| Community Tool Box

• What is a problem?

• Why can a collaborative process be important?

• What is the problem-solving process?

Imagine that a community coalition has formed to support economic development in a neighborhood that has experienced long-term disinvestment.

After months of outreach, the coalition has brought together residents, local businesses, community organizations, public agencies, young people, and other partners.

At its first major planning session, however, participants discover that they do not agree about the problem.

Some believe affordable commercial space is the highest priority. Others are concerned about housing costs and displacement. Some want immediate investment in public safety and infrastructure. Others argue that residents should have more authority over how development funding is used.

The coalition also has limited money, different organizations have different decision-making authority, and several participants are uncertain whether their input will actually affect the final decisions.

What should the coalition do next?

Community problems are often more complicated than they first appear.

What looks like one problem may involve several interconnected conditions, institutions, policies, incentives, resources, behaviors, and histories.

Changing one part of the system may affect another, sometimes in ways that were not anticipated.

Effective problem solving therefore requires more than identifying a problem and selecting a solution. It requires understanding the situation, deciding who needs to be involved, examining evidence and uncertainty, considering alternatives, selecting an appropriate response, implementing it, monitoring what happens, and adapting when necessary.

What is a problem?

A problem is an observed condition, gap, risk, unmet need, or unwanted outcome that people or organizations believe requires attention.

A useful problem statement describes:

• What is happening
• Who or what is affected
• Where it is occurring
• How large or serious it is
• How it has changed over time
• Why it matters

The standard used to define a problem should also be clear.

For example, a difference between current conditions and a desired condition may be identified through:

• Community priorities
• Program goals
• Health or safety standards
• Law or policy
• Evidence of avoidable harm
• Comparison with an appropriate benchmark

Problems vary in complexity

Some problems are relatively straightforward.

If a required supply is repeatedly unavailable because no one has responsibility for ordering it, the organization may be able to solve the problem by assigning ownership and establishing a reorder process.

Other problems are systems problems.

They may:

• Change over time
• Have several interacting causes
• Involve multiple organizations or sectors
• Affect different groups differently
• Be influenced by policy, infrastructure, economics, history, or institutional practices
• Produce feedback effects
• Respond unpredictably to an intervention

Complex problems may not have one root cause or one permanent solution.

The goal may instead be to reduce harm, improve conditions, manage risk, strengthen protective factors, or change part of the system over time.

Problems are not automatically opportunities

A problem may lead an organization or community to identify an opportunity for improvement.

But problems may also involve real loss, inequity, danger, or hardship.

Avoid treating the existence of a serious problem as inherently positive or character-building.

The useful question is:

What can we understand, improve, prevent, reduce, or change?

Avoid embedding the solution in the problem statement

A problem statement should describe the condition before assuming how it must be solved.

For example:

Less useful: We need to hire more outreach workers.

More useful: Participation in the program has declined by 30% over the past year, with the largest decrease among residents in three neighborhoods.

The second statement leaves room to determine whether staffing, program design, transportation, scheduling, trust, communication, eligibility rules, competing services, or another condition is contributing to the decline.

Why can a collaborative process be important?

Many organizational and community problems involve knowledge that is distributed among different people.

Staff may understand operational barriers. Community members may understand how a policy is experienced in practice. Technical specialists may understand evidence or infrastructure. Leaders may understand funding, legal, or governance constraints. Partners may understand other parts of the system.

Bringing these forms of knowledge together can improve problem definition and reveal options that one person might miss.

Collaboration, however, does not mean that every person needs to participate in every step or that everyone has the same decision authority.

Decide who needs to be involved

Consider who:

• Experiences the problem or its consequences
• Has relevant community or lived knowledge
• Has technical or professional expertise
• Controls resources or authority needed for action
• Will implement the response
• May experience unintended consequences
• Is legally or organizationally responsible for the final decision

Clarify roles in the process

Before beginning, identify:

• Who provides information
• Who is consulted
• Who helps develop options
• Who recommends an approach
• Who decides
• Who implements
• Who remains accountable

These roles may belong to different people.

Be clear when a process is consultative rather than giving participants the impression that they hold decision authority they do not actually have.

Pay attention to power

People do not enter collaborative processes with equal authority or freedom to speak.

Consider differences involving:

• Employment authority
• Funding
• Professional status
• Government authority
• Community influence
• Access to information

When public disagreement may be risky, consider written, anonymous, confidential, small-group, or separate input methods.

Make participation accessible

Depending on the participants, meaningful involvement may require:

• Language access
• Accessible electronic materials
• Captioning
• Interpretation
• Accessible meeting spaces
• Remote participation
• Flexible ways to contribute

Create psychological safety

People need to be able to:

• Ask questions
• Identify uncertainty
• Admit mistakes
• Challenge assumptions
• Raise risks
• Disagree respectfully

Psychological safety does not mean that everyone agrees, that every idea is accepted, or that accountability disappears.

Use group processes where they add value

Not every part of problem solving requires a meeting.

Useful methods may include:

• Data analysis
• Individual interviews
• Community listening sessions
• Surveys
• Observation
• Document review
• Technical analysis
• Workshops
• Facilitated discussions
• Shared digital work

Choose the method according to the question rather than assuming that putting everyone into a meeting will produce a better answer.

What is the problem-solving process?

Problem solving can be organized into a series of related steps.

The steps are useful, but the process is not always linear.

New evidence may require returning to the problem definition. Implementation may reveal a condition that was not visible during planning. Evaluation may show that the selected strategy needs to be changed or stopped.

1. Clarify the problem and the purpose of the process

Ask:

• What condition are we trying to understand or change?
• Why does it matter?
• Who is affected?
• What decision or action may result from this process?
• What is outside the scope?

Write a preliminary problem statement.

Treat it as a starting point that may change as evidence is gathered.

2. Determine who needs to be involved and who decides

Identify relevant participants, affected communities, experts, implementers, partners, and decision-makers.

Clarify decision rights before asking people to invest substantial time in the process.

3. Gather credible information

Depending on the problem, information may include:

• Quantitative data
• Qualitative information
• Research
• Program records
• Community and lived experience
• Professional expertise
• Financial information
• Policy or legal requirements
• Information from comparable communities or organizations

Consider the quality and limitations of the information.

Distinguish:

• What is known
• What is estimated
• What is assumed
• What remains unknown

4. Examine context, causes, and system relationships

Ask what produces or maintains the condition.

Consider:

• Policies and rules
• Resources
• Incentives
• Infrastructure
• Organizational practices
• Access barriers
• Social and economic conditions
• Historical conditions
• Relationships among organizations
• Community assets and protective factors

A complex problem may have several interacting causes rather than one root cause.

Systems maps, causal diagrams, process maps, timelines, or other tools may help when relationships are difficult to see.

5. Refine the problem statement

After analysis, ask whether the original problem was defined correctly.

A useful problem statement should be specific enough to guide action without prematurely prescribing the solution.

6. Generate a range of options

Consider more than the first idea that appears workable.

Options may include:

• Improving an existing approach
• Changing a policy or process
• Creating a new intervention
• Partnering with another organization
• Removing an unnecessary barrier
• Testing a pilot
• Implementing in stages
• Stopping an ineffective activity
• Maintaining the current approach while gathering more information
• Referring the issue to another authority

7. Establish criteria for comparing options

Possible criteria include:

• Expected effectiveness
• Strength of evidence
• Equity
• Safety
• Accessibility
• Legal and ethical requirements
• Community impact
• Cost
• Staff and organizational capacity
• Feasibility
• Sustainability
• Time
• Reversibility
• Potential unintended consequences

Also ask:

• Who is likely to benefit?
• Who may bear costs, burdens, or risks?
• What other work will not be possible if resources are committed here?

8. Compare options and choose an approach

Use the agreed decision process.

There may not be one objectively best solution.

Several options may be reasonable, each with different tradeoffs.

Document:

• What was selected
• Who decided
• What criteria were used
• Important assumptions
• Major risks and tradeoffs

9. Test when appropriate

When uncertainty is substantial and a smaller-scale test is practical, consider a pilot.

Define:

• What the pilot is testing
• Who will participate
• What outcomes will be monitored
• How long the pilot will run
• What would lead to expansion, revision, or stopping

10. Plan implementation

Implementation deserves as much attention as selecting the approach.

Clarify:

• Who is responsible
• What authority they have
• What staffing and resources are needed
• What training is required
• What partners or vendors are involved
• What milestones and deadlines apply
• How progress will be communicated
• What risks require escalation

Do not assume that a well-designed solution will automatically be easy to implement.

11. Monitor implementation

While the approach is being carried out, ask:

• Is implementation occurring as intended?
• Are intended participants being reached?
• Are resources sufficient?
• Are unexpected barriers appearing?
• Are unintended consequences occurring?
• Are some groups experiencing different effects than others?

Monitoring allows the organization to identify problems before waiting for a final evaluation.

12. Evaluate results

Determine whether the approach produced the intended results.

Evaluation questions may include:

• What changed?
• For whom?
• Under what conditions?
• At what cost?
• What unintended effects occurred?
• What evidence supports the conclusion?
• What limitations remain?

Choose evaluation methods appropriate to the question, scale, resources, and maturity of the intervention.

13. Adapt, continue, expand, or stop

Use monitoring and evaluation findings to decide what happens next.

The organization may:

• Continue the approach
• Modify it
• Expand it
• Reduce its scope
• Test another strategy
• Stop it
• Revisit the original problem definition

Changing course when evidence changes is not necessarily failure. It can be part of responsible problem solving.

14. Communicate what was learned

Share appropriate findings with the people who participated in or were affected by the process.

Explain:

• What was decided
• What was implemented
• What happened
• What was learned
• What will happen next

If community members or other participants provided input but did not make the final decision, explain how their input influenced the result.

Related group-process skills

Several skills discussed elsewhere in the Community Tool Box can support problem solving.

• Running effective meetings can help when real-time discussion, coordination, or decision-making is needed. Not every step of problem solving requires a meeting.
• Developing facilitation skills can support fair participation, clarify disagreement, manage time and process, and help participants understand how decisions will be made.
• Developing recorder skills can help preserve decisions, significant findings, action items, and unresolved questions when documentation is useful.
• Defining and analyzing the problem helps distinguish symptoms from underlying conditions and identify the scope and context of the issue.
• Generating and choosing solutions can help groups identify and compare different possible responses.
• Putting your solution into practice addresses the implementation work that begins after an approach has been selected.

In Summary

Community and organizational problems vary greatly in complexity.

Some have relatively direct solutions. Others involve interacting systems, several organizations, unequal power, changing conditions, uncertainty, and competing priorities.

A structured problem-solving process can help people understand these conditions without assuming that every problem has one root cause or one correct solution.

Begin by defining the problem carefully and determining who needs to be involved. Gather credible information, examine context and system relationships, and distinguish what is known from what remains uncertain.

Generate several possible responses and compare them using explicit criteria such as effectiveness, equity, safety, accessibility, evidence, feasibility, cost, sustainability, and unintended consequences.

Then plan implementation deliberately. Assign responsibility, provide necessary resources, monitor what happens, evaluate results, and be willing to modify or stop an approach when evidence shows that conditions or assumptions have changed.

Collaboration can improve problem solving when participants bring relevant knowledge and have meaningful opportunities to influence the process. It should not obscure decision authority or create the impression that everyone has equal power when they do not.

Effective problem solving is therefore not simply finding an answer. It is an ongoing cycle of understanding, deciding, acting, learning, and adapting.

About problems.

___Problems are usually seen as negative.

___Advantages problems may bring:

• Most problems are solvable (or partially solvable, or at least improvable).
• Problems are opportunities to make some good things happen and to create change.
• Problems call upon the best of our abilities, and ask us to go beyond what we thought we could do.

Why is a group problem-solving process important?

___Effective group processes enhance a group's ability to solve problems and make decisions. When working with more than just a couple of people, solving a problem with a set process becomes more manageable.

___It increases the group's efficiency and productivity.

___It increases the group's participation - more people tend to be involved, and, as a result,

___It increases group satisfaction. This means, among other things, that the group is more likely to want to take on other problems. And when they do so, they'll be better placed to solve them.

What is the problem-solving process?

___Run effective meetings.

___Develop facilitation skills.

___Develop recorder skills.

___Define and analyze the problem.

___Generate and choose solutions.

___Put your solution into practice.

Tool #1: Problem analysis sheet

The following page gives you room to analyze the problem or issue you want your group to address. This information can then be used when you go to step 7 in the "how-to's": Set goals and objectives.

Problem Analysis Sheet

What factors put people at risk for (or protect them against) the problem or concern?
Whose behavior (or lack of behavior) caused the problem?
Whose behavior (or lack of behavior) maintains the problem?
For whom is the situation a problem?
What are the negative consequences for those directly affected?
What are the negative consequences for the community?
Who, if anyone, benefits from things being the way they are now?
How do they benefit?
Who should share the responsibility for solving the problem?
What behaviors need to change to consider the problem "solved"?
What conditions need to change to address the issue or problem?
How much change is necessary?
At what level(s) should the problem be addressed?
Will you be able to make changes at the level(s) identified?

Tool #2: Components and Elements Background Table

Use this table to look holistically at the intervention you will develop.

	Enhancing Support	Providing Information and Skills Training
Problem/ Issue to be Addressed
Risk/ Protective Factors
Targets of Change
Agents of Change
Components
Elements
Mode/ Context of Delivery

Tool # 3: Table of Components and Elements

You can fill in this table to look at all of the components and elements that will be done as a part of your intervention. By filling this out, you can see if there are any gaps in your plan that need to be filled in. (For example, if your plan doesn't have any elements related to providing information and skills training, that gap will be very apparent on this table.)

	Providing Information and Skills Training	Enhancing Support and Resources	Modifying Opportunities and Barriers	Monitoring and feedback
Components
Elements

Tool # 4: Determining if interventions done by others are appropriate for your purpose and situation

Use this table to help you determine if a particular intervention you know about is right for your purpose and situation.

What is the intervention?
Is it appropriate for our purpose?
Is it effective?
Is it replaceable?
Is it simple?
Is it practical?
Is it compatible to our situation?

Additional comments:

A PowerPoint presentation summarizing the major points in the section.

• What is critical thinking?

• Why is critical thinking important?

• Who can and should learn to think critically?

• How do you help people learn to think critically?

Suppose you see a widely shared online post claiming that a particular community program has dramatically reduced a serious local problem.

Before accepting or rejecting the claim, what would you want to know?

You might begin with the claim itself. What exactly is being said? Does "dramatically reduced" refer to a percentage, a number of people, or someone's impression? Over what period did the change occur? Compared with what?

Next, you might ask about the evidence. Where did the numbers come from? How were they measured? Is there information from before the program began? Are other explanations possible? Does the original report support the way the social-media post summarizes it?

You might also investigate the source. Who created the post? Who conducted the evaluation? Do they have relevant expertise? What interests or incentives might affect how the findings are presented? Can you find the original report or data? Do independent sources support the same conclusion?

Finally, you might consider context. Did anything else change in the community during the same period? Who benefited? Were some groups affected differently? What remains uncertain?

If you ask questions like these when you encounter information, consider a problem, make a decision, or evaluate your own conclusions, you are using critical thinking.

Critical thinking is especially important in health, human service, and community work because decisions can affect people's opportunities, resources, safety, health, rights, and everyday lives.

What is critical thinking?

There are many ways to describe critical thinking.

In this section, critical thinking means a disciplined process of examining information, claims, assumptions, evidence, reasoning, context, and alternatives before deciding what conclusion or action is justified.

Critical thinking includes questioning:

• Survey and evaluation results
• Research findings
• Theories
• Personal observations and anecdotes
• Media reports
• Social-media posts
• AI-generated information
• Data visualizations
• Historical accounts
• Political statements
• Professional recommendations
• Organizational traditions
• Conventional wisdom
• Statements from authority figures
• Our own assumptions and preferred explanations

Critical thinking does not mean automatically rejecting authority, conventional wisdom, or widely accepted knowledge.

It also does not mean treating every claim as equally uncertain.

Instead, it means asking what level of confidence is justified by the available evidence and being willing to change that confidence when better evidence becomes available.

Elements of critical thinking

Critical thinking is not always a rigid sequence, but several recurring activities are useful.

• Clarify the question or problem: What are we actually trying to understand, decide, or change?
• Examine what is known: What evidence and experience are available? How strong are they?
• Identify uncertainty: What do we not know? What are we estimating or assuming?
• Examine assumptions: What beliefs, values, definitions, or expectations are shaping the way the issue is framed?
• Consider context: What historical, social, economic, organizational, cultural, legal, or physical conditions matter?
• Consider alternatives: What other explanations, interpretations, options, or responses are plausible?
• Evaluate reasoning: Do the conclusions actually follow from the evidence?
• Make a judgment: What conclusion or action is best supported at this point, and with what degree of confidence?
• Act when appropriate: Carry out the decision proportionately to the evidence, stakes, and uncertainty.
• Reflect and revise: What happened? What did we learn? What evidence would cause us to change our conclusion or approach?

Critical thinking is therefore both analytical and reflective.

It includes examining the issue and examining your own reasoning about the issue.

Goals of critical thinking

Accuracy

Critical thinking helps distinguish well-supported claims from claims that are inaccurate, incomplete, exaggerated, misleading, or unsupported.

Not every question has a simple true-or-false answer.

Sometimes the most accurate conclusion is:

The available evidence suggests this is probably true, but important uncertainty remains.

Context

Information rarely exists in isolation.

Consider:

• When the information was produced
• Why it was produced
• What happened before it
• What conditions existed at the time
• Whether those conditions are still present

Assumptions

Critical thinking helps make assumptions visible.

Ask:

• What are we taking for granted?
• Why do we believe it?
• What evidence supports it?
• What would happen to our conclusion if it were wrong?

Alternatives

An early explanation or solution may feel obvious because it is the first one that came to mind.

Critical thinking asks what other explanations or approaches deserve consideration.

Calibration

Confidence should match the strength of the evidence.

Be cautious about being highly certain when:

• Data are limited
• Sources conflict
• Important information is missing
• The situation is changing rapidly
• Results depend heavily on assumptions

Intellectual humility

Critical thinking includes the ability to say:

I may be wrong.

That does not mean treating every conclusion as equally doubtful.

It means remaining willing to revise a conclusion when the evidence warrants it.

Critical thinking and action

In community work, critical thinking often informs action.

But action is not always the immediate result.

Critical analysis may show that the organization should:

• Act
• Test a smaller intervention first
• Gather additional evidence
• Consult people with relevant expertise or experience
• Change the problem definition
• Delay an irreversible decision
• Decide that no additional action is justified

Critical thinking should improve the quality of judgment, not create pressure to act before the evidence supports action.

Why is critical thinking important?

People encounter more information than they can examine in depth.

Some of that information is accurate and useful. Some is incomplete or outdated. Some is opinion presented as fact. Some is advertising, advocacy, entertainment, satire, or speculation. Some misinformation is shared unintentionally, while some misleading information is deliberately created or amplified.

Critical thinking helps people decide what deserves attention, what evidence deserves greater weight, and what conclusions are justified.

It helps examine assumptions

Every person approaches information with prior knowledge, values, expectations, experiences, and beliefs.

These can be useful.

They can also cause us to overlook evidence, interpret ambiguous information too quickly, or favor explanations that already fit what we believe.

Ask:

• What did I expect to find?
• Am I treating evidence differently because I like or dislike the conclusion?
• Would I accept the same evidence if it supported the opposite position?
• What evidence would change my mind?

It helps distinguish evidence from interpretation

Consider these two statements:

Program enrollment fell from 300 participants to 220 participants.

The community has lost interest in the program.

The first is a description of a measured change.

The second is an interpretation that may or may not explain the change.

Other explanations might include:

• Changes in eligibility
• Transportation barriers
• Reduced outreach
• Different program hours
• A competing service
• Problems with how enrollment was measured

Critical thinking helps prevent an interpretation from becoming a fact merely because it sounds plausible.

It helps evaluate evidence

Evidence varies in quality.

Ask:

• How was the information collected?
• How many people or cases were included?
• Who was included and excluded?
• What was measured?
• Were appropriate comparisons made?
• How much uncertainty is present?
• Do the conclusions go beyond what the data support?

It reduces overreliance on anecdotes

Individual experiences can provide important information and can identify questions that larger data sets miss.

But one person's experience does not automatically tell us how common something is.

For example:

One participant had a negative experience with the program, so the program does not work.

That experience should be taken seriously, but additional evidence is needed to determine whether it reflects a broader pattern.

It helps examine cause and effect

Two things occurring together does not necessarily mean one caused the other.

Ask:

• Did the proposed cause occur before the effect?
• Is there a plausible mechanism connecting them?
• Could another factor explain both?
• What happens in comparable situations?
• Is the evidence strong enough to support a causal conclusion?

It helps people work with numbers more carefully

Numbers can create an impression of certainty even when the interpretation is weak.

When evaluating statistics, ask:

• What is the denominator?
• Is the change an absolute number or a percentage?
• What is the baseline?
• What time period is being compared?
• Is an average hiding important differences?
• How uncertain is the estimate?

A claim that a risk "doubled," for example, means something very different if it increased from 1 in 1,000,000 to 2 in 1,000,000 than if it increased from 1 in 10 to 2 in 10.

It helps people evaluate digital information

Online information requires more than judging whether a page looks professional.

Useful questions include:

• Who is behind the information?
• What is the original source?
• Is the account or organization what it claims to be?
• What do reliable independent sources say?
• Is the image, video, quotation, or statistic being shown in its original context?
• Is the information current?

Sometimes the quickest way to evaluate a website, post, or video is to leave it temporarily and investigate the source elsewhere.

It helps people use AI-generated information responsibly

Generative AI can help summarize, brainstorm, translate, explain, or organize information.

Fluent output is not proof that the information is correct.

When important decisions depend on AI-generated information:

• Verify important factual claims
• Check cited sources
• Confirm that a source actually supports the claim attributed to it
• Look for missing context
• Avoid treating invented detail as evidence
• Use appropriate human expertise for high-stakes decisions

It helps people distinguish facts, opinions, values, and narratives

These categories can overlap, but they are not interchangeable.

A value judgment cannot always be settled simply by collecting more data.

For example, evidence may estimate how much a policy costs and who is affected. Evidence alone may not determine how a community should weigh cost, fairness, freedom, safety, or other competing values.

Critical thinking makes those differences visible instead of disguising a value disagreement as a factual one.

It helps people understand context

An approach that worked in one organization or community may not work the same way somewhere else.

Consider:

• Local resources
• Infrastructure
• Population characteristics relevant to the issue
• Institutions
• Policies
• History
• Trust
• Economic conditions
• Geography
• Existing programs and partnerships

It supports better decisions without promising certainty

Critical thinking cannot guarantee that a decision will succeed.

People may have incomplete information, conditions may change, or an intervention may create unexpected effects.

The goal is to make a decision that is better supported, clearer about its assumptions, and easier to revise when new evidence appears.

Who can and should learn to think critically?

Critical thinking is useful across ages, occupations, education levels, and communities.

Children can begin by asking simple questions about evidence, comparison, cause and effect, and how they know something.

More advanced learners can examine:

• Competing explanations
• Statistical evidence
• Research methods
• Complex systems
• Uncertainty
• Ethical tradeoffs

Adults continue to need critical-thinking skills as information environments, technology, professional knowledge, and community conditions change.

Critical thinking is not a trait that some groups possess and others lack

Avoid assuming that someone's education level, income, occupation, age, community, political beliefs, religion, or other background tells you whether they can think critically.

People may have deep expertise in one domain and limited knowledge in another.

Critical thinking is affected by both reasoning skills and subject knowledge.

Someone who knows how to ask good questions may still reach a poor conclusion if important factual knowledge is missing.

Likewise, a person with substantial factual knowledge may still reason poorly if they do not examine assumptions, uncertainty, or competing evidence.

Opportunities to develop critical thinking are not distributed equally

Some people have had more opportunities than others to practice:

• Asking questions
• Discussing evidence
• Challenging ideas safely
• Working with data
• Conducting research
• Reflecting on their own reasoning

The appropriate response is to provide opportunities, instruction, tools, and practice rather than viewing learners through a deficit lens.

Critical thinking can begin with concrete problems

People do not need to master abstract philosophy before they can practice critical thinking.

Concrete questions can provide a useful starting point:

Why did attendance decrease?

How do we know this outreach strategy is reaching the intended audience?

What evidence supports this claim?

What other explanation is possible?

More complex reasoning can be built progressively through modeling, practice, feedback, and reflection.

How do you help people learn to think critically?

Critical thinking develops through practice.

It is most useful when connected to real subject matter rather than taught only as an abstract set of thinking rules.

Learners need opportunities to apply critical thinking to questions that require knowledge, evidence, interpretation, judgment, and reflection.

Teaching critical thinking can be considered in three connected areas:

• Creating conditions that support questioning and revision
• Teaching metacognitive and information-evaluation strategies
• Applying those strategies to real problems and decisions

Create conditions that support critical thinking

People are less likely to question assumptions when doing so routinely leads to ridicule, retaliation, or dismissal.

Create an environment in which learners can:

• Ask for evidence
• Admit that they do not know
• Change their minds
• Challenge the facilitator respectfully
• Identify mistakes
• Raise alternative explanations

Critical thinking does not require treating every claim as equally credible.

Evidence and reasoning still matter.

Model the process

Make useful reasoning practices visible.

For example, a facilitator might say:

My first interpretation was that participation decreased because people lost interest. But I realized I was assuming we had maintained the same outreach and schedule. Before I accept that explanation, I want to check whether those conditions changed.

Modeling should focus on the reasoning strategy that learners can reuse:

• Identify the assumption
• Identify missing information
• Look for another explanation
• Check evidence
• Revise the conclusion if necessary

Teach metacognition

Metacognition means thinking about and monitoring your own thinking.

Encourage learners to plan, monitor, and evaluate their reasoning.

Before analyzing

Ask:

• What is the question?
• What do I already know?
• What might I be assuming?
• What information will I need?

During analysis

Ask:

• Am I answering the actual question?
• Am I relying too heavily on one source?
• Have I considered another explanation?
• Does the evidence support the strength of my conclusion?

Afterward

Ask:

• How confident am I?
• What evidence would change my mind?
• What did I find difficult?
• Which strategy helped?
• What should I do differently next time?

Help learners recognize assumptions

Assumptions are ideas or expectations we accept without examining them each time.

They can come from:

• Prior knowledge
• Personal experience
• Values
• Professional training
• Community and organizational history
• Social and cultural context
• Interests and incentives
• Repeated messages
• Institutions and authority
• The information environments we participate in

An assumption is not automatically wrong.

The question is whether an important conclusion depends on it and whether there is reason to test it.

Examine values and interests without pretending they can always be removed

Community decisions often involve both evidence and values.

Ask:

• What outcomes are we prioritizing?
• Who benefits?
• Who bears costs or risks?
• What rights or responsibilities are involved?
• Which tradeoffs are factual questions and which are value judgments?

Being explicit about values can improve reasoning more than pretending that values are absent.

Recognize the role of emotion

Emotions can affect attention, interpretation, and decision-making.

They are not automatically evidence that a factual conclusion is true or false.

They can, however, identify something worth examining.

For example, anger about a proposed policy may lead to questions about fairness, harm, or rights that deserve investigation.

The critical-thinking task is to examine both the reaction and the relevant evidence rather than simply suppressing the reaction.

Examine information systematically

Useful questions include:

What exactly is the claim?

State it precisely enough that evidence could support or challenge it.

What is the source?

Determine:

• Who produced the information
• Their relevant expertise
• Their purpose
• Their evidence
• Whether significant conflicts or incentives are present

Do not decide that information is true or false solely because you agree or disagree with the source's politics, institution, profession, or identity.

Can you trace the claim to original evidence?

A news story, social-media post, AI answer, or advocacy document may summarize another source.

When the issue is important, look for the underlying:

• Research study
• Dataset
• Government document
• Court decision
• Policy
• Speech or recording
• Evaluation report

What do independent sources say?

Corroboration is especially useful when:

• A claim is surprising
• The source has a strong stake in the outcome
• The information is spreading rapidly online
• The consequences of acting on it are significant

Is the information current and in context?

Accurate information can become misleading if:

• It is old
• A quotation is shortened in a way that changes its meaning
• An image comes from another event
• A statistic refers to a different population
• Conditions have changed since the evidence was collected

Is the information complete enough for the decision?

No source contains everything.

Ask whether important missing information could change the conclusion.

Is the reasoning sound?

Watch for problems such as:

• Generalizing from one or a few examples
• Treating correlation as causation
• Presenting only two choices when more exist
• Selecting only evidence that supports a preferred conclusion
• Ignoring relevant base rates or comparison groups
• Attacking a person instead of addressing the argument
• Changing the standard of evidence depending on who makes the claim

How strong is the evidence?

Avoid treating all evidence as equivalent.

A personal story, a carefully conducted study, an administrative dataset, professional judgment, and a community survey may each provide useful information, but they answer different questions and have different limitations.

Teach digital verification

Information online often needs to be checked beyond the page where it appears.

Learners can practice:

• Searching for the organization or author in independent sources
• Finding the original claim
• Checking whether a quotation is complete
• Checking publication and event dates
• Comparing several credible sources
• Verifying images or videos
• Looking for corrections or updated information

The visual appearance of a website or social-media account should not substitute for verification.

Teach people to work with AI-generated information critically

AI systems can produce useful explanations and summaries, but they can also produce incorrect details, unsupported claims, incomplete context, or nonexistent citations.

Practice asking:

• Which claims here need verification?
• What source would be authoritative for this question?
• Can I confirm the cited source exists?
• Does that source actually support the statement?
• What information might be missing?
• Is this a factual question, interpretation, prediction, or recommendation?

Consider context

When examining a community issue, relevant context may include:

• Community priorities
• Geography
• Infrastructure
• Economic conditions
• Policies and laws
• Institutions
• Existing programs and services
• Community assets
• Relationships among organizations
• Historical experience
• Trust
• Information access

History

Previous efforts can reveal both useful lessons and unresolved concerns.

Ask:

• Has this approach been tried before?
• What happened?
• Why?
• Have important conditions changed since then?
• Whose account of the history are we hearing?

Use more than one perspective when the history is contested or when earlier decisions affected groups differently.

Interests and power

Consider:

• Who has decision authority?
• Who controls resources?
• Who experiences the consequences?
• Who benefits from the current situation?
• Who might benefit or lose under different alternatives?

An interested party's evidence should not automatically be dismissed, but the interest should be considered when evaluating how claims are presented and what additional verification is needed.

Information environment

What people encounter is shaped partly by:

• Search and recommendation systems
• Social networks
• Repetition
• Influencers and content creators
• Platform incentives
• Advertising
• AI-generated and algorithmically selected content

Repeated exposure can make a claim feel familiar without making it more accurate.

Facilitating problem solving using critical thinking

Critical thinking can be applied directly to community and organizational problems.

Clarify the current situation

Ask:

• What is actually happening?
• How do we know?
• Who is affected?
• How large is the problem?
• Over what period?
• Compared with what?

Identify assumptions about the problem

Ask:

• What are we assuming causes the problem?
• What evidence supports that assumption?
• What other explanation might fit the evidence?
• Are we confusing a symptom with an underlying condition?

Test important assumptions

Not every assumption needs an exhaustive investigation.

Focus on assumptions that would materially affect the decision.

Ask:

If this assumption were wrong, would we choose a different strategy?

If the answer is yes, the assumption deserves closer examination.

Identify what evidence would change your mind

Before choosing a solution, ask participants:

What would we need to learn to conclude that our current explanation is wrong?

This can reduce the tendency to search only for evidence supporting the group's preferred view.

Generate alternative explanations

Before generating solutions, consider several plausible explanations for what is happening.

A program may have low participation because of:

• Limited awareness
• Eligibility requirements
• Schedule
• Transportation
• Accessibility
• Lack of trust
• Program design
• Competing services
• Measurement problems

Different explanations may imply different responses.

Generate alternatives

Once the problem is reasonably understood, generate more than one possible response.

Brainstorming can be useful, especially when participants temporarily separate idea generation from evaluation.

Broad idea generation does not require accepting proposals that are clearly outside legal, ethical, safety, or organizational boundaries.

Work backward from a desired outcome

Another useful approach is to define the condition you want to create and work backward.

For example, if the goal is reliable access to a community service, ask:

• What would reliable access look like?
• What conditions would have to exist?
• Which of those conditions are currently missing?
• Which conditions can the organization influence?

This approach can identify necessary steps, but it does not prove that a particular intervention will produce the desired outcome.

Compare alternatives using explicit criteria

Criteria may include:

• Evidence of effectiveness
• Expected benefits
• Costs
• Feasibility
• Equity
• Safety
• Accessibility
• Legal requirements
• Ethical considerations
• Community priorities
• Organizational capacity
• Sustainability
• Potential unintended consequences
• Reversibility

Some criteria may matter more than others.

Make those priorities explicit rather than allowing them to influence the decision invisibly.

Examine tradeoffs

Several alternatives may be defensible.

Ask:

• What do we gain with this option?
• What do we give up?
• Who experiences the benefits?
• Who bears the costs or risks?
• What opportunity are we giving up by using resources here?

Reframe the problem when necessary

Critical analysis may show that the original problem statement was incomplete or wrong.

Restate:

• The current situation
• The problem as it is now understood
• Important causes or contributing conditions
• What remains uncertain
• The outcomes the group hopes to achieve

Reframing is not a failure of the original process.

It is often evidence that the analysis has improved.

Make a proportionate decision

Decide using the strongest available evidence while acknowledging uncertainty.

When uncertainty is high and the decision is reversible, a pilot or limited test may be appropriate.

When a decision is difficult to reverse or could create significant harm, stronger evidence and review may be necessary.

Continue thinking critically during implementation

Critical thinking does not end when a solution is selected.

Monitor:

• Whether implementation is occurring as intended
• Whether the expected results are occurring
• Whether assumptions remain valid
• Whether unexpected effects are appearing
• Whether some groups are affected differently

Evaluate and revise

Ask:

• What happened?
• What evidence supports that conclusion?
• What did we misunderstand?
• What worked?
• What did not?
• What should continue?
• What should change?
• What have we learned that applies elsewhere?

A strong critical thinker is not someone who never reaches a wrong conclusion.

It is someone who can recognize when a conclusion is no longer supported and revise it.

In Summary

Critical thinking is a vital skill in health, human service, organizational, and community work.

It involves examining claims, evidence, assumptions, reasoning, context, alternatives, uncertainty, and one's own thinking before deciding what conclusion or action is justified.

Critical thinking does not require automatic skepticism toward authority, conventional wisdom, institutions, or unfamiliar ideas. Nor does it mean attempting to eliminate every value, emotion, or perspective from judgment.

Instead, it asks people to distinguish evidence from interpretation, make assumptions visible, seek appropriate context, compare competing explanations, evaluate the quality of information, and match confidence to the strength of the evidence.

These skills are especially important in a digital environment where people encounter social media, rapidly changing information, synthetic images and video, online influencers, algorithmically selected content, and generative AI alongside traditional research and news sources.

Critical thinking can be developed across ages and backgrounds. Teaching it works best when people practice the skills in meaningful subject matter and real situations, with explicit modeling, opportunities for reasoning and discussion, feedback, and metacognitive reflection.

Finally, critical thinking continues after a decision is made. People should monitor results, test assumptions against what actually happens, evaluate new evidence, and be prepared to revise conclusions and actions when the evidence changes.

What is critical thinking?

___You know that critical thinking is the process of examining, analyzing, questioning, and challenging situations, issues and information of all kinds.

___You know the elements of critical thinking:

• Problem/goal identification
• Diagnosis
• Exploration
• Action
• Reflection
• Repeat the process

___You know the goals of critical thinking:

• Finding the truth
• Considering the context
• Understanding assumptions
• Creating alternative approaches

Why is critical thinking important?

You understand that:

___It identifies bias

___It's oriented toward the problem, issue, or situation that you're addressing

___It brings in other necessary factors

___It considers both the simplicity and the complexity of its object

___It gives you the most nearly accurate view of reality

___It is most likely to get you the results you want

Who can (and should) learn to think critically?

___You know that most people can and should learn to think critically

___You know that the many adults who have the capacity for critical thinking, but who haven't been taught and lack the experiences to learn on their own are both most in need of, and most receptive to, learning critical thinking.

How to help others learn to think critically

___You know that learning critical thinking is an irreversible, often frightening process that requires support.

___You understand how to be a facilitator of critical thinking:

• Affirm learners' self-worth
• Listen attentively to learners
• Show your support for critical thinking efforts
• Reflect and mirror learners' ideas and actions
• Motivate people to think critically, but help them to understand when it's appropriate to voice critical ideas and when it's not.
• Regularly evaluate progress with learners
• Be a critical teacher
• Make people aware of how they learn critical thinking
• Model critical thinking

___You know how to encourage the critical stance (i.e. applying critical thinking to whatever you encounter):

• Help learners recognize and examine their own assumptions
• Examine information for accuracy, assumptions, biases, or specific interests
• Consider the context of what you're looking at

___You know how to facilitate problem solving using critical thinking

• Identify the assumptions behind the problem
• Challenge those assumptions
• Imagine alternatives to what you started with
• Critique those alternatives
• Reframe the problem and solution

Tool #1: Two Conceptions of Cognitive Development

There are a number of ways to look at cognitive development, i.e. the development of thinking. Perhaps the most familiar is the conception of Jean Piaget, a Swiss philosopher, who looked at the development of his own children to try to understand the development of the intellect in general. From his sample of three, he saw a pattern of development that had, in its simplest terms, three stages:

• Preoperational: Piaget used the word "operations" to refer to the logical structures of thinking. At the preoperational stage, logical structures really aren't much of a factor except in the most fundamental ways. The light comes on when you flip the switch simply because it does. There's very little, if any, understanding of cause and effect, or of the consequences of any but the simplest actions.

A defining moment in my own life came when I was three. I was coasting down an incline on my tricycle, and realized that I was about to hit some bushes. I turned right...down a flight of stairs I knew full well was there. It just hadn't occurred to me that my action would have a consequence in the future, even the future that was only two or three seconds ahead.

• Concrete operations: At this stage, people can understand what they can take in through the evidence of their senses (things that are "concrete" enough to touch or see). Thus, addition and subtraction are easy -- you can manipulate objects to see how they work -- but algebra, which involves "unknowns" is harder. You can't see the unknowns, so they're a great deal more difficult to understand.

A professor of cognitive psychology used to tell his classes this story: "When the channel changer knob fell off my TV set, the channel had to be changed with a pair of pliers. Without the numbers on the channel changer, I could never find the stations. One day when I was struggling with the thing, my eight-year-old daughter asked what was wrong. I said,'I can't find Channel Four.' My daughter went over and picked up the knob, pointed to the number, and said'There's Channel Four.' That's concrete operations."

• Formal operations: At this highest stage (which has a number of more narrowly defined substages within it), people are capable of abstract thought. This is often defined as the ability to think about thinking. It includes bringing ideas or events that aren't present or obvious to bear on a particular issue; being able to project consequences into the future; predicting what others might do, even if it's very different from what you might do; envisioning several possible outcomes from the same action; etc.

A couple of older-children examples of formal operations:

A sixth-grade class in the '50's was told that English newspapers were seldom longer than eight pages, and were printed on thin paper. The teacher asked why this was the case. Two of the children understood immediately that the answer had to do with a fact they had learned the week before: that England had cut down most of its forests. They realized that its relatively few trees were much too valuable to be used for making paper.

A nine-year-old was asked to explain why Earth was a sphere. After a few seconds of thought, he was able to explain that, since gravity pulls equally in all directions, the shape that would be formed by gravity pulling space debris and dust together from a central point would be a sphere. Every point on a ball, if it's perfectly spherical, is exactly the same distance from the center.

Since he observed, for many years, only his own children, Piaget assumed that their development was typical. He therefore assigned preoperational thinking to very early childhood; concrete operations to the elementary school years, about ages 6 to 11 or 12; and the start of formal operations to puberty or early adolescence.

As it happens, there are great variations in development, depending to a large extent upon an individual's experiences and stimulation, and probably upon brain development as well. A large number -- perhaps a majority -- of adults still function at concrete operations in at least some areas.

And that's another issue: even people who spend much of their cognitive lives at the highest levels of thought -- theoretical physicists, for instance -- probably don't use formal operations all the time. Certain issues, such as dealing with their parents, may present emotional barriers to thinking in critical or logical ways. In reality, few of us are able to turn the full force of our intellect on everything we encounter.

Piaget saw cognitive development as a process of increasing differentiation (understanding how things, people, events, ideas, etc. differ from one another) and increasing integration (understanding the connections among all those different things, people, etc.) The mechanism of that process is set off by a person coming into contact with something that doesn't match his view of reality.

Someone in this situation has two options: he can ignore the new phenomenon, and simply continue seeing the world as he always has; or he can try to make sense of the world in a different way in light of the new reality he has seen. It may take many encounters with reality to start a change in perception, especially if cognitive development means leaving behind some basic belief. Some people simply are unable ever to see anything that doesn't agree with their preconceptions.

Although textbooks tend to present this material as if changes happened abruptly, in fact change is going on all the time. People's thinking may get more sophisticated in some areas, but not others, which brings us to another theory of cognitive development.

Howard Gardner sees Piaget as looking at only one part of cognitive functioning. Gardner finds eight aspects of intelligence, rather than just one:

• Logical-mathematical (what he believes Piaget was examining)
• Verbal (speaking and writing ability, learning languages, etc.)
• Interpersonal (relations with others)
• Intrapersonal (understanding of self)
• Spatial (ability to see, understand, and use spatial relationships, including talent for painting and the other visual arts)
• Kinesthetic (physical and athletic ability)
• Music
• Environmental (Being able to recognize patterns in one's environment)

According to Gardner, each of these aspects is separate from the others. Different aspects develop at different rates in different people, so that some who are far advanced in, for instance, music at an early age, may still have very little interpersonal capacity. This is one way of explaining those theoretical physicists we mentioned earlier: some of their intelligence's are highly developed, while others are not.

For the most part, at least in the past century, schools and the society at large have valued the logical/mathematical and verbal abilities, while paying little attention to the others. If Gardner is right, his theory has major implications for education, as he himself has written. We should be stimulating children in all areas, so that they can become adults who are competent in every aspect of intelligence.

A PowerPoint presentation summarizing the major points in the section.

• The nature of problems

• Clarifying the problem

• Deciding whether and how to act

• Analyzing the problem

When people encounter a community or organizational problem, the first impulse is often to move quickly toward a solution.

But the way a problem is defined strongly influences which solutions appear reasonable.

If the problem is defined too broadly, the group may not know where to begin. If it is defined too narrowly, important contributing conditions may be ignored. If the definition already contains a preferred solution, other potentially more effective approaches may never be considered.

Defining and analyzing the problem therefore deserves deliberate attention.

This section focuses on four related tasks:

• Understanding the nature of the problem
• Clarifying what is known and what remains uncertain
• Deciding whether and how your organization should act
• Analyzing contributing conditions, context, assets, and system relationships

These tasks are related and often iterative. New information may cause you to revise a problem statement that originally seemed clear.

The nature of problems

A concern may first appear as a pattern, complaint, unexpected result, safety issue, gap in services, inequity, unmet goal, or observation that conditions are not working as intended.

Intuition or discomfort can be a useful signal that something deserves investigation.

It should not, however, be treated as proof of what the problem is or what causes it.

What is a problem?

A problem can be understood as an observed condition, gap, risk, unmet need, or unwanted outcome that warrants attention.

Often, the problem involves a difference between current conditions and a desired condition.

When using that definition, make the desired condition explicit.

Ask:

• What is happening now?
• What condition are we comparing it with?
• Where does that standard or goal come from?
• Is it based on community priorities, evidence, policy, law, safety standards, organizational goals, rights, or another benchmark?

For example:

Current condition: Fewer than half of eligible residents complete the program's enrollment process.

Desired condition: Eligible residents can complete enrollment without unnecessary procedural, communication, transportation, technology, or accessibility barriers.

This identifies a gap without assuming what intervention will close it.

Problems differ in complexity

Some problems are relatively straightforward.

For example, if required supplies are repeatedly unavailable because no one is responsible for reordering them, assigning ownership and establishing a reorder process may resolve the problem.

Other problems involve systems.

They may:

• Change over time
• Involve multiple organizations and groups
• Have several interacting causes
• Be affected by policy, funding, infrastructure, institutions, and behavior
• Affect different groups differently
• Produce feedback effects or unintended consequences

A complex problem may not have one root cause or a single permanent solution.

The goal may instead be to reduce harm, improve conditions, change a particular part of the system, strengthen protective factors, or manage risk over time.

Do not define people as the problem

Define problems in terms of conditions, outcomes, systems, policies, practices, barriers, or risks rather than labeling populations.

For example:

Less useful: Young people are the problem because they do not participate.

More useful: Participation among residents ages 16–24 has declined over the past two years, and the organization does not yet know which barriers are contributing to the decline.

This keeps the analysis focused on conditions that can be investigated.

Look for assets as well as problems

Communities and organizations usually have strengths, protective factors, existing relationships, successful practices, and other resources that can help address the problem.

Ask:

• Where is the problem less severe?
• What is working there?
• What strengths already exist?
• Which organizations, relationships, practices, or community assets could support improvement?

Clarifying the problem

Before finalizing a problem statement, clarify what is known, what is believed, and what still needs investigation.

Start with what is currently known

Gather existing information before deciding what additional information is necessary.

Sources might include:

• Program and administrative records
• Surveys
• Interviews
• Community listening sessions
• Observations
• Research studies
• Public datasets
• Policies and regulations
• Previous evaluations
• Geographic information
• Professional expertise
• Community and lived experience

Not every source answers the same kind of question.

A community member's experience may reveal a barrier that administrative data do not show. Administrative records may reveal the scale or frequency of a pattern that individual experiences cannot establish by themselves.

Distinguish different kinds of information

As information is gathered, distinguish among:

• Observed evidence: information directly documented through reliable data, records, observation, or other appropriate methods.
• Interpretation: an explanation of what the evidence may mean.
• Hypothesis: a possible explanation that can be examined further.
• Lived or community experience: information about how a condition is experienced by people affected by it.
• Value judgment: a conclusion about what is desirable, fair, acceptable, or important.
• Unsupported assertion: a claim for which adequate evidence has not yet been provided.

These forms of information can all influence problem analysis, but they should not be treated as interchangeable.

Identify what information is missing

Ask:

• What information would materially change how we understand the problem?
• What do we currently assume rather than know?
• Are important groups or perspectives missing?
• Do we know how conditions differ by location, time, or population?
• Do we have enough information to distinguish symptoms from contributing conditions?

Do not collect information simply because it might be interesting.

Focus on information that can improve understanding or decision-making.

Examine the quality and limitations of information

For important evidence, ask:

• Who produced it?
• How was it collected?
• Who or what was included?
• Who or what may have been left out?
• How current is it?
• What does it actually measure?
• What uncertainty or limitations are present?
• Does another credible source support the same conclusion?

Gather information ethically

When collecting information from people, consider:

• Privacy
• Confidentiality
• Informed participation where appropriate
• Accessibility
• Language access
• Burden on participants
• How information will be stored and used

Community engagement should be a two-way relationship rather than a process in which organizations simply extract information and disappear.

Define the problem without embedding the solution

A problem statement should describe the condition that needs attention.

For example:

Less useful: We need to create a mobile outreach team.

More useful: Residents in three neighborhoods use the service at substantially lower rates than eligible residents elsewhere, and transportation, scheduling, awareness, eligibility, accessibility, or trust may be contributing factors.

The second statement leaves room to investigate whether a mobile team, schedule change, transportation support, communication change, eligibility reform, partnership, or another approach would be most appropriate.

Do not manufacture agreement

People may understand or experience a problem differently.

The goal is not necessarily to write a statement that makes everyone equally satisfied.

Instead:

• Identify areas of agreement
• Document important differences
• Identify which claims are supported by evidence
• Identify what remains uncertain
• Clarify who has responsibility for deciding how the problem will ultimately be framed for organizational action

Define important terms

Words such as access, community, safety, participation, affordable, quality, success, and underserved can mean different things to different people.

Define important terms precisely enough that participants know what is being discussed and, where possible, how the condition will be measured.

Deciding whether and how to act

After clarifying the problem, determine what role your organization should play.

Not every important problem should be addressed by every organization.

Your organization may decide to:

• Lead the response
• Work in partnership
• Support another organization
• Refer the issue to an authority with greater expertise or responsibility
• Gather more information before acting
• Address only one part of a larger problem
• Maintain the current approach while monitoring conditions

Consider severity and urgency

Ask:

• How serious is the harm or risk?
• How many people are affected?
• How severely are they affected?
• Is the condition worsening?
• Are immediate protective actions required?

Some safety, legal, safeguarding, or public-health concerns may require action before a complete analysis can be finished.

Immediate action can occur while deeper analysis continues.

Consider equity

Overall averages can hide large differences.

Ask:

• Who experiences the greatest burden?
• Are barriers concentrated among particular groups or places?
• Who has historically had the least influence over decisions about the issue?
• Could a proposed response reduce one problem while increasing another inequity?

Consider organizational authority and fit

Ask:

• Does the issue fit the organization's mission and responsibilities?
• Does the organization have legal or professional authority to act?
• Does another organization already have primary responsibility?
• Would partnership be more effective than acting alone?

Consider feasibility and capacity

Consider:

• Staff and volunteer capacity
• Funding
• Expertise
• Technology
• Partnerships
• Time
• Political or organizational conditions

Feasibility should not be used to dismiss an important problem merely because it is difficult.

It may instead indicate that the organization needs partners, a smaller initial objective, or a longer-term strategy.

Consider consequences and tradeoffs

Ask:

• What benefits are expected?
• What harms or burdens could occur?
• Who receives the benefits?
• Who bears the costs or risks?
• What unintended effects are plausible?
• Can those effects be prevented or reduced?

Legal, ethical, safety, or rights-based obligations should not be treated merely as optional costs to be balanced away.

Consider opportunity cost

Resources used for one problem are not available for another.

Ask:

If we devote substantial staff time, funding, and leadership attention here, what other work will receive less attention?

Consider what happens if you do not act

Maintaining the current approach is itself a choice.

Compare the likely consequences of action with the likely consequences of no additional action.

Prioritize among several problems

When several problems compete for attention, establish criteria before choosing among them.

Criteria might include:

• Severity
• Urgency
• Number of people affected
• Equity
• Organizational responsibility
• Evidence that meaningful improvement is possible
• Available capacity
• Community priority
• Opportunity cost

A simple matrix can help participants compare problems consistently.

Numerical scores may be useful in some situations but should not create an illusion of precision where judgments remain uncertain.

Analyzing the problem

After developing a preliminary problem definition and deciding that the issue warrants attention, examine it in greater depth.

The purpose is not to force everyone toward one causal story.

It is to develop a sufficiently accurate understanding of the conditions that create, maintain, worsen, or reduce the problem.

Ask the basic descriptive questions

What is happening?

Describe the condition as specifically as possible.

Ask:

• What outcome or condition are we observing?
• How is it measured?
• What evidence supports the description?

Who is affected?

Ask:

• Who experiences the condition directly?
• Are effects different among groups?
• Who may experience indirect effects?

Avoid assuming that the people most affected are also the people responsible for causing the condition.

Where is it happening?

Geographic patterns may reveal differences in:

• Access
• Infrastructure
• Resources
• Exposure
• Institutional practices

When is it happening?

Examine:

• When the problem emerged
• Whether it is increasing or decreasing
• Seasonal patterns
• Important events or policy changes that occurred around the same time

A long-standing problem may reflect entrenched systems, resource constraints, policies, incentives, infrastructure, or other conditions rather than simply people's unwillingness to change.

How much?

Examine:

• Number of people or cases affected
• Rate or proportion
• Frequency
• Duration
• Severity
• Trends over time

Use appropriate denominators and comparison groups so the scale of the problem is not misleading.

Examine contributing conditions

Instead of asking only, "What is the root cause?" ask:

What conditions contribute to this problem, and how do they interact?

Consider:

• Policies and rules
• Organizational processes
• Funding
• Incentives
• Staffing
• Infrastructure
• Access
• Information and communication
• Social and economic conditions
• Historical conditions
• Trust and relationships
• Individual and organizational behavior

Use repeated “why” questions carefully

Asking "Why?" several times can help reveal assumptions and deeper contributing conditions.

For example:

Program appointments have a high no-show rate.

Why might that be happening?

Participants report transportation and scheduling difficulties.

Why are those difficulties affecting this program more than others?

Appointment times are concentrated during working hours and the site is not served directly by public transportation.

This exercise can identify useful lines of investigation.

It does not prove that the final answer is the one true root cause.

Several causal pathways may operate at the same time.

Use systems thinking when the problem is complex

For complex issues, consider mapping relationships among:

• Policies
• Organizations
• Resources
• Infrastructure
• Incentives
• Behaviors
• Community conditions
• Feedback loops

Tools may include:

• Causal diagrams
• Process maps
• System maps
• Timelines
• Stakeholder maps

Use the simplest tool that helps participants see relationships they were previously missing.

Examine forces maintaining and changing the situation

Force-field analysis can still be useful when the group wants to identify factors that maintain the current condition and factors that support change.

Instead of treating the exercise as an unrestricted list, ask participants to identify:

• Evidence supporting each factor
• How strongly the factor influences the situation
• Whether the organization can influence it
• How it interacts with other factors

Identify assets and protective factors

Ask:

• Where is the desired outcome already occurring?
• What is different there?
• What community strengths can be built upon?
• Which relationships or institutions already reduce the problem?

An analysis focused only on deficits can overlook practical solutions already operating in part of the system.

Analyze stakeholders without assigning simplistic blame

Instead of asking only "Who is causing the problem?" ask:

• Who is affected?
• Who influences important conditions?
• Who controls relevant resources?
• Who has formal decision authority?
• Who has relevant knowledge or experience?
• Who might help implement change?
• Who may experience costs or unintended effects?

Accountability still matters.

If a particular policy, organizational practice, decision, or harmful behavior materially contributes to the problem, identify it accurately.

Examine power and interests

Ask:

• Who currently defines the problem?
• Who controls the data?
• Who controls funding or authority?
• Whose knowledge has historically carried the greatest weight?
• Who has less ability to influence the response?
• Are conflicts of interest or incentives affecting how the problem is framed?

Identify uncertainty and competing explanations

At the end of the analysis, the group may still have several plausible explanations.

Document:

• What is well supported
• What is plausible but uncertain
• What information is missing
• What evidence would help distinguish among competing explanations

Do not force agreement merely to make the process appear complete.

Revisit the problem statement

Analysis may show that the original statement was:

• Too broad
• Too narrow
• Focused on a symptom
• Based on an unsupported assumption
• Missing an important population, place, or condition

Rewrite it when necessary.

Prepare a concise problem-analysis summary

Before moving to potential solutions, summarize:

• The problem statement
• Magnitude and trend
• Who is affected
• Relevant context
• Major contributing conditions
• Assets and protective factors
• Important differences among groups or places
• Areas of uncertainty
• Evidence still needed
• Relevant authority and organizational role

This summary gives participants a shared reference point when they begin generating and comparing possible responses.

Keep the analysis open to revision

Defining a problem is not a one-time event.

New information may emerge while an intervention is being designed, implemented, or evaluated.

If the evidence changes, revisit the analysis.

A responsible organization should be willing to change its understanding rather than continuing to act on a problem definition that the evidence no longer supports.

In Summary

Defining and analyzing a problem is a foundation for effective community and organizational action.

Begin by describing the condition rather than assuming the solution. Make clear what standard, goal, right, or community priority defines the difference between current and desired conditions.

Gather credible information from multiple appropriate sources. Distinguish observed evidence from interpretations, hypotheses, values, and unsupported assertions, and identify important limitations and uncertainties.

Decide what role your organization should play by considering severity, urgency, equity, authority, capacity, opportunity cost, community priorities, likely benefits, and potential harms.

When analyzing causes, avoid assuming that a complex community problem has one root cause. Examine interacting policies, systems, institutions, resources, behaviors, relationships, historical conditions, assets, and feedback effects.

Include affected communities and other relevant people in ways that are meaningful, accessible, and appropriate to their knowledge, responsibilities, and decision authority. Pay attention to power, trust, and whose interpretations have historically shaped the issue.

Finally, treat the problem definition as revisable. Monitoring, implementation, community feedback, and evaluation may reveal conditions that were not visible at the beginning.

Strong problem analysis does not guarantee a simple answer. It gives the organization a clearer, better-supported foundation for deciding what to do next.

You understand the nature of problems:

___They may be defined as the difference between what is and what might or should be.

___They may occur within or outside of the group.

___They occur at different levels of severity.

You have clarified the problem:

___You have started with what you know.

___You have decided what is missing.

___You have gathered information on the problem.

___You have defined the problem.

You have decided to solve the problem:

___It is important.

___It is feasible.

___You are the best people to solve the problem.

___You have weighed the negative impacts.

___You have chosen among possible problems.

You have analyzed the problem:

___You know what the problem is.

___You know why the problem exists.

___You know who is causing the problem.

___You know when the problem first occurred or became significant.

___You know how much, or to what extent, the problem is occurring.

Choosing which problem to solve

A small, rural substance use prevention group is trying to decide where to focus their youth related efforts. In the following chart, the group compared two problems to see which one is more important to the group.

	Problem 1: Many underage teens smoke cigarettes or chew tobacco	Problem 2: Many teenagers use illegal drugs (marijuana, cocaine, et cetera)
How frequently does the problem occur?	Very Frequently	Frequently
How many people are affected?	Most area high school students have smoked at least once; a significant percentage smoke regularly	In our rural community, few illicit drugs are available; this is a fairly small number
For what amount of time are they affected?	Regular smokers, often for life	Often life-long consequences
How severe is the effect?	Relatively severe	Can be tremendously severe
How important do group members perceive the problem to be?	Very Important	Less Important
How important is the problem perceived to be by others?	Less important; smoking and chewing are widely accepted here	Very Important
How likely is it that we can solve/significantly improve the problem?	Very Likely	Possible, but difficult
Are there any negative impacts?	None	None

Which problem will the coalition choose? That remains to be seen; this chart won't give a magic answer. But by using this or a similar device, it's easy to see all of the different aspects of the problem, and the group is now better equipped to make an informed choice.

Tool 1: Deciding on a problem statement

This exercise is adapted from an exercise on developing vision statements created by Lori Alvarado, DCCCA Center, Lawrence, KS. This activity works best in groups with less that 40 people.

• Ask everyone present at the meeting to write down his/her definition of the problem.
• Ask people to pair off and share their problem statements with each other. Together, the pair can create a new problem statement, incorporating ideas from both.
• Ask pairs to join together in groups of four, and again merge the statements into one.
• Continue joining the groups in larger and larger groups until everyone is together again, and you have one agreed upon statement.

Tool 2: Choosing which problem to solve

The following table can be used or adapted to help you decide which problem you want to try to solve if you have several on your plate at the same time. By answering each question, you can get a clearer idea of all of the aspects of solving a problem, and should be able to choose more easily and effectively. For a completed example of this chart, see the Examples section above.

	Problem 1	Problem 2
How frequently does the problem occur?
How many people are affected?
For what amount of time are they affected?
How severe is the effect?
How important do group members perceive the problem to be?
How important is the problem perceived to be by others?
How likely is it that we can solve/significantly improve the problem?
Are there any negative impacts?

A PowerPoint presentation summarizing the major points in the section.

What are "root causes?"

The term "root causes" is often used to describe conditions that help create or maintain a problem.

For relatively straightforward problems, it may be possible to identify a small number of underlying causes.

Many community problems, however, are more complex. They may develop through several interacting causes involving people, organizations, policies, resources, infrastructure, institutions, relationships, and broader social and economic conditions.

For that reason, it is often more useful to think in terms of underlying and contributing conditions rather than assuming that every problem has one root cause.

Understanding these conditions is an important part of the problem-solving process.

Cause analysis can help a group:

• Look beyond the most visible symptom
• Identify several places where change might be possible
• Examine individual, organizational, community, policy, and other system conditions
• Avoid assuming a preferred solution before understanding the problem
• Identify what additional evidence is needed

Cause analysis does not guarantee that the group will identify the correct response.

The explanations developed during the process should be treated as hypotheses to examine with evidence, community knowledge, implementation experience, and evaluation.

What is the "But why?" technique?

The "But why?" technique is a simple method for exploring conditions that may contribute to a community problem.

It is related to an approach often called the "Five Whys," although there is no required number of times that the question must be asked.

The technique begins with a clearly described condition.

Participants ask why that condition may be occurring.

For each proposed explanation, they ask another question such as:

• But why is that happening?
• What conditions make that possible?
• What evidence supports that explanation?
• What else could explain it?
• Could it have been prevented or reduced?
• What conditions would have to change?

The goal is not necessarily to arrive at one final answer.

One outcome may have several causes, and one contributing condition may lead to several additional questions.

The result may therefore look more like a branching map than a single chain.

A simple example

Suppose a community health program notices that evening appointments have a much higher no-show rate than daytime appointments.

The group might ask:

Condition: Evening appointments have a high no-show rate.

Q: Why might that be happening?
A: Some participants report difficulty getting to the site in the evening.

Q: Why is transportation more difficult in the evening?
A: Public transportation serving the site operates less frequently after 6:00 p.m.

Q: What evidence supports that?
A: Transit schedules and participant interviews show fewer evening routes and longer travel times.

But transportation may be only one pathway.

The group should also ask:

Q: What else could contribute to the no-show rate?
A: Some appointments overlap with work, caregiving responsibilities, or other obligations.

Q: Are there other possibilities?
A: Reminder messages may not reach everyone, and some participants may not know how to reschedule.

The analysis now identifies several possible intervention points rather than one supposed root cause.

Why should you identify underlying and contributing causes?

Taking action without understanding what contributes to a problem can lead to an intervention that addresses only a visible symptom or an incorrect assumption.

Cause analysis can help a group direct its resources toward conditions that meaningfully influence the outcome.

It can also reveal that several responses may be needed at the same time.

To distinguish immediate conditions from underlying ones

A community may need an immediate response while also addressing conditions that repeatedly produce the same problem.

For example, emergency food assistance can be essential for people who need food today.

Longer-term analysis might also examine:

• Food affordability
• Household income
• Transportation
• Availability of food retailers
• Eligibility and access to benefits
• Housing and other household costs
• Employment conditions

Immediate relief and efforts to change underlying conditions do not have to compete with one another.

To identify several possible intervention points

A problem may be influenced at several levels.

Depending on the issue, contributing conditions may involve:

• Individual knowledge, skills, behavior, or health
• Family, peer, or other interpersonal relationships
• Organizational practices
• Services and institutions
• Community resources and infrastructure
• Economic conditions
• Policies and laws
• Access to power and resources
• Physical environments
• Social norms and other contextual factors

Do not assume in advance that an individual behavior is the most important cause simply because it is easy to observe.

To avoid blaming people for conditions outside their control

Individual choices matter in many situations, but choices are made within social, economic, organizational, and physical environments.

For example, before concluding that people need more nutrition education, ask whether nutritious food is affordable, accessible, available, and practical within people's actual circumstances.

Before concluding that people need to make better use of a service, ask whether the service is available at appropriate times, physically and financially accessible, trustworthy, understandable, and responsive to community needs.

To identify structural and institutional conditions

Some problems are strongly influenced by:

• Policies
• Funding arrangements
• Institutional procedures
• Housing
• Transportation
• Employment conditions
• Education
• Discrimination
• Access to services
• Distribution of power and resources

These conditions may be less visible than individual behavior but can strongly shape what options people actually have.

To identify protective factors

Cause analysis should not focus only on what is going wrong.

Ask:

• Where is the desired outcome already occurring?
• What is different there?
• What strengths or resources are protecting against the problem?
• What existing practices should be preserved or expanded?

Understanding why a problem is less severe in some places or circumstances can reveal intervention possibilities that a deficit-only analysis would miss.

To improve community participation in analysis

People affected by a condition often have knowledge about barriers, resources, history, and everyday experience that organizations may not see in administrative data.

Meaningful participation can improve the analysis and help determine whether proposed explanations fit people's actual experiences.

Participation should not be framed as requiring community members to "own" a problem that may be influenced by institutions, policies, markets, or other actors outside their control.

Instead, clarify who has knowledge, who has decision authority, who controls relevant resources, and who can contribute to change.

When should you use the "But why?" technique?

The technique can be useful when:

• A group is describing symptoms but has not explored what contributes to them
• A proposed solution appears to assume a cause that has not been examined
• Participants have different explanations for why a condition exists
• The group wants to identify several possible intervention points
• An operational or organizational problem appears to involve a chain of contributing conditions

The technique is quick and inexpensive, but it should not be treated as sufficient for every problem.

Additional methods may include:

• Surveys
• Interviews
• Community listening sessions
• Administrative data
• Research evidence
• Observation
• Process mapping
• Causal diagrams
• System mapping
• Program evaluation

Use additional methods when the stakes are high, the problem is complex, participants disagree substantially about causes, or the group lacks evidence to support the proposed causal chain.

When immediate action is also necessary

Cause analysis should not delay urgent action needed to protect health, safety, rights, or basic needs.

A group can address an immediate harm while continuing to investigate why the condition occurred and how recurrence might be prevented.

How does the "But why?" technique work?

Technique Guide

1. Start with a clearly defined condition

Begin with a specific description of what is happening.

Avoid defining a population as the problem or embedding a preferred solution in the statement.

For example:

Participation in the program has declined by 25% during the past year.

is more useful than:

People do not care about the program.

The first statement describes a condition that can be investigated. The second assumes a cause.

2. Involve people with relevant knowledge

Depending on the issue, include people who:

• Experience the condition
• Have relevant community or lived knowledge
• Work directly with the program or system
• Have relevant professional or technical expertise
• Control resources or authority related to the problem
• May help implement change

Broad participation can improve the analysis, but it does not guarantee that every cause will be identified.

Consider power differences as well. Some participants may be less willing to challenge an explanation publicly when supervisors, funders, government officials, or other powerful participants are present.

Written, confidential, anonymous, small-group, or separate input may sometimes improve the quality of information.

3. Ask the first "Why?" question

Ask:

What conditions may be contributing to this?

Record several plausible answers rather than accepting the first explanation as the causal pathway.

4. Ask for evidence

For each proposed explanation, ask:

• What evidence supports this?
• Is this something we know, something participants have experienced, or a hypothesis we still need to test?
• Do other credible sources support it?
• Could another factor explain the same pattern?

This helps prevent a plausible story from becoming accepted as fact simply because it sounds convincing.

5. Continue along several branches

Each answer may lead to another question.

For example:

Condition: Evening appointment attendance is low.

Q: Why might attendance be low?
A: Some participants have transportation difficulties.

Q: Why are transportation difficulties especially important in the evening?
A: Transit service is less frequent after 6:00 p.m.

At the same time, another branch might be:

Q: What else may contribute?
A: Evening appointments overlap with work and caregiving responsibilities.

Q: Why are appointment options concentrated at those times?
A: Staffing and facility schedules limit the hours currently offered.

Another branch might examine reminders, rescheduling procedures, accessibility, or other conditions.

The purpose is to see the network of plausible contributing factors rather than forcing every observation into one chain.

6. Ask what could have prevented or reduced the condition

Prevention questions can reveal intervention points.

Ask:

• What could have prevented this?
• What could have reduced its likelihood or severity?
• What existing protective factors already reduce it in some places or circumstances?

7. Look beyond individual error or behavior

If the analysis reaches an answer such as:

Someone made a mistake.

continue asking:

• What conditions made the mistake more likely?
• Were instructions clear?
• Was training sufficient?
• Was workload reasonable?
• Did technology or equipment contribute?
• Did the process make errors easy to make or difficult to detect?

Individual accountability may still matter, but stopping at "human error" may hide system conditions that can be changed.

8. Examine several levels of the system

Depending on the issue, ask about:

• Individual conditions
• Interpersonal relationships
• Organizational processes
• Community resources
• Physical environment and infrastructure
• Economic conditions
• Policies and laws
• Distribution of power and resources

Not every problem requires analysis at every level. Use the levels that are relevant to the condition.

9. Look for relationships and feedback

Causes do not always operate in one direction.

A condition may create a response that later strengthens or weakens the original condition.

Ask:

• Does this factor affect another factor?
• Does that second factor eventually affect the first?
• Could an intervention create an unintended effect elsewhere?
• Does the importance of the factor change over time?

A systems map or causal diagram may be more useful than a simple chain when these relationships become complicated.

10. Identify what the group can influence

Once several contributing conditions have been identified, distinguish among factors the group can:

• Change directly
• Influence through partnership or advocacy
• Monitor but not directly control

This helps turn causal analysis into realistic intervention planning without pretending every underlying condition is within the group's authority.

11. Document uncertainty

At the end of the exercise, identify:

• Contributing conditions strongly supported by evidence
• Plausible conditions that need more investigation
• Explanations for which evidence is weak or conflicting
• Important information that is still missing

Do not force agreement on a causal explanation simply to complete the exercise.

12. Use additional analysis when necessary

The "But why?" technique is a starting point, not proof.

Follow it with other methods when necessary, including:

• Research
• Surveys
• Interviews
• Administrative data
• Observation
• Process mapping
• Systems mapping
• Evaluation

13. Compare possible intervention points

Cause analysis may reveal several possible places to act.

Compare them using criteria such as:

• Evidence
• Expected effectiveness
• Equity
• Safety
• Accessibility
• Feasibility
• Cost
• Organizational authority and capacity
• Sustainability
• Potential unintended consequences

Several interventions at different levels may be more appropriate than one solution directed at one supposed root cause.

14. Test the analysis during implementation

A causal analysis is a working explanation of how a problem operates.

Once action begins, monitor whether the expected changes actually occur.

Ask:

• Did changing the identified factor affect the outcome?
• Did another barrier become more important?
• Were there unintended effects?
• Did the problem affect different groups differently?
• Does the causal explanation need to be revised?

In Summary

The "But why?" technique is a useful way to move beyond an immediate symptom and begin exploring why a community problem may be occurring.

Its strength is its simplicity. Repeated questioning can reveal conditions that were not obvious when the problem was first described.

Its simplicity is also its limitation.

Complex community problems often result from several interacting causes rather than one root cause. A single chain of "why" questions can therefore produce an explanation that is too narrow or overly linear.

Use the technique to generate possible causal pathways, not to prove them. Ask what evidence supports each explanation, consider competing explanations, examine individual and system conditions, identify protective factors, and look for feedback and unintended consequences.

Include people affected by the condition along with others who hold relevant knowledge, responsibility, resources, or decision authority. Pay attention to power and create additional ways to contribute when people may not be comfortable challenging an explanation publicly.

Finally, connect cause analysis to action and learning. Compare possible intervention points, select responses using explicit criteria, monitor what happens during implementation, and revise the analysis when new evidence shows that the problem works differently than expected.

___You understand what root causes are

___You understand what the "but why?" technique is

___You understand why you should identify root causes

___You know when you should identify root causes

___You understand how the "but why?" technique works

___You know how to decide among the options you're left with from the "but why?" technique

___You know how to apply the "but why?" technique

"But why?" in Latin America

David Werner, a community health organizer in Latin America, used the "But why?" technique to get to the more fundamental, underlying causes of widespread ill health of villagers in Western Mexico:

"...(At first) I did not look far beyond the immediate causes of ill health. As I saw it, worms and diarrhea were caused by poor hygiene and contaminated water. Malnutrition was mainly caused by scarcity of food in a remote, mountainous area where drought, floods and violent winds made farming difficult and harvest uncertain.

Little by little, I became aware that many of their losses -- of children, or of land or of hope -- not only have immediate physical causes, but also underlying social causes. There is a photograph of a very thin little boy in the arms of his malnourished mother. The boy eventually died of hunger. The family was -- and still is -- very poor. Each year the father had to borrow maize from one of the big landholders in the area. For every liter of maize borrowed at planting time, he had to pay back three liters at harvest time. With these high interest rates, the family went into further debt. No matter how hard the father worked, each year more of his harvest went to pay what he owed to the landholder." - D. Werner, Helping Health Workers Learn, Front-7

 

The "But why?" method is not explicit in this story, but by asking "But why?" questions, Werner could help people analyze their problems, and prevent waste of tactics and resources. Using the "But why?" technique, he could see beyond the most obvious causes for the problems he was trying to eliminate. For instance, he learned that malnutrition may have more causes than simply lack of food.

Tool 1: Discussion Guide for Identifying Root Causes

A note to all readers/participants: This exercise is designed to help practice identifying underlying factors that are behind a community problem. We are calling these underlying factors "root causes." To identify "root causes," we will be using a technique called "But Why?"

Goal: To analyze a community problem by trying to determine its most fundamental reason, or "root causes."

Task 1: Select one member of your group to act as the "asker." This Person will be the one asking the "But why?" questions.

Task 2: Chose a issue to examine, a specific problem. Once the specific problem is identified and described, your "asker" will guide you in identifying what your group considers to be the "root causes" of that problem. The identification of root causes should be made by answering the "But why?" questions.

Task 3: After you have identified some key root causes for your priority problem, discuss what approaches might be undertaken to remove or counteract those root causes.

Possible Approach: _____________________________________________________

Possible Approach: _____________________________________________________

Possible Approach: _____________________________________________________

At this point, you should look at all possible approaches and select the one that fits your problem better, the one that is the best solution.

A PowerPoint presentation summarizing the major points in the section.

 

What are social determinants of health and development?

Health and development are influenced by far more than individual choices or access to medical care.

Social determinants of health are the conditions in which people are born, grow, learn, live, work, play, worship, and age, together with the wider systems and distribution of power, money, and resources that shape those conditions.

These conditions influence opportunities for health and well-being and help explain why some communities and populations experience better health outcomes than others.

Social determinants can include:

• Income and economic security
• Employment and working conditions
• Education access and quality
• Health care access and quality
• Housing
• Transportation
• Food access and affordability
• Neighborhood and environmental conditions
• Social support and community connection
• Discrimination and exclusion
• Public policies and institutional practices
• Access to political, economic, and social power

These determinants interact.

For example, unstable employment can affect income, housing, transportation, insurance or health care access, stress, and the amount of time available for family responsibilities. Poor transportation can affect access to work, school, food, health services, and community participation.

For many community health and development issues, there is no single social determinant or one root cause. Several conditions may operate together, and their importance may differ across communities and over time.

A practical framework

In the United States, one useful framework groups social determinants of health into five broad domains:

• Economic stability
• Education access and quality
• Health care access and quality
• Neighborhood and built environment
• Social and community context

These categories are useful for organizing analysis, but they should not be treated as isolated boxes.

Broader economic, social, environmental, and political systems can influence several domains at once.

Health equity

Differences in health are not automatically inequities.

Health inequities are differences that are linked to avoidable and unfair conditions or distributions of opportunity and resources.

Examining health equity means asking not only:

What is the average health outcome?

but also:

• Who experiences better or worse outcomes?
• What conditions contribute to those differences?
• Are some groups exposed to greater risks?
• Do some groups have fewer protective resources?
• Do the same health events have more serious consequences for some people because of economic, social, or institutional conditions?

Exposure, protection, and consequences

One way to examine social determinants is to consider how conditions affect:

1. Exposure. Are some people more likely to encounter environmental hazards, unsafe working conditions, violence, food insecurity, economic instability, or other risks?
2. Protection and access to resources. Do people have access to health care, safe housing, transportation, social support, legal protections, information, and other resources that can reduce risk?
3. Consequences. Does the same health or economic event create more serious effects for people with fewer financial reserves, less workplace flexibility, limited insurance, unstable housing, or other constraints?

These differences are produced by conditions, not by an inherent weakness of the people experiencing them.

Economic stability

Income, employment, job security, debt, benefits, and the cost of basic needs can affect health through many pathways.

Economic instability can influence:

• Housing stability
• Food security
• Transportation
• Access to health services and medication
• Exposure to stress
• Ability to take time away from work
• Educational opportunities

Avoid assuming that income alone explains an outcome. Examine how income interacts with costs, public benefits, household responsibilities, local services, discrimination, and other conditions.

Education access and quality

Education can affect health through employment opportunities, income, health literacy, social networks, access to information, and other pathways.

Relevant conditions can include:

• Early childhood opportunities
• School quality and resources
• Language access
• Disability access
• Safety
• Educational costs
• Opportunities for training and continuing education

More education does not automatically produce good health, and less formal education should not be treated as an individual deficiency. Examine the conditions connecting educational opportunity with health and development.

Health care access and quality

Health care is only one influence on health, but timely access to appropriate, high-quality services remains important.

Barriers may include:

• Cost
• Insurance or eligibility
• Distance and transportation
• Appointment availability
• Work schedules
• Disability access
• Language access
• Digital access
• Administrative complexity
• Quality of care
• Trust based on current or historical experiences with institutions

Neighborhood and built environment

Where people live can affect health through:

• Housing quality and stability
• Drinking water and sanitation
• Air quality
• Exposure to environmental hazards
• Transportation
• Street and pedestrian safety
• Parks and public spaces
• Food availability
• Broadband and other infrastructure
• Access to schools, services, employment, and health care

Describe these conditions directly rather than labeling communities as "blighted," "bad," or unhealthy.

Social and community context

Relationships and social conditions can influence health and development.

Relevant factors may include:

• Social support
• Community networks
• Civic participation
• Discrimination
• Social exclusion
• Community safety
• Trust
• Institutional relationships

Community connection can be protective, but do not assume that every family, neighborhood association, faith community, or other social network is equally available or beneficial to everyone.

Racism, discrimination, and exclusion

Discriminatory policies, practices, and treatment can affect access to:

• Employment
• Housing
• Education
• Health care
• Transportation
• Financial resources
• Public services
• Political and institutional influence

Discrimination can also produce chronic stress and affect trust in institutions.

Where inequities are linked to discrimination or institutional practice, identify those mechanisms directly rather than treating racial or ethnic identity itself as the cause.

Cultural context

Culture can shape communication, social relationships, food practices, beliefs about health, family roles, help-seeking, and other aspects of community life.

Culture should not be used as a convenient explanation for a health outcome without evidence.

Avoid assuming that everyone who shares a racial, ethnic, national, religious, or linguistic identity has the same beliefs or practices.

Use cultural humility:

• Ask rather than assume
• Recognize variation within communities
• Include relevant community knowledge
• Examine institutional barriers alongside individual practices

Language and communication access

People may experience barriers when important health, educational, employment, or public information is not available in a language or communication format they can use effectively.

Addressing the determinant may therefore involve improving:

• Interpretation
• Translation
• Accessible documents
• Plain-language communication
• Digital accessibility

The information and commercial environment

People's information environments now include television, news media, social media, online video, search systems, recommendation algorithms, advertising, influencers, messaging platforms, and AI-generated content.

These systems can influence:

• What health information people encounter
• Which products are promoted
• Perceptions of risk
• Social norms
• Trust in institutions and health information

Commercial conditions can also affect health through product design, pricing, marketing, availability, workplace practices, and business decisions.

Policy and governance

Laws, regulations, budgets, institutional rules, and public policies can shape health conditions at scale.

Policies may affect:

• Housing
• Employment and workplace protections
• Education
• Transportation
• Environmental exposure
• Food systems
• Health care
• Public benefits
• Civil rights and nondiscrimination

Policy choices may involve real tradeoffs among resources, costs, rights, economic interests, health, and other public priorities.

Analyze those tradeoffs directly rather than assuming that disagreement reflects bad motives.

Climate and environmental conditions

Environmental and climate conditions can affect health through heat, air quality, severe weather, infectious disease patterns, water availability, housing, food systems, displacement, and infrastructure.

These effects may be greater for people who have fewer resources to avoid or recover from hazards.

Why address social determinants of health and development?

Social determinants matter because interventions focused only on immediate symptoms may leave important conditions unchanged.

Addressing social determinants can:

• Prevent some health problems before they occur
• Reduce exposure to hazards
• Improve access to protective resources
• Reduce barriers to health care and other services
• Improve material and social conditions that influence health
• Reduce avoidable differences in health outcomes

This does not mean that immediate services should be withheld while organizations work on longer-term conditions.

A person who needs food, shelter, medical care, protection, or another urgent service needs an appropriate response now.

At the same time, organizations and communities can examine why the need keeps occurring and which conditions could be changed to reduce it.

Move beyond a single-root-cause model

Social determinants often operate through several interacting pathways.

For example, difficulty accessing preventive health care might involve:

• Cost
• Insurance
• Transportation
• Clinic location
• Work schedules
• Childcare
• Language access
• Disability access
• Appointment availability
• Trust

Several intervention points may therefore be more appropriate than one supposed root cause.

Improve prevention

Prevention often requires changing the conditions that repeatedly expose people to risk or limit access to protective resources.

For example, preventing waterborne disease involves not only knowledge about safe water but reliable infrastructure, water quality protections, sanitation, monitoring, and appropriate public-health response.

Reduce inequities

Overall health can improve while large differences between groups remain or even grow.

When evaluating a strategy, ask:

• Did average outcomes improve?
• Did people facing the greatest barriers benefit?
• Did gaps narrow, remain unchanged, or widen?
• Were new burdens or barriers created?

Who should address social determinants of community health and development?

Social determinants usually extend across sectors.

Health organizations alone cannot control housing, wages, transportation, education, environmental conditions, employment, or every other factor affecting health.

Depending on the issue, relevant participants and partners may include:

• People and communities directly affected
• Community-based organizations
• Public-health and health-care organizations
• Schools and educational institutions
• Housing organizations
• Transportation agencies
• Employers and workforce organizations
• Local, state, Tribal, territorial, or federal government
• Businesses
• Social-service organizations
• Researchers and evaluators
• Funders
• Advocacy organizations
• Other organizations with relevant authority, resources, expertise, or community relationships

Community engagement should be meaningful

People affected by an issue often hold knowledge that organizations and institutions do not.

Community engagement should therefore begin early enough to influence:

• How the problem is defined
• What priorities are identified
• Which strategies are considered
• How implementation occurs
• How success is evaluated

Engagement should not consist only of asking people for information after major decisions have already been made.

Be clear about power and decision authority

Collaboration does not automatically mean that everyone has identical authority.

Clarify:

• Who provides knowledge and experience
• Who makes recommendations
• Who controls funding or other resources
• Who has legal or institutional authority
• Who makes the final decision
• Who is responsible for implementation

Where shared governance is appropriate, establish it explicitly rather than implying shared power that does not actually exist.

Recognize community assets and self-determination

Communities are not empty settings waiting for outside organizations to provide capacity.

They already contain:

• Knowledge
• Relationships
• Organizations
• Leadership
• Informal support systems
• Skills
• Cultural and historical knowledge

External partners can contribute resources, technical expertise, connections, and support while respecting community priorities and existing strengths.

When should you address social determinants of community health and development?

Social conditions should be considered whenever they may meaningfully influence the issue.

They are particularly important to examine:

• When a health or development problem persists despite direct services
• When outcomes differ substantially among groups or places
• When people repeatedly encounter barriers to accessing services or opportunities
• When prevention is a major goal
• When policy, funding, or institutional change is being considered
• When environmental or economic conditions appear to influence the problem
• When an emergency reveals longstanding weaknesses in housing, transportation, communication, health care, food systems, or other infrastructure
• When a community is developing a long-term health or development strategy

When direct services are not enough

A service can be effective and still leave the conditions producing the need unchanged.

For example, a health organization may provide high-quality treatment while people continue to experience difficulty reaching the clinic because of transportation, cost, work schedules, or other barriers.

The appropriate response may include both the service itself and changes to the conditions affecting access.

When advocating for policy or funding

Policy and funding proposals should be based on a clear understanding of:

• The problem
• Who is affected
• Contributing conditions
• Expected benefits
• Costs and tradeoffs
• Possible unintended consequences
• How results will be evaluated

When focusing on prevention and community well-being

Prevention frequently requires action beyond individual education.

Knowledge matters, but so do the conditions that make healthier choices practical, affordable, safe, accessible, and sustainable.

How do you address social determinants of community health and development?

Addressing social determinants involves two broad tasks:

1. Understand which conditions influence the issue and how they interact.
2. Develop, implement, monitor, and adapt strategies that address conditions the organization or partnership can reasonably influence.

Identify relevant social determinants

Do not assume in advance which determinants are most important.

The same health outcome may have different contributing conditions in different communities.

Assess the community

A community assessment can combine:

• Community and lived experience
• Interviews
• Focus groups
• Surveys
• Administrative data
• Public-health data
• Geographic information
• Observation
• Research evidence
• Policy analysis
• Historical information
• Existing community assessments and plans

Talk with people who know the issue

Depending on the situation, this may include:

• People directly affected
• Community organizations
• Service providers
• Public officials
• Advocates and organizers
• Researchers
• Employers or businesses
• Other people or organizations with relevant knowledge

No individual should be expected to represent an entire racial, ethnic, religious, disability, neighborhood, professional, or other community simply because they belong to it.

Make engagement accessible

Consider:

• Language access
• Disability access
• Transportation
• Childcare or caregiving constraints
• Technology
• Meeting schedules
• Compensation where appropriate
• Confidential or anonymous participation where power differences create risk

Examine history

Current conditions may reflect earlier policies, investment patterns, institutional practices, economic changes, environmental decisions, or community experiences.

Ask:

• How did the present condition develop?
• What previous interventions were tried?
• What worked and what did not?
• Which groups experienced previous decisions differently?
• How have past experiences affected current trust?

Apply critical thinking

As you analyze the information:

• Check the accuracy and limitations of important evidence
• Distinguish evidence from interpretation
• Examine assumptions
• Consider competing explanations
• Identify important missing information
• Consider conflicts of interest and incentives
• Document uncertainty

Ask questions about distribution and power

Consider:

• Who is affected, and how?
• Where are outcomes better or worse?
• What conditions differ between those places or groups?
• Who controls relevant resources?
• Who has authority to change policies or practices?
• Who benefits from the current arrangement?
• Who bears the greatest costs or risks?
• What would action and inaction cost, and to whom?

Use the "But why?" technique carefully

Repeatedly asking why can help a group move beyond an immediate symptom.

Do not assume that the final answer in a chain is automatically the root cause.

Ask:

• What evidence supports this explanation?
• What else could contribute?
• Are several pathways operating at once?
• What protective factors are present?

For complex problems, process maps, causal diagrams, systems maps, or other tools may provide a more complete picture.

Develop strategies at appropriate levels

Social determinants can be addressed through many kinds of action.

Economic conditions

Depending on the issue and organizational authority, strategies may address:

• Employment opportunities
• Job quality and workplace conditions
• Income supports
• Benefits access
• Housing and food costs
• Financial barriers to services

Education and information

Education can be an important intervention when lack of useful information or skills contributes to an outcome.

It is less likely to be sufficient when the main barriers are structural.

For example, telling people how to use a service will not solve a problem if the service is unaffordable, inaccessible, unavailable, or does not meet their needs.

Health care access and quality

Strategies might address:

• Service availability
• Cost
• Location
• Transportation
• Scheduling
• Language and disability access
• Administrative barriers
• Quality and continuity of care

Social connection and community infrastructure

Communities may strengthen:

• Mutual support
• Community organizations
• Referral networks
• Civic participation
• Partnerships
• Community gathering spaces

Build on existing community relationships rather than assuming new organizations must always be created.

Access and administrative barriers

Organizations can examine whether their own systems create avoidable barriers through:

• Complicated eligibility rules
• Difficult application processes
• Excessive documentation requirements
• Limited hours
• Long wait times
• Inaccessible technology
• Lack of interpretation or translation
• Transportation barriers

Simplifying the process may sometimes be as important as expanding the service.

Environmental and occupational hazards

Reducing exposure may require:

• Enforcement of safety standards
• Infrastructure improvements
• Pollution control
• Safe water and sanitation
• Workplace protections
• Housing improvements
• Emergency preparedness

Use qualified technical expertise where interventions affect engineering, environmental safety, occupational health, utilities, or other specialized systems.

Policy and systems change

Policy can influence conditions for large numbers of people.

Potential actions may include:

• Changing organizational policy
• Improving implementation of existing policy
• Advocacy
• Administrative reform
• Funding changes
• Regulatory change
• Cross-sector agreements

Policy adoption is not the end of the process.

Monitor implementation, enforcement, access, and actual effects.

Use multisector collaboration when necessary

An organization may identify determinants it cannot directly control.

In that case, partnership may be necessary.

For example:

• A health organization may work with transportation agencies on access to care.
• A school system may work with housing and community organizations on student stability.
• Public-health agencies may work with planning departments on built-environment conditions.

Clarify responsibilities so collaboration does not mean that everyone is generally responsible and nobody is accountable for specific action.

Strengthen community capacity without treating communities as deficient

Capacity strengthening can include:

• Funding
• Technical assistance
• Leadership opportunities
• Data access
• Training requested by the community
• Stronger organizations and partnerships
• Support for community-led decision-making

Begin by identifying what capacity and assets already exist.

External organizations should not assume that community members need to be taught how to act in their own interests.

Start at a manageable scale when appropriate

A small organization may not be able to change every determinant affecting an issue.

It can still identify:

• Conditions it can change directly
• Conditions it can influence through partnership
• Longer-term policy goals

A focused pilot or staged approach may be appropriate when uncertainty is high or resources are limited.

Small steps should still connect to the broader analysis so that the organization does not mistake a limited intervention for a complete solution.

Monitor social determinants and health equity

Identify indicators that show whether relevant conditions are actually changing.

Depending on the strategy, monitor:

• Access
• Service use
• Economic conditions
• Housing stability
• Transportation
• Environmental exposure
• Education or employment outcomes
• Community experience
• Health outcomes

Where appropriate, examine whether outcomes differ among relevant groups or places rather than relying only on overall averages.

Evaluate effects and unintended consequences

Ask:

• Did the strategy change the determinant it was intended to change?
• Did health or development outcomes improve?
• Who benefited?
• Who did not?
• Did inequities narrow or widen?
• What unintended consequences occurred?
• What should be continued, changed, expanded, or stopped?

Adapt as conditions change

Social determinants are not static.

Economic conditions, policies, migration, climate, technology, services, institutions, and community priorities can change.

Continue to monitor the context and revise strategies when evidence shows that the original approach no longer fits.

Principles for collaborative action

Several principles can guide work on social determinants:

• Engage people affected by the issue early and meaningfully.
• Recognize multiple forms of knowledge, including community and lived knowledge, professional expertise, and research evidence.
• Build and maintain trust through transparent, reliable action.
• Recognize power differences and share decision-making where appropriate.
• Build on community assets and existing organizations.
• Match intervention scope to the evidence, problem, authority, and resources available.
• Work across sectors when the determinants extend beyond one organization's authority.
• Provide adequate resources for community participation and implementation.
• Monitor both overall outcomes and equity.
• Learn and adapt rather than assuming the original strategy will remain correct indefinitely.

In Summary

Social determinants of health and development are the social, economic, environmental, institutional, and policy conditions that shape people's opportunities for health and well-being.

They include conditions related to economic stability, education, health care, neighborhoods and the built environment, social and community context, and the broader systems that influence access to power, money, resources, protection, and opportunity.

These determinants interact. Complex health and development problems rarely have one social cause or one permanent solution.

Effective analysis therefore combines community knowledge, credible data, research, historical context, and an examination of policies, institutions, resources, power, and environmental conditions.

People directly affected by an issue should have meaningful opportunities to influence how it is understood and addressed. Engagement should be ongoing, accessible, trustworthy, and clear about decision authority.

Responses may include direct services, organizational changes, stronger access to resources, environmental improvements, economic strategies, community partnerships, policy change, and multisector action. Immediate assistance and longer-term structural action can occur together.

Finally, addressing social determinants requires monitoring and learning. Track whether relevant conditions change, who benefits, whether inequities narrow or widen, and whether unintended effects appear.

The goal is not to identify one root cause and declare the problem solved. It is to understand and improve the conditions that shape health, use the authority and resources available responsibly, and adapt as evidence and community conditions change.

What are social determinants of community health and development?

___Social determinants of community health and development issues are the social factors that determine and influence the issues.

___The three overarching factors are:

• Economic inequality
• Social connectedness
• Sense of efficacy

___The ways they most often play out are in:

• Differences in exposure
• Differences in vulnerability
• Differences in consequences for different populations

___More specific social determinants can include:

• Racial and ethnic bias
• Cultural differences
• Media influences
• Politics
• Living conditions
• Geography

Why address social determinants of community health and development?

___If you want to solve or prevent a problem for the long term, you have to deal with its root causes.

___If you address the root causes, you’re more likely to successfully address the issue for the short term as well.

___The social factors involved may have more resonance for those affected than the issue itself.

___It may be easier to approach an issue through its underlying social factors than to deal with it directly.

___Addressing the social determinants of community issues is crucial to understanding them fully, so that your strategy and tactics for dealing with them correspond to reality.

___Addressing social determinants presents a tremendous opportunity for learning and community leadership development.

Who should address social determinants of community health and development?

___Those affected by the issues (the targets of change).

___Those who can have an effect on the issues (the agents of change).

___Staff members from organizations that work directly with the target population and/or the issue.

___Respected community leaders and citizens.

___Those who will be asked to change, sacrifice, or take action in order to address the issue.

___Anyone else who has a stake in the issue.

When should you address social determinants of community health and development?

___When it’s clear that simply focusing on the issue isn’t enough.

___When you’re advocating for changes in laws, policies, or funding.

___When you’re seeking fundamental change.

___When you’re seeking a long-term solution to a long-term problem.

___When your focus is on community wellness and prevention.

How do you identify social determinants of community health and development?

___You assess the community.

___You ask people who know.

___You apply critical thinking principles to the issue.

___You ask the right questions.

How do you address social determinants of health and community development?

___You work to address larger social factors through environmental and policy conditions, including:

• Knowledge and skills
• Support within and between groups
• Modification of access to, barriers to, and opportunities for resources and services
• Consequences of actions
• Exposure to or protection from hazards
• Policy change

___You’re guided by these basic principles:

• People most affected should choose the issues and plan strategies for the work.
• True change in social determinants demands comprehensive interventions that address multiple and interrelated factors at multiple levels.
• Collaborative efforts should aim at bringing about change in multiple sectors and systems.
• Support organizations should build capacity in the community to control its own fate.
• Health and development efforts should involve collaborative partners as catalysts for change.
• Strategies should be self-sufficient and sustainable over the long term.
• Efforts should be aimed at goals that can be accomplished by the people in question with the resources at hand.
• Successes should be consolidated and maintained, so that new and greater challenges can be taken on.
• Efforts should continue indefinitely.

Example #1: Meet the Wonder Women of Indonesia

Rovina is one of hundreds of "wonder women" in Kopernik’s Wonder Women initiative that has empowered women to become clean energy micro-social-entrepreneurs, connecting life-changing solar lights, clean cookstoves, and water filters with last mile communities in some of Indonesia's poorest provinces.

More than 80 million people live without any electricity in Indonesia, and many more live with unreliable access to electricity.

Almost 100 million people rely on smoky, fuel-hungry three-stone fires for cooking.

And clean drinking water is often a costly luxury.

There is great demand for affordable, clean energy technologies, especially in the poorest provinces of eastern Indonesia, but geography and demography make energy access a huge challenge.

This is where Kopernik's Wonder Women Eastern Indonesia initiative comes in.

Equipping women with the skills and resources to become clean energy micro-social entrepreneurs is a viable, sustainable way of connecting these technologies with the people who need them the most.

Read more

 

 

Example #2: Community Health And Literacy Center: A Health, Literacy & Recreation Hub

The Community Health and Literacy Center, formed out of a collaboration between the Children’s Hospital of Philadelphia (CHOP) and the City as unexpected partners, worked together to bring a neglected neighborhood both improved access to health care and health, promoting recreation and literacy opportunities.

The center, which opened in the spring of 2016, is a first-of-its-kind hospital-city partnership. The project includes a CHOP pediatric clinic; a full-service community health center run by the city’s department of public health; a branch of the Free Library of Philadelphia; and a modern recreation center with a playground and green space, run by the city’s Department of Parks and Recreation. It offers welcoming outdoor space for the neighborhood and an indoor community meeting space. The location has excellent public transit access, with a subway stop on site. CHOP and the city are working to integrate services and programming as a way to have more of an impact on improving population health.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #3: Vita Health & Wellness District: Health at the Center of a Neighborhood Transformation

The Vita Health & Wellness District project was established through a partnership between the Stamford housing authority and Stamford hospital to revitalize an impoverished inner city area, in Stamford Connecticut, into a mixed-income community with expanded neighborhood services centered around a sustainable urban farm. Addressing the social determinants of health provide a framework for managing the neighborhood transformation in ways that would support and strengthen the existing community.

The Vita project is a great example of how a hospital can fulfill the Affordable Care Act’s mandate to engage its community by partnering to address the social determinants of health. The project also demonstrates how a forward-thinking community development organization can effectively partner with the health sector to pursue comprehensive community revitalization that could not have been achieved otherwise. These are still early days in what promises to be a fruitful and long-lasting partnership.

Read more about the Vita Health & Wellness District project on the Building Healthy Places Network blog.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #4: Rolling Hills Apartments: Weaving Together Opportunities for Healthier Lives for a Diverse Immigrant Community

Twin Cities LISC, a local community development financial institution, has partnered with local organizations and city agencies to create quality affordable housing with improved healthcare access, including constructing a Federally Qualified Health Center. LISC also employed community health advocates to weave together the isolated health-related efforts in the neighborhood of focus into a cohesive health agenda. More specifically, they connect and help support existing efforts, identify and help address gaps, and facilitate the conversations and activities that sustain collaboration.

Learn how social determinants of health are being addressed to build healthier lives for immigrants in St. Paul, Minnesota in this Community Close-Up from the Building Healthy Places Network.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #5: Revitalizing People and Place with a Healthy Food Hub Origin

Following the devastation of Hurricane Katrina in New Orleans, the founders of what became Broad Community Connections (BCC) began to attend community meetings, and investigate with their fellow community members how to rebuild a city in disarray. These discussions highlighted many of the problems that many central New Orleans resident had faced even before the storm, including but not limited to economic disadvantage, community disinvestment, health disparities, and lack of access to many needed goods and services. BCC was designed to revitalize Broad Street, a commercial thoroughfare running through the heart of the city and to connect several of the central city neighborhoods.

Founded in 2008, BCC set its sights on improving health and improving economic vitality in the area. Ultimately, the ReFresh project provided a high-quality grocery store to a low-income food desert and created a multi-faceted hub to improve healthy food access and local food systems, foster community connectivity, support youth development, and anchor economic development.

Read more about the ReFresh project in New Orleans on the Building Healthy Places Network blog.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #6: Under One Roof: Health Care and Social Services in the Same Place

The Chicanos Por La Causa (CPLC) is the largest community development corporation based in Arizona. CPLC is committed to building stronger, healthier communities as a lead advocate, coalition builder, and direct service provider. CPLC helps more than 200,000 people through programs in four areas–housing, economic development, education, and health and human services. CPLC recognizes that the needs of the families it serves are complex as a family rarely approaches the CDC with only one need. As a result, CPLC sought to establish cross-sector partnerships that would more effectively and holistically meet the needs of families.

Read more about CPLC on Rooflines - The Shelterforce Blog, from the National Housing Institute.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #7: Boston Children’s Hospital Community Asthma Initiative

The Community Asthma Initiative (CAI), an initiative of Boston Children’s Hospital, began addressing health disparities in Boston neighborhoods impacted by asthma in 2005. CAI provides an enhanced model of care, which includes asthma education and home visits for families with children ages 2–18 living in the Greater Boston area that were previously treated in the Emergency Department (ED) or hospitalized as a result of asthma. CAI works with partners and coalitions to address asthma health disparities by implementing changes in policies at the local and state levels. As of June 2014 there were reductions in the number of children with ED visits, hospitalizations, missed school days, and missed work days for parents.

Read more about the Community Asthma Initiative from the National Forum on Hospitals, Health Systems & Population Health.

Contributed by Lia Thompson, University of Kansas, Community Tool Box Intern.

 

Example #8: It’s Not Just About the Buildings: How Community Development Organizations are Promoting Residents’ Mental Health

Around the country, housing and community development groups are increasingly stepping up to partner with residents to improve community well-being by proactively strengthening residents’ emotional and mental health. Read more.

Example #9: Pilot Project Directs Healthcare Resources to Rural Missouri

A pilot project has been announced that plans to improve health outcomes in rural Missouri communities. It’s a collaborative effort between the Missouri Department of Social Services and the MO HealthNet Division.

The Transformation of Rural Community Health (ToRCH) project focuses on addressing social care challenges that impact residents’ ability to maintain their health and manage chronic conditions.

“(It’s) a groundbreaking initiative that empowers and encourages rural communities to collaborate to address healthcare-related social needs among their Medicaid population, with a focus on driving better health outcomes,” said Robert Knodell, Missouri Department of Social Services Director.

One key focus of the project is to tackle social determinants of health that influence overall wellbeing – safe housing, transportation, access to healthy foods, and physical activity opportunities. The U.S. Department of Health and Human Services explained that these needs influence the conditions where people are born, grow, learn, work, play, worship, and age.

“For too long, our payment systems have failed to reward hospitals for efforts to address some of the root causes of poor health,” said Kirk Mathews, MHD Chief Transformation Officer, “The ToRCH program allows hospitals to receive payment for proactively addressing issues that contribute to poor health outcomes. Under this model, hospitals are empowered to truly be in the ‘healthcare’ business in addition to the ‘sick care’ business.”

Six rural hospitals were selected last June as part of the pilot project, in Salem, Clinton, Sedalia, Rolla, Bolivar, and Richmond. The funding allows them to act as community hubs.

Click here to read the full article at the MissouriNet website.

A PowerPoint presentation summarizing the major points in the section.

• Before you start

• Generating solutions

• Evaluating solutions

• Making a decision

 

 

Once a group has defined and analyzed a problem, the next task is to decide what might be done about it.

The first idea that comes to mind is not necessarily the most effective, feasible, or appropriate response. There may also be several reasonable options, each with different benefits, costs, risks, and tradeoffs.

A useful solution-development process therefore separates several tasks:

• Generate a range of possible responses
• Clarify and improve the options
• Compare them using explicit criteria
• Use the appropriate decision process
• Document the decision, assumptions, and next steps

Group participation can broaden the range of ideas and knowledge available, but the group should also be clear about who is providing input, who has decision authority, and who will be responsible for implementation.

Before you start

Good idea generation depends less on creating a particular atmosphere than on creating conditions in which people can contribute meaningfully.

Before beginning, make sure participants understand:

• The problem as it is currently understood
• The intended outcome
• Important evidence and uncertainties
• What is within and outside the group's authority
• Important legal, ethical, safety, budgetary, or policy constraints
• How the final decision will be made

Create conditions for useful participation

People are more likely to offer developing or unconventional ideas when they do not expect ridicule, retaliation, or immediate dismissal.

Encourage participants to:

• Ask questions
• Suggest ideas that are not yet fully developed
• Challenge assumptions respectfully
• Build on another person's idea
• Identify concerns and uncertainties

This does not require every idea to be praised or ultimately accepted. Evaluation comes later, but respectful clarification is appropriate throughout the process.

Make participation accessible

Physical comfort matters because unnecessary discomfort can interfere with concentration and participation.

Depending on the setting, consider:

• Accessible meeting space
• Seating
• Restrooms
• Lighting and acoustics
• Temperature
• Breaks
• Water or refreshments where appropriate
• Language access
• Captioning or interpretation
• Accessible electronic or printed materials
• Remote participation where needed
• Technology that participants can use effectively

Do not assume that one environment or activity will make everyone equally comfortable.

Use introductions or relationship-building only when useful

If participants do not know one another, a brief introduction may help establish who is present and what knowledge or role each person brings.

Do not require personal disclosures, games, or unrelated icebreakers simply because the group is beginning a creative activity.

Review relevant evidence before generating solutions

Creativity is more useful when participants understand the problem.

Depending on the issue, review:

• Relevant data
• Community and lived experience
• Previous efforts
• Research evidence
• Available resources
• Policy or legal requirements
• Important uncertainties

If a group does not have enough information to evaluate possible responses responsibly, gather additional evidence before making a high-stakes decision.

Generating solutions

The purpose of idea generation is to develop a reasonable range of options before committing to one.

Different methods work well for different groups. The facilitator should choose a process that fits the number of participants, available time, accessibility needs, power relationships, and complexity of the problem.

Generate ideas individually

One useful approach is to give participants several minutes to think and write independently before group discussion begins.

This can give people time to develop ideas without immediately being influenced by the first suggestion or by the most vocal or highest-status participant.

Ideas can be written on:

• Paper or cards
• A shared document
• A digital whiteboard
• An anonymous form

Use a structured round

Participants can take turns offering one idea at a time.

Allow someone to pass rather than requiring every person to contribute on every round.

Continue until the allotted time ends or the group has no significant new ideas to add.

Use brainwriting

Brainwriting allows participants to develop ideas in writing and build on one another's suggestions.

For example:

1. Each participant writes one or more possible responses.
2. Ideas are shared with other participants.
3. Participants add questions, extensions, or related possibilities.
4. The ideas are collected and reviewed by the group.

This method can be useful when participants prefer written reflection, when the group is large, or when rapid spoken discussion would make participation difficult.

Use brainstorming

Brainstorming can help a group generate options quickly.

During the initial idea-generation stage:

• Focus on generating possibilities rather than choosing among them
• Avoid premature criticism
• Allow clarification when an idea is not understood
• Encourage participants to combine or build on ideas
• Record ideas where participants can review them

Brainstorming does not require pretending that every conceivable action is acceptable.

Ideas should remain within relevant:

• Legal requirements
• Ethical boundaries
• Safety requirements
• Respect for people's dignity and rights
• The legitimate scope of the group's work

Within those boundaries, avoid rejecting an idea simply because it is unfamiliar or different from what the organization usually does.

Ask what assumptions are limiting the options

A group may narrow the solution space without realizing it.

Ask:

• What are we assuming cannot change?
• Are we assuming we must create something new?
• Are we assuming our organization must do this alone?
• Are we assuming the current budget, process, location, schedule, or staffing model cannot change?
• Which constraints are real, and which are assumptions?

Look for existing approaches

Generating solutions does not mean every solution must be invented from scratch.

Ask:

• Is something already working within part of the community?
• Has another organization addressed a similar problem?
• Is there relevant research or practice guidance?
• Could an existing program be improved, expanded, or made more accessible?

Consider different types of response

Possible options might include:

• Improve an existing program or process
• Create a new intervention
• Change a policy or procedure
• Remove an unnecessary barrier
• Partner with another organization
• Refer the issue to an organization with greater authority or expertise
• Test a small pilot
• Implement the change in stages
• Stop an ineffective activity
• Continue the current approach while collecting additional information

Include the current approach or taking no additional action when it is a legitimate option. This gives the group a comparison point for judging whether a proposed change is actually better.

Use anonymous input when appropriate

Anonymous or confidential contribution may be useful when:

• Participants have different levels of authority
• A supervisor or funder is present
• People may experience consequences for challenging the current approach
• The issue is sensitive

Anonymous input does not eliminate every power difference, but it can provide another route for ideas or concerns that may not emerge publicly.

Know when to stop generating

More ideas are not always better indefinitely.

Stop when:

• The agreed time has ended
• Few genuinely new ideas are emerging
• The group has a sufficiently broad range of realistic options to evaluate

New alternatives can still be added during evaluation if an important option was overlooked.

Evaluating solutions

After generating a range of possibilities, clarify the options and compare them systematically.

The goal is not simply to identify which idea people like best.

The group should ask which option, combination of options, or staged approach best fits the problem, evidence, values, resources, responsibilities, and constraints.

Clarify each option

Before evaluating an idea, make sure participants understand what it actually proposes.

For each option, clarify:

• What would be done
• Who would be responsible
• Who would be affected
• What resources would be required
• What outcome the option is expected to influence

Establish evaluation criteria

Agree on important criteria before participants become strongly attached to one option.

Criteria may include:

• Evidence: What evidence suggests this approach could work?
• Expected effectiveness: How likely is it to improve the intended outcome?
• Feasibility: Can it be implemented with available or obtainable staff, time, resources, technology, partnerships, and authority?
• Cost: What resources will it require?
• Opportunity cost: What other work may receive fewer resources if this option is chosen?
• Equity: Who is likely to benefit, and who may be left out or experience additional burdens?
• Accessibility: Can the people who need the intervention actually use or participate in it?
• Safety: What risks could it create or reduce?
• Legal and ethical fit: Is the approach consistent with relevant rights, responsibilities, policies, laws, and ethical requirements?
• Community and participant impact: How do people affected by the proposal understand its likely benefits, barriers, and consequences?
• Organizational fit: Is it consistent with the organization's legitimate mission and responsibilities?
• Sustainability: What would be needed to maintain the approach if it proves useful?
• Unintended consequences: What additional positive or negative effects might occur?
• Reversibility: If the approach does not work as expected, how difficult would it be to modify or stop?
• Evaluation: How would the group know whether it was working?

Not every criterion will carry the same weight.

Identify which considerations are requirements, which are priorities, and which involve tradeoffs.

Examine evidence and uncertainty

For each option, distinguish:

• What is supported by strong evidence
• What is supported mainly by local experience or professional judgment
• What assumptions the option depends on
• What remains uncertain

Absence of perfect evidence does not always mean that no action should be taken.

It may mean that the response should be proportionate to the uncertainty and monitored carefully.

Examine who benefits and who bears burdens

Do not look only at the overall effect.

Ask:

• Who gains access, resources, protection, or opportunity?
• Who may face new costs, requirements, risks, or barriers?
• Are some effects concentrated among people with less decision-making power?
• Can harmful effects be prevented or reduced?

Consider implementation early

An option can appear promising on paper and still fail because the conditions for implementation are missing.

Ask:

• Who would lead implementation?
• What authority would they need?
• What staffing and training are required?
• What partners or approvals are needed?
• What dependencies could delay the work?
• How long would implementation take?

Consider a pilot

When an option is promising but uncertainty remains, a smaller or time-limited pilot may be appropriate.

Before beginning, specify:

• What the pilot is intended to test
• What outcomes will be monitored
• How long it will run
• What would justify continuing, expanding, modifying, or stopping it

Use a decision matrix where helpful

A group can place options in rows and criteria in columns and compare how well each option meets the criteria.

This can make tradeoffs easier to see.

If numbers or scores are used, remember that they summarize judgments. They should not create an impression of mathematical certainty where the underlying evidence or values remain uncertain.

Improve or combine options

Evaluation does not have to leave each idea unchanged.

The group may:

• Modify an option to reduce a risk
• Combine useful parts of several options
• Implement different strategies for different parts of the problem
• Stage actions over time

Remove options that do not meet necessary requirements

Some options may be eliminated because they:

• Violate a legal, ethical, or safety requirement
• Fall outside the organization's authority
• Require resources that cannot reasonably be obtained
• Are unlikely to address the problem
• Create harms that cannot be adequately reduced

For important decisions, record why major options were rejected.

Making a decision

Before deliberating among the final options, participants should understand who has authority to make the decision and what process will be used.

Common approaches include:

• An accountable person makes the decision
• An accountable person makes the decision after consultation
• A delegated team or committee decides
• The group votes according to established rules
• The group uses consensus
• The group uses consent or another established decision method

No single method is best for every decision.

The method should fit:

• Formal decision authority
• Governance requirements
• The importance and reversibility of the decision
• Available time
• The need for expertise or community participation
• Who will be accountable for the outcome

Decision by an accountable person

Sometimes one person is responsible for the final decision.

That does not prevent the person from seeking information and advice from others.

Be clear from the beginning that consultation is informing the decision rather than transferring final authority to the group.

Voting

Voting can be appropriate when the group has formal decision authority and voting rules are established.

Follow applicable requirements involving:

• Quorum
• Voting thresholds
• Conflicts of interest
• Abstentions

Avoid inventing a voting threshold only after the group sees how members are divided.

Consensus

Consensus can be useful when broad support is important and the group has enough time to examine disagreements carefully.

Define what consensus means before using it.

Depending on the group, it might mean:

• Unanimous agreement
• Agreement that everyone can support the decision
• No participant has a defined blocking objection

These are not the same standard.

Consensus should not require someone to hide a serious concern simply so the group can report agreement.

During consensus discussion

Encourage participants to:

• Listen carefully to reasoning they disagree with
• Explain the evidence or values behind their concerns
• Change their position when new evidence or reasoning warrants it
• Avoid changing their position merely to end the discussion
• Look for modifications that address legitimate concerns

A compromise or third option can sometimes resolve disagreement, but it is not automatically better simply because more people find it acceptable.

Structured ranking and nominal group technique

Structured methods can help when a group has many options or when some participants are likely to dominate open discussion.

One method is the nominal group technique.

A typical process includes:

1. Participants generate ideas silently and independently.
2. Ideas are shared in a structured round.
3. Participants clarify and discuss the options.
4. Participants privately rank or vote on priorities.
5. Results are summarized and used according to the group's established decision process.

A ranking can inform the decision without necessarily determining it automatically.

If the group intends the ranking to determine the final choice, establish that rule before participants rank the options.

What if the group cannot decide?

Whenever possible, establish the fallback process before deliberation begins.

If the group cannot reach the required decision threshold, it may:

• Use another authorized decision method
• Gather missing evidence
• Seek legal, financial, technical, or community input
• Modify the options
• Pilot one or more approaches
• Refer the decision to the person or body with appropriate authority
• Defer the decision when additional time would serve a clear purpose

Deferral should not become a way to avoid a difficult decision indefinitely.

Protect dissent and unresolved concerns

Disagreement does not automatically mean that the process failed.

A participant may identify a risk or consequence that the majority considers acceptable but that still deserves documentation.

Depending on the setting, record:

• Significant unresolved concerns
• Dissenting positions where relevant
• Information that must still be gathered

Document the decision

Once a decision is made, clarify:

• What was decided
• Who made the decision
• What decision method was used
• Which criteria were most important
• Major evidence and assumptions
• Important tradeoffs or unresolved concerns
• Who is responsible for implementation
• What happens next

Ask for process feedback

After an important decision, useful questions may include:

• Was the decision process clear?
• Did participants have appropriate opportunities to contribute?
• Were the important criteria and evidence considered?
• Are there material concerns that still need to be documented or addressed?
• Are responsibilities and next steps clear?

Do not require everyone to say that they are completely satisfied with the outcome.

A legitimate decision may still involve disagreement or tradeoffs.

In Summary

Generating and choosing solutions requires both creativity and disciplined judgment.

Begin with a clear understanding of the problem, relevant evidence, important constraints, decision authority, and the outcome the group hopes to achieve.

Generate several options before committing to one. Use methods that give people different ways to contribute, including individual reflection, written or anonymous input, structured rounds, brainstorming, and collaborative idea development.

Then evaluate the options using explicit criteria. Consider evidence, effectiveness, feasibility, cost, equity, accessibility, safety, legal and ethical requirements, organizational authority, sustainability, unintended consequences, and how results will be measured.

Choose a decision method that fits the situation. Consensus can be useful, but it is not automatically preferable to voting, delegated authority, consultation followed by an accountable decision, or another established process.

Finally, remember that selecting a solution does not complete the problem-solving process. Clarify responsibility, document assumptions and tradeoffs, plan implementation, monitor results, and be prepared to modify the approach when evidence shows that it is not working as expected.

___You understand that it's important to make people comfortable to stimulate creativity and to promote open discussion of ideas.

___You understand that you can make people comfortable both through team-building activities and by providing physical comfort.

You understand the different methods used to generate solutions:

___Simply go around the room and suggest ideas

___Send a piece of paper around the room

___Idea writing

___Brainstorming

You know how to evaluate solutions:

___You have judged each idea independently.

___You have determined whether each idea is practical, effective, cost-effective, easily put into practice, accepted by everyone involved, and consistent with other things done by the group.

___You have modified the solution where necessary.

You understand the different ways to make a decision:

___You can have one person decide, and announce the decision to the group.

___You can gather input from individuals, and then have one person decide.

___You can gather input from the group, and then decide.

___You can vote.

___You can try to build consensus among everyone at the meeting.

You know what to do if the discussion doesn't result in an agreement accepted by everyone:

___You can try one of the other decision-making possibilities listed above.

___You can try the nominal group technique.

___You can choose not to decide.

A PowerPoint presentation summarizing the major points in the section.

• Why should you plan your action?

• How do you plan your action?

• How do you implement your solution?

• Evaluating what's happened

• What can go wrong, and what to do about it

A group can spend substantial time defining a problem, examining its causes, generating possible responses, and choosing an approach. None of that guarantees that the decision will actually be carried out.

Implementation is the part of the problem-solving process in which a proposed solution becomes organized action.

It requires more than enthusiasm or agreement. People need to know what will happen, who is responsible, what resources and authority are available, when important steps are due, how progress will be monitored, and what the group will do when conditions change.

This section focuses on turning a selected approach into an action plan, implementing it, evaluating what happens, and adapting when the plan does not work as expected.

Why should you plan your action?

Planning creates a practical bridge between a decision and implementation.

A useful action plan can:

• Clarify the scope of the work
• Assign responsibility
• Identify required resources and authority
• Establish milestones and deadlines
• Identify dependencies among tasks
• Anticipate major risks and barriers
• Establish how progress and outcomes will be monitored
• Make follow-up easier

Planning cannot anticipate every problem.

Conditions may change, assumptions may prove wrong, resources may become unavailable, or implementation may create unexpected effects.

A good plan should therefore provide enough structure for coordinated action while allowing responsible adaptation.

Match the planning effort to the work

A small, low-risk action may need only a responsible person, deadline, and brief written record.

A larger or higher-risk intervention may require:

• A detailed action plan
• A budget
• Formal approvals
• Contracts or procurement
• Staff or volunteer training
• A communication plan
• An accessibility plan
• A data and evaluation plan
• Risk and contingency planning
• A longer implementation timeline

Do not create a complicated planning process for work that does not need one.

At the same time, do not rely on informal verbal agreements for a project whose success depends on many people, organizations, resources, or deadlines.

How do you plan your action?

Confirm what was decided

Before developing the implementation plan, make sure the selected approach is clearly described.

Ask:

• What problem or condition is this intended to address?
• What outcome do we expect?
• Who made or authorized the decision?
• What assumptions does the approach depend on?
• What important risks or uncertainties remain?

If the solution has changed so much during decision-making that it no longer clearly addresses the original problem, revisit the analysis before implementation begins.

Describe how the solution is expected to work

For a complex intervention, it can help to describe the connection between:

• Resources or inputs
• Activities
• Immediate outputs
• Short-term outcomes
• Longer-term outcomes
• Important contextual factors and assumptions

This can be written as a logic model, program roadmap, theory of change, or another format that clearly shows how the group expects its activities to produce results.

The purpose is not to create paperwork for its own sake. It is to make assumptions visible so they can be tested during implementation and evaluation.

Break the solution into action steps

Identify the work required to move from the decision to implementation.

Depending on the project, action steps may involve:

• Approvals and governance
• Staffing or volunteer roles
• Partnerships
• Funding
• Procurement
• Facilities
• Technology
• Accessibility
• Training
• Communications
• Participant recruitment or outreach
• Data collection
• Evaluation

Example

Suppose a community health program has found that evening appointments have a high no-show rate. After examining several causes and possible responses, the organization decides to pilot later transit support, more flexible appointment times, and a simpler rescheduling process.

Action steps might include:

• Confirm which transportation partner can support the pilot
• Identify the appointment times and participants included in the pilot
• Update scheduling and rescheduling procedures
• Make information available in accessible formats and appropriate languages
• Train staff on the revised process
• Establish baseline attendance data
• Define measures for attendance, access, participant experience, cost, and unintended effects
• Establish a review date and criteria for continuing, modifying, expanding, or stopping the pilot

This type of planning connects implementation directly to the problem analysis and to the evidence that will later be used to judge results.

For each action step, answer the key questions

What will be done?

Describe the task clearly enough that the responsible person knows what completion means.

Who owns it?

Identify one person or role with primary responsibility for making sure the task moves forward.

Other people may provide support, advice, approval, or information.

Make clear who:

• Is responsible for doing the work
• Is accountable for completion
• Must be consulted
• Needs to be informed

Do not assign someone responsibility without considering whether they have the authority, time, skills, resources, and role needed to carry it out.

What is the timeline?

Identify:

• Start date
• Deadline
• Important milestones
• Dependencies

Some activities cannot begin until another task is finished. Others can occur at the same time.

Make timelines realistic enough to support planning rather than simply choosing the earliest possible date.

What resources are needed?

Resources may include:

• Funding
• Staff or volunteer time
• Expertise
• Equipment
• Technology
• Facilities
• Data
• Training
• Partnerships

Identify where those resources will come from and what happens if they are not available.

What approvals or authority are required?

Determine whether the step requires:

• Leadership approval
• Board or committee action
• Government authorization
• Contract or procurement approval
• Legal or compliance review
• Partner agreement

Do not assign responsibility to someone who cannot legally or organizationally authorize the work.

What accessibility and inclusion requirements apply?

Consider accessibility during planning rather than adding it after implementation begins.

Depending on the activity, this may include:

• Physical access
• Language access
• Communication accommodations
• Accessible electronic materials
• Transportation
• Scheduling
• Technology access

What could interfere with the work?

Identify major risks and dependencies.

For each important risk, consider:

• How likely is it?
• What would the effect be?
• What warning signs should be monitored?
• What can reduce the likelihood or impact?
• What is the contingency plan?
• Who decides whether the contingency plan is activated?

How will progress be monitored?

Decide before implementation begins:

• What information will show whether the step is on track
• Who will collect or review that information
• How often it will be reviewed
• What would trigger follow-up or escalation

Establish a source of truth

Put the action plan in an approved location where the people responsible for the work can find the current version.

The plan may be maintained in:

• A shared action-plan document
• A spreadsheet
• A project-management system
• Another organizational system

Avoid keeping the only current version in one person's notes or email.

For complex work, document significant changes to scope, budget, responsibilities, timeline, or strategy.

How do you implement your solution?

Implementation is not simply carrying out a finished plan.

It is a period in which assumptions, capacity, partnerships, and real-world conditions are tested.

Confirm responsibilities

Before work begins, each responsible person should understand:

• Their task
• Deadline
• Available resources
• Decision authority
• Dependencies
• How to raise a problem or request assistance

Responsibility may be accepted voluntarily, assigned as part of a legitimate staff role, or established through another appropriate organizational process.

Do not pressure volunteers into responsibilities they have not agreed to take on.

Use appropriate communication channels

Identify how project participants will communicate about:

• Routine updates
• Questions
• Delays
• Decisions
• Urgent risks

Use appropriate organizational contact methods rather than requiring people to disclose personal telephone numbers or other private contact information.

Monitor implementation as it happens

Ask:

• Are activities occurring as planned?
• Are milestones being met?
• Are resources sufficient?
• Is the intervention reaching the intended participants?
• Is the quality of implementation acceptable?
• Are barriers or unintended effects appearing?

Monitoring allows the group to respond before a missed milestone becomes a major implementation failure.

Use meetings when they are useful

A follow-up meeting may be useful when people need to:

• Make a decision
• Resolve an interdependent problem
• Examine evidence together
• Coordinate significant changes

Routine status information may be shared asynchronously.

Do not schedule recurring meetings merely because meetings were part of the original plan.

Adapt responsibly

Some implementation changes can be made by the person responsible for the work. Others may affect budget, scope, legal requirements, evaluation, community commitments, or strategy and require additional approval.

Establish in advance:

• What can be adjusted routinely
• What requires approval
• Who has authority to approve it
• How significant changes will be documented

Evaluating what's happened

Evaluation should begin during planning, not after implementation is finished.

Before the work begins, identify what the group needs to learn and what evidence will answer those questions.

Evaluate the implementation process

Process or implementation evaluation asks whether the intervention was carried out as intended and what helped or hindered it.

Questions might include:

• Were planned activities completed?
• Were they completed on time?
• Who was reached?
• Who was not reached?
• What resources were used?
• What barriers affected delivery?
• What adaptations were made?
• Was implementation quality consistent with what was intended?

Evaluate outcomes

Outcome evaluation asks whether the intended results occurred.

Depending on the project, questions might include:

• Did the targeted condition improve?
• By how much?
• For whom?
• Over what period?
• Were results different across relevant groups or locations?
• What unintended positive or negative effects occurred?

An observed improvement does not automatically prove that the intervention caused it. Other events or conditions may also have influenced the result.

Use credible evidence

The appropriate evidence depends on the question and stakes.

Sources may include:

• Administrative data
• Program records
• Surveys
• Interviews
• Observations
• Financial information
• Community and participant feedback
• Other appropriate measures

Define baseline measures before implementation when change over time is important.

Evaluate equity and access

Overall improvement may hide important differences.

Ask:

• Who participated?
• Who benefited?
• Who encountered barriers?
• Did the intervention reduce, maintain, or increase important disparities?

Gather feedback about the process

Feedback from staff, volunteers, partners, participants, and other relevant people can help identify:

• Confusing procedures
• Accessibility problems
• Workload issues
• Unanticipated barriers
• Useful adaptations

Feedback can be collected through written, digital, verbal, anonymous, interview, or other accessible methods.

Satisfaction may be useful information, but it should not be confused with evidence that the intervention achieved its intended outcome.

Act on the findings

Evaluation should inform decisions.

The group may decide to:

• Continue the approach
• Modify it
• Expand it
• Reduce its scope
• Test another approach
• Stop it

Document the evidence and reasoning behind significant changes.

What can go wrong, and what to do about it

Implementation rarely proceeds exactly as planned.

When a problem appears, diagnose it before choosing the response.

The person assigned to a task does not have the right capacity or support

Ask:

• Were role requirements clear?
• Does the person have the time, authority, skills, and resources needed?
• Would training or a co-owner help?
• Would another role be a better fit?

Discuss role fit respectfully rather than labeling someone as the "wrong person."

No one accepts responsibility for a task

Ask why.

• Is the task necessary?
• Is the workload realistic?
• Are the required skills available?
• Is the responsibility appropriately a volunteer role?
• Does it need to be assigned to staff or contracted expertise?
• Are adequate resources or compensation available where appropriate?

Do not pressure someone privately to take on a responsibility merely because nobody volunteered publicly.

Participation or energy declines

Low participation may reflect:

• Excessive workload
• Competing responsibilities
• Unclear progress
• Insufficient resources
• Frustration with the process
• Lack of clarity about the purpose

Identify the cause before assuming that people simply need more motivation.

Recognizing progress can be useful, but celebration does not substitute for resolving an implementation barrier.

The work is taking longer than expected

Examine:

• Whether the original estimate was realistic
• Which tasks are delayed
• Whether a dependency is blocking progress
• Whether staffing or resources are sufficient
• Whether unnecessary scope has been added
• Whether lower-priority work should be deferred

Adding more people does not automatically make work faster and may increase coordination needs.

Community members or partners oppose the approach

Do not assume opposition should be defeated or appeased.

Determine what the concern is.

It may involve:

• A legitimate harm or unintended consequence
• Accessibility
• Rights or legal concerns
• Cost or burden
• Different community priorities
• Insufficient engagement
• Missing information
• Misinformation about the project

Respond according to the substance of the concern.

The appropriate response may be explanation, additional engagement, modification, mitigation, further evidence, or reconsideration of the approach.

A new opportunity or alternative appears

Avoid switching direction solely because something new appears attractive.

Compare:

• Evidence
• Expected benefits
• Risks
• Transition costs
• Existing commitments
• Strategic fit
• Effect on the implementation timeline

Use the established decision authority to approve significant changes.

The solution is not being implemented as planned

This is an implementation problem.

Ask:

• Which activities are not occurring?
• Why?
• Are resources, staffing, training, or systems inadequate?
• Is the original plan unrealistic?
• Should the implementation approach be adapted?

The solution is being implemented but outcomes are not improving

This may indicate a different problem.

Ask:

• Was the causal analysis correct?
• Has enough time passed for the expected outcome?
• Is the intervention reaching enough of the intended population?
• Is the intervention strong enough to affect the outcome?
• Have outside conditions changed?
• Are the measures capturing the outcome accurately?

Do not assume that waiting longer will eventually make an ineffective intervention work.

The intervention creates unintended harm

Some problems require immediate modification, pause, or termination.

Establish criteria in advance where possible for:

• Pausing implementation
• Escalating a safety concern
• Modifying the intervention
• Ending the intervention

Legal, ethical, safety, and safeguarding obligations should take priority over preserving the original plan.

The intervention appears successful

Success also requires analysis before expansion.

Ask:

• Is the evidence strong enough to support the conclusion?
• Under what conditions did the approach work?
• For whom did it work?
• What resources made the result possible?
• Can those conditions be maintained at a larger scale?
• Were there unintended consequences?

Scaling a successful pilot may require a different implementation plan rather than simply doing more of the same thing.

In Summary

Choosing a solution is not the end of problem solving. Implementation is where the group's assumptions are tested against real conditions.

Begin with a clear action plan. Identify tasks, owners, authority, resources, timelines, milestones, dependencies, accessibility requirements, risks, and communication methods.

Plan monitoring and evaluation before implementation begins. Track both whether the intervention is being delivered as intended and whether the expected outcomes occur. Use credible evidence, examine who is reached and who benefits, and watch for unintended consequences.

When implementation problems occur, diagnose them rather than assuming that people simply lack motivation. Delays, opposition, weak results, or declining participation may reveal problems with resources, workload, accessibility, assumptions, strategy, or context.

Finally, use what you learn. Continue approaches that are working, improve those that can be strengthened, and modify or stop those that are ineffective or harmful.

Effective implementation is not rigid execution of a plan. It is coordinated action supported by clear responsibility, evidence, monitoring, communication, and the willingness to adapt when conditions or results show that a different approach is needed.

You understand why you should plan your action:

___To provide the framework on which your solution will hang.

___To be sure you have taken care of all the details.

___To save time, energy, and resources.

You have planned your action:

___You have broken down your solution into individual action steps.

___You have decided to what extent each action step will occur.

___You have decided who will do the work.

___You have decided when each action step will take place.

___You have decided what resources you will need and where you will get them.

___You have decided what you will do if something goes wrong.

___You know which steps need to happen first.

You have implemented your solution:

___You have made sure everyone is clear and in agreement about the process.

___The facilitator has asked for new questions.

___Everyone knows how to contact each other.

___You have set another meeting date.

You have evaluated what happened:

___You have evaluated the success of the meeting.

___You have evaluated the success of the solution.

You know what to do if something goes wrong:

___You know what to do if the wrong person volunteers for the job.

___You know what to do if no one volunteers for the job.

___You know what to do if enthusiasm fails.

___You know what to do if the solution is taking too much time.

___You know what to do if the solution arouses community opposition.

___You know what to do if a seemingly new and better opportunity arises.

___You know what to do if the solution doesn't seem to be working.

Tool #1: Action planning sheet

Use the following table to list each of your action steps in the first row, and answer the following questions for each.

	Action Step 1	Action Step 2:	Action Step 3:
How much, or to what extent, will this action occur?
Who will do it?
When will it take place?
What resources do we need? Where will we get them?
What is the backup plan?
In what order will these steps occur? Does it matter?

Tool #2: Feedback form

At the end of the meeting, the facilitator and recorder can pass out the following sheets to be filled in anonymously by meeting participants.

Participant Feedback Form

Date of meeting:

Overall, how useful did you find the meeting?

What did you like best about the meeting?

What did you like least about the meeting?

Was the proper amount of time spent on each subject?

If not, which subjects took too long?

Which weren't given enough time?

What should be different about future meetings?

Additional comments:

We appreciate your help and feedback at and about today's meeting. The facilitator will address concerns brought up on these feedback sheets and send a letter to all participants in the next two weeks.

A PowerPoint presentation summarizing the major points in the section.

Adapted from "Conducting intervention research: The design and development process" by Stephen B. Fawcett et al.

You've brought together people who want to improve conditions in the community. Perhaps the goal is to increase opportunities for physical activity, improve students' success in school, reduce exposure to violence, strengthen access to services, or address another community priority.

The desired outcome may be relatively clear. The more difficult question is what combination of actions is likely to produce that outcome.

That is the purpose of intervention development.

What is an intervention?

An intervention is a deliberate action or set of actions designed to create positive change.

Interventions can take many forms, including:

• Programs
• Policies
• Organizational practices
• Changes in services
• Environmental or infrastructure changes
• Communication or education efforts
• Community initiatives
• Partnerships or coordinated systems changes

What makes something an intervention is not its form, but its purpose: to influence conditions, practices, behaviors, systems, or environments in ways expected to improve outcomes for individuals, organizations, or communities.

Effective interventions often go beyond asking individuals to change their behavior.

They may also address:

• Access to resources or services
• Organizational procedures
• Policies
• Physical environments
• Economic conditions
• Information and communication systems
• Social relationships
• Institutional or structural barriers

An example

A community that wants to prevent sexual violence might consider several intervention approaches.

Depending on the local problem analysis and available evidence, these could include:

• Education and skill-building that support healthy relationships, consent, bystander action, and violence prevention
• Organizational policies and reporting systems that strengthen accountability and response
• Accessible services and support for survivors
• Changes to transportation, lighting, or other environmental conditions where those conditions are shown to affect safety
• Work with schools, workplaces, community organizations, and other institutions on practices that promote safety and respect

The appropriate combination depends on the problem, evidence, community context, authority, available resources, and the mechanisms the intervention is intended to influence.

More components do not automatically make an intervention more effective.

The intervention should be complex enough to address the important contributing conditions without adding activities that do not serve a clear purpose.

Why should you develop interventions?

Intervention development provides a structured way to move from understanding a problem to taking action.

A deliberate process can help an organization:

• Connect proposed activities to the problem they are intended to address
• Use available research and practice evidence
• Incorporate community knowledge and priorities
• Make assumptions about how change is expected to occur more explicit
• Compare alternative approaches
• Identify implementation requirements before launch
• Plan evaluation and monitoring
• Learn and adapt as evidence changes

A well-designed intervention is not guaranteed to succeed.

Implementation conditions may change, evidence may be incomplete, participation may differ from what was expected, or the intervention may produce effects that were not anticipated.

Intervention design should therefore include a plan for learning as well as a plan for action.

When should you develop or redesign an intervention?

It may make sense to develop, adopt, adapt, or redesign an intervention when:

• A clearly identified community or organizational condition warrants action
• Existing approaches are not producing sufficient results
• Evidence suggests that another approach could improve outcomes
• Community priorities or conditions have changed
• Policy, technology, funding, or other contextual changes create a new opportunity
• An existing intervention needs to be adapted for a different setting or population

Decide whether your organization should lead the intervention

An organization may be capable of doing something without being the most appropriate organization to lead it.

Ask:

• Does the issue fit our mission and responsibilities?
• Do we have relevant authority?
• Do we have or can we obtain the necessary expertise and resources?
• Is another organization already responsible for this work?
• Would partnership be more effective than acting alone?
• What other priorities would receive fewer resources if we take this on?
• Are there legal, ethical, or safety responsibilities that require us to act?

The answer may be to lead an intervention, partner with another organization, support someone else's effort, refer the issue to an appropriate authority, or address only the portion that falls within your organization's role.

How do you develop an intervention?

Intervention development is often iterative rather than strictly linear.

New evidence may change how the problem is understood. Community engagement may reveal a barrier that was previously overlooked. Pilot testing may show that a proposed activity is impractical. Evaluation may show that the intervention's assumptions need to be revised.

The steps below provide a useful structure while allowing the process to change when the evidence requires it.

1. Clarify the desired change

Begin with the condition or outcome the intervention is intended to improve.

Ask:

• What is happening now?
• What outcome do we want to improve?
• Who or what is affected?
• What evidence shows that the issue warrants attention?
• What would meaningful improvement look like?

Do not begin by assuming that individual behavior must be the primary target.

Depending on the problem, meaningful change may require changes in:

• Individual knowledge or behavior
• Relationships and social support
• Organizational practice
• Services
• Access
• Physical environments
• Funding or resource allocation
• Policies or regulations
• Larger systems

2. Establish a baseline and understand the scope of the issue

Gather enough information to understand the current condition and to provide a baseline against which later change can be assessed.

Depending on the question, sources may include:

• Administrative or program records
• Public datasets
• Surveys
• Interviews
• Focus groups or community listening activities
• Direct observation
• Research evidence
• Geographic information
• Policy and organizational documents
• Community and lived experience

Ask:

• How large is the issue?
• How severe is it?
• Where does it occur?
• How has it changed over time?
• Are some groups or locations affected differently?
• What information is missing?

Examine the quality and limitations of the evidence rather than assuming that every available measure describes the problem equally well.

3. Identify who is affected and who needs to be involved

An intervention may affect more people and organizations than the people who directly experience the desired outcome.

Identify:

• People and communities directly affected
• People who use or receive the intervention
• Staff or volunteers who would implement it
• Organizations whose practices may need to change
• Decision-makers with relevant authority
• Partners who control needed resources or infrastructure
• People who may experience unintended costs or burdens

Avoid defining people as "targets" simply because the intervention is intended to influence a behavior or decision.

Be specific about what the intervention is trying to influence and why.

4. Engage people and communities meaningfully

People affected by an intervention may have knowledge about barriers, resources, implementation conditions, history, and priorities that planners do not have.

Engagement should begin early enough to influence important decisions rather than being used only to obtain approval for a plan that has already been developed.

Clarify:

• What participants can influence
• What has already been decided
• Who has final decision authority
• How participant input will be used
• How the organization will report back on what happened

Meaningful participation does not automatically create "ownership" or guarantee support for an intervention.

Participants may contribute substantially and still disagree with the final decision.

Make engagement accessible

Depending on the context, consider:

• Language access
• Disability access
• Transportation
• Childcare or caregiving demands
• Meeting schedules
• Technology
• Remote participation
• Compensation for substantial community time or expertise where appropriate
• Anonymous or confidential input where power differences create risk

5. Analyze contributing conditions

Examine why the issue exists and what conditions maintain or reduce it.

Do not assume that one underlying cause explains a complex community problem.

Ask:

• What conditions contribute to the problem?
• What conditions protect against it?
• What policies or institutional practices matter?
• What environmental or infrastructure conditions matter?
• What individual or interpersonal factors matter?
• What economic or resource conditions matter?
• How do these factors interact?
• Which explanations are well supported?
• Which explanations remain hypotheses?

Example

Suppose a community is trying to reduce housing instability.

The analysis might examine:

• Rental prices and housing supply
• Income and employment stability
• Eviction practices
• Availability of emergency assistance
• Disability and health-related needs
• Domestic violence
• Discrimination
• Reentry from institutions
• Access to legal assistance
• Local and state housing policy

An intervention based only on employment training would miss many of these pathways.

6. Define goals and objectives

Describe what the intervention should accomplish before deciding exactly which activities will be used.

Goals describe the broader desired outcome.

Objectives describe specific changes the intervention intends to produce.

Strong objectives identify:

• What will change
• For whom or what
• By how much, where appropriate
• By when
• How the change will be measured

Objectives should reflect outcomes the intervention can reasonably influence.

Avoid writing objectives that place responsibility for complex outcomes entirely on individuals when important system or environmental barriers remain.

7. Describe how change is expected to occur

Before choosing activities, make the intervention's logic explicit.

A logic model, theory of change, program roadmap, or similar tool can connect:

• The identified problem and context
• Contributing conditions
• Resources or inputs
• Intervention activities
• Immediate outputs
• Short-term outcomes
• Intermediate outcomes
• Longer-term outcomes
• Important assumptions

Ask:

If we carry out these activities, why do we expect these outcomes to change?

The answer should be supported by a reasonable combination of evidence, theory, local knowledge, and clearly identified assumptions.

8. Learn from existing evidence and practice

Before creating a completely new intervention, examine what has already been tried.

Sources may include:

• Systematic reviews
• Evidence-based recommendations and guidelines
• Peer-reviewed research
• Government and professional guidance
• Evaluations of similar programs
• Local and regional initiatives
• Community experience

Consider both successful and unsuccessful efforts.

An intervention that worked elsewhere may not produce the same results in a different setting.

9. Assess whether an existing intervention fits the context

When considering an established approach, ask:

• Does it address the contributing conditions identified here?
• What evidence supports its effectiveness?
• In which populations and settings has it been studied?
• How similar are those conditions to ours?
• What resources and expertise does implementation require?
• Is it accessible to the people intended to benefit?
• What effects has it had on equity?
• What unintended consequences have been reported?
• Can our organization implement it with adequate quality?
• Does it fit our legitimate mission and authority?

10. Decide whether to adopt, adapt, combine, or develop

The group may decide to:

• Adopt an established intervention largely as designed
• Adapt an established intervention to fit the local context
• Combine compatible strategies
• Improve an existing local approach
• Develop a new intervention when available approaches do not adequately address the problem

Adapt thoughtfully

When modifying an intervention with existing evidence, distinguish between:

• Essential functions or mechanisms believed to produce the outcome
• Delivery details that can reasonably be changed to improve local fit

An adaptation that removes the mechanism responsible for effectiveness may no longer be the same intervention.

Document significant adaptations so their effects can be interpreted during evaluation.

11. Generate additional intervention options

Existing evidence may not provide a complete answer.

Generate additional options when necessary.

Useful approaches include:

• Individual idea generation
• Brainwriting
• Structured brainstorming
• Community design sessions
• Process mapping
• Systems mapping

Generate broadly while respecting legal, ethical, safety, rights, and scope boundaries.

12. Compare intervention options

Compare potential interventions using explicit criteria.

These may include:

• Relevance: Does the intervention address the problem and contributing conditions?
• Evidence: What is known about effectiveness?
• Equity: Who is likely to benefit, and who may experience additional barriers or burdens?
• Accessibility: Can the intended participants actually use or benefit from it?
• Feasibility: Can it be implemented with available or obtainable staff, authority, time, technology, partnerships, and other resources?
• Safety: What harms or risks might occur?
• Ethics and legality: Is it consistent with rights, professional responsibilities, law, and organizational policy?
• Cost: What resources are required?
• Opportunity cost: What other work may receive fewer resources?
• Acceptability: How do relevant participants and communities understand the intervention and its effects?
• Sustainability: What would be required to maintain it if it proves useful?
• Reversibility: Can it be modified or stopped if assumptions prove wrong?
• Evaluation: Can meaningful implementation and outcome measures be collected?

Several intervention options may remain reasonable after evaluation.

Document important tradeoffs and the reasons for selecting the approach.

13. Understand implementation facilitators, barriers, and concerns

Before launch, examine what may help or interfere with implementation.

Possible factors include:

• Staffing
• Training
• Funding
• Leadership support
• Community trust
• Technology
• Facilities
• Transportation
• Language and disability access
• Policy or legal requirements
• Partner capacity
• Competing priorities

If people or organizations oppose the proposed intervention, determine why.

Opposition may reveal:

• Legitimate risks
• Conflicting priorities
• Rights or legal concerns
• Accessibility problems
• Unanticipated costs or burdens
• Inadequate communication or engagement
• Misinformation

Respond to the substance of the concern rather than treating all resistance as an obstacle to overcome.

14. Identify intervention components and activities

Break the intervention into the major components necessary to carry out its theory of change.

Possible intervention strategies include:

• Providing information or skill-building
• Strengthening services and supports
• Removing access barriers
• Changing organizational procedures
• Changing policies or regulations
• Modifying physical environments
• Improving infrastructure
• Changing resource allocation
• Improving coordination among organizations
• Using communication or outreach strategies
• Monitoring implementation and providing feedback

Not every intervention needs every type of strategy.

Select components because they address identified contributing conditions and support the expected pathway to change.

15. Specify the intervention clearly

For each major component, describe:

• What activity will occur
• Who or what it is intended to influence
• Who will deliver or implement it
• Where and when it will occur
• What resources are required
• What level or amount of activity is expected
• What implementation quality is required
• How accessibility will be addressed
• How the component connects to the intended outcome

Specific intervention descriptions make implementation, replication, adaptation, and evaluation easier.

16. Develop an action plan

Translate the intervention design into specific implementation responsibilities.

The action plan should identify:

• Components and activities
• Responsible owners
• Required approvals and decision authority
• Supporting partners
• Timelines and milestones
• Dependencies
• Resources
• Accessibility requirements
• Communication responsibilities
• Major risks and contingency plans
• Monitoring and evaluation responsibilities

17. Plan evaluation before implementation

Do not wait until the intervention is finished to decide how success will be assessed.

Identify:

• The purpose of the evaluation
• Who will use the findings
• The questions the evaluation needs to answer
• Indicators and measures
• Baseline information
• Data sources
• How and when data will be collected
• Who is responsible for collection and analysis
• Privacy, confidentiality, and ethical requirements

Distinguish types of evaluation

Different questions require different approaches.

• Formative evaluation can examine whether the intervention is feasible, appropriate, understandable, accessible, and ready for implementation.
• Process or implementation evaluation examines how the intervention was delivered, who was reached, how much was delivered, what adaptations occurred, and what helped or hindered implementation.
• Outcome evaluation examines whether the intended outcomes changed.
• Impact evaluation uses designs intended to determine whether the intervention caused observed changes.
• Economic evaluation can examine costs in relation to results.

Match evaluation rigor to the questions, stakes, available resources, intervention maturity, and claims the organization hopes to make.

18. Pilot or test when appropriate

A pilot can help determine whether an intervention or implementation process works as expected on a smaller scale.

Pilot testing can be useful when:

• The intervention is new
• Important implementation assumptions remain uncertain
• The organization is adapting an approach substantially
• Accessibility or usability needs testing
• A limited test can reduce the risks of a larger rollout

A pilot may not be appropriate when urgent protective action is required or when delaying a well-supported intervention would create unnecessary harm.

Before the pilot, decide:

• What is being tested
• Who will participate
• How long the test will run
• What data will be collected
• What unintended effects will be monitored
• What findings would support expansion
• What findings would require modification, another test, or stopping

Use participant and implementer feedback alongside other evidence.

19. Implement the intervention

Implementation is a major phase of the work, not simply the execution of a finished design.

During implementation, monitor:

• Whether activities are occurring
• Whether they are being delivered with appropriate quality
• Whether the intended participants are being reached
• Whether staffing and resources are sufficient
• Whether important barriers have emerged
• Whether adaptations are occurring
• Whether unintended consequences are appearing

20. Adapt deliberately when necessary

Real-world implementation often requires adjustment.

Adaptation may be appropriate when:

• Community conditions change
• The intervention is not accessible as designed
• Implementation barriers emerge
• New evidence becomes available
• A component is not functioning as expected

Document important adaptations.

Record:

• What changed
• Why it changed
• Who approved the change
• Whether the theory of change was affected
• How the change affects evaluation

21. Evaluate outcomes and unintended effects

Evaluation should answer more than whether the intervention was completed.

Ask:

• Was the intervention implemented as intended?
• Who was reached?
• Who was not reached?
• Did the intended outcomes improve?
• For whom did they improve?
• Under what conditions?
• Were important disparities reduced, maintained, or increased?
• What unintended positive or negative effects occurred?
• What did implementation cost?

Outcome change by itself does not necessarily establish that the intervention caused the change.

The strength of the causal conclusion depends on the evaluation design and available evidence.

22. Use the findings

Evaluation should inform action.

Based on implementation experience and findings, decide whether to:

• Continue the intervention
• Improve particular components
• Adapt delivery
• Expand or scale the intervention
• Reduce its scope
• Test an alternative
• Stop the intervention

Avoid continuing an ineffective or harmful intervention simply because substantial resources have already been invested in it.

23. Communicate what happened

Report findings to the people and organizations who need them.

If community members or participants helped shape the intervention, close the feedback loop.

Explain:

• What was implemented
• What was learned
• What outcomes occurred
• What limitations remain
• What was changed because of participant or community input
• What will happen next

24. Continue monitoring and learning

An intervention that works today may need to change as community conditions, resources, policies, technology, or participant needs change.

Continue to monitor:

• Implementation quality
• Reach
• Outcomes
• Equity
• Cost
• Sustainability
• Context
• Unintended effects

Use those findings to refine the intervention and its underlying assumptions.

In Summary

Developing an intervention means moving systematically from an identified problem or desired outcome to a practical, evidence-informed approach for creating change.

Begin by understanding the problem, its context, the people and communities affected, and the conditions that contribute to it. Do not assume in advance that individual behavior is the main cause or that behavior change is the only appropriate intervention.

Engage people affected by the intervention early enough for their knowledge and priorities to influence important decisions, while being transparent about decision authority and how input will be used.

Define clear goals and objectives, describe how the proposed activities are expected to lead to outcomes, and examine existing evidence before deciding whether to adopt, adapt, combine, improve, or create an intervention.

Select intervention components because they address identified contributing conditions and fit the evidence, context, authority, resources, accessibility needs, equity considerations, and implementation capacity.

Plan implementation and evaluation together. Establish responsibilities, timelines, resources, indicators, data sources, and criteria for adapting, expanding, or stopping the intervention before implementation begins.

Finally, treat intervention development as a learning process. Monitor how the intervention is actually implemented, evaluate intended and unintended effects, communicate results, and be willing to revise both the intervention and the assumptions behind it when the evidence changes.

___You understand that an intervention can be a program, a change in policy, or a practice that becomes popular

___You understand that interventions focus on people's behaviors, and how changes in the environment can support those behaviors

___You understand the advantages of developing interventions

___You understand when you should develop or redesign interventions

Developing the intervention:

___You have decided what needs to happen

___You have used a measurement system to gather information about the level of the problem

___You have decided whom the intervention needs to help

___You have involved potential clients or end users of the intervention

___With these clients, you have identified the issues or problems you will attempt to solve together

___You have analyzed these problems or the issue to be addressed in the intervention

___You have set goals and objectives

___You have learned what others have done

___You have brainstormed your own ideas

___You have tried to decide what interventions or parts of interventions have worked, and what might be applicable to your situation

___You have identified barriers and resistance you might come up against

___You have identified core components and elements of the intervention

___You have developed an action plan to carry out the intervention

___You have pilot-tested your intervention

___You have implemented your intervention

Example 1: "Caring Pairs" Components and Elements Background Table

Problem/Issue to be Addressed	Pairing local children with adults in mutually helpful volunteer opportunities
Risk/Protective Factors	Opportunities to serve Stronger adult-youth relationships Stronger peer relationships Supervised alternative activities Stronger community support Social skills Improved academic performance Increased life options
Targets of Change	Corporations, faith institutions, schools, service organizations, adults, program staff, students, teachers, Federal and State agencies
Agents of Change	Advisory Board, School District Coordinators, program staff, current volunteers, school districts, YMCA, School District Coordinators, Students in kindergarten through twelfth grade
Components	Recruitment, matching, activities
Elements	Marketing, selection, background checks, activity assignment, orientation, training One-to-One Mentor Tutor Phone pal Career exploration Group After-school Facilitator Lunch reading group Church-school program Saturday activities Pregnant teen Support Group Basketball clinic Career Discovery Day
Mode/Context of Delivery	Media, businesses, faith institutions, nonprofit organizations, service organizations, government, schools, School District Coordinators, field trip locations

 Example 2: "Caring Pairs" Table of Components and Elements

	Providing Information and Enhancing Skills	Enhancing Support and resources	Modifying opportunities and barriers	Monitoring and Feedback
Components	- Recruitment - Matching	- Celebrations - Resource Sharing - Recognition	- Provide opportunities to serve - Making it easier to volunteer	- Tracking the number of youth and volunteers
Elements	- Promote awareness - Selection of volunteers - Background checks - Activity assignment - Orientation - Training	- Monthly celebrations - Agency newsletter - Articles on volunteers in town newspaper	- Change policies to allow flex time at work Opportunities: - Mentor - Tutor - Phone Pal - Career Exploration - After-school Facilitator - Lunch Reading Group - Church-School Program - Saturday activities - Pregnant teen Support Group - Basketball clinic - Career Discovery Day	- How many hours are spent by volunteers and youth? - How many volunteers and youth are involved?

 Example 3: Teen Pregnancy Prevention Program Components and Elements Background Table

Problem/Issue to be Addressed	Adolescent pregnancy is a serious problem in our community
Risk/Protective Factors	Knowledge of contraceptives, risks Access to contraceptives Skills Values and beliefs Problems at home (conflict, inconsistent rules from parents) Economic deprivation
Targets of Change	Adolescents, peers, parents and caregivers, teachers, service providers, business people, and elected and appointed officials
Agents of Change	Peers, parents and caregivers, teachers, service providers, religious leaders, business people, elected and appointed officials
Components	Sexuality education, develop community alliances, improve access to contraceptives, monitor rates of adolescent pregnancy, improve peer support, increase alternative activities
Elements	Offer graduate-level training for teachers in sexuality education Offer skills training for teens for the choice of avoiding unprotected sexual activity Use bulletin boards and the school newspaper to keep teens up-to-date on special events Begin a "brown bag" program for teens to buy contraceptives without others knowing what they are doing Start a support group to help teen mothers stay in school
Mode/Context of Delivery	Schools, media, businesses, faith institutions, service organizations

 Example 4: Teen Pregnancy Prevention Program Table of Components and Elements

	Providing Information and skills training	Enhancing support and resources	Modifying opportunities and barriers	Monitoring and Feedback
Components	- Sexuality education	- Provide peer support - Provide support from influential others - Develop community alliances	- Improve access to contraceptives	- Monitor rates of adolescent pregnancy
Elements	- Offer graduate-level training for teachers in sexuality education - Offer skills training to teens on avoiding unprotected sexual activity - Use bulletin boards and the school newspaper to keep teens up-to-date on special events	- Start a support group to help teen mothers stay in school - Establish a mentoring program for at-risk youth to gain access to potential employers and job opportunities	- Begin a "brown bag" program for teens to buy contraceptives without others knowing what they are doing - Contraception and information about its use will be made available at places where teens congregate	- How many teens report abstaining from intercourse? - How many teens report the use of contraceptives if they do engage in sexual activity? - How many teens become pregnant? - Report the estimated pregnancy rate to the community on an annual basis

 Example 5: Neighborhood Revitalization Project Components and Elements Background Table

Problem/Issue to be Addressed	We want to improve neighborhood life through better jobs, housing, and education.
Risk/Protective Factors	Economic deprivation Community disorganization Mobility Availability of illegal substances / weapons Skills training
Targets of Change	Business people, residents (including youth), elected and appointed officials, funders, higher education institutions
Agents of Change	Business people, residents (including youth), elected and appointed officials, funders, higher education institutions
Components	Job training, job availability, land reorganization, monitoring of joblessness, education and training
Elements	Develop adult literacy programs Expand affordable childcare Expand computer access for residents through local community organization Hold an annual job fair Provide loans to support small business development Clear land for new business Increase incentives to encourage rehabilitation of existing housing Increase clean up of yards, sidewalks, and vacant lots Build more low- and middle-income housing in the neighborhood
Mode/Context of Delivery	Businesses, housing authority, schools, media, faith institutions, service organizations

Example 6: Neighborhood Revitalization Project Table of Components and Elements

	Providing information and skils training	Enhancing support and resources	Modifying opportunities and barriers	Monitoring and Feedback
Components	- Increase job training - Provide information on job training - Increase general education	- Provide support for new businesses - Provide financial support for home rehabilitation	- Reduce barriers to going to work - Reorganize land use	- Monitoring joblessness, education
Elements	- Develop adult literacy programs - Hold an annual job fair - Develop programs to help residents obtain their GED - Increase the number of computers in schools - Establish a summer internship program for high school students	- Provide low interest loans to encourage rehabilitation of existing housing - Build more low- and middle-income h ousing in the neighborhood - Institute tax breaks for employers who relocate in the neighborhood	- Expand affordable childcare - Expand computer access for residents through local community organizations - Provide loans to support small business development - Clear land for new business - Improve the public transportation system	- What is the rate of unemployment for the neighborhood? - What percentage of high school freshmen graduate high school or obtain a GED? - What percentage of high school students receive further education?

 

Tool 1: Problem analysis sheet

The following page gives you room to analyze the problem or issue you want your group to address. This information can then be used to help you set goals and objectives.

What factors put people at risk for (or protect them against) the problem or concern?
Whose behavior (or lack of behavior) caused the problem?
Whose behavior (or lack of behavior) maintains the problem?
For whom is the situation a problem?
What are the negative consequences for those directly affected?
What are the negative consequences for the community?
Who, if anyone, benefits from things being the way they are now?
How do they benefit?
Who should share the responsibility for solving the problem?
What behaviors need to change to consider the problem "solved"?
What conditions need to change to address the issue or problem?
How much change is necessary?
At what level(s) should the problem be addressed?
Will you be able to make changes at the level(s) identified?

Tool 2: Components and Elements Background Table

Use this table to look holistically at the intervention you will develop.

	Providing Information and Skills Training	Enhancing Support
Problem/Issue to be Addressed
Risk/Protective Factors
Targets of Change
Agents of Change
Components
Elements
Mode/Context of Delivery

 Tool 3: Table of Components and Elements

	Providing Information and Skills Training	Enhancing Support and Resources	Modifying Opportunities and Barriers	Monitoring and Feedback
Components
Elements

Tool 4: Determining if interventions done by others are appropriate for your purpose and situation

Use this table to help you determine if a particular intervention you know about is right for your purpose and situation.

What is the intervention?
Is it appropriate for our purpose?
Is it effective?
Is it replaceable?
Is it simple?
Is it practical?
Is it compatible with our situation?
Additional domments:

 

A PowerPoint presentation summarizing the major points in the section.

• What is a participatory approach to planning?

• What are the advantages of a participatory planning approach?

• What are the challenges of a participatory planning approach?

• What are the levels of participatory planning?

• When is participatory planning appropriate?

• When might participatory planning need to be adapted?

• Who should be involved in a participatory planning process?

• What do you have to do to get a participatory planning process up and running?

 

 

Community interventions are often stronger when people affected by the issue have meaningful opportunities to influence how the intervention is understood, designed, implemented, and evaluated.

That does not mean that every person must participate in every decision or that every planning process should give participants the same amount of authority.

Participatory planning means deliberately involving relevant people and communities in ways that match the purpose of the process and the influence they have been promised.

Done well, participation can improve local knowledge, reveal barriers that planners might otherwise miss, strengthen relationships, identify community assets, and produce plans that better reflect the context in which they will be implemented.

Done poorly, participation can become performative. People may be asked for input after important decisions have already been made, invited to meetings without having meaningful influence, or repeatedly asked for information without receiving feedback about what happened.

The quality of participatory planning therefore depends not simply on how many people participate, but on how clearly their role is defined, how equitably the process is designed, how power and resources are handled, and whether commitments made during engagement are honored.

What is a participatory approach to planning?

A participatory approach is one in which people and organizations with relevant interests, knowledge, responsibilities, or experience have meaningful opportunities to contribute to planning.

Depending on the issue, participants may include:

• People and communities directly affected
• People who will use or participate in the intervention
• Community organizations and networks
• Staff or volunteers who will implement the intervention
• Service providers
• Government agencies or officials with relevant authority
• Funders or resource partners
• Researchers or people with relevant technical expertise
• Other people who may experience significant benefits, burdens, or unintended effects

Participation does not require everyone to be present in the same meeting.

Engagement may occur through:

• Community meetings
• Advisory groups
• Interviews
• Focus groups
• Surveys
• Workshops
• Small-group conversations
• Shared documents
• Digital engagement
• Virtual meetings
• Written or anonymous input
• Community-led planning groups

Be clear about the degree of influence

Not every participatory process gives participants the same role in the final decision.

Before asking people to participate, explain what they can influence.

For example, an organization might:

• Provide information about a decision or program
• Ask for feedback
• Involve community members throughout development
• Collaborate with community partners in developing and selecting options
• Place final authority for a particular decision in a community-led body

These approaches involve different levels of influence.

Do not describe a process as shared decision-making if the sponsoring organization retains all final authority.

Participation should be meaningful

Meaningful participation is more than asking people what they think.

Participants should understand:

• The purpose of the process
• What decisions are open to influence
• What has already been decided
• Who has final authority
• What information is available
• How their input will be documented and used
• How the organization will report back on the result

Participants should be able to question assumptions, disagree, offer alternative ideas, and identify risks without being expected to endorse the final plan.

Recognize different forms of knowledge

Community members may bring:

• Lived experience
• Local history
• Knowledge of community relationships and institutions
• Cultural and linguistic knowledge
• Practical knowledge about how services work in everyday life

Other participants may bring professional, organizational, legal, policy, research, financial, or technical expertise.

These forms of knowledge answer different questions.

A strong planning process uses them together rather than assuming that professional expertise automatically overrides community knowledge or that lived experience automatically settles every technical or factual question.

Recognize power differences

Participants may enter the process with very different levels of authority, resources, status, information, and freedom to disagree.

Ask:

• Who controls funding?
• Who has formal decision authority?
• Who supervises or evaluates other participants?
• Who controls important information?
• Who may experience consequences for speaking openly?

When these differences could suppress participation, consider confidential interviews, anonymous input, separate sessions, community-led meetings, or other ways to reduce the pressure created by hierarchy.

What are the advantages of a participatory planning approach?

Participatory planning can provide important benefits when the engagement is genuine and well designed.

• It can improve understanding of the issue. People affected by the intervention may identify barriers, strengths, history, and practical realities that are not visible in administrative data or professional planning.
• It can broaden the range of ideas. Participants with different experiences and expertise may identify options that a smaller planning group would miss.
• It can improve local fit. Participants can help determine whether a proposed intervention is accessible, understandable, feasible, and appropriate in the actual community context.
• It can reveal unintended consequences. People may identify costs, burdens, risks, or exclusions that planners had not anticipated.
• It can strengthen relationships. Consistent, trustworthy collaboration may improve communication and coordination among organizations and communities.
• It can make decision-making more transparent. Participants can better understand the evidence, constraints, tradeoffs, and authority behind a decision.
• It can strengthen implementation. People responsible for delivering an intervention may identify practical requirements early enough to address them.
• It can strengthen community-led action. Where decision authority and resources are genuinely shared, communities can shape and lead work that reflects locally defined priorities.
• It can build useful skills and relationships. Participants may gain experience with planning, data, evaluation, facilitation, policy, or collaborative decision-making.

These benefits are not automatic.

Participation does not guarantee trust, support, agreement, credibility, or intervention effectiveness.

Those outcomes depend on the quality of the process, the intervention itself, implementation, relationships, resources, and whether commitments made to participants are honored.

Participation and trust

Trust is not created simply by inviting people to meetings.

Organizations demonstrate trustworthiness by:

• Being clear about their purpose
• Providing accurate information
• Following through on commitments
• Acknowledging limits and uncertainty
• Respecting confidentiality
• Explaining how decisions are made
• Reporting back on how input was used

Participation and community ownership

Avoid promising that people will feel ownership merely because they were involved in planning.

Meaningful influence may strengthen commitment, but participants may still disagree with the final plan.

Community-led work is most credible when communities actually hold meaningful authority, resources, or governance responsibility rather than simply being described as owners of a plan controlled by another organization.

What are the challenges of a participatory planning approach?

Participatory planning can require substantial time, coordination, resources, and attention.

It requires resources

Meaningful participation may require:

• Staff time
• Facilitation
• Interpretation and translation
• Accessible materials
• Technology
• Transportation
• Childcare or other caregiving support
• Meeting space
• Compensation for substantial community time or expertise where appropriate

An organization should not design an intensive engagement process without considering the burden it places on participants.

It can take additional time

Gathering perspectives, explaining technical information, working through disagreement, and reporting back can extend a planning timeline.

That additional time may prevent later redesign or implementation problems, but organizations still need realistic schedules.

Representation is difficult

No planning group can contain every person affected by a large community intervention.

A small number of participants should not be assumed to represent everyone who shares their neighborhood, race, ethnicity, language, religion, age, disability, profession, or another characteristic.

Ask:

• Which perspectives are represented?
• Which are missing?
• Who selected the representatives?
• Are participants speaking for themselves, an organization, or a defined constituency?

Power can distort participation

A process may appear inclusive while some participants have much greater ability to shape the outcome.

Examples include:

• Funders controlling resources
• Employers participating with employees
• Government officials holding final authority
• Professionals controlling technical information
• Organizations controlling the agenda and meeting format

Name these differences rather than pretending everyone enters the process with equal power.

Participants may disagree strongly

Disagreement is not automatically a failure.

Participants may have different:

• Interests
• Values
• Evidence
• Experiences
• Responsibilities
• Risk tolerance

Facilitation should help clarify these differences without forcing compromise where agreement is not necessary or appropriate.

Harmful or disruptive behavior may require intervention

Address behavior such as:

• Persistent domination
• Personal attacks
• Harassment
• Discrimination
• Threats
• Repeated violation of agreed process

Do not describe a participant as difficult simply because they raise an unpopular concern or strongly disagree with the sponsoring organization.

Participation can create risk

Some people may face professional, social, political, immigration-related, interpersonal, or other consequences for participating publicly or expressing particular views.

Consider whether confidential, anonymous, separate, or other forms of participation are needed.

Communities may experience participation fatigue

People may have been repeatedly surveyed, interviewed, or invited to meetings without seeing any meaningful action.

Before asking for more participation:

• Learn what previous engagement has occurred
• Avoid asking for information the organization already has
• Explain what is different about the current process
• Report back on outcomes

What are the levels of participatory planning?

Participation can involve different degrees of influence.

A useful contemporary framework distinguishes among the following approaches:

Inform

Provide balanced, timely, understandable, and accessible information about the issue, alternatives, decision, or process.

Informing people is essential communication, but by itself it does not give them influence over the decision.

Consult

Ask for feedback on a problem, analysis, proposal, alternatives, or decision.

Explain how feedback will be considered and report back on how it influenced the outcome.

Involve

Work with participants throughout the process so their concerns, knowledge, and priorities are consistently considered as alternatives are developed.

Collaborate

Partner with community participants in important parts of the decision process, such as developing alternatives, setting criteria, selecting priorities, or governing implementation.

Empower or delegate decision authority

Place final authority for a defined decision in the hands of the participating community or community-led body.

Only describe a process this way when the authority is real.

Choose the level based on the actual decision

More participation is not automatically better in every situation.

Ask:

• What decision is being made?
• Who has legitimate authority to make it?
• How significantly will people be affected?
• What knowledge is needed?
• Are rights or legal obligations involved?
• What level of influence can the organization genuinely promise?

Whatever level is chosen, be transparent about it from the beginning.

When is participatory planning appropriate?

Some form of engagement is useful in many community interventions, but the degree and method should fit the situation.

Information may be appropriate when:

• A decision has already been made through a legitimate process and the remaining task is to communicate it clearly
• The organization is reporting on work already underway
• People need information before later participation
• A legal, safety, or emergency requirement leaves little discretion over the action itself

Even when a decision cannot be changed, people may still have useful input about implementation, accessibility, communication, or unintended effects.

Consultation may be appropriate when:

• An organization needs feedback about existing services
• Several feasible options are being considered
• Community experience is needed to test assumptions or identify barriers
• Final authority belongs to another accountable person or body

If you consult people, report back.

Explain:

• What you heard
• What changed because of the input
• What did not change
• Why

Involvement or collaboration may be appropriate when:

• Community knowledge is important throughout planning
• The intervention will substantially affect community conditions
• Implementation depends on several organizations or community partners
• The problem and potential responses are still open to significant change
• Shared decision-making is feasible and appropriate

Community-led decision-making may be appropriate when:

• The decision appropriately belongs to the community or a community-led body
• Resources and authority can genuinely be transferred or shared
• The organization is supporting a locally defined initiative rather than directing it

Urgent situations

Immediate action may be necessary when health, safety, rights, or basic needs are at serious risk.

Urgency does not always require abandoning community engagement.

Rapid engagement may occur alongside immediate action to:

• Identify urgent community concerns
• Improve communication
• Identify barriers to implementation
• Adapt the response as conditions change

When might participatory planning need to be adapted?

Instead of asking only whether participatory planning is appropriate or inappropriate, consider how the process may need to change.

When time is severely limited

Use rapid engagement methods, identify the decisions that are genuinely open, and plan deeper engagement for later phases where appropriate.

When conflict is severe

Participants may not be ready or able to meet in one shared forum.

Alternatives may include:

• Separate stakeholder meetings
• Confidential interviews
• Mediation
• Staged dialogue
• An independent facilitator

When specialized expertise is required

Some decisions must meet technical, legal, clinical, engineering, financial, safety, or professional standards.

Community participation can still help identify:

• Priorities
• Practical effects
• Access barriers
• Acceptability
• Implementation concerns

Be clear about which aspects are constrained by professional or legal requirements.

When participation creates safety or confidentiality concerns

Public meetings may not be appropriate for every issue.

Use confidential or anonymous methods where necessary and protect sensitive information.

When trust is low

Low trust is not necessarily a reason to avoid engagement.

Begin by:

• Acknowledging relevant history
• Clarifying what the organization can and cannot promise
• Following through on small commitments
• Working through trusted organizations or relationships where appropriate
• Providing regular updates

When not everyone can participate directly

Use several methods rather than assuming one large meeting can represent an entire community.

Combine approaches such as:

• Representative advisory groups
• Open community input
• Surveys
• Interviews
• Small-group sessions
• Digital or asynchronous engagement

Who should be involved in a participatory planning process?

Begin by identifying the people and organizations whose knowledge, interests, responsibilities, authority, or exposure to consequences are relevant to the intervention.

People and communities directly affected

These may include people who:

• Experience the issue
• Use the service or program
• Are intended to benefit
• May experience burdens or unintended effects

Do not assume that one participant represents everyone who shares a demographic characteristic or community identity.

Where representation is used, clarify how representatives were selected and whom they are authorized to speak for.

Community organizations, networks, and trusted partners

Organizations and networks may contribute:

• Community relationships
• Historical knowledge
• Communication channels
• Implementation capacity
• Subject-specific knowledge

These may include neighborhood organizations, advocacy groups, mutual-aid organizations, cultural organizations, disability organizations, faith-based organizations, youth groups, business associations, and other groups relevant to the actual community.

Do not assume that any category of organization is automatically representative or trusted.

Implementers and service providers

Include people who may be responsible for carrying out the plan or whose work would be affected.

They can identify:

• Operational barriers
• Staffing needs
• Training requirements
• Technology or infrastructure needs
• Risks and dependencies

Decision-makers and resource holders

Depending on the issue, this may include:

• Organizational leaders
• Governing Boards
• Government agencies or officials
• Funders
• Institutions controlling relevant facilities, data, or resources

Include these participants because of their actual role in the issue, not simply because of status.

People with relevant professional or technical expertise

Depending on the intervention, expertise may involve:

• Public health
• Health care
• Education
• Law
• Evaluation
• Engineering
• Finance
• Accessibility
• Technology
• Other relevant fields

People who may be missing from ordinary planning processes

Ask whether usual recruitment methods systematically exclude people because of:

• Work schedules
• Transportation
• Disability
• Language
• Caregiving responsibilities
• Technology access
• Institutional distrust
• Fear of consequences

Address barriers where possible rather than concluding that nonparticipation means lack of interest.

What do you have to do to get a participatory planning process up and running?

Clarify the purpose before recruiting participants

Before inviting people, define:

• The issue or decision
• The purpose of engagement
• Which decisions are open
• Who holds final authority
• What degree of participant influence is being offered
• The expected timeline
• How participation will affect the final plan

These points should be communicated honestly when people are recruited.

Identify relevant participants

Ask more than:

Who will be directly affected?

Also ask:

• Who experiences indirect effects?
• Who has relevant knowledge?
• Who implements the work?
• Who controls necessary resources?
• Who has decision authority?
• Who might experience costs or unintended consequences?
• Whose perspective is usually missing?

Recruit through several channels

Use communication methods that fit the actual community.

These may include:

• Direct outreach through community organizations
• Personal invitations
• Email
• Text messaging
• Websites
• Social media
• Community newsletters
• Local media
• Flyers or posters
• Public meetings or presentations
• Schools, libraries, service organizations, businesses, or other community locations

Do not assume that one communication channel will reach everyone.

Make invitations clear and accessible

Explain:

• Why the person is being invited
• What the process is about
• What influence participants will have
• What time commitment is expected
• Whether compensation or reimbursement is available
• How to request language, disability, or other participation support

Use plain language, appropriate languages, and accessible formats.

Reduce participation barriers

Consider providing:

• Compensation where appropriate
• Transportation assistance
• Childcare or caregiving support
• Interpretation
• Accessible materials
• Remote participation
• Multiple meeting times
• Technology support

Choose an appropriate convener

The person or organization convening the process sends an important signal about who controls it.

Consider:

• Credibility with relevant participants
• Conflicts of interest
• Formal authority
• Relationships with the community
• Ability to follow through on commitments

A well-known public figure is not automatically the best convener.

Decide whether you need a facilitator

A facilitator may be especially useful when:

• The group is large or diverse
• Significant power differences exist
• Conflict is expected
• The sponsoring organization has a strong substantive position
• The planning process is complex

An outside facilitator can provide independence, but outside status alone does not make someone neutral or effective.

Consider facilitation skill, credibility, cultural and community understanding, accessibility competence, conflicts of interest, and ability to manage the specific process.

Convene participation in ways that fit the community

A large public meeting is only one option.

Depending on the community and issue, use:

• One large meeting
• Several smaller meetings
• Neighborhood or constituency-specific sessions
• Individual interviews
• Virtual or hybrid meetings
• Asynchronous written input
• Community-led sessions

Design accessible meetings

Consider:

• Physical accessibility
• Transportation
• Safety
• Language access
• Captioning or interpretation
• Accessible documents
• Acoustics
• Technology
• Scheduling
• Breaks
• Remote access

Food or refreshments may be useful during longer meetings but do not substitute for accessible process design.

Use several ways for people to contribute

Participants should not have to compete for airtime in a large discussion.

Options include:

• Spoken discussion
• Small groups
• Written comments
• Chat
• Shared documents
• Polls
• Anonymous questions

Allow people to decline to speak publicly.

Establish participation expectations

Clarify appropriate expectations involving:

• Respectful disagreement
• Confidentiality where applicable
• Equal opportunity to contribute
• Handling conflicts of interest
• Harassment and discriminatory conduct
• Recording or documentation

Clarify decision authority early

Do not wait until the end of planning to explain who can approve the plan.

Participants should understand:

• What the planning group can decide
• What it can recommend
• What requires approval elsewhere
• Which laws, policies, funding rules, or other requirements constrain the decision

Maintain the planning process

Engagement needs continuing attention after the first meeting.

Maintain:

• Clear communication
• Updated timelines
• Access to relevant information
• Participation support
• Documentation of decisions
• Follow-up on commitments

Provide updates even when progress is slow.

Close the feedback loop

At important decision points, tell participants:

• What you heard
• What decisions were made
• How community input influenced those decisions
• What recommendations were not adopted
• Why
• What happens next

Asking for participation without reporting back can damage trust and contribute to participation fatigue.

Continue engagement during implementation

Community participation should not necessarily end when the plan is approved.

Participants may help:

• Identify implementation barriers
• Monitor unintended effects
• Review progress
• Recommend adaptations
• Evaluate outcomes

Protect information appropriately

If engagement collects personal information, recordings, contact information, demographic information, or other sensitive data, establish:

• What information will be collected
• Why it is needed
• Who can access it
• How it will be stored
• How long it will be retained
• How findings will be reported without creating unnecessary privacy risk

Evaluate the participation process

Ask:

• Did the process include the people and perspectives that were needed?
• Who was missing?
• Were important participation barriers addressed?
• Was the promised degree of influence actually provided?
• Did participants understand the decision process?
• Was participation adequately resourced?
• Were disagreements and power differences handled appropriately?
• Did participants receive feedback about how their input was used?

Use what you learn to improve future engagement.

Decide how long engagement will continue

A participatory process may support:

• One planning decision
• A specific intervention
• Ongoing implementation oversight
• Evaluation
• A long-term community partnership

Be clear about when a particular group or advisory process will end, continue, or transition into another role.

In Summary

Participatory planning can strengthen community interventions by bringing relevant knowledge, experience, priorities, and implementation realities into the planning process.

Effective participation is not measured simply by how many people attend a meeting. It depends on whether people understand the purpose of the process, have appropriate opportunities to influence it, receive the information and support needed to participate, and know how their input affects decisions.

Different decisions call for different degrees of participation. An organization may inform, consult, involve, collaborate with, or delegate defined decision authority to community participants. Whatever approach is used, the promised degree of influence should be clear from the beginning.

Participatory planning also requires attention to power, representation, accessibility, compensation, confidentiality, community history, and the practical burden placed on participants.

Communities contain multiple perspectives. No individual participant, organization, demographic group, professional, or public official should automatically be treated as representing the whole community.

Trust develops through trustworthy conduct: accurate information, transparency, follow-through, respect for community knowledge and self-determination, appropriate sharing of authority and resources, and honest communication about limits.

Finally, engagement should not stop once a plan has been written. Continue appropriate collaboration through implementation and evaluation, report back on decisions and results, and adapt both the intervention and the engagement process when experience shows that changes are needed.

What is a participatory planning approach?

___You know that a participatory planning approach means that all stakeholders' voices are heard and respected, and that everyone has some role in decision-making.

What are the advantages of a participatory planning approach?

___Participation carries with it feelings of ownership, and builds a strong base for the intervention in the community

___It ensures that the intervention will have more credibility in all segments of the community because it was planned by a group representing all segments of the community

___It brings a broader range of people to the planning process provides access to a broader range of perspectives and ideas

___Avoids pitfalls caused by ignorance of the realities of the community or the target population

___It involves important players from the outset

___It can provide an opportunity for often-disenfranchised groups to be heard

___It teaches skills which last far beyond the planning process,and can help to improve the community over the long term

___It can bring together and establish ties among community members who might normally have no contact

___It builds trust, both between your organization and the community and among the individuals involved

___It generally reflects the mission and goals of grass roots and community-based organizations

___It implies respect for everyone in the community

___It is generally effective

___It does things the way they should be done

What are the disadvantages of a participatory planning approach?

___A participatory process takes longer

___Members of the target population or the community may not agree with the "experts " about what is needed

___Lots of education may be needed, both for community members and the organization

___One determined individual can wreck the whole process if he's not handled well

___It may be difficult to assure that all the right people get to the table

___A participatory planning process takes patience and commitment on everyone's part

What are the levels of participatory planning?

___Information

___Consultation

___Deciding together

___Acting together

___Supporting local initiatives

When is participatory planning appropriate?

___Information-only may be appropriate when:

• The course of action has already been decided - by a funder, for instance
• You're simply reporting on something that's already in progress
• You're keeping people informed so that they'll have the information to be part of a participatory effort later

___Consultation-only may be appropriate when:

• You want to evaluate or improve existing services
• There are limited options, and you're trying to choose among them
• There are technical reasons - again, perhaps because of a funder - why only certain people or groups can be officially involved in the planning process

___Acting together may be appropriate when:

• The intervention will be more effective than if it were run by a single entity
• There is a funder's requirement for community oversight
• There is commitment to the development of a real partnership
• Everyone benefits from acting together
• One goal of the intervention is the eventual assumption of leadership or the learning of leadership skills by the target population and/or others in the community

___Supporting local initiatives may be appropriate when:

• There is a commitment to community empowerment.
• The community has the desire and at least some of the tools to start and run a successful intervention.
• There is a commitment to provide training and support where needed.
• Your organization can only provide support, or can only run an intervention for a short time.

When isn't participatory planning appropriate?

___When there's simply no time

___When a community is so brutally divided, it's impossible to get all - or even any - of the rival factions to the same table

___When there's no way to provide proper support - facilitation, structure, etc. - for the process

___When the target population is simply not interested in participating, and just wants the organization to take care of it

___When the intervention rests on technical knowledge of a kind that the target population and community members simply don't have

___When involving all or most stakeholders simply isn't logistically possible, because of distance, time, or other issues

___When funding constraints or funders' regulations don't allow it

___When there is no trust between your organization and the community

Who should be involved in a participatory planning process?

___Targets of change

• Members of the target community
• People whom the target community sees as significant opinion makers

___Agents of change

• Policy makers
• Influential people in the community

___Interested members of the community at large

___Members of the organization itself

What do you have to do to get a participatory planning process up and running?

___You've identified all the individuals and groups who need to be involved

___You've gotten the message about the planning process out to everyone who needs to be informed

___You've chosen someone to convene the process

___You've held an initial meeting, for which:

• You've personally invited as many people as possible
• You've planned meeting times around the convenience of those attending, rather than the convenience of the organization
• You've held the meeting in a place that's convenient and comfortable for everyone involved
• You've provided some food and drink
• You've considered carefully who'll run the meeting
• If the community is multilingual, you've made sure to have translators present, or to present everything in multiple languages, so that everyone feels included
• You've planned activities so that everyone at the meeting has a chance to be heard, either in the larger group or in a smaller one
• By the end of the meeting, there was a clear next step, and everyone knew what it was

___You've chosen someone to guide the planning process

___You've decided who will approve a final plan

___You've decided how long the planning process will go on

Example: Participatory Planning in The Literacy Project

In 1995, the Massachusetts Department of Education offered a three-year grant to communities to try to reach and serve the families of children aged three and under. Their idea was that, by providing services to families and children at risk, communities might be able to head off some of the problems these children might have later, when they got to school. The Request for Proposals (RFP) had a number of requirements, a major one being an oversight board that included people from all elements of the community that might be involved with families - schools and day care providers, hospitals and other health agencies, human service providers, parents, municipal government, etc.

The largely rural western Massachusetts county of Hampshire also contains several colleges and the main campus of the state university. At the urging of its Human Service Coordinator, Hampshire County decided to apply as a county, and got permission to do so. This decision made the application process much more complicated, because the Director and the agency convening the process had to contact and involve the appropriate people from 20 or so towns scattered over several hundred square miles.

Less than 10 days after the RFP came out, I, as director of an adult literacy program that operated in Hampshire County, sat at a meeting with several school principals and counselors; three doctors; two hospital administrators; three parents; the directors of a day care center, a mental health agency, a battered women's shelter, an agency that operated homeless shelters, a pregnant-and-parenting teen program, an information and referral service, and an anti-poverty agency; and representatives from the Department of Social Services, the county welfare office, the Office for Children, the  Department of Developmental Services (DDS), and other state and local agencies; as well as the County Human Services Coordinator.

We spent two long but productive meetings thinking through and planning the grant proposal, which was then written by an administrator at the anti-poverty agency. Using ideas from nearly everyone in the group, the proposal, rather than concentrating on a specific program, envisioned an intervention that encompassed supporting parents in whatever ways they needed. It created a safety net for parents and children that stretched across the whole county, and included both specific and general services and activities. In short, it was an intervention designed for a whole county, rather than a single community, and one that recognized that the needs of parents in that county were varied and constantly changing.

Much to everyone's surprise, our proposal was one of only a small number funded across the state. Ours was the only proposal that aimed at more than a single community, but it had county-wide support, and everyone was committed to making it work. The group that had been assembled to write the proposal agreed to stay together and serve as the oversight board, and the information and referral center housed the program 's coordinator and served as a clearinghouse for issues related to the grant.

The grant program worked on two levels. On one level, it ran activities and programs in different areas of the county - often tied into the already-existing work of county agencies, schools, hospitals, and the like - geared to the needs of families with kids three and under. Some of the grant money was used for outreach to families, particularly those often underserved, to encourage their attendance. Activities and programs included a semi-annual vaccination celebration (a fair with clowns, refreshments, and entertainment at which kids could get both vaccinated and face-painted), and pre- and postnatal parenting classes at one of the hospitals.

The larger part of the grant, however, was directed toward meeting needs expressed directly by parents and providers, and toward creating and maintaining a flexible network of integrated services and support for families that could be activated when a need or a problem arose. A small amount of the grant was used, for instance, to run a "taxi service" of volunteer drivers who helped parents without transportation (remember, this is a rural area, where the nearest store or population center can be ten or more miles away) to get to appointments with the pediatrician or welfare office, to do shopping, or to pick up children from day care.

The board met officially four times a year, and small groups of it met far more often to work out the details of specific new or ongoing activities. More important, the organizations involved worked together far more and in a far more focused way to meet the needs of mutual participants, and to try to narrow in on issues pertaining to young children and their families.

A good example of how the grant worked at its best took place in my own adult literacy program. At one of the Hampshire County sites, a female learner had just had a baby, whom she often brought to class. The instructor, himself the father of two young children, was very concerned about the well-being of the child, who was being fed solids at two months, and who was often ignored for long periods of time. Ultimately, the instructor decided he had to intervene.

He had a conference with the mother, at which he explained that he was concerned for the child, and that he wanted her to get help if she was to continue to participate in the literacy program. Rather than simply leaving her on her own to find assistance, however, he was able to put her directly in touch with a pediatrician, a parenting program, WIC (child nutrition), transportation assistance, and other help, all of which he had arranged through connections set up by the grant. He accompanied her to some of the initial meetings, and "handed her off" to specific individuals who, he knew, would establish relationships with her and help her through the process of learning to take better care of herself and her child.

Far from being resentful, the woman welcomed the help, and the instructor almost immediately noticed a marked improvement in the way she dealt with her infant. Furthermore, both mother and child were now getting basic services - regular medical checkups, help with proper nutrition - that would go toward keeping them healthy over the long term. The lives of that mother and baby were, in some sense, saved by the safety net the grant had set in place. And the flexibility of that net had been made possible by the participatory planning process that had generated the original grant proposal.

The Department of Education had been profoundly dubious when Hampshire County had submitted a county-wide proposal, and had funded it, at least in part, just to see what would happen. The Hampshire County program was, in fact, one of the most successful in the state. The participation in the grant was real and ongoing, and - perhaps even more important - ultimately involved the people most concerned with the issue.

Although I continued, as director of my program to attend board meetings, I also made sure that the instructors who ran the Hampshire County sites of our program were involved, and that their voices were heard in planning and committee sessions. Other program directors did the same, so that by the time I left my program, two or three years later, most of the work of the grant program was being accomplished by community members and by the line staff of the organizations involved, rather than by administrators.

A PowerPoint presentation summarizing the major points in the section.

• Who are the people and partners involved in community change?

• Who are the people and communities most directly affected by the problem or issue?

• Who can help contribute to improvement?

• What do partners in change do?

• How to identify people most directly affected and partners in change

Who are the people and partners involved in community change?

When doing work in your community, the first thing to decide is what issue or problem you want to address. Whether you are teaching children to read or trying to create safer neighborhoods, it's your group's reason for being; it's what you're all about.

You and your organization are not alone. There are people who can benefit from an initiative and people who can contribute knowledge, experience, resources, and support. We need to be clear about who should benefit--youth and parents, for example--and who can help address the issue or problem--including youth, parents and guardians, teachers, service providers, and others. Knowing who these people are is an important step.

In this section, we'll help you identify the people and communities your organization or initiative is trying to reach and involve, as well as the people, organizations, and institutions that can help contribute to positive change. We'll also consider what these partners can do and how you can develop a plan to make sure you have included everyone who can benefit, contribute, or offer important perspectives--and not just the most obvious participants.

Sounds simple, doesn't it? It can be. It's a question of being clear, complete, and making sure you look at every angle.

Who are the people and communities most directly affected by the problem or issue?

You're probably trying to change a certain behavior, condition, or outcome, such as reducing harmful substance use or creating decent jobs. Sometimes, the issue you are addressing is clear; other times, the root causes are less obvious. Children falling asleep in class, for example, might be affected by not having had breakfast rather than by a problem in the school itself. Limited access to food, in turn, may be connected to a family experiencing poverty, inadequate job opportunities, transportation barriers, or other conditions. Talking with people who experience the issue can help you gain a better understanding of what conditions and behaviors contribute to the problem or issue.

Like identifying the root causes of a problem, understanding who is most directly affected and who should be involved can be relatively simple or more complex.

Generally, people connected to the issue will fall into two broad categories:

• People who directly experience the problem or experience increased risk
• People whose actions, decisions, policies, or practices influence the problem or its possible solutions

Identifying who directly experiences an issue may sometimes be straightforward. If you are trying to increase immunization among children under two years of age in an urban community, for example, those children, along with their parents or guardians and health care providers, may be among the people most directly connected to the effort. People who inject drugs are important partners in HIV prevention efforts because they may experience increased risk of HIV transmission and can provide essential knowledge about effective prevention strategies.

Sometimes, however, the people most directly affected aren't the same people whose actions or decisions need to change. In the immunization example above, children under two years of age can't immunize themselves. Parents and guardians, health care providers, health systems, and others who influence access to vaccination may therefore also need to be involved. In this case, the effort should consider people whose actions, decisions, or practices influence the issue.

Examples of these people include:

• Peers
• Parents and caregivers
• Service providers
• Teachers
• Business owners and retailers (e.g., those who sell tobacco or alcohol)
• Elected and appointed officials

As you work on an initiative, you will want to consider both people who directly experience the issue and people who can influence the conditions connected to it. Often, people with lived experience can also be important leaders and partners in creating solutions.

For example, a community initiative to improve public transportation might use:

• A media campaign to increase public awareness of transportation challenges and engage people who would benefit from improved transportation
• A letter-writing campaign directed at public officials who have influence over resource allocations for improved transportation

Who can help contribute to improvement?

Next, you'll want to identify potential partners in change. Who can influence the people, policies, systems, and conditions connected to the problem or issue? These are individuals or groups who can contribute knowledge, relationships, resources, leadership, or decision-making authority to help address issues that matter to your community.

Sometimes, partners in change are members of the same groups as the people most directly affected. You might concentrate part of your "Healthy Eating" campaign on high school science and health teachers, for example, so that they can share nutrition information with their students. In this instance, teachers may both participate in changes themselves and help support broader improvements. Similarly, people with lived experience of gang involvement may contribute to efforts to reduce gang-related violence; peers may influence the academic achievement of other youth; and people who have experienced trauma or loss may help others with similar experiences cope with the effects.

Remember that successful community change depends heavily on relationships and collaboration. Ideally, people experiencing the issue are deeply engaged as partners in change. Success is more likely when people spend time together, build trust, care about each other, and recognize each other's contributions. Teachers may be more effective partners when they have the support of parents, just as parents may be more effective when their efforts are supported by teachers.

What do partners in change do?

Partners in change can contribute in a variety of ways. If they are working closely with someone who is directly affected by the issue, they may do the following:

• Establish a strong relationship with the person most affected. When people see someone as credible, trustworthy, and caring, they may feel more comfortable sharing their experiences, concerns, and ideas and working together toward change.
• Understand the issue or problem. In the classic novel To Kill a Mockingbird, Atticus Finch tells his young daughter she must walk around in other people's shoes if she really wants to understand them. A strong partner in change takes a similar approach. To support meaningful change, they need to understand the person's experiences, circumstances, strengths, and the conditions influencing the issue.
• Support informed choices and opportunities for change. Partners can help people understand available options, identify their own goals, and recognize opportunities and resources that may help them move toward those goals. A mentor, for example, might encourage a student by helping them recognize their strengths, explore educational opportunities, and develop a plan for what they want to pursue after high school.
• Help make change possible. Deciding to make a change is an important first step, but people may also need information, resources, encouragement, supportive policies, services, or other forms of assistance. Partners in change can help identify and provide the support needed to move from intention to action.
• Help sustain change. Meaningful change often takes time and ongoing support. Whether someone is returning to school, reducing or stopping substance use, beginning a new job, or pursuing another goal, supportive relationships and access to resources can help them continue making progress.

How do you identify people most directly affected and partners in change?

So, the next question is: How can you identify everyone who can benefit, contribute, and help? A first step is to answer the following questions. Just for your use, you might want to grab a piece of paper and write down your answers. Often, the act of writing something works as a brainstorming technique, and you'll come up with more ideas than you thought possible. You might do this with other members of your group and with people who experience the issue; the more perspectives you include, the stronger your understanding is likely to be.

• What is the problem or issue you are trying to address? What really contributes to it? As we mentioned above, you might want to talk with people who experience the issue or do research to better understand the root causes. You might also want to try the "But why" technique. This method examines a problem by asking what caused it. Each time an answer is given, a follow-up, "But why?" is asked.
• Who might resist the changes you want to make, and why? This is probably information you will want to use later, but it may be helpful to understand these perspectives from the beginning.

Now, you're ready to identify the people most directly affected and the partners who may contribute to change. As you did before, write down and brainstorm answers to the following questions. When you're done, review your answers and identify the people and groups who should be involved.

For people and communities most directly affected:

• Who is affected by the problem? Think carefully and go beyond the most obvious people. Consider who directly experiences the issue, whose decisions or circumstances influence it, and what broader conditions may be contributing. For example, if children are struggling in school, consider the perspectives of students, families, teachers, school leaders, community organizations, and public officials, as well as factors such as class size, transportation, access to resources, and opportunities for family engagement. Write down all of the answers that come up. You can always refine the list later.
• Who has been previously affected by the problem? Should they still be supported or involved? For example, if you are running an immunization program for children under two, ask whether there are older children who did not receive vaccinations when they were younger and could be reached now.
• Who are the peers of those affected? If you are focusing on youth violence, for example, you might include a broad range of young people in your action plan, not only those who have directly experienced or been involved in violence.

For partners in change:

• Who has the ability or authority to help bring about change?
• Who has the time, resources, knowledge, relationships, or desire to contribute to change?
• Who might be able to make a difference if your initiative engages them as a partner?
• Who has a relationship with the people most directly affected? Whom do community members trust? Who do they turn to for information, guidance, or support?
• Think about people who have lived experience with the issue. They may be some of the strongest partners in change. For example, a person in recovery from a substance use disorder may be able to provide meaningful peer support to someone who is working toward recovery. They can draw on lived experience, understand many of the challenges involved, and offer support without judgment.

For both:

• Have you thought about people from all parts of your community? Are there different community sectors (e.g., churches and faith communities; schools; businesses) that might become involved?
• Who does your organization particularly want to reach or work with? With whom do you think you can be particularly effective? What relationships or contacts do you already have that could help?

In Summary

Identifying the people and communities most directly affected by an issue and the partners who can contribute to change is an important step in your planning process. It helps put the work in context and reminds you that community change is a shared effort. People who experience an issue are not simply recipients of programs or services; they may also bring important knowledge, lived experience, leadership, relationships, and ideas for solutions. By involving people who can both benefit and contribute, your initiative can develop approaches that are more responsive to the community and more likely to create meaningful and lasting change.

___You understand that targets of change are people who experience the problem or issue or are directly at risk and who contribute to the problem through their actions or inactions

___You understand that agents of change are those who can influence the people and conditions that contribute to the problem or issue

___You understand that targets and agents of change may be the same people

You know what agents of change do:

___They establish strong relationships with the people most affected

___They diagnose the issue or problem

___They convince the people experiencing the issue of the need for (and the possibility of) a change

___They help make that change happen

___They help maintain that change

You know how to identify targets and agents of change:

___You know the problem or issue you want to address

___You know who might resist the changes you want to make

For targets of change:

___You know who is affected by the problem

___You know who has previously been affected by the problem

___You know who the peers of those affected are

For agents of change:

___You know who has the power to bring about change

___You know who has the time, resources, and desire to bring about change

___You know who might be able to do it, if your organization can convince them

___You know who already has a relationship with your targets of change

___You have considered people who were (or are) targets

For both:

___You have thought about people from all parts of your community

___You have considered those your organization particularly wants to target or work with

Example: Targets and agents of change for child abuse prevention program

Below is a filled out example of a planning sheet that can be used to help determine the targets and agents of change for your initiative. In the Tools section, you'll find a blank copy you can print out and use for your organization.

What behaviors and conditions contribute to the issue or problem?	Who are the people who experience or contribute to the issue? (Targets of Change)	Who are the people who can contribute to improvement? (Agents of Change)
Poverty / economic stress Poor anger management skills Substance use Lack of parenting skills Family history of abuse	Parents and guardians Relatives	Teachers Ministers Neighbors Parents and Guardians Relatives Service providers

 

Tool: Planning Sheet

Fill out the following sheet as part of your planning process. You can use the information to decide who can benefit and contribute when you write or revise your action plan.

Planning Sheet: Connecting targets and agents of change

Community issue or problem: ____________________________________________________

What behaviors and conditions contribute to the issue or problem?	Who are the people who experience or contribute to the issue? (Targets of Change)	Who are the people who can contribute to improvement? (Agents of Change)

 

A PowerPoint presentation summarizing the major points in the section.

An outreach worker, hired to help establish an English language learning program in a community with a large Portuguese-speaking population, was having difficulty connecting with potential participants. Partially because of language differences and partially because he was new to the community, his early outreach efforts had limited success. He knew he needed help from people who already had trusted relationships within the community.

The outreach worker decided to contact leaders from two important community institutions: a local soccer club and a Catholic church. The director of the soccer club and the priest both recognized a need for English language learning opportunities and agreed to help organize an informational meeting.

The priest shared information about the program with members of the congregation and invited people to attend the meeting. The director of the soccer club personally invited community members who might be interested and introduced the outreach worker at the club, where he was able to talk informally with potential participants and learn more about their interests and needs.

By the time of the meeting, word had spread through the community, and the hall was full. More than 40 people signed up for classes, and many said they would share information with friends and family. When classes began several weeks later, they were well attended from the start.

This story is an example of working through community sectors – in this case, faith and cultural/recreational networks – to connect with people through trusted relationships. We'll briefly examine who should be involved in community change and then explore how community sectors can help you reach, engage, and collaborate with people throughout the community.

What do we mean by community sectors?

“Community sectors” can mean a number of different things. In some cases, it describes broad categories – the public and private sectors, for example, referring respectively to government-related organizations and those outside government. Sometimes, the term “community sector” refers to community-based organizations, institutions, and initiatives, as distinguished from those operated by state or national governments, large corporations, or international organizations.

In this section, when we refer to “community sectors,” we’re pointing to the various groups, institutions, networks, and areas of community life that people may be connected to through common social, political, economic, cultural, professional, or religious interests. In some cases, membership in a sector may be obvious or intentional (business owners as part of the “business sector,” for example). In others, people may not think of themselves in those terms (parents may not think of themselves as part of the “education sector”). Many individuals may belong to, or have contact with, several sectors.

So what are these sectors? We’d be hard pressed to name all the sectors that exist in every community, but there are numerous categories that are common across many communities:

• Health. This includes medical and mental health professionals (physicians, nurses, psychologists, therapists, physical therapists, etc.), pharmacists and pharmacies, hospitals and other inpatient facilities, clinics, complementary health practitioners, community health workers, and public health agencies and systems.
• Education. Public and private K-12 schools, early childhood programs, colleges and universities, school boards, school administrators, teachers, other educational staff, parents and caregivers, students, state boards of education, adult education programs, and English language learning programs.
• Law and justice. Local and state law enforcement agencies, courts, judges, probation and parole officers, prosecutors, public defenders, legal aid organizations, restorative justice programs, and other justice-system partners.
• Government. Regional, provincial, state, local, and tribal governments, agencies, departments, and officials, both elected and appointed.
• Business. This sector can range from self-employed workers and locally owned small businesses to large employers and multinational corporations with a local presence.
• Youth. Young people themselves and the organizations, programs, schools, clubs, mentors, and other adults who work directly with them. There may be considerable overlap with education, families, human services, culture, and sports and recreation.
• Families and caregivers. Whether families and caregivers are viewed as a separate community sector may depend on the issue. They may be particularly important in efforts involving children, young people, older adults, people with disabilities, or others who receive family or caregiving support.
• Media and communications. This may include newspapers, magazines, radio, television, online news organizations, podcasts, social media platforms, community newsletters, content creators, and other communication channels.
• Human services. This sector generally includes nonprofit, public, and volunteer organizations that provide services such as workforce development, food assistance, housing support, older adult services, adult education, disability services, immigrant and refugee support, advocacy, and other community resources.
• Faith communities. Places of worship, faith leaders, members, and religious or spiritually based organizations representing the traditions present in the community.
• Service and membership organizations. Local, national, and international service organizations, professional associations, fraternities and sororities, veterans’ organizations, social clubs, and other membership-based groups.
• Community advocacy and volunteer groups. These might focus on public policy, support for local institutions, economic development, neighborhood improvement, environmental issues, community events, or other priorities identified by community members.
• Arts and culture. This sector includes musicians, dancers, writers, actors, designers, visual artists, cultural organizations, theaters, museums, galleries, arts educators, production staff, and community members who participate in or support the arts.
• Housing and development. This sector may include public and nonprofit housing organizations, tenant organizations, housing advocates, property owners and managers, developers, planners, affordable housing providers, and others involved in residential and commercial development.
• Sports and recreation. This sector might include sports clubs, recreation departments, amateur and professional athletic organizations, public and private recreation facilities, gyms, coaches, personal trainers, recreation leaders, camp staff, athletes, spectators, and supporters.
• Environment and natural resources. This sector may include environmental organizations, conservation groups, land trusts, farmers, hunters and anglers, outdoor recreation groups, scientists, environmental justice organizations, Indigenous communities, natural-resource professionals, and businesses whose work depends on healthy ecosystems.

A conservation land trust is an organization that protects land for conservation, recreation, agriculture, habitat, or other community purposes. It may purchase land directly or work with landowners to establish conservation agreements that limit future development while allowing the land to remain privately owned.

• Agriculture and food systems. This sector can include small and large farms, ranchers, agricultural workers, cooperatives, food processors, distributors, farmers markets, community gardens, food businesses, agricultural organizations, and consumers.

There can be, as we’ve discussed, a large amount of overlap among sectors. Furthermore, the list above is far from complete: a given community may have additional sectors because of its particular history, economy, geography, or culture. A community whose economy is largely agricultural, for instance, may have distinct dairy, grain, fruit-growing, or livestock networks. A culturally and linguistically diverse community may also have organizations and networks connected to particular racial, ethnic, cultural, immigrant, refugee, or language communities.

Sectors exist because of common interests, relationships, experiences, identities, or responsibilities shared by their members. As a result, they can be useful for building relationships and connecting with people who may want to participate in or contribute to a community effort.

Who are the people and partners involved in community change?

People and communities most directly affected

People and communities most directly affected include those who experience an issue, are affected by related policies or conditions, or stand to benefit from an effort. They may also be important leaders, decision-makers, advocates, and partners in creating solutions.

In some cases, an effort may focus partly on individual behaviors – such as supporting people who want to stop smoking or helping people manage chronic health conditions. In other cases, the most important changes may involve organizations, policies, services, systems, or environmental conditions rather than individual behavior.

Examples of people or groups who may be directly affected include:

• People managing health conditions who may benefit from supportive services, accessible health care, healthy environments, or changes they choose to make in their daily routines.
• People who use products associated with health risks, such as tobacco or alcohol, and communities affected by how those products are marketed or sold.
• People with substance use disorders or people seeking recovery support.
• Young people affected by or involved in community violence.
• People seeking employment or experiencing barriers to employment.
• People seeking literacy, digital skills, workforce skills, or instruction in a community’s primary language.
• People who are incarcerated or returning to the community after incarceration.
• People experiencing homelessness or housing instability.
• Farmers and agricultural communities seeking environmentally and economically sustainable practices.
• Individuals, businesses, or industries whose practices contribute to pollution and who can help reduce environmental harm.
• Developers and housing partners who can contribute to affordable, accessible, and environmentally responsible development.

Developers may also be important partners when an effort seeks to change policies, incentives, regulations, or development practices to encourage community-responsive practices.

• Legislators and other policymakers, such as school boards, boards of health, and regulatory agencies, whose decisions can influence discrimination, food access, neighborhood investment, workplace safety, worker protections, education, transportation, housing, health, and other community conditions.
• Media and communications organizations, which can help explain issues, share community perspectives, and increase public awareness.

Other people and communities may benefit from changes without necessarily needing to change their own behavior. Examples include:

• People and families seeking affordable, stable housing
• Students attending schools with limited resources or inadequate facilities
• Individuals or communities affected by social, economic, or political discrimination
• People with disabilities
• Individuals or communities without reliable access to clean drinking water or sanitation
• Communities with limited access to health care
• People experiencing food insecurity or malnutrition
• People and communities exposed to environmental hazards or pollution
• Workers exposed to hazardous substances or unsafe workplace conditions

People most directly affected by an issue should not be viewed only as beneficiaries of an intervention. They may also have essential knowledge, lived experience, leadership, and ideas about solutions. Community efforts are often stronger when people most affected have meaningful opportunities to identify priorities, shape strategies, advocate for change, and participate in implementation and evaluation.

Partners in change

Partners in change are people, organizations, institutions, and networks that can help create positive change. They may contribute lived experience, relationships, decision-making authority, expertise, resources, advocacy, services, or community leadership.

In many cases, people most directly affected by an issue and partners in change are the same people. For example, residents affected by housing affordability may also be advocates, organizers, advisory-board members, or leaders working to change housing policy.

Partners in change may also include public officials, media organizations, families, educators, health professionals, businesses, community organizations, and others whose participation can strengthen an effort.

Some common partners in change include:

• Legislators and other public officials
• Media and communications organizations
• Health care professionals, community health workers, and health administrators
• Teachers, educators, and school counselors
• Parents, caregivers, and other family members
• Peers
• People whose lived experience provides valuable knowledge and credibility, such as people with experience in violence-prevention efforts, recovery from substance use disorders, homelessness, disability advocacy, or other community issues
• Business owners, employers, and organizational leaders
• Community leaders – including people with formal leadership roles and those who are trusted because of their experience, relationships, fairness, knowledge, or service to the community

Sometimes an entire sector may be important to involve. The health sector, for example, can be an important partner when efforts seek to improve health systems, public health policy, health equity, or other community conditions.

Why use community sectors to reach and engage people and partners?

Community sectors can help you connect with people through organizations, relationships, and networks they already know and trust. They can also help broaden participation and bring additional knowledge and resources into an effort. Some reasons for working through community sectors include:

• To connect with people who may face barriers to participation. Some people may have limited contact with formal organizations because of language, transportation, accessibility, past experiences, work schedules, immigration concerns, geographic isolation, or other barriers. Trusted community organizations, cultural groups, faith communities, neighborhood networks, and other partners may help create more accessible and comfortable ways to participate.
• To ensure representation from across the community. It is important to include people who will implement, experience, or be affected by an effort. Working through different community sectors can help bring a broader range of perspectives into planning, implementation, and evaluation.
• To build trust. Community sectors can connect your effort with trusted people and organizations. These relationships can provide a foundation for long-term collaboration and can also strengthen trust among sectors that may not have worked together before.
• To draw on knowledge from different parts of the community. People in different sectors may bring knowledge of community history, previous efforts, relationships, strengths, priorities, barriers, and potential areas of conflict. This knowledge can strengthen planning and implementation.
• To bring sectors together. Different sectors may have limited opportunities to communicate or collaborate. Bringing them into the same effort can help build relationships and lay the groundwork for future collaboration.
• To raise awareness of the issue throughout the community. Community sectors often have established ways of communicating with members and partners. These networks can help share accurate information and community perspectives.
• To build broad community support. When people and organizations from different sectors participate meaningfully in an effort, they can share information through their own networks, encourage others to participate, and strengthen community ownership.

How do you use community sectors to reach and engage people and partners?

Working through community sectors is often easier when you already have relationships in the sectors you hope to involve. If you don’t, this may be a good opportunity to begin building them. The following steps can help you identify and engage the people and partners who should be involved.

Determine whom you need to reach and engage

This first step is closely connected to your strategy. What changes are you hoping to support, and who should be involved in making them happen? If you’re starting an advocacy campaign, you may want to engage policymakers as well as people directly affected by the issue. If you’re providing a service, you’ll want to connect with potential participants and the people or organizations they trust. If you’re trying to increase public awareness, you may want to involve media and communications partners.

In many cases, you’ll need to engage several different individuals and groups. An advocacy effort might involve legislators as well as community members with lived experience of the issue. Their stories, knowledge, and perspectives can help policymakers and the broader public understand why change matters. In recruiting participants for a service, you might also work with educators, families, community organizations, faith communities, or others who already have trusted relationships with potential participants.

What do you mean by “reach and engage?”

Different efforts have different goals for communication and engagement. Among the most common are:

• Share information. You may simply want people to know about an issue, resource, opportunity, or service.
• Encourage a specific action, such as attending a meeting, completing a survey, contacting a public official, accessing a service, or participating in a community activity.
• Support healthier or safer choices. For example, a tobacco-prevention campaign might provide young people with information about nicotine addiction, industry marketing practices, health effects, and resources for quitting.
• Invite people to an event, such as a vaccination clinic, job fair, community forum, workshop, or advocacy event.
• Connect people with a service or resource, such as workforce development, mental health services, a domestic violence program, housing services, food assistance, adult education, or community arts programming.
• Invite volunteers or community partners to participate in events, programs, outreach, planning, or other activities.
• Build public support for an event, program, initiative, or policy proposal.
• Engage in advocacy or influence policy. This may involve meeting directly with policymakers, sharing community perspectives, building coalitions, using media, or mobilizing public participation.

Reaching and engaging people can therefore involve much more than simply spreading information. It may include relationship building, listening, personal invitations, community conversations, partnerships, and creating meaningful opportunities for participation.

Decide what sectors might need to be involved to reach the desired group(s)

You might have to do some research here. Remember the importance of the soccer club and church to the Portuguese-speaking community in the introduction to this section? What organizations, networks, institutions, or groups are important to the people you hope to engage? Whom do they trust? Where do they get information? Where do they already gather or participate?

One group might be best connected through faith communities, another through schools, neighborhood organizations, cultural organizations, social media networks, or trusted community leaders. Public officials may be reached through professional relationships, community organizations, constituents, advocacy groups, or other networks.

Other sectors that might help are those people interact with regularly – businesses, community organizations, media outlets, schools, health care providers, libraries, recreation programs, and others. If these partners can share your information or help facilitate participation through their regular activities, they may help broaden your reach.

Determine who in a given sector is the best contact, and establish that contact

Using community sectors effectively depends on understanding which people and organizations are trusted and credible within a particular community. The fact that an organization serves a population does not necessarily mean that everyone in that population trusts it. In many cases, individual staff members, community leaders, peer advocates, or other trusted messengers may have especially strong relationships.

This is where existing relationships can be valuable. If your current contact isn’t the best person to connect with the community you hope to engage, they may be able to suggest someone else and provide an introduction. If you don’t already have contacts, take time to begin building relationships.

Making contacts in various community sectors

Personal introductions can be helpful when building new relationships. If you don’t know anyone in a sector who can help you get started, ask colleagues, community members, participants, or partners whether they know someone who would be appropriate to contact.

If a personal introduction isn’t possible, reach out using the communication method that is most appropriate for the person or organization. This might be email, phone, social media, an online contact form, or an in-person conversation. Briefly introduce yourself, explain why you are reaching out, and be clear about what you hope to discuss.

If you have no connection at all, you may need to contact several people before finding the right person. Community directories, organizational websites, social media, local events, and recommendations from other partners can help identify potential contacts.

A good starting point is often someone who knows many of the people or organizations you hope to involve. Depending on the community and issue, that might be a community organizer, cultural organization leader, faith leader, neighborhood association representative, librarian, Chamber of Commerce staff member, health care professional, school staff member, or public official.

There is no single best communication method for every community or sector. Some people prefer email, others phone calls, text messages, social media, scheduled meetings, or in-person conversations. When possible, use the communication methods people themselves prefer and make it easy for them to respond.

Clarify what you’re asking for

Why do you want to connect with people? What are you asking them to do? These are questions most people will want answered when you contact them. Be prepared to briefly explain your organization or effort, what you hope to accomplish, why you believe their perspective or participation matters, and what you are asking from them.

Whatever the answers are, they should be clear, complete, and accurate. Be transparent about the time, responsibilities, decisions, or resources involved. People should be able to make an informed choice about whether and how they want to participate.

Be creative

There are many ways to use community sectors to connect with people. We’ve largely focused on relationship-based approaches through individuals and institutions, but communication can also be built into places and activities people already use. For example, pharmacies might share information about a community blood-pressure program, libraries might promote adult learning opportunities, or arts organizations might share information about a local initiative in their programs and newsletters.

Use media and communication channels people already use

Media and communications cut across nearly every community sector. Depending on whom you are trying to reach, you might use local news outlets, community newsletters, social media, podcasts, streaming platforms, text-message networks, radio, television, community websites, or other channels. The key is to use communication channels that the people you hope to engage actually use and trust.

Another important network is made up of people already involved in your effort as participants, partners, volunteers, advisors, or community leaders. Ask them whether they can help connect with others who may want to participate. People already engaged in an effort can often be effective ambassadors because they can describe their own experiences and explain why participation matters.

These relationships can help your effort grow through existing community networks while also strengthening connections across sectors.

Keep at it

Engaging the first few participants or partners doesn’t mean your work is done. Programs and services may need ongoing outreach to remain accessible and responsive to the community. Advocacy efforts often require long-term relationship building and sustained participation. Continue listening, communicating, inviting new perspectives, and strengthening partnerships throughout the life of the effort.

In Summary

Whether your goal is to share information, provide a service, run a program or initiative, improve environmental or social conditions, or pursue advocacy, you’ll need to connect with people and organizations throughout the community. One way to do that is through community sectors – the groups, institutions, networks, and areas of community life connected by common interests, responsibilities, relationships, identities, or purposes.

The business sector, health sector, education sector, government sector, faith communities, cultural organizations, community-based organizations, and many other sectors can all contribute different relationships, knowledge, perspectives, and resources.

In general, people are more likely to participate when information and invitations come through sources they know and trust. By building relationships across community sectors, listening to community members, and working with trusted partners, you can broaden participation, strengthen collaboration, and create community efforts that are more responsive, inclusive, and sustainable.

What do we mean by community sectors?

___Community sectors are the various groups that people in the larger community might be divided into for reasons of common social, political, economic, cultural, or religious interests

___Membership in sectors often overlaps

___Different communities may contain sectors specific to those types of communities

___Sectors that exist in many or most communities include:

• Health

• Education

• Law enforcement

• Government

• Business

• Youth

• Parents

• The media

• Human services

• Religion

• Service/fraternal organizations

• Community activist and volunteer groups

• Arts and culture

• Housing and development

• Sports and recreation

• The environment

• Agriculture

Who are the targets and agents of change?

___Targets of change are either those whose behavior you want to change or those who stand to benefit from the changes your effort aims to bring about

__ Primary targets of change are those whose behavior you’re trying to change directly

___Secondary targets of change are those who stand to benefit from changes in others’ behavior or in circumstances, rather than from changes in their own behavior

___Agents of change are those – policy makers, for example – who can help to bring change about

___Agents of change are often primary targets of change as well, especially in advocacy efforts

Why use community sectors to reach targets and agents of change?

___To reach hard-to-contact populations

___To ensure representation from all sectors of the community

___To build trust

___To take advantage of the knowledge of people in different sectors

___To bring sectors together

___To raise awareness of the issue throughout the community

___To gain widespread community support

How do you use community sectors to reach targets and agents of change?

___Determine whom you need to reach

___Decide what sectors might be needed to reach the desired group(s)

___Determine who in a given sector is the best contact, and establish that contact

___Clarify what you’re asking for

___Be creative

___Use the media to reach people through the channels they normally pay attention to

___Keep at it

A PowerPoint presentation summarizing the major points in the section.

• What is a promising practice or intervention?

• Where do you find out about existing promising practices or interventions?

• How do you identify a true promising practice or intervention?

• How do you choose the particular practice or intervention that's right for your community?

The West Perry Youth Initiative (WPYI) has completed a careful assessment of youth issues involving all sectors of the community. The findings were revealing: young people and other community members alike were concerned by the number of young people who brought weapons to school and by the number of violent incidents that many youth encountered. The initiative therefore identified youth violence prevention as the area it most needed to address.

So far, so good. But a problem identified is not the same as a problem solved. Everyone knows that you can't just wave a magic wand and make youth violence in the community disappear. It's a complex issue that involves young people, parents and caregivers, schools, law enforcement, community resources, community attitudes, access to weapons, and many other factors. The initiative and the community have to choose an intervention that will work.

One way to deal with this issue is to look at what other communities have done to try to prevent youth violence. But the question then becomes "How do we know that a particular model will have the effect we're looking for?" WPYI has some choices here:

• It could just do what most other communities are doing, without worrying about how well it works. (This may sound silly, but a surprising number of organizations in a variety of fields adopt this approach.)
• It could invent something from scratch. After all, there was a lot of community involvement in the assessment and planning process. Surely, if we put all those brains together, we can come up with some good ideas.
• It could look for some practices and interventions that are already being used elsewhere that seem to be successful in the ways that WPYI has in mind.

This chapter is about finding out what kinds of practices and interventions are possible, choosing what's appropriate for your purposes and your community, and adapting it to the particular needs, strengths, and character of your community and priority population. In this opening section of the chapter, we'll discuss how to tell whether a practice or intervention is one that has a chance of fulfilling your purposes.

What is a promising practice or intervention?

Promising practices and interventions are those that have the potential to effectively address the issues of concern in your community. They are usually (though not always, as we'll see) approaches that seem to have worked elsewhere, as judged by standards that make sense for your community and your issue.

What's the difference between a practice and an intervention?

A practice is a particular way of doing things. It may encompass a whole program or it may simply refer to a single method or approach. Vaccinating infants according to recommended schedules in order to provide appropriate protection against disease is an example of a practice. Another example might be using a low-barrier approach in an emergency shelter so that people experiencing homelessness can access safe shelter while staff maintain clear procedures for protecting the safety and well-being of everyone using the service.

An intervention is usually a whole program or initiative meant to achieve an overall result. In the first example above, for instance, the practice is vaccinating infants according to an appropriate schedule. The intervention used to support this practice might include outreach to parents and caregivers, convenient vaccination opportunities, reminder systems, transportation assistance, and coordination with other health care services.

In the shelter example, an intervention might include street outreach, access to safe overnight shelter, connections to permanent housing, behavioral health services, transportation, and other supports. Individual practices within that intervention would be chosen to promote both accessibility and safety.

Practices are the tools that interventions use to get the job done. Sometimes a whole intervention may also be considered a practice. An adult literacy or workforce development program, for instance, might be seen as one practice within a larger initiative addressing economic opportunity. A substance use treatment program with several components might be treated as a single practice if those components work together as an integrated model.

Untried practices and interventions

Promising practices and interventions may also be untried, but based on something solid. Sometimes, there is no model for what you want to do, or at least no satisfactory one. In that case, there are places to look for ideas.

• Theory. You may have read about a new idea, or may know an academic whose research is in the area you're concerned with. Trying out a practice or intervention grounded in theory is a way both to come up with a strategy that has a good chance of working and to test the theory as well.

• Past experience. You may have tried or seen something that worked well in a similar situation, or you may have evidence from what you've done before that certain methods are likely to work well under certain circumstances. That's a reasonable basis for action.
• Analysis of the problem, especially one that comes from a broad community discussion. If lots of people are involved in looking at the issue, including members of the priority population and the community at large, solutions are more likely to reflect real causes, community strengths, history, and cultural realities.

New practices and interventions have to start somewhere. Sometimes they start from entirely new ideas or new perceptions of an issue. You may be in a situation where that's appropriate. One caution, however: there are few ideas that are totally new. If you do have a new idea, check around and see if it or something similar has been tried before. If it has, you may be able to get some suggestions about how to make it work and how to avoid pitfalls.

Where do you find out about existing promising practices or interventions?

The discussion above, of course, brings up the question of where to look for promising practices and interventions. There are a number of possibilities, and the ideal is to use as many of them as you can. The best strategy for learning about promising practices and interventions is to find and contact directly the programs or initiatives using the practices or interventions you're interested in.

Some sources of information about promising practices and interventions:

Networking.

Talk to everyone you know. Directors and staff from other agencies, coalition members, community partners, and others may know about things happening locally, statewide, nationally, or internationally. They may be able to provide introductions, or at least information so that you can contact programs or initiatives and learn about what they're doing.

Online sources.

Online sources can provide access to research, program descriptions, evaluation reports, toolkits, databases, and examples of practices being used in other communities. Look for credible sources, consider the quality and date of the evidence, and, when possible, contact the organizations implementing practices you are interested in.

Libraries.

Public libraries are open to all. Colleges and universities may also provide community or alumni access to their collections. Much of the material referred to above may be available through libraries, and librarians can be extremely helpful in finding what you're looking for. They are skilled at identifying credible sources, locating research, and helping users navigate both print and digital information.

State and national advocacy and professional organizations.

These organizations often identify promising practices, publish journal articles, host conferences, and maintain online resource collections. You can contact the organization or explore its website to find out what's available.

International, state and federal agencies.

UNESCO, HUD, public health agencies, government departments, and other public institutions often publish promising practices, program evaluations, guidance, and examples from initiatives they fund. These resources may be available online or through agency publications.

Foundations and other private funders.

These funders may identify promising practices or describe projects they support. Many publish reports, evaluations, case studies, and project descriptions online.

Academia.

Local colleges and universities may have researchers studying the issue you're concerned with, or may know others who are. Graduate students and faculty may also be interested in working with community organizations through research projects, practicum experiences, evaluation work, or master's and doctoral projects. Start by contacting the university department most closely connected to the work you do - education, environmental science, psychology, public health, social work, urban planning, etc.

Word of mouth from the community.

Faith leaders, members of service organizations, business leaders, community organizers, and other community members may know through their networks about intervention models being used elsewhere. Members of the priority population may also know of programs or initiatives similar to the one you want to start and may be able to offer valuable perspectives on what has or has not worked.

How do you identify a true promising practice or intervention?

Once you've looked at a number of promising or "best" practices and talked to some people about their programs, how do you decide what really works, and what might work for you? First, you need to determine what the practices you've been looking at are effective for. Then, the question is what criteria do you use to identify promising practices and interventions. In other words, how do you know they actually work? Finally, what are some of the common elements of successful practices and interventions, elements that you can incorporate into whatever you decide to do?

Best practice for what?

Particular promising practices may or may not be relevant to your goals. Some organizations, agencies, or government departments identify practices according to how effectively they address a specific problem or condition. For example, a practice addressing child maltreatment might focus on identifying immediate safety concerns, protecting children from further harm, and responding appropriately when maltreatment occurs. These responses are essential, but by themselves they may not address all of the conditions that contribute to the problem.

Another type of promising practice focuses on prevention. In the case of child maltreatment, a preventive intervention might combine effective responses to current harm with family supports, accessible behavioral and mental health services, parenting resources, economic and social supports, community education, and other strategies that strengthen protective factors for children and families.

Finally, some promising practices focus on promoting positive behaviors, relationships, or community conditions. These approaches build strengths rather than focusing only on stopping harmful outcomes. For example, sexual health initiatives may promote consent, healthy relationships, condom use, STI prevention, and safer sexual practices. Similarly, many health initiatives emphasize creating conditions that support physical activity, nutritious food, stress management, social connection, and access to preventive care.

As you look for promising practices, be clear about what kind of approach you're interested in and have the resources to support. Are you addressing an immediate problem or condition? Are you focusing on prevention by addressing contributing factors before harm occurs? Or are you promoting strengths, protective factors, and conditions that support well-being? Many effective interventions combine elements of all three.

There's another element to the question of what a promising practice is meant to do: what is the real problem or issue that your community needs to address?

Criteria for identifying promising practices and interventions

There are essentially two ways you can look at a practice or intervention: quantitatively and qualitatively.

The quantitative view uses numbers to analyze and understand the impact of particular practices or interventions on participants and communities. These numbers may be used in simple or complex ways. They could state the number of people served, the number who accomplished something specific, or changes in community-level outcomes. They can also be used in statistical analysis to draw more complex conclusions about the effects of a program.

Even simple numbers can provide useful information about how well a practice or intervention is working, but numbers should be interpreted carefully. Growth in participation may indicate that a program is valued and accessible, but participation alone does not prove that the program is accomplishing its goals.

Quantitative analysis can provide an important indication of whether change has occurred as a result of a program. It is often what public funders and public officials request as evidence of effectiveness. At the same time, quantitative analysis by itself may not explain why an intervention succeeds, why people participate or leave, or how participants experience the program.

Qualitative analysis looks at what actually happens when a particular practice or intervention is used. It may include interviews, observations, stories, focus groups, participant feedback, case studies, photographs, or detailed analysis of trends and experiences over time.

The quantitative analysis of the program may show that there are fewer violent incidents and that more young people are participating in programs that build skills for preventing and resolving conflict. The qualitative analysis may show that broader changes are taking place in relationships, attitudes, trust, and the overall climate of the community. Using both quantitative and qualitative data can provide a more complete picture of whether and how the program is working.

The lesson here is that the combination of quantitative and qualitative analysis is what's likely to give you the best picture of reality and make it possible to identify a promising practice or intervention. That's not the end of the lesson, however. Let's go back to that program that seems to serve a small number of people extremely well. What can we learn from that example?

If we make the standards for a "best practice" too strict, we're apt to reject some possibilities that may have potential. Remember, things work differently in different places and in different circumstances. If your standards are "nothing but the Mercedes," you'll never buy that Subaru that can get you home in the snow while your Mercedes is spinning its wheels in the parking lot.

When you look for promising practices and interventions, start by casting a wide net. Something that works only adequately in another community may work extremely well in yours with thoughtful adaptation. By the same token, something that works well someplace else may not be appropriate for you.

Another element of your search should be finding out what didn't work. You may have a terrific idea with a hidden flaw that has already been discovered elsewhere. Or there may have been an attempt to do something similar in your community before, with poor results because the approach did not fit local circumstances, culture, or priorities. Knowing your history can save you vast amounts of time, energy, and frustration. It's one of the most important criteria for assessing promising practices and interventions.

General characteristics of a successful program

One way to approach the search for promising practices and interventions is to look at the general elements of programs that seem to work. Lisbeth Schorr, in her book Common Purpose: Strengthening Families and Neighborhoods to Rebuild America (New York: Anchor Books, Doubleday, 1997), discusses what works in improving outcomes specifically for children and families. She identifies "Seven Attributes of Highly Effective Programs":

• Successful programs are comprehensive, flexible, responsive, and persevering. They address many aspects of an issue rather than a single one; they can, and do, change according to the needs and strengths of participants and the community; and they remain committed for as long as it takes to accomplish their purpose.
• Successful programs see children in the context of families. Children don't exist in a vacuum, and understanding their families, caregivers, relationships, and environments can be important to understanding their experiences and supporting positive outcomes.
• Successful programs understand families as parts of neighborhoods and communities. Families don't exist in a vacuum, either. Effective interventions consider the community conditions that affect families, draw on local strengths and knowledge, include people with community connections among staff and leadership, and help strengthen local leadership and capacity.
• Successful programs have a long-term preventive orientation, a clear mission, and continue to evolve over time. Successful programs address underlying causes rather than only responding to immediate symptoms, and realize that meaningful change may take years. They know what they're trying to accomplish, while remaining flexible about how they pursue that mission as new information, community priorities, and participant experiences emerge.

As Thomas Peters and Robert Waterman pointed out in In Search of Excellence, the key here is to be tight about your mission, but loose about how to achieve it. The mission itself - what you aim to accomplish in the long run - is non-negotiable. How you go about accomplishing it, however, should be flexible and responsive to the realities of the situation. It may change continually in response to new information, changes in the community, and the experiences of participants.

• Successful programs are managed by effective and committed individuals with clearly identifiable skills. Schorr identifies some of those skills as willingness to experiment and take risks, tolerate ambiguity, seek evidence of results, collaborate, and allow staff appropriate discretion.

Other skills that must be added here are the practical managerial skills that assure that bills are paid, that there's a reasonable budget in place and that it isn't exceeded, that funders receive the reports and other information they require, and that staff issues are dealt with quickly, fairly, and well. No matter how collaborative and community-based an organization is, someone still has to keep the organization functioning.

• Staffs of successful programs are trained and supported to provide high quality, responsive service. Just as participants and communities have to be considered in context, so do staff members of organizations. They need an organizational climate that supports their work and values ongoing learning and professional development.
• Successful programs operate in settings that encourage practitioners to build strong relationships based on mutual trust and respect. Strong programs treat participants with dignity, recognize their knowledge and lived experience, and avoid relationships that position staff as inherently more important or knowledgeable. Current and potential participants should feel welcomed, respected, and included as partners in the work.

In addition to Schorr's seven attributes, there are two more that might be added:

• Successful programs are collaborative both internally and externally. Internal collaboration refers to the inclusion of both staff and participants in the planning, implementation, and decision-making of the program. External collaboration means involving a broad range of agencies, officials, schools, community organizations, and others connected to the issue. This can make it easier to coordinate services and address the issue from multiple angles.
• Successful programs and their staffs generally have, both institutionally and individually, a set of relationships and core values that strengthen their sense of shared purpose, and give them confidence that disappointments and setbacks can be overcome. These values often manifest themselves as a passion for the work and for social justice, and translate into relationships with participants that support personal development, agency, and leadership.

All of these nine attributes might apply to a program of any sort: how do they help you sort out promising practices for what you want to accomplish? In fact, these general characteristics are some of the promising practices you need to pay the most attention to. They provide an overall structure for a program that works. How you decide to approach your specific issue should depend on the priorities and strengths of your community, what the priority population identifies as useful and appropriate, a participatory planning process, the talents and skills of your staff, and the resources available.

The nine attributes here paint a picture of a program that is responsive, flexible, equitable, collaborative, well-managed, effective, aware of context, supportive of staff members and their development, and committed for the long term to a clear mission. If you can adopt these general characteristics, the chances are your intervention will do well. To make it the best it can be, it's necessary to find - or create or adapt - the specific practices and/or interventions that are right for your community.

How do you choose the particular practice or intervention that's right for your community?

All of these steps assume community involvement, ideally in both planning and implementing an intervention.

• Conduct a community-based assessment and planning process to be sure that you're addressing the issues that are most appropriate and pressing for the community. If your intervention is to work, it has to address the real issues and priorities identified by the community. An assets and needs assessment and planning process will help you identify those issues and think about how to approach them most effectively.
• Decide whether you'll address the issue directly, or whether you'll try to change the conditions that contribute to it. It may be that working on underlying causes will be more successful than addressing the issue only at the individual level; and that could mean a totally different kind of intervention.
• Find (or create, if that's necessary) practices or interventions that have successfully addressed the issue in the way you want to address it. It's important to realize that not every successful program is successful in the way that you're interested in. If your focus is community empowerment, for instance, a highly centralized program that provides few opportunities for community participation may not be what you're looking for. If you want to address root causes, a program that focuses only on immediate symptoms may not be a good fit. Make sure that a practice or intervention matches both your immediate goals and the principles behind them.
• Determine what elements of a promising intervention will work in your community, and which ones need to be changed. In other words, adapt the intervention, or parts of it, so that it fits your community's needs, strengths, culture, and circumstances. Not all the pieces of an urban program will work in a rural area, for instance, where transportation, childcare, access to services, geography, and everyday life may be very different. The community and the priority population should have meaningful opportunities to shape an adopted practice or intervention and make it work for them. If no two communities are exactly alike, interventions may also need to look different while preserving the core elements that make them effective.

Everett Rogers, in his book Diffusion of Innovations (New York: Free Press, 1995), writes of the concept of "reinvention." Individuals and organizations, when adopting a new practice or idea, often make it their own by changing it - sometimes slightly, sometimes substantially - to meet their particular needs. These "reinvented" innovations may work better and be more likely to be sustained because they are better adapted to local circumstances and because the people using them have helped shape them.

• Implement the intervention, making adjustments as you go along. It's probably helpful to start out with the expectation that you'll have to make changes as you learn more about the fit between the practices you've adopted or created and the priority population. That attitude will make it easier to make those changes, and thus to become more effective over time.
• Evaluate your work and results regularly, understanding that no matter how well any intervention works, it can always be improved. It's important to examine your work and outcomes continually, whether formally or informally, so that you'll have more than intuition to tell you whether you're achieving your goals or not. It's perhaps even more important to keep the idea of a dynamic program always before you, so that no matter how well you're doing, you'll still be willing to try something new if it looks promising.

In the rest of this part of the section, we'll concentrate on finding and choosing the appropriate practice and intervention for your community.

Difficulties in finding practices or interventions you can use:

One possibility, of course, is finding the best program around and simply copying it exactly in your community. That should be fairly simple to do, shouldn't it? Actually, no... it's not. Copying - replication is the term that's most often used - doesn't always work well. Lisbeth Schorr, again, has some ideas on this subject:

• Excellent programs often don't travel well. You may know that some fine wines can't be sold far from where they're made, because the shaking they go through when they're being shipped changes their character. Community interventions can change character when they're transported, too.
  • You can't necessarily take something that works in one community and expect it to work the same way in another, entirely different, community. An intervention's success depends on the needs, strengths, culture, and circumstances of its community. A successful intervention from elsewhere may need to be adapted to fit a new setting.
  • Even where an intervention was tremendously effective, people may not be able to tell you exactly what they did. Some programs keep careful records of nearly everything; others keep almost none. Some programs are based on clear theoretical and philosophical foundations; others "just grew" out of their founders' experience and intuition. So you may not be able to replicate a program exactly simply because no one can tell you what "exactly" is.
  • A successful intervention - especially one which is hard to describe - may depend largely on the talents, relationships, or experience of a particular individual or small group. Sometimes, such a program can't be reproduced exactly because those relationships and local circumstances are unique.
• Even if you can replicate it exactly, you can't expect people to accept and embrace a program if it's imposed upon them from above. They should have meaningful opportunities to participate in its planning, adaptation, and, where possible, implementation in order to develop shared ownership.
• No intervention or practice that involves people - either staff or participants - is perfect. People, organizations, and communities change over time, so even a strong program will probably need to adapt as circumstances, priorities, and participants change.

A successful adult literacy program found itself adapting continually as the circumstances and goals of its learners changed. Changes in the local economy, housing and employment conditions, immigration policy, community resources, and other factors affected who participated in the program. At different times, participants included young people who had left school before graduating, adults seeking employment, people with substance use disorders, people learning English, and survivors of domestic violence. Different participants brought different strengths, goals, experiences, and support needs. Staff members continually adjusted their educational methods, services, and relationships with learners in response.

• The difference between a successful and an unsuccessful intervention can be subtle. It may be as simple as the way a participant is greeted the first time they walk through the door, whether the space is welcoming and accessible, or whether people feel respected and included. Often, the subtleties aren't even part of the formal intervention itself. Small shifts in the economic climate, transportation access, public assistance requirements, or other conditions can affect participation in ways that may not be immediately obvious. As a result, replicating a successful program may be more complicated than it looks, no matter how well documented the program and its practices are.
• If you can't replicate an intervention's resources as well as its practices, you're probably headed for trouble. Programs that are asked to reproduce successful models with substantially fewer staff, funding, facilities, or other resources may have difficulty achieving the same results. Successful adaptation requires realistic expectations about the resources needed to support quality implementation.

Keys to success in replication

Just as there are difficulties in replicating successful programs, there are also some factors that will help replication work. They depend largely on characteristics of the original intervention (the first six of these are also from the work of Lisbeth Schorr):

• Ideas that are sound and well-developed through experience. Interventions that are solid, evidence-informed, and based on well-tested concepts are more likely to transfer successfully to other settings.
• Ideas that can be taught and can inspire local leadership. The ideas behind the intervention need to be understandable and practical, while also giving community members and organizations meaningful opportunities to shape, lead, and sustain the work.
• A sense of mission, of belonging to something larger. The program has to carry a vision that transcends the immediate project and connects people with a greater purpose. This goes back to the sense of passion for the work and for social justice mentioned earlier. A program may be easier to sustain when people see how their work contributes to larger community goals.
• Access to people who have successfully implemented the program. As emphasized from the beginning of this section, the best way to find out about a program is to consult the people who are actually carrying it out. They can give you the details that no one else can and help you understand the relational and contextual elements that may affect success.
• Supportive and thoughtful consultation. This consultation might come from colleagues in other organizations; funding organizations; members of the community and priority population; people with lived experience; or a consultant with relevant expertise.
• Technical assistance that recognizes there are new things to be discovered.
• Local involvement in initial planning for, finding and choosing, adapting, and implementing the intervention. This will help to develop local ownership, leadership, and stewardship of the intervention.
• Awareness on the part of funders that trying to replicate a program that's been successful elsewhere doesn't guarantee immediate success. Even strong models need time to be adapted to local conditions, cultures, and community priorities. Funders can support success by allowing organizations time to build relationships, learn, adapt, and improve.
• Adequate resources - people, money, supplies, and time - to achieve your goals. Match the scope of your intervention to the resources you actually have.

Elements of successful replications of effective programs

Just as there are factors in the programs themselves, there are also elements in the replication process that lead to successful replication. Some elements of successful replications:

• They combine the replication of the essence of a successful intervention with the adaptation of many of its components to a new setting or population. Every program needs to be adapted to its community, its specific priority population, the skills and concerns of staff members, local culture, available resources, and other conditions.
• They have had the continuous backing of an intermediary organization. This might be a local coalition, a grassroots group, a particular agency - some entity that could offer expertise, mobilize support, lend legitimacy and influence, and connect the intervention with appropriate local networks.
• They recognize the importance of systems and institutional context. They seek settings where the intervention is welcomed and where there is real commitment to its success.
• They recognize the importance of people. They understand that participants, community members, staff, and partners need to see value in the intervention and have meaningful opportunities to contribute to its success.
• They judge success by the outcomes for individuals and communities. What actually happens - whether participants meet their goals, whether community conditions improve, and whether the changes people hoped for occur - is the standard for whether these interventions consider themselves effective.
• They tackle, directly and strategically, the obstacles to large-scale change. Successful interventions look beyond the immediate issue to underlying causes and community conditions. Part of a successful youth violence prevention program, for instance, might focus on strengthening supportive relationships, creating safe opportunities for young people, supporting family and caregiver involvement, addressing access to weapons, improving community conditions, and developing effective responses to violence.

In Summary

Choosing a promising practice or intervention for your purposes may not be a simple matter. What works in another community may not work in yours, and it may be difficult to determine exactly how a particular successful intervention operates or which parts of it are essential.

There are, however, some general elements that good programs seem to have in common:

• Responsiveness
• Flexibility
• An equitable philosophy
• Commitment to collaboration
• Good management
• Effectiveness
• Awareness of the context of the issue and the priority population
• Commitment for the long term to a clear mission

In addition to these general characteristics, there are some factors that identify successful replications. They include the adaptation of program features to local needs, strengths, and cultures; backing by an intermediary organization; an understanding of the importance of community and human context; judging success by individual and community outcomes; adequate resources; meaningful community participation; and a focus on root causes.

The process of choosing may be difficult, but it doesn't have to be a guessing game. If you follow the guidelines in this section, examine the available evidence, and listen to community members - especially people most directly affected by the issue - you can choose and adapt practices that support meaningful and lasting community change.

What is a promising practice or intervention?

___You know that a practice is a particular way of doing things.

___You know that an intervention is usually a whole program or initiative meant to achieve an overall result.

___You use theory, past experience, and/or analysis of the problem to help you create or judge untried practices and interventions.

Where do you find out about existing promising practices or interventions?

You use these sources to find out about existing promising practices or interventions:

___Networking.

___State and national advocacy and professional organizations.

___International, state and federal agencies.

___Foundations and other private funders.

___Academia.

___Libraries.

___The Internet.

___Word of mouth from the community.

How do you identify a true promising practice or intervention?

___You have decided whether you're searching for a best practice for treatment, prevention, or promotion.

___You know how to use both quantitative and qualitative data to judge promising practices and interventions.

You recognize the attributes of successful programs:

___Successful programs are comprehensive, flexible, responsive, and persevering.

___Successful programs see children in the context of families, and families as parts of neighborhoods and communities - in other words, they consider their work in context.

___Successful programs have a long-term preventive orientation, a clear mission, and continue to evolve over time.

___Successful programs are managed by competent and committed individuals with clearly identifiable skills.

___Staffs of successful programs are trained and supported to provide high quality, responsive service.

___Successful programs operate in settings that encourage practitioners to build strong relationships based on mutual trust and respect.

___Successful programs are collaborative both internally and externally.

___Successful programs and their staffs generally have, both institutionally and individually, a set of relationships and core values that strengthen their sense of shared purpose, and give them faith that disappointments and setbacks can be overcome.

How do you choose the practice or intervention that's right for your community?

You follow the basic steps to choosing a promising practice or intervention:

___You conduct a community-based assessment and planning process to be sure that you're addressing the issues that are most appropriate and pressing for the community.

___You decide whether you'll address the issue directly, or whether you'll try to change the conditions that make it possible.

___You find (or create, if that's necessary) practices or interventions that have successfully addressed the issue in the way you want to address it.

___You determine what elements of a promising intervention will work in your community, and which ones need to be changed.

___You implement the intervention, making adjustments as you go along.

___You evaluate your work and results regularly, understanding that no matter how well any intervention works, it can always be improved.

You pay attention to the difficulties in finding practices or interventions you can use:

___Excellent programs often don't travel well.

___You can't expect people to accept and embrace a program if it's imposed upon them from above.

___No intervention or practice that involves people - either staff or participants - is perfect.

___The difference between a successful and an unsuccessful intervention can be subtle.

___If you can't replicate an intervention's resources as well as its practices, you're probably headed for trouble.

You try to assure successful replication by:

___Choosing a program based on ideas that are sound and well-developed through experience.

___Choosing a program based on ideas that can be taught and can inspire local leadership.

___Choosing a program that conveys a sense of mission, of belonging to something larger.

___Making sure you have access to people who have successfully implemented the program.

___Making sure you have supportive and wise consultation.

___Making sure you have technical assistance that recognizes there are new things to be discovered.

___Including local involvement in initial planning for, finding and choosing, and implementing the intervention.

___Making sure funders know that trying to replicate a program that's been successful elsewhere doesn't guarantee success overnight, or even at all.

___Matching your goals to your available resources.

You structure the replication process for success by:

___Combining the replication of the essence of a successful intervention with the adaptation of many of its components to a new setting or population.

___Obtaining the continuous backing of an intermediary organization.

___Recognizing the importance of the systems and institutional context.

___Recognizing the importance of people.

___Judging success by the outcomes for individuals and communities.

___You tackle, directly and strategically, the obstacles to large-scale change.

Tool: A Self-Assessment to Help You Find and Choose Promising Practices

Starting the search

Answering these questions will help start your search for the best promising practice for your community.

• What is the broad area of interest (e.g., health promotion, independent living )?
• What specific problem are you working on (e.g., substance use, obesity)?
• What population will benefit from your effort (e.g., Hispanics, youth, rural groups)
• What type of intervention or community change (i.e., change in program, policy, or practice) are you seeking? Is it listed in your strategic plan?
• In what sector of the community will this take place (e.g., business, youth groups, churches)?
• Are you interested in a targeting an intervention at a high-risk group or a comprehensive approach, or both?

Choosing your approach

Answering these questions will help you choose the best promising practice for your community.

• Does the promising practice meet all of the criteria set by your search?
• Some programs can be complicated, which means an organization that can support the effort is needed. Are there organizations in your community that can support the effort? If not, can you create such an organization?
• What is the evidence that the promising practice will have some impact?
• Will you be able to replicate the practice? If not, how will you modify it for your community?
• What resources do you have or will you be able to generate to support the practice? Will a pared back version satisfy your needs?
• Is the practice compatible with your community's beliefs, attitudes and values (e.g., will your community support condom distribution)?
• Have you looked at different versions of the practice in the examples and stories provided in the Community Tool Box or in other resources? Have you contacted others who have implemented the practice?
• How will this promising practice work for you? What would make it a success for your community?

A PowerPoint presentation summarizing the major points in the section.

Have you ever wondered why some people in our communities have better outcomes than others? Why some children do well in school while other children - equally capable - face greater barriers? Why people in the same community may experience unequal health outcomes? Have you wanted to help change these outcomes?

There are many different and interrelated causes of problems and desired outcomes. If your organization can understand these causes, it can focus its intervention to better contribute to community improvement. This can help your organization and community work toward the conditions and outcomes you envision.

So, where do you begin in trying to make these changes? We believe one very good way to go about it is to consider the risk and protective factors that may contribute to a particular problem or desired outcome.

What are risk and protective factors? They are aspects of a person, group, environment, or life experience that make it more likely (risk factors) or less likely (protective factors) that people will experience a given problem or achieve a desired outcome. For example, smoking is a risk factor for cardiovascular disease. Regular physical activity can be a protective factor for cardiovascular health.

Risk and protective factors are key to figuring out how to address community health and development issues. It's a matter of taking a step back from the problem, looking at the behaviors, experiences, systems, and conditions that contribute to it, and then figuring out how those conditions can be changed or strengthened.

For example, in an effort to prevent harmful substance use, an approach that uses risk and protective factors to direct interventions might increase young people's access to positive activities, supportive adults and peers, accurate information, coping and decision-making skills, and environments that support healthy choices.

We suggest that you consider risk and protective factors as one of your early steps when you are writing or revising the strategic plan for your initiative.

In this section, you will learn more about risk and protective factors and their role in identifying the changes in your community that your organization wants to make. Specifically, we are going to look at:

• A more in-depth understanding of risk and protective factors
• When to look at the risk and protective factors for the issue that's important to you
• How to identify the specific risk and protective factors for your focus area
• How these factors can help your organization identify the people and communities who may benefit most and select strategies for making a difference

Ready? Then let's dive in!

What are risk and protective factors?

As we said above, risk and protective factors are aspects of a person or group, their environment, and their life experiences that make it more likely (risk factors) or less likely (protective factors) that people will develop a given problem or achieve a desired outcome. Risk factors increase likelihood; they do not determine what will happen to a particular person or community.

Often, risk and protective factors can be considered flip sides of the same coin. For example, a family history of alcohol use disorder may be a risk factor for developing problems related to alcohol. On the other hand, growing up in a family where parents and caregivers talk openly about alcohol, model healthy choices, and provide consistent support may be protective. Research suggests that the accumulation of risk factors can increase the likelihood of adverse outcomes in health, education, and development.

Another term used for protective factors is "assets." So-called "asset-based" approaches put the emphasis on strengths and resources that support positive outcomes. These assets may exist within individuals, families, organizations, neighborhoods, cultures, or broader community systems.

We generally group both risk and protective factors into two broad categories: those that occur in the environment, both socially and physically, and those that relate to individual characteristics and experiences. These categories interact with one another and should not be considered in isolation. Let's look at personal factors first.

Personal Factors

Personal factors are characteristics, knowledge, experiences, skills, and circumstances that differ among individuals. They include an individual's knowledge, skills, experience, history, health, and genetic makeup. Here is more specific information on the types of personal factors that may contribute to risk and protection:

Knowledge and Skill:

• Knowledge, including knowledge about available choices, possible consequences, and available resources
• Beliefs, such as ideas about the causes of problems or the consequences of choices
• Skills, including being able to navigate one's environment, communicate, make decisions, and set and accomplish goals
• Education and training, such as formal education, community-based learning, or specialized training

Experience and History

• Experience, such as experiences of care and support, maltreatment or neglect, overcoming barriers, or successfully attaining goals
• Cultural norms and practices, including values, traditions, and expectations that may influence behavior and well-being
• Social and structural position, including experiences of discrimination, exclusion, privilege, or access to opportunity

Biology/genetics

• Existing health, including current health status and health conditions
• Cognitive, mental health, and physical functioning, including disability-related factors and access needs
• Chronic health conditions, including needs for ongoing care, accommodations, or other supports
• Age and sex or gender, when these are relevant to the particular health or development issue
• Genetic predisposition or family history, such as a family history of diabetes, cardiovascular disease, or alcohol use disorder

Environmental Factors

Environmental factors are conditions that affect people within a community rather than being unique to one individual. The environment includes the conditions in which people live, learn, work, play, and interact - their households, neighborhoods, schools, workplaces, and larger communities. These may include aspects of the social environment, including relationships, social support, norms, policies, and community connections. They also include aspects of the physical environment, including access to resources, exposure to hazards, transportation, housing, and other living conditions. Environmental factors fall into the following categories:

Support and services

• Availability and continuity of social support and relationships, such as with family, friends, neighbors, mentors, and others
• Availability of appropriate services, including services that are accessible, responsive, and appropriate to community needs
• Availability of resources, including human, organizational, financial, and material resources

Access, barriers, and opportunities

• Physical access and barriers, including distance, transportation, accessibility, and physical access to services
• Communication access and barriers, including language access, interpreters, translation, accessible communication formats, and technology
• Competing requirements for participation, including work, caregiving, school, transportation, or other responsibilities that can make participation difficult

Consequences of efforts

• Social encouragement and discouragement, such as whether family, peers, institutions, or community norms support particular behaviors
• Incentives and disincentives, including monetary and material gain or loss and access to desired benefits
• Time costs and delays, including the time and effort required to take action, meet needs, and access services

Policies and living conditions

• Policies, such as those affecting access to benefits, enforcement of laws, workplace conditions, and eligibility for services
• Financial barriers and resources, including whether people have sufficient resources for needed goods and services and how resources are distributed
• Exposure to hazards, including toxic chemicals, air pollution, unsafe environments, or other environmental risks
• Living conditions, such as the availability and quality of housing, food, clothing, heating and cooling, transportation, and clean drinking water
• Economic hardship and inequities in resources and opportunity, including difficulty meeting basic needs and unequal access to income, services, and other resources

General principles about risk and protective factors

Before going further, let's look briefly at some general principles about risk and protective factors. These apply across risk and protective factors and across personal, social, physical, and environmental conditions. Research has consistently shown us that:

• Many risk and protective factors are related to multiple community outcomes. That is, they may influence more than one community health and development concern. As such, they can give you a useful place to start in developing your own lists of risk and protective factors. For example, economic hardship and limited access to resources can affect health care access, educational opportunities, nutrition, housing, and other outcomes. On the other hand, a young person having a strong relationship with a caring adult can be an important protective factor across a number of health and development outcomes.

• Not all risk and protective factors are equally influential. Some factors may have a stronger relationship with a particular outcome than others. For example, peer substance use may be an important factor to consider in adolescent substance use prevention. It's important to consider the relative importance of each risk and protective factor because this will help you prioritize your actions later on.
• Risk and protective factors can accumulate and interact. Greater exposure to multiple risk factors may increase the likelihood of an adverse outcome, while multiple protective factors and assets may help support positive outcomes. For example, cardiovascular risk may be influenced by the combination of tobacco use, physical inactivity, blood pressure, cholesterol, nutrition, health care access, and other factors rather than by any single factor alone.

When do you want to learn about the risk and protective factors for your issue?

So, you believe risk and protective factors are important, but are unsure when your initiative should address them. The answer depends in great part on the stage of development of your group - how long you've been around, what you are doing now, your resources, and so on.

Generally speaking, the rule is the earlier, the better. If your organization is already up and running, you might want to look at risk and protective factors before you revise the strategic plan for your initiative. That's something you will probably want to review regularly as conditions, priorities, and available information change.

If you are planning a new initiative or if your organization is starting a new program - perhaps your Youth Coalition recently received a grant to reduce adolescent pregnancy - then the time to start is after you have developed your long-term goals, but before you've developed the road map, or "model of change," that will get you to them.

If your organization is using the "VMOSA" (Vision, Mission, Objectives, Strategies, and Action Plan) approach to planning, you will want to look at risk and protective factors after you've developed your vision and mission, but before you get to the more specific goals outlined in the objectives, and definitely before you develop your strategies. This is because risk and protective factors will sometimes influence your objectives, but they generally fit hand in glove with your strategies, as well as the desired community and system changes that implement those strategies. Let's look at a specific example.

This is the point at which the coalition may want to study risk and protective factors. The LVHCC found that strong relationships with parents, caregivers, and other supportive adults were protective factors for child health and development, while school disengagement was associated with poorer outcomes. Further study suggested that some students faced barriers such as limited academic support, language-access needs, and insufficient culturally and linguistically responsive resources. Altogether, the coalition identified a range of risk and protective factors for child health and well-being. These findings led the coalition to develop a number of objectives and strategies, including the examples below.

• Two of our several objectives are: 1) Within two years, increase meaningful parent, caregiver, and adult interaction with children under 2 years of age by 40%; and 2) Within four years, increase the percentage of young people graduating from high school by 25%.

Remember: Your objectives are specific, measurable results of the work done by your organization. They include the practical details, including how much of what will be accomplished by when.

• Two of our strategies for supporting children and young people in school include: 1) Involving caring adults in talking with or reading to young children; and 2) Increasing the number of bilingual or multilingual teachers and other language-access supports in area schools.

Remember: Your strategies explain how you are going to achieve your goals; they are broad ways to address the mission. Most organizations use multiple and complementary strategies, for example providing information and enhancing skills, improving access and reducing barriers, strengthening services and supports, and changing policies or environmental conditions.

How do you identify risk and protective factors and use them to select people, communities, and strategies for your intervention?

Once you have an understanding of risk and protective factors, as well as when you should include them in your planning, the time is right to identify the particular risk and protective factors that your organization will address. The following few pages offer one possible way to go about doing this.

Review data and information about candidate risk and protective factors for the issue your community is facing.

You can do this by either gathering data that is already available or compiling your own if what you need doesn't seem to have been collected. And of course, you can also combine these two options by using the general data that already exist and supplementing them with information gathered by your organization and community partners.

Let's look briefly at both of these options - gathering and compiling data - and how you might go about each of them.

Gathering available data.

If information is already available, use it. Data on risk and protective factors may already be available for many of the issues of importance to your community. This includes topics such as substance use, cardiovascular diseases, adolescent pregnancy, child maltreatment, access to health care, school success, and a host of other community problems or goals.

To find this information, you can start with ideas given in this section for both general and issue-specific risk and protective factors. From there, you can search credible online sources, check your local library, or contact state agencies, local health or education departments, community organizations, or universities.

If you already know the risk and protective factors for the problem or goal you are working on, you're halfway home. The next step is to find current, reliable data to understand which risk and protective factors are most important in your community and how local conditions compare with appropriate benchmarks.

Historical example: Percentage of Kansans with selected risk factors for cardiovascular diseases

The table below is retained as a historical example of how state and national data can be compared. For current planning, use the most recent reliable data available.

	Kansas	National
Physical Inactivity	50%	56%
Obesity	26%	24%
Smoking	22%	23%
Hypertension	21%	21%
High Cholesterol	18%	18%

Source: 1992 Behavior Risk Factor Surveillance System, Kansas Department of Health and Environment

Developing your own information.

Sometimes, however, there just isn't information available on the topic that you are researching. Or, you might have general information on risk and protective factors, but also want to know which specific factors are important in your community, how people experience them, or the extent to which they exist locally. Then, you'll need to use other methods to develop the information you need. Although they are discussed more fully in other sections of the Community Tool Box, let's touch here briefly on several possibilities.

• The "But why?" technique. This is a method often used to identify underlying factors that contribute to a community issue. The "But why?" technique examines a problem by asking what caused it. Each time an answer is given, a follow-up "But why?" is asked. For example:

From the brainstorming done here, you might identify factors such as competing work and caregiving responsibilities, limited access to affordable childcare, and the need for more flexible educational or family supports. This technique is especially useful early on for developing possibilities that can then be explored through conversations with people affected, focus groups, surveys, or existing data.

Focus groups

Focus groups can also give you a better understanding of the issue. They are small-group discussions designed to gather participants' experiences, perspectives, and ideas. Depending on the purpose, a focus group may bring together people who share certain experiences or characteristics when doing so helps participants feel comfortable speaking openly. The composition of the group should be based on the questions you are asking rather than assumptions about who will or will not feel comfortable together.

One advantage of focus groups is that they can provide context, lived experience, and a deeper understanding of how people feel about an issue. Although a survey can provide systematic information about patterns across a larger group, focus groups can help explain what those patterns mean to community members and why they may exist.

Surveys

If you have the resources and would like to make your results more systematic, you can conduct a survey to find out which risk and protective factors are important in your community. It's possible that you will want to test some of the information you found using the "But why?" technique, compare local information with broader data, or develop or adapt a survey to address these topics.

Select risk and protective factors to be addressed by your comprehensive intervention.

Now that you have determined what the likely risk and protective factors for your issue are, the next step is to decide to what extent each of these factors should influence your strategic plan. There may be some factors on which you want to spend a great deal of time and resources, and others that you may not want to address directly, at least at the beginning. Two key questions can help you sort out how much weight you want to give to each risk and protective factor:

• Does it strongly influence the issue? Is a given risk or protective factor strongly associated with the outcome you hope to change, or is the relationship weaker? For example, peer substance use may be an important factor to consider in adolescent substance use prevention. The relative importance of a risk or protective factor can often be explored through existing research, local data, community experience, surveys, and other forms of evidence.
• How changeable is it? Most factors fall into one of three broad categories, or "degrees of changeability":
  • Some risk and protective factors can be changed substantially. For example, high cholesterol may often be improved through changes in nutrition and physical activity and, when appropriate, medication and clinical care.
  • Some risk and protective factors may be modified but not completely eliminated. An example might be access to alcohol or other substances among young people. Communities may be able to reduce access through policy, enforcement, retailer practices, education, family engagement, and other strategies, even if complete elimination is unrealistic.
  • Finally, some factors cannot be changed directly. Family history and genetic predisposition, for example, may influence the likelihood of developing some health conditions, including alcohol use disorder. These factors should not be used to label people or assume an outcome is inevitable. Instead, they can help identify opportunities to strengthen protective factors, supportive relationships, prevention resources, and early access to appropriate services.

One way to decide which factors to prioritize is to consider those that appear to have a strong relationship with the outcome and that your organization or partnership has a realistic and equitable opportunity to influence.

By answering the two questions above, you can start to decide the appropriate mix of risk and protective factors that you want to address. The next step is to decide how many of these factors your initiative has the resources and partnerships to pursue effectively.

It is quite common for an organization to address a mixture of risk and protective factors. How extensive your list is may be determined in large part by the people, partnerships, time, funding, and other resources available. Most organizations will not be able to address every factor at once, and some factors will have a higher priority than others. You will therefore have to make thoughtful choices about priorities.

But remember: positive outcomes can be supported by strengthening multiple protective factors and community assets. If your organization cannot address all of the factors needed to make a meaningful difference, consider forming a partnership with other groups that can contribute complementary strengths and resources.

Once you have considered all of this, make a list of the risk and protective factors your initiative will try to change or strengthen. You will want to have this list handy as you move to the next step.

Use information about risk and protective factors to identify people and communities who may benefit most.

Once you have decided which risk and protective factors are important and potentially changeable, your next step is to identify the people and communities who may benefit most from your intervention. This may include people who experience greater exposure to particular risk factors, have less access to protective resources, or are affected by systems and conditions connected to the issue.

Be careful not to use risk information in ways that stigmatize people or imply that an outcome is inevitable. Risk and protective factors can help identify where resources, opportunities, policy changes, or additional support may be useful, but they should be considered alongside community strengths, lived experience, and the priorities identified by people most affected.

Other considerations include cost, reach, feasibility, equity, and the likely benefit of different approaches. These choices have ethical implications. People or communities with the greatest barriers should not automatically receive less attention simply because reaching or serving them may require additional resources.

If the intervention you are planning is fairly new and there isn't yet much evidence about how it will work in your community, you might begin with a well-defined pilot group while involving community members in planning and evaluation. A pilot can help you learn and improve before expanding the effort, but participants should not be selected simply because they make success easier to demonstrate.

The table below shows how candidate personal and environmental factors can be used to help identify people and communities who may benefit from the intervention.

Use the information about the types of risk and protective factors to select promising strategies or components for the comprehensive intervention.

At this point, you have decided what you want to change or strengthen - the specific risk and protective factors your organization has chosen. You have also identified who may benefit most and who should be involved. The next step is to organize all of this information to help you develop your initiative's strategies - how you are going to get things done.

The table below shows how risk and protective factors, the people and communities involved, and strategies are all interrelated.

Using risk and protective factors to select people, communities, and strategies (components) for a comprehensive intervention

	What Candidate Risk and Protective Factors	Who People or Communities Who May Benefit	How Strategies for the Comprehensive Intervention
Personal	Knowledge and skills Knowledge Beliefs Skills Education and training	People who would benefit from additional information, education, training, or skill-building opportunities	Provide accessible information and opportunities to build knowledge and skills; engage participants and community partners in designing relevant approaches
Personal	Experience and history Experience Cultural norms and practices	People who have experienced maltreatment, discrimination, exclusion, or other barriers to achieving their goals People whose social or cultural environments may include factors that increase or reduce risk	Strengthen services, relationships, and support Expand opportunities and address barriers
Personal	Biology and genetics Existing health Cognitive, mental health, and physical functioning Chronic health conditions Age and sex or gender Genetic predisposition or family history	People living with health conditions or disabilities who may benefit from accessible services, accommodations, prevention, or other supports	Strengthen accessible services, supports, accommodations, and preventive resources
Environmental	Support and services Availability and continuity of social support and relationships Availability of appropriate services Availability of resources	People experiencing social isolation, unmet support needs, or limited access to appropriate services and resources	Strengthen services, relationships, resources, and support
Environmental	Access, barriers, and opportunities Physical access and barriers Communication access and barriers Competing requirements for participation	People facing barriers to services, participation, communication, transportation, accessibility, or opportunity	Improve access, reduce barriers, and expand opportunities
Environmental	Consequences of efforts Social encouragement and discouragement Incentives and disincentives Time costs and delays	People whose participation or choices are affected by social expectations, limited incentives or resources, work or caregiving responsibilities, time, or other competing demands	Adjust incentives, supports, expectations, and conditions to make desired actions more feasible
Environmental	Policies and living conditions Policies Financial barriers and resources Exposure to hazards Living conditions Economic hardship and inequities in resources and opportunity	People and communities experiencing economic hardship, inequitable access to resources, unsafe or unhealthy conditions, or disparities in outcomes	Modify policies, systems, resource allocation, and environmental conditions

For a concrete example of the above, consider the following example from an organization working to improve quality of life in an urban neighborhood. It lays out just a few of the group's identified risk and protective factors, the people and partners connected to them, and possible strategies. After each risk or protective factor, its category from the table above is listed in parentheses.

Risk and Protective Factors for a High Quality of Life in the Neighborhood	People, Communities, or Partners Involved	Strategies (Components of the Intervention)
Limited incentives for businesses to invest in the neighborhood (Consequences - incentives/disincentives)	Local residents, small and large business owners, economic development organizations, and public officials	Change incentives and conditions - consider targeted incentives, technical assistance, or other strategies that support businesses that meet community priorities and contribute to local economic opportunity
Lead paint and other housing hazards (Policies and living conditions - exposure to environmental hazards)	Residents of affected housing, property owners and managers, housing organizations, building inspectors, and public health agencies	Modify policies and practices - enact and enforce appropriate housing safety requirements Work with residents, property owners, building inspectors, and health departments to identify and address housing hazards
Community experience, leadership, and knowledge of overcoming barriers (Experience - protective factor/asset)	Local residents, neighborhood leaders, and community organizations	Strengthen community leadership - support resident-led advocacy, leadership development, shared decision-making, and opportunities for community members to shape policies and neighborhood improvements

In Summary

Having a solid understanding of risk and protective factors, along with the people and communities most affected by them, gives you an excellent base from which to develop strategies for your initiative. By reducing or changing important risk factors, strengthening protective factors and community assets, and addressing the systems and conditions that shape people's opportunities, your organization and its partners can work more effectively toward the outcomes the community has identified.

 

___You have a good understanding of risk and protective factors, including the different categories of factors, what affects these factors, and when they should be addressed by your organization.

___You have gathered available data on risk and protective factors for the issue your community is facing.

You have decided what technique(s) will best help your information on local risk and protective factors:

___The "but why" technique

___Focus groups

___Surveys

___You have developed your own information on risk and protective factors, using the mean(s) you decided were most appropriate ("but why," focus groups, and/or surveys ).

___You have selected the risk and protective factors your intervention will address.

___You have used information about who is affected by multiple risk factors to select your "targets of change."

___You have used the information about risk and protective factors and targets of change to select promising strategies for the comprehensive intervention.

Example 1: Risk and protective factors that may be related to disparities in health outcomes associated with race and ethnicity

Here, risk and protective factors are separated into three broad categories by who is affected by, or can affect, that factor.

This example is adapted from Promoting Health for All: An Action Planning Guide for Improving Access and Eliminating Disparities in Community Health. See Resources for a full citation.

Knowledge and skill (personal)
Consumers/Local Residents	Health Care Providers	Broader Agents/Allies
Knowledge (e.g., of preventative health practices, self-care, resources for health care) Beliefs (ie, about causes and consequences of health behaviors and outcomes, e.g., effects of diet, physical activity) Skill (e.g., in accessing available services, advocating for needed services, language spoken) Education and training (e.g., years of formal education)	Knowledge (e.g., of local culture, client health needs) Belief (e.g., about what consumers value) Skill (e.g., cultural competence, languages spoken) Education and training (e.g., extent and adequacy of training)	Knowledge (e.g., of the problem of access/disparities) Beliefs (e.g., about how our health is bound up in that of others)
Experience and history (personal)
Consumers/Local Residents	Health Care Providers	Broader Agents/Allies
Experience with health systems (e.g., discrimination in seeking services) Experiences of prior health care (e.g., pain, no improvement) Cultural norms and religious practices (e.g., diet, healing practices)	Experience with service provision (e.g., respect shown to consumers) History of working with consumers (e.g., hostility, no improvement)	Community norms for racial and ethnic harmony (e.g., history of race/ethnic relations ) History of collaboration in public problem solving (e.g., involving those most affected and those most responsible)
Biology/Genetics
Consumers/Local Residents
Type and degree of existing health (e.g., pre-existing conditions, risk markers ) Cognitive, mental or physical ability (e.g., mobility impairment, psychiatric disability, cognitive ability) Chronic illness (and requirements for care) Gender (e.g., women or men may be more at risk for particular health outcomes) Age (e.g., infants, adolescents, or older adults may be more at risk for particular health outcomes) Genetic predisposition (e.g., diabetes)
Support and services (environmental)
Consumer/Local Residents	Health Care Providers	Broader Agents/Allies
	Availability and continuity of services and support (e.g., continuity of care from providers; peer support)	Social support and ties (e.g., through neighbors, faith communities)
Access, barriers, and opportunities (environmental)
Consumer/Local Residents	Health Care Providers	Broader Agents/Allies
Communication access/barriers (e.g., languages spoken) Physical access/barriers (e.g., transportation)	Communication access/barriers (e.g., available interpreters) Physical access/barriers (e.g., distance and physical access to facilities) Human resources (e.g., too few providers for need; availability of providers from ethnic community)
Consequences of efforts (environmental)
Consumer/Local Residents	Health Care Providers	Broader Agents/Allies
Competing requirements to participation (e.g., child care, work)	Time costs (e.g., waiting time for service, convenient hours of service)
Policies and living conditions (environmental)
Consumer/Local Residents	Health Care Providers	Broader Agents/Allies
Living conditions (e.g., homelessness, adequate housing, heat/cooling, clean drinking water) Poverty/financial resources (e.g., not enough money for basic needs, for needed health services)	Financial barriers and resources (e.g., not enough money for needed health care, for prevention) Policies (e.g., requirements for insurance coverage, co-payments, refusal of service)	Public accommodations for participation (e.g., available child care, transportation ) Employer accommodations and policies (e.g., workplace health services, flextime policies to permit participation, health insurance policies) Government policies (e.g., distributive policies that assure access to care) Poverty and deprivation (e.g., policies supporting economic development, education, and housing in neighborhoods of concentrated poverty)

 

Example 2: Substance use among young people

Information in this example comes from Drs. David Hawkins' and Richard Catalano's book Communities that Care. See Resources for a full citation.

Researchers David Hawkins and Richard Catalano have done extensive research on the risk and protective factors associated with substance use, particularly among young people in the United States. They determined that the risk and protective factors in the environment include all of the following. (Note that the heading itself gives the risk factor with the corresponding protective factor following in parentheses.)

• Economic deprivation (affluence)
  Those who live in deteriorating neighborhoods with little or no hope of a better future are much more likely to abuse alcohol and other drugs than those who live in more affluent communities.
• Community disorganization (organization)
  There are more problems related to substance use in areas where there is little sense of community; where people don't feel as if they are part of a greater whole.
• Transitions and mobility (stability)
  The more young people move to new environments, the more likely they are to use drugs. These transitions can be as typical as changing from middle school to high school, but changes are more likely to increase risks when they are more significant, such as frequent moves to new cities or towns.
• Availability of substances (lack of availability)
  The easier it is for people to get a hold of illegal substances such as drugs, the more likely they are to use them.
• Community norms saying it's "okay" to use drugs and alcohol (community views that say it's not okay)
  An example of this might be students in a college town, where excessive drinking among younger students is seen as a type of rite of passage to adulthood and not as a public health problem.

Hawkins and Catalano also determined that some of the individual or personal risk and protective factors for substance use include the following things. Again, protective factors are in parentheses.

• Family history of drug abuse (family history of appropriate use or nonuse)
  Children who have parents who are alcoholic or who abuse drugs are much more likely to have drug problems themselves. This is true for both girls and boys, but is a higher risk for boys, for whom a genetic link for alcoholism has been established.
• Family management problems (family strengths)
  These include a lack of clear expectations of what a child is supposed to do, a lack of someone to pay attention to what a child is doing, and inconsistent or overly harsh discipline.
• Academic failure (academic success)
  Children may fail in school for a variety of reasons, but it appears that just not succeeding increases the likelihood of substance use problems.
• Antisocial behavior (strong, positive social skills)
  This may include aggressive behavior among small children, misbehaving in school, skipping school, or getting into fights with other children.
• Friends who use drugs (friends who don't approve of drugs)
  This is one of the risk factors that has consistently predicted the use of drugs. Children whose friends use drugs are much more likely to do so than those whose peers don't use drugs, even if they don't generally experience other risk factors.

Some of the protective factors (this time, with the associated risk factors in parentheses) Hawkins and Catalano have found for substance use include:

• Bonding (lack of caring adults)
  Research has consistently shown that close relationships with non-drug users are one of the cornerstones of keeping adolescents from experimenting with drugs. Young people who have adults who care about them, and who help strengthen their values or beliefs of what is strong, ethical behavior are likely to have a clear idea about what is right, and the strength to behave in an appropriate manner.
• Skills (lack of competence)
  Children need to have skills to feel like they are contributing members of their family. If children are given the chance to help out with responsibilities, and are also given adequate training for those responsibilities (for example, they are taught to cook dinner, or to help tend the family garden), they will feel useful and successful. They will be less likely to start abusing alcohol or other drugs in search of the positive recognition they aren't getting at home.
• Healthy beliefs and clear standards (mixed messages)
  Living in a community, attending a school, and being part of a family where beliefs and standards are clearly against the use of drugs is a strong protective factor against experimentation. On the other hand, if children receive mixed messages, this could become a risk factor. For example, the message to a child is clear when the family goes out to eat, and the waitress asks if the family would prefer the smoking or nonsmoking section. If mom says, "Non smoking, please, we worry about our children inhaling second hand smoke," the message against cigarettes is clear to the children, even if the reply wasn't directed to them. On the other hand, a father who instructs his children not to use alcohol over his fourth beer sends a message that is much less clear.

Example 3: Determination of which risk and protective factors to focus on for teen substance use

Members of a small anti-drug coalition in rural Mississippi wanted to decide which risk and protective factors they should address. Using the table below, several people sat down and discussed which risk and protective factors were both important and changeable. Then, they ranked what they had said. The smaller the number they used, the more important the risk or protective factor (or, the easier it was to change.)

This is what they found:

Risk or protective factor	Importance		Changeability		Final value
Family history of drug abuse	1	+	3	=	4
Community norms saying it's "okay" to use drugs and alcohol	1	+	1	=	2
Transitions and mobility	2	+	3	=	5
Availability of substances	1	+	2	=	3

When all of the information was in front of them, they realized that their choices were easier to make. Although they all agreed that a family history of drug abuse was a very important risk factor, they realized that, given their limited budget, there wasn't a whole lot they could do about that risk factor right now. Similarly, with the category "transitions and mobility," they all agreed it was at least somewhat important, but again, there wasn't a whole lot they could do. Besides, the community was relatively stable; there weren't a lot of people moving in and out, and so this factor seemed a little less important.

However, all of the members felt that changing community norms and lessening the availability of substances were important risk factors that they could do quite a bit about. They could talk to people, start media campaigns, and conduct "stings " on stores that were selling alcohol to people under 21. The members decided to concentrate on these two risk factors as part of their current strategic plan. They also decided to come together again and reevaluate their work in six months.

Example 4: Risk and Protective Factors for Sexual Violence Prevention

This infographic highlights the connections between risk and protective factors and social determinants of health at the various levels of the social ecology, and can be used to link sexual violence prevention with anti-oppression and related public health issues in order to create more effective change.

 

Download a PDF of this chart.