, admission policies, financial support and significance of campus life. This, in turn, provided visibility for academic institutions in their efforts to close the “town and gown” divide.

Challenges:

• The level of bureaucracy in colleges and universities and the communities’ inexperience in dealing with the complexities involved with developing partnerships with academicians were initial barriers to developing productive working relationships. However, once a “champion” within the college or university was identified, partnerships were developed.
• Community organizations often lacked full understanding of the costs associated with working in partnerships with colleges and universities. Negotiating budgets proved cumbersome and slowed the process in the beginning stages of the partnerships.

Lessons Learned:

• To reach the goals of the wellness village, it was important to identify a “champion” within the college or university and to find the department within the college that best fits the work of the wellness village.
• Community colleges proved valuable partners and made important contributions to community health.
• Large research institutions were eager to work with communities but, in the absence of graduate students, had difficulty sustaining a presence in the community.

Funding for six Community Wellness Enhancement Projects (CWEPs) were approved in March 1999. These six grants were recommended to those communities that completed the planning process but whose projects were deemed needier in terms of requiring additional planning time and resources to increase the capacity of lead agencies and residents to fully engage around their work plans as wellness villages. These CWEPs received $90,000 each over 18 months, which provided some transition and continuation support. These grants represented an effort to validate the grantees’ achievement of some measurable progress toward completing the objectives of the planning phase. The CWEP sites engaged in environmental improvements and youth development activities as a means of improving community health. Moreover, they strengthened organizational and community capacity, with support from the Technical Assistance Program and the Evaluation/Dissemination Program. Activities included researching other opportunities for funding, partnering and working with other community-based organizations, participating in technical assistance workshops, and implementing one community health project in their community.

Goal:

Provide resources to strengthen organizational capacity to better address community health issues.

Objectives:

• Implement a strategic, resident-driven community health project outlined in a logic model and involving the Wellness Village Advisory Committee (WVAC) in a consistent manner.
• Develop and implement community capacity-building plans to sustain asset-based community health projects.
• Participate in the Technical Assistance Program and Evaluation/Dissemination Program.

Accomplishments:

• Developed a community health plan. Through participation in both the Technical Assistance and Evaluation/Dissemination Programs, CWEP sites identified community health problems and developed a plan to help address them.
• Several of the CWEP sites have received funding from this and other foundations for their community health projects.

Challenges:

• CWEP sites had difficulty remaining on track because of the infrastructure of the lead agency and decrease in resources. The six sites selected for 18-month grants made progress toward achieving their original objectives but needed additional time and technical support to strengthen their planning group. Typically, the lead agencies in these projects had issues with staff turnover, the need for improved relationships with community residents, a stronger commitment to youth and adult partnerships and competence in supporting meaningful partnerships, and the need for more involvement with, and commitment to, community health and environmental improvements.

Lessons Learned:

• Additional funding assisted CWEPs in building their organizational capacity and improving community health. Technical reviewers and those who conducted site visits, as well as evaluators of the planning phase and staff, recognized the importance of sending an affirming message to these communities to continue their community health work beyond the planning phase. In most instances, there was an energetic core of youth involved in each of the communities that were committed to a longer period of involvement. Their efforts were supported with the smaller grants.

The Technical Assistance Program focused on the grantees at the community level--providing them with assistance to improve their capacity and effectively manage their grants. The technical assistance (TA) provider surveyed and assessed the strengths and resources of each wellness village and community wellness enhancement projects. Through group training, one-on-one coaching, linkage with other resources, and infusion of information to address stated needs, the technical assistance provider partnered with each lead agency to achieve results.

Goal:

Assist wellness villages and CWEPs with improving their capacity and effectively managing their programs.

Objectives:

• Conduct an assessment of TA needs of each of the wellness villages and CWEP grantees.
• Develop workplans and training curricula and assist the wellness villages and CWEP grantees in implementing specific strategies to meet the technical assistance needs.
• Participate as a member of the Initiative coordination team.

Accomplishments:

• Technical assistance efforts resulted in more efficient progress in the wellness villages’ program implementation and evaluation efforts. Wellness villages have stated in their progress reports that they valued the support of the TA providers.
• Coaching assisted wellness villages in becoming a learning community. The TA provider coordinated and facilitated monthly “coaching” calls among wellness village adult project leaders and staff. Through peer learning, participants took advantage of knowledge and resources of the entire group, supporting and coaching one another as much as possible.
• Site-specific technical assistance and training focused on strengthening programmatic and organizational infrastructure and specific program-related activities provided to each of the wellness villages. Regional trainings focused on improving communication and presentation skills of youth and adult wellness village members; on fundraising; and on staff, board and volunteer development.

Challenges:

• During the initial stages, the TA provider was challenged by how they were perceived by the wellness villages. The TA provider was forced to overcome the perception that they were the “eyes and ears” of the Foundation.
• Wellness villages did not take advantage of “coaching” during the initial stages of the implementation phase. Most of the wellness villages were unfamiliar with the coaching concept and did not treat it as a priority. Various staff members would sit in on coaching calls, creating inconsistency in this technical assistance strategy. As time progressed, grantees began to view these calls as an opportunity where participants learn from and support each other through problems and concerns.
• The level of attention and responsiveness of the TA providers was not always consistent. “Squeaky wheels” got the attention, while wellness villages that were less vocal with their needs received less assistance.
• Staff turnover at the wellness villages was a barrier in building capacity and created a challenge for the TA providers because retraining new staff slowed the progress of several wellness villages.

Lessons Learned:

• Technological improvements are essential in developing and strengthening organizations and communities. Improved organizational and individual capacity will last longer in the community than grant funds. Access to telephones, fax machines, the Internet and state of the art computers allowed communities to maintain up-to-date communication networks, as well as assist with operations, research and planning.
• Wellness villages appreciated the principles of TA. Instead of giving them “fish,” the technical assistance providers taught the wellness villages “how to fish.” Improved organizational and individual capacity will last longer in the community than grant funds.
• Investing in youth and adult partnerships is worthwhile and helps to build capacity within the wellness village. Adult and youth partnerships are difficult to achieve and frequently require training, technical assistance and coaching to foster mutually respectful environments and understanding to achieve community health goals.
• Adults also required training to better understand the transformation that was occurring with youth. Initially, it was assumed that only youth would require training.
• Cultural competency of the technical assistance providers is important. Providers needed to fully understand the unique history, environment and context in which each wellness village was operating.
• Technical assistance must be targeted and consistent to ensure effectiveness. Through technical assistance as well as resident involvement, communities and organizations were strengthened. As a result, new understandings about how to approach and implement youth development and community building strategies were reached as a result.
• Technical assistance providers with competencies in resident-driven community health program development need to be developed. The growth of technical assistance organizations capable of working at the community level has not kept pace with the availability of funds and the proliferation of community-based organizations in California.

The Initiative Support Program was distinguished by its emphasis on enhancing and strengthening communications among grantees, and by its concern for creating a learning community. It supported the involvement of the Initiative Advisory Committee by arranging and facilitating two meetings each year. It also supported the growth and development of wellness village grantees by convening a yearly large-scale meeting over a two- to three-day period.

Goal:

Enhance and strengthen communications among support grantees and wellness village grantees to create a learning community.

Objectives:

• Provide logistical, planning and management support for Advisory Committee meetings.
• Provide logistical, planning and management support for annual meetings of Wellness Village Program grantees.
• Design and implement a strategy for ensuring effective and ongoing communications between and among all CYCHI grantees.
• Establish and maintain an electronic networking system.
• Participate as a member of the Initiative coordination team.

Accomplishments:

• Created a learning community. Grantee, advisory and coordination meetings provided time and space for all grantees to share strategies and reflect on lessons learned as well as an opportunity to strengthen community networks and relationships.
• Convened five grantee and five advisory committee meetings.

Challenges:

• The website was ineffective and technology was never fully applied. Although the Initiative website was completed, the development and launch of the website was delayed for almost 18 months. A listserv was established to promote the website. While the listserv was active during the first two weeks of its introduction, the interest among the wellness villages dissipated. Because of the delay, the members of the wellness villages were not able to familiarize themselves with the website, which negatively affected their inclination to use it as a tool for communication, resource development and research. This stunted networking and learning opportunities for the wellness villages because they did not have the means for effective and on-going communication.
• Communication of expectations between TCWF staff and the Initiative Support grantee was not always clear. Planning for the convenings proved to be a difficult process each time. The Initiative Support grantee lacked understanding of the expectations and work style of the Foundation and the grantees.
• Inadequate leadership resulted in incomplete deliverables. The Initiative Support grantee for the implementation phase proved to have inadequate leadership and an unstable organizational structure. The lack of capacity within the staff and poor project management became evident by the midpoint of the grant. A change in management was a good-faith effort in addressing grantee performance issues. Unfortunately, the change happened too late when little could be done to improve deliverables.

Lessons Learned:

• The organization matters less than organizational capacity, level of expectations and communication. Two separate Initiative Support grantees failed to produce quality deliverables. Lack of organizational capacity, such as poor management and weak leadership, was a major issue that affected support for many wellness villages. Some sites did not receive much-needed technical assistance, and a breakdown in communication between TCWF staff and Initiative Support caused confusion about expectations.

The Evaluation/Dissemination Program (E/D) provided a comprehensive evaluation of the processes, outcomes and effects of the Initiative and designed and implemented an appropriate dissemination plan. E/D established objectives and outcome measures for each component of the Initiative, including the wellness villages. In addition, E/D participated in the management of the Initiative by providing continuous improvement feedback through regular participation in Initiative management meetings. An important feature of the E/D component was the development of a participatory action research design.

Goal:

Provide feedback for program improvement of grantees during the life of the Initiative, as well as a comprehensive assessment of their accomplishments, and disseminate those findings to appropriate audiences at the Initiative’s conclusion.

Objectives:

• Collect, analyze and summarize data from the wellness villages regarding environmental transformations to improve community health.
• Submit annual reports and a final report to TCWF by January 2002 regarding achievements and lessons learned from the Initiative.
• Disseminate to diverse audiences by June 2003 findings regarding achievements and lessons learned from the Initiative.

Accomplishments:

• Established resident-involved, resident-driven participatory evaluation as a norm in community-based efforts to improve environmental conditions. The Evaluation/Dissemination grantee designed and implemented a culturally appropriate, community-based approach to evaluating the planning and implementation phase of CYCHI. Evaluation strategies included training community residents to develop and administer surveys, gather and analyze data, and to utilize statistical analysis software and other data collection techniques.
• Equipped young people with research and evaluation skills. The Evaluation/Dissemination grantee maintained consistent contact with wellness villages. They worked with each wellness village to track activities. They also provided feedback workshops that enabled residents and youth to reflect on the achievement of their objectives. In the first year of the planning phase, youth were given the opportunity to participate in an Evaluation Youth Summit. All of these activities motivated youth to utilize evaluation in the improvement of their community’s health.
• Encouraged the understanding and application of the World Health Organization’s definition of community health. The evaluator assisted the Foundation, the wellness villages and the field in better understanding how to implement empowerment research to advance community health.
• Developed site-specific survey instruments. Survey instruments were developed to collect data and address issues at each wellness village. Analysis of each village’s data assisted the village in evaluating changes in their infrastructure and rates of participation. Additionally, the Evaluation/Dissemination grantee worked closely with the Technical Assistance provider to support incorporation of “continuous improvement” feedback into technical assistance.

Challenges:

• The Evaluation/Dissemination grantee’s infrastructure challenged the organization’s capacity to work at a consistently high level over a long period of time. Senior researchers with faculty appointments and other consultant relationships did not have the time to provide the oversight for an evaluation component of this scope. The CEO’s time on the project was spread across management, coordination, evaluation, writing and other tasks that were difficult to accomplish in anticipated timeframes. These issues were discussed over a series of meetings, and improvements were made throughout the duration of the Initiative.
• During the initial stages of the Initiative, the Evaluation/Dissemination grantee compromised its objectivity. Participatory evaluation calls for the development of close working relationships between the evaluators and the wellness villages. The evaluators were in constant contact with the wellness villages, collecting data and offering feedback and evaluation training. However, as the working relationships developed over time, the evaluators often became too close to the wellness villages and, for a brief period, lost sight of the objectives and goal of the Evaluation/Dissemination Program. As a result, many of the wellness villages became too reliant on their senior researcher and undermined their own development and potential. These issues were also discussed over a series of meetings, and improvements were made throughout the duration of the Initiative.

Lessons Learned:

• Participatory Action Research is a relatively new approach that was successfully implemented into the Initiative. Participatory action research allowed adults and youth to assess the condition of their community through data collection and analysis. Wellness villages gained a better understanding of research and evaluation. Both adults and youth are now equipped to evaluate the progress of their wellness village.
• Wellness villages valued the use of qualitative methods. By using qualitative methods, the Evaluation/Dissemination grantee built strong relationships with the wellness villages.

The Initiative Advisory Committee provided the Foundation with knowledge and expertise regarding the Initiative from diverse disciplines. The Advisory Committee consisted of 18 members and nine alternates, with nine of the advisors being youth between the ages of 16 and 26.

Goal:

To be a resource for the Initiative and advise TCWF staff about developments in their respective fields that may affect progress and to advise on ways to conceptualize and implement programs.

Objectives:

• To convene, on a regular basis, a qualified group of advisors to comment on the progress of the Initiative.
• To incorporate that ideas of the Advisory Committee into the planning and implementation of various Initiative components.
• To communicate ideas and suggestions from the Advisory Committee through TCWF staff to grantees.

Accomplishments:

• Provided keen insight and guidance to TCWF. The Advisory Committee assisted TCWF staff in the review and selection process of the Wellness Village Program grantees.
• The Advisory Committee members’ expertise, diversity and high level of participation provided credibility to the Initiative and to TCWF.

Challenges:

• Convening individuals from across different parts of the country was difficult to schedule.
• The level of direct involvement by the advisors with the wellness villages did not meet the expectations of the youth advisors. The youth advisors wanted very much to provide support and advice to the wellness villages and were disappointed that their role as advisors prevented such involvement.

Lessons Learned:

• Advisory groups need to be managed well in order to gain value from their collective expertise.
• Advisory groups can help promote and disseminate information about the Initiative beyond the Foundation’s usual sphere of influence.
• Advisory group members, when engaged, bring remarkable insights that are useful to the Foundation and the grantees. They were most helpful in understanding policy implications for our work and the nature of youth/adult partnerships.
• Engaging young people on the Initiative Advisory Committee gave credibility to the work and yielded information about the challenges faced by grantees in accommodating youth.
• Advisors were assets in the proposal review, site visit and ongoing implementation of the Initiative.

Empowering the community contributes to positive changes in their physical, social and chemical environments to improve community health. Community health empowerment models emphasize that people must actively participate in, and take responsibility for, their own education while promoting the idea that community is capable of creating positive health changes beyond adaptations in their personal lives. In applying this approach to community health, community members first identify health problems that they wish to overcome and explore the individual, community and organizational bases of those problems. Once their skills and knowledge are strengthened, participants design community health actions that bring about structural changes that positively affect the underlying causes of problems they have identified. In addition, they are able to plan activities for projects that will encourage people to adopt health-promoting practices.

In recent summary conversations with the wellness village staff and volunteers, all expressed their gratitude in having the opportunity to engage in a long-term endeavor to improve community health. They also credited CYCHI for the positive changes in their communities. Their neighborhoods are cleaner and more beautiful; neighbors feel safer and proud of their community; parents are proud of their children; residents are part of decisionmaking processes; and youth and adults are more connected to each other. More importantly, they believe that their families and their communities are healthier as a result of their participation in CYCHI.

During the course of five years, CYCHI’s youth development approach created a cadre of young people committed to community health, social change and environmental improvements. Many young people involved in the wellness villages underwent significant and positive changes and developed and strengthened skills such as analytical thinking, problem solving, public speaking, networking and leadership. Many of the youth attribute the improvement in their academic performance, employment opportunities and social relationships to CYCHI. Because of their participation in CYCHI, young people who had never even thought of college are pursuing careers in health, community service and evaluation. CYCHI activities encouraged youth and adults to work together as partners, developing stronger social networks in their communities. The communities engaged in CYCHI proved capable of overcoming many challenges to successfully meet objectives that addressed their needs. Their work will continue to inform efforts in California that attempt to understand what is required to build community health from the bottom up as well as from the top down.