Partnering with the Community
NORC Blueprint: Indiana has made an effort to work with the Area Agencies on Aging (AAA) on this demonstration, working differently with different initiative sites. More specifically, what roles have the AAAs played?
Jennifer Bachman: In three of the NORCs, the local AAA is serving as the lead agency. We were also involved with the AAAs through the AdvantAge Initiative. We partnered with Dr. Phil Stafford from the Center on Aging & Community at Indiana University, who was conducting the statewide AdvantAge Initiative, to have the survey include our five NNORC communities. With this survey data, we were able to drill down into each community. That has proved to be incredibly enlightening. The data revealed that what is happening in an eight-county AAA may be very different from what is happening in an individual community. For example, the survey showed that 78 percent of people 65 and older in Area 8 have had a flu shot in the past 12 months. However, in the Martindale/Brightwood NNORC, which falls within Area 8, the vaccination rate was just 56 percent. So, if the local AAA were to provide blanket programs and services for their area, they would not necessarily be meeting the needs of specific neighborhoods. This brings home even more the lesson that we need to listen to and involve people at the community level. One size does not fit all. We knew that, but having the objective data was worthwhile.
I’ve heard repeatedly that technical assistance has been critically important in Indiana’s statewide approach. What can you tell us about it?
One of the most important components of technical assistance was having a clear, structured process — and the same process for each NNORC program. Without that roadmap, it would have been very difficult for the programs to succeed. We developed training sessions on leadership development, asset mapping, and data collection, among other topics. We constantly referred to best practices and other proven methods in the field — for example, the United Hospital Fund’s NORC Blueprint and the work of Partners for Livable Communities.
We also developed new tools, such as an interim scorecard that we, or the community itself, used to evaluate whether the NNORCs were ready to implement programs and services. Interestingly, the need for technical assistance has been more intensive since they’ve begun implementation of programs and services. It’s one thing to plan for something and conceptualize it; it’s another thing to actually implement it. Many people are not familiar with project management or with things like negotiating with vendors to get the best prices or adjusting plans to deal with unexpected, real-world problems. Much of this depends on the leader you hire and on the experience they have as managers.
What was your approach to the technical assistance for the programs?
First came building the infrastructure for the NNORC programs. We worked with each program to identify the leaders in the community and pull together the key stakeholders, including agencies inside and outside the community, such as hospitals and universities. We also put a strong emphasis on bringing the residents together to form the steering committees, making sure their role was very clear.
Second was asset mapping, teaching and providing tools to work with the community to determine its assets — everything from residents living in the community to community service organizations to corner grocery stores.
Was the technical assistance individualized, in groups, online?
It was mostly individualized. We held quarterly meetings for the five project directors and their coordinators that included training on leadership, asset mapping, data collection, evaluation, and how to determine banner issues. These meetings also offered opportunities for the project leaders to network and share their successes and challenges. We did put some information on the CAC website, but most materials — for example, work plans and reporting templates — were sent directly to the communities. Site visits were made to all five communities to provide hands-on technical assistance and to meet with the community partners.
What are the next steps to making the NORC programs permanent?
We are still waiting to hear about our request for funding to sustain the NNORC programs for another two years. We do know that the state is extremely positive about the initiative, but they need to more fully evaluate the results of this pilot project. Before the State Division of Aging considers making NNORC funding permanent, they will want to know more information about outcomes — whether the programs are succeeding in addressing their banner issues and accomplishing other specific targeted goals they set out to meet.
Do you have plans for expansion?
As part of our funding request, we asked the state for funds to create five more NNORC programs. We’re also talking with the city of Indianapolis, which is very interested in the NORC concept. We’ve also had meetings with neighborhood centers and groups in the city who are interested in our work and see a potential link with the Housing and Urban Development Neighborhood Stabilization Program dollars.
Not knowing the state’s commitment, I don’t know how big the NNORC program concept can get in Indiana. The good news, for us and for Indiana, is that because of the AdvantAge Initiative, we have a great platform of information and data about our elderly and issues related to aging to build upon.
Looking back, what have been the greatest challenges for the initial five sites?
Each site faced different challenges. Participants at one site had been meeting as a community for years prior to the Communities for Life program. They were like the stallion out of the gate. The challenge was for them to slow down and not come up with the answers too quickly, to allow the community to come to its own decisions.
Another community struggled with political corruption. Their greatest challenge was choosing who would serve on the advisory committee, because if you brought the wrong person to the table — somebody who had been associated with corruption — then you wouldn’t get the buy-in from the community. That is an issue I would never have imagined.
And then there were the floods. In June of 2008, while we were planning the NORC programs, there was flooding that incapacitated entire regions. The planning process was interrupted in a few of the NNORC communities to deal with the immediate crisis, provide emergency assistance, and clean up. Millions of state dollars had to be redirected because of the flooding, which will undoubtedly impact funding this year. We don’t know the full impact of this natural disaster.
These are what I call local environmental contexts — things like weather, leadership changes, health issues — which any organizational model will have to contend with. You cannot anticipate these things. So, you can’t prescribe a process that does not allow the flexibility of movement and change within the community. You do need structure and accountability, but at the same time, you have to allow for fluidity.
In general, each community struggled to understand exactly what a NNORC program entailed and how much work it is and will continue to be. It’s a hard concept to grasp.
What would you do differently if you could do this process all over again?
We would change how we notified people about the RFA. We sent out information about the RFA through CAC’s e-notification system to about 1,500 aging network professionals. In retrospect, it would have been better if we had spent more time spreading the word, perhaps through local newspapers, giving the communities more time to complete their RFAs. As it was, the communities had to submit their RFAs within 30 days. Another thing we would do differently is, after narrowing down the list of candidates, we would conduct site visits, going out to meet with communities and the lead agencies before making the final selections.
Another lesson learned is the importance of evaluation — that is, determining whether a NNORC program is succeeding. The community needs to be closely involved in its own evaluation. It has to be a dialogue, a constant back and forth.
One last thing is that we’re constantly wrestling with that issue of fluidity, with responding to the community where it is. Nothing is static. The challenge for us is how to grow this model and build the community-based service programs and at the same time remain respectful of each community and its own processes, characteristics, and challenges.