Lessons Learned about Sustaining a Coalition Targeting Latinos

From the five-year Latino Health Access Coalition of Bedford and Coffee Counties

Advantages of Using a Coalition Structure to Address Health Access of Latinos

• Brings together diverse community members who do not normally meet face-to-face.
• Provides a neutral ground for exchanging ideas and information.
• Unify community structure: raises public awareness and reduces duplication and fragmentation of services.
• Advocates for an issue.
• Fosters trust among members.
• Not a magical cure --- does require work and leadership.

Leadership

• Rotate leadership.

Meetings

• Keep meetings at the same place, time and date.
  • As the coalition progresses, monthly meetings may not be necessary.
  • Changing meeting places leads to lower attendance because people forget where the meeting is going to be or forget directions.
• Luncheon meetings are best. Coalition members can attend during their lunch hour. Health care professionals from health departments, clinics, hospitals, and mental health clinics have a difficult time getting away outside of the lunch hour.

Member Participation

• Regular attendance is not critical.
  • Coalition members are very busy, with limited time to commit to this effort.
• Be inclusive.
  • Invite a variety of community members who serve or hire Latinos.
• A core group will actively participate in the coalition. They represent organizations who will gain by participating in the coalition. This group may know each other and have worked together successfully in the past. The rest of the membership will be fluid in response to the type of activities being coordinated by the coalition.
  • Accept that the membership will be fluid.
  • Meeting attendance will vary.

Communication

• Meeting agendas and minutes are critical.
• Use other forms of communicating with coalition members such as conference calls, e-mails and coalition Web site.

Latino Representation on the Coalition

• Include representatives from the Latino community on the coalition.
• In rural communities, it is difficult to include members of the Latino community.
  • Unless the Latinos are bi-lingual, language is a barrier.
  • Many Latinos are intimidated by professionals.
  • Not accustom to working with Anglos.
  • Many are not here legally so fear community organizations.
  • Finding Latino community leaders is challenging if the coalition does not have bilingual members who can easily access the Latino community and serve as their advocate.
  • It is not the cultural demeanor to serve in an advocacy role. Challenges focus more on the family and maintaining a job.
  • This coalition was able to build the bridges necessary to access the Latino community because of the bilingual program assistant with UT Extension in Bedford County. She was a Latina.

Cultural and Linguistic Competency of the Coalition Members

• Build linguistic and cultural competency of the membership by inviting experts to speak at the coalition meetings.
• At the meetings, practice using Spanish phrases such as hola for hello, gracias for thank you, adios for goodbye, muy bien gracias for very well thank you, and por favor for please.

Decision-Making

• Include as much of the membership in the decision-making process. This generates a sense of program ownership.

Team Building

• Recognize that the coalition is a team. There are four stages of team development: forming, storming, norming and performing. Each stage must occur before the majority of the members (core group) can function as a team.

1. Forming: In this first stage, there is a lack of common ground. Each person present at the coalition meeting is questioning why certain people are there. At this stage, it is critical for the coalition leader/chair to provide opportunities for members to get to know each other and discuss their expectations of the coalition.
2. Storming: At this second stage, each member is struggling with his/her role. The group is struggling with how to work together. The coalition leader must encourage open discussion of feelings and frustrations, avoid an authoritarian role, and establish meeting rules with input from members.
3. Norming: At this stage, members begin to be comfortable with each other. They begin to fit together and the team begins to "bond." Each member now accepts each other’s style, needs, and expectations. The overall mission of the coalition is accepted by all. The coalition chair needs to model cooperative behavior and focus on the group not the individual.
4. Performing: This the final stage of team development. The team now has a system for communication and a structure for working together. The coalition moves as a team. It is critical that the coalition chair serve as a catalyst to maintain this stage by working on tasks and building relationships.
• While the four stages of team building are vital, we found it advantageous to the coalition if team building is viewed as an ongoing, "growing" process. A somewhat "loose," less rigid structure may prove invaluable. A coalition does not simply move from stage 1 to 2, 2 to 3, 3 and on to 4 where the works begins. The group evolves as new people come to the meetings, make a contribution (or not), and go (or choose to stay). Performing takes place continuously as people bond, develop relationships and discover role(s) and degrees of commitment. A coalition may never feel a strong sense of "at last, we've arrived," and yet when looking back, see that they have accomplished a great deal.

Benefits of a Coalition Structure to Address Improving Health Access of Latinos

• We found a coalition structure to be an effective structure for making community changes.
• Cost little, modest time commitments, no special expertise required, and pooling of talents of community members
• Links people from different areas of the community to deal with a community problem

Coalition Successes

• Recognize that a coalition does not last forever.
  • Dissolve it if the goals have been met or the coalition is no longer effective.
  • Not all coalitions are effective.
  • Coalitions consist of people who may lose interest in the issues or their job focus changes.
• Regardless of the outcome, the shared effort of the coalition leaves members with:
  • Surprises
  • Memories
  • Mutual respect
  • Lasting community networks/partnerships
  • Lasting impact on a community problem

Suggested Resources on Coalitions

• Kaye, G. and Wolff, T.: From the Ground Up: A workbook on coalition Building and community Development. AHEC/Community Partners. 2nd Edition Spring 1997.
• Berkowitz, B. and Wolff, T.: The Spirit of the Coalition. American Public Health Association, Wash., D.C., 2000.
• Kretzmann, J. and McKnight, J.: Building Communities From the Inside Out. ACTA Publications, 1993.
• Winer, M. and Ray, K.: Collaboration Handbook: Creating, Sustaining, and Enjoying the Journal. Amherst H. Wilder Foundation, 2000.