Sound Partners for Community Health

Over the past several years, the Internet has captured the attention of Americans. Health-related websites, capable of providing a wealth of health care information for the "connected" population, seem to spring up on a weekly basis. The potential of the Internet should not, however, obscure the contribution made by a
more traditional means of communications that continues to reach millions of Americans—local radio.

To help local radio stations improve their health care programming and have more impact in their listening areas, The Robert Wood Johnson Foundation teamed up with the Benton Foundation to develop, in 1996, a national program called Sound Partners for Community Health. In an unusual twist, a local radio station, to be eligible for funding, needed to collaborate with a community organization, working in a field such as children’s health, welfare reform, or end-of-life care.

In this chapter, Digby Diehl, a free-lance journalist and previous contributor to The Robert Wood Johnson Foundation Anthology, tells the story of the Sound Partners program, largely as seen through the eyes of some of the 59 grantees and their partners. Unlike many Robert Wood Johnson Foundation-funded programs, which attempt to affect policy at national or state levels and which take place in large metropolitan areas, most of the activity of Sound Partners occurs in small towns and rural areas of America. The story that Diehl recounts is one of local public radio and local institutions, and the way in which they combine their forces to raise awareness of health issues and bring about change in their own communities.

Over the three years that the program has been in existence, some Sound Partners’ grantees have won awards. These include two from the National Federation of Community Broadcasters: KDNA of Granger, Washington, won the Community Impact Award for "Access to Health Care in Yakima Valley" and KGNU of Boulder, Colorado, won the Golden Reel Award for Best Local and Public Affairs Program for "Seeking a Good Death." Other winners include WBST in Muncie, Indiana, which won the Edward R. Murrow Regional Award for Overall News Excellence from the Radio & Television News Directors Association for its series "Living with Death," and KSTX of San Antonio, Texas, which won the Media Award from the Texas Public Health Association for its series "Caring for the Children of Children: Teen Pregnancy in San Antonio."

This chapter complements three other chapters on communications that have appeared in The Robert Wood Johnson Foundation Anthology: Frank Karel’s retrospective look at the Foundation’s global communications strategies elsewhere in this volume, Victoria Weisfeld’s examination of the Foundation’s radio and television grants in the 1998-1999 Anthology, and Marc Kaplan and Mark Goldberg’s analysis of how research on managed care was presented to the media in the 1997 Anthology.

This excerpt was generated on a radio show sponsored by Sound Partners for Community Health, a national program for public radio stations paired with local community health organizations. Administered by the Benton Foundation and funded by The Robert Wood Johnson Foundation, the program has two major goals:

Mainstream resources, such as traditional health care providers, TV, newspapers, and the Internet, are directed at the broad American population; public radio, however, is able to tailor its programming to reach smaller numbers of specific individuals and groups. The Sound Partners program uses the power of radio to aim health and wellness programming at groups who may not have good access to health care or health care information. Most are isolated in one fashion or another from mainstream health information providers. This isolation may have physical, psychological, and/or socioeconomic components—illiteracy, social custom, age, language barrier, fear, poverty, legal status, and geography can all serve to separate people from what they need to know. Community health organizations, the other half of the Sound Partners partnership, participate both in the preparation of broadcast materials and in reaching out to listeners to follow up on the issues covered on the air.

The Robert Wood Johnson Foundation’s participation in the Sound Partners program grew out of its long involvement with National Public Radio.¹ In 1994, it supported a program through NPR called "Critical Decision," which assisted local stations in their efforts to cover the issue of health care reform and to conduct outreach activities. The Sound Partners program was intended to go beyond this single topic. Designed to improve the coverage of health care issues where it was weakest—at the local level—Sound Partners attempts to identify important health care issues in communities; inform and stimulate public dialogue; build capacity to conduct effective outreach; and build partnerships between radio stations and local health care organizations.

Overseeing the Sound Partners program for the Benton Foundation is Anne Green, Director of Grantmaking Programs. "The Benton Foundation believes that communications is the driver of social change," she says. "We’re trying to use the media to activate citizens, to get them involved with issues." Jointly heading the Sound Partners program at the national level are Mark Sachs, president of Mark Sachs & Associates, a management consulting firm, and Beth Mastin, president of MasComm, a communications consulting firm.

The Sound Partners program—a $2 million five-year initiative—rolled out in two rounds. The Call for Proposals for round 1 was sent, in 1997, to the 400-plus public radio stations supported by the Corporation for Public Broadcasting, or CPB, and the first grants were awarded in October of that year. From more than 100 applicants, 35 recipients were selected; grants ranged from $15,000 to $35,000. A Call for Proposals was issued for the second round, and thirty-three round 2 grantees were notified in January, 2000, of awards for programming that run from August 2000 to August 2001.

In the first round, Sound Partners targeted four general health issues that could be explored by grant recipients. Stations and their partners were free to apply for funding in any area they preferred:

Of the 35 grantees in round 1, nine dealt with children’s health, nine with youth substance abuse, seven with end-of-life decisions, and ten with health care and welfare reform.

In the Call for Proposals for the second round, another issue—aging and chronic disease—was added. In addition, the category of health care and welfare reform was changed to the health care safety net. Of the 32 grantees in round 2, six are dealing with children’s health, ten with youth substance abuse, five with end-of-life decisions, seven with the health care safety net, and five with aging and chronic disease. By design, the number of returning grantees was limited in order to give additional stations an opportunity to participate. Thus, 23 of the second-round stations receiving grants are participating in the program for the first time.

The stations involved in Sound Partners reach a varied geographical and cultural cross-section of the United States. Grantees include stations serving Latino farming communities in Washington and California, Native Americans in Alaska, Wisconsin, and Arizona, hardscrabble Appalachian areas in West Virginia and Kentucky, and the diverse ethnic urban populations of New York, Detroit, and Minneapolis.

The Sound Partners program offers participants great leeway in how they deal with their subject matter and how they work with one another. Various grantees forge their own relationships with partner organizations. "For many years, I did a weekly show called the Activist Report," says Joan Buffington, news director of KVMR in Nevada City, California. "I’m a longtime political activist and longtime health care professional. When I wrote the proposal for the Sound Partners grant, I realized that this was an opportunity to put together my years of experience in both fields. For partners, I selected both the Nevada County Department of Human Services and an organization called FREED, which is a really vital, local non-profit group that serves seniors and the disabled. Working with the county was a tactical choice; it was my hunch from my community organizing experience that this would be advantageous, because they would have good connections. I also knew it could be rather limiting in terms of not being able to do things quickly. I chose FREED because I wanted to balance the county agency with a nonprofit organization that had a good reputation for advocacy."

"I picked the death and dying issue because it was of personal interest to me," says Sam Fuqua of KGNU in Boulder, Colorado. "I immediately started thinking of potential partners. Hospice of Boulder County was known to us, at least informally; we had interviewed people from their organization, and done public service announcements for them. Knowing that it was a well-run, stable organization with a really good reputation in the community made choosing both a partner and an issue easier." "Sam and I had great chemistry because he got it about dying, and from the get-go we had the same philosophy," says Fuqua’s partner, Kim Mooney of Hospice of Boulder County. "We had the nerve in the same place, and he was willing to do the same kinds of things we were willing to do. We had the same values."

Technical assistance has been a major component of the work of the national Sound Partners staff, headed by its program directors, Mark Sachs and Beth Mastin. This includes advice and assistance with audio production and story development, as well as training and education for radio staff in the coverage of health topics. Information on how to develop and maintain a website has also been made available. "We provide any kind of technical assistance they ask for," Mastin says. "We encourage the stations and partners to call on us as consultants if and when they run into problems, but we don’t meddle. We provide them with a framework and encourage them to do the best job with whatever their vision is. The recipients have produced this huge diversity of wonderful programming and connections to the community—which is what we intended them to do."

National conferences of grantees were held both at the beginning and at the end of the first round—a pattern to be repeated in round 2. At the initial gathering, participants received detailed handbooks, lists of contacts, outreach models, and sample promotional materials, as well as access to a website (www.soundpartners.org) with links to other information providers. Grantees were also encouraged to network with one another as the program proceeded.

Perhaps most valuable, however, the meeting served to solidify the working relationship between the two partners, and to focus them on the program. "The initial conference was very good," says Kim Mooney of Hospice of Boulder County. "The Sound Partners staff brought up a lot of things that they thought we should know, but much of it was more familiar to one partner than another. There were issues discussed that I didn’t understand that my partner, Sam Fuqua of KGNU, got right away, and vice versa. Between the two of us we understood what the major pieces were."

The initial gathering also offered participants a chance to fine-tune their programs. "After the kickoff conference, we downscaled some," says Jill Hannum of KZYX&Z of Mendocino County, California, "and even then we didn’t downscale enough." Hannum worked with the Mendocino County Youth Project to develop programming on the subject of youth substance abuse. "We were too ambitious. We completely gave up the idea of doing the program twice a month, which had been our original goal."

Sound Partners stations used many different programming formats for their broadcasts. They produced news features that varied in length from one minute to one hour. There were mini-dramas, panel discussions, public service announcements, live broadcasts of town meetings, and call-in programs. They used both experts and members of the community as hosts. Some formats seemed better suited to particular issues. Call-ins, for example, were effective for the children’s health and end-of-life issues, because listeners with specific needs could connect with professionals to get direct advice or referrals to agencies that could help.

Wading into delicate subjects such as this is a hallmark of Sound Partners programming. "We were not afraid of topics," says Graciela Orozco of KHDC, Salinas, California, which dealt with Children’s Health. Orozco hosted a Spanish-language program called La Placita Bilingüe [the Bilingual Town Square], which offered a forum for Hispanic families to talk about a wide variety of child-centered issues. In Latin culture, the plaza, or town square, is the traditional place for meeting and exchanging information. "We brought together parents and professionals on the air. We talked about teen sex, about AIDS, about child abuse, about raising children in single-parent households. One of our most popular programs was about circumcision," she says. "Sex is usually taboo as a topic of conversation," Orozco says. "You just don’t talk about it, but we had a doctor on the show, and he used all the proper names for anatomical parts. People were comfortable discussing it—we had call after call."

For KGNU in Boulder, Colorado, it wasn’t just one program but the entire series on end-of-life decisions that had the potential to make people uncomfortable. KGNU partnered with Hospice of Boulder County to produce a series on death and dying called Seeking a Good Death. "Fear of death is an incredibly intelligent thing, because it will motivate you to wake up and look people in the eye and say you love them," says Kim Mooney of Hospice of Boulder County. "But terror of death, which is what we face today, only makes you avoid the subject. It’s like a moat—there is so much terror around death that people don’t want to deal with the issue. We have trouble working with the senior centers in Boulder; they’re offering weightlifting classes rather than getting-ready-for-dying classes, because our seniors are so groovy."

"We had one fully produced documentary that was very moving, and we had live call-in for the first and last shows," says Sam Fuqua of KGNU. "The middle shows were Nightline style, with a short feature to set it up and a panel for the next 25 minutes. The advantage of working with Hospice was that they really knew all the people in the death and dying field. They had great guests."

"What the Hospice has been trying to do is gently open the door to the subject in a non-threatening way," Kim Mooney says. "That’s where the KGNU series really tried to go. The advantage to us of doing it over the radio was anonymity. People sitting at home alone listening to these stories about dying are going to take them differently from the way they would if they were sitting in a group and had to worry about whether they were crying or not. They don’t have to dialogue with you; there’s nobody standing there who they think is going to make them engage in conversation. Going into people’s homes through the radio in little bits was great. We introduced the topic from a couple of different angles, then talked about how to start thinking about death: What do you do to get ready for it? What are the mechanics of it? What does it mean to pay for it? What kind of care do you get? People got a chance to listen passively without having to worry about having to respond. We were planting seeds."

Stations dealing with similar issues developed a wide variety of approaches to covering the topic. WRTU in Puerto Rico offered thirteen one-hour programs on youth substance abuse. The series was anchored by a quartet of young adolescents, who also were involved in production. "The children brought a lot to these shows," says Luis Luna of WRTU. "They co-hosted with adults, did interviews, and selected music." The station’s partner was the Center for Rehabilitation through the Arts. "Using the arts is attractive to children," the center’s Jacqueline O’Neill says. "They are not intimidated by art." The two partners capped the series, called Como Gente Grande [Like Big People], with Punto de Encuentro, a day-long street fair in San Juan. "In addition to music, dance, and theatre, the carnival had booths, displays of confiscated drug paraphernalia, and demonstrations by the police canine unit," Luna says. "There were also mini workshops, where we involved parents in acquiring skills needed to cope with an environment where drugs are common, and promoted techniques kids need to resist drug offerings."

WRTU staff members had already spelled out the content of each of the station’s thirteen shows when they submitted their proposal. For the on-air hosts, they selected younger teens and pre-teens who were the age of those most at risk. In contrast, KZYX&Z in Mendocino worked with older teenagers, primarily high school juniors and seniors who were part of peer counseling programs at local high schools. Partnering with the Mendocino County Youth Project, they produced a series called What You Don’t Know: Youth Speaks Out. "We really let this be a youth-driven program," says Jill Hannum of KZYX&Z. "And we let them choose the topics. We didn’t tell them what to focus on. We asked, ‘What touches you? What’s hot in your life?’ and that’s where we certainly got our strongest stuff." The Mendocino peer counselors went way beyond "Just Say No," often putting an unexpected spin on how they chose to deal with substance abuse, and even how they defined it. To them, the addictive behavior of bulimia fit within the rubric of substance abuse, the substance being food.

WBAI’s Diana Mason, whose New York City station also worked with adolescents to cover the issue of youth substance abuse, had the same experience. "I learned to trust the kids and let ‘em roll," she says. "They took us into places I wouldn’t have gone—literally and figuratively." One program explored drug use associated with the very edgy dance club rave scene. "I thought I could come in and tell them how to put a radio show together, but I learned right away that this was not about adults telling kids what to do. It was about us listening to them, sharing skills with them, and supporting them so they could tell their stories on the radio."

WBAI partnered with Global Kids, a group that focuses on developing youth skills in leadership and teamwork. Global Kids "prepares young people as global citizens," says Mason, who decided to partner with the organization after several members appeared on her program, Healthstyles. "The kids examined the influence of advertising and the media on teen smoking, and incorporated global perspectives on the marketing of tobacco into the segment. Another show investigated the link between religion and drugs—they looked at Rastafarians and ganja, and at the spiritual uses of wine in the Catholic Church."

"It takes a leap of faith to let young people have a voice," says Jill Hannum’s partner, Leslie Rich of the Mendocino County Youth Project. Hannum of KZYX&Z was willing to make that leap, in part because she was prepared. "We had training programs. We had mock shows before they went on, and mock call-ins. By and large, I’d say that 80 percent of the kids acquitted themselves like experts. Most of the problems involved teenage boys. As we know, they mature more slowly and their tongues cleave to the roofs of their mouths for many more years. When there were problems, it was usually that the young men froze on the air, or just didn’t have the verbal skills to track the question into an answer. We found that as the program progressed the kids who did the program repeatedly were all young women."

"One of the best programs we did involved a girl who dealt with the subject of methamphetamine in her town," Hannum continues. "It amazed me how much was in the schools, how much influence it had on people’s lives, how easy she and the kids she interviewed said it was to get—and how completely the police turned their backs to the situation. The kids didn’t know whether the cops were just indifferent to it or whether they couldn’t figure out how to deal with meth and eleven-year-olds. She said, ‘It’s not in the high schools anymore so much; it’s in junior high.’ Here was this sixteen-year-old saying, ‘My group’s O.K., but I’m worried about the young people.’ She had a lot of anxiety about how her friends would react to her program, but when I spoke with her afterward, she was relieved. She said, ‘I thought that I would be ostracized for doing this, but all my fears were for nothing. I thought they would single me out for ratting on them, but people who heard it told me that it reflected the truth.’"

"We are in what they call the emerald triangle—a three-county area where there is a lot of marijuana grown," Leslie Rich says. "Marijuana is part of the subculture here, and the kids grew up in it. For grownups, marijuana cultivation is a viable option as a life choice. Mendocino County is economically depressed, and many kids here have family and friends—basically good people—who grow dope on the side."

"I’ve had my socks knocked off by the intelligence, the skills, the self-possession and the self-knowledge that most of the young people who have been on the program have displayed," Hannum says. "I’ve been nothing but impressed. The kids are all right. My only surprise was in the incredible openness that they were willing to display about topics one is told that teens keep their mouths shut about."

Whether this kind of reporting is viewed as civic journalism or advocacy depends on one’s orientation. "Civic journalism is a way to do reporting that is more of a dialogue than a monologue," says Sound Partners director Beth Mastin, "and for some journalists, that’s a sacrilege. Reporting to them by definition means that it’s going in one direction."

"A number of the larger stations had concerns about blurring the lines between journalism and outreach to the community," says Sound Partners director Mark Sachs. "The issues centered on getting involved in the community instead of just reporting."

"At WVPN, the allegation that I had slipped into advocacy didn’t really come during the course of the first round broadcasts," says Susan Leffler. "Interestingly, however, one of our former corporate partners later mentioned to the station general manager that he didn’t feel our coverage in round 1 was ‘objective.’ Although he was a partner in the Sound Partners program, he never brought this up at meetings, but chose to save his criticism until after the fact. We also heard after the grant was over that the some of the department heads in the West Virginia Department of Health and Human Resources, who were responsible for welfare reform, weren’t happy with our approach."

Sound Partners purposely did not define the working relationship between the radio stations and the partners, believing that the manner in which stations and partners came together to meet the goals of the program was one way to see civic journalism at work. Because civic journalism is a term which has no single meaning, various pairings of grantees forged their own definitions as they proceeded through the Sound Partners program.

The impact of round 1 of the Sound Partners program was examined by four different studies: one by O’Neal-Hobbs Associates, another by the Cosmos Corporation, a third by Sharon Griggins, and the last by Livingston Associates.² The studies mainly relied on self-assessments of the projects by the staff of the radio stations and collaborating community organizations. The question of how to measure success arose. "One possible area of concern is evaluating the project using measurable data. Documenting success is difficult because of the nature of radio," wrote Tom Livingston of Livingston Associates in Sound Partners Assessment. "Success benchmarks and indicators were not established for first round Sound Partners grantees," wrote Loretta Hobbs in her report. "Consequently, stations identified as successes a broad range of factors."

Participants in the studies generally reported that their projects were successful, often in ways that were not anticipated at the outset of the program. "Sound Partners grants changed the way that stations gathered and reported the news," wrote Sharon Griggins in her report, Sound Partners Lessons Learned Conference. "The projects brought new voices to the radio. The Sound Partners grant changed the way participants and their organization viewed themselves and their communities."

"Several grantees affirmed that their listenership increased," wrote Loretta Hobbs in Sound Partners for Community Health First Round Grantee Assessment. "Others indicated their off-air town hall approach yielded fewer listeners, but significantly improved the quality and depth of community education and interaction. Some stations won awards, and one raised an additional $200,000 from another funder to continue broadcasting after the Sound Partners grant ended."

Round 2 and Beyond

It is too early in the round 2 grant cycle to assess the programs of new recipients. A number of returning grantees, however, have a very clear picture of how they are going to proceed. In general the approach is ‘less is more.’ "For round 2, we’re going to be a little more realistic," says Joan Buffington of KVMR. "We’re cutting the number of on-air programs in half and going bi-weekly. However, we’re going to do what we had hoped to do in round 1, which is to produce some really well thought out longer pieces. This second round will have two stages. The bi-weekly program will provide the fuel, the raw material for two to four produced pieces, which will each be an hour long. We’re going to take the raw material and use the nuggets of that to make some very powerful programming which can be used, not only in this community, but in other rural communities that are dealing with the same issues of gentrification, and how you pay for all the incredible costs of aging and chronic illness."

"For round 2, Leslie Rich of the Mendocino County Youth Project is going to play a much bigger role," says Jill Hannum of KZYX&Z. "She has written an awareness of lessons learned into the round 2 grant. We are going to streamline the program and focus on just two schools that have some geographic proximity to one another, so that the young people from those two schools can interact with each other as part of the project. We chose the two schools that have the most committed peer counseling advisors. In round 1, we found that without the advisor being committed to the project, the students did not want to become part of it either. We’re also going to make the project more integrated with the classes."

"I’m working to identify teachers in the high schools who will make listening to the show an assignment for their students," says Leslie Rich. "We’re also going to drop the prerecorded teen diary, which was very time-consuming to produce for both the peer counselors and radio station personnel."

"The kids will have on-air guests who will be people whose decisionmaking powers have some kind of impact on young people’s lives," continues Hannum. "The idea would be to set it up so that the peer counselors can do research on a topic like Juvenile Hall, then bring someone like the sheriff or a probation officer on the show, and engage them in conversation to a point where the young people can feel as if they can have some impact in the community and get their voices heard. The show airs on Sunday night, which is a prime spot. We hope that in the second round we can really build this into something. We built a good audience in round 1, and people really appreciate the program, but it hasn’t really had an impact yet on the community. We want to have the county supervisors say, "Well, this problem was brought to light on this radio show and now we’re getting pressure from teens all over the county."

Sound Partners national staff will be working to deal with one inequality built into the program: it is the radio stations, not the
stations and their community partners jointly, who receive the funding. "At the Lessons Learned Conference, held in 1999, some of
the outreach partners told me that there was a really unequal power relationship in the program," continues Sachs. "Aside from the money, a number of partners felt that they were just there to fulfill the outreach provisions of the grant. In round 2, one of the things I’m going to do differently is to talk to stations on an ongoing basis, especially early in the program, to see if they have any issues with their partners, and how we can get them to work together on a more collaborative basis."

However Sound Partners evolves in round 2, the program has already shown itself to be an example of the philosophy that William Benton gave to the trustees of his foundation: "Favor those things which seem risky, unorthodox, hazardous, and even unlikely to succeed—but which, with success, offer more than ordinary promise and in some cases very exceptional promise."