California Health Insurance FamilyThe Program takes a multi-tiered approach that includes technical assistance, funding, promotion, coordination and collaboration, systems reform, program evaluation, and celebration.

Technical assistance. The goal of the Programs technical assistance services is to help participating cities and communities to develop, implement, and evaluate community-driven programs, policies, and plans for improved quality of life. Site-specific technical assistance is tailored to each community’s characteristics—recognizing its assets and challenges—to facilitate the discovery and sustainability of its collective wisdom and power. In addition, the Program facilitates networking and peer-to-peer exchange among communities in order to share resources and institutionalize best practices.

The Program provides the following forms of technical assistance: consultation, educational programs, literature and information, and a resource clearinghouse.

Consultation. The Program provides on-site skill-building consultation to community coalitions on such topics as governance, collaborative planning, systems thinking, and intersectoral coalition building. While technical assistance is often provided on request, the cultivation of pos itive relationships between Program staff and communi¬ties also allows the Program to identify challenges and proactively provide assistance and resources. This approach results in the integration of technical assistance into ongoing local planning and development. For exam¬ple, the Program staff often receives requests from com¬munities to participate in coalition retreats and vision workshops and for assistance in making presentations to governing bodies.

The Program also helps to facilitate communication within community coalitions. Staff members’ facilitative role includes assisting communities to bridge knowledge gaps and cultural understandings among residents, orga¬nizations, and institutions and to foster collaborative rela¬tionships to develop a collective vision, shared values, and mutual exchange of skills and resources. In this role, the Program also serves as a sounding board for commu¬nities, offering an “outsider” perspective that can present and interpret different viewpoints. California’s changing demographics challenge communities to embrace ethnic and cultural diversity as part of a commitment to full par¬ticipation. Program staff members have recommended strategies that are responsive to existing or emerging cul¬tural norms and that engage ethnic communities through inclusive and empowering approaches.

Technical assistance also has a role in monitoring community progress. Program participants submit progress reports and annual work plans. Review of reports and consultation on work plans provides opportunities to assess the integration of the Healthy Cities and Commu¬nities model. Program staff members identify local suc¬cesses and challenges, offer recommendations (including lessons learned from other communities), and assess the use of technical assistance.

Educational programs. The Program also sponsors interac¬tive educational programs to promote learning and the sharing of community-building skills. These include day¬long orientation sessions, an annual conference, and regional workshops. Through the exchange of informa¬tion, resources, and stories, the Programs educational opportunities help participants in their community improvement efforts and broaden their understanding of what it takes to do this work; develop and nurture rela¬tionships among participants; and energize and support all those in attendance (including Program staff).

Each educational event models Healthy Cities princi¬ples by involving program participants in the planning, implementation, and evaluation. For the annual confer¬ence, participants are surveyed on their interest with regard to content, and a planning committee of community representatives develops the agenda and conference format and identifies speakers.

The majority of the conference speakers and work shop facilitators are community residents. Meeting “ground rules” are posted, and “jargon police” monitor the use of acronyms and language that can be exclusionary. In the last eight years, attendance at the annual conference has grown more than five-fold, to over 270 participants.

A recent technical assistance survey of participating communities indicated great interest in the areas of: lead ership development, Healthy Cities and Communities “basics,” sustaining coalitions, inclusive community building strategies, and using evaluation results for advocacy. Participants also indicated a high level of willingness to be involved in educational sessions as hosts, participants, or facilitators. As a result of this interest and the growth in the number of participating communities, the Program will sponsor regional workshops to provide more accessible opportunities for sharing expertise. These workshops will be hosted by participating communities, will have minimal registration fees, and will offer low-cost meals.

Literature and information. As part of technical assistance, the Program provides participating communities with literature, including a comprehensive resource guide; Connections, our quarterly newsletter; and biannual mailings of Highlights, a bulletin of funding opportunities, best practices, innovative community-building strategies, and useful websites. Additionally, the Program makes available the latest reference materials on various topics, including meeting facilitation, coalition-building, and evaluation. The Program also maintains an electronic mailing list and website.

Resource clearinghouse. Each year, the Program receives hundreds of in-state inquiries and requests for information from throughout the United States and abroad. To respond to these, the Program has developed a wide selection of literature that explains the Healthy Cities and Communities concept and profiles, in a mini-case study format, the background, experiences, and results achieved by program participants. Planning guides have been developed on youth violence prevention, promoting youth development, and tobacco control and sent to thousands of professionals and activists.

The Program provides an important link to practitioners in the community-building field and the Healthy Cities and Communities movement nationally and internationally. For instance, as part of the Coalition for Healthier Cities and Communities, the Program assisted with nationwide dialogues on community-building in 1999-2000.

Funding. The initial funding for the Project was provided through the Preventive Health Services Block Grant from the Centers for Disease Control and Prevention, administered by DHS. This funding has remained at the same level since 1993. In the last few years, additional funding streams have been added to increase local grants, bolster the infrastructure of the state program, conduct a cross-site evaluation, and support special projects, such as conference scholarships and publications. Resource limitations, and a goal of engaging communities that are genuinely committed to Healthy Cities and Communities principles, determine local funding strategies. At first, for the Projects demonstration program, the only financial assistance provided was for travel to Project-sponsored meetings. The Project also had a small reserve for consultant contracts to be used locally. Frequently, however, communities needed resources for implementing the most basic activities of their work plans, for example, community outreach and local promotion.

Since 1993, the Project (and later the Program) has offered cities seed grants of $5,000 to $10,000 per year, based on population size. Typically, these awards have been used to offset costs for student and participant stipends, incentive or promotional items, and evaluation. Awards are granted on a merit basis; the criteria include focus, cohesiveness of work plans, community commitment, and evaluation methodology. Additionally, past per ormance and organizational integration of the Healthy Cities philosophy are considered for renewal applica ions. In addition to direct awards from the Program, millions of dollars have been leveraged. For every dollar pro-vided, cities have brought in more than eight dollars. Incalculable in-kind resources have also been generated.

Over time, state health department programs and external organizations have sought assistance from the Project for work on specific health promotion topics. In 1995, the Project began formalizing partnerships that resulted in categorical funding opportunities for participating communities. Over the last four years, approximately 25 awards, averaging $28,000 each, have been given for injury control, food security, cardiovascular and cancer disease prevention, and tobacco control projects. These awards, which have been made available to program participants on a competitive basis, have served as a catalyst for securing or reconfiguring resources.

In 1997, the Program received a small grant from the California Endowment to enhance the work of four
promising participants through one-year implementation grants. In addition, planning grants were made to two “budding” coalitions. The next year, a five-year, $5-million grant from the Endowment allowed the Project to expand into the Program, California Healthy Cities and Communities. The key audience for this grant program is communities that are just beginning to coalesce around Healthy Cities and Communities principles and that have disparities in income, educational status, or other demographic variables associated with health status inequities or health risk. Priority is further given to geographically, socially, or culturally isolated communities, including neighborhoods, unincorporated areas, and areas that cross jurisdictional boundaries.

Over a five-year period beginning in 1998, 20 communities will receive planning and implementation grants of $25,000 each. On successful completion of the planning phase, the program will make available implementation grants of up to $50,000 a year for two years. A 50% match is required for each of the implementation grants; the matching requirement is imposed to emphasize the need to plan for sustainability from the beginning.

Promotion. The Program has invested heavily in a multi-pronged information campaign to create a Healthy Cities and Communities movement in the state. Strategies have included enlisting key leaders, including policy makers and administrators from constituency groups the Program wants to reach; formal presentations as well as personal contacts; and widespread distribution of publications.

The language of Healthy Cities and Communities has always been a struggle. The term itself, while appealing and wholesome, is still confused with medical, or sick, care. Even people who understand the model and who may have participated in the Program for years, need the tools and appropriate “everyday language” to describe what this work is about to the community at large and their colleagues. Drawing connections to quality of life issues such as education, the environment, and the economy will often strike a responsive chord.
Enlisting city government officials, including city managers and key department heads, as spokespersons for the Healthy Cities movement has been one of the most effective promotion methods. These people have credibility because they are well-respected and active in their professions and can be vigorous advocates among their peers. The value of these peer-to-peer transactions cannot be overstated because they lend access to a larger audience. Spokespersons for the Program can also “translate” the Healthy Cities message with language familiar to their disciplines.

For example, in one case, a city manager made presentations to state and national audiences and wrote a feature article in the magazine of the International City/County Management Association. He also organized a staff team to visit another Healthy City to learn from its experience. So-called “social entrepreneurs” like this city manager come from a wide variety of fields, including public administration, community services, recreation, public safety, community development, and human services. In the policy making arena, the Programs Califor¬nia Smoke-Free Cities Program worked with city council members who championed the cause of clean indoor air not only in their jurisdictions but also with their counterparts in local and state government.

Another strategy for promotion is to go to the venues that attract the audiences we want to reach. Annually, Program staff members make dozens of presentations to community groups and at meetings of elected officials and of profes¬sional associations for public health, park and recreation, health care, education, and human services professionals. The Program routinely exhibits at the League of California Cities’ annual conference and other meetings.
To further promote the Healthy Cities and Communities message, the Program publishes a quarterly newsletter, Connectionsf which is mailed to more than 6,500 people. At the municipal government level this includes the mayor, council members, city manager, and various department heads in all of California’s 473 cities. It is also sent to health officers, administrators, health education directors, and division directors of local public health departments.