LESSONS LEARNED - Urban Health Institute Learned Monograph.pdfes and failures, and suggestions for advancing the mission and vision of the Urban Health Institute. The monograph that

LESSONS LEARNEDCreating Successful Community-University Partnerships

J O H N S H O P K I N S U N I V E R S I T Y U R B A N H E A L T H I N S T I T U T E

B a l t i m o r e , M a r y l a n d

T H E J O H N S H O P K I N S U N I V E R S I T Y U R B A N H E A L T H I N S T I T U T E

PARTNERSHIPS ARE INHERENTLY DIFFICULT. WHY SHOULD A PARTNERSHIP

BE FORMED AT ALL?

First, academic institutions thrive on ideas and vibrate withnew enterprises—and they increasingly interact with theirsurroundings. Universities exist to build and share the world’sstore of knowledge, and they are highly prized for their valu-able intellectual resources. Their missions may differ—from aland-grant institution to an arts academy—but none sub-scribes to an isolationist philosophy.

As universities have prospered, some have found themselves inbeleaguered urban communities. There has been a growingawareness that their institutional health is linked to the well-being of their neighborhoods. Then came a realization thatthese neighborhoods are rich with their own resources andhave much to offer in return. There is, then, the real promiseof mutual benefit from working together.

A COMMUNITY-UNIVERSITY PARTNERSHIP SHOULD BE FORMEDONLY WHEN BOTH PARTNERS DETERMINE THAT THEY CAN DO

MORE TOGETHER THAN ALONE.

J O H N S H O P K I N S U R B A N H E A L T H I N S T I T U T E L E S S O N S L E A R N E D Pg. 1

T H E C O M M U N I T Y- U N I V E R S I T Y PA R T N E R S H I P F O R U M

The Johns Hopkins Urban Health Institute hosted a one-day Community-University

Partnership Forum in 2007 at the Frederick Douglass-Isaac Myers Maritime Museum

in the Fells Point neighborhood of Baltimore. The event brought together 65 leaders

from the Johns Hopkins University, other Baltimore universities and community groups,

as well as colleagues from around the country who are involved in community-univer-

sity partnerships.

Planning for the forum began with conversations with local and national leaders to

identify model community-university partnerships. Six such collaborations were

selected for study: West Philadelphia-University of Pennsylvania; Detroit-University of

Michigan; East Lansing-Michigan State; San Francisco-University of California, San

Francisco; Harlem-Columbia University/New York Academy of Medicine; and Boston-

Tufts University.

In addition, UHI leaders spoke with other national experts in the field, including Judith

Rudin, president of the Rockefeller Foundation; William Richardson, president emeri-

tus of the Johns Hopkins University and former president of the W.K. Kellogg

Foundation; Burton Sonenstein, CFO of the Annie E. Casey Foundation and former CFO

of Wellesley College; and Sarena Seifer, executive director of the Community-Campus

Partnership for Health. Subsequently, site visits were conducted in West Philadelphia,

San Francisco and Harlem.

The Community-University Partnership Forum engaged community and university

representatives in discussions regarding establishing partnerships, creating bidirec-

tional collaborations, power sharing, financing and sustainability, real-life success-

es and failures, and suggestions for advancing the mission and vision of the Urban

Health Institute.

The monograph that follows is a distillation of the lessons learned from these wide-

ranging discussions, the forum and site visits. For the most part, it is written from the

university's point of view.

The Urban Health Institute gratefully acknowledges the following for their contributionsto the success of this initiative: forum panelists Ira Harkavy, Barbara Israel, Alex Allen,Alan Green, Ralph Moore, Karen Brau and Kathy Diaz; the Annie E. Casey Foundation,which provided generous support; and Kamila Mistry, who collected, organized andsummarized materials and drafted sections of the monograph.

Pg. 2 L E S S O N S L E A R N E D J O H N S H O P K I N S U R B A N H E A L T H I N S T I T U T E

L E S S O N No. 1

SELECT PARTNERS AND FIND CHAMPIONS

Having established that there can be reciprocal benefit, eachside must choose its partners carefully. There are twoapproaches to this: First, an institution can identify the issueit would like to address. It can explore any existing community-university links and select the appropriate university resourcesto engage in a partnership on the issue. Alternately, each canreach out to the other without a predetermined agenda, seekinginput regarding its potential partners’ priorities and determin-ing the best fit for a joint endeavor. During the search, do notoverlook smaller colleges and universities as potential partners.

Know the communi ty. With either approach, the next step for a university is to getacquainted with the community, beginning with a small group of stakeholders that will expandas these leaders recommend others. Each community is complex, with an assortment of poten-tial partners, from neighborhood activists to political and faith leaders. Listen carefully. Visit

their organizations. Learn about their expectations. Check their credentials and reputations.

Are they embedded and highly regarded in the community? Do they have a good history ofworking well with others? Are they serious about wanting to deal with the issue at hand? Do

they have the capacity to fulfill their obligations? Will they be committed long term?


S T O R I E S of S U C C E S S

IM P ROV I N G

UR B A N NU T R I T I O N

Funded by public and private donors,Penn's Urban Nutrition Initiativeengages K-16+ learners in a curricu-lum that strives to improve communitynutrition and wellness. The university-community partnership operates in 20schools in Penn's West Philadelphianeighborhood. The program aims toincrease knowledge of food and nutri-tion, improve the supply of healthyfoods and encourage active lifestyles.

UNI's endeavors include integratingnutrition lessons into the academiccurriculum, providing hands-on cook-ing classes during lunch periods, set-ting up fruit/vegetable stands andfarmers' markets, establishing school-based gardens, offering free communi-ty fitness and health programs, andproviding after-school and summer jobtraining in urban agriculture, entrepre-neurship and peer education.

Remain f lex ib le . Flexibility is as important to success ascommitment. The partnership may need to change as under-standing of the issue increases. People and organizations mayweave in and out as the process proceeds. Make room forpeople who invite themselves into the process, but give thema clear role or their presence will be questioned. As partici-pants come and go, ask about others who might be interest-ed. Remain open and fluid, allowing the partnership to drawupon various resources as circumstances require.

F ind champions . Every great purpose must find a cham-pion, and these partnerships are no exception. Individualsfrom both the community and the university must assumethe mantle of leadership and champion the cause. There is nosubstitute for explicit and unambiguous support from thetop. The USC president, for example, attends monthly meet-ings of the community board and addresses issues raised bythe members.


“It’s important to have a champion at the top of the academic institution toprovide visible and influential leadership.

Having the university president understand the importance of working with

the surrounding community has been a key to our success.”

IRA HARKAVY, PHD, FOUNDING DIRECTOR AND ASSOCIATE VICE PRESIDENT,

CENTER FOR COMMUNITY PARTNERSHIPS, UNIVERSITY OF PENNSYLVANIA

DETERMINE, SUPPORT AND EVALUATE THE MISSION

Most community-university partnership programs serve as aliaison between university students/faculty/staff and commu-nity organizations. As such, they perform outreach activitiesand coordinate partnership endeavors. Before determining thestructure of a community-university partnership, some keycomponents need careful consideration.

Establ ish—and communicate—the miss ion and v is ion . Partners must work

together to develop written mission and vision statements for the partnership. This willinvolve defining core values and goals. A broad understanding of the mission/vision will helpensure that all activities are in keeping with the purpose and priorities of the partnership. The

principles produced should be provided to all partners in writing and reviewed annually. Asthe partnership progresses, communication will include information consolidation and mediamanagement.

Prov ide in f ras t ruc ture . Support requirements will vary according to the scope of partnership activities, but adequate infrastructure—including two to three full-time/equiva-lent staff positions—is essential. Since most partnerships involve multiple projects, activitiesneed to be coordinated. Develop a listserv to promote communication among partnersbetween meetings, and establish working groups around priority areas. Build funding for core

support—staff and faculty time—into grant applications.


L E S S O N No. 2

Devise an e f fec t ive sys tem o f eva lua t ion .Assessment is a valuable way to learn from the partnership,and an effective method of evaluation should be included inany partnership agreement. From the outset, evaluation cri-

teria should be in writing and accessible to all partners.Benchmarks should flow from the principles governing thepartnership, be transparent, involve all partners and reflect

the highest methodological quality. Preferably, ongoing

assessments will gauge the progress of the partnership andallow mid-course corrections.

Out l ine a gracefu l ex i t s t ra tegy. Most partner-ships are not designed to be long-term relationships, andwhen their natural lifespan is over, they should be ended

gracefully. Other partnerships simply fail, and properly

acknowledging the failed effort can be a gesture of respect.Ideally, terms of disengagement will have been establishedalong with those for engagement. Whatever the case, part-

ners should try to leave on a positive note without severingall ties. There might be future opportunities to work togeth-er, and that potential should not be damaged by the dissolu-tion of the partnership.



EN S U R I N G

CH I L D R E N’S SA F E T Y

USC's priority of public safety gets a

boost from the Kids Watch program, which

teams the University with the Los Angeles

Police Department and the city's Unified

School District. To ensure the safety of

children who walk to and from schools in

the USC neighborhood, more than 1,100

volunteers put a decal on their homes,

identifying them as “safe houses.” The

volunteers also don bright yellow T shirts

and remain outside for 30 to 45 minutes

before and after school. Children know

that if they are harassed, they can find a

haven in any one of the safe houses.

All volunteers must pass an LAPD back-

ground check, and their presence has sig-

nificantly improved both the perception of

safety and the reality. As a result of the

program's success, the LAPD and the

school district have expanded it to other

areas of the city.

“Overcoming suspicion required a processof first forming (getting people together),then storming (coming up with shared

vocabulary) and finally norming (establishing a plan and priorities).

The long process was worth the hardwork because it served us well.”

DAVID VLAHOV, PHD, DIRECTOR, CENTER FOR URBAN

EPIDEMIOLOGIC STUDIES, NEW YORK ACADEMY OF MEDICINE

L E S S O N No. 3


ESTABLISH GOVERNANCE AND REWARDS

Like the best legal contract, which anticipates potentialproblems and provides solutions that protect both parties,the governing structure of a community-university partner-ship should be carefully crafted. Rules that govern the part-nership, such as a memorandum of understanding, must beclear. They should indicate open channels of communica-tion and provide access to decision makers on both sides.

Weigh the mer i ts o f communi ty boards . Assembling a community board canhelp the partnership. It can be advisory or decision making—but a community studywithout a board might be unethical. First, clearly identify the community for each proj-ect; then identify the best representatives within the community. Examine the ratio ofuniversity and community representatives and consider race, age, gender and ethnicity.

Define the board’s purpose and establish accountability. Decide together on equitablestructures for conflict negotiation.

The best community boards attract new organizations and individuals to the table.Advisors can help sort out power-sharing issues and drive the programs or research for-ward. Boards can reinforce the importance of relationships to long-term success, buildcapacity, address ongoing needs and help ensure sustainability. There is often a tempta-tion to use a board too extensively, however, and its role should be clearly defined and

tailored to partnership goals.

Compensate adv isors . Don’t assume that communityboard members are being paid by their organizations for theirparticipation in the partnership. Likewise, don’t assume thatthey don’t want to be paid. They may be volunteers, but theirtime and expertise are valuable. When possible, allot moneyto compensate community members. Otherwise, try to findan exchange that will be viewed as fair. Serving on a boardcan be a way to develop valuable contacts and connect withother community-based organizations. Any compensation,however, should avoid the appearance of conflict of interest.

Reward par t ic ipa t ion . From the university’s point ofview, building a community-university partnership requiresboth financial and personnel resources. University leaderswho support the endeavor should make certain that partici-pating faculty and staff are not penalized in their career pro-gression. Translational research has rarely been rewarded bythe academic culture, and universities provide fewer incen-tives—tenure and promotion—for faculty who do time-intensive community work. Penn faculty, however, started

with small seed grants and built a constituency of facultywho were committed to such work. Over time, they receivedmore support from university leadership.



IN V E S T I N G I N

HE A LT H Y NE I G H B O R S

Community Health Workers from theJohns Hopkins Urban Health Instituteare working in the OB/GYN Clinic of theEast Baltimore Medical Center to helpneighborhood mothers-to-be. Througheducation and emotional support, theyencourage the pregnant women toremain in prenatal care and, afterbirth, to breast-feed their babies.Breast-feeding lowers the risk for suchchildhood maladies as obesity, asthma,ear infections and bladder infections—and also lowers a mother's risk forbreast and ovarian cancer. In addition,the program is lowering the incidenceof preterm births, ensuring a healthierstart for children.

Most of the current Community HealthWorkers are members of AmeriCorps,and UHI is expanding the program byencouraging members of its EastBaltimore community to join CHW.

“Focusing on small wins helps overcomesuspicion and boost energy for both university and community partners.

It lets both sides focus on what they are getting out of the partnership.”

WIM WIEWEL, PROVOST, UNIVERSITY OF BALTIMORE

L E S S O N No. 4

Les son # 4

OVERCOME BARRIERS AND AVOID PITFALLS

Partnerships inevitably encounter barriers. One partnermay misconstrue the other’s level of interest. It may be dif-ficult to establish sufficient trust. There may be languagebarriers and cultural misunderstandings. There may evenbe internal miscommunication within one side of the part-nership. Here are suggestions from the field:

Avoid ar rogance. Too often, universities approach communities with the idea that

they will swoop in to fix a problem, as though knowledge and expertise reside on theirside alone. They may operate in a hierarchical model, alienating community collabora-tors. It is important to recognize and respect the considerable skills and resources within

the community.

Recognize d ispar i t ies . Large universities dwarf potential community partners, sorespect for the community’s gifts is critical. On the other hand, the resources of an indi-

vidual faculty member may not match “deep pockets” expectations from the community.Non-monetary strategies—like showing up at community events—will help demonstratethat the partnership is real.

Learn f rom mis takes. Failures can be of great value. Hold people accountable, butdon’t assign blame. Instead, use the opportunity to discuss, analyze, adjust and move forward.

Ant ic ipa te d isengagement . Some people and organizations will likely abandonthe partnership. Plan ahead for changes and be prepared to infuse the endeavor with freshtroops and ideas.


Accept d isagreement . Some tensions and disagree-ments are part of the learning process. While it is often easi-er to assign only agreeable community members to theboard, it can be less productive. Welcome those who havestrong opinions and their passion for the issue.

Acknowledge h is tory. Histories cannot be ignored.

Racism in a legacy, for example, is best recognized for what itis: ugly. A frank discussion of grievances and baggage canbuild trust and enable partners to move forward.

Keep your word . Meeting expectations is the founda-

tion for trust, and broken promises create enormous ill will.Community members may have passed on the assurances,and breaking an agreement places them in a difficult posi-

tion. Remain humble and accept that there may be thingsyou can’t promise. If you do promise, follow through.

Take suggest ions . Find more than one way to commu-nicate. A suggestion box, for example, gives even quiet mem-bers a comfortable opportunity to participate and allowsproblems to surface before they become toxic.



FU N D I N G CO M M U N I T Y

NO N P RO F I TS

The Good Neighbors program at theUniversity of Southern Californiaencourages USC employees to donate aportion of their salaries to communityinitiatives. To be eligible for one-time orongoing grants up to $50,000, nonprof-it community agencies must be basedin and provide services within the geo-graphic boundaries established by theUniversity, have a link to USC andaddress at least one of USC's civic andcommunity priorities.

The program is administered by a groupof 12 USC faculty and staff memberswho select the awardees. The Universityabsorbs all overhead expenses for the program so all funds go directly to thecommunity. USC has established a“President's Leadership Circle” ofemployees who contribute one percentor more of their salaries to the program,and President Sample hosts an annualdinner in their honor.

“I’ve learned that knowledge empowers.Someone’s limits are really a reflection of

their lack of knowledge. However, with theright information, tools and skills, anyone

can be healthy and successful.”ANNIE COPLES, COMMUNITY HEALTH WORKER,

JOHNS HOPKINS URBAN HEALTH INSTITUTE

L E S S O N No. 5

ENSURE SUSTAINABILITY

Relationship building should drive the partnership, notresearch priorities. When a research partnership has ful-filled its objectives, the university should leave the commu-nity with tangible benefits, increased capacity and new orimproved programs. Follow-up is not only a courtesy butanother opportunity to assess long-term impact.

Empower the communi ty. Acknowledge the resources contributed by the commu-nity, and let the community-based organization take the lead. It then receives the funds,and the university serves as a subcontractor. Some community organizations will have thecapacity to function in this role, while others may need help writing grants and manag-ing budgets. That, in turn, becomes part of building capacity.

Information, research objectives and timeframes should be clearly communicated so the

community can make timely, informed decisions. The partnership should have an impacton the community in terms of programs, policies and structures—perhaps in increasedemployment and capacity for using research data.

Empower s tudents . A university student body is a powerful force. Students caninfluence how a community partnership is perceived by the university—and they can saythings that faculty could not. Engage them and their talents in the partnership.

Moni tor expendi tures . A true partnership will outlast funding. If there is real commitment to a solution, each can use the dearth of money to build trust and apply creativity. The result can be a high-performing relationship that is stronger than ever. Theideal, however, is not to put the relationship to that particular test. Money comes withstrings attached, and the allocation of financial resources should be carefully monitoredbased on clear objectives.


Fol low the money. Sustainability cannot be achieved bysole reliance on grant funding. A steady stream should be created from university and philanthropic support, city andstate health department funding and other donor gifts. Theuniversity’s fundraising team should be aware that partner-ships are a priority. Another idea is to “tax” all money coming

into the university and dedicate that portion to partnerships.

Celebra te success . Even small-scale victories areimportant for generating and maintaining energy andmorale. Never lose an opportunity to celebrate success andacknowledge those who contributed to it. For more majorachievements, send press releases to the media and make cer-tain that the community gets its fair share of credit.



ADVA N C I N G

CO M M U N I T Y HE A LT H

The University of Pennsylvania hasengaged hundreds of students andsome 20 faculty members in an effort to increase their civic involvement andstrengthen families and institutions in the Penn neighborhood. In one initia-tive, Sayre eleventh graders in anIntake Medical Procedures course work with Penn students to learn intakebasics—such as blood pressure, height,weight, glucose, reflex and vision.

The high schoolers also learn about significant community health concerns(hypertension, obesity and diabetes)and gain clinical experience by operat-ing an after-school health monitoringclinic. At the recently opened permanenthealth clinic facility, Sayre studentswork with Penn doctors and nurses,health professional students and com-munity members to provide basicintake services and referrals.

For more information on community-university partnerships,

visit our website: www.jhsph.edu/urbanhealth

“I know some of the people from growingup in this area, and many of them knowthat I’ve experienced the same problems.

That’s like a beacon of hope. They see that there’s a way out and

a way to live positively.”ROBERT ALLEN, COMMUNITY HEALTH WORKER,

JOHNS HOPKINS URBAN HEALTH INSTITUTE

Communi ty -Univers i ty Par tnersh ip Ar t ic les

Bell-Elkins, J. (2002). Assessing the CCPH Principles of Partnership in a Community-Campus Partnership: available at http://depts.washington.edu/ccph/pdf_files/friendly%20principles2.pdf

Harkavy, Ira (2000). Historical Evolution of University-Community Partnerships.Community News, 12(2):1-3.

Harkavy, I. and Wiewel, W. (1995). University-Community Partnerships: Current Stateand Future Issues. Metropolitan Universities, 6(3):7-14.

Green, L.W. and Mercer, S.L. (2001). Community-based participatory research: Can public health researchers and agencies reconcile the push from funding bodies and thepull from communities? American Journal of Public Health, 91(12):1926-1929.

Israel, B.A.; Krieger, J.W.; Vlahov, D.; Ciske, S.J.; Foley, M.; Fortin, P., et al. (2006).Challenges and facilitating factors in sustaining community-based participatory researchpartnerships: Lessons learned from the Detroit, New York City, and Seattle UrbanResearch Centers. Journal of Urban Health, 83(6):1022-1040.

Israel, B.A.; Lichtenstein, R.L.; Lantz, P.M.; McGranaghan, R.J.; Allen, A.; Guzman, J.R.,et al. (2001). The Detroit Community-Academic Urban Research Center: Development,implementation and evaluation. Journal of Public Health Management and Practice, 7:1-20.

Kone, Ahoua; Sullivan, Marianne, et al. (2000). Improving CollaborationBetweenResearchers and Communities. Public Health Reports, 115:243-248.

Lantz, P.M.; Viruell-Fuentes, E.; Israel, B.A.; Softley, D.; Guzman, R. (2001). Can communities and academia work together on public health research? Evaluation resultsfrom a community-based participatory research partnership in Detroit. Journal of UrbanHealth, 78:495-507.

Maurana, Cheryl A.; Beck, Barbra; Newton, Gail L. (1998). How Principles ofPartnership Are Applied to the Development of a Community-Campus Partnership.Partnership Perspectives, 1(1):47-53.

Minkler, Meredith; Blackwell, Angela Glover; Thompson, Mildred; Tamir,Heather(2003). Community-Based Participatory Research: Implication for Public HealthFunding. American Journal of Public Health, 93:1210-1213.

Rubin, Victor (2000). Evaluating University-Community Partnerships: An Examinationof the Evolution of Questions and Approaches. Cityscape: A Journal of Policy Developmentand Research, 5(1):219-230.

Wiewel, W. and Lieber, M. (1998). Goal Achievement, Relationship Building, andIncrementalism: The Challenges of University-Community Partnerships. Journal ofPlanning Education and Research, 17(4):291-301.

Dr. Robert Blum, Director

2013 East Monument Street, Baltimore, MD 21205

410-502-6155

www.jhsph.edu/urbanhealth

Documents

LESSONS LEARNED - Urban Health Institute Learned Monograph.pdfes and failures, and suggestions for advancing the mission and vision of the Urban Health Institute. The monograph that