The Power of Collaborative Solutions

Six Principles and Effective Tools for Building Healthy Communities

Tom Wolff

• Publisher: Jossey-Bass
• Year: 2010
• Print ISBN: 9780470490846
• eBook ISBN: 9780470579589
• Edition: 1
• Topic: Business
• Subtopic: Business Development
• Index: Business

In this groundbreaking book, Tom Wolff spells out six proven principles for creating collabo- rative solutions for healthy communities. The Power of Collaborative Solutions addresses contemporary social problems by helping people of diverse circumstances and backgrounds work together to solve community challenges. Filled with clear principles, illustrative stories, and practical tools, this book shows how to make lasting change really happen.

Praise for The Power of Collaborative Solutions

"This is a truly transformative book and a must-read. Tom Wolff crafts a path to change that is at once visionary and achievable."
—MEREDITH MINKLER, professor of health and social behavior, University of California, Berkeley, and coauthor, Community-Based Participatory Research for Health (Jossey-Bass, 2008)

"If you want to bring about sustained positive change in your community, read this book. The stories will inspire you, and the lessons will shine a light on your leadership path."
—TYLER NORRIS, founding president, Community Initiatives

"Here you'll find not just theory, but also the hard-won, down-to-earth detail on how to make collaboration work where you live and act."
—BILL BERKOWITZ, professor emeritus of psychology, University of Massachusetts Lowell

"Tom has a tremendous fount of knowledge, and he knows just what to do with it and how to help others use it. His kind and commonsensical manner means that his intellect is accessible."
—LINDA BOWEN, executive director, Institute for Community Peace, Washington, D.C.

1

Why Collaborative Solutions?

HOW OUR HELPING SYSTEMS ARE FAILING US

ON SEPTEMBER 11, 2001, the New York City Police and Fire Departments had difficulty coordinating their actions because they were operating on different radio frequencies. Urgent messages between emergency professionals could not get through as they dealt with the tragedies at the twin towers. It seems that this is a metaphor for many of our modern approaches to community problem solving—we are struggling because groups that need to work together are on different frequencies, both figuratively and literally.

In the late 1980s, I heard Ann Cohn Donnelly, former director of the National Committee to Prevent Child Abuse, tell a story of being a young social worker and getting a request from one of her inner-city parents to come to the woman’s house on a Saturday morning. Donnelly arrived and found a room filled with people like herself. The mother of the family announced, “You are all social workers working with our family. I am going to leave the room. It would be really helpful for our family if you would talk to each other.”

Then there was the time I was working with a rural community coalition that was addressing issues of hunger and homelessness. The coalition members gathered the leaders of six local churches to find out what the religious groups had been doing to alleviate hunger among homeless community members. We asked who was serving warm meals during the week. Representatives of two churches raised their hands. We asked when these meals were served. The people from the first church said, “On Sunday, of course.” And the people from the second, rather sheepishly, said that they also served food on Sundays. In this small community, neither group knew that the only hot meals being served to homeless residents were served on the same day. One of the churches agreed to move its hot meal to the middle of the week.

Here’s another story. In a poor former manufacturing city in Massachusetts with a population of about forty thousand, we held a meeting of representatives of the existing community coalitions. These coalitions had been formed to coordinate activities on various topics. Coalitions such as these are often created out of goodwill, but the number of independent groups can proliferate due to external pressures—for example, state agencies that require coalitions dedicated to single topics. That was the case here. In this meeting, with ninety representatives of community agencies and city departments, we identified more than thirty-five coalitions working in a hodgepodge manner across the community. This array was confusing and wasteful. Similarly, a colleague has told me that in Mexico City there are more than ninety HIV programs. Duplication of effort seems rampant.

Too often we work as individuals rather than as part of a community or of a community of helpers. It is an “I” world rather than a “we” world. As a result, our approach to community problems is often ineffective.

This is not just a community problem. It happens in our individual lives as well. On a daily basis all of us encounter many ways that our world disconnects and makes our survival harder. People don’t talk with each other. People won’t work with each other. Your physician won’t speak to your specialist or your acupuncturist. Your child’s teacher doesn’t speak to your child’s therapist or privately hired tutor. Your plumber can’t make time to talk to your contractor. This lack of collaboration in our world hurts us all.

I recently had a painful swelling and clicking of a finger in my left hand. My personal physician diagnosed this as a “trigger finger” and didn’t think he could do much to alleviate my discomfort. He referred me to a surgeon, who suggested a cortisone shot or surgery. My holistic chiropractor suggested a regimen of supplements and tied the new symptoms to other systemic problems I was having. My acupuncturist treated my difficulty and cured it! But none of these people ever talked to each other.

Community Solutions Demand a New, Collaborative Approach

Our communities and our world face such complex problems that we no longer can solve them by gathering a few experts in a room and letting them dictate change. We need new ways to find solutions. Many of us now understand that the emerging problems that communities face have such complex origins that we can only fix them if we use comprehensive community problem-solving efforts rather than single-focus approaches. We need to meet and communicate and partner with each other, and we need to include representatives from all parts of our communities.

We cannot reduce youth violence using only a public safety approach. To find a solution, we need to have neighbors, clergy, and the young people themselves involved. We cannot fight childhood obesity by just asking individuals to show more self-control. We must also address school policies on access to junk food, as well as the advertised appeal and offerings of fast-food restaurants. Asthma rates in inner cities cannot be reduced without involving hospitals, health centers, housing authorities, environmental protection agencies, neighborhood groups, and the families of those most affected. Community solutions demand community collaboration.

In many communities, neighbors are disconnected from each other and continue to focus on their differences rather than their common interests. Organizations and institutions that might be working together to pursue a common purpose are too often ignorant of each other and focused on their own singular tasks.

I have spent much of my professional life in the community-based health and human service system, and was stunned early on to discover that this system does not make enough of an effort to collaborate in order to deliver the best possible services to those in need. Instead its habits are based on competition and fragmentation, and it resorts to collaboration only under great pressure. Because of this lack of collaboration, the so-called helping system has become extremely dysfunctional.

These dysfunctions have become so bad that they now provide a major impetus for changing the way we work. They are pushing us to create processes that encourage collaborative solutions to problems. This is true not only in health and human services, which is my area of concentration, but also across many other systems in the United States and around the world—in education, community development, community planning, national program development, and international peacemaking.

How Our Traditional Community Problem-Solving Methods Fail

Not only are our systems non-collaborative, our traditional problem-solving mechanisms are flawed as well. As nations, states, neighborhoods, and organizations attempt to solve problems, address issues, and build a sense of community, the one-dimensional approaches that have worked in the past utterly fail them. The problem-solving systems that we are accustomed to now struggle with a whole array of limitations. I’ll spend some time considering how the old ways are failing, but here are the realms in which they fall apart:

• Fragmentation

• Limited information

• Duplication of efforts

• Competition

• Crisis orientation

• Lack of connection to those most affected and their communities

• Blaming the victims and ignoring social determinants

• Lack of cultural competence

• Focus on deficits

• Excessive professionalism

• Loss of spiritual purpose

Now let’s take those shortcomings one at a time.

Fragmentation

We approach problems in pieces. Our helping system sees people through a fragmented lens. For example, in health care each of our medical specialists knows our organs, but who knows our whole being? The fragmentation is even worse than my “trigger finger” example suggests. My ophthalmologist knows my eyes, my internist knows my gut, my psychologist knows my mind, and my chiropractor knows my spine. But who knows how my eyes, gut, mind, and spine interact? Who understands how each of these aspects of who I am is affected by events in my life—personal traumas, losses, changes in diet, or exposures to toxic chemicals? In communities it is the same. My life, just like your life, is affected by all aspects of the community each of us lives in—by its businesses, government, parks, health systems, neighborhoods.

I once presented a theoretical case to a meeting of human service providers who all worked in the same community. I described a woman in her mid-twenties who lived in poverty, drank a little too much, couldn’t find work, and got a little too rough in spanking her children; who was married to a man who was a little too rough with her; whose kids were involved in street gangs; and who generally felt hopeless and depressed. I asked the room full of people, “If this woman came into your agency, how would you understand her and what would you do for her?”

The responses were fascinating. In short order, the group offered seven labels and diagnoses: depression (mental health agency), substance abuser (substance abuse agency), victim of domestic violence (domestic violence agency), child abuser (child welfare agency), disempowered woman (women’s center), victim of economic inequality (poverty agency), and at risk for homelessness (housing agency). No one could see her as a whole person. This fragmented reaction was not due to the people’s individual limitations but rather was produced by their agency missions, their personal training, and the compartmentalized helping system that compelled them to look at one aspect of this woman at a time.

Fragmentation of our helping systems and fragmentation of our solutions waste resources and prevent us from implementing holistic approaches that will make people’s lives substantially better. To be effective and appropriate, to really solve problems, we must use holistic approaches.

Limited Information

Those of us attempting to solve problems usually do not have all the information we need to generate the best possible solutions. Too often our information is limited by our personal or organizational view of the issue.

Human service agency personnel who work with complex families that are affected by multiple problems need to have resources and referral sources in multiple agencies across a community. Yet they often only have good referral relationships with one or two outside agencies. Consumers themselves are also short of the information and resources they need in order to make smart choices about where to get appropriate help and to find out whether they are eligible for that help.

Health care access is a perfect example of how missing information stymies attempts to provide health insurance for the uninsured. Not only do we have to provide affordable and accessible health coverage programs for citizens, we then have to get them information so that they can enroll in the programs we have made available.

My fellow workers and I learned this after Massachusetts created legislation that effectively provided universal health care coverage for all children. (This achievement was the precursor of the federal children’s health program called at the federal level SCHIP, the State Children’s Health Insurance Program. The federal program is called State CHIP or SCHIP because it allows each state to do its own children’s plan under some federal requirements.) Legislating coverage does not mean that all those in need will get what they’re newly entitled to, and eligibility is not the same as enrollment (DeChiara and Wolff 1998). We spent four years in a massive outreach and education campaign across the state trying to get enrollment information to all the pockets of uninsured children and their families. This mainly meant working with groups who were the recipients of state outreach grants, groups that represented the yet-to-be-reached individuals—immigrants, cultural and racial minorities, the rural poor, and others. Access to the right information was as important for our goal of moving uninsured children to coverage as was the legislation. (The full story of the Health Access Networks is told in Chapter Seven.)

Sometimes changes can be made successfully only if we develop new channels for sharing information. Deinstitutionalization, the process of changing from predominantly institutional to community-based treatment for people with mental illnesses, provides an example of how important clear, open, and multidirectional communication can be.

For nine years, I chaired a group called the Mayor’s Task Force on Deinstitutionalization for the city of Northampton, Massachusetts. Both a state mental hospital and a Veterans Administration hospital were in the process of closing their long-standing mental health units and releasing patients into the community. This produced a fair amount of chaos, conflict, and confusion in the city. The mayor had brought together all the critical players for monthly meetings, and he asked me to be the chair. I learned a lot from the experience, and will discuss it in depth in Chapter Four. In short: although the initial meetings involved much high-volume disagreement, we were slowly able to quiet the discourse and get people to hear each other (Wolff 1986).

What did they learn? What information was exchanged that made a difference?

People working in the mental health system learned that when a city police officer waited in the emergency room of the general hospital for the mental health department’s psychiatrist to show up to assess a violent patient, the mental health system was tying up fully one-third of the city’s available police patrols. The mayor and the police learned why the patient who broke a window in an ice cream shop on Friday night and was admitted to the state mental hospital that evening had been released back into the community two days later. The patient could not be kept hospitalized without being legally declared “dangerous to self or other,” and window-breaking didn’t count toward that status.

Both of these situations had caused great conflict between the city and the mental health system. Each resulted from a simple lack of information. However, the resulting problems could only be dealt with when the appropriate people were sitting in a room together and were ready to start hearing each other.

A lack of crucial information keeps consumers from finding appropriate resources, and keeps helpers from effectively working with each other. We all need reliable information and good communication systems.

Duplication of Efforts

We often think there is duplication of services and waste in the helping system. In reality the big problem comes from duplication of efforts, more than specific services. This means that several groups in a community are working on the same problem without knowing about each other. Collaborative solutions cannot be found until people begin to consolidate their efforts.

Here’s an example of duplication of effort in one small community. The topic is reducing teen pregnancy. One group gathers at the family planning agency, another addresses the problem at the state Department of Public Health, and a third forms at the high school. The groups don’t know about each other.

This happens again and again.

In the federal government, the cabinet-level Department of Homeland Security was established because the events of 9/11 made it clear that the several agencies responsible for making the country secure were not working together. Combining a number of mega-institutions under one secretary by no means guarantees that those organizations will coordinate their efforts, in the same way that moving a group of agencies into the same building does not guarantee that they will coordinate their services. We will see different results only if these groups follow the principles that lead to collaborative solutions.

At the kick-off meeting of the year for a community coalition in a small community, we asked the participants, “What’s new in your agency? What’s happening?” Three different mental health counseling agencies had representatives in the room. One agency had been in town a long time. It had recently lost contracts, so its staff member told about offering fewer services. A small counseling agency had expanded by merging with an agency outside the community. Its report included a marketing plan for expanding services. The third agency was brand new to the community. It had won the contracts that used to go to the first agency, and its representative talked about the organization’s new commitment to the area.

As we looked around the room at the other participants who came from agencies that provided services in other areas, we saw a lot of blank looks. We knew what those blanks were covering up: the other people in the room were struggling with the question, “Now, with all these changes where do we refer people who need mental health help?”

We asked the representatives of the mental health agencies to explain to people how the three organizations worked together, where people should go for which services, and whether their offerings included any overlapping services. The mental health providers acknowledged that those were great questions, but said that before they could answer t...

Table of contents

• Epigraph
• Title Page
• Copyright Page
• WEB CONTENTS
• Foreword
• Dedication
• PREFACE
• Acknowledgements
• THE AUTHOR
• Chapter 1 - Why Collaborative Solutions?
• Chapter 2 - Building Healthy Communities Through Collaborative Solutions
• Chapter 3 - Encouraging True Collaboration
• Chapter 4 - Engaging the Full Diversity of the Community
• Chapter 5 - Practicing Democracy
• Chapter 6 - Employing an Ecological Approach That Builds on Community Strengths
• Chapter 7 - Taking Action and Working for Social Change
• Chapter 8 - Engaging Spirituality as Your Compass for Social Change
• CONCLUSION
• APPENDIX - Evaluation: Assessing Our Progress and Celebrating Our Success
• REFERENCES
• INDEX
• This constitutes a continuation of the copyright page.