U6D2-28 - Explore, Examine and Identify Hybrid Action Learning Data Tools (Model). ***PLEASE FOLLOW THE INSTRUCTIONS AS OUTLINED BELOW*** See Attached Documents for Reference and Readings.

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8 Cases From Other Fields

or hybrid implementation, it is not surprising that examples are found in public health given its importance and the local and national funding that flows into the field. These cases are complex, usually take an extended period of time, and require a lot of resources for identifying assets and

resources (Chapter 7). It should be stressed that federal and state levels and even local ones maintain health care and disease statistics from routinely collected data that are entered into accessible databases. Information about needs is commonplace, and workers in relevant professions are attuned to it and readily take advantage of what is available. This is also in their formal training via epidemiology. Combinations of needs assessment and asset/capacity building à la a hybrid are appropriate for them.

Researchers, evaluators, and needs assessors in a number of other fields (education, social work, community affairs) do not have epidemiology in their training programs. Thus they may not have the understanding that lends itself almost naturally to working across approaches. Going further in these areas, the focus on a more traditional deficit position may be common. It may crowd out consideration of an alternative. Whatever the reason, fewer projects were found that cut across the two approaches, and those that did tended to load more on asset/capacity building than on needs assessment.

An overview of several cases is provided in Table 8.1. In their full explanations, there are similarities to those in the prior chapter. Contexts vary, but techniques for collecting and utilizing information aren’t diametrically different.

Table 8.1 Overview of Cases From Fields Other Than Public Health That Were Moving Toward Implementation of the Hybrid Framework

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OVERVIEW OF CASES FROM FIELDS OTHER THAN PUBLIC HEALTH

The table entries include the author(s), when the work was conducted, key aspects of the hybrid framework it demonstrated, and a rating of its strength in that regard. For the latter, + would be a judgment that it was there, ++ that it was there in a major way, and +++ that it was extremely strong—plusses are desirable. Special aspects of what was done are in the Comments column.

CASE 1. USING COMMUNITY PERSPECTIVES ON YOUTH FIREARM VIOLENCEFOR PREVENTION PROGRAM PLANNING

The emphasis of this project, while stronger on assets, did have a needs assessment component. It was seen as appropriate for this text.

Structure of the Project A coalition in North Philadelphia was concerned with youth firearm violence. It wanted to examine the

problem and to resolve it or at least reduce the level of crimes committed with guns. Remember in Chapter 7, and relevant here, it was observed that some communities have been involved in looking at needs and resources in the past. This gives them a better chance of succeeding in a new endeavor. Having that experience may be significant, further reinforcing existing partnerships that could pay big dividends.

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The community in Philadelphia wanted to understand the situation, frame solutions, identify assets that could be applied to resolve the situation, engage key members of the community and groups in solutions, and as suggested in the hybrid framework determine variables that would indicate progress and be useful for evaluating outcomes. This was a major undertaking.

The coalition was very much along the lines of what the hybrid framework recommends. It consisted of a youth outreach organization, public health and law departments of a university, and medical care providers. Numerous project directors, representatives of city agencies, the foundation that funded the effort, and others were involved. Community members who had a history of working on programs were part of the effort. The coalition had an evaluation team, subcommittees, a governing council, and a community advisory group. In Exhibit 8.1 and Table 8.2 on page 188, what they did and the application of the first part of the evaluation checklist to the case are described.

Exhibit 8.1 Activities Incorporated Into the Firearms Prevention Project

Formation of the project Determining actors and groups to be represented Developing committees and a governance mechanism Enhancing community member involvement by eventual inclusion on the governing council

Review of other similar projects conducted in other inner cities (use of the literature)

Description of the target neighborhoods and areas (needs orientation) Use of existing reports for the areas of the city in concern Trends in data over years Demographics Youth homicides

Description of a conceptual pyramid Foundation consisting of community composition, organization, and capacity for action Middle level consisting of the socioecological factors affecting health Top level consisting of existing services that have bearing for improvement

Rapid participatory appraisal (RPA) Follows tenets of RPA in general but more investigator led Community heavily included in analysis, interpretation, and use of information Semistructured individual interviews of key informants Questions about topics: Community composition Organizations Capacity Aspects of the environment (socio, economic, physical) Health services And so on

Sample initially consisted of key informants and then expanded by a “snowball” technique Covered a wide spread of the community Included youths Interviewers recruited with experience applicable to the study Three hired interviewers

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Good listening and communication skills Also participated in the analysis

Analysis Key themes identified Clustered into four main ones Assets Problems (needs) Solutions

Indicators of successful programming Interviewees meeting as a group to discuss themes Reports from the interviews being fed back to interviewees

Results (positives)

PERCEPTIONS OF THE PROCESS

The above process was considered to be a needs assessment and asset/resource identification.

Interviewers felt that the results captured what had been said.

A strong community identity emerged, including a sense of pride and history.

Interest arose in new efforts to help the community: Local groups were mentioned in this regard. Local agencies did not arise in the interviews.

Aspects (positive and negative) of the physical community were noted.

Results (negatives) Drugs and drug problems are the root cause of the problem (violence and guns). The problem is increasing. The youth community has changed and become more resistant to older solution ideas. Drugs are affecting many facets of the community (education, housing, etc.). Senior citizens seem leery of participating in new efforts (intimidation may be a factor).

Unemployment Young men in particular are affected. Training in job skills and readiness is needed.

Insufficient educational services are in existence across many segments of the community. More activities for youth are needed. Some services are there but not coordinated. Even what churches do has to be better tied together.

Health concerns Alcoholism in addition to drugs Abandoned houses leading to trash and rat problems Physical quality of streets

Solutions Getting rid of drugs

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Seeking help from outside the community in relation to eliminating drugs Recognizing the issue and its severity Strengthening the police presence Increasing educational and vocational services Increasing services for youth Enhancing internal community groups and allowing them to pull together more Recognizing the criticality of the internal community to long-term success Strengthening cooperation and coordination Engaging in better communication

What are the signs of successful improvement activities and programs? Safer environment Less drug abuse, violence, crime Fixing up homes, more appealing neighborhoods Organizations, people, and services (e.g., police) working together to improve the community Visibly increased services

One thing to emphasize is that there was community input and insight into the evaluation of activities that would result from the study. If the full evaluation checklist had been used, this case would have rated fairly high on later aspects of it.

Discussion of the Case First, the authors raised the question of what constitutes a neighborhood and noted that there are many

subneighborhoods in a larger one. At this finer level of detail, people in them are less aware of resources available nearby. Staff observed that they did not fully understand the local communities in which the investigation was conducted. The subtle diversity was hard to comprehend.

Second, the authors observed fear in the interview responses. With it comes isolation, which may account for some of the lack of awareness of services available to residents. At the same time, the interviewees recognized that internal solutions were important to resolving problems and were equal to the idea that there must be external awareness of the issues. Thus the “can do” attitude and feeling of empowerment was in the thinking of the community.

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Third, solutions suggested in the interviews actually became the basis for action. To a high degree they loaded on the concepts of coordination and communication. The project led to the formation of three subcommittees charged with developing programs aimed at reducing firearm violence. Each had a cross section of the community in its membership. The procedures recommended drew heavily on linking organizations, agencies, and services together for improvement, and strategies went so far as to involve youth in their implementation, which was almost a centerpiece of what was to be done.

Fourth, a strength was that those who participated in the study became instrumental in subsequent new initiatives. In this text and previous writings, the author has stressed that this is crucial for ultimate success and change in needs assessment, asset/capacity building, or a combination of the two. It propels subsequent development and improvement.

Fifth, as noted above and in accord with the hybrid, evaluation was part of what the subcommittees were putting into place. Concerns focused on ensuring the quality of leadership, looking at the process of programs, keeping adequate records, prioritizing outcome indicators, and making observations of efforts. This part of the framework might not be realized in many circumstances. It demonstrates that the coalition was open to the citizenry and wove the citizens’ perceptions into the process.

Sixth, while a timeline was not provided, a sizable period was needed for collecting input and for trust to develop. This was a cost but, in terms of what was achieved, a necessary and a worthwhile one.

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CASE 2. THE AGRICULTURAL UTILIZATION RESEARCH INSTITUTE (AURI) OF MINNESOTA

Agriculture is a major driver of the U.S. economy, as attested to when Hurricane Katrina hit New Orleans in 2005 and disrupted huge shipments of farm goods from the Great Plains and upper Midwest. Recently, the state of Minnesota established the Agricultural Utilization Research Institute (AURI) to promote the transfer of technology and research to its large agricultural industry and nearby states in regard to basic areas— bioproducts, renewable energy, coproducts (coming from residues generated from corn in the manufacture of ethanol, from processing of raw materials into edible substances, etc.), and food. AURI is an outgrowth of extension as it enters a new era of service to the public.

Structure of the Project Immediately, this calls for needs assessment and asset/capacity building. Needs must be addressed in

relation to establishing new directions, enhancing productivity and profitability in agribusiness, changing practices in the field, developing career opportunities, and so forth (Altschuld & Hung, 2012). At the same time, there are vast assets in family and large farm enterprises, research centers and labs, and large and small commercial establishments. There is value in identifying and cataloging them and juxtaposing needs against them to establish policies and procedures for improvement and the betterment of the state and the region.

The activities (needs, resource identification) occur in a complex environment. Building consensus, empowerment, and ownership are essential to this kind of endeavor. Many individuals and groups are involved—farmers, businesspeople, university scientists and researchers in other venues, company staffs, service providers, food processors, educators, and others. Needs-related questions could be formulated:

What are the problems facing producers?

What information that AURI has or will develop will be attended to by potential users?

What information is most persuasive and utilitarian, and why?

What trends are occurring in areas of concern or interest?

How do practices align with what is known about the four foci of AURI?

What do farmers understand about market conditions?

What problems and issues are they encountering in delivering what they produce to middle and end users?

What is happening, and what should happen, in regard to alternative energy sources?

What is employment in all facets of agriculture at the present time?

What might it be in 10 years?

There is no shortage of what could be examined, and similar thinking could be applied to assets. Recognizing the nature of the situation, the director of AURI, in conjunction with staff, state government, and key groups, elected (in 2012 and continuing in 2013) to determine needs and assets and to see what the problems and resources are and how they could be looked at in a proactive manner. External contracting was employed to determine gaps, resources, and strengths, which will be carefully reviewed. A detailed description of the case is in Exhibit 8.2, and the application of the first part of the evaluation checklist is in Table 8.3 on page 194.

Exhibit 8.2 Activities Incorporated Into the AURI Needs Assessment/Capacity-Building Project

Recognition of the situation Actors to be involved Extent of the issue on the needs and assets sides Having the resources for expert involvement Seeing the importance of investigating assets and needs independently

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Recognition that funds would eventually become scarce Independent local councils in operation—better coordination would be desirable Stress on the potential of collaboration

Focus on capacities Contracted with an external agency for assessment of capacities/opportunities Idea of targeting what AURI does to take advantage of capacity areas Interdisciplinary strengths Better alignment of assets with where the most good could be done Interestingly, guiding this was the three-phase model of needs assessment. Heavy reliance was placed on the Needs Assessment Kit (see Chapter 1). A broad-based needs assessment committee (NAC) was formed with wide representation. Local council buy-in and support of the endeavor was crucial and there. Meetings were externally facilitated. AURI considered itself to be a catalyst in the process, not a controller.

Initial get-together session NAC Pre-Assessment meeting Orientation Focus on current status of individual organizations as related to the study Looking for commonalities Discussion of advantages of working together (establishing the base) Meeting agenda supplied in the in-progress report

Outcomes Local councils worked together on specific projects (positive history there). There were crosscutting issues. Notion of leveraging was part of the discussion. Rich interaction occurred, but the full agenda could not be accomplished. Loss of completing agenda was mitigated by buy-in.

For the future Need for coordination to move forward Work with external contractor to better define the tasks to be done Focus on several of the key issues for in-depth exploration How to capitalize on agricultural talent, especially for employment Ways to leverage funding for research Negotiation across entities

Subsequent meeting and activities Maintaining attendance statewide requires attention, and AURI did focus on doing so. AURI reviewed prior work to get everyone on the same page.

Discussion of an agricultural research capacity assessment and strategic road map to be done by consultant group looking at

assets, strengths, and opportunities; needs; and possible outcomes from doing this.

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Also, how could results be linked to markets and other facets of agriculture? Breakout and discussion groups were incorporated into the sessions. They created “what is” and “what should be” statements. After the meeting, staff pulled together and summarized what was done. They contacted those who could not attend for input. They made contact with local councils. They did interim steps pursuant to the next meeting.

Next steps (project is in process at the time of this writing) Planning for next meetings Considerations of instruments to use Developing an instrument with multiple sections to look at needs Administering same to involved statewide group Going beyond Pre-assessment into Phases 2 and 3, Assessment and Post-assessment Moving toward priorities and procedures for doing so Meeting with the governor and key state administrators

Discussion of the Case First, as with the previous cases, this is an extensive undertaking that could not be done without outside

expertise, and sizable funding. To the credit of AURI staff, careful thought was given to what their role and stance should be and how external individuals would be integrated into the work. It was critical that the voice of stakeholders be there and that their buy-in be kept foremost. To date, this seems to have been accomplished.

Given that extensiveness, this venture will take a considerable period of time to produce fruitful results. Quick turnaround would not be expected. Stakeholders and decision makers should be made aware of this early on and not assume that immediate changes and new directions will occur as a result of initial activities. Unrealistic pressure for outcomes can occur and should be dealt with openly; otherwise, difficulties will be encountered.

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Second, is this a needs assessment, asset/capacity building, or closer to the hybrid framework? Although it uses the three-phase model of needs assessment, a lot of its activities fit the hybrid (including the determination of assets and resources), and it is perceived to be an example of the process. One small difference is that assessing needs and assets is more sequential than simultaneous in the framework. Circumstances may dictate such an order.

Third, this investigation is for a state, and that complicates matters greatly. At the time of this writing, two meetings have been held of the NAC, and a third is in the plans. Keeping up attendance and participation of busy NAC participants from all parts of the state and in different areas related to agriculture will not come easily, and even with electronic meetings and connectivity it will be a difficult proposition. How are communications maintained, and how will AURI see to it that the buy-in and ownership persist over what might be a lengthy period? These are serious questions. There was a drop-off from the first to the second sessions as might be anticipated. AURI staff were sensitive to this possibility and made commendable attempts to contact those who could not be there for comments and views as well as to make sure that they were apprised of progress and potential next steps.

Doing so is necessary for the flow and pace of this project. Without it, there is likelihood of less success or even failure, but it comes with a price. Keeping involvement going does not take place by happenstance. It is a calculated investment with resources and time being required. This is an almost hidden cost that groups absorb but do not record or think about. This was also observed in other cases, and because of it there is difficulty in estimating the funding needed for investigations. Certainly, activities that tie things together are continuous throughout a study, as well as later for planned and undertaken actions. One thing that might be

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done is to have staff members keep logs of contacts they make by phone, e-mail, or other means. In this way, we could get a picture of the time to keep the hybrid running and functional.

Fourth, this was an interesting application and unanticipated twist on the three phases of needs assessment. AURI tweaked it so that its third phase was much more into asset/capacity building along with some aspects of that being embedded in initial work. This strategy may yield insights into alternative ways to do the hybrid framework. Or it could be argued that this project was emanating from a needs assessment base and therefore was more oriented that way. A case study here would be interesting as to how well the two parts of the hybrid approach were blended into a whole.

Fifth, the attention to the details of potential meetings was apparent. AURI staff in their facilitation role were diligent in letting all participants know about upcoming meetings, agendas, what had been accomplished to date, and other details. This created a positive and solid foundation, and it was assumed that people from across the state would notice and see the sincerity and seriousness with which a complex set of issues was being addressed. Perception of the endeavor could only be enhanced by this stance. This was built into project plans, and it was the right course to follow.

CASE 3. SNIPPETS FROM MULTIPLE CASES IN THE PAPERS ON THE CADISPA WEBSITE

When the author was looking for examples of hybrid work outside of public health, he had dinner with an old friend and mentioned the search for examples. The friend sat up and recalled that the CADISPA website from Scotland had entries that fit (R. Jurin, personal communication, September 18, 2012). He was on target.

Scotland was facing tight budgets that would affect communities, particularly rural ones. The need was there, and without looking at resources, serious consequences in human terms would appear. Many policy papers were on the website that dealt with “community resiliency,” not needs assessment or asset/capacity building. The term was different, but the concept was not. Resiliency, which was not in the original literature query, refers to the ability of a community or a collective to handle adversities and be proactive for the well- being of its members. It implies communities working together to plan for programs that are preventative for health, financial strains, and other things that may arise. A resilient community or organization is capable of dealing with and resolving situations, whereas others may just hold steady or lose out when problems are encountered. This was a common theme throughout the website entries.

Four policy-oriented papers (APS Group, 2011; Boyle & Harris, 2009; Carnegie UK Trust, 2011; Woolvin, 2012) were selected for inclusion here. They did not contain complete cases but drew heavily from community-based endeavors exhibiting many of the principles in the framework. Descriptions of salient features were highlighted throughout the materials. In the papers, the starting point was the assets that a community had to offer (the bedrock strengths of Kretzmann and McKnight, 1993), but at the same time they were not oblivious to needs, and needs data were part of the equation.

Another feature throughout was the voluntary ethos of rural settings or other similar contexts. A spirit of working collectively to solve problems was almost ingrained in the people. This included involving community members in the delivery of services such as transportation of the elderly or being partners with professional personnel in aspects of health care provided to individuals. This is analogous to the example in Chapter 7 in which prior experience with needs and asset types of efforts was a type of learning that facilitated projects and new ventures.

What comes from the Scottish papers may not totally generalize, but there are valuable principles adaptable to our context. Exhibit 8.3 has an overview of key elements from snippets of the papers, and Table 8.4 on page 201 shows the first part of the evaluation checklist applied to them.

Exhibit 8.3 A Distillation of Premises and Activities Prominent in the Papers on the Website

Basic premises Clearly seeing the need due to funding limitations Recognizing assets that collectively reside in communities Focusing on assets and capacity but considering needs

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Thinking about communities and services required by them Discouraging dependency type of thinking Recognizing that a community must determine its own direction In some instances, the community must be an integral part of service delivery. Short-term efficiency (saving money and resources) thinking is not the way to go, especially at the expense of the long-term good. Government agencies must change to foster meaningful community involvement. The voice of the people must be there.

Models of what a well-functioning, resilient community means in terms of four features: Healthy engaged people Localized economy Linkages in and across communities Inclusive and creative culture

Community involvement for long-term benefits

With such involvement, greater transparency

Improving performance/reducing costs

Avoidance of “top down” direction, more partnering

Humanism

Collaboration seen as critical

Engagement, empowerment, and enablement

Coordination and leadership

Long-term strategic planning

Dealing with rapid change

Break-through, break-even, and break-down communities

Activities (needs) Needs in the form of gaps, a consideration in the papers Examination of existing data in bases Looking at trends Reliance on health, employment, and utilization of services statistics Pressures on public services Public expenditures over time Demographic patterns and growth of an aging population

Observations from data about dealing with problems, not seeing proactive prevention Noting where discrepancies are located as well as overlaps in services Housing prices, crime rates, and so on Local and disaggregated data Studying climate and environmental changes in relation to needs Community engagement in research and self-study

Extent of vulnerability in the community and to persons in re to jobs, health, and so forth

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Data from surveys and interviews Household surveys on energy Extracting needs from the data Oral histories

Prioritization suggested based on needs but always with asset thinking being prime

Activities (asset/capacity building) Seeking information from the community by a variety of mechanisms Training for community meetings complete with forms for brainstorming

Forms focus on break-through communities, break-even communities, and those breaking down. Extensively use scenarios with community groups. Employ tools (instruments) to determine the extent to which the four features of a resilient community have been achieved. Look for linkages to other communities. Stress the concept that no community can do it alone. Avoid use of resilience principles to promote politicized agendas.

Do surveys and assessments of the nature of community assets such as volunteering, physical facilities, and so forth.

Oral and cultural histories Create a sense of local values. Community members might collect and analyze data. Visit local places of culture. Encourage local events to reinforce culture.

Use summary tables to capture the nature of the culture (similar to devices proposed for the hybrid model in this text; see Table 3.3).

Tie assets and capacity building with needs. Get away from a dependency mind-set. Focus on public services.

One aspect is coproduction (service delivered by professionals and government but with large-scale and meaningful involvement of community members).

Heavy emphasis was placed on volunteers (in one of the papers this led to an in-depth study of volunteerism in the area).

Recognize that some services (police, justice) are not amenable to this approach, but aspects of them may be.

Results Numerous examples of results are embedded in the papers. The authors cited positive instances in Washington, DC, and Wisconsin regarding the juvenile court system and offenders with similar application and outcomes for a youth jury approach in the United Kingdom. Fifty thousand individuals with long-term health conditions have received support from like individuals in the United Kingdom. All of the papers have citations to success stories. Other outcomes were noted such as broadening of social networks or fairly creative ways of service delivery (giving credits to local leisure services for volunteer effort) not considered previously. Some stress was placed on longer-term outcomes.

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To reiterate, the papers, which are for public services in Scotland, are in response to needs arising from budgets that are to be reduced or at best remain flat. Need is clearly there, but the main emphasis is asset/capacity building. Needs are a lesser part of the materials, and at times the author of this text inferred them from what he found on the website.

Using the checklist is problematic because detailed examples were not in the policy papers, yet excerpts from many efforts helped to capture a sense of what occurred. They led to the composite in Exhibit 8.3 and the ratings in Table 8.4. Without more information, the second item in the table was not rated. Programs had been initiated based on determination of needs and assets and resources, as well as comparisons of them.

The snippets that were mentioned might have rated high on other sections of the checklist. Thought had been given to the evaluation of improvement endeavors and would have led to significant ratings on other items, and in one paper there was a summary table congruent with what was proposed for the hybrid framework in Chapter 3.

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Discussion of the Composite First, context is important—public service in Scotland, looming budgetary issues, and the recognition that

there were resources (human, community) to attenuate the situation. There was a long-standing culture of volunteerism, and such history is important. How well approaches like these might generalize to education, business, or various state agencies is a question.

Second, there are concerns about resources and time frames. Studies like these cannot be carried out in an instant without diligence and a great deal of persistence. They include community groups and service delivery organizations and agencies, and entail costs for coordination. They necessitate that needs be assessed and that resources and assets be identified. Upfront capital must be there. Who will pay the bills and buy into what is to be done is not to be glossed over. More detail would have been desirable.

Third, in virtually every case, much information about assets and needs was collected, with more weighting on the former. How was the information amalgamated into coherent, valuable, and useful data sets for decision making and priority setting? The readings were insightful but need more specifics. What happened in the details, in coming to conclusions about what the data were indicating and what direction might be pursued? What was and wasn’t done, and why were certain actions taken and others not? What might summary tables contain?

Fourth, are these internally or externally led projects or some combination of the two? The voice of the people and their eventual participation was obviously valued, but who made the choices about the data collected and what it led to were not so patent. Was the process top down, bottom up, or a mixture, and was one voice more prominent than another? Roles and responsibilities and how they factor in are important, and whether some patterns work better than others is a consideration for this type of work.

Fifth, politics come into play. Public organizations, agencies, service providers, and others like to control their turf. For example, in coproduction as done in Scotland, professionals may have to concede some of their territory to segments of the public in regard to service delivery. How does this sit with them, and are they willing to relinquish what they hold dear in their practice to others? Could this affect the quality of services? If done on a large scale, who handles the extended list of players? What are the hidden costs, and how would they compare to other mechanisms for delivering programs directed toward issues and problems?

Sixth, an aspect of the policies and projects was movement away from a short-term, narrow, efficiency focus to a longer perspective and broader outcomes. This departs from current thinking. At the same time, it calls for being accountable for in-depth results and achievement of impacts. It may be a challenge to more orthodox views of service delivery.

Seventh, the overall stance in the writings forces a reconsideration of how communities and public agencies join together for betterment. That was accomplished with an asset/capacity-building approach tempered against needs. The ideas are refreshing for employing a hybrid framework for improvement and development.

ACROSS THE CASES

Many of the entries in Table 7.5 would apply to the cases in this chapter, and repeating them would be redundant. Much of what was there fits here, although the degree would vary. What will be explained now are additional observations coming from the summaries of North Philadelphia, Minnesota, and Scotland. One of the cases was from an article, and the other two were from documentation (a report in progress and a website of many papers). The latter did not detail all aspects of what was done but provided enough for the author to make inferences.

In these cases and in the previous three, the problems being investigated were substantive, vast in scope, and of deep concern. Doing solely a needs assessment or the identification of resources and strengths would not suffice. Neither by itself would be up to the task. The situations required that assets be marshaled to resolve issues and develop programs to resolve them. Without fully understanding the area of concern, knowledge of assets and lists of the same would not be as meaningful as when each side of the equation has been explored.

The examples in the chapter necessitate long periods of time to delve into and come up with and install solutions across groups, service deliverers, individuals, and agencies. Size does matter, and smaller entities may elect to assess needs or probe resources, but not to do both. The finances to support the use of a hybrid

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framework may not be at hand, and groups will opt for one approach or the other. Dollars will dictate what can be done. This is especially true when the subtle costs of communication and coordination are considered for hybrid efforts.

Another thing is that the six studies in Chapters 7 and 8 received high and similar scores on the first category in the rating schema. That is not surprising because they were selected as fitting the premise of the book, exemplifying the hybrid framework. If a broader spectrum had been chosen, the scoring would have varied more. Other investigations would still illustrate main principles but probably would not have enough resources to do work like this, and corners undoubtedly would have been cut.

Lastly, two of the cases in this chapter were unusual in their emphasis on evaluation. In one, the voice of the people in large part determined such content. That was striking. Ultimately, what outcomes are being achieved will have to be addressed in order to say that hybrid undertakings are worth the cost and investment of human capital, an obvious point begging for substantial evaluation data to buttress the argument in favor of the framework.

HIGHLIGHTS OF CHAPTER 8

1. Issues involved in searching the literature were raised, including the terms that were employed for seeking examples outside of public health.

2. An overview of three selected cases was provided, and the cases were presented in regard to what they did.

3. To avoid repeating the analysis in Chapter 7, only unique facets across these cases were offered in terms of scope, communication, coordination, time, and so forth.

4. Included in that discussion was the idea that the issues of concern were major and anything less than the hybrid framework would have been insufficient.

5. Lastly, the hybrid entails a strong and substantial base of support, which may not be there for smaller endeavors.

DISCUSSION QUESTIONS

1. Building from the above point, is size so prominent that the hybrid framework will not be used when dollar and human resources are more limited or perhaps there are shortcut ways it could be conducted? What are your thoughts?

2. What is an adequate time for major endeavors, and if it is more than a year or two how will organizations, agencies, or communities maintain commitment, motivation, and so forth? What are ways to ward off a maturation effect?

3. The assets part of things can get daunting, especially for a large community or for a state. How might it be conceptualized and then investigated? How would under-the-surface assets, such as contributions of family members to an individual’s health when that person is confronted with a major illness, be assessed? The same idea applies to community programs where volunteerism could be key. What would you do to get an estimate of such assets and resources?

4. It was suggested that staff members involved in a hybrid study keep logs of time spent in facilitating the project. Can you think of other ways to collect this subtle and complex data?

5. All three cases indicated the inclusion of groups and organizations in the study and in solutions in a significant, not a lip-service, way. How is this to be carried out, who does it, and at what expense to them or their organizations? How is this sustained according to your perceptions?