This paper was developed by the Contra Costa County Health Services Department Prevention
Program to assist public health programs in developing effective community coalitions
for injury prevention. Although the examples given are specific to injury prevention
colations, most can be applied to coalitions working on a variety of health-related issues.
Outlined in this paper are the general principles for initiating and maintaining effective
coalitions that emerged duriung the Prevention Program's ten years of experience and through
the review of numerous other materials on coalition building.
Written in the format of eight specific steps, this paper attempts to give structure
to a process that is somewhat variable. Therefore, this paper is
to be used as a general guide. Each group will find ways of interpreting the eight
steps to best suit its own needs. The particular details of the solutions arrived
at by each coalition will be unique.
The ideas presented in this paper are an outgrowth of a Special Project of Regional
and National Significance (SPRANS) grant awarded to the Contra Costa County Health
Services Department by the U.S. Department of Health and Human Services Maternal
and Child Health Division. This is a new version of "Developing Effective Coalitions:
An Eight-Step Guide" that was published in the "Injury Awareness &
Prevention Centre News," Vol. 4, No. 10, Alberta, Canada, December, 1991.
"The opportunity to interact with people from related programs strengthens my
day-to-day work. Now I know who to refer my clients to and where to go for advice
when I need it."
"Without the coordination that this coalition provides, we never would have
accomplished such a broad policy objective."
"Another meeting? I'd like to attend but I have real work to do."
"This coalition used to be worthwhile, but now I find it a waste of time."
Health professionals attend numerous meetings and sometimes assume that they understand
everything it takes for working groups to succeed. Often, however, groups fail or,
perhaps worse, flounder. To avoid this type of experience, which only erodes faith
in collaborative efforts, people need to sharpen the skills that are necessary to
build and maintain coalitions. This paper contributes to the discussion of group
processes by offering an eight-step guide to building effective coalitions. This
paper is written from the perspective of an organization considering initiating and
leading a coalition, but can be helpful to anyone eager to strengthen a coalition
in which he or she participates.
What Is A Coalition?
A coalition is a union of people and organizations working to influence outcomes
on a specific problem. Coalitions are useful for accomplishing a broad range of goals
that reach beyond the capacity of any individual member organization. These goals
range from information sharing to coordination of services, from community education
to advocacy for major environmental or policy (regulatory) changes. In this Eight
Step Guide, the word "coalition" is used in a generic sense to represent
a broad variety of organizational forms that might be adopted. The approach outlined
in this paper is intended to be used by any collaborative group seeking to influence
outcomes or goals (see Figure A).
A coalition can be an effective means of achieving a coordinated approach to injury
prevention. For example, many agencies that focused primarily on providing direct
services after the occurrence of violent incidents wanted to join together to develop
effective ways to prevent violence. As a result, government and agency leaders established
the Violence Prevention Coalition (VPC), a network of county organizations and community
agencies dedicated to the prevention of abuse and violence.
The Injury Prevention Coalition (IPC) was formed a few years later by groups focusing
on other injury issues (e.g. crib death, drowning, car crashes). These groups wanted
to develop a broad campaign emphasizing that "injuries are no accident."1
Although coalition building has become a popular approach, the concept of coalition
building is not new. In 1840, Alexis de Tocqueville, the first noted international
researcher on the American society remarked that "... Americans are a peculiar
people... If, in a local community, a citizen becomes aware of a human need that
is not met, he thereupon discusses the situation with his neighbors. Suddenly a committee
comes into existence. The committee thereupon begins to operate on behalf of the
need, and a new community function is established. It is like watching a miracle."2
Figure A provides working definitions of various
types of group processes.
Figure B defines terms that are often used with
respect to coalitions.
Advantages Of Coalitions
Coalitions offer numerous potential advantages over working independently.
Coalitions can conserve resources. For example, the IPC invited teachers and Parent
Teacher Association (PTA) members to become involved in the coalition's educational
effort to promote a new law requiring children to wear bike helmets when riding to
school. The PTA and teachers then educated students and parents on the proposed law
while doing their regular work, thereby eliminating the need for other IPC members
to visit schools.
Coalitions can achieve more widespread reach within a community than any single organization
could attain. For example, when the VPC held a community resource fair, they were
able to invite two thousand interested community members just by combining their
Coalitions can accomplish objectives beyond the scope of any single organization.
For example, the IPC was able to lobby successfully for child passenger safety legislation
that no single program had the time, geographic scope, or mandate to pursue.
Coalitions have greater credibility than individual organizations. The broader purpose
and breadth of coalitions gives them more credibility than individual organizations.
In addition, coalitions reduce suspicion of self-interest. For example, the IPC wrote
a letter to the editor of a local newspaper asking him to ensure that all bicycle-related
photos printed in the newspaper include bicyclists who were wearing helmets. Seeing
the breadth of groups on the letterhead, the editor could not dismiss the letter
as one sent from a "special interest group."
Coalitions provide a forum for sharing information. For example, at an IPC meeting,
each member announced upcoming events, and then those members who had attended the
National Safe Kids conference gave a report. Only two members of the coalition could
afford to attend the conference, but by reporting back, all members were informed
about the conference proceedings.
Coalitions provide a range of advice and perspectives to the lead agency. For example,
after a suicide attempt by a local high school youth, the lead agency convened VPC
members for advice on the best way for the Health Department to respond to the concerns
of principals and teachers in that school district.
Coalitions foster personal satisfaction and help members to understand their jobs
in a broader perspective. For example, an IPC member who was a traffic engineer was
able to use his graphic art skills to develop an educational manual for the coalition.
In addition, his involvement in the coalition allowed him to see how his work as
an engineer impacted childhood and pedestrian safety.
Coalitions can foster cooperation between grass roots organizations, community members,
and/or diverse sectors of a large organization. Coalitions build trust and consensus
between people and organizations that have similar responsibilities and concerns
within a community. For example, three VPC agencies who had been struggling with
turf issues over working in the local high schools decided to combine their efforts
by collaborating on a joint education project.
However, a coalition is not appropriate in every situation and is only one of a variety
of effective tools for accomplishing organizational goals. A lead agency should consider
carefully the responsibilities of developing and coordinating a coalition. The success
of a coalition is usually uncertain. In addition, lead agencies tend to underestimate
the requirements needed to keep coalitions functioning well, especially the commitment
of substantial staffing resources. Coalitions also require significant commitment
from the members, who frequently must weigh coalition membership against other important
work. Potential results need to be measured against their costs, keeping in mind
that results of coalition efforts often diverge from the initial expectations of
the organizations that created them. Furthermore, some tasks are inappropriate for
coalitions because they may require quick responses that are unwieldy for coalitions
or an intensity of focus that is difficult to attain with a large group.
Before initiating a coalition, it is important to determine if related groups already
exist within the community. There are times when it will be far more effective to
participate in an already existing group with compatible goals than to form a new
TIP: People and organizations often define terms differently. It is important
to define clearly the type of group that will be set up, including its mission, membership,
and structure, and to make sure that all participants understand and agree with this
See Figure C for a list of the eight steps.
The Eight Steps
Step 1: Analyze the program's objectives and determine whether
to form a coalition
Three different situations may cause an organization to consider whether or not to
form a coalition: 1) the organization recognizes a community need or responds to
community leaders' requests to facilitate an effort, 2) the organization recognizes
that a coalition will help it fulfill its own goals, or 3) the process of building
a coalition is required, for example, by a grant mandate or as the outcome of a conference.
Recently, many grants have required organizations to establish coalitions. Consequently,
the initiation of a coalition may be in response to the grantor rather than as a
result of recognizing that it is the best solution to a problem. Therefore, the organization's
objectives may be based on an assessment of data, may stem from an existing programmatic
emphasis, or may be set by a funding mandate.
Sometimes a coalition is established by "spontaneous combustion" based
on the joint decision of a group of individuals and organizations, without a lead
agency. These coalition organizers should approach the eight steps to effective coalition
building as though they share the responsibility as the lead agency. Between them,
they must achieve the responsibilities that are delineated throughout this paper
for the lead agency. Sometimes these shared efforts can capitalize on the energy
of their beginnings and can achieve remarkable results.
A potential lead agency must assess its credibility in and capacity for providing
neutral facilitation. On some issues, the organization may have the credibility and
resources to provide the lead. In other situations, history, turf issues, or lack
of resources might prevent the achievement of a cohesive effort. In these cases,
the group should consider designating a different lead agency, if a coalition is
still going to be developed.
When deciding whether or not to form a coalition, first consider whether or not a
coalition is the appropriate tool to serve the organization's needs. Then consider
the resources needed, from the lead agency and from coalition members. Finally, consider
whether or not coalition efforts represent the best use of these resources. To answer
these questions, it is important to examine the objectives and to determine specific
strategies that could help achieve those objectives.
To determine whether or not to form a coalition, the following steps should be undertaken:
a) Clarify the objectives and appropriate activities. One tool that is useful for
planning objectives is the Spectrum of Prevention (see Figure
D), which describes six types of interventions that can be used. Each part of
the Spectrum depends on the others to work best, and generally, coalitions that aim
to accomplish a combination of the spectrum's strategies are most effective. By grouping
these separate approaches together, a preventive health program builds on the strengths
of each and promotes permanent, effective change.
For example, environmental changes, which are key in injury prevention, generally
result from changing organizational practices or advocating policy and legislation.
As a specific example, an educational program aimed at decreasing bicycle-related
injuries will be enhanced if a local ordinance requires bicyclists to wear helmets
and a civic program is implemented to change the environment by developing off-street
bicycle paths. Often policy advocacy requires the resources of several organizations
within a community and may necessitate the formation of a coalition.
See Figure D for the Spectrum of Prevention.
Take a broad, creative look at activities that can accomplish the objectives. In
many prevention programs, efforts center primarily on education. Yet, individual
and community education is not enough. A child can drown in minutes, even with an
attentive caretaker nearby who knows that water is dangerous. A fence around a pool,
however, is an effective safeguard that helps prevent such tragedies by physically
separating the child from the danger. In this case, promoting an ordinance requiring
proper pool fencing will be a more effective method of reducing childhood drownings
than funneling all of the coalition's resources into individual and community education.
Critical questions to consider are the breadth of what the group may accomplish and
the scope of the coalition's activities. For example, should the effort focus on
car seats or on all childhood injuries? Will the coalition focus on a specific injury
(e.g. sports-related injuries) or on a cross-cutting issue (e.g. improvement of data
access)? The direction the coalition will ultimately take depends on the vision and
interests of the lead agency and on the likelihood of success in meeting the identified
objectives. The coalition's direction will also depend on the composition and interests
of the membership (see Step 3). For each
approach, it will be important to have at least a general understanding of the roles
of particular members in accomplishing the objectives. Different members may be better
suited to different activities.
b) Assess community strengths and weaknesses. How do the proposed approaches of the
coalition fit into the context of the community's strengths and weaknesses? Look
at the community in terms of potential barriers and supports. Is there a history
of success or failure in dealing with similar problems in the community? Are there
organizations that have similar objectives? Are there organizations (or even coalitions)
that deal with closely-related issues? Are there individuals or organizations that
could be enlisted to provide support or overcome potential barriers? Are there organizations
from other geographic regions with whom collaboration could occur? Are there individuals
and organizations that may be opposed to the objectives or may view the coalition
as competition for scarce resources?
c) Determine the costs and benefits to the lead agency. How great will the resource
drain be? How much will the coalition's results coincide with the organization's
overall goals? What will a coalition provide to the lead agency's program? Determine
if adequate resources are available. If not, the objectives must be revised, or perhaps
the coalition should not be created.
Next: Appendix B. Developing
Effective Coalitions: An Eight Step Guide (continued)