BHSOAC
Eval Deliv 4 Approved
Read the report at Behavioral Health Services Oversight & Accountability Commission ↗
MHSA Community Program Planning
Processes
Deliverable 4: Report of Other Public Community Planning Processes
Project/Agreement #12MHSOAC009
Prepared by:
Resource Development Associates
Primary Author: Jennifer Susskind, MCP
Contributors: Laurel Duchowny; PhD, John Cervetto, MSW; Eric Sloan,
MA; Roberta Chambers, PsyD
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Table of Contents
Introduction ........................................................................................................................................3
Chapter 1: MHSA-Defined CPP Principles and Practices ........................................................................4
Chapter 2: Public Community Planning Theory, Frameworks, Models and Case Studies ........................7
Community Engagement Framework ................................................................................................9
Community Readiness Framework ................................................................................................. 13
The Active Community Engagement (ACE) Continuum .................................................................... 17
Community Based Participatory Research ...................................................................................... 21
Neighborhood Planning Framework ............................................................................................... 24
Public Engagement in Education ..................................................................................................... 28
Mobilizing for Action through Planning and Partnerships (MAPP) ................................................... 32
Community Dialogue in Health Impact Assessments ....................................................................... 35
Participatory Budgeting ................................................................................................................. 38
Community COPE ........................................................................................................................... 41
Use of Technology in Community Planning ..................................................................................... 45
Chapter 3: Application to MHSA Community Program Planning .......................................................... 49
Principles and Practical Applications for MHSA Community Program Planning ................................ 49
Bibliography ...................................................................................................................................... 57
Appendix 1: Eight CPP Principles and their Sources ............................................................................. 62
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 2
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Introduction
The purpose of the Mental Health Services Act (MHSA) Community Program Planning (CPP) Process
Evaluation (herein “Evaluation”) is to use a participatory research process to measure the impact and
effectiveness of CPP processes in California’s 58 counties and two municipalities that provide public
mental health services (herein “California counties”). The Evaluation will identify Promising MHSA CPP
Practices, which will be incorporated into a curriculum and trainings that will be made available to
California counties and taught to stakeholders throughout the State of California.
This document supports the Evaluation aims by investigating public Community Planning processes,
including their theoretical underpinnings, principles, frameworks and specific methods and activities, in
arenas other than public mental health departments. Practices gleaned from this report may be used by
MHSA CPP stakeholders to inform future MHSA CPP processes.
In preparation of this report, the Evaluation Team conducted a review of relevant literature, interviewed
nine informants, and identified frameworks, models, principles and practices that could apply to MHSA
CPP process advancement. The evaluation team reviewed literature and interviewed informants with
knowledge of community and neighborhood development, land use, disaster and emergency planning,
education, the environment, housing, public health, transportation, and violence prevention. The key
informant interviews targeted academics, researchers and practitioners knowledgeable about
comparable public community planning processes, including individuals with experience working in the
U.S. and internationally. Key informants were asked to describe examples of effective community-based
program planning processes and to recommend theoretical frameworks and additional thought-leaders
and practitioners of community planning processes for the evaluation team to research. The selected
case studies derive from our literature review as well as recommendations from the key informants and
represent a breadth of community planning processes across multiple fields that use a variety of
approaches.
This report includes three chapters and an attached bibliography. The first chapter provides an overview
of the principles and requirements of the MHSA CPP process, as articulated in California legislative codes
and regulations. The second chapter offers theoretical frameworks, models, and case studies of public
community planning processes facilitated by public agencies and institutions outside of mental health.
The third chapter describes the ways in which comparable public community planning processes could be
considered by MHSA planners and stakeholders. The bibliography includes documents accessed in the
preparation of this report.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 3
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Chapter 1: MHSA-Defined CPP Principles and Practices
The MHSA Community Program Planning process is defined in California Codes and Regulations. By law,
County MHSA CPP processes must adhere to the following general standards:
Community Collaboration is a process by which clients and/or families receiving services, other
community members, agencies, organizations, and businesses work together to share
information and resources in order to fulfill a shared vision and goals (Title 9, California Code of
Regulations, §§3320 and 3200.060).
Cultural Competence means that equal access is provided to equal quality of services to all
racial/ethnic, cultural and linguistic communities. Disparities are identified and strategies
developed to eliminate disparities. Cultural competence means that program planning and
service delivery takes into account diverse belief systems and the impact of historic forms of
racism and discrimination on the mental health of community members. Services and supports
utilize strengths and forms of healing that are unique to an individual’s racial/ethnic, cultural and
linguistic community. Service providers are trained to understand and address the needs and
values of the particular communities they serve, and strategies are developed and implemented
to promote equal opportunities for those involved in service delivery who share the cultural
characteristics of individuals with SMI/SED in the community (summarized from Title 9, California
Code of Regulations, §§3320 and 3200.100).
Integrated Services Experience means the client, and when appropriate the client's family,
accesses a full range of services provided by multiple agencies, programs and funding sources in a
comprehensive and coordinated manner ( Title 9, California Code of Regulations, §§3320 and
3200.190).
Client Driven means that the client has the primary decision-making role in identifying his/her
needs, preferences and strengths and a shared decision-making role in determining the services
and supports that are most effective and helpful for him/her. Client-driven programs/services use
clients' input as the main factor for planning, policies, procedures, service delivery, evaluation,
and the definition and determination of outcomes (Title 9, California Code of Regulations, §§3320
and 3200.050).
Family Driven means that families of children and youth with serious emotional disturbance have
a primary decision-making role in the care of their own children, including the identification of
needs, preferences, and strengths, and a shared decision-making role in determining the services
and supports that would be most effective and helpful for their children. Family-driven
programs/services use the input of families as the main factor for planning, policies, procedures,
service delivery, evaluation, and the definition and determination of outcomes (Title 9, California
Code of Regulations, §§3320 and 3200.120).
Wellness, Recovery and Resilience focused means that planning for services shall be consistent
with the philosophy, principles, and practices of the Recovery Vision for mental health
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 4
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
consumers: “To promote concepts key to the recovery for individuals who have mental illness:
hope, personal empowerment, respect, social connections, self-responsibility, and self-
determination. To promote consumer-operated services as a way to support recovery.” (MHSA
Section 7, W&I §5813.5(d))
MHSA CPP processes, per legislation and regulations, must include the following participants and
processes:
Clients and family members: Involvement of clients with serious mental illness and/ or serious
emotional disturbance and their family members in all aspects of the Community Program
Planning Process (WIC, § 5848(a)).
Broad-based constituents: Participation of stakeholders defined by Welfare and Institution Code
Section 5848a as adults and seniors with severe mental illness, families of children, adults, and
seniors with severe mental illness, providers of services, law enforcement agencies, education,
social services agencies, veterans, representatives from veterans organizations, providers of
alcohol and drug services, health care organizations, and other important interests (WIC, §
5848a).
Underserved populations: Participation from representatives of unserved and/or underserved
populations and family members of unserved/underserved populations (CCR, 9 CA § 3300).
Diversity: Stakeholders that “reflect the diversity of the demographics of the County, including
but not limited to, geographic location, age, gender, and race/ethnicity, and have the opportunity
to participate in the Community Program Planning Process” (CCR, 9 CA § 3300).
MHSA CPP processes, per regulation must include:
Training (CCR, 9 CA §3300).
Outreach to clients with serious mental illness and/or serious emotional disturbance, and their
family members, to ensure the opportunity to participate (CCR, 9 CA §3300).
A local review process prior to submitting the Three-Year Program and Expenditure Plans or
Annual Updates that includes a 30-day public comment period (CCR, 9 CA § 3315).
Counties must submit documentation of Three-Year Program and Expenditure Plans and Annual Updates
that includes:
A description of methods used to circulate copies of the draft Three-Year Program and
Expenditure Plan or Annual Update to representatives of stakeholders' interests and any other
interested parties who request the draft for the purpose of public comment.
Documentation that a public hearing was held by the local mental health board/commission,
including the date of the hearing.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 5
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
A summary and analysis of any substantive recommendations.
A description of any substantive changes made to the proposed Three-Year Program and
Expenditure Plan or annual update that was circulated (CCR, 9 CA § 3315).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 6
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Chapter 2: Public Community Planning Theory, Frameworks, Models and
Case Studies
Other than the legal regulations described in Chapter 1 of this report, no commonly agreed upon
description of MHSA CPP theories of change, goals, principles, or frameworks exists. Aside from guidance
provided in Three-Year Program and Expenditure Reports and subsequent Annual Update instructions, no
description of best or promising practices exist. For this reason, we look to the literature as well as to
experts in community development and organizing, municipal planning, public health and other fields for
examples of frameworks, theories of change, models and case studies. Our research found that many
community planning processes are developed without theories of change and without plans for
evaluating processes or outcomes. While we were able to identify numerous planning frameworks and
case studies loosely or tightly linked to the framework, none of the frameworks or case studies included
rigorous evaluations of process or outcomes, and more specifically, none demonstrated significant
associations between specific activities, methods or practices and predefined outcomes. More will be
said about the challenges associated with and opportunities for evaluating community planning
processes later on in this report.
The following frameworks, therefore, were selected because they are currently or have recently been
used by local government entities to engage broad-based stakeholders in planning local government and
nonprofit services, infrastructure and systems. Many of the frameworks we identified differed only
slightly or in name only, or differed only in how they were applied in the particular field. The following
were selected to demonstrate a breadth of applications (e.g., land use, education, and public health) and
a diversity of principles, theories of change, methods of engagement and degrees of participation.
1. Community Engagement: used by public health professionals, healthcare providers, and other
stakeholders in health research, planning, and health improvement efforts.
2. Community Readiness: a practical tool to help communities plan and implement prevention
programs.
3. The Active Community Engagement Continuum (ACE): used to plan for and evaluate
participatory public health initiatives.
4. Community Based Participatory Research: a collaborative approach to conducting research with,
rather than on, communities; builds community capacity to act for social change.
5. Neighborhood Planning: a process by which residents develop a shared vision and a plan to solve
neighborhood problems.
6. Public Engagement in Education: a collaborative, inclusive, participatory approach to bringing
about meaningful change in public schools.
7. Mobilizing for Action through Planning and Partnership (MAPP): developed by The National
Association of County and City Health Officials (NACCHO) to improve community health.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 7
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
8. Health Impact Assessment: a specific model that engages community stakeholders in reviewing
plans, policies and projects before they are implemented.
9. Participatory Budgeting: used by municipalities to engage residents in democratic decision-
making and fiscal planning.
10. Community COPE: a quality improvement model used in the assessment and planning of local
health care systems.
11. Use of Technology in Participatory Planning: bringing the tools of planning to the people to
democratize and ensure that those who are most affected are empowered to participate in the
decisions that affect their lives.
For each of these theoretical frameworks, to the extent possible, we describe the historical
underpinnings, purpose and theory of change, principles and approaches. When possible, we describe
the outcomes of the project and methods by which the processes and outcomes were measured. We also
provide case studies that describe how the principles and practices described in the theoretical
frameworks were operationalized, as well as the recorded outcomes of the project.
Research and Application Limitations
This literature review does not pretend to capture the full range of public community planning
frameworks or models. Participatory or community-based planning has a long and rich history; theories
and practices cross paths with a variety of disciplines, that range from purely academic anthropological
pursuits that engage study targets in collecting and interpreting data, to community and labor organizing
and other social movements that engage historically disenfranchised communities in planning and action
for political, economic and social justice. Nor does this literature review consider the rich history of
mental health recovery consumer and family member movements, which must also be studied to
understand how advocacy-oriented planning and activism has influenced mental health service delivery
systems and programs.
The theoretical frameworks and processes described in the following case studies, furthermore, should
not be construed as promising MHSA practices, as defined by an ability to predict or be associated with
positive MHSA goals and outcomes. In part, this is because of the unique contexts within which MHSA
planning occurs, and perhaps more importantly, due to the shortage of research on the predictability of
outcomes of public community planning processes.
A 2006 report from Canada explores what was known at the time about the degree to which public
participation goals have been achieved, and found the following: “Scholars within different fields of study
are unanimous in their conclusions about the paucity of good quality research evidence about public
participation and its effects” (Albelson, 2006). Similarly, a report out of the United Kingdom, which
reviewed public engagement in education planning from 2000 to 2008, arrived at the following
conclusion: “Formal research of public involvement was rare. The literature was replete with enthusiastic
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 8
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
reports and reflections, but with little or no detail about public involvement, and often little attempt at
objectivity” (Hart, 2009).
We found the same lack of evidence about the effects of participatory processes when researching
individual frameworks and case studies. In most cases, no rigorous evaluations were found, and in
particular, no promising practices were identified using statistical associations. In some cases, the lack of
research was cited. A 2011 publication, from which we drew a community-based participatory research
case study, states the following: “The use of community-based participatory research (CBPR) to address
health disparities in underrepresented communities has been widely regarded as a promising practice.”
Yet, in the same paragraph, “A challenge to understanding the impact of CBPR partnerships and
participation in healthy research, whether it be epidemiology, intervention or policy, is the paucity of
conceptual models of CBPR that are empirically tested and validated,” and, “Little is known, however,
about CBPR pathways of change and how these academic-community collaborations may contribute to
successful outcomes” (Sandoval, 2011). Problems with evaluating CPP processes are documented in
several meta-analyses of evaluation. They include: diverse and often contradictory perceptions of what
constitutes a positive outcome (Abelson, 2006); contextual differences (Abelson, 2006; Connell, 1995);
lack of consensus on process and outcome measures (Abelson, 2006); uncertainty on how to measure the
effects of democratic processes (Agger and Lofgren, 2008); disagreement on distal outcomes (Abelson,
2006); lack of control group (Uddin, 2002; Abelson, 2006); measurement problems (Sandoval, 2011 and
Abelson, 2006); and horizontal and vertical complexity within planning environments (Connell, 1995).
Due to the paucity of evaluative evidence regarding promising practices, this literature review seeks to
identify widely recognized, theoretically-based principles of participatory/community-based program
planning which may be applied by public mental health systems to improve services and achieve MHSA
goals. The final chapter also provides some practical strategies that emerge from the principles and that
are practiced within the case studies, but we do not make the case that these practical applications are
associated with positive outcomes.
Community Engagement Framework
In recognition that community engagement and mobilization efforts may lead to the development of
effective programs for addressing obesity, cancer, smoking cessation, and heart disease, and to better
understand how these efforts lead to improving health outcomes, in 1995 the Centers for Disease Control
and Prevention (CDE) established the Committee on Community Engagement. In 1997, the Committee
produced the first edition of Principles of Community Engagement (CDC/ATSDR). The report defined
community engagement as:
The process of working collaboratively with and through groups affiliated by geographic
proximity, special interest, or similar situations to address issues affecting the well-being
of those people. It is a powerful vehicle for bringing about environmental and behavioral
change that will improve the health of the community and its members. It often involves
partnerships and coalitions that help mobilize resources and influence systems, change
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 9
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
relationships among partners, and serve as catalysts for changing policies, programs and
practices. (CDC/ATSDR, 1997).
In 2011, the National Institutes for Health (NIH) released the Second Edition of Principles of Community
Engagement, which provides public health professionals, healthcare providers, and other stakeholders
with additional theoretical underpinnings and guidance for engaging in health research, planning, and
health improvement efforts.
Community Engagement, according to the Second Edition, can take many forms, but is frequently
measured on a continuum from lesser to greater degrees of engagement:
Outreach: whereby communication flows from one entity to another; used to inform.
Consult: which seeks to get information and feedback from the community.
Involve: whereby information flows both ways; partnerships are created.
Collaborate: where partnerships are developed to plan and implement a strategy.
Share leadership: where decision making occurs at the community level.
Defining the Community
The second edition of Principles of Community Engagement recognizes two definitions of community,
which influence how planning practitioners select participant stakeholders. Community can be
understood as those individuals and groups that are most effected by the health issue being addressed.
In this context, the community, by definition, includes those who have historically been left out of health
improvement efforts. The second definition of community includes a broader range of stakeholders, such
as public health professionals, academics and elected officials and policymakers. The second edition
places a greater emphasis on the first definition, the engagement of those community members who are
most affected by the health issue, suggesting that their participation is the lynchpin of successful
community engagement and planning efforts (Clinical and Translational Science Awards Consortium,
2011).
History and Current Application
Community Engagement theory emerges from earlier principles of community organizing, which
recognize social justice, fairness and equity, empowerment and self-determination. Theorists that help
define community engagement include Saul Alinsky, whose groundbreaking book, Rules for Radicals
(Alinsky, 1971), helped define principles of community organizing. Other critical theorists include Paulo
Freire, a Brazilian philosopher and educator most known for Pedagogy of the Oppressed (Freire, 1970),
which outlines the critical pedagogy movement. Pedagogy of the Oppressed suggested that educational
efforts should be a liberating force that empowers oppressed peoples to overcome their conditions.
Freire emphasized the importance of dialogue and informed action. Other important contributors include
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 10
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Myles Horton, who founded the Highlander Folk School (1932), a center for adult education, civil rights,
and community empowerment in Tennessee (Adams, 1975).
Most recently, Community Engagement as an approach is reflected in a variety of federal initiatives,
including the CDC’s Prevention Research Centers, which is a network of community, public health and
academic partners who conduct applied public health research (http://www.cdc.gov/prc/); U.S.
Department of Health and Human Services’ Agency for Healthcare Research and Quality
(http://www.ahrq.gov/); Healthy People 2020 (http://www.healthypeople.gov), a 10-year initiative to
improve the health of all Americans, whose national objectives emphasize collaboration among diverse
groups to develop strategies for health improvement; Clinical and Translational Science Awards and
Research Centers, which helps to make findings from science useful for practical applications
(http://www.ncats.nih.gov/research/cts/ctsa/ctsa.htm); and Minority Institutions Programs of the
National Institutes of Health, which develops and strengthens research capacities of minority institutions
(http://www.nimhd.nih.gov/our_programs/research_centers.asp).
Principles of Community Engagement includes a chapter on evaluation, and suggests that evaluation
approaches should engage stakeholders. They describe participatory evaluation, which actively engages
stakeholders at all stages of the evaluation, and empowerment evaluation, which helps program staff
develop skills to ensure that their programs operate effectively. The chapter provides a rudimentary
description of qualitative and quantitative methods for determining if programs are participatory in
nature. They recommend asking the following process-oriented questions:
Are the right community members at the table?
Does the process and structure of meetings allow for all voices to be heard and equally valued?
How are community members involved in developing the program or intervention?
How are community members involved in implementing the program or intervention?
How are community members involved in program evaluation or data analysis?
What kind of learning has occurred, for both the community and academics?
Principles of Community Engagement
The authors of Principles of Community Engagement (2011) draw on their experience, theoretical
frameworks and models from the literature to develop a set of principles to help practitioners plan,
implement and evaluate community engagement efforts. These 9 principles are organized into three
sections: 1) what practitioners need to consider before engagement; 2) what is necessary to consider
during the engagement effort and 3) how to ensure successful engagement efforts.
Before starting a community engagement effort:
1. Be clear about the purpose and goals of the engagement effort and the populations and/or
communities you want to engage.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 11
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
2. Become knowledgeable about the community’s culture, economic conditions, social networks,
political and power structures, norms and values, demographic trends, history, and experience
with efforts by outside groups to engage it in various programs.
For engagement to occur:
3. Go to the community, establish relationships, build trust, work with the formal and informal
leadership, and seek commitment from community organizations and leaders to create processes
for mobilizing the community.
4. Remember and accept that collective self-determination is the responsibility and right of all
people in the community. No external entity should assume it can bestow on a community the
power to act in its own self-interest.
For engagement to succeed:
5. Partnering with the community is necessary to create change and improve health.
6. All aspects of engagement must recognize and respect the diversity of the community.
Awareness of various cultures of a community and other factors affecting diversity must be
paramount in planning, designing, and implementing approaches to engage a community.
7. Community engagement can only be sustained by identifying and mobilizing community assets
and strengths and by developing the community’s capacity and resources to make decisions and
take action.
8. Organizations that wish to engage a community as well as individuals seeking to effect change
must be prepared to release control of actions or interventions to the community and be flexible
enough to meet its changing needs.
9. Community collaboration requires long-term commitment by the engaging organization and its
partners.
The principles of community engagement described above could be considered by MHSA planning
coordinators and stakeholders. Understanding that the CPP processes may benefit from pre-planning
investment in learning about behavioral health constituents; reaching out and developing trust among
representatives of community-based organizations who have longstanding relationships with diverse
constituents; and respecting consumer and family strengths and desires for self-determination may
strengthen community planning processes.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 12
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Community Readiness Framework
The Community Readiness Model was developed as a practical tool to help communities plan, implement
and evaluate prevention programs. The model is based on the theory that all communities are at
different levels of readiness for developing and implementing programs. For example, attitudes vary
across communities—in some communities a strategy for social transformation may be recognized as
productive and in another perceived as counterproductive. Other examples of ways in which different
communities are at different levels of readiness have to do with the amounts and types of resources
available for change and the differing levels of political support for change. The Community Readiness
theory emerged in the early 1990s, in part, thanks to the work of Mary Ann Pentz, of the Midwest
Prevention Project (Pentz, 1999). She argued that unless a community was ready, implementation of a
prevention program would likely lead to failure. Pentz’s work led researchers at Tri-Ethnic Center, in Fort
Collins Colorado to focus on the question of community readiness. The model is based on a theory of
change that suggests:
…efforts by local people are likely to have the greatest and most sustainable impact in
solving local problems and in setting local norms. When community resources are tapped,
efforts are more likely to be based on concepts and ideas that are theoretically and
culturally appropriate for that unique community. Successful prevention programs are
“owned” by the target community itself (Edwards, 2000).
To achieve the greatest and most sustainable impact, communities must be ready. Researchers
identified 9 stages of readiness, and specific strategies at each stage to help communities advance
along the continuum. Stages include:
1. No awareness: Community members don’t recognize the problem or that there is something
that can be done.
2. Denial/resistance: Little recognition that the problem occurs locally (i.e., “It’s not our
problem”).
3. Vague awareness: General feeling in the community that something should be done, but no
motivation to do something or identifiable leaders or agents of change.
4. Preplanning: There is an awareness that something should be done and leaders are
mobilized, but there is no strategy or focused plan for action.
5. Preparation: Community leaders begin planning; the community offers modest support.
6. Initiation: Enough information exists to support action. Activities have started and there is
great enthusiasm because no problems associated with implementation have been
experienced. No active resistance at this phase.
7. Stabilization: Programs are running and supported. Little perceived need for change or
expansions. No evaluation.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 13
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
8. Confirmation/Expansion: Community members feel comfortable using services. Initial
implementation has been evaluated and modified.
9. Professionalization: Detailed knowledge about the problem exists; highly trained staff are
running programs; leaders are supportive and community is involved. Community members
hold program accountable.
In 2006, the Tri-Ethnic Center produced a community readiness handbook, which identifies specific
strategies to determine community readiness and advances along the nine-stage continuum (Plested,
2006). The handbook includes a Community Readiness Assessment, which involves conducting a
minimum of 4 - 5 key informant interviews with individuals in the community, and asking 36 specific
questions related to: 1) knowledge in the community about the issue; 2) extent of community efforts
to address an issue; 3) knowledge of local efforts to address the issue; 4) existence of community
leadership who are interested in the issue; 5) perceived attitude in the community towards the issue;
and 6) availability of local resources to support efforts. The interview is then scored along the 6
dimensions and overall. The overall score determines the degree of community readiness, which then
allows planners to develop specific planning and program implementation strategies that are
appropriate for the community. The model provides examples of strategies for each level of
community readiness: For communities that are at the first stage—no awareness—the goal is to raise
awareness of the issue, and the authors of the model point to the need to visit with individual leaders
and small groups to inform them of the issue. During the fifth stage—preparation, for example—
planners seek to gather information to help form a plan. During this stage, strategies include:
conducting surveys; sponsoring a community picnic to initiate the planning effort; and presenting
data. During the final professionalization stage, the goal is to maintain momentum and continue to
grow the initiative. During this phase, funding sources are diversified; external evaluation helps
determine if progress has been made, and if and how programs should be modified (Plested, 2006).
The Community Readiness Handbook (Plested, 2006) describes ways in which the model can be used
for program evaluation, particularly related to shifts in community norms. In Oklahoma, ten counties
developed a program to improve services to seriously emotionally disturbed Native American
children and their families. The model was used to measure community readiness before and after
program implementation, and saw advancement along the continuum.
The authors of the Community Readiness model describe challenges associated with establishing
validity. Specifically finding measures with similar intent is difficult because “each application is
unique and the constructs or ideas that the tool is measuring have not been addressed by other
measures.” They did, however, establish construct validity via hypothesis testing and argue that
widespread acceptance lends credence to its validity.
The authors also note that Community Readiness “does not lend itself well to traditional measures of
reliability, partcularly test-retest reliability, because readiness levels are not typically static.”
However, the authors note that they have seen consistent patterns in community readiness over
time, which reflect on the reliability of the stages. Additionally, they did see consistency among
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 14
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
respondents in rating community readiness (92% inter-reater reliability), but note that each
respondent has a unique role in the community and, as such, they expect different perspectives on
community readiness (Plested, 2006).
Community Readiness could be an effective framework to measure MHSA stakeholder involvement
in planning for universal prevention programs and to measure the degree to which stakeholders are
able to collectively address community norms and issues such as mental health stigma. By measuring
readiness at various intervals, MHSA planners may be able to develop effective strategies that are
relevant to current community readiness for change.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 15
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Community Engagement and Community Readiness Case Study
Healing the Canoe
Time Period: 2005-2013.
Jurisdiction: Port Madison Indian Reservation, Washington State.
Stakeholders: Members of the Suquamish Tribe, including tribal elders and youth, service providers, and other
community members.
Lead Public Agency or Organization: The Suquamish Tribe’s Wellness Program and University of Washington’s
Alcohol and Drug Abuse Institute.
Types of Services or Uses Planned: Youth Development Curriculum.
Description of Process, and Outcome and Findings: The Healing of the Canoe Project, funded by the NIH’s National
Center on Minority Health and Health Disparities, was a multi-year participatory research and planning effort to
reduce health disparities by: assessing community needs; prioritizing health disparities of greatest concern to the
community; identifying resources from within the community; and developing and piloting appropriate and
culturally relevant interventions. The project launched with interviews of key stakeholders and focus groups with
tribal elders, youth, service providers, and other community members to determine project readiness and issues of
concern. The participants identified the prevalence of substance abuse among Suquamish youth and the need for
the development of tribal identity and a sense of belonging. By engaging and preparing the community, the project
achieved the development of a culturally-grounded curriculum called “Holding Up Our Youth,” which incorporates
traditional practices, values, teachings and stories to provide youth with skills necessary to avoid drug and alcohol
use (Healing of the Canoe Project, 2013).
The Healing of the Canoe Project demonstrated adherence to a number of strategies outlined in the Community
Readiness and the Community Engagement models. First, the project assessed community readiness via sixteen key
informant interviews using an adaptation of the Tri-Ethnic Prevention Research Center’s community readiness
interview guide. The interviewers asked informants to identify the three areas of greatest concern to the
community, and to assess community readiness, including community efforts to address the concern to date,
community knowledge of the issue, the level of leadership and commitment to addressing the issue, and the
resources available to address the issue (Healing of the Canoe Project, 2013).
According to the CDC’s handbook on Community Engagement (Clinical and Translational Science Awards
Consortium, 2011), the Project also demonstrated practical applications of the principles outlined in the Community
Engagement model. Principle #4, which affirms the right to community self-determination, was demonstrated by
the community identifying the issues that were most critical to them. Principle #5, the necessity of partnering with
the community, was achieved in part through the hiring of a tribal member with a master’s degree in social work as
a co-investigator. Principle #7, which calls for the mobilizing of community strengths and assets, was met with the
development of curriculum that relies on the knowledge and experience of tribal elders, the resiliency of tribal
youth, and the rich Suquamish culture and traditions. Principle #8, calling for release of control to the community,
was addressed by the researchers, who submitted a report on the interviews and focus groups to the Suquamish
Cultural Cooperative, for feedback, suggestions, and approval. The foundation for Principle #9, to prepare for the
long-haul by engaging community organizations, was demonstrated by including the Tribe in all aspects of the
project (Healing of the Canoe Project, 2013).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 16
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
The Active Community Engagement (ACE) Continuum
As outlined above, in 1997, the CDC’s Committee on Community Engagement developed principles for
community engagement in public health. These principles provided the basis for the development of the
ACE Continuum, which provides a conceptual framework for engaging communities in reproductive
health (RH) and family planning (FP), and for developing indicators for the measurement of community
engagement and empowerment (CDC/ATSDR, 1997).
The ACE Continuum includes three levels of community engagement that move from 1) consultative, to
2) cooperative, to 3) collaborative. At the first level, community members are targets of change, and
public community planning activities are likely to consist of outreach and messaging. Community
empowerment increases at each subsequent level towards community members becoming agents rather
than targets of change. The theory of change suggests that the more involved and informed the
community is in planning for services, the more likely the resulting services will be sustained. At Level 3,
the service delivery system reaches a high level of collaboration with the community; activities are likely
to include participatory exploration of power relationships and collaborative decision-making
(CDC/ATSDR, 1997). Jane Wickstrom, a Senior Manager at EngenderHealth, an aid organization
concerned with international health, describes the ACE continuum as a tool used by EngenderHealth to
“check in” and monitor progress. Wickstrom states, “…it is really helpful in that it encourages people to
focus on what we mean by community involvement, and how it works. There are so many levels we can
talk about, so the model can be a descriptor. It helps because people have different expectations about
community involvement” (2013).
ACE uses five characteristics of empowerment, adapted from the World Bank (Naryan, 2002). These
include: 1) inclusion of communities in preprogram assessment; 2) access of communities to information;
3) inclusion of communities in decision making; 4) development of local organizational capacity to make
demands on institutions and governing structure; and 5) accountability of institutions to the public. For
each of the five characteristics of empowerment, the model establishes indicators or characteristics at
each of the three level of engagement (Russell et. al., 2008).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 17
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Characteristics of Level 1 Level 1 Level 3
community
engagement
Community General information As in Level 1 plus: Level 1 & 2 plus:
involvement in from community Discussions with leaders Participatory
assessment meetings used to refine regarding RH and FP exploration of
programs. issues. community power
relationships and social
contest.
Access to information Accurate RH/FP As in Level l, plus: As at Levels 1and 2,
messages disseminated Community agents plus: Community agents
through media and disseminate messages facilitate dialogue on
government structures. with limited FP/RH and its relevance
interpersonal to daily life.
interaction.
Inclusion in decision Input/approval solicited As in Level 1, plus: As in Levels 1 and 2,
making from influential Leaders and advisory plus: Community-based
community leaders at groups involved as organizations (CBOs)
start of project. ongoing partners in and groups collaborate
decision-making. in decision making.
Local capacity to Strengthen FP service As in Level 1, plus: Build As in Levels 1 and 2,
advocate to institutions delivery through capacity of local plus: Build capacity of
and governing community outreach. leadership and advisory CBOs and foster
structures groups to oversee organizational
quality of RH/FP linkages to advocate for
services. quality RH/FP services
and policies.
Accountability of Health services/policies As in Level 1, plus: As in Levels 1 and 2,
institutions to the informed by providers Health services/policies plus: Health
public and governments with have systems for citizen services/policies
limited community participation (e.g. ensure equitable input
input. health advisory groups). from community to
inform RH/FP resource
allocation.
ACE defines community engagement as “the process of working collaboratively with groups of people
affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting
their well-being” (Russell et. al., 2008 p.1).
1. Value partnerships, and their unique contributions, from the global to the community levels.
Each partner, from governmental organizations to local CBOs, may have different missions, but to
make the partnership work, each partner needs to value the strengths of the others, finding
points of agreement.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 18
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
2. Be clear about the purposes and goals of community engagement before starting. All partners
must agree on what community engagement means before beginning the project. Understanding
the level of engagement and the roles that community members are to play will allow the
partners to agree on indicators and on methods for documentation and evaluation.
3. Define from the beginning such terms as participation, communication, engagement,
mobilization, and empowerment as they apply to the project. These terms are often used
interchangeably. Indeed, they are very similar. The distinctions between them are small, but it is
important that everyone agree on what they mean before starting a project. All of these actions
are interrelated and ongoing.
4. Understand that flexibility (of donors, organizations, and communities) is needed to
collaborate and share power at all levels of community engagement. Due to the dynamic nature
of community engagement, processes and outcomes can change. All partners, including donors,
need to be flexible, to adjust to the changes that may occur.
5. Be willing to determine the level of engagement, including key capacity-building interventions
and the time frame, before starting a project. All partners need to agree to these details before
beginning a project so that expectations are clear for everyone.
6. Agree on clear indicators with expected outcomes and on a documentation process that will
reflect both RH/FP outcomes and levels of engagement. Some partners may see an empowered
community as an outcome in itself. Others will only value a health outcome. When using an
engagement process, however, it is important to document both the engagement process and
the health outcome.
7. Expect to engage and then reengage throughout the life of the project, as communities are
dynamic and behavior change is not linear. Community engagement is a dynamic process in
which leadership and needs are constantly changing. The engagement process is continuous. It
can move from level to level or stay at one level, but it constantly must be reevaluated to ensure
that indicators are appropriate and met.
8. Plan the time frame and budget for maintaining community involvement from the start of the
project. It is important that time frames match the needs of the desired outcomes and
appropriate activities. Budgeting to ensure that the community engagement process lasts the life
of the project is important but is sometimes forgotten (Russell et. al., 2008 pp.5-6).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 19
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Similar to the Community Readiness model of measuring stakeholder preparedness for change, the ACE
model could be used by MHSA CPP planners to measure the degree to which stakeholders are engaged in
MHSA planning. By developing collaborative principles of planning, such as those described above, ACE
hypothesizes that stakeholders can become increasingly empowered agents of change, which is
consistent with the principles of MHSA.
ACE Case Study
Using ACE Continuum to Address Health Inequities in an Urban Area: Los Angeles County
Time Period: 2006-2011.
Jurisdiction: Los Angeles County – Second Supervisorial District.
Stakeholders: Program staff, community leaders from school, CBO, and faith based organizations.
Lead Public Agency or Organization: Los Angeles County Sexually Transmitted Disease (STD) Program.
Types of Services or Uses Planned: STD testing.
Description of Process, and Outcome and Findings: In 2006, Los Angeles County’s Sexually Transmitted Disease
Program began mobilizing community leaders to plan and implement prevention strategies to reduce the disparities
in chlamydia and gonorrhea rates among youth of color in the city’s Second Supervisorial District. At the 2012
National STD Prevention Conference, using the ACE Continuum framework, staff (Magee, 2012) presented methods
they used to engage the community in 2006. The presentation showed that planning efforts to include stakeholders
in assessing health needs involved community leaders at Level 2—town hall meetings were held to hear the
opinions of leaders from school, CBO and faith based organizations. By 2011, assessment efforts had achieved Level
3—whereby meetings with stakeholders and community leaders were being held to identify social determinants
related to STD disparities. Similarly, in 2006, community advocacy had achieved Level 1—whereby community
organizations approached the Los Angeles County Public Health Department (DPH) to provide STD testing outside
STD clinics. In 2011, advocacy efforts had achieved Level 3—a community Advisory Group provides oversight to DPH
and seeks funding to expand STD testing capacity. This case study demonstrates how the ACE Continuum can be
used to measure the success of community engagement efforts by using an established framework. Community
planning activities are mapped on a hierarchical grid to see the degree to which their efforts have achieved
standards of empowerment and engagement. The ACE framework was used post-planning to show the degree to
which efforts had contributed to community engagement and empowerment, but the framework can also be used
to establish benchmarks and milestones of success upon launch of a public community planning initiative (Magee,
2012).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 20
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Community Based Participatory Research
Community Based Participatory Research (CBPR) is a collaborative approach to conducting research that
“equitably involves all partners in the research process and recognizes the unique strengths that each
brings” (Minkler et. al., 2008, p. 7). CBPR conducts research with, rather than on, communities, and seeks
to build community capacity to act for social change at the same time as studying locally relevant issues
or problems. Inherent in CBCR is the notion that the same individuals who conduct the research also
participate in planning and the implementation of programs and policies to improve community
wellbeing (Minkler et. al., 2008).
The concept of CBPR, referred to interchangeably as “participatory action research,” “participatory
research,” “action research,” and “community based research,” have theoretical underpinnings that
emerge from an understanding that social, economic and environmental factors contribute to health
status, and that these factors have a disproportionate impact on poor and marginalized communities.
Such communities exhibit numerous strengths and skills and resources that can be leveraged to address
social problems and promote health and wellbeing. CBPR is one way to leverage such community
resources. Key principles of CBPR include:
Build on the strengths and resources of the community.
Involve all participants equally in all phases of research and action.
Promote co-learning and empowerment to address social inequity.
Disseminate findings to all participants.
Promote long-term commitment by all participants (Israel, 1998).
Most research on the impacts of CBPR has occurred outside the United States. One study, entitled
Promoting Healthy Public Policy through Community-Based Participatory Research: Ten Case Studies,
funded by W.K. Kellogg Foundation and produced by PolicyLink in partnership with University of
California Berkeley School of Public Health (2008), provides some useful findings on the policy outcomes
of CBPR for initiatives in the United States. The study reviewed 80 cases of purported CBPR initiatives but
found that only 27 met criteria such as: 1) being participatory and empowering; 2) promoting systems
change; 3) fostering co-learning and capacity building; and 4) balancing research and action.
The PolicyLink study focused on 10 such cases, all of which appear to have contributed to systems- or
policy-level change. However, authors cite that the emphasis on coalition-building and the involvement
of numerous change agents made singling out CBPR’s role in policy victories nearly impossible. Rather,
the study focused on ways in which CBPR appeared to contribute to change. They were not able to
attribute outcomes to the CBPR initiatives alone (Minkler et al., 2008).
The report found that several factors contributed to the success of a CBPR partnership, including:
The presence of a strong, autonomous organization prior to the development of the partnership.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 21
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
A high level of mutual respect and trust among the partners and an appreciation of the
complimentary skills and resources that each partner brought.
Appreciation by all partners of the need for solid scientific data as a prerequisite for making the
case for policy action.
Commitment to “doing your homework”—finding out what other communities had done, who
holds decision-making authority, key leverage points, etc.
Facility for and commitment to building strong collaborations and alliances with diverse
stakeholders beyond the formal partnership (Minkler et al., 2008, pp. 8-9).
The report also captured a variety of recommendations for ensuring that CBPR contributed to health-
promoting policy change. Thirteen such recommendations were made; the following are most relevant to
MHSA planning efforts, especially those that involve stakeholder involvement in identifying community
mental health issues:
Build leadership by being genuinely community-driven. Particularly, start with a “hot-button
issue” that the community is committed to helping research and mobilize around.
Use a mix of research methods, people’s stories as well as facts and statistics.
Produce high-quality research but make results easily accessible.
Use approaches that reflect stakeholder culture, even if it slows the process down.
Increase stakeholder understanding of policymaking and issues through training, web-based tools
and other resources, including academia.
Offer solutions, not just complaints.
Recognize that policy change takes a long time and commit to staying involved for the long-haul
(Minkler et al., 2008, pp. 9-10).
The principles of CBPR are applicable to MHSA CPP because they are strength-based and seek to develop
individual as well as community capacity. This is entirely consistent with the principle of wellness,
recovery, and resiliency. The recovery movement’s concept of “nothing about us without us” also applies
to CBPR, in that stakeholders are included in studying persistent community problems, reflecting on the
data to make informed choices, and participating in implementing solutions. CPP practitioners could
model their activities based on CBPR by encouraging stakeholders to collectively investigate a mental
health issue, develop strategies, participate in implementation, and measure success.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 22
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Community Based Participatory Research Case Study
Reintegrating Drug Users Leaving Jail and Prison
Time Period: 1996-2004.
Jurisdiction: Harlem, New York City.
Stakeholders: Local service providers, city health organizations, advocacy groups, community residents, and former
inmates.
Lead Public Agency or Organization: Harlem Community and Academic Partnership (HCAP) comprised of New York
City Department of Health, New York Academy of Medicine, and a Community Action Board.
Types of Services or Uses Planned: Reintegration programs for inmates leaving jails and prisons.
Description of Process, and Outcome and Findings: Launched with funding from a CDC Urban Research Center Grant
to promote innovative strategies to improve the health of low income and urban populations, HCAP leadership
initially sought to address substance abuse in the Harlem neighborhood. Having begun the initiative with few local
connections, the leadership formed a Community Action Board comprised of representatives from local service
providers, city health organizations, advocacy groups and residents. Through several iterations of research and
planning, the partnership defined its focus on addressing the local challenge of reintegrate drug users leaving jail
and prison. Specifically, the data suggested that over 6,000 inmates were released into Central and East Harlem
every year, and half were re-incarcerated within a year.
The partnership conducted a literature review and secondary source data analysis on incarceration and substance
abuse. They facilitated focus groups with 36 substance abuse service providers and former inmates and added a
question to a poll of NYC residents related to public opinion on reentry. Findings from the research suggested that
people leaving prison and jail were not prepared for release and did not have adequate support. Following the
study, the partnership shared their findings with an even broader range of stakeholders within the community,
generating strong local interest in developing an action plan for addressing reintegration issues. The partnership
advocated for and then used research from a city-sponsored cost analysis, which showed that the City would save
money by supporting reintegration programs. Members spoke at city council meetings, produced policy reports and
developed a set of 12 recommendations. Several outcomes are attributed to the work of the partnership including:
1) Department of Corrections releases more inmates during daylight hours; and 2) expanded housing, drug
treatment, and employment services for people leaving jail and prison. In addition the partnership is credited with
having helped pass legislation to reinstate Medicaid coverage to newly-released inmates (Minkler et al., 2008).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 23
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Neighborhood Planning Framework
Neighborhood Planning is a process by which residents in a particular geographic area develop a shared
vision and a plan to solve neighborhood problems. A report out of Cleveland State University defines
neighborhood planning as:
…a process whereby residents and other stakeholders learn about their neighborhood,
envision a shared future, and develop strategies to shape it for the better and sustain it
for the long term. The process results in a plan that encourages and directs future social
and economic investments toward the development of a healthy neighborhood
(Burkholder, Chupp & Star, 2003, p. 1).
The concept of Neighborhood Planning has emerged over time, taking flight in recent years as many
federal programs now require citizen participation in planning for land use and social services.
Community Development Block Grants (CDBG), established in 1974, for example, require that grantees
provide adequate opportunities for residents to participate in planning, implementation and evaluation.
In the early 1900s, the settlement house approach emerged to address urban problems by focusing on
social and economic solutions to the problems of poverty. Later, from the 1920s to the 1960s, community
action focused on the physical environment of neighborhoods. Between the 1960s and 1970s,
neighborhood actions focused on political means to address poverty. Most recently, neighborhood
planning has focused on attempts to coordinate political, social and physical approaches to solve poverty
and related social issues (Burkholder, Chupp & Star, 2003).
Neighborhood Planning is based on Community Development Theory, the principles of which include
democratic decision-making by the people whose lives are most affected, engaging community members
in learning about community issues, and the development of local leadership. The authors of the Ohio
report cite a range of guiding principles for Neighborhood Planning:
Thoughtful, deliberate preparation.
Identification and development of neighborhood assets.
An inclusive process for a specific, agreed upon area.
Resident involvement in the development and approval of the plan.
Defined and appropriate roles for all participants.
Transparency in planning processes.
Democratic decision-making.
Development of a vision of what the neighborhood can become.
Collection of data to inform the process.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 24
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Recognition of market dynamics.
Feasible implementation plans (Burkholder, Chupp & Star, 2003).
Neighborhood Planning theorizes that when local residents and other stakeholders are involved in
planning, the quality of decision making improves and the resulting plan reflects resident needs and
vision. “The process creates a sense of community and can empower residents by building their
confidence, capabilities, skills and ability to cooperate” (Burkholder, Chupp & Star, 2003, p. 7).
Neighborhood Planning yields greater legitimacy. “… a greater sense of ownership of the plan often
translates into greater determination to implement the plan” (p. 7). Additionally, when residents are
involved in implementation of a plan, they feel more connected to their community, and are better able
to manage and maintain their neighborhoods, for example, leading to reductions in vandalism and
neglect. Daniel Lacofano, Principal and CEO of MIG, a planning and design firm committed to “sustaining
environments that support human development,” emphasizes the necessity of inclusiveness and true
engagement of participants for successful planning efforts: “Inclusiveness…A commitment to working
through problems, some very technical. Not just asking for stakeholder opinions” (2013).
There are two broad-based approaches to Neighborhood Planning. In one approach—community-
initiated planning—community development corporations, advocacy and other CBOs plan programs and
influence government. The other approach, perhaps more applicable to MHSA planning, is city-initiated
planning. In this approach, city governments initiate planning in a particular neighborhood, and staff the
planning effort themselves or empower consultants or community organizations to participate in various
ways, from reviewing plans and budgets to actively developing strategies and participating in decision
making (Burkholder, Chupp & Star, 2003).
In 2013, the United States Environmental Protection Agency (EPA) produced a report outlining strategies
for creating equitable, healthy and sustainable communities (McConville, 2013). One of the primary
principles, which aligns seamlessly with the Neighborhood Planning model, is to: “facilitate meaningful
Community Engagement in Planning and Land Use Decisions.” The EPA suggests that meaningful
community participation and leadership can ensure that revitalization efforts are based on local values
and address resident needs. The EPA submits that early and consistent stakeholder involvement is critical
to effective engagement. Additionally,
Inclusive involvement results in planning and development decisions that have been
improved by a variety of perspectives, have authentic support from a broad range of
constituents, and are more enduring and better for the community as a whole. Obtaining
input from groups not historically engaged in planning can help reduce the
disproportionate environmental harms and health impacts they often face and make sure
that future development brings fair access to new opportunities (McConville, 2013, p. 17).
The EPA report outlines three principal strategies for facilitating meaningful community engagement:
1. Conduct Multilingual Outreach: Increasing participation to those who have typically been
left out of the process produces better solutions. For example, by reaching out to non-
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 25
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
English-speaking groups, transportation authorities are finding that ridership and public
support for public transit increases. In the Othello neighborhood of Seattle, the City
employed outreach liaisons to reach Cambodian, Somali, Vietnamese, Latino, Amharic
residents, as well as Native American, African Americans, youth and persons with disabilities.
Before public meetings, the liaisons translated materials and held breakout sessions with
their constituents to ensure they could effectively participate. Using this strategy, attendance
grew from 10 - 400 residents per public meeting.
2. Conduct Community Assessments: Many planning processes do not understand the specific
geographic region nor resident priorities and needs. Community Assessments engage
residents in gathering, analyzing, and reporting information about current conditions and
available resources. Examples include walkability audits, which measure the safety and
convenience of walking in a particular neighborhood. In Santa Clara County, the Public Health
Department engaged local college students in assessing street segments in predominantly
Latino neighborhoods to identify opportunities to reduce high rates of obesity and diabetes
among Latino residents.
3. Hold Community Planning and Visioning Workshops: One of the first steps in Neighborhood
Planning should be to define a shared vision and set of goals. Community workshops are
often led by professional facilitators who lead structured discussions and exercises and often
produce visual representations of a desired future. Maps and drawings can be used. Local
decision-makers should participate in the workshop to learn about community needs and
goals. Elected officials in Gary Indiana, for example joined residents in a neighborhood design
workshop to revitalize the Broadway corridor of a predominantly African American
community. The resulting plan called for strengthening cultural heritage sites, improving
transportation, and reusing vacant parcels of land (McConville, 2013).
The theory of Neighborhood Planning, which suggests that when local residents and other
stakeholders are involved in planning, the quality of decision making improves, applies to MHSA
planning as well. While the mental health community is only loosely defined geographically (i.e.
countywide) stakeholders are bound by a common desire to improve mental health outcomes. In
theory, when stakeholders collectively learn about mental health issues, envision a healthy
community, and develop strategies for achieving their vision—like neighborhood residents— the
process helps to build their confidence, capabilities, and skills. Participatory planning under these
conditions leads to the development of leadership’s commitment to effective implementation.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 26
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Neighborhood Planning Case Study
Strong Neighborhood Initiative (SNI)
Time Period: 2000-2010.
Jurisdiction: San Jose, California.
Stakeholders: Neighborhood leaders, residents, business owners and other community members.
Lead Public Agency or Organization: City of San Jose and San Jose Redevelopment Agency.
Description of Process, and Outcome and Findings: Between 2000 and 2010, the SNI partnership sought to
strengthen communities by building strong, clean and safe neighborhoods, and capable, independent and
sustainable neighborhood organizations. The partnership coordinated resources from property and business
owners, community leaders, and private-public partnerships to help communities reach their full potential. There
were 19 active Strong Neighborhoods throughout the City seeking to leverage community assets and bring in
dedicated resources. Service priorities included affordable housing, neighborhood safety, economic development,
and parks and recreation. SNI included two phases: planning and implementation.
Planning Process: A neighborhood advisory committee (NAC) served as a lynchpin in each neighborhood, and was
comprised of neighborhood leaders, residents, business owners, and other stakeholders. Each SNI was tasked with
developing or revising their neighborhood improvement plan by establishing a vision and a set of ten priority action
plans. During the planning phase, which lasted between 8 - 12 months, the NACs facilitated monthly public planning
meetings and workshops. The NACs continued to meet during the implementation phase, overseeing plans and
providing input. One neighborhood, Five Wounds/Brookwood Terrace, used the SNI to help maintain their small-
town atmosphere, redevelop commercial areas, improve streetscapes, and add more recreational corridors and
parks. Other services planned included the rehabilitation of housing and programs for local teenagers.
Outcomes: In 2008, the National League of Cities presented SNI with a Municipal Excellence award. A December
2009 progress report on SNI stated that the existing projects succeeded in improving neighborhood conditions,
enhancing community safety, expanding community facilities, and reducing blight. SNI and Redevelopment Agency
staff convened community conversations with 140 neighborhood leaders and staff asking, “What is most important
for building strong neighborhoods?” According to the progress report, their answer was to focus on: 1) removing
barriers to neighborhood action; 2) stabilizing neighborhoods in crisis; 3) mobilizing neighborhood action; and 4)
connecting resources to priorities. (Redevelopment Agency Board, 2010). In June 2010, following the defunding of
state and local redevelopment agencies, SNI ended. In its 10-year span, SNI funded streetlights, community centers,
revamped sewer systems, sidewalks, parks, and crime-plagued shopping centers. In our research on SNI, we did not
find evaluation literature linking specific community planning activities to specific outcomes.
According to Urban Land Institute, a nonprofit land use and real estate education and research institute, a variety of
lessons emerged from the SNI planning processes, including: 1) City departments should organize programs by
neighborhoods; neighborhoods are the building blocks for planning and implementation. 2) Plans should be
developed on neighborhood strengths and assets. 3) Neighborhoods should establish clear priorities (for example,
the development of ten priority action plans).Specific individuals or institutions should be responsible for
implementation. 4) Neighborhood priorities and city budgets should be aligned to avoid conflicts and maximize
impact. 5) Elected officials and other city leadership must be developed to support the collaborative planning and
implementation efforts. 6) Planning efforts must maintain momentum (Myerson, 2004).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 27
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Public Engagement in Education
The Public Engagement model of planning for public education is a collaborative, inclusive, participatory
approach to bringing about meaningful change in public schools that emphasizes substantive community
involvement in all phases of school planning. Although U.S. schools have traditionally sought input from
community stakeholders, such as Parent Teacher Associations (PTAs), these relationships are often
unequal partnerships, with community groups placed in roles of support for the educational ideas and
policies as decided by school administrators. The Public Engagement Model turns this notion on its head,
and suggests that instead of seeking community input in the form of support for existing ideas, schools
and school districts actively engage the public more meaningfully and substantially in order to generate
new ideas, participate in consensus-based decision-making processes, and ultimately shape local
educational policy in partnership. Proponents of the Public Engagement Model seek active and inclusive
school-community partnerships, but not for the purpose of bringing current policies and those who
implement those policies more power. Rather, proponents seek to decrease this centralized power by
increasing the role and control of the community: “not gaining control, but giving it up” (Michigan
Association of School Boards, 2006, p.2). According to the Public Engagement model, community
participation in school planning is viewed as essential to school reform, resulting in greater trust, parent
involvement, increased funding, and “the potential to build learning environments that are more
inclusive, extensive, and integrated into the community as a whole” (Bingler, 2003, p.3).
The Public Engagement approach follows from the work of seminal education theorist Paolo Freire, who
suggested a horizontal, rather than a vertical approach to participatory action, particularly as it related to
educational policies and planning. For Freire, a horizontal relationship based on empathy between the
parties involved enables them to engage in inclusive, trusting, and critical dialogue, which will lead to a
true understanding of the educational needs of the community, as well as the processes for satisfying
them (Freire, 1974). Further, in his concept of praxis, Freire emphasized the importance of going beyond
this dialogue to unified action, stating, “It is not enough for people to come together in dialogue in order
to gain knowledge of their social reality. They must act together upon their environment in order
critically to reflect upon their reality and so transform it through further action and critical reflection”
(Freire, 1970).
Following from this, the Public Engagement Model for education identifies four key components to
community engagement for the purposes of educational planning: 1) active listening, 2) deliberation, 3)
collaboration, and 4) shared responsibility.
In order for schools to move from more traditional communication models to a public engagement
orientation, some general guidelines are suggested:
1. Begin with the right issue: According to a traditional model, this first step—the choice of an issue to
focus on—would be decided by school staff, faculty, administrators and school board members. Working
within a Public Engagement Model, schools and the community share an equal voice, with schools
considered as a part of the broader community. To decide on the appropriate issue to be addressed, a
school-community steering committee might be formed to guide the selection of this choice and may
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 28
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
include school staff, students, parents, local residents and business people, and other interested
stakeholders.
2. Frame the issue: Whereas traditionally, the way the issue is framed would come from only one
viewpoint—that of the school—the Public Engagement Model emphasizes the need to consider all
viewpoints, including those of the school, parents, students, and the broader community. A working
meeting with representatives from all stakeholder groups to determine how the issue will be framed for
a broader discussion is one approach to this step.
3. Create community conversation: Face-to-face interaction is at the core of the Public Engagement
Model; for this reason it is essential to provide an opportunity for all stakeholders to be heard and for
multiple approaches to the issue be considered. Educators are encouraged to participate but not drive
these conversations. Participants must feel that everyone has a stake in the issue, and therefore
everyone has a responsibility for its solution. An action plan is often developed in this stage, and tasks
divided among participants. This conversation may take the form of a large community forum.
4. Reconvene stakeholders: After significant time has passed, stakeholders may be reconvened to revisit
conversation on the issue, and review any action taken. This meeting may take the form of a fair, and
increased community participation may be sought (Michigan Association of School Boards, 2006)
Ten principles to authentic community engagement:
1. Involve all sectors of the community.
2. The community will be engaged on important questions, and the views and contributions of the
community will be acknowledged.
3. The community will be involved early in the process.
4. Opportunities for people to gather at convenient and comfortable locations and a variety of
times will be offered.
5. More than one meeting will take place, and enough time will be offered to make informed
judgments.
6. The community’s values and aspirations for the future will inform discussion and action.
7. The process should have a learning component that helps build community awareness and
knowledge about the subject at hand.
8. The process should allow for sustained involvement by community stakeholders.
9. Community partnerships and expertise will be utilized.
10. Clear, open, and consistent communication will be employed (Michigan Association of School
Boards, 2006)
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 29
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
The public engagement model in education entails a shift in traditional power relationships whereby
stakeholder groups actively generate new ideas, participate in decision-making processes, and shape
policy. This model can be applied to MHSA processes to the extent that departmental leadership is willing
and able to decentralize power and increase the role of stakeholders. This shift need not occur overnight;
the model hypothesizes, however, that such transition will lead to greater trust and community
integration.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 30
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Public Engagement Case Study
New Facility for Capitol Elementary School
Time Period: Beginning 1994.
Jurisdiction: Phoenix, AZ.
Stakeholders: School staff, faculty, and administrators, parents, students, local business people, and residents.
Lead Public Agency or Organization: Phoenix Elementary School District #1.
Types of Services or Uses Planned: Improved school facility and programs.
Description of Process, and Outcome and Findings: Located in one of the most economically disadvantaged
neighborhoods in downtown Phoenix, Capitol Elementary School had been operating out of small, dilapidated
portable classrooms, with no windows, insulation or air-conditioning. According to the principal at the time, Cora
Garrido, “The district viewed us as a dying community.” Teachers felt burnt out, disconnected, parents felt equally
disaffected; and attendance was among the worst in the district. In 1994, at the principal’s request, voters approved
a $6.2 million bond measure to build a new school.
At the principal’s request, a committee comprised of parents, school staff, local business owners, and district
personnel assumed responsibility for planning the new school, which surprised many traditional school planning
stakeholders, including professional educators, architects, and engineers. Looking back, the school district’s director
of facilities, Greg Johnson, thought “What do these people know about construction?” Nonetheless, the committee
met each week to discuss educational philosophy and best practices, forming a set of educational goals the new
facility was intended to support. Some of the “experts” found the process slow and irrelevant. “What’s to talk
about,” recalled Johnson, “Let’s just build a square box that’s easily maintained.” Ultimately, however, an
architectural firm was selected to lead the design process, to help translate the school’s educational goals into a
new school building. The committee expanded the planning process to the broader community, who worked with
the architect to develop design goals.
The school was built according to the collaborative design developed as a result of the participatory process. The
community envisioned a school which would: 1) be colorful; 2) have plenty of natural light, foster a sense of
community with its design, with many gathering places; 3) have ample space for large projects, and encourage
cross-classroom learning and collaboration; 4) include shared office space for teachers, to encourage and facilitate
common planning; and 5) encourage integration of technology. Project architects stayed true to these goals, and
the new Capitol Elementary School facility includes non-traditional colors, skylights, classrooms arranged in a
circular fashion around a shared activity area with movable classroom walls, shared office areas for teachers, and
computer areas in all of the classrooms. The outdoor area of the school includes a large, inviting circular courtyard
which has naturally developed into a gathering place for children, teachers and families. Other school gathering
places include a multi-purpose room and a community room, where parents often work on projects for classroom
teachers. The school design also includes a small health center for students and their families, with one full time
nurse, and one half time nurse practitioner.
The success of the project reached beyond the grounds of the school itself, and extended into the local
neighborhood, with neighbors reporting a reduction in crime, an increase in home and neighborhood beautification
projects, and a new sense of pride in the community, as a result of the planning and construction of the new school
(Furger, 2003).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 31
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Mobilizing for Action through Planning and Partnerships (MAPP)
A community assessment is a method of identifying local problems, needs, strengths and assets. The
assessment is used to establish priorities and explore strategies for action. Mobilizing for Action through
Planning and Partnerships (MAPP) is a community-driven, place-based public health assessment and
planning process developed between 1997-2000 by the National Association of County and City Health
Officials (NACCHO), and the Centers for Disease Control and Prevention (CDC). Stakeholders in the MAPP
process include public health professionals, other health and human service providers, policy makers,
public servants, service recipients, and neighborhood residents (National Association of County & City
Health Officials, 2013).
The MAPP model emerged from a 1988 report that argued that public health in the U.S. was in
“disarray.” A predecessor model developed in 1991, called Assessment Protocol for Excellence in Public
Health (APEXPH), no longer receives CDC funding. According to MAPP’s lead program analyst, MAPP
distinguishes itself from predecessors and from many other public community planning models because
of its focus on “strategy, inclusiveness and a commitment to effectiveness” (Allee, 2013).
MAPP envisions “communities achieving improved health and quality of life by mobilizing partnerships
and taking strategic action.” Other goals of the MAPP process are to increase awareness and knowledge
of public health issues, strengthen public health infrastructure, develop a sense of community ownership
of public health issues, and better manage and respond to environmental changes (National Association
of County & City Health Officials, 2013).
MAPP uses a step-by-step process that includes the following phases:
1. Organizing the planning process and developing planning partnerships. The purpose of this
phase is to engage public health stakeholders and develop their commitment to the planning
process.
2. Visioning. During this phase, participants develop a shared vision about what an ideal future
would look like. The visioning process helps establish common values.
3. The 4 assessments. Participants collectively engage in collecting and interpreting data on four
topics:
a. Community themes and strengths—“What is important to our community?” and “What
assets do we have that can be used to improve community health?”
b. Local Public Health System Assessment—“How are essential services being provided to
the community?” and “What are the activities and capacities of the local public health
system?”
c. Community Health Status Assessment—“How healthy are our residents?”
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 32
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
d. Forces of Change Assessment—“What is occurring or might occur that affects the health
of our community or the local public health system?”
4. Identifying strategic issues. During this phase, participants review assessment data and develop
a list of the most important issues facing their community.
5. Developing goals and strategies: Participants develop goals and strategies after identifying the
most important issues.
6. Action Cycle: During this phase, the local public health system develops and implements the
action plan. This phase includes an evaluation of the actions taken to improve health (National
Association of County & City Health Officials, 2013).
MAPP operates from the following seven principles:
1. Systems thinking: to promote an appreciation for the dynamic interrelationship of all
components of the local public health system required to develop a vision of a healthy
community.
2. Dialogue: to ensure respect for diverse voices and perspectives during the collaborative process.
3. Shared vision: to form the foundation for building a healthy future.
4. Data: to inform each step of the process.
5. Partnerships and collaboration: to optimize performance through shared resources and
responsibility.
6. Strategic thinking — to foster a proactive response to the issues and opportunities facing the
system.
7. Celebration of successes: to ensure that contributions are recognized and to sustain excitement
for the process (National Association of County & City Health Officials, 2013).
The MAPP process broadens the definition of public health stakeholders to include many groups other
than public health department employees. All public health stakeholders, from local business leaders,
faith community, service providers, and recipients, can engage in planning and action. MHSA
coordinators may consider a MAPP or similar framework for their CPP processes by guiding a broad range
of stakeholders through a step-by-step approach to establishing a vision, conducting an assessment,
identifying issues from the data, developing strategies, and engaging stakeholders in the implementation
or action phases. The MAPP process entails a leap from research to planning, and then another leap from
planning to action. To engage mental health stakeholders in a MAPP-like process, the department will
need to commit to engaging stakeholders not only in planning, but in implementing strategies.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 33
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
MAPP Case Study:
San Francisco Healthy Homes
Time Period: 2011-2012.
Jurisdiction: San Francisco, CA.
Stakeholders: Public and community-based health care providers, government agency representatives, the local
YMCA, community advocates, and residents of low-income housing developments.
Lead Public Agency or Organization: San Francisco Department of the Environment in collaboration with San
Francisco Department of Public Health.
Types of Services or Uses Planned: Strategies to address health inequities Description of Process, and Outcome and
Findings: Funded by a grant from the CDC’s Racial and Ethnic Approaches to Community Health program, the
Department of the Environment (SFE) launched San Francisco Healthy Homes (SFHH). SFHH sought to address
health inequities in the Bay View Hunters Point and surrounding neighborhoods by “transforming the community’s
vision of healthy homes and neighborhoods into achievable goals and actions.” SFHH participants included public
and community-based health care providers, community advocates, and residents of low-income housing
developments. The local YMCA served as a key partner by training and stipending local residents to help conduct
the assessments and engage in strategic planning. Through the assessment and planning phases, SFHH participants
identified the following four goals: 1) Address post-traumatic stress disorders (PTSD) among children, youth and
families; 2) Reduce violence in Bayview Hunters Point and surrounding neighborhoods; 3) Reduce preventable
health inequities in chronic disease and infant health; and 4) Reduce injury and chronic health conditions by
addressing substandard housing conditions.
In July 2012, SFHH entered into MAPP Phase 6, the Action Cycle. Four planning meetings engaged government
agency representatives, service providers, residents, and community based organizations, and discussed current
initiatives and existing services, gaps and needs, potential strategies and activities, and potential impacts of the
activities. Two strategies, along with more detailed tasks, emerged to address health inequities: Support training
and employment of local community health promoters and Improve partnerships and communications between
local public health system providers, the community, and police (San Francisco Department of the Environment,
2013).
Resource Development Associates (RDA) provided technical assistance and conducted a brief process evaluation
using satisfaction surveys and focus groups with participants. The evaluation determined that one of the greatest
strengths of the process was the engagement of the Resident Committee, whose members came from low income
and public housing developments. During the first year, between 14 and 20 participants attended a total of 6
meetings. Resident Committee members helped collect data, including over 400 resident surveys. During the first
year, several challenges were identified: the shortage of Spanish- and Chinese-speaking Resident Committee
members resulted in fewer respondents from these demographic groups. Residents described that in the future, it
would be useful to spend more time strengthening personal bonds between each other and between the
facilitators, and to work on building trust. Ultimately, residents reported feeling very proud about participating in
the process. Several reflected on the significance of having their names written into the acknowledgement section.
Others stated that they hoped they would continue to meet and support the actions outlined in the final plan
(Resource Development Associates, 2013).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 34
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Community Dialogue in Health Impact Assessments
Health Impact Assessment (HIA) is a highly structured means for examining the intended, and often
unintended, health effects of proposed policies, plans and projects in land use, transportation, housing,
agricultural, energy and other infrastructure arenas. HIAs help to determine if a proposed program or
project should be approved, and when conducted in a principled manner, examine the physical, social
and mental wellbeing of community members using a broad, systems based approach that includes
evidence from a variety of sources (UCLA School of Public Health, 2003-2006). Meredith Minkler,
Professor of Health and Social Behavior at the University of California at Berkeley, suggests Health Impact
Assessments as a participatory planning method worth further exploration (Oct, 2013).
There are three basic methods to conducting an HIA: 1) Community Dialogue; 2) Quantitative Analysis;
and 3) Bureaucratic Pragmatism. Not all of these HIA methods emphasize stakeholder participation. For
instance, HIAs which utilize the Quantitative Analysis approach alone focus on the numerical
measurement of the impacts of policies and projects on health outcomes. Quantitative Analysis applies
methods from risk analysis, epidemiology, economics, and toxicology. The Bureaucratic Pragmatism
approach is utilized by government agencies required to assess health impacts as specified by agency
regulations or rules. These HIAs use the analytical methods which the governing agency requires, and
emphasize efficiency, expediency, and adherence to regulations. Tools which encourage community
input such as community meetings may be included, but are not common with this approach (UCLA
School of Public Health, 2003-2006).
The community dialogue approach to HIA focuses on public participation in decision making, with the
belief that the broad inclusion of stakeholders allows for a close alignment with the four core values
which guide HIAs. These core values, as set forth by the World Health Organization, are democracy,
equity, sustainable development, and the ethical use of evidence (World Health Organization, 2013). The
theory behind the dialogue approach to HIAs suggests that stakeholder involvement and leadership help
to promote the goals of inclusive, healthy, and equitable communities. According to the Stakeholder
Participation Workgroup of the 2010 HIA in the Americas Workshop, convened in Oakland, California, in
2010, “In such communities, positive health outcomes are equitably distributed; low-income people,
communities of color and other vulnerable populations have access to the opportunities necessary to
thrive; and the democratic process empowers all to participate in the decision-making processes that
impact their lives” (Stakeholder Participation Working Group of the 2010 HIA of the Americas Workshop,
2012, p. 2). Human Impact Partners (HIP), a public health advocacy organization, use Health Impact
Assessments as their primary analytical tool. Johnathan Heller, Co-Director of HIP, discusses the need for
tools like HIAs to promote democratic planning processes, “Agencies need to think about power. Are they
just filling in the boxes or are they interested in promoting democracy? Participation is necessary to
promote democracy” (2013).
The Stakeholder Participation Workgroup described stakeholders as those individuals who stand to gain
or lose from the policy, plan or project. These include CBOs, residents, service providers, elected officials,
small businesses, industry and big business, developers, public agencies, advocacy organizations and
academics. Some specific recommendations related to involving stakeholders emerged:
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 35
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Ensure stakeholder participation is diverse in order to understand the community and political
realities related to the policy, project or program being studied.
Involve stakeholders affiliated with organizations rather than independently engaged residents
who are only representing their personal interests.
Pay special attention to those representing vulnerable populations, including low-income people,
communities of color, people with disabilities, children, and seniors.
Due to the diversity of interests among potential stakeholders the workgroup notes that “no
single approach can be prescribed for stakeholder participation” (Stakeholder Participation
Working Group of the 2010 HIA of the Americas Workshop, 2012).
While HIAs focus on the impact of land-use decisions on individuals who stand to gain or lose from the
decisions, HIA principles could be applied to MHSA community planning processes. Departmental
leadership can engage stakeholders in dialogue about the impact of new programs and policies, paying
special attention to feedback received by those who have historically been left out or inappropriately
served. Implicit in the concept of dialogue is a commitment to leveling the playing field so that all
stakeholders can participate without fear of reprisals. Creating a safe space is therefore critical to CPP
planning based on the HIA model. Finally, the idea that no single approach can be prescribed for
stakeholder participation is a critical concept, which counties must take seriously when developing their
CPP processes. The principle suggests that there are no cookie cutter practices, but that the CPP
processes themselves should derive and evolve from dialogue with stakeholders.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 36
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Health Impact Assessment Case Study
Adams Park: A Catalyst for Community Revitalization and Health
Time Period: 2011.
Jurisdiction: City of Omaha, Nebraska.
Stakeholders: Neighborhood residents.
Lead Public Agency or Organization: Douglas County Health Department, Omaha, Nebraska.
Types of Services or Uses Planned: Parks and Recreation.
Description of Process, and Outcome and Findings: North Omaha, a once thriving African American Neighborhood
and birthplace of Malcolm X, in recent years has experienced economic disinvestment, and insufficient employment
and housing options. Community-based planning efforts resulted in a neighborhood revitalization plan that centers
on the improvement of the 68-acre Adams Park. The plan seeks to attract visitors, improve recreational options for
residents and attract investment. At the heart of the plan is a community garden and urban farm, which the Douglas
County Health Department (DCHD) feels could help support resident access to healthy foods (Centers for Disease
Control and Prevention, 2013).
In 2011, the CDC funded a Health Impact Assessment to measure the effect the 10- to 20-year Adams Park Plan
would have on the wellbeing of the surrounding community. The DCHD collected and analyzed demographic, health
and food access, crime, and traffic condition data. Empirical data collection focused on expert informers and
scientific research. The African American Empowerment Network and North Omaha Neighborhood Alliance, two
local organizations, offered information about resident priorities and concerns. “We saw the opportunity to bring
health and health equity into the revitalization effort around Adams Park,” said Andy Wessel, a planner for the
DCHD. “In the beginning, a lot of people were skeptical about HIA because they felt it would slow down the
[planning] process. At the end of the day, the Adams Park HIA showed how including health and community
concerns was a real benefit for decision-makers” (Centers for Disease Control and Prevention, 2013).Ultimately, the
HIA showed that if the plan were adopted, the park would improve the health of North Omaha residents. The
farming and garden center would improve access to affordable and healthy foods and the park would allow for
greater social interaction, recreation, and exercise.
This case study shows the Adams Park HIA’s commitment to capturing the vision and desires of the stakeholders
most impacted by the project—the neighborhood residents. As recommended in the Stakeholder Participation
Workgroup, the planners relied on CBO input rather than individual community members. While there was no
indication that stakeholders were involved in data collection, interpretation or decision making, Wessel described
the project contributing to democracy and equity due to the questions that were asked by the planners, such as
“What are the hopes and concerns of the people most affected by this decision?” and “How is this decision likely to
affect the lives of those who are already struggling” (Centers for Disease Control and Prevention, 2013).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 37
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Participatory Budgeting
Participatory Budgeting is a democratic process that engages community members in decision-making
about how to spend part of a public budget. The process was developed in Porto Alegre in 1989 during
the first year of Brazilian democracy following a military dictatorship. The Workers’ Party, upon electoral
victory, started Participatory Budgeting as a result of community organizations’ demands for greater
inclusion in financial planning and decision-making. The concept of participatory budgeting soon took
flight. In 2012, approximately 1,500 municipalities around the world use participatory budgeting (Tian,
2013).
The Participatory Budgeting Process: Municipal governments invite residents to neighborhood assemblies
and facilitate a discussion about problems and solutions that can be funded through the city’s
discretionary budget. The community delegates an individual or group to research concerns and
solutions, and return with a slate of project proposals for participants to vote on. The top projects are
sent to the city council for approval. The process was first used in the United States in 2009, when
Alderman Joe Moore of Chicago’s 49th Ward decided to implement Participatory Budgeting. He set aside
$1.3 million for the process, which engaged 1,427 residents (Tian, 2013).
A 2002 World Bank study on Participatory Budgeting in Porto Alegre (Bhatnagar & Rathor, 2002, as cited
in Tian, 2013) found that the process empowered residents in four critical ways:
1. Information: Participants learn about their communities.
2. Inclusion/participation: Community members who might not otherwise be included in decision
making engage fully in the process.
3. Accountability: Municipal leaders are held accountable for sharing financial information and
monitoring the status of selected projects.
4. Local organizational capacity: Community organizations that form to help influence the budget
build capacity and experience.
The report cited that a number of improvements occurred in Porto Alegre between 1986 and 1989,
following participatory budgeting, including the development of new public housing units, new sewer and
water connections, and new schools. The share of budget allocations dedicated to participatory
budgeting grew from 17% in 1992 to 21% in 1999. Another indicator of success has to do with the level of
participation. In 1990, 1,000 residents participated in the process. In 1999, 40,000 residents participated.
A recent published essay highlights three core principles of Participatory Budgeting. The first principle—
active citizen participation—places citizens in a position to make decisions that affect not only their lives,
but also the lives of others. As a result, participants learn “social justice” discourse. The second
principle—increased citizen authority—moves citizen involvement beyond consultive to deliberative
roles. They join the realm of “state-sanctioned” decision-makers. In the consultive role, citizens provide
feedback to the government, but there is no explicit requirement that the government implements
projects selected by citizens. In participatory budgeting, citizens hold the decision-making authority. The
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 38
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
third principle—reallocation of resources—suggests that by expanding voice and vote to those who have
traditionally been excluded from deliberative roles, Participatory Budgeting helps to redistribute
resources, which leads to social justice. Finally, the essay describes the principle of Improved
Transparency, which suggests that Participatory Budgeting helps to reform local administrative
processes. Bureaucrats and policymakers directly engage with citizens, and ongoing conversation results
in direct oversight by citizens over the allocation of public resources (Wampler, 2012).
Participatory budgeting could be applied to MHSA community program planning if counties have the
authority to relinquish decision-making authority related to budgetary decisions. A county could engage
stakeholders in budgetary recommendations using PB approaches but the authority might need to
remain within the jurisdiction of county staff and board of supervisors. To understand how PB could be
used in CPP planning, a greater understanding of budgetary decision-making authority is needed.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 39
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Participatory Budgeting Case Study
Participatory Budgeting New York City
Time Period: 2011 – 2013.
Jurisdiction: New York City, NY.
Stakeholders: between 8,000 and 13,000 residents from four to eight Council districts annually, including youth under 18, people
of color, low income earners, immigrants and ex-offenders.
Lead Public Agency or Organization: City of New York.
Types of Services or Uses Planned: City budget development.
Description of Process: In FY 2011-12, 8,000 New York City residents from four districts voted on how to spend $6
million in public funds. In FY 2012-13, the Participatory Budgeting process expanded to over 13,000 resident
participants, in eight districts, voting on nearly $10 million in public money. Typically, in February of each year, the
Mayor releases a preliminary budget and the City Council holds a hearing where community members can testify.
This is the only citizen involvement in the budgetary process. Through participatory budgeting, between September
and November, City Council members present information on the budget at neighborhood assemblies in each
jurisdiction. In FY 12/13, over 1,500 people participated in 41 assemblies. Residents then brainstorm project ideas
and select delegates. Between November and March, delegates meet in committees to transform initial project
ideas into proposals, with support from Council staff and other experts. In March, delegates present their proposals
and receive feedback in Project Expos, and in April, over 13,000 people residents vote on project proposals. PB
represents only a small fraction (0.014%) of the total NYC budget and only 1.8% of discretionary capital funds.
Evaluation and Outcomes: An evaluation of year-two of New York’s PB involved 8,200 collected surveys, 30 meeting
observations, and 63 in-depth interviews. An evaluation report included a citywide section and detailed breakdowns
for each of the eight districts. The evaluation focused on who participated and why, attitudes toward local
government and civic engagement, and how City Council members believed they benefitted from the process. The
evaluation identified
Measures of civic participation: The evaluation found that PB mobilized long-term residents, many of whom had
never worked in their communities to solve a problem. Participation was diverse, with higher proportions of African
Americans, low-income earners, and women than the population as a whole. Participants who traditionally are
barred included immigrants, youth under age 18 and formerly incarcerated.
Decision-making outcomes: Schools were the big PB winners, with 24% of budget directed toward school
improvement. The evaluation found that schools can have disproportionate influence, since they have significant
institutional power, and many who got involved in the process were school volunteers. Some delegates pushed for
projects in their child’s school.
Outreach: Participants heard about PB through social networks, community organization, Council Members and by
email. Word of mouth and flyers were most common.
Benefits to City Council Members: Council members reported heightened visibility in the media, deeper
connections to constituents and increased awareness of issues.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 40
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Community COPE
Community COPE is a model used in the assessment and planning of local healthcare systems in poor
communities in the U.S. and internationally. The model emerged from a quality improvement initiative,
COPE®—“client-oriented, provider-efficient”, developed in 1988 by EngenderHealth, an international aid
organization seeking to support family planning, reproductive and maternal health projects, improve
quality of care, and advocate for evidence based practices. COPE® is a process and set of tools that health
professionals can use to assess, plan, implement and evaluate program and site-level improvements.
Since the development of COPE, many health programs have come to recognize the importance of
involving community members in the quality improvement process. They argue that by not paying
sufficient attention to community and client perspectives, service providers risk clients discontinuing
services and potential clients avoiding seeking services. This is because staff members and clients
perspectives on the quality of services often differ (EngenderHealth, 2003). Community COPE responds to
this concern and theorizes that through community involvement:
1. Community members achieve a greater level of commitment toward and ownership of quality
improvement efforts at a particular healthcare site.
2. Healthcare sites achieve access to community resources, such as human effort and time, which
may contribute to more in-depth analysis and effective solutions.
3. Sites and communities experience a sense of teamwork and ongoing communication.
4. Community members think about ways to avoid health problems before they become health
problems.
5. Community members better understand the problems faced by the healthcare site
(EngenderHealth, 2002).
While traditional COPE seeks feedback from existing clients, Community COPE provides outreach to
potential clients and other community stakeholders to gather feedback for systems planning efforts, and
simultaneously educates the community on their rights and “the ways they can influence the content and
quality of health services” (EngenderHealth 2002: vi). The use of the Community COPE model is
recommended for health care service delivery sites that wish to increase the involvement of the
community in planning and decision making processes. For example, in one Community COPE project in
Kenya, interviews, group discussions, and community meetings revealed the following community
priorities: 1) access (wait time, distance); 2) client-provider interaction (unfriendly staff); 3) safety
(inadequate cleanliness, rats in mortuary); and 4) privacy (crowded/co-ed wards, insufficient screens). As
a result, the following changes were identified and implemented: 1) shorten waiting times; 2) increase
specialized services; 3) outreach services; 4) improve staff attentiveness and friendliness; 5) clarify
charges; 6) address blood shortage; 7) improve cleanliness; 8) clean and renovate mortuary; and 9) install
screens and curtains for privacy. From this case study as well as another project in Senegal, the following
lessons were learned:
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 41
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
The community is not a uniform group; it is comprised of diverse groups with different needs.
Participatory community assessment activities revealed more information than client interviews.
Community involvement is more than soliciting the community perspective on services; it
includes community members in the action planning process as well.
Community Cope uses a Community Based Participatory Research framework for the purposes of quality
improvement, outlining nine distinct steps in 3 phases: 1) orientation and preparation; 2) information
gathering and action plan development; and 3) implementation and follow-up:
Orientation and Planning
1. Orient staff to the Community COPE process.
2. Identify groups for community activities.
3. Meet with local community leaders to determine level of interest and seek support.
4. Select and plan participatory activities, which may include Individual interviews, group discussions,
site walk through, participatory mapping, and other methods. Ensure that the methods chosen
reflect the needs of the community participants.
Information Gathering and Action Plan Development
5. Conduct the participatory activities to gather information about community members’ views of
services, their health concerns, and recommendations for improving services. Identify problems to be
solved and the root causes of problems. Celebrate successes.
6. Conduct action planning with the community and prioritize recommendations.
7. Form a Quality Improvement Committee with appropriate community representatives ensuring two-
way communication between health site and community and accountability.
Implementation and Follow-Up
8. Implement the action plan; plans may be implemented by staff alone or with community members.
9. Provide ongoing monitoring and feedback. Emphasize the use of local resources; keep records of
progress made; communicate progress with communities through local media; follow up quickly on
action plan recommendations and revise plan. Community involvement process should be repeated
at least once per year.
The Community COPE model assumes that community activities should not take the place of traditional
quality assurance activities that involve staff and outside experts. The initiative recognizes both the rights
of clients as well as the needs of healthcare staff. Rights of clients include: access to information and
services; informed choice; safe services; privacy and confidentiality; dignity, comfort and expression of
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 42
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
opinion; and continuity of care. The needs of staff include quality supervision and management;
information, training and development; and sufficient supplies, equipment and infrastructure
(EngenderHealth, 2002).
As part of their annual CPP processes, counties could adopt a community-oriented approach to
investigating community mental health issues, service gaps and barriers. Community COPE reminds
practitioners that stakeholders, including those who are not involved in planning or receiving services,
have critical knowledge about community needs and may be most useful in understanding the challenges
and barriers to seeking, obtaining and maintaining services and supports. The Community COPE
framework and interview tools may also be modified and used by MHSA coordinators when seeking input
from stakeholders, including those who have historically not participated in services or planning for
services.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 43
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Community COPE Case Study
Centro Diagnóstico
Time Period: 2001-2002.
Jurisdiction: Santo Domingo, Dominican Republic.
Stakeholders: Reproductive health clinic clients, clinic staff, and members of the neighborhoods surrounding the
clinic.
Lead Public Agency or Organization: The Dominican Republic Family Planning Association (ADOPLAFAM).
Types of Services or Uses Planned: Reproductive health services.
Description of Process, and Outcome and Findings: Centro Diagnóstico is a family planning and reproductive health
clinic that serves low income neighborhoods on the outskirts of Santo Domingo. One of the clinic’s major donors is
the United States Agency for International Development (USAID). USAID, via its performance improvement
program, PRIME II, funded the Integrating Consumer Perspectives (ICP) initiative in an effort to promote the clinic’s
financial sustainability. Upon the opening of Centro Diagnóstico in 2001, only 28% of clients were paying for their
services. Within a year, following the PRIME initiative, the number of clients doubled and 83% were paying for their
services.
Multiple reports credit PRIME II’s participatory processes for the success of the clinic. According to PRIME II, “The
willingness of consumers to pay for family planning and reproductive health services can be related to the perceived
quality of those services. Developing mechanisms for consumers to provide regular feedback on service quality is a
key component of PRIME II’s Consumer-Driven Quality (CDQ) approach” (PRIME II).
The project looked to improve performance of primary providers through the integration of consumer perspectives
into protocols for service delivery. For this purpose, Centro Diagnóstico designed an ongoing mechanism for
listening to customer feedback and incorporating what they had learned into quality improvement action plans. This
collaborative, ongoing activity then acted to shape ongoing relationships between consumers and providers.
PRIME II organized 5 community meetings in neighborhoods surrounding the clinic in order introduce community
leaders to the quality improvement project. Using Community COPE methodology, they collected consumer
feedback about reproductive health needs and service delivery barriers and identified community spokespersons to
serve on a Clinic-Community Committee. The data from this process was integrated into a quality improvement
plan, which, during the implementation stage, was continually monitored by the Committee. The Committee also
ensured ongoing dialogue between community members and the clinic staff.
The resulting action plan produced many changes to Centro Diagnóstico, including an increase of open clinic hours,
a wider array of services, additional services and staffing, increased privacy, and improved client/provider
interactions. Over the course of the intervention, between December 2001 and December 2002, the perception
that the clinic provided necessary services and that clients can ask questions of their providers rose nearly 100%.
Additionally, the number of clients attending the clinic more than doubled, and the proportion of those paying for
their services rose from 28% to 83%. According to the clinic’s director, Dr. Jose Gregorio Aponte, “Involving people
from the community is critical because they will always have the best idea of how to better their own quality of life”
(Voices from the Field: Involving Communities In Quality Services, 2002).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 44
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Use of Technology in Community Planning
The growth in recent years of information and communication technologies has led to the development
of innovative tools that have the potential to change the way people engage in public processes, allowing
for unprecedented levels of community engagement, especially among groups historically excluded from
planning processes. By bringing the tools of planning to the people, through new and readily available
technologies, planning can be democratized, and ensure that those who are most affected are
empowered to participate in the decisions that affect their lives (Chin et al., 2010; Xie, 2013).
Technological strategies used in participatory planning processes, often referred to as “Planning Support
Systems,” do not commonly displace more traditional tools of community engagement, such as town hall
meetings, but rather are used to supplement and enhance these traditional participatory methods,
promoting a broader base of citizen participation.
Planning Support Systems can be used to enhance participatory processes in a number of ways. Emerging
technologies have the potential to increase participants’ understanding of the issues at hand, leading to
more informed decision-making and an increase in consensus building. Planning Support Systems also
facilitate communication among participants, enhancing the collaborative aspects of community-oriented
planning, and building community among participants. The use of technology also makes possible real-
time capabilities for conversation and debate, data capture, and analysis (Slotterback & Hourdos, 2009).
Several factors potentially limit the use of technology for community planning purposes. Constraints
include limited technological capacity of some participants; resistance to change; limited access to
training; costs associated with new systems; and limited access to technology. Additionally, while
Planning Support Systems can lead to broader stakeholder participation in general, evidence suggests
that these technologies may not be as effective in engaging marginalized or disenfranchised populations
(Chin et al. 2010).
Planning support systems may be used at various phases of community planning, including during the
preparation, execution and analysis of participatory processes, and for the dissemination of their results.
A multitude of technologies have been identified for use during all phases. Some examples of these
include:
Project Websites: According to researchers, project websites are most useful for those engaged in
community planning processes for their ability to attract participants, their broad availability, and their
ease of understanding (Slotterback & Hourdos, 2009). Project websites are effective in communicating
information and encouraging immediate, real time participation. One example of a website associated
with participatory planning efforts is ImproveSF.com, which is an online platform used by the City and
County of San Francisco, designed to “provide opportunities for government and citizens to work
together by connecting civic challenges to community problem-solvers” (ImproveSF, About, 2013). A
current initiative on the ImproveSF website, implemented by the Mayor’s Office of Civic Innovation and
the San Francisco Planning Department, seeks to revitalize public spaces in the city. The project, called
Living Innovation Zones (LIZ), asks San Francisco residents to submit ideas on ways in which the city’s
Market Street may be reimagined “as a showcase for new ideas, technologies, interactive projects, and
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 45
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
more” (ImproveSF, Living Innovation Zones, 2013). Participants submit ideas in an open forum, where
others are able to read and vote on the projects they like. Ideas are ultimately chosen through a
collaboration between the city, city partners, and community input gained through the interactive
website.
Geographic Information System (GIS): GIS is a computer system designed for capturing, visualizing,
manipulating, analyzing, and interpreting all types of geographical data. Until recently, GIS has been used
almost exclusively by experts and academics in fields such as urban planning, cartography, environmental
impact assessment, and natural resources management. In recent years, GIS has been identified as a
powerful tool for use in participatory planning processes, for its ability to translate complex spatial
information into a simple visual language, easily understood by all categories of stakeholders. GIS was
used in an inclusive neighborhood planning project conducted by the University of Illinois at Chicago, in
the Pilsen section of that city. Planners designed a technique which used GIS in combination with artists’
renderings of residents’ perceptions of their neighborhood, which was used during planning sessions to
provide immediate and interactive access to images of neighborhood characteristics. The resulting spatial
and artistic images assisted participants to easily and immediately visualize their neighborhood in its
current conditions and what they hoped it would be in the future, which enhanced their ability to direct
planners. This process was developed by the University planners as a result of their commitment to active
and meaningful community participation. They proposed, “this technique not only allowed community
members to truly participate in designing revitalization projects in their neighborhood, but also gave
them confidence that the University would be an equal partner, rather than a unilateral decision maker,
in the process” (Al-Kodmany, 1999, p. 29). James Rojas, urban planner and founder of the Latino Urban
Forum, based in Los Angeles, advocates for the use of creative, physical, and play-like activities such as
those described above, to better engage community participants in neighborhood planning activities.
Rojas states, “I started working with poor and Latino residents of Los Angeles. My goal was to use the
power of play to empower people to have a better understanding of their neighborhoods and how they
might shape them for the good” (2013).
Web-Based Surveys: The survey is a potent strategy for gathering focused, specific, feedback from
stakeholders taking part in community planning processes. Surveys have historically been utilized as a
quick, powerful, and efficient way to gather information about people’s attitudes and opinions; rank
issues in terms of importance and urgency; determine support for initiatives under discussion; and to
evaluate current programs and policies, to name a few. Until recently, the only reliable methods for
conducting surveys were through the mail, through face-to-face interaction, or on the telephone, and
were often expensive and time consuming. The development of web-based surveys have a number of
benefits over conventional survey methods: they are more inclusive, allowing further reach; they are less
expensive, allowing for a greater number of participants; and data are captured directly in an electronic
format, making tabulation immediate, and analysis much simpler (Wyatt, 2000). In addition, platforms for
construction of web-based surveys are readily available, in user-friendly formats, making them within
reach not just for experts but for many stakeholders. These benefits support the goals of participatory
planning processes by reaching a broader constituency, and making survey construction, dissemination,
and tabulation available to the people. Stakeholders in the New River Valley (NRV) Region of Virginia are
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 46
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
currently in the final year of a three year long participatory community planning process (2011-2014)
designed to develop a vision for the future of the region. The New River Valley Livability Initiative has
engaged close to 3,000 citizens so far, who have shared their ideas and thoughts about how they would
like the region to remain the same, and how they envision it being different in the future. As part of this
process, the Livability Initiative, facilitated by the New River Valley Planning District Commission, has
conducted two web-based surveys so far, with one more planned for the future. The first survey sought
feedback on a range of possible policies and projects proposed to address challenges faced by the region.
Over 700 NRV residents completed this initial survey, with many accessing it from their homes, and
others accessing the survey at public libraries and town halls, where it was available to community
members without internet access. The results of this survey sought citizen feedback on the preliminary
goals developed by the Livability Initiative’s seven working groups. The second survey, also web-based,
focused on community priorities and was developed from public input during earlier phases of outreach
and a set of topic area goals resulting from a year’s worth of research and discussion on the part of the
Livability Initiative’s seven working groups. Close to 700 residents participated in order to provide
feedback. The results of this survey were used to inform the direction of the community planning process
over the following six months (New River Valley Planning District Commission, 2013).
Principles of the use technology in participatory planning processes
Understanding the characteristics of meeting types and contexts is important in informing the
selection of technologies to enhance participatory processes.
Many technologies can be understood by the general public; however it is important to be aware
that individuals may have differing abilities in the use of technology.
Decisions about the use of technology in participatory processes should be based on a clear
sense of the contribution that the technology can make to the communication and discussion of
information.
Disenfranchised audiences should be identified early in the process. Determining the barriers
they may face to technology will help with the creation of user-friendly tools.
A culturally competent lens should be employed to assess the needs of the populations targeted.
Selecting the right medium entails an understanding of the demographics being targeted and
their access (or lack of access) to any required tools or technologies.
Feedback should be solicited from target populations on which technologies are more accessible
to them.
How well the tool reaches populations that don’t speak English as a first language should be
considered.
If using software requiring hands-on assistance, accessibility for all abilities and disabilities should
be ensured and assistance made available.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 47
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Different curricula and tools may need to be developed to accommodate the unique interests
and needs of different populations and the range of technological skills that different populations
have.
Dialogue complements and deepens ideas and knowledge gained from the online experience.
Time and space for face-to-face interaction and deliberation of planning ideas and concerns
between participants is essential (Chin et al., 2010)
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 48
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Chapter 3: Application to MHSA Community Program Planning
The theoretical frameworks and practical models used to implement community planning initiatives—as
described in Chapter 2—offer guidance to county MHSA staff, professional planners, and CPP
stakeholders for the development of planning guidelines, methods and tools. In this chapter we
synthesize both common and unique themes that emerged from our research into a set of eight
principles that may inform future MHSA CPP processes. Additionally, we describe practical strategies that
county mental health administrators and MHSA/CPP staff and contractors can implement to adhere to
these principles.
Principles and Practical Applications for MHSA Community Program Planning
The following eight principles derive from an amalgamation of 79 values, principles and codes extracted
from our research into public community planning frameworks, as summarized in Chapter 2. Appendix 1
shows how each of the 79 concepts were synthesized to form the principles. Below are practical
applications for each of the principles. These practical applications derive from practices described in the
case studies as well as from cited research and the expertise and experience of the authors.
Be strategic. Practice thoughtful, deliberate preparation. Establish purpose, priorities and goals
before launching the planning process. Use methods and tools based on a clear sense of how
they contribute to the process and intended outcomes. Recognize political, social, and market
realities to create feasible implementation plans. Engage in systems-thinking by considering the
interconnectedness of issues and institutions. Prior to completing planning processes, identify
measurable outcomes and indicators of success to support accountability and encourage ongoing
programmatic improvement.
o Practical application: Mental health administrators and MHSA/CPP coordinators can
schedule dedicated time on an annual basis to mapping out CPP activities and strategies.
Time can be spent evaluating and reflecting on prior year’s process. Counties may wish to
invite several experienced stakeholders to participate in discussing planning methods
(Planning Processes).
o Practical application: Whenever possible counties can use existing, step-by-step strategic
planning frameworks, such as MAPP (See MAPP Framework above) or World Health
Organization’s Planning Cycle (Von Schirnding, 2002), to guide planning processes. These
frameworks should include practical and strategic steps such as visioning, assessment,
goal setting, strategizing, prioritization, feasibility analyses, and action planning,
implementation planning, monitoring and evaluation.
o Practical application: MHSA Coordinators can research and use tools from the
Community Toolbox. The toolbox, which is maintained by University of Kansas Work
Group for Community Health and Development, includes a database on best practices for
community health and development and over 300 learning modules on specific skills for
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 49
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
creating and maintaining partnerships; assessing community needs and resources;
choosing strategies to promote community health and development; promoting interest
in community issues; encouraging involvement in community work; etc. The best
practices database is a portal to over 60 websites ranging from the CDC’s Community
Guide of effective practices for disease prevention, model practices from National
Association of County and City Health Officials (MAPP is one such practice), National
Registry of Evidence-Based Programs and Practices, and more. The Community Tool Box
is a free online at http://ctb.ku.edu/en (Community Toolbox, 2013).
o Practical application: Prior to launching the annual planning process, MHSA/CPP
coordinators can informally survey colleagues, mental health board members, and
consumer and family advocates to learn about “hot button” issues. Time can be taken
early on to research issues and best practices for addressing such challenges (See Healing
the Canoe case study).
o Practical application: MHSA/CPP coordinators and mental health administrators can seek
to understand the relationships between advocacy organizations, CBOs and agencies and
develop strategies for improving dialogue and trust prior to launching the process.
o Practical application: All development of or adjustments to existing plans, policies,
programs and initiatives can be coupled with a set of process and outcome measures and
a plan for collecting, analyzing and sharing data for systems improvement. Evaluation
strategies can be simple and low-cost or more extensive, depending on resources.
Focus on strengths and aspirations: Learn about the community, including their values, hopes,
and aspirations through research and participatory visioning processes. Develop plans based on
community strengths and assets, and celebrate small and large successes.
o Practical application: If the county has not done so in a while, staff and/or professional
facilitators can lead stakeholders through a visioning process that asks a variety of key
questions, such as “What will behavioral health and wellness look like in our county in
the future?”, “What role would the mental health department play in developing a
healthy future?, “What role would your friends, families and neighbors play in promoting
wellness, recovery and resiliency?”, and “What positive values help us promote healthy
communities?”(See Adams Park HIA and San Francisco Healthy Homes case studies).
o Practical application: MHSA/CPP coordinator can work with a CPP stakeholder steering
committee or other stakeholder group to develop a participatory research project related
to an important mental health issue in the community (See Reintegrating Drug Users
Leaving Jail and Prison case study). Alternatively, the research project could focus on a
more general needs assessment or asset mapping project. Plans generated from needs
assessments should take advantage of community strengths and assets (See Strong
Neighborhoods Initiative case study). The project should seek to understand community
strengths and resources, not just challenges and barriers. Agree ahead of time to invest
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 50
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
resources and working collaboratively to develop a strategy to address the issue being
studied.
o Practical application: Use a variety of methods to learn about the stakeholder community
including interviews with community representatives and organizational leaders; focus
groups with various subpopulations, including various underserved, unserved and
historically inappropriately served communities; and paper-based and/or electronic
surveys. Conduct site visits to community based organizations to better understand the
culture of the community and to measure community readiness to implement change
(See Adams Park, Centro Diagnóstico, Reintegrating Drug Users and Healing the Canoe
case studies).
o Practical application: Every year, counties can celebrate CPP successes by inviting
stakeholders to present their achievements and lessons learned. Make it a party.
However, don’t wait to recognize the contribution of community volunteers, who
dedicate their time to the process. Make sure to privately and, when appropriate,
publicly acknowledge their contributions.
Develop partnerships: Establish collaborative relationships with all sectors of the community by
respecting diversity, encouraging dialogue, valuing and utilizing local knowledge, strengths and
expertise, and by seeking points of agreement. Seek commitment. Time and space for face-to-
face interaction and deliberation is essential.
o Practical application: Maintain a database of community leaders and representatives of
community based organizations. Keep track of interactions and reach out to groups who
are less engaged.
o Practical application: MHSA/CPP coordinator can reach out to community leaders to have
one-on-one conversations about their experience with and expectations for the planning
process, and to seek commitment to participate. Coordinators should follow up to
encourage ongoing interaction.
o Practical application: Counties can hire consumers and/or family members to help
facilitate needs assessments and planning, thereby lending their knowledge, expertise
and experience to the process (See Healing the Canoe case study).
o Practical application: Seek data from community based organizations, include them in
data collection processes, and share findings from mental health department data
collection efforts. Engage community organizations in identifying the issues that are most
important to their membership. Ask “What are the hopes and concerns of the people
most affected by decisions?” and “How is the decision likely to affect the lives of those
who are already struggling?” (See Adams Park HIA case study).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 51
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
o Practical application: Schedule community meetings to introduce stakeholders and
community organizations to the planning process. Invite participants to dialogue about
their hopes and expectations for the process. Ask participants to complete a survey or
sign a pledge card that asks about their level of commitment, what types of issues and
activities they are willing to participate in, who else should be at the table, etc. (See
Centro Diagnóstico case study).
Be accountable: Model clear, open, and consistent communication. Be accountable and
transparent throughout the planning process. Be direct about roles and responsibilities and the
degree of decision making authority participants can expect throughout the process. The
resulting plans should include specific individuals or institutions that are responsible for
implementation, so that accountability continues through the implementation cycle.
o Practical application: Counties can draft a planning charter that describes the roles and
responsibilities of all participants, including planning facilitators. Describe how meeting
minutes and other materials will be disseminated, how county will respond to feedback,
how decisions will be made.
o Practical application: MHSA/CPP coordinator and other leaders of the planning process
should be careful what to promise and be sure to follow-through on commitments.
Respond to all emails; send out agendas and meeting materials on a consistent timeline.
o Practical application: To all extents possible, include key stakeholders, particularly
consumers and family members in all meetings. This will help to ensure and demonstrate
transparency, and will help guarantee community participation for the duration of the
planning initiative (See Healing of the Canoe case study).
o Practical applications: Ensure that participants have an opportunity to provide feedback
on all planning activities by: 1) providing contact information for MHSA/CPP
coordinators, offering drop-in hours, and maintaining an “open-door” philosophy; and 2)
handing out and collecting comment cards and /or evaluation forms. Report back to
participants on how their feedback was incorporated into ongoing processes (See San
Francisco Healthy Homes case study).
o Practical applications: Commit to collecting data about community characteristics and
concerns if and only if the intention is to share the findings and use the data to inform
action plans. Vulnerable communities are frequently the target of research, which is not
then used to improve social, environmental, economic and health outcomes.
o Practical applications: Seek verbal and written commitments from mental health
administration, service providers, policymakers and elected officials to champion the
implementation of plans as part of the planning process. Do not publish plans without
demonstrating commitment by those responsible for implementation (See San Francisco
Healthy Homes case study above and Action Plan http://www.sfenvironment.org).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 52
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Build capacity: Develop individual and organizational knowledge and capacity through co-
education and dialogue, and opportunities to participate in research, deliberation and decision
making.
o Practical application: Coordinate interactive trainings for CPP participants about critical
mental health issues, but also about best practices in community-building, participatory
research, analysis and planning, and social change. Utilize local training resources
whenever possible (See San Francisco Healthy Homes case study).
o Practical application: Sensitize mental health professionals, academics and other
“experts” to the expectations of community members so that they do not “talk down” or
use alienating concepts or terminology. Encourage external training resources to lead
with curiosity and engage in dialogue while at the same time establishing rigorous
learning objectives.
o Practical application: Be prepared to reciprocate. When asking community based
organizations to participate in planning efforts, the mental health departments should
also be prepared to assist in their own campaigns. Find out about their local initiatives,
and offer support, when possible.
o Practical application: Provide individual CPP participants with incentives that will help
them gain knowledge, skill and experience. For example, offer training, jobs and stipends
to community-based data collectors and outreach workers; provide scholarships to
attend conferences and continuing education credits for health professional
stakeholders.
Be inclusive: Recognize the value of meaningful participation by those people whose lives are
most affected by the issues at hand. Pay special attention to vulnerable populations and those
who might not otherwise be included in decision making. At the same time, be conscientious of
stakeholder diversity. Frame issues from multiple perspectives. Recognize the rights of clients but
also the needs of service providers. Provide opportunities for people to gather at convenient and
comfortable locations at a variety of times and use a variety of approaches and tools that reflect
stakeholders’ cultures and skills—even if doing so slows the process down.
o Practical applications: Focus on outreach to unserved, underserved and historically
inappropriately served communities, and on consumers and family members, as they are
the most affected by MHSA plans. Engage representatives of local CBOs in dialogue about
how to reach those who don’t typically participate (See Centro Diagnóstico case study.
o Practical application: Strategies for inclusion include: hiring bilingual outreach workers;
translating materials into threshold languages; providing various types of incentives for
participation; conducting meetings at various times and in various locations; providing
food, language interpretation and childcare at meetings; conducting language-specific
meetings; and making sure that meetings are ADA accessible and have comfortable
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 53
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
seating. When using technology, make sure that it is accessible to all participants, or
provide equally useful alternatives; hand out glossaries with acronyms and jargon.
o Practical application: Reach out to the greatest number of community members to
participate in a variety of planning activities. Large-scale forums and meetings are useful
for visioning and goal-setting, data collection about community needs and assets,
brainstorming strategies, prioritizing strategies (See Los Angeles County’s STD Program).
Large gatherings are not necessarily useful for strategy development; strategies are best
developed by representative committees (See Capital Elementary School and Strong
Neighborhood Initiative case studies).
o Practical application: Consider ways in which technologies can increase meaningful
participation, and particularly participation by historically disenfranchised communities.
For example, develop a project website (See ImproveSF.com). Additionally, the county or
mental health department might invest in simultaneous interpretation equipment. Large
counties may invest in technologies to facilitate 21st Century Town Meetings (See
http://americaspeaks.org/services/21st-century-town-meeting/).
o Practical application: Uphold the “nothing about us without us” principle by ensuring that
consumers and family members are invited to participate in all CPP activities, including
planning framework, identifying stakeholders, collecting data, interpreting data, planning
strategies and, when possible, participating in decision making (See Healing of the Canoe
and Capital Elementary School case study).
o Practical application: Engage all levels of mental health department staff in conversations
about their hopes and concerns related to the CPP process. Unless staff members are
comfortable with and feel included in the process, they are not likely to support it, and as
a result, implementation efforts will likely fail (See Centro Diagnóstico case study).
Similarly, prepare elected officials for the process and encourage them to show support.
o Practical application: Offer newcomer orientations on an ongoing basis. Orientations can
occur half-hour before meetings; assign a “newcomer buddy” who can help orient
newcomers and latecomers.
Be prepared to share power and release control. Build active, meaningful, and inclusive
partnerships with stakeholders, not to affirm preconceived assumptions or decisions, but to
support community and individual self-determination. Include participants in all phases, from
research, to development, and approval of the plan. Teach the skills of research, analysis,
advocacy and democracy to enable shared power and leadership.
o Practical application: Submit written assessments, reports and plans to MHSA
stakeholder committees for feedback, suggestions, and approval well before they are
finalized. Follow MHSA guidelines for posting, public hearings and documentation of final
drafts of annual updates, and also provide formal opportunities for public comment and
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 54
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
feedback early on (See Healing the Canoe case study). Be conscious not to merely use the
CPP process as a means of “rubber-stamping” county-designed projects.
o Practical application: Provide training to CPP participants in effective advocacy. Advocacy
Unlimited, Inc. provides a 14-day advocacy training for persons with mental health and
co-occurring disorders in self, systems and legislative advocacy (See
http://www.mindlink.org/ed_advocacy_course_overview.html). The World Health
Organization provides an advocacy training module as part of its Mental Health Policy
and Service guidance package.
(See http://www.who.int/mental_health/resources/en/Advocacy.pdf)
o Practical application: Encourage planning participants in self-directed outreach and
advocacy. For example, invite them and provide them resources to reach out to their
peers and colleagues to broaden participation (See Capital Elementary School and
Reintegrating Drug Users case studies). Open up portions of meetings for participants to
share information on current events, local and statewide initiatives, public hearings, etc.
Provide stipends for planning participants to serve as “change agents” whereby they
educate a broader base of stakeholders about participatory and community-based
initiatives, new services and interventions.
o Practical application: Provide facilitation training to CPP participants and rotate
facilitation and note-taking among willing and able participants. Employ co-facilitation
techniques by pairing more and less experienced facilitators.
o Practical application: Provide technical support and training to a stakeholder steering
committee that meets regularly to research and plan strategies (See Strong
Neighborhoods Initiative case study). Make sure the steering committee includes diverse
representation from underserved communities, consumers and family members, mental
health department staff who have the authority to advance the committee’s agenda.
o Practical application: County mental health departments can research the possibility of
initiating a Participatory Budgeting initiative, whereby a proportion of the public mental
health budget is set aside for a democratic process, and a committee of individuals
research a problem, identify a variety of strategies, and vote on how to spend resources
(See NYC Participatory Budgeting case study). Since departments do not have the
authority to yield budgetary decision making to stakeholders, they may be able to modify
the process by allowing stakeholders to make recommendations regarding a portion of
MHSA budget.
o Practical application: Appoint a community-based quality improvement committee to
collect and review data on the performance of programs implemented as a result of the
planning process, and to make recommendations for improvements and funding (See
Centro Diagnóstico and Los Angeles County STD case studies).
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 55
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Plan for the long-haul: While recognizing the CPP processes are organized around a fiscal year
calendar, prepare stakeholders for ongoing and long-term committed participation. Recognizing
that social transformation takes time and may not follow a linear path, develop strategies for
maintaining momentum; engage and reengage over the years, and throughout the planning and
implementation process.
o Practical application: Each year, or upon initiating a community-driven mental health
initiative, conduct outreach and invite stakeholders to a community event or several
community events to inform them about the planning process (See Centro Diagnóstico
case study). Provide ample opportunity for stakeholders to share their vision. At the
same time, reach out one-on-one to community leaders to seek their input on the
planning process and on critical issues that need to be addressed.
o Practical application: Form planning and/or advisory committees early on, but realize
that while some individuals will participate for many years, others will drop out or
participate sporadically. Therefore, continuously reach out to community organizations
and leaders, and replenish your committees on regular intervals (See Strong
Neighborhoods Initiative case study).
o Practical application: Identify long-term and short term planning objectives. Each time an
objective is met, celebrate successes through email notices, face-to-face celebrations,
etc. Send out quarterly newsletters (See San Francisco Healthy Homes case study).
o Practical application: If a CPP planning committee developed a new initiative or program,
continue to engage the committee during the implementation phase to review data on
processes and provide recommendations for program improvement (See Strong
Neighborhoods Initiative and Centro Diagnóstico case studies).
o Practical application: At each meeting or gathering, let participants know where they are
in the planning process via a visual timeline. Make sure they are aware of the level of
commitment expected of them and provide opportunities for different levels of
commitment. For example, some individuals may agree to meet on an annual basis to
review plans; others on a monthly basis to review data and formulate strategies, or even
weekly basis to collect data and conduct outreach.
o Practical application: Educate participants about the history of social transformation. Let
them know that change does not always happen fast, but assure them that the mental
health department will be measuring and reporting on progress along the way.
The authors of this report encourage local and statewide stakeholder groups and county mental health
departments to consider these applications and to develop other strategies based on the principles
described above. During subsequent phases of the Evaluation, we encourage members of the Client
Stakeholder Project (CSP), in conjunction with the MHSOAC, to review these principles and applications in
addition to practices deemed “promising,” which emerge from the evaluation of current CPP processes.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 56
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Bibliography
Abelson, J. & Gauvin, F. (2006). Assessing the Impacts of Public Participation: Concepts, Evidence and
Policy Implications. Canadian Policy Research Networks/Reseaux canadiens de recherché en
politiques publiques.
Agger, A. & Lofgren K. (2008). Democratic Assessment of Collaborative Planning Processes. Planning
Theory. Sage Publications, 7 (2): 145-164.
Al-Kodmany, K. (1999). Combining Artistry and Technology in Participatory Community Planning. Berkeley
Planning Journal, 13(1):28-36.
Alinksy, S. (1971). Rules for radicals. New York: Vintage.
Allee, M. K. (2013). Interview conducted by RDA, October 10, 2013.
Adams, F., with Myles Horton (1975). Unearthing Seeds of Fire: The Idea of Highlander. John F. Blair
publisher, Winston-Salem, NC.
Avey, H. (2013). Interview conducted by RDA, October 10, 2013.
Bannon, T. & Kozo, J. (2013). Interview conducted by RDA, October 24, 2013.
Bingler, S. B. (2003). Community-Based School Planning: If Not Now, When? Edutopia: The George Lucas
Educational Foundation. Retrieved on November 9, 2013, from
http://www.edutopia.org/community-based-school-planning-if-not-now-when
Burkholder, S., Chupp M. & Star P. (2003). Principles of Neighborhood Planning for Community
Development. Maxine Goodman Levin College of Urban Affairs, Cleveland State University:
Cleveland, Ohio.
Cal. Welfare and Institutions Code §5813.5 (2012).
Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry,
Committee on Community Engagement (CDC/ATSDR) (1997). Principles of Community
Engagement. Centers for Disease Control and Prevention: Atlanta, Georgia.
Centers for Disease Control and Prevention (2013). HIA Stories From the Field: Douglas County Health
Department, Reviving Adams Park. Retrieved November, 2013, from:
http://www.cdc.gov/healthyplaces/stories/omaha.htm
Chin, J., Dinshaw, A., Likuski, A., McBrayer, M., & Monty, J. (2010) Interactive Technologies in
Participatory Planning: A Guide for Sommerville Community Corporation. Urban and
Environmental Policy and Planning Department, Tufts University, Medford, MA.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 57
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Clinical and Translational Science Awards Consortium, Community Engagement Key Function Committee
Task Force on the Principles of Community Engagement (2011). Principles of Community
Engagement, 2nd ed. National Institutes of Health: Washington, District of Columbia.
Community Toolbox (2013) Accessed November 17, 2013 from http://ctb.ku.edu/en/table-of-contents.
Connell, et. al. (1995). New Approaches to Evaluating Community Initiatives. Concepts, Methods, and
Contexts. Roundtable on Comprehensive Initiatives for Children and Families. Aspen Institute for
Humanistic Studies, New York, NY.
Edwards, R., Jumper-Therman, P., Plested, B., Oetting, E., & Swanson, L. (2000) Community Readiness:
Research to Practice. Journal of Community Psychology, Vol 28, No. 3 291-307.
EngenderHealth (2002). Community COPE®: Building Partnership with the Community to Improve Health
Services. New York, NY.
EngenderHealth (2003). COPE Handbook : A Process for Improving Quality in Health Services, revised
edition. New York, NY
EngenderHealth. COPE® and Community COPE®: Tools for Engaging Communities in Defining and
Addressing Quality of Care. PowerPoint accessed December 27, 2013 from
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&ved=0CEEQFjAE&url=ht
tp%3A%2F%2Fwww.k4health.org%2Fsites%2Fdefault%2Ffiles%2FCOPE%2520and%2520Commun
ity%2520COPE%25202.ppt&ei=Dv69UtKMII39oASEp4DwBQ&usg=AFQjCNGD6WMahOWYPjIQiTP
a0_Xr_Ewznw&bvm=bv.58187178,d.cGU
Freire, Paolo (1970). Pedagogy of the Oppressed. Herder and Herder, New York, NY.
Freire, Paulo (1974). Education for Critical Consciousness. London: Sheed & Ward.
Furger, R. (2003). Rebuilding a school, Revitalizing a Community: School Improvements Enhance a Desire
to Learn. Edutopia: The George Lucas Educational Foundation. Retrieved on November 9, 2013,
from http://www.edutopia.org/rebuilding-school-revitalizing-community)
Hart, Angie, Northmore, S. & Gerhardt, C. (2009). Auditing, Benchmarking and Evaluating Public
Engagement. National Co-Ordinating Centre for Public Engagement, Bristol, UK.
Healing of the Canoe Project (2013). Retrieved from http://healingofthecanoe.org/phase-i/ November,
2013.
Heller, J. (2013). Interview conducted by RDA, October 17, 2013.
Lacofano, D. (2013). Interview conducted by RDA, October 18, 2013.
ImproveSF, About (2013). Retrieved on November 11, 2013, from http://www.improvesf.com/about-this-
site.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 58
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
ImproveSF, Living Innovation Zones (2013). Retrieved on November 11, 2013, from
http://www.improvesf.com/living-innovation-zones.
Israel, B., Schulz, A., Parker, E. & Becker, A. (1998). Community-based Participatory Research: Policy
Recommendations for Promoting a Partnership Approach in Health Research. Education for
Health, 14(2):182-193.
Magee, C., Cavalier, Y. (2012). Using Active Community Engagement Continuum to Address Health
Inequities in an Urban Area. Poster presented at the National STD Prevention Conference,
Minneapolis, MN.
McConville, M. (2013). Creating Equitable, Healthy, and Sustainable Communities: Strategies for
Advancing Smart Growth, Environmental Justice, and Equitable Development. United States
Environmental Protection Agency: Washington, District of Coumbia.
Mental Health Services Act, Cal. Admin. Code tit. 9, §§3100-3856
Michigan Association of School Boards (2006). MASB Journal: Special Report. (Summer, 2006). Lansing,
MI: Michigan Association of School Boards. Retrieved November, 2013 from
http://www.masb.org/Portals/0/pdf/SRcommeng06.pdf.
Minkler, M. et al. (2008). Promoting Healthy Public Policy through Community-Based Participatory
Research: Ten Case Studies. PolicyLink, School of Public Health, University of California, Berkeley,
W.K. Kellogg Foundation.
Minkler, M. (2013). Interview conducted by RDA, October 8, 2013.
Myerson, D. L. (2004). Involving the Community in Neighborhood Planning. Urban Land Institute: Denver,
CO.
Naryan, D. (2002). Empowerment and Poverty Reduction: A Sourcebook. World Bank: Washington, District
of Columbia.
National Association of County & City Health Officials. (2013). MAPP. Retrieved November 5, 2013, from
NACCHO: http://www.naccho.org/topics/infrastructure/mapp/
New River Valley Planning District Commission (2013). Livability in the New River Valley: Moving from
Vision to Action. Virginia Department of Health: Richmond, VA.
Participatory Budgeting (2013) City of Vallejo, CA. Retrieved November 17, 2013 from
http://www.ci.vallejo.ca.us/city_hall/departments___divisions/city_manager/participatory_budg
eting/.
Pentz, M. (1999). Effective prevention programs for tobacco use. Nicotine and Tobacco Research, 1 (Suppl
1): S99-S107.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 59
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Planning Processes. (n.d.). The Challenge Forum. Retrieved November 17,2013, from
http://www.chforum.org/methods/xc412.shtml
Plested, B., Edwards, R. & Jumper-Thurman, P. (2006). Community Readiness: A Handbook for Successful
Change. Fort Collins, CO: Tri-Ethnic Center for Prevention Research.
PRIME II. (n.d.). CDQ in Action: Consumer Feedback Improves Clinic Services, Increases Paying Clients.
Retrieved November 11, 2013, from PRIME II: http://www.prime2.org/prime2/pdf/PP_DR-
CDQ_hi-res.swf
Resource Development Associates. (2013). San Francisco Healthy Homes: Project Evaluation. Oakland,
CA.
Rojas, James (2013) Interview conducted by RDA, October 9, 2013.
Russell, N., Igras, S., Johri, N., Kuoh, Hl, Pavin, M., & Wickstrom, J. (2008) The Active Community
Engagement Continuum. Retrieved from Acquire Project Website:
http://www.acquireproject.org/fileadmin/user_upload/ACQUIRE/Publications/ACE-Working-
Paper-final.pdf
Russell, Nancy (2013). Interview conducted by RDA, October 11, 2013.
San Francisco Department of the Environment. (2013). San Francisco Healthy Homes: Community Action
Plan. San Francisco Department of the Environment: San Francisco, CA.
Sandoval, J. et al. (2011) Process and outcome constructs for evaluating community-based participatory
research projects: a matrix of existing measures. Health Education Research 27(4): 680-690.
Slotterback, C. S. & Hourdos, J. (2009). Technology in Planning and Participatory Processes: Identifying
New Synergies Through Real World Application. Hubert Humphrey Institute of Public Affairs,
University of Minnesota. Minneapolis, MN.
Stakeholder Participation Working Group of the 2010 HIA of the Americas Workshop. (2012). Guidance
and Best Practices for Stakeholder Participation in Health Impact Assessments, Version 1.0.
Strong Neighborhoods Initiative. (n.d.). Retrieved November 9, 2013, from San Jose Government:
http://www.sanjoseca.gov/index.aspx?NID=1745
Tian, C. (2013). Open Budget, Open Process: A Short History of Participatory Budgeting in the US. Sunlight
Foundation: Washington, District of Columbia. Retrieved in November, 2013, from
http://sunlightfoundation.com/blog/2013/07/15/open-budget-open-process-a-short-history-of-
participatory-budgeting-in-the-us/
Uddin K (2004) Public Participation Evaluation: A Conceptual Model for Evaluating Planning Advisory
Committee, PIA NSW Division Conference, Wollongong
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 60
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
University of California at Los Angeles, School of Public Health (2003-2006). Retrieved November 6, 2013,
from http://www.ph.ucla.edu/hs/health-impact/whatishia.htm#item4.
Voices from the Field: Involving Communities In Quality Services. (2002, November 14). Retrieved
November 11, 2013, from IntraHealth International: http://www.intrahealth.org/page/involving-
communities-in-quality-services
Von Schirnding, Yasmin (2002). Health in Sustainable Development Planning: The Role of Indicators.
World Health Organization. Geneva.
Wampler, B. (2012). Participatory Budgeting: Core Principles and Key Impacts. Journal of Public
Deliberation, 8(2): article 12.
Wickstrom, J. (2013). Interview conducted by RDA, October 22, 2013.
World Health Organization (2013). Retrieved November 6, 2013, from
http://www.who.int/hia/about/why/en/index.html).
Wyatt, J. C. (2000). When to Use Web Based Surveys. Journal of the American Medical Informatics
Association, Jul-Aug 7(4):426-430.
Xie, L. (2013). The Combination of Mobile Applications and Games as a New Method for Community
Engagement. Georgia Institute of Technology: Atlanta, GA.
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 61
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Appendix 1: Eight CPP Principles and their Sources
Be strategic
Principle Source of Principle
Agree on clear indicators with expected outcomes and on Active Community Engagement
documentation process Continuum
Active Community Engagement
Be clear about purpose before getting started Continuum
Be clear about the purpose and goals of engagement before
you begin Community Engagement
Mobilizing for Action through
Systems thinking Partnership and Planning
Mobilizing for Action through
Strategic thinking Partnership and Planning
Establish clear priorities Neighborhood Planning
Thoughtful, deliberate preparation Neighborhood Planning
Recognize market dynamics Neighborhood Planning
Create feasible implementation plans Neighborhood Planning
Begin with the right issue Public Engagement in Education
Understanding the characteristics of meeting types and
contexts is important in informing the selection of technologies
to enhance participatory processes. Technology in Community Planning
Decisions about the use of technology in participatory
processes should be based on a clear sense of the contribution
that the technology can make to the communication and
discussion of information. Technology in Community Planning
Focus on strengths and aspirations
Principle Source of Principle
Community Based Participatory
Build on the strengths and resources of the community Research
Identify community assets and strengths Community Engagement
Learn about the community Community Engagement
Mobilizing for Action through
Data Partnership and Planning
Mobilizing for Action through
Celebrate success Partnership and Planning
Collect data to inform process Neighborhood Planning
Development of a vision of what the community can become Neighborhood Planning
Develop plans based on neighborhood strengths and assets Neighborhood Planning
ID and development of neighborhood assets Neighborhood Planning
Participants learn about their community Participatory Budgeting
Community's values and aspirations for the future will inform
discussion and action Public Engagement in Education
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 62
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Develop partnerships
Principle Source of Principle
Establish partnerships by valuing the strengths and finding Active Community Engagement
points of agreement Continuum
Partner with the community Community Engagement
Establish relationships with the community Community Engagement
Mobilizing for Action through
Dialogue Partnership and Planning
Mobilizing for Action through
Partnerships and collaboration Partnership and Planning
Community Partnerships and expertise will be utilized Public Engagement in Education
Involve all sectors of the community Public Engagement in Education
Create conversation Public Engagement in Education
Dialogue compliments and deepens ideas and knowledge…time
and space for face-to-face interaction and deliberation of
planning ideas and concerns between participants is essential Technology in Community Planning
Feedback should be solicited from target populations on which
technologies are more accessible to them. Technology in Community Planning
Be accountable
Principle Source of Principle
Specific individuals or institutions should be responsible for
implementation Neighborhood Planning
Transparency in the planning process Neighborhood Planning
Defined and appropriate roles for all participants Neighborhood Planning
Aligned with oversight and accountability Participatory Budgeting
Clear, consistent and open communication Public Engagement in Education
Build capacity
Principle Source of Principle
Promote co-learning and empowerment to address social Community Based Participatory
inequality Research
Develop local leadership Community Development Theory
Educate community about issues Community Development Theory
Involve organizations rather than independent individuals Health Impact Assessment
Democratic decision making Neighborhood Planning
Build capacity of community by helping form effective
organization Participatory Budgeting
Process should have a learning component that helps build
community awareness and knowledge about the subject at
hand Public Engagement in Education
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 63
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Be inclusive
Principle Source of Principle
Use approaches that reflect stakeholder culture, even if it slows Community Based Participatory
the process down Research
Recognize the needs of staff and the rights of clients Community COPE
Democratic decision making by people who's lives are most
affected Community Development Theory
Respect diversity Community Engagement
Hierarchy of the community: those who are most effected Community Engagement
No single approach can be prescribed for stakeholder
participation Health Impact Assessment
Ensure diverse participation to understand the community and
political realities related to the policy, program, project being
studied Health Impact Assessment
Pay special attention to those representing vulnerable
populations Health Impact Assessment
Include those who might not otherwise be included in decision
making Participatory Budgeting
Opportunities for people to gather at a convenient and
comfortable location at a variety of times Public Engagement in Education
Frame issue from multiple perspectives Public Engagement in Education
Be aware that individuals may have differing abilities in the use
of technology. Different curricula and tools may be needed, etc. Technology in Community Planning
Be prepared to share power and release control
Principle Source of Principle
Understand that flexibility is needed to collaborate and share Active Community Engagement
power Continuum
Involve all participants equally in all phases of research and Community Based Participatory
action Research
Disseminate findings to all participants (in a manner that is Community Based Participatory
easily accessible) Research
Self-determination Community Engagement
Release control Community Engagement
Resident involvement in the development and approval of the
plan Neighborhood Planning
meaningful community engagement Neighborhood Planning
Inform/teach/elected officials and city leadership Neighborhood Planning
Increase citizen authority Participatory Budgeting
Voice: participants learn to employ social justice discourse, thus
expanding the public debate regarding public spending Participatory Budgeting
Alter the way that government receives input; enable
bureaucrats to engage with citizens Participatory Budgeting
Active and inclusive partnerships, not to affirm existing
leadership but to decrease centralized power Public Engagement in Education
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 64
MHSOAC: MHSA CPP Evaluation and Curriculum Development
Report of Other Community Program Planning Processes
Plan for the long-haul
Principle Source of Principle
Expect to engage and then reengage throughout the life of the
project, as communities are dynamic and behavior change is Active Community Engagement
not linear Continuum
Promote long-term commitment by all participants (recognize
that policy changes take a long time and commit to staying Community Based Participatory
involved for the long-haul) Research
Long term commitment Community Engagement
Planning efforts must maintain momentum Neighborhood Planning
Early and consistent involvement Neighborhood Planning
Process should allow for sustained involvement by stakeholders Public Engagement in Education
Enough time to make informed decisions; more than one
meeting Public Engagement in Education
Reconvene stakeholders Public Engagement in Education
Community will be involved early in the process Public Engagement in Education
Prepared by RESOURCE DEVELOPMENT ASSOCIATES December 31, 2013| 65