COMM-ORG Papers 2006

Chapter 1:  Introduction

"Holding each other close across differences, beyond conflict, through change, is an act of resistance." ~ bell hooks

The aftermath of Hurricane Katrina unfolded while I endeavored to write my findings that detail how collaborative groups comprised of institution and grassroots representatives handle conflict. In the midst of this national crisis, the intersection of community development and public health is particularly relevant. The public health field has long recognized the interrelated political, economic, and social structures that contribute to poor health, most notably poverty and social inequities based on race, class, and gender (Hofrichter, 2003; Minkler, 1997). Current research increasingly emphasizes the link between social conditions arising from global capitalism, increased income disparity, and health status (Rafael, 2003; Eitzen and Baca Zinn, 2003; Ambert, 1998). The transformation of economy has changed the nature of work, family life, food production, mobility, and social cohesion. The stresses arising from these changes – for example, greater job insecurity and unemployment, increased poverty and social exclusion, and the disruption of social networks resulting from demographic changes such as migration, the influx of women into the workforce, and an increase in single parent families – impact both economic and health status (Eitzen and Baca Zinn, 2003).

The images of the most vulnerable – the young, elderly, poor, and sick – stranded in the midst of urban collapse highlights the social inequity that reigns in American culture. Most who remained in New Orleans were poor, African American, and without access to transportation out of the city. Decades of industrialization and the excesses of modern consumer capitalism contributed to the toxic soup that submerged the long-neglected urban infrastructure. The citizens of New Orleans must now mobilize to heal, clean up the environmental mess, and rebuild community. To solve these complex problems, local residents, community based organizations (CBOs), and institutions must collaborate. This will be no small task, especially given the fertile ground for conflict. The courageous people accept this challenge may be heartened by the stories of community collaboration happening throughout California.

The story is one of ordinary people coming together to cooperatively solve problems and the conflicts that inevitably arise under conditions of scarcity, fear, and competition. Despite the material wealth of the U.S., a significant segment of our population lives in poverty. Economic inequities affect health in a myriad of ways from the inability to maintain optimal hygiene practices to the increased risk of infections and accidents arising from unsafe and overcrowded housing. Chronic stress arising from poverty, inequity (position in a hierarchy) and social exclusion correlate with higher death rates, increased susceptibility to infectious disease, compromised immunity, retarded growth in early childhood, and increased rates of conditions such as cardiovascular disease and diabetes (Wadsworth, 2000; Brunner and Marmot, 2000; Shaw, et.al., 1999; Wilkinson and Marmot, 1998). Research by Kawchi, Kennedy and others (1997, 1998) concludes that income inequality coupled with reduced social cohesion and the erosion of social capital leads to increased total mortality, cardiovascular and infant mortality, and death from violent crime.

Through community health partnerships, everyday people take collective action to address the conditions that contribute to poor health. Heroically, they come together as social change agents despite seemingly enormous global forces that shape local conditions. Their stories of collaboration and conflict are immersed in the historical, political, and economic structures of our society. By combining community development with public health approaches, people are discovering innovative ways to improve quality of life.

Why Community Development as a Health Improvement Strategy?

As a comprehensive approach to social change, community development seeks to improve the social and economic status of people within a defined geographical region. This is no easy task in an era of globalization characterized by urbanization, fragmentation, specialization, bureaucracy, and spatial flexibility (Davies and Herbert, 1993). As a process grounded in values, there is considerable variation in accepted definitions. Generally, community development is characterized by attention to inequities in the distribution of wealth, resources, opportunities, and power as well as a concern for sustainable solutions. Sustainable approaches acknowledge the interrelation of social, environmental, and economic issues and they support development that will persist over time without degrading the social or physical environment (Wheeler, 1998; Christenson, et. al., 1989).

Community development brings diverse constituencies together to work towards common goals. For many community development practitioners, the means are as important as the ends. There is a prominent focus on participation and empowerment of people living in poverty, especially in decision-making. Practitioners attempt to engage local residents in activities to define a common vision, plan strategies to address issues of concern, and mobilize action on their own behalf. Community building occurs by connecting individuals, associations and institutions in new relationships that focus on common goals and build on assets (Rubin and Rubin, 2001; Green and Haines, 2001; Checkoway, 1995; Hester, 1985; Kretzmann and McKnight, 1993). These activities serve as a mechanism to increase individual and collective capacity – participants build skills, develop leadership and strengthen social connections. This outcome often is characterized as increased social capital, which refers to the stocks of trust and norms of reciprocity and mutual obligation that exist among networks of people (Rubin and Rubin, 2001; Putnam, 2000).

Twenty-first century health promotion efforts recognize good health as an essential component of development – both as an outcome of development efforts as well as a means to achieve it. In a statement on urban health, the World Health Organization (WHO) Regional Office for Europe declares, “Poverty is the single largest determinant of health, and ill health is an obstacle to social and economic development” while WHO’s Regional Director for Africa has argued that “…health and development are interrelated and indeed, health is a prerequisite for development” (Toure, 1994). WHO’s Healthy Cities project has evolved into a global movement for public health and asserts, “There can be no progress on health without socially and environmentally sustainable economic development” (World Health Organization, 2002: 3, 6).

Health improvement efforts that use a community development approach focus on improving the lives of the most marginalized in society by engaging diverse people to plan, implement, and evaluate strategies designed to create a healthier community. The goal is to achieve changes in the community conditions that affect health through broad based, collective action. A commitment to equal partnership and a focus on assets and capacities are frequently the stated values. Because health problems are more prevalent among marginalized or socially excluded people, these efforts often emphasize the inclusion of the “grassroots,” especially low-income people, minorities and those affected by particular health issues (e.g., disabled, uninsured, HIV/AIDS).

By imposing constraints on the material conditions of every day life, poverty and social exclusion limits access to the fundamental building blocks of health, such as adequate housing, good nutrition, education, and opportunities to participate in society. As a concept, social exclusion goes beyond the definition of poverty as a lack of material resources and refers to the process of being shut out from any of the social, economic, political, or cultural systems that determine the social integration of a person in society (Shaw, et. al., 1999). Exclusion from participation in decision-making and political activities, access to employment and material resources, and integration into common cultural practices combine to create acute forms of marginalization that manifest spatially in particular neighborhoods (Byrne, 1999). Thus, social stratification is reflected in the built environment as multidimensional disadvantage and stigma become concentrated in segregated locales, affecting not only individuals, but also whole communities (or segments thereof).

Chronic health conditions such as diabetes, heart disease, obesity, asthma, and HIV/AIDS often are connected to environmental conditions prevalent among socially excluded populations. Traditional medical prescriptions are not available to cure the health problems associated with polluted air and water, unsafe neighborhoods, dilapidated housing or long-term unemployment. Individual behavior modification – such as advice to eat five fruits and vegetables a day – is extremely difficult to implement if one lives in an area without a grocery store that carries affordable, fresh food; lack of transportation imposes an additional barrier. Daily exercise such as walking may be a life threatening activity in a neighborhood that lacks sidewalks and streetlights or is under siege from gun violence. Increasingly, there is greater understanding that health is produced by people within a social context rather than being a commodity dispensed by health care systems (Wallerstein and Duran, 2003; McKnight, 1995).

Consequently, public health improvement efforts have shifted from a primary focus on disease treatment and individual behavior change to community organizing and advocacy for policy changes that promote social justice and eliminate disparities. While individual behavioral change and access to medical services is important, there is a significant and growing consensus among multidisciplinary practitioners that improvements in population health require interventions that address root causes arising from complex social and economic structures rather than simple curative technologies. Legislative mandates and funding guidelines further influence the use of participatory, community development approaches to health improvement (Thompson et al, 2003; Chavis, 2001; Minkler, 1997; Wandersman, et. al., 1997).

Background and Purpose

The problems of poverty, social exclusion, and poor health require comprehensive solutions that include collective action, the mobilization of local resources supplemented by external support, and policy change. Decades of experience with community development and public health theory and practice provide evidence that community participation and collaboration are effective means to achieve improved health and quality of life. However, collaborative efforts are often dominated by service providers and challenged by conflict. Collaborative groups must have skills for managing conflict if they are to maintain the partnership and attain shared goals. Indeed, the ability to resolve conflict is one characteristic of successful collaborations (Cohen and Gould, 2003; Shortell et. al., 2002; Chavis, 2001; Mizrahi, 1999; Winer and Kay, 1994). This research explores how this is managed in collaborative groups that include both grassroots community members and representatives of helping institutions such as public health departments, social service agencies, schools, and law enforcement.

This research was initiated under the assumption that there are differing perspectives and levels of power between collaborative group members that inevitably lead to conflicts. Collaboration does not necessarily come “naturally” to citizens in a capitalistic society that emphasizes individualism and competition. Because “genuine partnerships” are rarely observed (McKnight, 1996), understanding this critical process may serve useful to a broad range of development efforts. Moreover, in diverse partnerships that include marginalized grassroots members, the strategies for handling conflict may be quite different than those used in “inter-agency” collaborative groups.

I entered the research field with a strong foundation of knowledge and experience related to community collaboration. For several years, I served as the coordinator for a children’s health collaborative as part of Sierra Health Foundation’s Community Partnerships for Healthy Children (CPHC) initiative. Through this work, I learned about asset-based community development (ABCD), civic engagement, coalition building, policy advocacy, and innovations in health, education, and social services from cutting-edge thinkers.

Later, I joined the Public Health Institute’s Center for Collaborative Planning (CCP) where I provided statewide training and technical assistance. Grounded in ABCD theory and practice, our organizational philosophy rested on the belief that people have the capacity to solve their own problems; every person is gifted; and in the quest for social change to improve health, we need the valuable contributions of our most marginalized community members and support from institutional resources. We advocated grassroots engagement in health improvement efforts because “expert” help too often resulted in misguided interventions that further dashed the hopes of flailing communities.

Working closely with John McKnight and John Kretzmann, CCP founded the California ABCD Institute and I became a lead trainer. Through work with hundreds of leaders and policy makers from the grassroots, health, education, philanthropic, and government sectors, I witnessed the amazing transformation of individuals and communities that occurs when people mobilize around a common vision. The contacts and relationships that grew from this work enabled me to carry out this research.

At the turn of the millennia, I joined the Skills for Change Radical Therapy Collective. For three years, our training group met monthly to learn how to apply conflict resolution skills in our professional and personal lives. The primary theoretical concepts of radical therapy¹ complemented my understanding of asset-based community collaboration. Radical therapy principles maintain that all people are essentially good, have value, and can resolve their own problems when connected to and supported by community. These principles demand that people respect each other as equals and avoid categorizing those with less power solely as victims. However, real inequalities arising from structural and material conditions such as class, race, gender, and sexual orientation are examined to understand how power shapes conflict in relationships. Like asset-based community development theory, radical therapy emphasizes understanding how structural and internalized oppression imprisons people and limits their ability to change.

Radical therapy principles outline the necessary conditions for equal relationships where conflict is resolved and both parties achieve maximum satisfaction. Key to this process is the willingness to cooperate and develop power without infringing on others. “Rescue” is a central concept in the analysis of conflict. Defined as doing more than your fair share or agreeing to something you don’t want to do, rescue usually occurs when people perceive others as less capable. However, this “victim” identity is eventually rejected, resulting in conflict as the “one-down” person retaliates against the rescuer. Asking for “100% of what you want 100% of the time” is the primary means of handling conflict that arises from rescue. Another key tool to resolve conflict is validating intuitions. This is based on the premise that people are not crazy; their feelings and intuitions arise from some kernel of truth. Conflicts are more rapidly resolved when people validate the other’s truth before denying, defending, or explaining why the other is mistaken.

Through my study and practice of collaboration, ABCD, and radical therapy, I began to wonder how collaborative groups handle conflict when the membership is comprised of both grassroots and institution representatives. What happens when people come together with the desire to forge a partnership in which all members are equally valued and a conflict arises? How do the inequalities arising from social class, race, and gender influence collaboration and conflict? How are disagreements resolved? Can power really be shared? While radical therapy provides useful tools for navigating individual relationships, the practice offered limited avenues for applying the concepts to larger social organizations in which hierarchal structures dominate. I wondered if some of the concepts could be applicable in a collaborative setting since participants intend to share power and value everyone as equals.

My familiarity with the world of community collaboration was both a benefit and a challenge. I recognize that my experiences shape my perceptions and analysis and other interpretations are possible. I am a White, college-educated woman, feminist, and social justice advocate who envisions a world in which inequality and exclusion are rare events. Though I have enjoyed many privileges as a result of my demographics, I’m no stranger to social marginalization, poverty, and the accompanying health consequences. Thus, I could easily navigate conversations with people from diverse perspectives, understand the lion’s share of acronyms, and follow complicated explanations of group structure and funding streams. But since I didn’t bring the fresh eye of a newcomer, my vision is clouded by preconceptions and limited by blind spots. Most notably, I entered the field with a polarized, dualistic assumption: grassroots versus institution. What I discovered is a false dichotomy and a third way that represents integration. The process of collaboration and conflict is dialectical, dynamic, and evolving. Power is not a static energy.

Organization and Overview

In the next chapter, I explore the literature pertinent to understanding community participation and collaboration as tools for community health improvement. The literature review also examines conflicts in the context of collaborative efforts, especially those that arise from ideology, power differentials, identity, and communication. Finally, the concept of transforming conflict is examined. Chapter three explains the methodology used to investigate the primary research questions related to conflict in community health partnerships. Chapter four is divided into three subsections. Each reports on significant findings in terms of partnership structure, membership and outcomes; conflict triggers; and common methods for handling conflict. The final chapter provides conclusions and implications for community development and public health practice.

Chapter Two: Literature Review

As society grows ever more complex and single agencies prove unable to unilaterally resolve problems, collaboration is necessary to appropriately address a wide range of seemingly intractable community issues such as poverty, poor health, and violence (Mays, 2002; Chavis, 2001; Bradshaw, 2000; Wandersman, et.al., 1997; Gray, 1989). Changes in the structure of the welfare state also influence the collaboration trend. Devolution at the federal level provides states and in turn, local governments (cities, counties) greater authority and flexibility in designing health improvement programs (Sabol, 2002, Sherraden et al., 2002). However, this increased freedom is coupled with a climate of ever shrinking budgets and an expectation to maximize resources. As a result, collaboration often is required in order to receive funding from both public and private sources (Thompson et al, 2003; Chavis, 2001; Minkler, 1997; Wandersman, et. al., 1997).

Legislation as well as private philanthropic grant guidelines usually require local jurisdictions to collaborate with representatives of various social welfare agencies, along with the private sector and affected community residents to plan services and allocate funds. These trends create benefits such as the ability to tailor programs that more effectively address local conditions as well as challenges such as how to share power with the people most affected by the problems. Collaboration provides an opportunity for diverse sectors of a community to plan and implement a shared vision. However, policy and funding trends can also force people to work together out of necessity rather than a commitment to common goals.

Funding guidelines for a variety of social welfare programs not only require collaboration, but community participation as well.² In part, this is a legacy from the 1960s when War on Poverty and civil rights advocates sought “maximum feasible participation” of community residents typically left out of decision-making. Specifically, this meant that “consumers, especially the poor and minorities served by the programs, would participate in the institutional decision-making process” (Koff, 1988: 32). The requirements also result from the realization that in order to improve social conditions (and perhaps achieve lasting change), the people most affected by the problem must be involved in developing solutions.

Community participation and collaboration are particularly relevant strategies for addressing processes of social exclusion that result in poor health. Current thinking posits that in order to adequately address health inequities and the systemic causes, local community members must be engaged in the social change process. The concept of community participation in health development and promotion is not necessarily new. What is new is how the concept is defined and practiced.

Authentic Participation

The essence of community participation as a strategy to improve health is “based on the premise that participation is a prerequisite of democracy” (Koff, 1988: 82). Meaningful participation is “key for democratic decision making” and balances power between citizens and their government. It “provides a check on the power of local elites – the role of influentials” (Kearns and Gesler, 1998: 253). Broad participation is thought to lead to better quality decisions that serve the public good (as opposed to solely the elite) as well as create commitment to implement plans (Koff, 1988: 82).

Authentic participation is conceived as a proactive role where community members are positioned as equal partners with the formal sector (government, health experts, researchers, etc.) and act as “an agent for health and development, rather than a passive beneficiary” of health programs. Rather than a mechanism to lend support to externally led health development efforts, a participatory approach involves “a commitment to promote better health with people and not merely for them.” This is a radical departure from simply seeking consultation and advice from community members. Explicit in this approach is the “obligation of the formal sector to share power rather than merely to foster cooperation” (Kahssay and Oakley, 1999).

Some theorists describe participatory approaches to social change as a shift necessitated by postmodern society. In our diverse, complex world, problems cannot be solved with a top-down, expert-driven approach. Consequently, inclusive and collaborative approaches are required for goal attainment in virtually every sector – business, education, public health and social services. A participatory perspective is one that involves a new way of thinking, experiencing, and acting; it recognizes that people and communities are co-creators of the world in which we live.

“The emergent worldview has been described as systemic, holistic, relational, feminine, and experiential, but its defining characteristic is that is participatory: our world does not consist of separate things but of relationships that we coinvent” (Bradbury and Reason, 2003: 206).

Ultimately, a participatory worldview is rooted in democratic principles and is about power – the power to know, decide, act, and shape our lives. At its best, participatory planning brings together a diverse constituency in a democratic, visionary, and consensus-community building process that empowers participants.

Central to the discussion of participation is the question, “Who participates and to what end?” Community participation is a tool to reclaim decision-making from the “expert” realm and provides a means to achieve creative approaches to problem solving based on local assets. Inclusive, authentic participation occurs when community residents, especially those from traditionally marginalized groups, share the power to define problems, develop solutions, and make decisions with institutional representatives. “To be anything other than tokenism, participation must involve the sharing of power” (Hart, 1987: 227). Diversity is achieved by including a variety of perspectives reflective of differences in culture, ethnicity, socioeconomic status, education level, gender, sexual orientation, religion, political affiliation, and age. That is, all affected groups participate and citizens are treated as constituencies; they take part in naming the problem and selecting the issue; and resources are made available to enable the full participation of less powerful groups (Labonte, 1997). Innes and Booher (2004) refer to this equitable, inclusive approach where dialogue is a central feature as “collaborative participation.”

This type of collaboration operates at the upper rungs of Arnstein’s ladder of participation, or as what Labonte defines as “true participation.” Citizen participation occurs along a continuum that begins with manipulation and progresses toward more meaningful involvement where citizens ultimately have decision-making power and control (Healy, 1997; Labonte, 1997). McKnight defines this as a genuine partnership – a “relationship of equal power between two parties with distinctive interests. Each preserves its authority, distinct capacity, and integrity but gains power through partnership” (1996: 10-11). As in consensus organizing, power is built and change achieved by bringing all potential partners together, identifying common interests, and developing relationships of mutual trust and respect. Participants share power to gain power (Eichler, 1995).

Citizen participation is not without its critics. Despite legislative and policy mandates to engage community participation, actual practice often falls short of the ideal (Innes and Booher, 2004; Hester, 1999; Krause, 1977). In practice, collaboration typically involves professional representatives (government, nonprofit, business) and perhaps a few token parents or clients to meet grant or statutory requirements. Because action takes place within the existing institutional framework and involves political ideology, power can be skillfully exerted to prevent significant change (Krause, 1977). Some so-called participatory processes are easily manipulated to exclude or override contributions of marginalized people or may reproduce existing power structures. The result is cooptation or tokenism rather than citizen empowerment. In these relationships, the community serves the system as an advisor or volunteer; the institution locates within the community to assure access to clients; powerful interests dominate the planning process; and polarization among competing special interest groups occurs (Innes and Booher, 2004; Hester, 1999; McKnight, 1996; Krause, 1977).

Communities and professionals alike have learned a great deal about the realities of public participation in community health improvement efforts during the last few decades. While there are still plenty of examples of inauthentic community participation, there also are a growing number of successful efforts. Private philanthropic foundations often provide the seed money and technical support for innovative approaches coupled with the requirement to evaluate and learn from the process. Over time, these lessons are brought to bear on subsequent community health improvement efforts that seek to engage citizen participation. And, the Federal government continues to play a role in promoting community participation and collaboration, especially with the recent emphasis on eliminating health disparities.

Collaboration as a Structure for Authentic Participation

Collaboration can be thought of as one form of community participation that provides the structure to engage local residents in planning, decision-making, and implementation of solutions. Collaboration is a process to reach goals that cannot be achieved acting singly or, at a minimum, cannot be reached as efficiently. While coordination or cooperation may involve joint activity, a mutual commitment to a shared vision and high level of trust distinguish collaboration. This new conceptual meaning of collaboration goes beyond a simple strategy for achieving a particular goal. Gray (1989) defines collaboration as an emergent, dynamic process “through which parties who see different aspects of a problem can constructively explore their differences and search for solutions that go beyond their own limited vision of what is possible.” Chrislip and Larson (1994:13) emphasize the revival of participation in civic life and democracy that occurs through collaboration. They characterize collaboration as a powerful way of “doing business around public issues,” which results in a new norms that makes communities and regions stronger and more effective:

“When collaboration succeeds, new networks and norms for civic engagement are established and the primary focus of work shifts from parochial interests to the broader concerns of community. Collaboration…not only achieves results in addressing such substantive issues as education, health, and children’s services; it also builds ‘civic community’”³.

A host of research highlights key factors that contribute to a successful collaboration (or partnership, coalition, or consortium). These generally include a common purpose; shared leadership; broad institutional support; participation of diverse stakeholders; trust; shared, informed decision-making; effective communication; the ability to resolve conflict; and sufficient resources (Thompson et al, 2003; Wanderman, et.al., 1997; Chrislip and Larson, 1994; Gray, 1989). Successful partnerships also “actively encourage diversity through grassroots involvement of consumers and target populations” (Zukoski and Shortell, 2001). This growing body of research supports the conclusion that collaboration is an effective vehicle for achieving both short-term goals and longer term health outcomes (Thompson et al, 2003). For example, collaboration can result in greater self esteem and empowerment of participants; increased individual and organizational capacity; learning and the generation of new knowledge; stronger social networks; system and policy change; innovations and new community projects; and the leveraging of resources (Innes and Booher, 2004; Thompson et al, 2003; Sherraden et al., 2002; Wanderman, et.al., 1997; Chen et al., 1997; Chrislip and Larson, 1994).

Collaboration characterized by inclusive, authentic participation of diverse stakeholders can be contrasted with typical “interagency” collaborative groups that include token representation from grassroots residents whose participation is limited to advice or consultation on a pre-determined agenda. While “inter-agency” collaborations may achieve changes in the way services are delivered, they are not usually forums for community building. As such, their work does not result in increased resident leadership, nor does it build the capacity of residents to shape their own destiny. Since community ownership isn’t achieved, all too often when the funding stops, so does the collaborative effort, resulting in frustration and the belief that collaboration doesn’t work. In that scenario, residents’ restricted ability to influence decisions results in reduced participation and agency, ultimately affecting community level outcomes. In contrast, when grassroots residents participate authentically in decision-making, solutions are more likely to be effective, appropriate to local conditions, and sustained over time.

Asset-Based Collaboration

The trend toward community collaboration in health improvement efforts is in part informed by the asset-based community development (ABCD) framework described by John McKnight and John Kretzmann. Asset-based community collaborations are structured so that residents and institutional representatives work together in partnership and share power. Ongoing participation that makes full use of members’ skills and capacities is essential for successful collaboration. As defined by Kretzmann and McKnight, an asset-based approach requires inclusive, authentic participation:

“In a community whose assets are being fully recognized and mobilized, these [marginalized] people too will be part of the action, not as clients or recipients of aid, but as full contributors to the community-building process” (1993: 6).

Asset-based community development theory does not presume that communities have everything necessary to address conditions of poverty without external resources. Rather, an asset-based approach stresses the “primacy of local definition, investment, creativity, hope and control” (Kretzmann and McKnight, 1993: 9). Consensus organizing shares some similar principles; both point to the potential of these approaches to unleash creativity, build capacity in low-income communities, and serve as an antidote to ever shrinking resources (Eichler, 1995; Kretzmann and McKnight, 1993).

As a community development strategy, an asset-based approach begins with what is already present; “the capacities of its residents and workers, the associational and institutional base of the area” rather than with what is absent, problematic, or deficient. Instead of focusing on problems and expecting outside experts to solve them, marginalized community residents are mobilized to create solutions that build on existing resources. For example, rather than conduct needs assessments, residents undertake a systematic process to identify or map community assets, especially the skills and talents of individuals, potential contributions of voluntary citizen associations, and the hidden resources of formal institutions. Once identified, these assets can be used for community development (Kretzmann and McKnight, 1993).

This internally focused, relationship driven approach requires the constant building and rebuilding of relationships among local citizens, their associations, and institutions. Community building occurs as these new connections develop in ways that multiply their power and effectiveness (Kretzmann and McKnight, 1993). As community assets are identified, connected, and used to implement solutions, social networks increase and new community norms emerge (e.g. trust, reciprocity, interdependence). The result is neighborhood regeneration and a community rich in social capital – outcomes that also could be characterized as a healthier community and improved quality of life.

An asset-based approach contrasts sharply with the traditional focus on identifying a community’s needs and deficits, most especially in the results and consequences for local residents and their communities. The approach used affects how problems are defined, what solutions are created, where resources are directed and ultimately, how the community and residents themselves are characterized. The table below encapsulates differences discussed by Kretzmann and McKnight (1993).

 

Table 1: Comparison of Community Improvement Approaches

 

Collaboration and Community Conflict

Before turning to a discussion of the sources of conflict in collaborative groups, it is useful to examine the concept of social conflict in general. Sociology, psychology, communications studies, and business management perspectives inform multiple theories about the causes and consequences of conflict. Conflict is typically defined as the perceived incompatibility of values, interests, or goals between interdependent people (Folger, et al. 1997; Dukes, 1996). Traditionally, conflict has been conceived as a negative outcome of dysfunction and something to avoid due to its destructive consequences. However, contemporary theorists suggest that not only is conflict normal and inevitable, it is necessary to catalyze social change and maintain a strong democracy. In this conception, conflict is a transformative, creative force that can help raise awareness of injustice, mobilize participation, and foster leadership (Coy and Woehrle; 2000; Dukes, 1996). In contrast to the highly polarized, “win-lose” nature of destructive conflict, “productive” conflict results from a “sustained effort to bridge the apparent incompatibility of positions” and attain mutually satisfactory solutions that produce “a general feeling that the parties have gained something.” (Folger, et.al, 1997).

Conflict is a predictable element in participatory planning and the ability to resolve conflict is one factor influencing collaborative success (Cohen and Gould, 2003; Shortell et.al., 2002; Chavis, 2001; Mizrahi, 1999; Winer and Kay, 1994). Though the “norms to get along dominates many coalitions (Chavis, 2001), the tendency to avoid or suppress conflict may exacerbate it and make it more destructive (Dukes, 1996). There are numerous reasons conflicts occur – from a lack of shared vision and competition over scarce resources to determinations about who participates and how decisions are made. Regardless of the specifics, conflict seems to center on issues of power and control; identity and representation; and communication (Jones, 2001; Coy and Woehrle, 2000; Gardner and Cary, 1999). Additionally, “the history of individual or group relations (i.e., previous conflicts or reasons for loss of trust) can significantly influence the emergence and later escalation of conflict situations” (Coy and Woehrle, 2000: 2).

Though there is abundant research that describes the conditions that enhance or limit community participation in collaborative efforts, there is surprisingly little that describes how groups successfully handle conflicts rooted in power differentials between grassroots community residents and institutional representatives (Chavis, 2001; Hastings, 1999). Research on mediation and alternative dispute resolution exists but these practices are generally employed in highly structured negotiations of rights and interests between organized stakeholders. Instead, an examination of power, discourse, and identity is more useful to further our understanding of conflict dynamics in the routine functioning of community partnerships.

A few recent studies focused on collaborative efforts to improve health examine power and conflict. One study of substance abuse prevention coalitions observed that the most intractable type of conflict occurs between grassroots and agency professionals. These conflicts resulted from the different environments and organizations typical of each sector, exacerbated by a history of racial and social inequities. The goals of service provider organizations tended to conflict with those of the grassroots. In turn, this influenced conflicts over how the problem of substance abuse was defined and how to best address it (Lindholm, et al, 2004). Nelson and others (2001) also found that establishing common goals and the strategies to achieve them is a challenge due to divergent priorities among diverse stakeholders that include marginalized people. Both studies identify situations in which professionals and grassroots people conflicted over the use of a service delivery approach versus a model that would result in greater empowerment of marginalized people.

Other findings illuminate the conflicts that arise when power is used to control discourse. In a study of how power operates in a community collaboration to raise awareness of HIV, conflict arose when women of color and lesbians challenged the project agenda set by dominant White leaders. White leaders showed little awareness of the dynamics of power based on race and class privilege and without realizing it, used “power over” to complete the agenda despite protests from women representing marginalized groups. Concerned with the ability to meet deadlines and accomplish tasks, “the facilitator silenced dissenting voices by insisting that the group stay on track.” As a result of “not feeling heard” many of the women from non-dominant groups ceased participation (Champeau and Shaw, 2002). Scarcity of time also influenced the climate of this partnership, contributing to conflict.

Power Differentials as a Source of Conflict

Sociologists, feminists, social justice advocates, community organizers and public health practitioners have long debated and theorized about power dynamics in relation to community change. The prevalent notion of power involves a repressive ability to dominate or control; that is, “power over” someone or something exercised along a continuum ranging from brute force to subtle, silent, and indirect means that are embedded within our social systems and structures. Power derives from status and rank achieved within a competitive hierarchy mediated by factors such as class, race, gender, age, and educational status. In this perspective, power is conceived as a possession, a zero-sum game where the only way to increase power is to take it from someone else (Wallerstein and Duran, 2003; Champeau and Shaw, 2002; Gardner and Cary, 1999; Hill, 1991). Conflict arises as differently positioned individuals and groups in a community vie for limited resources, including the power to participate and decide.

Defining all the dimensions of power is a somewhat elusive task but certainly some aspects can be found in the organizations people create in order to take social action. Many theorists contrast the power derived from community organizations with the dominant power inherent in bureaucratic institutions. For example, in his classic community organizing manual, Saul Alinsky states, “Change comes from power, and power comes from organization. In order to act, people must get together. Power is the reason for being of organizations” (1971: 113). Alinsky influenced generations of organizers with a social change model predicated on traditional concepts of power. Emphasizing the power inherent in high-profile public conflict to win a place at the bargaining table, Alinsky calls upon organizers to “…rub raw the resentments of the people of the community; fan the latent hostilities of many of the people to the point of overt expression” (116). His approach centers on gaining collective power by building strong local organizations that can challenge established institutional power. Self-interest provides the motivation for participation. Professional organizers work with indigenous leaders, though there is strict division between their roles (Stall and Stoecker, 1998).

Building on the work of de Toqueville, McKnight describes a slightly different conception of power that arises when citizens within a democratic society form associations. In these small, self-appointed groups, members assume the power to determine problems, decide solutions and take action. As an expression of care, each person participates voluntarily and makes unique contributions towards a common vision (McKnight, 1994). McKnight maintains that as the consumer/client model of capitalist and social welfare systems expands, the power of community associations declines. Like Alinsky, this reflects the traditional conception of power as a zero sum game.

But postmodern, feminist, and critical theorists have introduced alternative conceptions where power is framed as relational and mutually transformative rather than unidirectional and repressive. Power is the ability to act, a capacity available to all regardless of institutional rank. For example, marginalized people have the power to resist oppression by refusing to accept identities imposed by those more powerful (Wallerstein and Duran, 2003; Champeau and Shaw, 2002; Hill, 1991). Discourse and identity are key aspects of relational power absent from traditional notions. In this view, power is a role or self-image which is constructed collaboratively and negotiated through discourse (Diamond, 1996).

Ideology, Identity, and Discourse: Sources of Power, Conflict, and Social Change

The ability to change minds and shape social reality constitutes one of the most effective uses of coercive power. Higher ranking community members exercise dominance in discourse and establish hegemony when they are able to convince those with less power to interpret the world from their perspective (Mumby and Clair, 1997; Diamond, 1996). Once hegemonic power and its accompanying ideologies are established, it “makes people act as if it were natural, normal, or simply a consensus” (Van Dijk, 1997: 19). Thus, hegemonic ideologies influence how people experience and interpret their everyday life, identity, and roles within society. Shared ideologies contribute to solidarity and the accomplishment of cooperative tasks by ensuring that group members will “generally act in similar ways in similar situations” (Van Dijk, 1997: 26). Consequently, dominant ideologies rooted in class, race, and gender disparities define the limits of acceptable behavior, thought, and speech. Thus, the use of power to maintain social benefits for one group over another often happens subtly, rather than by force.

In the postmodern world, the systems world of bureaucracies increasingly dominates the landscape of our lives, eclipsing the associational life of communities (Wallerstein and Duran, 2003; McKnight, 1994). “Professionalism as an ideology attempts to create a monopoly on a set of roles and functions to which one group has exclusive claim” (Mizrahi, 1999). One manifestation of the hegemonic power of consumer capitalism and social welfare bureaucracies is that marginalized people feel deficient, inferior, alienated, and powerless to act. Well-intended, privileged professional helpers or researchers may unconsciously wield power based on race, class, gender, or education level when trying to partner with grassroots communities. An unstated sense of ‘I know better’ pervades the attitudes and behaviors of many in the health and human services and academic fields. Deep down, well-educated professionals are loath to give up control to people who ‘know less.’ As a result of this hegemony, “people begin to define themselves by their role within systems” as clients and consumers rather than productive citizens of a democratic society (Wallerstein and Duran, 2003: 32). McKnight (1994) also views this identity shift as a primary negative consequence of hegemonic power that limits the regenerative capacity of communities. The chart below draws on his work to outline the major elements that distinguish the systems and community worlds.

Table 2: Systems and Communities: Structural & Ideological Comparisons

Blurred Boundaries and Multiple Identities: Conflicts in Representation and Discourse

Though theorists identify bureaucracy and everyday life as two distinct social contexts, the boundary between institutional and community roles or identities is not always clear. The complexity of modern life causes individuals to differentiate distinct roles within different settings, for example family and work. This process of “role segmentation” includes the reconstruction of traditional roles as well as the creation of new ones (Callero, 2003: 63). Thus each individual in modern society experiences “a number of subject positions” that may be “lived as complementary.” However, the boundaries between these positions can conflict and result in “members experiencing contradictory identities” (Jackson, 1999: 48). In describing this ambiguity as it relates to tenants in low-income housing and their participation in a collaborative social change effort, Jackson (1999: 45) states:

“The bureaucracy as a system distinct from the world of everyday life is a common element of our experience. Neither tenants nor managers can plausibly be said to be on one side or the other of a boundary conceived mechanically like a line drawn on a map, but the Tenants’ Forum in this study can be seen as continuous negotiation of a boundary or boundaries. In so far as it meets the criteria of a ‘public space,’ it has ‘liminality’…the quality of altering structures or systems without destroying them”

According to Esteva and Prakash (1998:3), the ambiguous term “grassroots” is identified with “movements and initiatives that come from ‘the people’: ordinary men and women, who autonomously organize themselves to cope with their predicaments.” They describe “the people” as those who comprise the two-thirds social majority in a global society; the “have nots” marginalized from the wealth generation of the modern global economy. Concerned with the common good, the grassroots exist independently from and antagonistic to the state and its formal structures. Yet, who represents the grassroots in collaborative groups can be difficult to determine. For some “grassroots” people employed by institutions, the bureaucracy is everyday life. The daily routines, ways of behaving and thinking, and presuppositions about social interactions required by the hierarchy becomes ingrained (embodied) in a person’s language and identity – the bureaucracy becomes part of the self. We see this in collaborative groups when an individual member identifies both as an employee of a bureaucratic institution as well as with grassroots community groups or constituencies. This is commonly referred to as “wearing multiple hats.”

How individuals negotiate these conflicting multiple identities within a collaborative setting and during conflict is a central question that ultimately can determine a group’s long-term success. Group members shape their social identities, exercise power, and negotiate conflicts through discourse, often reproducing power relations found in the larger society (Mumby and Clair, 1997). “People adapt what they say – and how they say it, and how they interpret what other say – to at least some of their roles or identities, and to the roles of other participants” (Van Dijk, 1997: 12). Thus, how an individual responds and reacts to conflict is in part a function of what “hat” they are wearing; that is, who or what identity they represent. Multiple roles can cause conflict for an individual “torn between incompatible loyalties and allegiances” (Coser, 1956: 76) and this may be observed through speech and other behaviors. For example, Jackson (1999: 52) observes that “interdiscursive ambivalence” arises from the attempt to maintain conflicting subject positions and may result in an “undecidable subject position.” This may explain why people don’t speak up at times or have trouble formulating their comments - they’re conflicted over their role and which identity to speak from.

Because identity influences discussions and decisions related to planning community change (e.g., problem definition, vision and goals, and solutions) questions of representation are critical considerations. For example, who “represents” the grassroots community in collaborative groups may reproduce dominant power relations and thus lead to conflict. Though they aren’t elected, these representatives may be expected to “make decisions on the basis of how they conceive the common (best) interest of the collectivity.” When a person tries to simultaneously represent both an institutional and grassroots community perspective, the “best interests” of the community may not be constructed accurately, especially if the representatives do not

“possess the knowledge and authority to influence such a construct. There is a strong possibility that community representatives will find themselves committed to a view of ‘best interests’ not shared by significant sections of the community, opening up the very real possibility of a ‘gap’ developing between the representative and the represented” (Atkinson, 1999: 69).

This gap was observed in a study of health partnerships when Jewkes and Murcott (1998) found that “community representatives” generally had little dialogue with, let alone a mandate from, the groups they were supposed to represent.

Communication Conflicts

From the identification of community issues to the development of proposed actions and the evaluation of success, discourse forms the nexus of collaborative work. For those that seek to achieve social change and bridge the divides created by the fragmentation and inequities that characterize postmodern society, “the ability to communicate, not only within one’s own group, but also between different specialist groups and between experts and lay people, is absolutely vital if society is to function properly” (Gunnarsson, 1997: 285).

Effective communication is not so easy to achieve however. Shared ideologies (values, beliefs and identity) are expressed through language. Though people with different view points share the same language, the same words can evoke vastly different meanings though this often is not noticed. During conflict, this polarization becomes clearer because “the same words are mobilized in different ways, with different meanings and intentions, by differently located speakers, and so come to embody ‘the clash of live social accents’. This in turn, can further heighten conflict and in so doing make a profound impact on processes of social change” (Collins, 1999: 76). For example, in one study of health partnerships, researchers identified 28 different definitions of “community.” The use of these multiple and conflicted meanings inevitably resulted in tensions (Jewkes and Murcott, 1998).

Conflict also can result when expressions lack politeness, polarize social groups through the use of pronouns such as “we, they, us or them” or when negative, biased evaluations about another group are made (Van Dijk, 1997). Negative (particularly ethnocentric) attributions can cement stereotypes that increase intergroup conflict. This process is fueled by an emotional climate of contempt and anger. Contemptuous behavior displays “superiority over the other” and “challenges the legitimacy of the other as a person deserving of respect.” Displays of disrespect or intentional demonstrations of perceived superiority spark anger, which in turn escalates conflict (Jones, 2001:96).

Transforming Conflict Through Participatory, Authentic Collaboration

When people immersed in the “systems world” interact with “others” who do not share a similar worldview within a collaborative partnership, both conflict and the opportunity for social change occur. Several theorists and researchers maintain that collaboration can transform conflict from a potentially destructive situation to one that is productive, integrative, and results in positive social change (Chavis, 2001; Nelson, et al; 2001; Gardner and Cary, 1999; Hill, 1991). For example, Chavis (2001) argues that collaborative groups hold great potential for transforming community conflict because difference among diverse representatives form the basis for participants to work together. In a study of 86 substance abuse coalitions, he concluded that the ability to transform conflict into a process of positive change is a major contributing factor to, and strong predictor of, goal attainment.

The transformation of conflict requires conceptualizing collaboration as a dialogic, public space that is open to multiple perspectives, shared power, and creative solutions. The concepts of “hot housing” social change, “balancing,” and “perspective taking” are particularly relevant for thinking about the function of collaborative groups in resolving conflict and creating change. These ideas consider the effect of diverse identities on discourse and conflict.

Similar to Alinsky’s view of organizational power built on self-interest, Mumby and Clair (1997: 182) describe organizations as “sites of struggle where different groups compete to shape the social reality of organizations in ways that serve their own interests.” Yet, it may be argued that collaborative partnerships serve as a site for disparate groups to struggle to discover how they can work together to serve their mutual interests. Building on Fairclough’s idea that social change is constituted in part through changes in linguistic practices, Hastings (1999: 93) argues that partnerships are a “form of governance capable of ‘hot-housing’ social change…at least among those who participate in them.” By bringing together people with different cultures, perspectives, and attitudes, the social and communicative space in which partners operate is altered.

As discussed, individuals bring diverse perspectives based on their multiple roles and identities. Coser (1956: 76-77) refers to the pattern of “multiple group affiliations” characterized by conflicting interests and values and the institutional channels for handling conflict as “balancing mechanisms.” Destructive conflicts and a total breakdown in consensus are less likely to occur due to interdependency between groups and a lack of convergence along any one line of conflict, such as those based on class, gender, and ethnicity. In so far as institutions increasingly rely upon collaborations to plan, implement, and evaluate community improvements, they may constitute a balancing mechanism for conflict. More recent research also supports the idea that multiple roles allow individuals to mediate conflict. For example, in one study of social service administrators, “daily confrontations with conflicting roles forced individuals to be open to different points of view, to be more flexible, and to expand their sources of information” (Gardner and Cary, 1999).

The resolution of the tension between differing worldviews often takes place through language – through a process of inquiry and learning, ongoing discussions enables group members to establish trust, produce new knowledge, and resolve conflict. As one component of constructive conflict, “perspective taking” is the ability to understand another’s orientation, view it as legitimate, and recognize the significance of that perspective to the other. This skill may act as a moderating variable in group conflict by reducing the potential for destructive emotional expressions (Jones, 2001: 96). Additionally, Hill (1999: 497) maintains it is important that “reconceptualized power employ languages of cultures previously excluded from public discourse.” Ultimately, the vital discussions and learning that take place within partnerships create the conditions for the establishment of a new group ideology that can influence social change.

Balancing Power

The resolution of conflict in a collaborative setting can be defined not as one side dominating another or by compromise but rather by “a creative integration of different needs and solutions” (Gardner and Cary, 1999). That is, instead of either/or hierarchical or market driven solutions, “collaboration uses synthesis to invent third alternatives.” They go on to state that “without conflict among diverse perspectives, no synthesis occurs and decision quality suffers.” In contrast, dominant power creates a win/lose environment where the integration of multiple perspectives is not valued. Their research finds that greater distancing, distrust, and attributions of negative qualities to the other result when both parties use coercive or dominant power during conflict. In contrast, the use of “goodwill” power that emphasizes mutual respect and assumes noble intentions results in less distancing, more trust, greater cooperation, and de-escalation of conflict. They conclude that the overuse of dominant (formal) power during conflict can escalate it and decrease collaborative efforts (Gardner and Cary, 1999).

In order to transform conflict into increased capacity for community change, inequities in power must be addressed (Champeau and Shaw, 2002; Chavis, 2001; Nelson, et.al., 2001; Gardner and Cary, 1999; Hill, 1991). According to Nelson and others (2001), “when there is a power imbalance between two groups, efforts to strengthen the power of the disadvantaged group facilitates power sharing between partners.” These researchers identify several ways to achieve this in collaborations between professionals and marginalized grassroots groups. Members must learn to “work together across difference.” While professionals need to unlearn “dominator habits,” grassroots people need to actively participate and develop a strong voice. Rotating leadership, meetings chaired by grassroots people, and the development of separate organizations operated by and for marginalized people also help to balance power (Nelson, et al; 2001).

Decisions about how resources are allocated are also important to examine (Thompson, et al; 2003; Chavis, 2001; Nelson, et al; 2001). Providing material support and incentives restores some equity and enables low-income people to participate more effectively in partnerships. Training, education, jobs, child care, and transportation assistance are particularly effective in this regard. Additionally, Kretzmann and McKnight (1993) call for a shift in how funds are directed so that resources are leveraged to support community-driven development. Other strategies institution members of coalitions can use to equalize relations include: engaging grassroots representatives at the beginning of an effort, identifying shared values, sharing information, providing training and consultation, sponsoring participatory research, and employing self-reflective process evaluation (Champeau and Shaw, 2002; Chavis, 2001; Nelson, et.al., 2001; Gardner and Cary, 1999).

New Roles for Professionals and the Grassroots

“Effective collaboration requires knowledge beyond one’s role” that can be applied in the larger systems context. Understanding the “big picture” or “whole” system and using networking skills to effectively integrate subsystems are key competencies for collaboration” (Gardner and Cary, 1999). While Gardner and Cary discuss the importance of one’s ability to “integrate expert perspectives,” the integration of community perspectives may be equally important to resolving conflict in collaborative settings. According to Dukes (1996), the transformation of conflict in part depends on an engaged citizenry and responsive governance. Institutions are viewed not as directive of the public, but as potential channels that encourage active, meaningful, and sustainable public participation in decisions made on their behalf. By insisting on inclusion and participation, a transformative practice moderates powerlessness and alienation. Additionally, it establishes “a standard of public discourse that empowers people to articulate their needs freely and to explore their differences fairly” (Dukes, 1996: 172-173).

This transformation is not easy to achieve, especially given the hegemonic power that influences collaborative dynamics and individual and collective identities. In collaborative groups that have established a sense of “we-ness,” the construction of a collective identity “may come at a high price for those members whose salient identities are forced to shift to meet group norms” (Woehrle and Coy, 2000: 5). The changing role of professionals who must learn to share power and equally value grassroots perspectives is a major identity shift. Likewise, grassroots people adopt new roles as leaders, change agents, and advocates rather than consumer, client, or victim. This shift in identity can alienate people from their communities once they are “indoctrinated” into the institution’s culture (Minkler and Pies, 1997). However, there are some strategies that can help people resolve conflicts that result from these transitions.

Nelson and others maintain that “working in partnership with oppressed people requires a readiness to enter into an uncomfortable zone, a zone in which social and cultural norms may differ from that of professionals.” Unable to rely on usual custom and unquestioned assumptions, dominant group members are likely to have “unsettling experiences that may threaten professional and personal identities.” They identify three factors that can help professionals cope effectively with these challenges: a supportive and safe organizational climate, peer support, and a strong sense of self-esteem to help accept criticism constructively (Nelson, et al., 2001). Likewise, unlearning internalized oppression is a primary challenge for marginalized grassroots representatives. Intentional education efforts for both sectors are necessary in order to “understand the dynamics of power and learn to act in ways that do not reproduce experiences of domination and subordination” (Champeau and Shaw, 2002).

The transformation of conflict in collaborative groups depends greatly on how social change professionals approach their work. A participatory, assets (or strengths) based approach requires new roles for employees of institutions (Mizrahi, 1999; Pilisuk, et.al., 1997; Dukes, 1996; McKnight, 1994; Kretzmann and McKnight, 1993). Redefining expertise according to an assets framework means that everyone is considered an expert and recognized as having something to contribute (Mizrahi, 1999; Kretzmann and McKnight, 1993). As part of this redefinition, the role of the “client” must be reconstructed from that of victim in need of repair to partner in problem solving. Kretzmann and McKnight (1993) urge professional helpers to return to the idea of “public servant,” a role that emphasizes support rather than control. A primary function of professionals then is to use their skills, connections, and resources to enhance local leadership and magnify their capacities. This requires a respect for community wisdom and the ability to supply useful information that community members need to analyze problems and develop solutions (McKnight, 1994). A first step is to employ active listening in order to understand how community members perceive problems and discover potential bridges between subgroups. Relinquishing control over the problem and its definition gives grassroots people an opportunity to contribute their unique perspective, which in turn creates a more thorough understanding of an issue and potential solutions (Pilisuk, et.al, 1997).

However, the reconstruction of identity and roles for institution and grassroots community representatives should not be confused with “anti-professionalism,” which denigrates the value of social change professionals and can undermine collaborative efforts. As Labonte (1997) asserts, this attitude “reinforces a we/they polarity and ignores the formative role that respectfully delivered, useful, and usable services have often played in developing new community organizations and overcoming the isolation of society’s most marginalized or oppressed.”

Summary

This literature review explores participatory, authentic collaboration between grassroots and institution representatives as a tool for community development efforts that focus on improving health. I also described the primary sources of conflict within community partnerships – power, identity, and communication – and methods for handling such conflicts.

In collaborative processes, people who represent a myriad of organizations and cultures come together to engage in problem-solving discourse where the goal is to understand issues and formulate actions. Each individual carries ideologies from the specific group (or groups) they represent and this influences the direction of the discussion and action. In authentic community partnerships, the emergent ideology based on principles of inclusive citizen participation and asset based community development challenges existing power relations in order to ‘hot-house’ social change. This new ideology promulgated by funders, legislative mandates, and social justice advocates requires that institutional representatives share power with the grassroots community – especially those members who represent the “target population” for health improvement efforts and are typically excluded from decision-making. Conflicts occur as representatives from collaborative groups both adopt and resist this new ideology, at times due to confusion resulting from the multiple roles or identities of individual representatives. The following chapters focus on the specific research questions and findings of this study.

Chapter Three: Methodology

To explore the dynamics of conflict within collaborative groups that include both grassroots and institution representatives, I chose a qualitative research approach that would allow both flexibility and consistency within the data collection process. Methods included semi-structured, in-person confidential interviews, participant observation, and document review.

This methodology seemed most applicable to this exploratory style of research and is based upon ethnographic methods of developing grounded theory. The grounded theory method stresses discovery and theory development, allowing theory to be constructed from the data. Data collection is shaped from analytic interpretations and discoveries while emerging ideas are investigated by the collection of further data (Charmaz, 1983). For example, I applied this process early in my research when I discovered that participants varied in their definition of “grassroots community member.” Therefore, who is considered “representative of the grassroots” became a subject of inquiry. In following a tradition of qualitative research that does not use operational definitions (Carspeken, 1996), meaning developed from the research process.

I sought to develop theories based upon practice that “takes a set of events that occur, seeks to find a common pattern among them, provides for generalizations concerning relationships, and allows repeated investigation of the same phenomenon” (Andranovich and Riposa, 1993). Rather than use a case study methodology, I opted to extend my query to a diverse sample of community health partnerships and sought to understand commonalities across groups. Exploratory research emphasizes breadth in order to develop more information and identify the basic characteristics of the phenomenon (Andranovich and Riposa, 1993). This type of “extensive research” is well suited to mapping the characteristics of a population (Stoecker, 2005). In following the tradition of applied research or what Stoecker terms “project based research,” I wanted to explore a subject that could potentially be useful to those working in community health partnerships.

Research Goals and Questions

My initial goals for this project were to:

1. Understand how different types of power operate in collaborative groups and their influence on conflict and its resolution (e.g., power as a result of knowledge, education, position, race, ethnicity, gender, role, class).

2. Identify the types, patterns, and causes of conflict that arise in collaborative groups that seek to improve community health through authentic community participation.

3. Discover “best practices” for handling conflict.

To explore characteristics of genuine partnerships and determine the best practices (formal and informal) for resolving conflict in collaborative groups that seek authentic participation from community residents, I developed the following key questions:

1. How is the community defined and what constitutes grassroots participation?

2. What causes conflict in collaborative groups that include both grassroots and institution representatives?

3. How do collaborative groups that represent “genuine partnerships” between grassroots community residents and institutional representatives handle conflict?

Sample Selection

In order to gain a broad view of partnership dynamics, I sought a diverse sample in terms of geographic location, mission, group structure, and membership. However within this diversity, I wanted the partnerships to share certain characteristics indicative of “success.” While many groups may disband due to conflict, I wanted to examine how groups sustain themselves despite experiences with conflict, especially when there is a diversity of perspectives represented by members. Therefore, groups selected for the sample met the following criteria:

1. Included both members from agencies or institutions and grassroots representatives (i.e., not solely interagency groups).

2. Established a minimum of two years.

3. Worked to improve some aspect of community health (e.g., nutrition, child health, violence prevention, environment, school readiness, housing, etc.).

4. Interacted in-person on a regular basis.

The assumption is that after two years, a group must be experiencing some level of success because community participation would cease otherwise. While agency representatives may continue with an unproductive coalition, it’s highly unlikely that community volunteers would do likewise.

Between April and June 2004, I used snowball sampling to identify collaborative groups from throughout California (see Appendix C for referral request). To establish a population from which I could select a sample, I conducted outreach to people in the fields of public health, education, community development, and philanthropy via personal contact and by posting inquiries on electronic listservs. I also conducted an internet search, using key words such as “California community health partnerships,” which resulted in the identification of thousands of groups.

I narrowed this population to 115 groups and began to contact group leaders, starting with groups for which I received multiple referrals and direct responses. If a group expressed interest in participating, I conducted an initial telephone conversation with the partnership’s coordinator to determine if the group met the above mentioned criteria. This conversation also provided an introduction to and overview of the partnership. I selected an initial sample of 13 groups based on the group’s willingness and availability to participate, geographic location, and how well they seemed to match the initial criteria. Two groups initially selected later declined to participate, citing limitations on their time and in one case, concern over the research process (they believed they should tell their own story of conflict). These groups were replaced with alternates. The selected collaborative groups are located in 11 California counties. Nine groups operate in highly urbanized cities or surrounding suburbs; four of the sites are rural.

Table 3: Partnership Geographic Distribution

Southern CA (6 partnerships)	Northern CA (7 partnerships)
San Diego (3)	San Francisco Bay Area (3)
Los Angeles (1)	Mountains (3)
San Bernardino (1)	North Coast (1)
Ventura (1)

Sample Overview: General Characteristics of Community Health Partnerships

The sample represents collaborations between nonprofit community-based organizations (CBOs), citizen associations, residents, and local institutions such as health departments, hospitals, schools, and law enforcement. The selected partnerships focus on a wide variety of health issues including: a broad mission to create healthy communities for children and families, addressing health disparities in African American communities (e.g., cancer, diabetes), prevention (e.g., HIV/AIDS, violence, injury, substance abuse), school readiness, and child health. The partnerships have different functions that include: planning services and developing innovative solutions to health problems; making recommendations for disbursement of public health funds; organizing and leadership development; and providing a forum for networking, communication, and coordination of community services. Most have a shared vision, defined mission and goals, and an annual plan. Many also evaluate their efforts, often as part of grant requirement.

Partnership longevity ranged between two and 10 years – the average length of existence for these partnerships was six and a half years, though almost half the sample had sustained the partnership for 10 years. Most groups initially formed in response to a funding opportunity or as a result of cooperative efforts by area health and human service providers to coordinate services. Two groups started through the efforts of grassroots community members interested in addressing a specific issue of concern. Two other groups function as official county planning bodies, one of which is mandated through federal legislation.

All of these partnerships receive funding from multiple sources in the form of grants and service contracts. Many participate in statewide health improvement initiatives launched by private and public funders such as The California Endowment, The California Wellness Foundation, the California Department of Education and First Five/California Commission for Children and Families. Four groups receive funding based on participation in national initiatives to improve health sponsored by philanthropic organizations or the federal government. Many groups also receive financial support from local institutions (e.g., hospitals, businesses, community foundations) and city or county governments. For a brief summary of each partnership, see Appendix A.

Table 4: Summary of Partnership Attributes

Partnership Name (pseudonyms)	State Region	Area Type	Priority Issues	Longevity	Grassroots Estimate4
African American Health Disparities Collaborative	Southern	County: Urban, rural, suburban	Health disparities, HIV, cancer, diabetes	2 years	50%
Family Resource Community Network	Southern	Urban	Healthy children and families	10 years	15%
Healthy Town Community Collaborative	Southern	Suburban	Healthy children and families	10 years	5%
Kids Breathe Freely Coalition	Southern	Urban	Child asthma clean air	5 years	25%
School Readiness Collaborative	Southern	Suburban	Kindergarten readiness	3 years	30%
South Area Community Collaborative	Southern	Urban	Youth development, asthma	5 years	25%
Action for African American Health	Northern	Suburban (county)	Cancer, health disparities	9 years	80%
Alliance for a Meth Free Community	Northern	Rural	Drug prevention, youth development	3 years	55%
Collaborative for Children’s Health	Northern	Rural (county)	Child health, poverty, access	10 years	1%
Partnership for Community Health	Northern	Rural (county)	Healthy children and families, substance abuse prevention	10 years	1%
Partnership for HIV Prevention Planning	Northern	Urban	HIV/AIDS prevention	10 years	95%
Partnership for Rural Health	Northern	Rural	Highway safety, senior and youth health	5 years	90%
Safe Streets Partnership	Northern	Urban	Violence prevention, youth development	4 years	70%

Data Collection

Data collection included document review, in-person interviews, and participant observation during site visits.

Document Review

Prior to interviews and during site visits, I collected background material and documents about the group’s history, mission, and membership. When available, I reviewed sources such as membership rosters, bylaws, brochures, fact sheets, community assessments, strategic plans, surveys, evaluation reports, websites, or other promotional materials.

Interviews

I developed an interview guide and conducted two pilot interviews in the spring of 2004. I then revised the question guide and used it to direct subsequent interviews (Appendix C). Between June and December 2004, I interviewed 56 collaborative group members, typically three or four from each partnership. Interviewees usually consisted of the group’s coordinator or director (the day-to-day lead person) as well as one representative from the community and one from a local agency. A two year history with the partnership was preferred. I worked with the group’s coordinator to identify interview candidates and once I arrived in the field, additional members often expressed interest in participating. These confidential interviews typically averaged 90 minutes, were conducted face-to-face, and digitally audio recorded. Interviews took place in a variety of locations including: public health departments, family resource/community centers, coffee shops and restaurants, parks, homes, churches, schools, and hospitals. The semi-structured interviews explored such themes as:

• Group history and membership.

• Identity and representation: Who are the grassroots?

• Strategies that encourage participation from people typically marginalized or excluded from public decision-making process.

• Influence, power, and decision making within the partnerships.

• Examples and outcomes of conflict.

• Differences in how agency and grassroots representatives handle conflict.

• Accomplishments of which the participants were most proud.

Characteristics of Interview Participants

Interview participants represented the following perspectives: Partnership coordinators/directors, volunteer mothers, evaluators, academics, residents, community outreach workers, public health and hospital officials, probation and school representatives, family resource center employees, nonprofit and community group leaders, faith community leaders, and representatives from local businesses and community development corporations. Though there is some overlap (see findings), half of the interview sample represented local institutions and half represented a grassroots community perspective.

The majority of interviewees worked for the partnership, including those who worked for partner institutions where a substantial part of their responsibility included participation in the collaborative effort. However, because some institutional representatives volunteer and some grassroots community members are employed by the partnership, the employment status of interviewees does not necessarily correlate with a grassroots or institutional perspective. The following tables describe the characteristics of the fifty-six interview participants.

Table 5: Community Perspective of Interview Participants

 

Table 6: Geographic Characteristics of Interview Participants

Table 7: Gender Characteristics of Interview Participants

 

Table 8: Ethnicity Characteristics of Interview Participants

 

Table 9: Volunteer Status of Interview Participants

Table 10: Employment Characteristics of Interview Participants

Participant Observation/Site Visits

When possible, I scheduled site visits and interviews at times that corresponded with partnership meetings or other group sponsored events. In total, I attended 14 meetings or events related to the work of the health partnerships. I observed six regular collaborative group meetings in Southern California. I toured seven family resource centers in both urban and rural communities; visited two churches located in urban barrios, one of which hosted a community meeting attended by approximately 50 people (mostly local residents); and two celebratory events hosted by partnerships. I also attended a county-wi