Why Are Some Coalitions Better Community Problem Solvers Than Others? a Mixed Methods Study of the Coalition Developmental Process

Introduction: Community changes (new or modified program, policies and practices) are important intermediate outcomes for coalitions on the way to population-level reductions in health problems (Allen, et al, 2008; Butterfoss, 2007; Kegler, et al, 2000). Effective community problem solving capacity plays a significant role in a coalition’s ability to achieve community change. CADCA’s community problem solving model adequately represents the coalition community problem solving process (Yang, et al, 2012). Longitudinal study findings indicate that CADCA training and TA builds coalition capacity in each element of CADCA’s community problem solving model. This paper presents findings from a longitudinal study to further explore the model and the extent to which it predicts coalition achievement of population-level outcomes. The study builds our understanding of the developmental process of substance abuse (SA) coalitions as they become effective agents of community change. For example, what factors lead to rapid coalition problem solving capacity growth and what coalition practices are associated with reductions in population level SA outcomes?

Methods: The mixed methods study uses CADCA Annual Survey data, DFC grantee core measures outcome data, and case studies of coalitions on different developmental trajectories. A longitudinal evaluation was conducted with 101 coalitions focused on bringing about systems changes to impact population-level SA prevention outcomes. Coalitions attended a training and TA program delivered by CADCA and six waves of data were collected (baseline and 3, 6, 12, 24 & 36 mths) following program delivery.

Results: Cross-sectional study analyses indicate good model fit. CADCA’s Community Problem Solving Model (CPSM) is a robust framework for explaining coalition effectiveness through 36 months post training. The level of, and growth within particular elements of the CPSM are important in coalition problem solving capacity. The pattern of growth and timing of change in each element of the CPSM varies (e.g., between months 3-6, post training growth begins for all elements, except systems change). Systems change growth is triggered after month 6. Systems change had a stronger impact on population-level outcomes than other elements in the CPSF. The amount of coalition systems change appears to positively impact coalition population-level outcomes. Coalitions vary in their pursuit of systems changes.

Conclusions: We see important implications for coalition training and TA.  Some elements in the CPSM may be more important than others in achieving community change. Focusing on building coalition capacity in these elements may move coalitions along the path to population level outcomes more rapidly.