The Coaction Fellowship is a year-long professional development opportunity, building capacity in multi-level, inter-sector collaboration for community and population health improvement. The program evolved from concern that while understanding of the complexity of the social determinants of health is leading to more multidisciplinary action in community and population health, it is too often done as parallel play. Much has been learned about the continuum of how we can work together in community; such as Arthur Himmelman’s often cited definitions of networking, coordinating, cooperating, and collaborating in his work, Collaboration for a Change.  Experience still shows, however, that there is much yet to be learned about how to apply these concepts in the real world.

Even as communities are coming together to identify shared concerns and goals, for too many communities these actions are primarily motivated by compliance with external requirements. Working on shared goals is not the same as coaction, which goes further than participating in community planning, and even sharing resources. It requires having the individual, institutional and political will to change both the system and how you carry out business in your corner of that system. 
 
Coaction Institute is creating a space for community health advocates to learn together and from each other to overcome current obstacles to authentic coaction.  As Coaction Fellows, the participants study and practice proven community building strategies that enhance their own work, and will go on to serve as mentors and models for others in the community looking to overcome the problem of parallel play. The cohort begins by identifying key issues currently presenting obstacles to true coaction in their community work, from which the study circle readings are selected from the shared resource center being developed. Topics include trust, multi-culturalism, communication, power-sharing, collaborative process evaluation, and others.
 
 As communities work towards overcoming the hurdle of parallel tunnel vision in understanding and addressing their greatest population health needs, the goal posts must keep moving further downfield to authentic coaction.

Unfortunately, when critical concepts gain broad acceptance are at risk of becoming diluted and losing their significance to marketing interests.  Is resilience such a concept?  Let’s hope not, as 2017 unfurls to feelings of both exuberance and anxiety in the country. In either case, opportunities to use that energy to build and sustain efforts to improve the health and well-being our communities abound.  So, what does resilience look like?


Finding yourself in community with others who share your passions and concerns, rather than staying in bed with the covers pulled over your head is resilience.
Learning from your mistakes and then acting on what you’ve learned is resilience.
Believing in second chances is resilience.
Reaching out to support someone facing even greater hurdles than you are, instead of blaming them for your own challenges is resilience.
 
​Coaction Institute has been working with grassroots Promotores de Salud in low-income Spanish-speaking communities in Marin County, California to understand how their communities and institutions can support their resilience as they serve out in the trenches:

• learning about secondary trauma and the factors that put them at particular risk and protect them from that on social, institutional and personal levels;
• fostering connectedness between the promotores and between them and the institutions that support their work;
• creating intentional spaces of mutual support within their teams;
• assessing and analyzing current levels of compassion satisfaction, work fatigue and secondary trauma within the teams;
• facilitating conversation between the promotores and their supervisors about how the institutions could better support them in preventing secondary trauma through policies and practices; and
• developing institutional and individual plans to prevent secondary trauma and reduce work fatigue among the promotores.

To learn more about working with Coaction on building resilience to prevent secondary trauma among your frontline community workers, email dory@communitybldg.net.

Growing awareness and understanding of the social determinants of health and health equity do not necessarily translate into sustainable change of our traditional system; which is more grounded in profitability than in feasible efforts to eliminate structural inequities that result in clusters of unmet need and poor health.  Nor is it enough to ensure the construction of a culture of health in the U.S.  As we struggle through the challenges of creating a system of equitable opportunities for healthy living; existing social norms, institutional policies, and individual habits frequently replicate the very same inequitable practices they claim to be addressing. The healthcare and public health sectors openly appreciate the power of community health workers (CHWs), promotores de salud, and other grassroots agents of change in improving health outcomes in diverse communities. Unfortunately, current initiatives using CHWs and Promotores de Salud as “extensionists” in health improvement efforts often puts these community workers at risk for harms associated with secondary stress, also known as vicarious traumatization.  They are tasked with addressing important emerging priorities, such as building social connection and cohesion; but not well prepared to reduce the risks to their own wellbeing in this endeavor.  A study of Promotores de Salud in Chile found that only half of the participants had a healthy lifestyle (Cid, Merino & Stiepovich, 2006).
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Just as promoting health equity and a culture of health in communities requires the inclusion of strategies that address social determinants of health, the prevention of secondary stress in grassroots community workers relies on more than individual behavior change (The National Child Traumatic Stress Network, 2014); but rather must include a shift in the social norms and institutional policies and practices that enable and promote those healthy behaviors. It should come as no surprise that a multi-country study of CHW productivity and retention found that a work environment that provides supportive supervision, including the facilitation of peer-to-peer support is key to their ability to ability to their ability to do their work (Jaskiewicz & Tulenko, 2012).
  
Learn more about multi-level self-care policies and practices at Coaction Institute. Strategies included in the model include education, as an empowerment tool; community building among the participants to generate a sense of connectedness, learning, solidarity and mutual support; development of a shared vision of what self-care promoting institutions and communities look like; participatory action planning; and advocacy and action to generate institutional and community systems policy and practice changes to support self-care among agents of change. The 18-month program period includes partnership development, collaborative planning, engagement of participants, self-assessment, implementation, on-going monitoring and evaluation.

Inter-disciplinarity is about doing more together than we can apart. While the understanding of the complexity of the social determinants of health (SDH) is leading to more multidisciplinary action in community and population health, it is too often done as parallel play.  Much has been learned about the continuum of how we can work together in community; such as Arthur Himmelman’s often sited definitions of networking, coordinating, cooperating, and collaborating in his work, Collaboration for a Change (http://www.himmelmanconsulting.com).  Experience still shows, however, that there is much yet to be learned about how to apply these concepts in the real world.

More and more, communities are coming together to identify shared concerns; and even shared goals addressing their concerns. Yet the fact is that for too many communities, these actions are primarily motivated by compliance with external requirements, such as the Affordable Care Act (ACA), which mandates the assessment of community health needs every three years and incentivizes population health improvements.

Working on shared goals is not the same as coaction, which is about taking action together.  This requires going even further than participating in community planning, and even sharing resources. It requires having the individual, institutional and political will to change both the system and how you carry out business in your corner of that system.  As communities work towards overcoming the hurdle of parallel tunnel vision in understanding and addressing their greatest population health needs, the goal posts must keep moving further downfield to coaction.
 
In upcoming conversations, we’ll address the issues of how the replication of traditional power dynamics in community health initiatives limits their capacity to achieve their stated shared long-term goals; among other topics.  We’re interested in your thoughts, questions, and suggestions. Please keep the conversation going!