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Example 1: The North Quabbin Community Coalition

Background: The Need

The North Quabbin area of central Massachusetts comprises nine towns with a total population of under 25,000. While several are picture-perfect, white clapboard New England villages, three are industrial - mill towns from which the mills are in the process of disappearing. Athol, the largest, was also, in 1984 as now, the region's commercial hub, with the largest employers, the only local hospital, most of the shopping options, the YMCA, and the regional Chamber of Commerce.

By the 1980's, the area had been losing its traditional base of employment - machine tool and shoe factories - for several years. It was in a part of the state that was sparsely populated and regularly ignored in Boston, where policy was made and funds allocated. In addition, although the nine towns operated as a coherent region - most residents of the nine towns did their grocery shopping in Athol and Orange, for instance - they were divided between two counties and among as many as three different state representatives and two state senators.

In 1984, the North Quabbin area had one of the highest unemployment rates in the state. A strike had precipitated the closing of one of the largest employers in Athol, and the loss of over 300 jobs had proved devastating. After two medical students dispatched by the Area Health Education Centers (AHEC) reported that the region was on the verge of a serious increase in hunger and homelessness, Tom Wolff, a community psychologist, was hired by AHEC's director to try to start a coalition to address the North Quabbin's situation.

The core group

Tom came equipped with experience working with communities and a short list of people in the area who might be helpful. He eventually assembled a Steering Committee of community people that was small, but influential. It included the President of the Athol-Orange Area (now North Quabbin) Chamber of Commerce; the Director of Athol Memorial Hospital; the Executive Director of the Human Resource Center, the local mental health agency; and one of the region's state representatives.

"We decided to take the summer to plan, and to try to hold a meeting in the fall," Tom explains. "We got the Chamber of Commerce involved because it was an economic development issue, and also because the President, a banker, had been both a minister and a human service worker. The hospital was one of the area's largest employers, and the Human Resource Center was the biggest of the agencies. It was an obvious group to work with."

The mission

The Steering Committee developed a list of goals for the Coalition (later approved by the Coalition as a whole):

  1. To develop a planning body for health and human services for the area.
  2. To promote greater cooperation among all agencies delivering services to the nine towns.
  3. To collaboratively solve problems regarding the major local health and human service issues.
  4. To develop an advocacy capacity to lobby for appropriate services for the area.
  5. To provide information to community providers and residents to increase accessibility and visibility of available services.
  6. To monitor successful implementation of plans developed by the Coalition.

The Steering Committee also adopted a set of guidelines for reaching these goals.

  1. All decision-making and problem solving should be collaborative, so that everyone would buy into Coalition initiatives.
  2. The Coalition should follow the rules of group process, which included having a defined leader or facilitator; clear goals; capacity to focus on its own process; respect for all contributions; and encouragement of participation.
  3. Addressing any issue should begin from the assumption that the community often already has some or all of the resources to solve the problem. Resources should be sought from within the community before anyone begins to look outside.
  4. The membership should be open to anyone who wanted to join, and should include line staff as well as directors of health and human service agencies, and broad representation from the community.
  5. The Coalition should take an "ecological " approach to individuals and problems, considering the whole context of an issue or an individual's life, and not limiting either through the narrow focus of a single agency's point of view.

Recruiting members

The Steering Committee put together a list of people and organizations that needed to be included in any North Quabbin coalition if it was to be successful. These included all the local health and human service agencies (a sore point was that some services were only available from agencies based in Greenfield, 25 miles away and not part of the region), all the state legislators representing the area, the clergy, employers (the Chamber connection was important here), local officials, and such area institutions as the YMCA.

Tom and the other Steering Committee members got on the phone and started contacting people. They received immediate and eager support from the legislators, among others, and were pleasantly surprised to find how much general enthusiasm there was for the idea. "We had planned to start with a small group," Tom remembers, "but there were more than 60 people who wanted to play. We couldn't turn them away."

The first meeting

The first meeting of the Coalition was held at the Knights of Columbus hall in Orange, and it was packed. All the legislators were there, representatives of all the health and human service organizations, members of the Chamber, clergy, local officials... almost everyone who had been invited.

Tom facilitated the meeting for several reasons: First, he was a neutral presence, with no connection to any of the agencies or other entities represented at the meeting, and therefore carried with him no negative history. Second, he had had experience working in communities and bringing groups together. Third, he was an expert facilitator, with the skills to make sure everyone was heard, to keep the meeting from being derailed by individual agendas or old conflicts, and to see that the group accomplished something substantive. And finally, AHEC had sent him into the area to bring the coalition together: it was part of his job.

Community history didn't bode well for collaboration. "The human service agencies never talked to each other, and didn't really interact with other parts of the community," recalls Tom. "Just getting everyone in the same room was an accomplishment. Then they started to talk about what they saw as the issues, and found they had all kinds of experience in common. It all really started at that first meeting."

The immediate agenda, set by the core group, was to define the issues the Coalition would address. Nearly everyone spoke, and all spoke of a community with a negative self-image, few employment opportunities, emerging homelessness, and an across-the-board lack of information. Agencies didn't know what others did or who they served, people who might use agency services often didn't know they existed, and the community had no idea what was available.

By the end of the meeting, it was clear that, at the very least, agencies needed to share information, and needed a way to get information out to the community. The group set a next meeting, agreeing to meet monthly, and to continue to recruit members. Tom announced the time and place of the next Steering Committee meeting, and made it clear that anyone interested was welcome to join.

"One of the most important things that came out of that first meeting was that people who had never talked to each other were talking. Even at the first meeting, connections were being made that hadn't been made before, and agencies that had never worked together were starting to see ways they could cooperate. There were mammoth turf issues and defensiveness, and those didn't go away all at once. But at least there was some conversation going on."

Defining issues and developing a way of working together

As the Coalition continued to meet, people started addressing the approved goals and the issues that arose from the first meeting. An Information and Referral Task Force was formed at the second meeting, and began to explore ways to set up a local Information & Referral service. A group constituted itself early on as the Planning Committee, and developed and distributed a survey, asking Coalition members where they wanted the community to be in ten years, and how they thought it could get there. The Steering Committee and legislators began working together on advocacy for more resources for the area, helped by some of Tom's and others' connections in the state bureaucracy.

Coalition meetings themselves took the form of information-sharing and problem-solving sessions. When problems were identified, task forces formed to address them, and there was an effort to involve everyone with any connection to the problem. Specific problems were analyzed so that they could be approached by all the concerned organizations and entities working together, and inter-agency cooperation became far more common. The mere existence of the Coalition had begun to solve one of the biggest problems originally identified by the medical students when they came to the area: a lack of coordination among agencies in delivering services and dealing with the area's larger issues.

The Steering Committee was also changing, with more members beginning to attend meetings and some of the original members dropping off. By the end of the year, only Tom and two of the other original members remained: the rest were Coalition members who, as had been hoped, had started attending and ended up joining the Committee.

Halfway through the year, a combination of the Coalition's advocacy efforts and the designation of the area as an economic target brought the Governor to Athol. Tom and other members of the Steering Committee were able to speak with him, and to gain some promises of increased resources for area human services. Unlike many of such promises, these were kept, and the Coalition had a solid accomplishment under its belt.

By the end of the first year, the Coalition could point to funding for an Information & Referral service, awarded, after some fairly nasty infighting among agencies, to a grassroots organization that had already been doing it on a small scale. More state money had been directed to the area, and local agencies were beginning not only to deliver more services, but to reach out to the community more. Agencies were collaborating on programs, and there was talk of case coordination for individuals involved with several different organizations.

At that point, Tom offered to leave and turn the Coalition facilitation and coordination over to the community. Coalition members refused the offer, feeling that a neutral facilitator remained a necessity. (Over time, an assistant was hired, who ultimately became a paid coordinator. That position remains, and the Coordinator provides most of the leadership and administration for the group. Tom continues to be involved with the Coalition, attending meetings from time to time and acting as a resource for the Coordinator and the Coalition as a whole.)

The Coalition marked the end of its first year with a luncheon, with much to celebrate. Monthly meetings were attracting between 25 and 40 people, and they weren't the same people at every meeting. By the end of the year, more than 90 individuals had participated in Coalition activities, many of them devoting many hours to task forces and advocacy efforts as well as meetings. The North Quabbin Community Coalition was off and running.


More than 17 years later, the Coalition continues to flourish, and to successfully address issues in the North Quabbin area. Task forces on child sexual assault, teen pregnancy, and youth development have spun off into successful, independent programs. The North Quabbin Coalition became the model for several others around the state, all of which are still going concerns.

The success of the Coalition rests on its beginnings. It filled a need, but it would not have been effective - and would not have lasted - if it hadn't started with a vision and inclusiveness that fostered trust among members and led to substantive achievement.

Example 2: The East Quabbin Alliance (EQUAL) Collaborates for Community Change

This story is adapted with permission from AHEC/Community Partners' Healthy Communities Newsletter, Mar.-Apr. 2002 issue

In the beginning: coming together for a purpose

Some coalitions are born of a crisis. Others, like EQUAL (the East Quabbin Alliance ), in Barre, Massachusetts, are created by a desire to make long-term improvements in a community.

Coalitions can be complex community organisms, and it is often hard to pinpoint an exact moment of creation. While there wasn't a single burning issue that got EQUAL going, many people in the area had shared concerns, and were eager to work together for change.

EQUAL's roots can be traced to the local Barre Family Health Center that it eventually helped save (more on this below). In 1999, to help raise the understanding of community health approaches in Barre, Dr. Joseph Stenger, a staff physician at the center, and Suzanne Cashman, of the Center for Family and Community Health at the UMass Medical School, organized a series of discussions about the blending of clinical medicine, public health, and community activism in a Healthy Communities model.

These discussions stimulated interest in developing a community health coalition, and a core group of residents came together to form EQUAL. They described the new group as "a community-wide coalition committed to nurturing the quality of life for all those living in the East Quabbin Region."

"I was resistant to getting involved at first," says Sue Coles, a member of EQUAL's steering committee, "because I didn't want to be part of a bureaucratic boondoggle." But she was pleasantly surprised when she first started attending meetings to find that the group was intent on making changes in the community.

In 2001, Healthy Communities Massachusetts granted scholarships to the eight members of EQUAL's steering committee, enabling them to attend the Healthy Communities Massachusetts Institute. With lessons on community visioning techniques, asset mapping, issue framing, planning, evaluating progress, and more, the group came away feeling prepared to take on the challenges ahead.

"The training session really instilled a lot of confidence for me," says steering committee member Sam Kertiles. "I realized I just had to 'do it,' rather than think about whether or not I could do it. I learned that it really doesn't matter who you are, everyone brings something to the group that can be helpful."

Setting-and sticking to-an agenda

Rather than incorporating and becoming an independent organization that runs programs, the volunteers in EQUAL decided to help existing organizations and agencies in Barre and surrounding towns formulate and carry out their work. "There are already so many assets out there," says Gail Murphy, another steering committee member. "We didn't need another group."

The coalition made an impact on Barre within its first year. One of its projects was to publish a community resource guide, a directory of 232 local agencies and organizations that has proven valuable for organizations with clients who need referrals.

"EQUAL's primary achievement has been to get a lot of the organizations in town to collaborate, cooperate, and share resources," says Stenger. "The organization has become a venue where people can come talk about what their groups are doing."

EQUAL does not sit and wait for existing organizations to come to them, though. The group's members began attending meetings of agencies like the local Youth Commission, which had been stagnating for some time. Thanks to EQUAL's participation, the Youth Commission is now more active than ever, with a group providing support for kids with emotional problems, regular meetings for teens to discuss their concerns, and plans to develop a youth center.

In the youth group, Sam Kertiles worked with local teens on "empathy, understanding and support." After the first eight week session, participants in the group overwhelmingly endorsed it, with one teen commenting that the group had "helped me to grow a little more mature and has showed me better ways to handle my feelings."

EQUAL also saw that work on Barre's open space plan was languishing, so several members restarted the planning process. Martha Varnot, who is active on EQUAL's steering committee, was surprised to find "no growth plan in a community that's growing," and few people concerned enough to create such a plan. EQUAL is helping create that interest, she says, and is working with residents to develop leadership skills and confidence.

Residents were also worried about the local landfill, located right next to the Ware River, the community's primary watershed. In collaboration with the Board of Health, information is being gathered on water safety, recycling, and toxins. "We're using the open space committees work to address the issues posed by the landfill," explains Varnot.

Like any community, the number of issues to be tackled in the Barre region is seemingly endless, but EQUAL has maintained its focus on these two-the environment and youth issues. That focus contributes to their ability to make headway in their work, and helps ensure that new participants in EQUAL know just what they're getting into.

Responding to crisis

Though its focus is on long-term issues, EQUAL has also been able to put out at least one fire. The crisis was a threat to the Family Health Center in Barre-the same health center whose staff introduced the healthy community ideas that led to the coalition's creation.

The clinical staff is like family for many Barre residents. So when several staff positions were cut from the health center in the fall of 2001 due to budget cuts by the facility's parent company, the town felt a loss. EQUAL organized a town forum, inviting Dr. Marianne E. Felice, Interim CEO of UMass Memorial, to address the community's concerns. More than 80 residents attended, an amazing turnout for a town whose population is well under a thousand. (And though the cuts were system-wide, Barre was the only town to hold a forum.)

The efforts to save the center were successful. "I can see the relationship that the town has with the center," Felice said at the forum. While she defended the cuts in staff as necessary to keep the corporation in business, she promised the community that she "wouldn't even consider ever closing the clinic."

"I remember when then-freshman Senator Ted Kennedy cut the ribbon opening that center in 1962," says State Senator Stephen Brewer. "Those clinics are still the most cost effective health delivery system. Thanks to EQUAL, the forum helped put a face on the need and value of that clinic."

Seeking new members, listening to new voices

EQUAL's broad purpose enables its members to work to their own strengths and interests. Sue Coles has committed to bringing other voices to EQUAL that might not otherwise be heard--those of seniors, people with disabilities, and residents who can't come to meetings. Coles goes to these people instead and interviews them as part of what she calls her "Conversations on Community" project.

In the course of these interviews, Coles asks her subjects what they think a healthy community is, what they like about their community, and what they would miss if it were lost. These questions inevitably lead to discussions about what aspects of the community need attention, she says, and those thoughts are taken into account as EQUAL plots its evolving course. Coles writes up her interviews for publication in the Barre Gazette.

Her interviews have lent a wide range of perspectives to EQUAL's work. Edith Swindell, who has lived in Barre for 94 years, said "There should be places for children to play," and stressed the importance of re-connecting residents to the town's natural assets and beauty, saying "I don't think a lot of people have any idea. They go whizzing by and don't see a thing."

"A healthy community means one where people are engaged," says Coles, when asked to respond to some of the questions she puts to her subjects. "It's where people care about connecting with other people to share responsibility and pride in their community." In an ideal world that kind of atmosphere is created naturally, she says, but in reality it needs to be fostered constantly, lest inertia and apathy take over.

Maintaining the momentum

Kertiles says she was "smitten" with EQUAL after attending her first meeting; since then she has been writing grants and creating a newsletter for the organization. She said the core group of EQUAL participants "know that to keep people involved you just need to include them, listen to them, and not judge them. They made me feel like there was a place for me."

That kind of attitude needs to be maintained for the coalition to succeed, agree organizers. "For this to work we need to keep getting new people to participate so that nobody gets stuck taking on jobs they don't want to do," says Coles. "It also has to keep evolving and re-evaluating its mission. We have to keep ourselves open so we can engage more people and keep them interested."

EQUAL relies entirely on volunteer efforts. Members of the steering committee share the responsibilities of chairing meetings, and the Barre Family Health Center provides some services such as photocopying.

After operating with almost no budget its first year, though, EQUAL received a $1,000 Incentive Grant from Healthy Communities Massachusetts, which was matched with a $1,000 gift from the Barre-based Stetson School. The funds will help the group carry on, engage new members, and perhaps pursue new issues, such as the needs of local seniors.

When asked what headline she would want to see in the local newspaper about EQUAL in five years, Kertiles says, "Volunteer-Staffed Teen Center Opens in Barre." Coles sets her sights a bit differently, and offers "EQUAL's Model Community Implemented by U.N."

Example 3: How Public Health Advocate D'Jillisser Kelly is Raising Awareness to Reduce Tobacco Use and Vaping

For decades, the tobacco industry has used menthol as a tool to disguise the harsh effects of cigarette smoke and to lure young people into becoming smokers. More than 18 million people in the U.S. smoke menthol cigarettes – and a recent study states that menthol cigarettes were responsible for “157,000 smoking-related premature deaths” among Black Americans during the period of 1980-2018.

D’Jillisser Kelly, MPH, CP, knows that reaching young people is key to tobacco education and prevention. In fact, most adults who currently smoke began smoking before age 18. As lead project coordinator with No Menthol Movement ATL, an initiative to reduce tobacco use and vaping in Atlanta and surrounding areas, D’Jillisser helps cultivate multigenerational coalitions to address the harm of menthol and other flavored tobacco products.

She shares her journey to public health, discusses the importance of tobacco education, and how youth can use their voices in the QA and full article at this link.

Phil Rabinowitz