This article explores how researchers can build relationships with community stakeholders to facilitate the establishment of a coordinated and informed community response in the context of teen pregnancy reduction initiatives. The case study of a Memphis/Shelby County, Tennessee collaborative revolves around a community engagement process founded on four strategies: 1) building policy legitimacy through broad-based participation, 2) seeking funding support for the work of the collaborative, 3) building knowledge of the political landscape, to better identify potential policy champions for the issue, and 4) building a shared understanding of the issue, specifically collecting and discussing reliable data substantiating a community problem and assessing the communitys assets and gaps. The article describes the challenge of establishing the policy legitimacy of the problem as well as getting and staying on the public agenda, collecting more segmented information on the target population. A portion of the research effort is funded by the federal demonstration project, from the U. S. DHHS Office of Adolescent Health, Pregnancy Assistance Fund.
INTRODUCTION
Community leaders increasingly have formed networks, partnerships, and coalitions to pool expertise, resources, and political influence, and to improve communication exchange among stakeholders (Gray, 1989; Mattessich, Murray-Close, & Monsey, 2001; Fung & JHHSA WINTER 2012 275 Wright, 2001; Morrow, Collins, & Smith, 2007; Norris- Tirrell & Clay, 2010; Eschenfelder, 2010; Goldberg, Frank, Bekenstein, Garrity & Ruiz, 2011). Integrating researchers into action-oriented local collaborative and coalition- building efforts offers great potential for targeting sought- after community outcomes. Researchers bring knowledge of research findings and best practices, as well as skills related to data analysis, assets and gaps assessment, intervention review, and program evaluation (Newman et al., 2011; Tataw & Rosa-Lugo, 2011). Thus, community engagement can connect the universitys outreach efforts to community priorities, enhancing informed practice and strengthening community capacity (Israel, Schulz, Parker, & Becker, 1998). Over the last decade, such university-community collaboration has been encouraged by funders and government officials (Percy, Simper, & Brukardt, 2006; Henig, 2008; Hess 2008; Nutley and Davies, 2007), especially in the public and community health arenas (Minkler & Wallerstein, 2003; Seifer, 2003; Schulz, Israel, & Lantz, 2004). Sustaining community-researcher relationships is not without its challenges. Not always trained in policy and political processes, researchers may not be skilled in communicating their assets effectively to community partners nor be able to balance engagement with competing university demands for their time. Yet, relationship building between community and university partners is especially critical in a climate where policy constraints are complex and the seemingly intractable challenges require bold and collaborative leadership (Ledingham, 2003; Norris-Tirrell & Clay, 2010; Wallerstein, Yen, & Syme, 2011). In this paper, we describe how researchers can successfully build relationships with community stakeholders to facilitate the establishment of a coordinated community response in the context of teen pregnancy reduction initiatives. 276 JHHSA WINTER 2012 Challenges to Action-Oriented Engagement: The Case of Adolescent Sexual Behavior Community collaboration leaders focused on positively affecting teen sexuality behaviors must systematically, proactively, and purposefully design processes and build collaborative relationships that assure broad inclusion of competing agendas, traverse ideological pitfalls, and leverage change across multiple systems (Luker, 1996; Kramer et al., 2005). Moreover, participants who are intent on creating community-university collaborations focused on intractable public problems can face a skeptical, sometimes cynical, political climate that both affects and shapes community perceptions. Thus, community collaboratives focused on changing adolescent sexual health-risk behavior will need to understand the nature of the public debate on the issue and establish sufficient legitimacy to merit the communitys attention, energy, and response.
Nature of the public debate. Community collaborators engaged in tackling adolescent pregnancy prevention face a serious challenge; the policy discourse surrounding this issue can become polarized and impassioned when opposing interests and priorities attempt to shape the political environment by gaining ascendency of their problem definition and preferred policy alternatives. U. S. culture is generally uncomfortable with public talk about private matters. This discomfort, combined with a wish to punish promiscuous, non- normative behavior; and a protective frame, intent on safeguarding childhood innocence, synergistically can combine to constrain the ability of communities to effectively negotiate this policy issue (Irvine, 2002). While the policy debate gridlocks over appropriate sex education paradigms (e.g., abstinence-only, abstinence plus, comprehensive), high rates of adolescent pregnancy JHHSA WINTER 2012 277 continue (in 2009, 39.1/1000 females aged 15-19; 20.1/1000 females aged 15-17) (CDC, 2011a; CDC, 2011b), and serious negative consequences on adolescent parents and their children endure. More than 80% of teen mothers live in poverty during their childrens important developmental years (Hoffman & Maynard, 2008), and many will not graduate from high school (Hoffman, 2006). Consequently, leaders of the collaborative must not only be broadly inclusive by bringing disparate views to the table, but also provide an environment that builds trust and openness among the participants; in that way community consensus can build a coordinated response.
Establishing local legitimacy. As with so many public policy arenas, place matters. Consequently, researchers engaged in teen pregnancy prevention collaborations need to address the central factors that affect their particular teen population, including ethnicity and racial discrimination race, income, culture, language, urban/rural nature of the community, and the legal environment, as well as the landscape of service providers/stakeholders. Although researchers interested in this topic will already be familiar with the effects of health disparities on community health, the complex, multidimensional set of biological, psychosocial, and structural factors involved with teen sexual behavior likely needs multi-disciplinary perspectives to assist the community collaborative to build consensus on goals and priorities.
BACKGROUND OF THE COLLABORATIVE
The city of Memphis (located in Shelby County, Tennessee) is the largest city, by population size, in the state. According to the Census Bureau (2010), the citys population is predominantly African American (63.3% 278 JHHSA WINTER 2012 African American, 29.4% white, and 6.5% Hispanic). Further, the poverty rate Memphis is high, with 24.2% of people living below the poverty line, as compared to 14.3% nationally. According to a report from the Brookings Institution (2011), the Memphis metropolitan area ranks third in concentrated poverty among the nations largest 100 cities. Further, speaking to the challenges faced by this population, low-income communities are increasingly decentralized across the region away from the center city and face a limited public transportation infrastructure (Sagrestano, Clay, Finerman, Rapino, & Gooch, 2010) and high unemployment (9.1% U. S.; 9.8%, Tennessee and 10.3%, Memphis Metropolitan Area; Bureau of Labor Statistics, 2011). An examination of local data reveal a pattern of disproportionately high rates of teen pregnancy and birth, STIs and HIV/AIDS, low birth weight, and infant mortality. In addition, substantial disparities exist overall between white non-Hispanics and African Americans (Tennessee Department of Health, 2006, 2010 and 2011; CDC, 2011b). In late 2008, the Mid-South Collaborative on Adolescent Pregnancy, Prevention, and Parenting (MCAPPP) was convened by The Urban Child Institute, a local research foundation. Their vision was of a community where all children, youth, and families are provided the information, services, and support needed to make responsible decisions about planning and raising a healthy family. In late 2009, the foundation asked the Center for Research on Women at The University of Memphis to lead the collaborative. Over the next several months, the group revised their vision and mission, and selected a new name, Memphis Teen Vision (MemTV). The process of developing the new vision and mission was lengthy, as the group was dedicated to being comprehensive and inclusive of all members perspectives. The new vision of MemTV is: A future where all teens are taught comprehensive sex JHHSA WINTER 2012 279 education, teens onset of sexual intercourse is delayed, teen pregnancies are reduced/eliminated, and teen parents are provided assistance. The mission of MemTV is: Coordinated community response to teen pregnancy and parenting that includes: o Comprehensive sex education for teens including abstinence and contraceptive information o Services, support, and education to pregnant and parenting teens o Strong policies and programs that promote adolescent sexual health The guiding principles of MemTV are: Dedicated to making resources for teens and teen parents more transparent and easily accessible Promote a non-judgmental environment where teens have access to comprehensive sex education Promote strategies that focus on both boys and girls Promote programs based on evidence and best- practices
MemTV includes approximately 35 organizations, and brings together groups from multiple perspectives that typically do not work together (e.g., abstinence-only education programs, abortion service providers). MemTV is committed to increasing communication and cooperation across agencies, presenting accurate data about teen pregnancy and parenting in Memphis, and developing a media campaign to bring new voices to the table and increase the relevance of the dialogue and action plans for the community. A federal demonstration project funded by the U. S. DHHS Office of Adolescent Health Pregnancy Assistance Fund (the Teen Pregnancy and Parenting Initiative, or TPPI), which flowed through the state and then Shelby County, is funding some of the collaboratives efforts, including a needs assessment/gap analysis, and part 280 JHHSA WINTER 2012 time staff for the collaborative. In addition, the grant funds several programs to assist teens in the community, including expanding the school clinic program to provide reproductive services and prenatal care. Clinic staff will offer Centering Pregnancy (a prenatal program that also builds a support network for the pregnant teen), and dedicated social workers in the schools will provide case management services. MemTV leadership worked with the media to more comprehensively and accurately report on the issue, and partnered with political and school board leaders to address the issue. On the National Day to Prevent Teen Pregnancy (May 4, 2011), MemTV held a half-day community event to publicize the issues surrounding teen pregnancy and parenting, with over 250 people attending. In addition, MemTV has become a working group of the Shelby County Early Success Coalition, a private-public partnership dedicated to developing and expanding an early childhood comprehensive system of care for children in Shelby County from preconception to age eight.
CREATING A SHARED UNDERSTANDING AND COORDINATED COMMUNITY RESPONSE
Memphis/Shelby County has disproportionately high levels of prematurity, low birth weight births, preterm delivery, infant mortality, and adolescent pregnancy (The Urban Child Institute, 2011). Pregnant adolescents experience higher rates of certain medical complications during pregnancy, including anemia, lung disease, pregnancy-related hypertension, renal disease, and eclampsia (Martin et al., 2005). It is these medical conditions that put the infant at risk for adverse outcomes (Gilbert, Jandial, Filed, Bigelow, & Danielson, 2004). Infants born with such complications are also at higher risk for cognitive, behavioral, and emotional impairment and JHHSA WINTER 2012 281 death. The challenge in responding to these poor community health outcomes is in creating a community- based, coordinated response that is adolescent and culturally sensitive, grounded in reliable and valid data, and inclusive. Thus, MemTVs priority is on: 1) building policy legitimacy through broad-based participation, 2) seeking funding support for the work of the collaborative, 3) building knowledge of the political landscape, to better identify potential policy champions for the issue, and 4) building a shared understanding of the issue, specifically collecting and discussing reliable data substantiating a community problem and assessing the communitys assets and gaps.
Policy Legitimacy through Broad-Based Participation To assure inclusivity and partnership sustainability, the collaborative is documenting and examining the programs that already exist in order to identify community assets and gaps, and also to assure that participants with varying political and ideological positions are at the table, including the secular and faith-based organizations. Active involvement of recognized opinion and policy leaders in the African American community has been particularly critical in sustaining the legitimacy of the collaboration in Memphis. Further, an important stakeholder in the collaboration is the school system, since the schools are responsible for the delivery of the health education curriculum. These representatives are active collaborative members and have built an open line of communication and partnership. As noted by Ledingham (2003), attention to shared understanding and mutual benefit leads to positive outcomes for organizations when those involved focus on the common wants, needs, and expectations of organizations and interacting publics (p. 194). This, in turn, can lead to positive health outcomes as community 282 JHHSA WINTER 2012 partners work together on public health challenges (Wise, 2008). County officials are working with Early Success Coalition members to regularly exchange information, shared metrics for measurement of benchmarks, and to coordinate a larger system of care.
Seeking Funding Support The Memphis collaborative has faced serious obstacles in being able to attain existing and accessible local and segmented data. Funding support may be critical to build a required data collection infrastructure. Moreover, community agencies see funding and political leadership support as a yardstick that measures political salience. That is, achieving governmental and/or foundation funding helps them determine their willingness to become involved and, most importantly, their degree of involvement, in the collaboration (Norris-Tirrell & Clay, 2010). For tenure, promotion, and recognition, the practical reality for academic faculty is the expectation of attaining funding to support engaged research as well as the ability to be able to publish in peer-reviewed journals (Israel, Schulz, Parker, & Becker, 1998). Currently, the funding climate is deeply constrained, and sources that support this type of community collaborative effort are limited. Champions for local programs and funding may include the Governor, General Assembly, Mayors, School Board members, and others, yet each has unique priorities. State and county officials, however, do tend to recognize the challenges of building a strong community collaborative and sustaining political support. Fortunately, Tennessee and Shelby County, through the federal grant, is providing funding to further the work of the agencies involved in the TPPI as well as assure that sufficient attention is placed on building common data in order to evaluate outcomes. JHHSA WINTER 2012 283 From our experience in various community coalitions and collaborations, a tension can build among participants over competition for funding support (Norris- Tirrell & Clay, 2010). The reality is that grant seeking and advocating for adequate funding for their programs is a continual challenge.. Yet the ability to sustain a community collaborative also requires at least some infrastructure funding. Consequently, community collaborative leaders need to commit energy and time to advocate for funding and other resources to support the work of the collaborative. Researchers engaged in the collaborative will likely need to be willing to provide their expertise in the grant seeking process.
Understanding the Political Landscape Legislators have multiple roles in public policymaking, including congressional committee assignments, political party affiliation, agenda-setting negotiations, and the natural give and take of legislative processes as members attempt to influence each other. Advocates need to examine congressional, state legislator, and local political officials voting patterns to understand the policymaking climate for their locality. Given the continuous political shifts in Shelby County and Tennessee, advocates for adolescent programs should frame the policy debate in a way that will engender support and encourage policymakers to use the findings and analysis from the collaborative in developing public policy (Lavis et al., 2002; Robert Wood Johnson Foundation, 2010; Wallerstein, Yen, & Syme, 2011; Mah, Deber, Guttmann, McGeer, & Krahn, 2011). Clearly, action-oriented collaboratives in Shelby County, as elsewhere, need to understand their national, regional, and local political contexts to be effective policy advocates.
284 JHHSA WINTER 2012 Analyzing voting patterns. In the context of concerns over the cost of government and the ballooning federal deficit, federal programs are being carefully scrutinized and reduced or eliminated. The fiscal environment adds an important constraint to gaining political support for programming. Although voting records do not sufficiently describe legislator policy positions, votes do capture a position taken at a specific time for a specific legislation. Records also provide hints as to whether legislators may support a bill in general, or what sort of elements may in the end elicit their opposition. Moreover legislator support or opposition to a specific bill may overstate or understate their support/opposition to efforts in an overall policy arena. Examining specific voting records, nevertheless, helps advocates identify potential champions and allies and how advocates may need to define policy problems, frame positions, prioritize advocacy strategies, and disseminate information. Extrapolating from the American Public Health Associations (APHA) report (2011) on public health congressional voting records, comparing 2009 and 2010 sessions, suggests an increasingly challenging policy climate for adolescent health promotion activities. For the 111 th Congress, APHAs analysis indicates that the number of legislators who never supported APHA positions 1
increased over the two years, from the First to Second Session (First Session: 16 Senators, 10 Representatives; Second Session: 27 Senators, 155 Representatives). At the same time, 53 Senators and 248 Representatives voted 80% or more above in accord with APHA positions in the First Session and 52 Senators and 265 Representatives in the Second Session. Although congressional support of public health legislation continues, opposition towards APHA positions on health promotion and prevention programs
1 APHA analysis reported a zero rating for these legislators. JHHSA WINTER 2012 285 may strengthen in the future, especially as some attempt to negate the Affordable Care Act.
Sustaining local attention: Locally, the issue of teen pregnancy began to heat up when a local foundation reported in fall 2010 that the teenage pregnancy rate had increased substantially over the previous year (The Urban Child Institute, 2010). Although this information was later found to be based on inaccurate census estimates of the teen population, local school board officials became concerned. Consequently, the City School Board passed a resolution supporting greater attention to the teen pregnancy problem, keeping their focus/priority on assuring that pregnant and parenting teens graduate on time (Memphis City School Board, 2010). The resolution calls for: collecting data on student pregnancies throughout the school year; fully implementing the existing Family Life curriculum in all Memphis City high schools; and collaborating with other local organizations working to reduce teen pregnancy.
Around the same time (October 2010), Tennessee received notification of a $4.2 million, three-year grant from the U.S. Department of Health and Human Services Office of Adolescent Health for the Pregnancy and Parenting Success Program in Shelby County. The program seeks to improve school attendance, graduation, birth, and early childhood outcomes. Upon assuming office, the new Governor finally accepted this federal grant after an unusually lengthy (6 month) review process. Local media attention to the issue also began to grow during this time (e.g., Madden, 2011), centered on reports of 90 pregnant teens in one high school. Although local school officials refuted the validity of the number, the 286 JHHSA WINTER 2012 story captured the national media spotlight (e.g., Mandell, 2011, Males, 2011) and local media pressed for action. MemTV leadership served as a liaison between local agencies involved in the collaborative and the media, school officials, and local government leaders. Unfortunately, local school board attention decreased as a debate and vote on consolidation of city and county schools, a racially charged issue, dominated local consideration and energy as advocates and opponents pressed to influence city voters (election held March, 2011). Although various community groups have continued their support for various child-related social service issues, media attention has focused on school consolidation dynamics and budgetary battles. Consequently, the ability to sustain politician and community stakeholder interest remains a continuous struggle for the teen pregnancy collaborative in Memphis.
Sifting through Extensive I nformation Resources With the chain of circumstances progressing from risky sexual behavior, to teen pregnancy and births, to adverse birth outcomes, to infant mortality, the children of teen parents face a higher risk of negative social, economic, and educational outcomes. What is not adequately known is how these factors cluster and play out in Memphis-Shelby County, and what assets can be mobilized or created to intervene at various points in the chain. To gain policy legitimacy locally, the community collaborative members are building a deeper understanding of their local social, economic, demographic, political, and cultural context. Moreover, participants have realized that they not only need to draw upon the knowledge and experience of local experts, but also become articulate about national and state data and national benchmarks about effective program characteristics. Ideally and where available, segmented data relating needs and gaps in specific communities will JHHSA WINTER 2012 287 also assist program officials to design more effective strategies and take into account infrastructure/system barriers.
Establishing benchmarks. National, state, and county level data can be effective in establishing benchmarks, goals, and metrics for tracking progress. Agencies that oversee federal programs relevant to families, children, and youth - such as the Department of Health and Human Services, the Department of Education, and the National Institutes of Health - disseminate research findings and data on adolescent health useful in comparisons to other localities/states. The broad array of advocacy groups interested in influencing social policy have electronically available fact sheets, policy briefs, news releases, bibliographies of research articles, reports, statements, presentations, training, policy analysis, and publications. For example, the Childrens Defense Fund provides state data on children, the Guttmacher Institute focuses on sexual and reproductive health and provides monthly policy updates and state policy briefs, and the Healthy Teen Network emphasizes advocacy on issues related to teen pregnancy prevention, teen pregnancy, and teen parenting to promote policy initiatives. The National Campaign to Prevent Teen Pregnancy commissions original research and also is a clearing house for data and other resources related to teen pregnancy prevention (e.g., Kirby, 2007; Kirby, Rolleri, & Wilson, 2007). The wealth of information available about teen pregnancy is both an asset and challenge, as the collaborative has had to carefully sift through a large volume of sometimes inconsistent statistical data and try to relate this general, but fragmented, information to the local situation. Familiarity with current expectations about community collaboration processes and best practice 288 JHHSA WINTER 2012 program characteristics will be critical for a community collaborative wishing to seek grant funding for projects.
Teen sexual behaviors in the bluff city. A key resource for understanding adolescent health-risk behaviors, including sexual behaviors that can result in unintended pregnancy and sexually transmitted diseases, is the CDCs Youth Risk Behavior Surveillance System (YRBSS). Because Memphis participates in the YRBS Local Survey, some data are available for students enrolled in Memphis City Schools. According to the 2009 YRBS, almost half of U. S. high school and almost two-thirds of Memphis high school students reported ever having sexual intercourse (U.S.: 46%; Memphis: 61.6%); and twice as many Memphis students reported they had their first sexual intercourse before age 13 years (U.S.: 5.9%; Memphis: 12.1%) (CDC, 2010b, pp. 98-102). Similar patterns of results emerge when considering the percentage of students who are currently sexually active and have had four or more lifetime partners (U. S.: 13.8%; Memphis 23.0% (CDC, 2010b, p. 101). Of those students reporting being currently sexually active (with at least one person during the 3 months before the survey), a higher percentage of Memphis youths reported that they or their partner used a condom (U. S.: 61.1%; Memphis, 72.4%) but a much lower percentage reported using birth control pills (U.S.: 19.8%, Memphis: 9.2% (CDC, 2010b, pp. 102-103). A lower percentage of Memphis high school students reported that they were ever taught about AIDS or HIV infection in school (U. S.: 87.0%; Memphis: 79.4%) (CDC, 2010b, pp. 108-109). Adolescents, who have a greater number of sexual partners, face an increased risk of contracting a sexually transmitted infection. Girls who have sex in their early teens are also less likely to use contraception overall and more likely to get pregnant (Institute for Youth JHHSA WINTER 2012 289 Development, 2002). According a recent report issued by the Tennessee Department of Health (2011), the adolescent pregnancy rate for teens aged 10-19 in Shelby County is the third highest county rate in Tennessee (Tennessee: 31.2; Shelby County, 44.0). Moreover, the county adolescent pregnancy rate is higher for Black teens than White teens, ages 10-19 (Black Teens: 58.1 and White Teens: 18.7). Of note, Shelby County has high STI rates, ranking 11 th
nationally for Chlamydia and 7th for Gonorrhea (CDC, 2010a). The States special report on racial disparity in infant mortality indicates that although the leading cause of infant mortality is congenital related conditions, the second leading cause is conditions associated with short gestation and/or low birth weight (TN Department of Health, 2006). As a percent of the States total births for adolescents ages 10-17, the Tennessee Department of Health (2011) reports that infant low weight birth weights were higher for Black teens than White teens in 2009 (Black teens: 13.2%; White teens, 9.2%). The infant mortality rate in Tennessee is much higher for African Americans than among whites (African Americans: 17.4/1,000; Whites: 6.4), with Shelby County having the second highest infant mortality rate in the state (TN Department of Health, 2006). In Shelby County, although teens account for 15% of the live births, they suffer 24% of the infant deaths (Memphis and Shelby County Health Department, 2009). The various national, state, and local data support the need for developing a coordinated community response to reducing adolescent sexual risk taking behaviors. The collaborative seeks to supplement what is known about the issue with more specific locally based information about adolescents, programs, and the particulars about the impact of adolescent pregnancy as well as both risk and protective factors. Consequently, the Center for Research on Women is conducting a needs assessment to more fully assess the 290 JHHSA WINTER 2012 demographics of youth in our community, the prevalence and incidence of pregnancy and birth outcomes, sexual risk taking behaviors, community asset inventories and maps, local economic impact of teen pregnancy, and the policy climate that will affect policy action. The needs assessment will systematically gather information and report the results to the collaborative for review and deliberation (Healthy Teen Network, 2011; Robert Wood Johnson Foundation, 2010; Walker, 2011).
DISCUSSION
In this paper, we describe how researchers and the research process are building relationships with community stakeholders to facilitate the establishment of a coordinated community response in the context of teen pregnancy reduction initiatives. As noted by various public health experts (Mann, 2011; Israel, Schulz, Parker, & Becker, 1998), engaged community research is different than medical research or conventional social science research as there is no lab, participants come and go, and multiple agency partners and individuals are involved with varying degrees of involvement and commitment. Our experience suggests that university researchers bring an especially important ability to analyze problems from both a critical, evidence-based approach as well as a multi-disciplinary perspective. Researchers can be an asset to their communities as they bring their research skills and knowledge to community deliberations. To be successful in helping to build collaborative relationships, this experience with the Memphis collaborative illustrates that researchers can play multiple roles. They facilitate increased and broad community engagement to increase policy legitimacy of the collaborative, use their grant funding knowledge to write/support grant seeking, analyze the political landscape JHHSA WINTER 2012 291 to help seek political and policy champions, provide informal leadership to keep the issue on the public agenda, and critically sift through data to capture reliable, valid, and useable information. When the university researchers are not involved in providing services, community members appear to perceive these partners as neutral experts, not as competitors, who can help the collaborative move forward and be successful. At the same time, a critical early step for academic-based researchers is to decide the role(s) they are willing to play in the community collaboration as well as the amount of effort they can expend. As their role expands, researchers must realistically assess resource needs and understand community timelines that do not align with academic semester/quarter demands. Researchers also need to expend the time to fully understand the history of the policy arena, the policy champion landscape in their community, and communication strategies that are effective locally. Given recent partisan shifts in Shelby County and Tennessee, advocates for adolescent programs will likely need to frame the policy debate in a way that engenders broad support. Since other crises will occur that remove the issue from the center of the communitys and political leaders attention, researchers can also be helpful in helping the collaborative keep focused on the larger goal of building relationships even as issue salience waxes and wanes. This becomes especially important since coalitions formed solely around funding are less likely to be sustainable (Kramer et al., 2005). Experience continues to illustrate that effective collaboration require processes that are open, relational, and ethical in nature and coalesced on sought after health outcomes can sustain participant commitment (Norris-Tirrell & Clay, 2010).
292 JHHSA WINTER 2012
CONCLUSION
Although this community engagement project is not complete and will be ongoing for several years, this experience offers some useful insights into connecting community engagement and building shared understanding that informs a coordinated community response, and consequently a more feasible, accepted, and sustained effort to counter the negative consequences of adolescent pregnancy. As we complete the next stages of the adolescent pregnancy prevention and care collaboration, our work will quantify the relationship between the community efforts and better outcomes for adolescents and their families. Based on the first phase of the community response to teen pregnancy effort, we present four summary insights for other academics and communities considering this type of collaborative effort. These include: 1) Collaborative processes must occur in the spirit of cooperation and inclusion with the commitment renewed regularly. The partners involved in the collaborative need to gain broad acceptance of the problem definition, community needs and gaps, and intervention design. Moreover, there is value in including multidisciplinary research collaborations that advance inclusion and expand problem definition; 2) Community collaboration leaders must be skillful facilitators, effective communicators, and thoughtful innovators. Building a shared understanding and developing consensus takes leadership energy. Although leadership continuity is important to progress, participants must be sensitive to collaborative and leadership fatigue; 3) Patience and long term, but strategic, commitment to community issues is a requisite for effective community-university engagement. Building broad-based JHHSA WINTER 2012 293 consensus and commitment requires time and a willingness to stay engaged, even when significant barriers challenge the best intentions; and 4) Informing policy decisions is a serious challenge given the lack of adequately segmented data about the populations most at risk. Collecting the data and turning it into useable information is critical to building consensus on collaborative deliberations and the communitys capacity to create an informed response.
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