To Heal a Community, Build Capacity

Jul 20, 2016, 11:00 AM, Posted by

Lessons from Washington State show a culture shift can lead to healthier lives.

Neighbors gather around a home at night.

About 15 years ago, non-profit and public service providers in Cowlitz County, Wash. were trying to figure out why—despite great planning and programming—there were still problems in the neighborhood that made the most 911 calls. The prevailing wisdom was that the neighborhood was dangerous because it was dark outside people’s homes, and it stayed dark because people liked it that way. It helped conceal criminal activity. But the coordinator for the service collaborative knew she needed to engage with residents and learn what they thought. So to start to figure out what was happening, she went house by house to talk to people.

As those discussions with community residents grew, it became clear that residents saw things differently.

Some warned her that the neighborhood was dangerous, that once it got dark at night the streets weren’t safe. But others felt it was a much simpler issue: it was dark because people couldn’t afford light bulbs for outside their homes. The darkness made people feel like they didn’t have control over their own safety, and that in turn led to negative assumptions that further exacerbated the problem.

So the residents and the coordinator crafted a simple solution. After giving residents advance notice, they recruited volunteers from local neighborhood organizations to go around and count the number of outdoor light fixtures missing bulbs. They got bulbs donated by a local hardware store owner, and they scheduled a free barbecue and community lighting ceremony. Residents named the event Take Back the Light and when the lights came on, the music started, and the food was served, barriers broke down even further.

Neighbors talked to neighbors they had been wary of, and everyone saw their direct role in addressing a problem that was important to the community. Residents who previously had no formal leadership role in the community became leaders because of their involvement with Take Back the Light. Success belonged to the group, and the community’s capacity grew. They began to talk about other challenges in their neighborhood that needed to be addressed. As this organization took root, the coordinator changed her title to “community coach” to illustrate her community-centered, supportive role.

Stories like this illustrate the core components of the Self-Healing Community Model that Laura Porter and her colleagues developed in Washington in the 1990s. This model helps communities build their own capacity to define and solve problems. We’re pleased to publish these new papers illustrating the model and sharing information about the success Washington state has seen working with it.

This Self-Healing Community Model is focused on four phases:

  1. Leadership expansion: Expanding the circle of people who are actively engaged in leading community improvement efforts makes them more likely to succeed.
  2. Focus: Generating a shared understanding of the values and priorities that make up the local culture helps residents generate solutions everyone wants to support.
  3. Cycles of learning: Interactive and reflective processes support the learning of community members and lead to continuous transformation.
  4. Results: Local participation in research and reporting of outcomes motivates communities to improve their strategies and activities based on the gap between current outcomes and their aspirations for community and family life.

Starting in the mid-1990s, these phases of community engagement played out in counties and Tribes across Washington. Researchers measured and tracked outcomes as this work was getting underway, so they know that this model can move the needle on some of the most intractable problems communities face. Over about 10 years in Cowlitz County:

  • Births to teen mothers went down 62 percent;
  • Infant mortality went down 43 percent;
  • Youth suicide and suicide attempts went down 98 percent;
  • Youth arrests for violent crime went down 53 percent; and, 
  • High school dropout rates went down 47 percent.

Each of these is a dramatically better improvement than the state as a whole saw during the same time period. One study of their work found that, with a budget of just $8 million, they ended up saving $55 million over two years by reducing rates of teen pregnancy, juvenile felonies, school dropouts and out-of-home placement of children.

Screen capture of chart

We’re excited about this work because it documents that building strong, resilient cultures in communities, works. In an era when we’re seeing growing distrust in leaders, and skepticism about what we can accomplish collectively, that’s a meaningful lesson.

It also clarifies that a true push to build a Culture of Health must be a push for health equity. Many of the challenges Cowlitz and other counties in Washington faced at the time were not borne equally by everyone. Residents in lower-income areas and in communities of color often face much higher, tougher barriers to health than wealthier, whiter communities do. But we cannot say we are making progress if we’re not making progress for all. This Self-Healing Community Model can be particularly helpful in building capacity in communities that have been historically neglected.

The good news is, many other communities are putting into practice the principles this model illustrates. For example, Mobilizing Action for Resilient Communities (MARC) is a group of 14 cities, counties and states across the country that are building robust networks in order to address adverse childhood experiences. Teachers, doctors, social service workers, policymakers, first responders and parents are identifying the sources of childhood trauma, neglect and abuse, and building networks to support resilience. The 20 winners of the RWJF Culture of Health Prize have used the principles of self-healing communities to develop shared values, define health broadly, and build the collective power of leaders and community members to make change.

These principles are strong but flexible. They’re not a cookie cutter approach. It’s not about importing one great program or “best practice.” Each community has and must have the power to develop their solutions as they see fit. As more communities do, we’re hopeful we’ll see results as strong as those from Cowlitz County.

To learn more about the Self-Healing Community Model, view the full report.

Martha Davis, MSS, is a senior program officer at the Robert Wood Johnson Foundation where she focuses on the root causes of violence, including child abuse and intimate partner violence. Read her full bio. 

Laura Porter is Co-Founder of ACE Interface, LLC. Ms. Porter develops and disseminates educational products and empowerment strategies that help leaders throughout the nation to dramatically improve population health. Read her full bio.