1. Steps Towards Sustainability Jim Krieger, MD, MPH Steps National Grantees Meeting June 5, 2007

2. What do you want to sustain… Programs and services? Programs and services? Policies? Policies? Coalitions? Coalitions? Relationships? Relationships? The Steps Model? The Steps Model? Accumulated knowledge and experience? Accumulated knowledge and experience? Your youth? Your youth?

3. Choosing what to sustain… Passion for the initiative Passion for the initiative –Coalition members –Constituents Clear benefits Clear benefits Effectiveness Effectiveness Feasibility and adaptability Feasibility and adaptability Opportunities Opportunities

4. What do you want to sustain?

5. Strategies for sustainability… Embedding into practice Embedding into practice Implementing policies Implementing policies Building capacity and leadership Building capacity and leadership Maintaining relationships Maintaining relationships Developing lessons learned and passing them along Developing lessons learned and passing them along

6. Strategies for sustainability… Securing resources (programs) Securing resources (programs) –Budget line item –Donated/shared resources –Local funders (private and public) –Fee-for-service Securing resources (coalition) Securing resources (coalition) –Donated staff and leadership time

7. What strategies will you use?

8. Tools for sustainability Engage community leaders from the beginning Engage community leaders from the beginning Develop a business/strategic plan Develop a business/strategic plan Develop data to make the case Develop data to make the case –Gap assessment (the need) –Program effectiveness and cost-effectiveness (the solution) Evidence from the literature Evidence from the literature Program evaluation data Program evaluation data

9. Tools for sustainability Prepare promotional materials Prepare promotional materials –Stories and photos –Newsletters –Brochures –Websites –Press clippings –Etc.

10. Tools for sustainability Make a plan Make a plan –Problem statement –Goals –Objectives –Activities –Evidence –Resources needed Make a one-page summary in plain English Make a one-page summary in plain English

11. Tools for sustainability Advocate with decision makers and senior leaders Advocate with decision makers and senior leaders –Figure out who they are –Develop relationships with them –Identify champions among them –Develop systematic approach to mobilizing membership/partners for advocacy –Build advocacy skills of partners –Seek media coverage

12. Tools for sustainability Build leadership and skills… Build leadership and skills… –In organizations: to sustain programs –In coalition: to sustain efforts Seek continuity of participants Seek continuity of participants –Individuals –Organizations Integrate service/program into routine operations Integrate service/program into routine operations

13. Tools for sustainability Build partnerships and nurture relationships Build partnerships and nurture relationships –Convene –Link Develop relationships with local funders/foundations Develop relationships with local funders/foundations Grant writing Grant writing

14. What tools will you use?

15. Examples from King County Steps to Health Embed into practice: Clinical Quality Improvement Embed into practice: Clinical Quality Improvement Secure resources: Community Health Workers Secure resources: Community Health Workers Implement policies: School Wellness Implement policies: School Wellness Spread the Steps Model Healthy and Active Rainier Valley Spread the Steps Model Healthy and Active Rainier Valley

16. Embed in practice: Clinical Quality Improvement Goal: Improve asthma care and overweight prevention Goal: Improve asthma care and overweight prevention Strategy: Embed Strategy: Embed Tools: Tools: –Improvement Model –Data –Champions/Leadership Development –Advocate with Clinic Leadership

17. Embed in practice: Clinical Quality Improvement

18. Secure resources: Community Health Workers Goal: Fund CHWs to provide home visits for children with asthma Goal: Fund CHWs to provide home visits for children with asthma Strategy: Secure Medicaid funding Strategy: Secure Medicaid funding Tools: Tools: –Community advocacy team –Legislative champions –Proposal for legislative staff –Partner mobilization

19. Secure resources: Community Health Workers

20. Implement policies: School Wellness Goal: Create school environments that support healthy eating and active living Goal: Create school environments that support healthy eating and active living Strategy: Support district in developing healthy policies Strategy: Support district in developing healthy policies Tools Tools –Champions –Data and evidence –Partner mobilization –Staffing for committees (nutrition and PE)

22. Develop partnerships: Healthy and Active Rainier Valley Goal: Make Rainier Valley a community that supports healthy eating and active living Goal: Make Rainier Valley a community that supports healthy eating and active living Strategy: Build a local coalition to integrate partner efforts and enthusiasm Strategy: Build a local coalition to integrate partner efforts and enthusiasm Tools: Tools: –Convening –Linking –Technical assistance –Seed funding

24. Lessons we have learned Takes a long time Takes a long time –start early… –but never too late Use multiple strategies and tools Use multiple strategies and tools Have a strategic plan with benchmarks Have a strategic plan with benchmarks Go for easier, early successes Go for easier, early successes

25. Lessons we have learned Champions are key Champions are key –elected officials –institutional leaders –opinion leaders –strong community advocates Retain paid staff Retain paid staff

26. So, what are you going to do when you go home? http://www.metrokc.gov/health/steps/

28. Examples from King County Asthma Forum Sustained active coalition until funding ended Sustained active coalition until funding ended Built capacity to take on new challenges: Steps, obesity, etc. Built capacity to take on new challenges: Steps, obesity, etc.

29. Examples from King County Asthma Forum Transitioned most effective activities to other organizations/coalitions Transitioned most effective activities to other organizations/coalitions –Learning Collaborative –CHWs Applied lessons learned to new coalitions Applied lessons learned to new coalitions Maintained relationships Maintained relationships

30. Implement policies: Healthy Eating in Schools

31. Implement policies: Physical Activity in Schools