LESSONS LEARNED Creating Successful Community-University Partnerships

JOHNS HOPKINS UNIVERSITY URBAN HEALTH INSTITUTE Baltimore, Maryland

THE JOHNS HOPKINS UNIVERSITY URBAN HEALTH INSTITUTE

PARTNERSHIPS ARE INHERENTLY DIFFICULT. WHY SHOULD A PARTNERSHIP BE FORMED AT ALL?

First, academic institutions thrive on ideas and vibrate with new enterprises—and they increasingly interact with their surroundings. Universities exist to build and share the world’s store of knowledge, and they are highly prized for their valuable intellectual resources. Their missions may differ—from a land-grant institution to an arts academy—but none sub- scribes to an isolationist philosophy. As universities have prospered, some have found themselves in beleaguered urban communities. There has been a growing awareness that their institutional health is linked to the well- being of their neighborhoods. Then came a realization that these neighborhoods are rich with their own resources and have much to offer in return. There is, then, the real promise of mutual benefit from working together.

A COMMUNITY-UNIVERSITY PARTNERSHIP SHOULD BE FORMED ONLY WHEN BOTH PARTNERS DETERMINE THAT THEY CAN DO MORE TOGETHER THAN ALONE.

J OHNS H OPKINS U RBAN H EALTH I NSTITUTE LESSONS LEARNED Pg.1 T HE C OMMUNITY-UNIVERSITY PARTNERSHIP F ORUM

The Johns Hopkins Urban Health Institute hosted a one-day Community-University Partnership Forum in 2007 at the Frederick Douglass-Isaac Myers Maritime Museum in the Fells Point neighborhood of Baltimore. The event brought together 65 leaders from the Johns Hopkins University, other Baltimore universities and community groups, as well as colleagues from around the country who are involved in community-university partnerships.

Planning for the forum began with conversations with local and national leaders to identify model community-university partnerships. Six such collaborations were selected for study: West Philadelphia-University of Pennsylvania; Detroit-University of Michigan; East Lansing-Michigan State; San Francisco-University of California, San Francisco; Harlem-Columbia University/New York Academy of Medicine; and Boston- Tufts University.

In addition, UHI leaders spoke with other national experts in the field, including Judith Rudin, president of the Rockefeller Foundation; William Richardson, president emeri- tus of the Johns Hopkins University and former president of the W.K. Kellogg Foundation; Burton Sonenstein, CFO of the Annie E. Casey Foundation and former CFO of Wellesley College; and Sarena Seifer, executive director of the Community-Campus Partnership for Health. Subsequently, site visits were conducted in West Philadelphia, San Francisco and Harlem.

The Community-University Partnership Forum engaged community and university representatives in discussions regarding establishing partnerships, creating bidirec- tional collaborations, power sharing, financing and sustainability, real-life success- es and failures, and suggestions for advancing the mission and vision of the Urban Health Institute.

The monograph that follows is a distillation of the lessons learned from these wide- ranging discussions, the forum and site visits. For the most part, it is written from the university's point of view.

The Urban Health Institute gratefully acknowledges the following for their contributions to the success of this initiative: forum panelists Ira Harkavy, Barbara Israel, Alex Allen, Alan Green, Ralph Moore, Karen Brau and Kathy Diaz; the Annie E. Casey Foundation, which provided generous support; and Kamila Mistry, who collected, organized and summarized materials and drafted sections of the monograph.

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L ESSON No.1 SELECT PARTNERS AND FIND CHAMPIONS

Having established that there can be reciprocal benefit, each side must choose its partners carefully. There are two approaches to this: First, an institution can identify the issue it would like to address. It can explore any existing community- university links and select the appropriate university resources to engage in a partnership on the issue. Alternately, each can reach out to the other without a predetermined agenda, seeking input regarding its potential partners’ priorities and determining the best fit for a joint endeavor. During the search, do not overlook smaller colleges and universities as potential partners.

Know the community. With either approach, the next step for a university is to get acquainted with the community, beginning with a small group of stakeholders that will expand as these leaders recommend others. Each community is complex, with an assortment of potential partners, from neighborhood activists to political and faith leaders. Listen carefully. Visit their organizations. Learn about their expectations. Check their credentials and reputations. Are they embedded and highly regarded in the community? Do they have a good history of working well with others? Are they serious about wanting to deal with the issue at hand? Do they have the capacity to fulfill their obligations? Will they be committed long term?

J OHNS H OPKINS U RBAN H EALTH I NSTITUTE LESSONS LEARNED Pg.3 Remain flexible. Flexibility is as important to success as commitment. The partnership may need to change as understanding of the issue increases. People and organizations may weave in and out as the process proceeds. Make room for people who invite themselves into the process, but give them a clear role or their presence will be questioned. As partici- pants come and go, ask about others who might be interest- ed. Remain open and fluid, allowing the partnership to draw upon various resources as circumstances require. Find champions. Every great purpose must find a champion, and these partnerships are no exception. Individuals STORIES of SUCCESS from both the community and the university must assume I MPROVING the mantle of leadership and champion the cause. There is no U RBAN N UTRITION substitute for explicit and unambiguous support from the Funded by public and private donors, top. The USC president, for example, attends monthly meet- Penn's Urban Nutrition Initiative ings of the community board and addresses issues raised by engages K-16+ learners in a curricu- the members. lum that strives to improve community nutrition and wellness. The university- community partnership operates in 20 schools in Penn's West Philadelphia neighborhood. The program aims to “It’s important to have a champion increase knowledge of food and nutri- at the top of the academic institution to tion, improve the supply of healthy foods and encourage active lifestyles. provide visible and influential leadership.

UNI's endeavors include integrating Having the university president nutrition lessons into the academic understand the importance of working with curriculum, providing hands-on cook- the surrounding community has been ing classes during lunch periods, set- ting up fruit/vegetable stands and a key to our success.” farmers' markets, establishing school- IRA HARKAVY, PHD, FOUNDING DIRECTOR AND ASSOCIATE VICE PRESIDENT, based gardens, offering free communi- CENTER FOR COMMUNITY PARTNERSHIPS, UNIVERSITY OF PENNSYLVANIA ty fitness and health programs, and providing after-school and summer job training in urban agriculture, entrepre- neurship and peer education.

Pg.4 LESSONS LEARNED J OHNS H OPKINS U RBAN H EALTH I NSTITUTE L ESSON No.2 DETERMINE, SUPPORT AND EVALUATE THE MISSION

Most community-university partnership programs serve as a liaison between university students/faculty/staff and community organizations. As such, they perform outreach activities and coordinate partnership endeavors. Before determining the structure of a community-university partnership, some key components need careful consideration.

Establish—and communicate—the mission and vision. Partners must work together to develop written mission and vision statements for the partnership. This will involve defining core values and goals. A broad understanding of the mission/vision will help ensure that all activities are in keeping with the purpose and priorities of the partnership. The principles produced should be provided to all partners in writing and reviewed annually. As the partnership progresses, communication will include information consolidation and media management. Provide infrastructure. Support requirements will vary according to the scope of partnership activities, but adequate infrastructure—including two to three full-time/equiva- lent staff positions—is essential. Since most partnerships involve multiple projects, activities need to be coordinated. Develop a listserv to promote communication among partners between meetings, and establish working groups around priority areas. Build funding for core support—staff and faculty time—into grant applications.

J OHNS H OPKINS U RBAN H EALTH I NSTITUTE LESSONS LEARNED Pg.5 “Overcoming suspicion required a process of first forming (getting people together), then storming (coming up with shared vocabulary) and finally norming (establishing a plan and priorities). The long process was worth the hard work because it served us well.”

DAVID VLAHOV, PHD, DIRECTOR, CENTER FOR URBAN STORIES of SUCCESS EPIDEMIOLOGIC STUDIES, NEW YORK ACADEMY OF MEDICINE

E NSURING C HILDREN’ S S AFETY

USC's priority of public safety gets a boost from the Kids Watch program, which Devise an effective system of evaluation. teams the University with the Los Angeles Assessment is a valuable way to learn from the partnership, Police Department and the city's Unified and an effective method of evaluation should be included in School District. To ensure the safety of any partnership agreement. From the outset, evaluation cri- children who walk to and from schools in the USC neighborhood, more than 1,100 teria should be in writing and accessible to all partners. volunteers put a decal on their homes, Benchmarks should flow from the principles governing the identifying them as “safe houses.” The partnership, be transparent, involve all partners and reflect volunteers also don bright yellow T shirts the highest methodological quality. Preferably, ongoing and remain outside for 30 to 45 minutes assessments will gauge the progress of the partnership and before and after school. Children know allow mid-course corrections. that if they are harassed, they can find a haven in any one of the safe houses. Outline a graceful exit strategy. Most partner- All volunteers must pass an LAPD back- ships are not designed to be long-term relationships, and ground check, and their presence has sig- when their natural lifespan is over, they should be ended nificantly improved both the perception of gracefully. Other partnerships simply fail, and properly safety and the reality. As a result of the acknowledging the failed effort can be a gesture of respect. program's success, the LAPD and the school district have expanded it to other Ideally, terms of disengagement will have been established areas of the city. along with those for engagement. Whatever the case, partners should try to leave on a positive note without severing all ties. There might be future opportunities to work together, and that potential should not be damaged by the dissolu- tion of the partnership.

Pg.6 LESSONS LEARNED J OHNS H OPKINS U RBAN H EALTH I NSTITUTE L ESSON No. 3 ESTABLISH GOVERNANCE AND REWARDS

Like the best legal contract, which anticipates potential problems and provides solutions that protect both parties, the governing structure of a community-university partnership should be carefully crafted. Rules that govern the partnership, such as a memorandum of understanding, must be clear. They should indicate open channels of communication and provide access to decision makers on both sides.

Weigh the merits of community boards. Assembling a community board can help the partnership. It can be advisory or decision making—but a community study without a board might be unethical. First, clearly identify the community for each proj- ect; then identify the best representatives within the community. Examine the ratio of university and community representatives and consider race, age, gender and ethnicity. Define the board’s purpose and establish accountability. Decide together on equitable structures for conflict negotiation. The best community boards attract new organizations and individuals to the table. Advisors can help sort out power-sharing issues and drive the programs or research forward. Boards can reinforce the importance of relationships to long-term success, build capacity, address ongoing needs and help ensure sustainability. There is often a tempta- tion to use a board too extensively, however, and its role should be clearly defined and tailored to partnership goals.

J OHNS H OPKINS U RBAN H EALTH I NSTITUTE LESSONS LEARNED Pg.7 Compensate advisors. Don’t assume that community board members are being paid by their organizations for their participation in the partnership. Likewise, don’t assume that they don’t want to be paid. They may be volunteers, but their time and expertise are valuable. When possible, allot money to compensate community members. Otherwise, try to find an exchange that will be viewed as fair. Serving on a board can be a way to develop valuable contacts and connect with other community-based organizations. Any compensation, however, should avoid the appearance of conflict of interest. Reward participation. From the university’s point of STORIES of SUCCESS view, building a community-university partnership requires I NVESTING IN both financial and personnel resources. University leaders H EALTHY N EIGHBORS who support the endeavor should make certain that partici- Community Health Workers from the pating faculty and staff are not penalized in their career pro- Johns Hopkins Urban Health Institute gression. Translational research has rarely been rewarded by are working in the OB/GYN Clinic of the the academic culture, and universities provide fewer incen- East Baltimore Medical Center to help tives—tenure and promotion—for faculty who do time- neighborhood mothers-to-be. Through intensive community work. Penn faculty, however, started education and emotional support, they with small seed grants and built a constituency of faculty encourage the pregnant women to remain in prenatal care and, after who were committed to such work. Over time, they received birth, to breast-feed their babies. more support from university leadership. Breast-feeding lowers the risk for such childhood maladies as obesity, asthma, ear infections and bladder infections— and also lowers a mother's risk for breast and ovarian cancer. In addition, “Focusing on small wins helps overcome the program is lowering the incidence of preterm births, ensuring a healthier suspicion and boost energy for both start for children. university and community partners. Most of the current Community Health It lets both sides focus on what they are Workers are members of AmeriCorps, and UHI is expanding the program by getting out of the partnership.” encouraging members of its East WIM WIEWEL, PROVOST, UNIVERSITY OF BALTIMORE Baltimore community to join CHW.

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L ESSON No. 4 OVERCOME BARRIERS AND AVOID PITFALLS

Partnerships inevitably encounter barriers. One partner may misconstrue the other’sLesson level # 4 of interest. It may be difficult to establish sufficient trust. There may be language barriers and cultural misunderstandings. There may even be internal miscommunication within one side of the partnership. Here are suggestions from the field:

Avoid arrogance. Too often, universities approach communities with the idea that they will swoop in to fix a problem, as though knowledge and expertise reside on their side alone. They may operate in a hierarchical model, alienating community collabora- tors. It is important to recognize and respect the considerable skills and resources within the community. Recognize disparities. Large universities dwarf potential community partners, so respect for the community’s gifts is critical. On the other hand, the resources of an indi- vidual faculty member may not match “deep pockets” expectations from the community. Non-monetary strategies—like showing up at community events—will help demonstrate that the partnership is real. Learn from mistakes. Failures can be of great value. Hold people accountable, but don’t assign blame. Instead, use the opportunity to discuss, analyze, adjust and move forward. Anticipate disengagement. Some people and organizations will likely abandon the partnership. Plan ahead for changes and be prepared to infuse the endeavor with fresh troops and ideas.

J OHNS H OPKINS U RBAN H EALTH I NSTITUTE LESSONS LEARNED Pg.9 “I’ve learned that knowledge empowers. Someone’s limits are really a reflection of their lack of knowledge. However, with the right information, tools and skills, anyone can be healthy and successful.”

ANNIE COPLES, COMMUNITY HEALTH WORKER, STORIES SUCCESS of JOHNS HOPKINS URBAN HEALTH INSTITUTE

F UNDING C OMMUNITY N ONPROFITS The Good Neighbors program at the University of Southern California Accept disagreement. Some tensions and disagree- encourages USC employees to donate a ments are part of the learning process. While it is often easi- portion of their salaries to community er to assign only agreeable community members to the initiatives. To be eligible for one-time or ongoing grants up to $50,000, nonprof- board, it can be less productive. Welcome those who have it community agencies must be based strong opinions and their passion for the issue. in and provide services within the geo- Acknowledge history. Histories cannot be ignored. graphic boundaries established by the University, have a link to USC and Racism in a legacy, for example, is best recognized for what it address at least one of USC's civic and is: ugly. A frank discussion of grievances and baggage can community priorities. build trust and enable partners to move forward. The program is administered by a group Keep your word. Meeting expectations is the founda- of 12 USC faculty and staff members tion for trust, and broken promises create enormous ill will. who select the awardees. The University Community members may have passed on the assurances, absorbs all overhead expenses for the program so all funds go directly to the and breaking an agreement places them in a difficult posi- community. USC has established a tion. Remain humble and accept that there may be things “President's Leadership Circle” of you can’t promise. If you do promise, follow through. employees who contribute one percent Take suggestions. or more of their salaries to the program, Find more than one way to commu- and President Sample hosts an annual nicate. A suggestion box, for example, gives even quiet mem- dinner in their honor. bers a comfortable opportunity to participate and allows problems to surface before they become toxic.

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L ESSON No. 5 ENSURE SUSTAINABILITY

Relationship building should drive the partnership, not research priorities. When a research partnership has ful- filled its objectives, the university should leave the community with tangible benefits, increased capacity and new or improved programs. Follow-up is not only a courtesy but another opportunity to assess long-term impact.

Empower the community. Acknowledge the resources contributed by the community, and let the community-based organization take the lead. It then receives the funds, and the university serves as a subcontractor. Some community organizations will have the capacity to function in this role, while others may need help writing grants and manag- ing budgets. That, in turn, becomes part of building capacity. Information, research objectives and timeframes should be clearly communicated so the community can make timely, informed decisions. The partnership should have an impact on the community in terms of programs, policies and structures—perhaps in increased employment and capacity for using research data. Empower students. A university student body is a powerful force. Students can influence how a community partnership is perceived by the university—and they can say things that faculty could not. Engage them and their talents in the partnership. Monitor expenditures. A true partnership will outlast funding. If there is real commitment to a solution, each can use the dearth of money to build trust and apply creativity. The result can be a high-performing relationship that is stronger than ever. The ideal, however, is not to put the relationship to that particular test. Money comes with strings attached, and the allocation of financial resources should be carefully monitored based on clear objectives.

J OHNS H OPKINS U RBAN H EALTH I NSTITUTE LESSONS LEARNED Pg.11 Follow the money. Sustainability cannot be achieved by sole reliance on grant funding. A steady stream should be created from university and philanthropic support, city and state health department funding and other donor gifts. The university’s fundraising team should be aware that partnerships are a priority. Another idea is to “tax” all money coming into the university and dedicate that portion to partnerships. Celebrate success. Even small-scale victories are important for generating and maintaining energy and morale. Never lose an opportunity to celebrate success and acknowledge those who contributed to it. For more major achievements, send press releases to the media and make cer- STORIES SUCCESS of tain that the community gets its fair share of credit. A DVANCING C OMMUNITY H EALTH The University of Pennsylvania has engaged hundreds of students and some 20 faculty members in an effort “I know some of the people from growing to increase their civic involvement and strengthen families and institutions up in this area, and many of them know in the Penn neighborhood. In one initia- that I’ve experienced the same problems. tive, Sayre eleventh graders in an That’s like a beacon of hope. Intake Medical Procedures course work with Penn students to learn intake They see that there’s a way out and basics—such as blood pressure, height, a way to live positively.” weight, glucose, reflex and vision. ROBERT ALLEN, COMMUNITY HEALTH WORKER, The high schoolers also learn about JOHNS HOPKINS URBAN HEALTH INSTITUTE significant community health concerns (hypertension, obesity and diabetes) and gain clinical experience by operat- ing an after-school health monitoring clinic. At the recently opened permanent health clinic facility, Sayre students work with Penn doctors and nurses, For more information on health professional students and community members to provide basic community-university partnerships, intake services and referrals. visit our website: www.jhsph.edu/urbanhealth

Pg. 12 LESSONS LEARNED J OHNS H OPKINS U RBAN H EALTH I NSTITUTE Community-University Partnership Articles

Bell-Elkins, J. (2002). Assessing the CCPH Principles of Partnership in a Community- Campus Partnership: available at http://depts.washington.edu/ccph/pdf_files/friendly%20principles2.pdf

Harkavy, Ira (2000). Historical Evolution of University-Community Partnerships. Community News, 12(2):1-3.

Harkavy, I. and Wiewel, W. (1995). University-Community Partnerships: Current State and Future Issues. Metropolitan Universities, 6(3):7-14.

Green, L.W. and Mercer, S.L. (2001). Community-based participatory research: Can public health researchers and agencies reconcile the push from funding bodies and the pull from communities? American Journal of Public Health, 91(12):1926-1929.

Israel, B.A.; Krieger, J.W.; Vlahov, D.; Ciske, S.J.; Foley, M.; Fortin, P., et al. (2006). Challenges and facilitating factors in sustaining community-based participatory research partnerships: Lessons learned from the Detroit, New York City, and Seattle Urban Research Centers. Journal of Urban Health, 83(6):1022-1040.

Israel, B.A.; Lichtenstein, R.L.; Lantz, P.M.; McGranaghan, R.J.; Allen, A.; Guzman, J.R., et al. (2001). The Detroit Community-Academic Urban Research Center: Development, implementation and evaluation. Journal of Public Health Management and Practice, 7:1-20.

Kone, Ahoua; Sullivan, Marianne, et al. (2000). Improving CollaborationBetween Researchers and Communities. Public Health Reports, 115:243-248.

Lantz, P.M.; Viruell-Fuentes, E.; Israel, B.A.; Softley, D.; Guzman, R. (2001). Can communities and academia work together on public health research? Evaluation results from a community-based participatory research partnership in Detroit. Journal of Urban Health, 78:495-507.

Maurana, Cheryl A.; Beck, Barbra; Newton, Gail L. (1998). How Principles of Partnership Are Applied to the Development of a Community-Campus Partnership. Partnership Perspectives, 1(1):47-53.

Minkler, Meredith; Blackwell, Angela Glover; Thompson, Mildred; Tamir, Heather(2003). Community-Based Participatory Research: Implication for Public Health Funding. American Journal of Public Health, 93:1210-1213.

Rubin, Victor (2000). Evaluating University-Community Partnerships: An Examination of the Evolution of Questions and Approaches. Cityscape: A Journal of Policy Development and Research, 5(1):219-230.

Wiewel, W. and Lieber, M. (1998). Goal Achievement, Relationship Building, and Incrementalism: The Challenges of University-Community Partnerships. Journal of Planning Education and Research, 17(4):291-301.

Dr. Robert Blum, Director 2013 East Monument Street, Baltimore, MD 21205 410-502-6155 www.jhsph.edu/urbanhealth