Appendix B. Developing Effective Coalitions: An Eight Step Guide

Written by: Larry Cohen, Nancy Baer, and Pam Satterwhite

Edited by: Kelly O'Keefe


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 mailing lists.

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 coalition.

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 definition.

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)

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