1. Dialogue as a core MAPP Philosophy Stephanie Welch, MS-MPH, RD, LDN Strategic Planning Coordinator East Tennessee Regional Health Office stephanie.welch@state.tn.us

2. Section Overview Background and Context Dialogue Defined Dialogue in Practice Benefits and Lessons Learned

3. Setting: East Tennessee Region One of 13 regions under the Tennessee Department of Health (7 rural, 6 metro) 15 mostly rural, Appalachian counties surrounding Knox County Population nearly 700,000 Local Health Depts. in each county focusing primarily on disease prevention and health promotion services to women and children. 48 66 23 49 84 79 24 38 17 27 92 09 40 57 35 55 12 39 36 9150 28 52 2658 3306 70 68 51 20 41 60 59 02 64 16 31 77 04 72 61 5462 53 05 73 78 47 6501 76 07 13 2987 32 45 15 81 42 43 63 22 94 19 11 74 8356 85 95 75 14 69 446725 80 21 08 89 88 93 71 18 34 37 30 86 90 82 10 46 03

4. History: Community Diagnosis State-developed community health planning process initiated in mid-1990s Led to the formation of Local Health Councils (LHCs) in each county Local citizen volunteers Process Assessment Prioritization Implementation By 2000, several LHCs were prepared for another round of planning

5. Transition to MAPP: East TN Challenges More comprehensive than Community Diagnosis Balancing current activities with strategic planning process Role of staff, community members Issue of scale Regional vs. local implementation Paradigm shift to a New Way… Discomfort with not knowing

6. Transition to MAPP: East TN Opportunities Health council structure in place Previous experience with community health planning Health councils asking Whats Next? Partnership with University of Tennessee Introduction of Dialogue in East Tennessee Region

7. Structure of MAPP in East TN Regional MAPP Steering Committee Subcommittee of regional health council Staff facilitated Community and staff representation Resource and catalyst for local MAPP implementation Familiarization with MAPP process to provide guidance for local implementation Local MAPP Committees Subcommittee of local health council Staff facilitated; Chaired by community member Decisions made at local level: Whether to implement MAPP Implementation details: Subcommittee membership, tailoring the MAPP model

8. Dialogue in Theory Skills Listening Community engagement Facilitation Building trust, safety, sense of team Principles Comprehensive Inclusive Locally Owned Attitudes and Intentions Openness Equality Empathy

9. Dialogue in Practice Physical set up Circle Comfortable chairs and no tables preferred Meetings – agenda and skills Clear desired outcomes Check in and connect Good question(s) Small group breakouts Reflective listening Next steps Respectful closure

10. Dialogue in East Tennessee Cross River Connections Danny Martin and Leonadi Ward Facilitated MAPP Steering Committee retreat Provided statewide Basic Dialogue Training for Community Services staff Provided statewide Training for Dialogue Facilitation 4 East Tennessee Region staff trained (TDFs) East Tennessee Region public health leadership received Basic Dialogue Training as a result

11. Examples of Dialogue in Action MAPP Steering Committee Initial Retreat Half day of Appreciative Inquiry Values, Peak Experiences, Future Half day of Team Building Ropes course activities Half day of Visioning Model for Regional Visioning

12. Examples of Dialogue in Action Regional Visioning Event Modeled after the MAPP Steering Committee retreat 45 participants representing 13 ETN counties Small group breakouts facilitated by Basic Dialogue trained staff Large group reports Following event, MAPP Steering Committee and Regional Health Council representatives: Developed themes Composed draft vision statement Vision statement adopted by MAPP Steering Committee and Regional Health Council

13. Vision for East Tennessee All stakeholders in East Tennessee will be engaged in creating conditions for improved health and quality of life.

14. Examples of Dialogue in Action Monroe County: MAPP Kickoff Event Approximately 50 community leaders attended Presentation followed by small group breakouts Facilitated by Health Council members Hybrid between Organizing for Success and Visioning Community Health Status Assessment Follow- up Dialogue Meeting focused on bringing meaning to data Outcomes informing development of the other assessment phases

15. Lessons Learned from Dialogue Transition from public health directing the process to community directing the process challenging and uncomfortable Creating a space for trust and safety controversial Skills are a piece of Dialogue…Intention is just as important for achieving MAPP desired outcomes It takes time, but its worth it!

16. Dialogue Benefits Move from I to We A team connected by values, stories, experience Shared vision Commitment to process Clarification and shared understanding of roles (public health, community organizations, etc.) Increased awareness and emphasis placed on community engagement and local ownership Meetings are enjoyable!