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BUILDING RELATIONSHIPS TO

STRATEGICALLY IMPACT COMMUNITY


INITIATIVES TO REDUCE TEEN PREGNANCY

JOY A. CLAY
LYNDA M. SAGRESTANO
RUTHBETH FINERMAN

University of Memphis


ABSTRACT

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%
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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
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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
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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.

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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
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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
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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.

294 JHHSA WINTER 2012
REFERENCES

American Public Health Association. (2011). APHA annual
congressional record: How members of Congress
supported public health. The Nations Health, 41
(1), 13-18.

Brookings Institution. 2011. The re-emergence of
concentrated poverty: Metropolitan trends in the
2000s [Metropolitan Opportunity Series,
November]. Washington, D. C.: Metropolitan
Policy Program at Brookings.

Bureau of Labor Statistics. (2011). Local area
unemployment statistics, Tennessee and Memphis,
TN-MS-AR; not seasonally adjusted, August 2011.
http://www.bls.gov/web/metro/laummtrk.htm .

Census Bureau. 2010 State and County QuickFacts.
Washington, DC: U. S. Census Bureau. Retrieved
November 17, 2011 at
http://quickfacts.census.gov/qfd/states/47/4748000.
html

Centers for Disease Control and Prevention. (2010a).
Sexually transmitted disease surveillance 2009.
Atlanta: U.S. Department of Health and Human
Services.

Centers for Disease Control. (2010b). Youth risk behavior
surveillance-United States, 2009. MMWR, 59.
Atlanta: U. S. Department of Health and Human
Services.

JHHSA WINTER 2012 295
Centers for Disease Control and Prevention. (2011a). Vital
Signs: Teen Pregnancy United States, 1991-2009.
MMWR, 60(13), 414-420.

Centers for Disease Control and Prevention. (2011b). U. S.
Teenage Birth Rate Resumes Decline. NCHS Data
Brief, 58.
http://www.cdc.gov/nchs/data/databriefs/db58.pdf
and
http://www.cdc.gov/nchs/data/databriefs/db58_table
s.pdf#3

Eschenfelder, B. (2010). Using community-based needs
assessments to strengthen nonprofit-government
collaboration and service delivery. Journal of
Health and Human Services Administration, 32 (4),
405-446.
Fung, A. and Wright, E.. 2001. Deepening democracy:
Innovations in empowered participatory
governance. Politics and Society, 29 (1), 5-41.
Gilbert, W. M., Jandial, D., Filed, N. T., Bigelow, P., and
Danielson, B. (2004). Birth outcomes in teen
pregnancies. Journal of Maternal-Fetal and
Neonatal Medicine, 16, 265-270.

Goldberg, B., Frank, V., Bekenstein, S., Garrity, P. and
Ruiz, J. (2011). Successful community engagement:
Laying the foundation for effective teen pregnancy
prevention. Journal of Children and Poverty, 17
(1), 65-86.

Gray, B. (1989.) Collaborating: Finding common ground
for multi-party problems. San Francisco: Jossey-
Bass.

296 JHHSA WINTER 2012
Healthy Teen Network. (2011). Best practices for
conducting a needs and resource assessment: Tip
sheet (A guide for the Office of Adolescent Health
and Administration on Children, Youth and
Families Grantees).

Hening, J. (2008). Spin cycle: How research is used in
policy debates: The case of charter schools. New
York: Russell Sage Foundation.

Hess, F. (2008). When research matters: How scholarship
influences education policy. Cambridge: Harvard
Education Press.

Hoffman, S. A., and Maynard, R.A. (Eds.). (2008). Kids
having kids: Economic costs and social
consequences of teen pregnancy. Washington, DC:
The Urban Institute Press.

Hoffman, S. D. (2006). By the numbers: The public costs of
teen childbearing. Washington, DC: National
Campaign to Prevent Teen Pregnancy.

Institute for Youth Development (2002). Americas youth:
Measuring the risk (4th Ed.). Washington, D.C.:
Institute for Youth Development.

Irvine, J. (2002). Talk about sex: The battle over sex
education in the United States. Berkeley, CA:
University of California Press.

Israel, B., Schulz, A., Parker, E., and Becker, A. (1998).
Review of community-based research: Assessing
partnership approaches to improve public health.
Annual Review of Public Health, 19, 173-202.

JHHSA WINTER 2012 297
Kirby, D. (2007). Emerging answers 2007: Research
findings on programs to reduce teen pregnancy and
sexuallly transmitted diseases. Washington, DC:
The National Campaign to Prevent Teen Pregnancy.

Kirby, D., Rolleri, L.A., and Wilson, M. M. (2007). Tools
to assess the characteristics of effective sex and
STD/HIV education programs. Healthy Teen
Network and ETR Associates
(http://www.etr.org/recapp/documents/programs/tac
.pdf).

Kramer, J., Philiber, S., Brindis, C. Kamin, S., Chadwick,
A., Revels, M., . . . Abelson, J. (2005). Coalition
models: Lessons learned from the CDCs
Community Coaliton Partnership Programs for the
Prevention of Teen Pregnancy. Journal of
Adolescent Health, 37 (3, Supplement 1), S20-30.

Lavis, J., Ross, S., Hurley, J., Hohenadel, J., Stoddart, G.,
Woodward, C., and Abelson, J. (2002). Examining
the role of health services research in public
policymaking. The Milibank Quarterly, 80 (1), 125-
154.

Ledingham, J. (2003). Explicating relationship
management as a general theory of public relations.
Journal of Public Relations Research, 15 (2), 181-
198.

Luker, K. (1996). Dubious conceptions: The politics of
teenage pregnancy. Cambridge, MA: Harvard
University Press.

298 JHHSA WINTER 2012
Madden, U. (2011, January 11). Teen pregnancy epidemic
hits Memphis high school. WMC-TV, Memphis.
Retrieved from
http://www.wmctv.com/story/13824956/90-
students-at-frayser-high-school?redirected=true

Mah, C., Deber, R., Guttmann, A., McGeer, A., and Krahn,
M. (2011). Another look at the Human
Papillomarvirus vaccine experience in Canada.
American Journal of Public Health, 101 (10), 1850-
1857.

Males, M. (2011, January 28). Behaving like children. The
New York Times. Retrieved from:
http://www.nytimes.com/2011/01/29/opinion/29mal
es.html

Mandell, N. (2011, January 15). Pregnancy epidemic: 90
teens, 11 percent of student body, pregnant at
Frayser High School in Memphis. The New York
Daily News. Retrieved from
http://articles.nydailynews.com/2011-01-
15/news/27087580_1_teen-pregnancy-pregnancy-
epidemic-pregnancy-rate

Mann, S. (2011). Merging researchers and communities to
improve outcomes. AAMC Reporter (May).
Washington, D.C.: Association of American
Medical Colleges. Retrieved from
https://www.aamc.org/newsroom/reporter/may11/1
88552/merging_researchers.html.

Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J.,
Menacker, F., & Munson, M. L. (2005). Births:
Final data for 2003. National Vital Statistics
Reports, 54 (2), 1-116.
JHHSA WINTER 2012 299
Mattessich, P, Murray-Close, M., and Monsey, B. 2001.
Collaboration: What makes it work. Saint Paul,
MN. Amherst H. Wilder Foundation.

Memphis and Shelby County Health Department. (2009).
Infant mortality: Progress in Shelby County.
Memphis, TN: Fetal and Infant Mortality Review
Team, June.

Memphis City Schools (MCS) Board of Education. (2010,
October 18). Resolution for Comprehensive
Strategy to Reduce Teen Pregnancies in MCS.
Memphis, TN: Memphis City Schools Board of
Education.

Minkler, M., and Wallerstein, N. (2003). Community based
participatory research for health. San Francisco:
Jossey-Bass.

Morrow, H., Collins, B., and Smith, D. (2007). Public
health coalitions: Patterns and perceptions in state
immunization programs. Journal of Health and
Human Services Administration, 30 (2), 156-175.
Newman, S., Andrews, J., Magwood, G., Jenkins, C., Cox,
M., and Williamson, D. (2011). Community
advisory boards in community-based participatory
research: A synthesis of best processes. Preventing
Chronic Disease: Public Health Research, Practice,
and Policy, 8 (3), 1-12.

Norris-Tirrell, D. and Clay, J. A. (2010). Strategic
collaboration in public and nonprofit
administration: A practice-based approach to
solving shared problems. Boca Raton, LA: CRC
Press.

300 JHHSA WINTER 2012
Nutley, S, Walter, I., and Davies, H. (2007). Using
Evidence: How Research can Inform Public
Services. Bristol, UK: Policy Press.

Percy, S., Zimpher, N., and Brukardt, M. (Eds.). (2006).
Creating a new kind of university: Institutionalizing
community-university engagement. Bolton, MA:
Anker Publishing.

Robert Wood Johnson Foundation. (2010). A new way to
talk about social determinants of health. (2010).
Vulnerable Populations Portfolio, July 28.
http://www.rwjf.org/files/research/vpmessageguide
20101029.pdf .

Sagrestano, L. M., Clay, J. A., Finerman, R., Rapino, M., &
Gooch, J. (2010). Mind the gap: Ryan White Part A
HIV/AIDS transportation needs assessment special
study. Memphis, TN: University of Memphis,
Center for Research on Women.

Schulz, A., Israel, B., and Lantz, P. (2004). Assessing and
strengthening characteristics of effective groups in
community-based participatory research
partnerships. In C. D. Garvin, L. M. Gutierrez, &
M. J. Galinsky (Eds.), Handbook of Social Work
with Groups, (pp. 332-349). New York: Guilford.

Seifer, S. D. (2003). Community based participatory
research for health. In M. Minkler, & N. Wallerstein
(Eds.), Community based participatory research for
health (pp. 429-435). San Francisco: Jossey-Bass.

JHHSA WINTER 2012 301
Tataw, D., and Rosa-Lugo, Jr., B. (2011). Municipal health
policy development, planning and implementation:
Addressing youth risk factors through participatory
governance. Journal of Health and Human Services
Administration, 33 (4), 491-533.

Tennesee Department of Health. (2006). Racial disparity in
infant mortality in Tennessee. Nashville, TN: Office
of Policy, Planning, and Assessment.

Tennessee Department of Health. (2010). Memphis/Shelby
County, Tennesseereported STD cases by
race/ethnicity, age group and sex. Retrieved on
November 3, 2011 from
http://health.state.tn.us/STD/2010_Data_Surveillanc
e/2010Shelby.pdfhttp://health.state.tn.us/STD/data.s
html

Tennessee Department of Health. (2011). Tennessee
adolescent pregnancy summary data: 2009.
Nashville, TN: Policy, Planning, and Assessment
Division of Health Statistics.

The Urban Child Institute. (2010). The state of children in
Memphis and Shelby County: Data book 2010.
Memphis, TN: Author.

The Urban Child Institute. (2011). The state of children in
Memphis and Shelby County: Data book 2011.
Memphis, TN: Author.

Walker, W. M. (2011). Guest editors introduction to
special issue. Journal of Children and Poverty, 17
(1), 3-5.


302 JHHSA WINTER 2012
Wallerstein, N., Yen, I., and Syme, S. (2011). Integration of
social epidemiology and community-engaged
interventions to improve health equity. American
Journal of Public Health, 101 (5), 822-830.

Wise, K. (2008). Why public health needs relationship
management. Journal of Health and Human
Services Administration, 32 (4), 309-331.

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