|
GRANTWATCH: REPORTStrengthening A State’s Health Advocacy Infrastructure
Although coordination among advocates may be a critical ingredient for achieving health policy change, opportunities for discussions that lead to cooperation among advocates are rare. For the past seven years, the California Wellness Foundation has funded an annual two-day retreat for California health advocates. These gatherings have created a reflective time period for them to consider their differing advocacy agendas as well as areas of overlap. The retreats have also helped to soften the fault lines that can be barriers to cooperation. An independent evaluation has provided some important points for foundations to consider when making grants for such a retreat.
MANY NONPROFITS are so busy doing their work that they lack time to consult with others doing related work. For nonprofits engaged in public policy and advocacy, consultation and collaboration can be particularly important to successful advancement of a policy agenda. Yet, too often, groups do not consult one another when they are formulating their agendas. For example, well-established advocacy groups frequently take for granted that their agendas will be rubber-stamped by newer (generally smaller) organizations. The newer groups are called upon to sign on to support letters or to appear at press conferences with no prior consultations on the policy being proposed. These groups generally comply with the request because they support the policy, but at the same time, they feel disrespected and used. The hard feelings that may result from the lack of consultation create tensions that make it more difficult for groups to work together. At worst, the groups end up working at cross-purposes from each other, leaving policymakers confused about the action they should take to remedy the problem identified. To address this challenge in California, in 1999 the California Wellness Foundation (TCWF) hosted a retreat for health advocates in California working on access-to-care issues. Some were TCWF grantees; others were not. The idea that prompted the retreat was simple: If people have the opportunity to get to know one another better, they might work together more effectively. The foundation had three goals for the retreat: provide an opportunity for reflection and strategic thinking about common challenges and opportunities ahead; strengthen the relationships among participants and organizations; and identify opportunities for new collaborations. During the past six years, 139 people representing more than thirty health advocacy/policy organizations have participated in retreats. Most work at the state level, but some are key local advocates. Overall, the participants represent the diversity of California; more than half are people of color. One-fourth of the participants have attended at least four retreats; 39 percent, at least two; and 36 percent, only one. Each retreat is framed around a theme related to strengthening advocacy. When the first retreat was held, TCWF program staff did not know if there would be a second; the answer was to depend upon whether participating advocates felt that the retreat was useful. Foundation staff did not attend the first retreat, because they felt strongly that their presence could distort the conversation—participants might pitch their remarks to the funders instead of speaking candidly with each other. The first retreat was quite contentious, as grievances about how the groups treated one another were aired, and differences between state policy groups and grassroots organizations as to policy approaches were debated. Despite this, the retreat was highly rated, and attendees said that they would like a second one. Since then, the retreat has become an annual affair. It has been facilitated by the same two consultants for the past six years. This has provided valuable continuity and created a strong bond of trust between the participants and the facilitators. As a result, the facilitators are able to push participants to deal with difficult issues. The retreat goals have remained the same over the years. It is important to note that the agenda, which is designed by a committee of past participants, is very much a retreat agenda. The two-day period is a time for reflection and networking, not for hearing lectures or developing a plan of action. The use of outside speakers has led to mixed results. Provocative speakers discussing a subject of interest to everyone and outside of participants’ areas of expertise—for example, new approaches to message development—were praised. However, speakers on issues about which participants were knowledgeable, such as community organizing, were criticized. At the request of the participants, TCWF staff now attend the latter half of the retreat, allowing for a time of informal give-and-take between foundation staff and participants. The only major change over the years has been the composition of the invitation list. In the early years, invitations were limited to an organization’s executive director or senior health policy staffer. This kept the retreat small, averaging thirty people. After a retreat on leadership development, the executive directors asked if they could bring an "emerging leader" from their group to build staff leadership capacity. Although the increased attendance—about fifty participants—has changed the intimate nature of the retreat, it has also brought new energy and ideas. The challenges now are to keep attendance of executive directors high as the exclusivity of the retreat changes and to maintain regularity in attendance. Some executive directors send different emerging leaders each year as a reward and to "get the retreat experience," which then does not allow for deeper networking among colleagues who have formed connections at earlier retreats.
In 2005 TCWF commissioned an independent evaluation of the retreat to assess its value for the health advocacy community.1 Measuring the direct impact of grants on policy change is extremely difficult to do, as noted in a recent Foundation News and Commentary article.2 Many factors affect whether legislation is enacted—the political and economic environment, and what else is on the legislative agenda, to name a few. With these factors plus the work of grantees influencing legislation, it is unfair to hold them accountable for whether they succeed in achieving the policy changes that their grants seek. For this type of grant, TCWF, of course, keeps its eyes on the policies that are at issue but evaluates grantees on measures that are more within their control. This evaluation for TCWF focused on attendees’ perceptions of the retreat’s indirect effects on their advocacy work. The evaluation consisted of an online survey sent to 110 past retreat participants, of whom 53 percent responded. Sixteen respondents were then interviewed by telephone. About half of the respondents to the online survey were executive directors. The response was overwhelmingly positive. Networking was identified as the retreats’ most important benefit, rating a 4.7 on a scale of 1 to 5, with 5 being the highest. Several retreat participants indicated that the retreat has helped to "legitimize" the voices and the experiences of community-based advocates working with low-income and ethnic-minority populations. The retreat has also helped reduce the tension between advocates working at state and community levels. The statement that health advocacy groups are working better together to address health policy issues as a result of the retreat also received a high rating. As one chief executive officer (CEO) respondent said, "We’re far from unified as a voice for our different constituencies, but at least we have stronger, more cohesive relationships, and that’s a real plus." The evaluation also found that the retreat was especially valuable for executive directors and emerging leaders who were new to their positions because it offered a unique opportunity for new advocates to get up to speed on a wide variety of health policy issues. "A major fast-forward" was how one respondent described it; others voiced similar sentiments. It was difficult to determine how much collaboration was occurring as a result of the retreat, because many participants had already worked together; however, the survey found that the retreat had helped solidify relationships and "remind us who else is out there to work with." As a direct result of the first retreat, members of a new collaborative decided to include two new groups, representing communities of color, with whom they had spoken at the retreat. The collaborative was formed to ensure that consumers’ voices were represented in the development of the newly established California Department of Managed Health Care. One success of this collaborative was a requirement that state report cards on health maintenance organizations (HMOs) include rankings on cultural and linguistic competence; this goal might not have been such a high priority had the collaborative not included the two groups focused on ethnic health. There has been an ongoing tension around developing policy agendas at the retreat. A small faction has wanted to come away from the retreat with an "action plan," feeling that the retreat was not capitalizing on the opportunity to focus on products or outcomes such as a collaborative health advocacy agenda for California. Most participants reported, though, that they did not see the retreat as the appropriate venue for such an ambitious undertaking, in part because important partners might not be there. These participants saw the retreat as having instrumental value in informal policy development, simply as a result of the networking. In the retreat’s early years, participants always asked about TCWF’s reason for holding the retreat. It took years for some participants to understand that the foundation simply wanted to provide an opportunity for health advocates to get away from their daily work and spend time getting to know one another, discuss the larger policy picture, and identify opportunities where they might work together. The foundation sees the retreat as an important strategy in building a stronger state health advocacy infrastructure and plans to continue to fund the annual retreat until advocates suggest that it is no longer useful.
As TCWF staff have mentioned the retreat at meetings with colleagues from other foundations, a few funders have begun to adopt the idea. The Missouri Foundation for Health (MFH), for example, has held three annual retreats for the health advocacy community in that state. The two-day event includes approximately thirty people from nearly twenty organizations across the state. At the 2005 MFH advocacy retreat, one long-standing Missouri advocate commented that working cooperatively with other advocacy groups has become much more natural and frequent now that the MFH has provided the groups with unstructured time together. Another noted that the MFH’s best contribution to advocates has been the opportunity for them to gather without a specific legislative crisis as the focus of their meeting. Some advocates would like support to create a shared strategic plan for coordinated statewide health advocacy, while others simply value the exchange of ideas with colleagues.3 As funders explore the usefulness of retreats for the health advocates in their states, there are two important questions to consider: What is the purpose of the retreat, and who should be invited? The answer to the first question will determine the answer to the second. If the retreat’s goal is to strengthen the health advocacy infrastructure with no demands for a policy outcome, as is the goal of TCWF and the MHF, then participants need to be representative of the state health advocacy organizations, regardless of their grantee status. In TCWF’s case, some participants did not represent health advocacy groups but were, as individuals, considered important players in the health policy debate—for example, heads of prominent community clinics. If the goal of the retreat is to have advocates develop an agenda, it is critically important that all of the right people be in the room. Whoever is invited, it is important to have clearly established criteria because word spreads quickly, and members of the health advocacy community who were not invited will want to know why. After seven years the TCWF advocates’ retreat has become an institution. Although it is difficult to point to any specific policy outcomes that have resulted from the retreat, there is no doubt that it has strengthened California’s health policy advocacy infrastructure.
Ruth Holton-Hodson (rholton{at}tcwf.org) is director of public policy at the California Wellness Foundation (TCWF). Ruth Brousseau is director of evaluation and organizational learning at TCWF. Both authors are based in TCWF’s San Francisco office.
| ||||||||||||||||||||||||||||
Top
Evaluation Of TCWF's Retreats
Another Funder Adopts The...
