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Health Promotion Practice
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DOI: 10.1177/1524839906289557
2007 8: 375 Health Promot Pract
Cheryl Merzel, Gail Burrus, Jean Davis, Ngozi Moses, Sharon Rumley and Dionna Walters
Healthy Start
Academic Partnerships: Lessons From Downstate New York Developing and Sustaining Community

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Developing and Sustaining CommunityAcademic
Partnerships: Lessons From Downstate New York
Healthy Start
Cheryl Merzel, DrPH
Gail Burrus, BS
Jean Davis, BBA
Ngozi Moses, MSc
Sharon Rumley, RN, MPH
Dionna Walters, MPH, MPA
programs involve collaboration between an academic
institution and community organizations. These asso-
ciations often represent an uneasy fit between organi-
zations with very different purposes, operating cultures,
and power statuses. This article presents a model of a
communityacademic partnership based on a linkage
between a school of public health and several community-
based organizations (CBOs). We examine and reflect on
factors influencing the nature of the interrelationships
and the success of the collaboration.
>BACKGROUND
Participation by community members is viewed as
an essential component of health promotion programs
that aim to improve community health (Baker, Homan,
Schonhoff, & Kreuter, 1999; Cheadle et al., 1997). The
emerging field of community-based participatory research
(CBPR), defined as a collaboration that involves com-
munity members in all aspects of the process, empha-
sizes the importance of decision making and control by
nonacademics and empowering a community to take
action for its well being (Israel, Schulz, Parker, & Becker,
Partnering with communities is a critical aspect of con-
temporary health promotion. Linkages between universi-
ties and communities are particularly significant, given
the prominence of academic institutions in channeling
grants. This article describes the collaboration between a
school of public health and several community-based
organizations on a maternal and infant health grant pro-
ject. The partnership serves as a model for ways in which
a university and community organizations can interrelate
and interact. Central lessons include the significance of
sharing values and goals, the benefit of drawing on the
different strengths of each partner, the gap created by the
universitys institutional focus on research rather than
service and advocacy, and the strains created by power
inequities and distribution of funds. A key element of the
partnerships success is the emphasis on capacity build-
ing and colearning. The project demonstrates the poten-
tial of employing communityacademic partnerships as
a valuable mechanism for implementing community-
based health promotion programs.
Keywords: community collaboration; community
academic partnership; community-capacity
development
C
ommunity participatory approaches are cur-
rently receiving major attention in health pro-
motion research and practice. Many participatory
Health Promotion Practice
October 2007 Vol. 8, No. 4, 375-383
DOI: 10.1177/1524839906289557
2007 Society for Public Health Education
Authors Note: Funded through a grant from the Maternal and
Child Health Bureau, Health Resources and Services Administra-
tion, U.S. Department of Health and Human Services. The views
expressed in this article are solely those of the authors. We thank
the members of the Downstate New York Healthy Start Project
Governance Board for their insightful comments and reflections,
which contributed to the development of this paper and continue
to strengthen the project and partnership. Please address corre-
spondence to Cheryl Merzel, Columbia University Mailman
School of Public Health, 722 W 168th Street, 9th Floor, New York,
NY 10032; e-mail: cm449@columbia.edu
375
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2001). The aim of the community-based participatory
approach in public health is improved health promotion
efforts as a result of programs that are more attuned to
the conditions and needs of particular communities, and
activities that can be sustained because they are
grounded in community structures and ownership
(Altman, 1995). Thus, the ideal collaborative model is
based on partnerships that are not only community
based, that is, involving community members, but also
community driven, with communities playing a leading
role (Hatch, Moss, Saran, Presley-Cantrell, & Mallory,
1993). The participatory approach is particularly signifi-
cant for marginalized communities and communities of
color as it embraces the goals of empowerment and
control (Israel, Schulz, Parker, & Becker, 1998).
Existing community-based health promotion collab-
orations reflect a diversity of structures and purposes.
Many are coalitions comprising a wide variety of
community organizations and institutions, voluntar-
ily joining together to address specific health issues,
such as the Community Substance Abuse Prevention
Partnership Program (Center for Substance Abuse
Prevention, 2000) and the Kaiser Community Health
Promotion Grant Program (Wickizer et al., 1998).
Other collaborations provide a central coordinating
role for public health agencies as seen with the Turning
Point program, which charges state and local health
departments to engage numerous public and private
organizational partners in a planning process for
strengthening the public health infrastructure (Nicola,
2005). A third approach, exemplified by the Centers for
Disease Control and Prevention (CDC)-funded Urban
Research Centers and Prevention Research Centers,
focuses on the collaboration between a university and
community partners for the express purpose of con-
ducting health-related research (Brownson, Riley, &
Bruce, 1998; Metzler et al., 2003). Universities and com-
munities also have joined together to support the devel-
opment of new community health services and programs
(Greenberg, Howard, & Desmond, 2003; Thompson,
Story, & Butler, 2003).
Regardless of the specific purpose of the collabora-
tion, CBPR principles help guide health professionals
and communities in developing partnerships that give
communities a full voice in the development, imple-
mentation, and assessment of health promotion programs.
These principles can serve as a blueprint for academic
institutions and communities engaging in joint public
health ventures. Because of their prominence in acquir-
ing grant funding for U.S. public health programs, uni-
versities have the potential to be major institutional
players in implementing the community participatory
approach. Communityacademic partnerships, how-
ever, reflect a major shift from the traditional model of
researcher control over a project with little account-
ability to communities (Lythcott, 2000). As a result,
these partnerships face many hurdles. Often, commu-
nity members distrust research activities because of
previous negative experiences and historical exploita-
tion by researchers (Cheadle et al., 1997; Suarez-
Balcazar, Harper, & Lewis, 2005). Programs may
experience conflicts over project funding, control, and
different operational styles and approaches to problem
solving (Buchanan, 1996; Israel et al., 1998). Thus,
developing a climate of mutual trust and respect and
overcoming the many differences between universities
and communities in priorities, values, and resources is
a challenging and ongoing element of these partner-
ships (Greenberg et al., 2003; Suarez-Balcazar et al.,
2005; Thompson et al., 2003).
Reviewing the experience of existing collaborations
can provide lessons for strengthening the viability of
communityacademic partnerships and contribute to
the evolution of this innovative approach. The follow-
ing discussion focuses on structures and processes that
have helped sustain a communityuniversity partner-
ship formed more than 5 years ago to implement a
grant-funded public health service project. The part-
nerships history and current strategies for maintaining
positive and fruitful relationships provide instructive
376 HEALTH PROMOTION PRACTICE / October 2007
The Authors
Cheryl Merzel, DrPH, is an assistant professor in the
Department of Sociomedical Sciences, Columbia University
Mailman School of Public Health in New York City, New
York, and the principal investigator and project director
for Downstate New York Healthy Start.
Gail Burrus, BS, is the executive director of the Suffolk
County Perinatal Coalition in Patchogue, New York.
Jean Davis, BBA, is the deputy director of the Economic
Opportunity Commission of Nassau County in Hempstead,
New York.
Ngozi Moses, MSc, is the founding executive director of
the Brooklyn Perinatal Network in Brooklyn, New York.
Sharon Rumley, RN, MPH, is the founding executive director
of the Queens Comprehensive Perinatal Council in Jamaica,
New York.
Dionna Walters, MPH, MPA, is the program coordinator for
the Downstate New York Healthy Start Project at Columbia
University Mailman School of Public Health in New York
City, New York.
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examples for promoting collaboration between large
institutions and smaller community agencies.
>METHOD
This article draws on the experiences of Downstate
New York Healthy Start (DNYHS), representing a
school of public health and several community-based
organizations. The observations reported here incorpo-
rate perspectives obtained in group discussions with a
variety of people involved with the project, including
key staff of the university and community-based orga-
nizations, representatives of health departments,
service and advocacy organizations, and several com-
munity residents. The discussions were conducted for
the purpose of gathering the opinions of project leader-
ship regarding lessons from the partnership and took
place in the context of project meetings. The discus-
sions were a formal part of the meetings and were
structured as open exchanges focusing on strengths and
weaknesses of the relationship between the university
and the community agencies and assessing the success
of the collaboration in general. Participants endorsed
the development of a paper for publication as a way of
disseminating the projects experiences and lessons.
Directors of the lead community agencies agreed to be
co-authors and reviewed and commented on drafts of
this paper developed by the first author.
>INTERVENTION
DNYHS is one of 96 projects constituting the
Healthy Start Initiative, implemented in 1991 under
the U.S. Health Resources and Services Administration.
The programs objective is to promote healthy birth out-
comes in communities with high rates of infant mortal-
ity. Healthy Start projects are diverse, encompassing
urban and rural communities and all regions of the
United States. Healthy Start is one of the few government-
sponsored maternal and child health programs that
promote infant health by focusing on individual-level
prevention and community-service delivery system
improvements. Healthy Start provides women who are
pregnant or have children younger than age 2 years
with case management, to link them with needed
health and social services, and health education on
perinatal and infant health issues. Community health
care system improvements are supported by promoting
collaboration and coordination between service providers
and public health agencies. Another unique feature of
Healthy Start is the charge to include community rep-
resentation in project decision-making vis--vis com-
munity consortia that address health system issues.
The DNYHS project area crosses several geopolitical
boundaries in the New York City and Long Island met-
ropolitan area, ranging more than 70 miles. DNYHS
communities include urban, suburban, and rural areas
with high concentrations or pockets of poverty.
Communities served are primarily African American
and Latino and include large numbers of immigrants,
particularly from the Caribbean and Central America.
In 2004, 65% of program participants were African
American and 23% were Latina. The communities
experience large racial disparities in birth outcomes.
The project area infant mortality rate in 2001 was 12.7
deaths per thousand live births for Blacks compared
with a rate of 6.0 for Whites. Low-income families in
each DNYHS community confront many challenges to
obtaining needed services including a shortage of
accessible health care providers, lack of health insur-
ance coverage, inadequate transportation, language bar-
riers, fear of being reported to immigration officials,
and unstable housing.
The core partners of DNYHS are a university-based
school of public health and three community-based
organizations (CBOs) that serve low-income communi-
ties. Two of the CBOs are relatively small agencies of
fewer than 10 employees in operation for 10 to 16 years,
with specific missions to address community maternal
and infant health issues, primarily through consumer
and provider educational activities and advocacy;
Healthy Start represents the largest component of
direct services offered by these two agencies. The third
agency is a large community development organization
with more than three decades experience offering mul-
tiple educational, social service, and economic devel-
opment programs including Head Start, job training,
emergency housing and food services, and an HIV
counseling program. None of the CBOs is a clinical
provider of medical care. The university subcontracts
with the community organizations to conduct Healthy
Start activities in each community. Although many
Healthy Start projects have a relationship with an
academic institution as the local program evaluator,
DNYHS is one of a handful of projects for which a uni-
versity serves as the grantee with full fiduciary and
administrative responsibilities.
The community-based agencies deliver the man-
dated Healthy Start core services including outreach
and case finding, case management and home visiting,
and health and parenting education, provided primar-
ily by peer case managers, many of whom are commu-
nity residents. Health education also is delivered in
group settings through such events as empowerment
workshops, baby showers, and Kwanzaa celebrations.
The CBOs facilitate increased coordination in the service
Merzel et al. / COMMUNITYACADEMIC PARTNERSHIPS 377
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delivery system by developing provider referral net-
works, engaging in planning activities with public health
departments, organizing provider educational activities,
and offering ongoing forums for communication between
various community service providers. To assist with
these coordinating activities, each community agency
sponsors a local Healthy Start consortium, bringing
together key stakeholders including health and social
services providers, faith-based organizations, business
leaders, elected officials, and community residents. The
evaluation of the project focuses on providing agencies
with quantitative and qualitative service performance
feedback regarding mandated core services and consor-
tium activities.
Project History
The history of DNYHS provides an important con-
text for understanding the relationship between the
university grantee and community partners and is
instructive in identifying many of the challenges
encountered by community-based programs. DNYHS
was initiated in 1997 with a large established nonprofit
social service agency serving as the original grantee,
which contracted with the CBOs to provide Healthy
Start services. The School of Public Health was the
contracted local evaluator. During the projects 2nd
year, tensions arose between the grantee and the com-
munity contractors over the role of the partners and
implementation issues. The grantee then decided to
call for an open competition for contractors. The com-
munity agencies objected because this was seen as a
violation of partnership operating principles. Tensions
escalated, and the grantee withdrew from the project
while the grant was still active. The community agen-
cies then asked the School of Public Health to serve as
grantee, understanding that an organization acceptable
to all parties, including the funding agency, needed to
be able to step in quickly to administer the grant but
also making clear that they were free to seek a CBO as
the grantee for the next funding cycle. Since that time,
the CBO partners have asked the University to continue
as grantee for all successive funding cycles.
When the University became the grantee, the com-
munity partners hired an organizational development
consultant to serve as a broker to negotiate the condi-
tions of the collaboration. The community agencies
wanted the contract to include a description of the proj-
ect as a partnership and a provision specifying griev-
ance procedures before a contract could be terminated.
The University administration was open to these changes
as they did not impinge on legal oversight responsi-
bilities. Thus, the community partners obtained the
symbolic and procedural assurances they were seeking.
Two other important issues that were addressed in the
1st year after the University became grantee were the
development of project bylaws and a mission state-
ment. The bylaws established the guiding principles
for the partnership, addressing roles and responsibili-
ties of each project partner and establishment of a
Project Governance Board. The bylaws stipulate that
the grantee and CBOs each have an equal number of
votes on the Governance Board and that the office of
chair rotates between the four core partner agencies.
The bylaws and contracts include a clause providing
the core community agencies with a voice in select-
ing the programs project director. The mission state-
ment, developed at an early meeting of the Project
Governance Board, describes the project as a collabora-
tion and identifies its goal as improving the health and
social well-being of women and their families.
Project Organization and
Collaborative Processes
Frequently, tensions arise when academics portray
themselves as the primary experts and the skills and
capacities of community partners are not recognized
(Buchanan, 1996; Cheadle et al., 1997; Suarez-Balcazar
et al., 2005). DNYHS follows a model where the func-
tions and roles of each partner organization are clearly
differentiated, building on respective strengths and
resources (Israel et al., 1998). The School of Public
Health acts as a facilitator and support system and the
CBOs are the lead agencies in their communities for
implementing the program and delivering services.
Each subcontracting community agency has service
and administrative staff funded either partly or entirely
through Healthy Start and sponsors the local commu-
nity consortium. The School of Public Health admin-
isters the grant and supports a central project staff
funded through the grant and headed by a faculty
member who serves as principal investigator and pro-
ject director. The Project Governance Board serves in
an advisory capacity.
The community partners have primary responsibil-
ity for organizing and delivering Healthy Start services
to community residents. Each agency integrates the
Healthy Start component with existing activities; thus,
Healthy Start funding enables expansion of the
agencys scope of services. Although each agency is
responsible for providing mandated Healthy Start core
services, each is free to develop a community-specific
configuration of service delivery. The community partners
also are actively involved in advocacy and community-
organizing activities such as sponsoring legislative
378 HEALTH PROMOTION PRACTICE / October 2007
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breakfasts for local policy makers, testifying at hearings
called by local governments, and holding community-
wide forums on maternal and child health issues. The
community consortia serve as the vehicle for many of
these advocacy and educational activities. The consor-
tia also engage in community health planning through
the development and implementation of action plans
aimed at addressing community-identified unmet health-
related needs.
The University focuses on administrative and fiscal
oversight and management of the grant and taking
primary responsibility for submitting all reporting
requirements and grant reapplications, enabling the
community partners to focus on program development.
The University project team organizes and coordinates
project-wide meetings and training events for CBO staff
and local consortia and is responsible for program eval-
uation and management of project data. The project
also is a training ground for public health students,
who serve as program assistants to help plan and coor-
dinate project-wide activities and provide technical
assistance to staff at the partner agencies.
The functions of the University and community part-
ners intersect in the areas of project leadership and
community-capacity development. All partners take an
active role in building capacity to meet health and social
services needs and in developing the skills of commu-
nity residents to participate in project and communal
affairs. Project-wide technical assistance and educa-
tional events for local consortia members are jointly
planned by the University and the community agencies.
Program protocols and procedures are developed
together. Regular meetings are conducted on the execu-
tive level, among program coordinators, and among case
managers to help facilitate information sharing and con-
structive problem solving. Agencies with more devel-
oped programs advise those experiencing challenges in
implementing activities. The evaluation team provides
extensive ongoing technical assistance to help the com-
munity agencies use the project data system and improve
the quality of information collected.
The partnership facilitates the sharing of best prac-
tices and enables the project to engage in a number of
specific capacity-building activities related to service
delivery and community health needs. For example, a
CBO partner that already had a well-developed case
management program shared its tools and procedures
with the other two, which then formed the basis of
project-wide protocols. The University organized a
training session for case managers regarding mental
health issues, led by a community mental health
provider. Other case manager trainings took advantage
of expertise in the School of Public Health in the area
of smoking cessation. Faculty from the School of Public
Health conducted a training session for the local con-
sortia on evaluation of community health-planning
efforts. Recently, the partners agreed to adopt a joint
approach to implementing mandated local health sys-
tems action plans, deciding to focus on improving
provider cultural competency in the areas of breast-
feeding, mental health, and sudden infant death
syndrome.
>DISCUSSION: LESSONS LEARNED
FROM THE PARTNERSHIP
The defining strength of collaboration lies in the
ability to make connections between people, agencies,
and systems (Lasker, Weiss, & Miller, 2001). Thus,
interactions are crucial in establishing a collaborations
success. The nature of interrelationships and interac-
tions in DNYHS are described below employing a
framework based on the dynamics of interdependence
in organizations model (Tjosvold, 1986). According to
the model, organizational interrelationships are shaped
by a number of factors including the manner in which
organizational members work together, the distribution
of tasks, and organizational values. These factors com-
bine to produce an organizational environment that
can promote cooperation, competition, or autonomy.
Cooperation, that is, a positive interrelationship, is
enhanced when people are united by a sense of
common values and shared goals, tasks are fairly distrib-
uted, and rewards are accrued to the group. Negative
interrelationships are characterized by conflicts and rival-
ries, which are fostered under conditions of incompati-
ble tasks, opposing goals, and competition for rewards.
Independence and autonomy occur when goals are
seen as separate from others, and little interaction is
needed to accomplish tasks (Tjosvold, 1986).
Thus, unlike many common models of collaboration
that focus on partnership stages of development, the
dynamics of interdependence in organizations model
helps identify factors influencing how organizational
members interact (OLooney, 1994). The model is par-
ticularly useful in examining interagency collaboration
as it views the extent of cooperation or conflict as a
function of the degree to which there is concordance
regarding organizational values, goals, roles, tasks, and
rewards. As summarized in Table 1, the DNYHS partner-
ship experiences all three types of interrelationships and
illustrates the conditions, structures, and processes that
can shape the quality of interactions between commu-
nities and academic institutions.
Merzel et al. / COMMUNITYACADEMIC PARTNERSHIPS 379
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Factors Facilitating Collaboration
One of the most important elements facilitating a
positive relationship between the university and com-
munity agencies is the strong commitment by all part-
ners to the projects goals and mission. The mission
statement helped establish a common purpose beyond
the particular interests of any participating organiza-
tion. All partners concur that the way to achieve the
goal of promoting healthy families is by addressing
health in a social ecological context combined with a
community development approach. The shared mission
is a significant factor cited by the community agencies
as cultivating the partnership.
Project goals reflect and shape shared core values
and attitudes, which emphasize principles of collabo-
ration and community ownership, as embodied in the
contracts and bylaws. All partners view adoption of the
bylaws as a defining moment for the project as they
clarified and formalized roles and responsibilities and
identified the unique contribution and expertise of
each partner. Inclusion of bylaw provisions for gover-
nance sharing and conflict resolution was an important
step that helped the University gain the trust of the
community agencies.
A significant cohesive element is the expressed
commitment by each partner to the success of the pro-
ject and partnership. Our interactions reflect, for the
most part, a cooperative approach to project manage-
ment and implementation. In practice, when disagree-
ments over project policy arise, the partners convene
a meeting to work through differences and come to a
consensus. Cooperation between the University and
community organizations is facilitated by the lack of
380 HEALTH PROMOTION PRACTICE / October 2007
TABLE 1
Key Elements of Partner Interrelationships in Downstate New York Healthy Start
Cooperation Conflict Autonomy
Goals Project mission Protection of self-interest Independent goals
Community building of each agency
Holistic view of health Different institutional
and social determinants goals
Partnership approach
Values and Community collaboration Priority given to grant Operational autonomy
attitudes and ownership requirements of each agency
Recognition of each partners Different institutional values
contribution and expertise and procedures
Commitment to project
Commitment to service model
Tasks and benefits Mutually reinforcing roles Time commitment Different institutional
and responsibilities required rewards (service
Joint development of Project performance versus and/or advocacy
protocols community accountability vs. research)
Capacity building
Technology transfer
Interactions Sharing of governance Allocation of grant funds Relationship with
responsibilities Fiduciary responsibilities service and/or
Conflict resolution process Agencies at different stages policy sectors
Information sharing and of development
colearning
Peer oversight
University noncompetitive with
community-based organizations
for other funding sources
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competition for funding from the same sources, given
differences in focus and scope of activities. Collabora-
tion also is enhanced by mutually reinforcing roles and
tasks, which derive from each organizations particu-
lar skills and strengths. This reduces conflict and
strengthens the fabric of the project as a whole. From
the perspective of the community agencies, the part-
nership structure helps clarify the complementary
roles. The CBOs view the University as contributing
public health theory while they provide skilled prac-
tical application, leading to a synergy of improved
service delivery.
The emphasis on developing the capacity of each
partner agency and community is a major unifying
factor. Colearning activities, reflected in numerous
technical assistance meetings and events, foster an
environment of ongoing improvement and constructive
problem solving. Thus, much of the motivation for per-
formance derives from the rewards and benefits of
program development rather than from punitive mea-
sures imposed by a grantee. A major factor fostering
collaboration between the CBOs is the commitment to
colearning. Each of the community partners assumes
responsibility for sharing its best practices with the
others, informally and through regular project-wide
meetings and training events. Cooperation also is facil-
itated by the community agencies recognition of the
benefits of bringing in funds to their organizations and
communities, which promotes acceptance of the
programs mandated parameters and constraints.
University-based project staff views its role as involv-
ing more than grants management and devotes sub-
stantial resources to organizing technical assistance
activities and working cooperatively with agencies to
correct deficiencies. The University project team places
primacy on the projects service goals, rather than
research.
Barriers to Cooperation
Although much of the association between partners
is positive, a number of factors create tension. Sharing
project mission and goals does not eliminate each part-
ners fundamental need to ensure that organizational
interests are protected. This colors agency priorities,
actions, and transactions with the other members of the
partnership.
Organizational survival and maintaining client and
community relations preoccupy the community part-
ners as well as competing demands for time from other
funding sources and liaisons. As grantee, the Universitys
first responsibility is management of the grant and
monitoring performance. The University is highly
bureaucratic, and the more loosely structured commu-
nity agencies struggle to comply with the Universitys
complex administrative procedures. These procedures
result in delays in executing contracts and issuing
reimbursements, straining the cash flow capacity of
small agencies. Tensions also arise from differing
degrees of programmatic and administrative capacity
among the community agencies. One of the most diffi-
cult challenges involves allocation of grant funds. In
part, this conflict reflects fundamental differences in
power between the University and the community
organizations, which remain a barrier to a truly equal
partnership. Discord has arisen over the Universitys
share and whether funding among the community
agencies should be equally divided or performance
based. Another source of tension and inequity is the
university-mandated cost of living salary increases for
its staff, which cannot be matched by the community
organizations.
Over time, the partners have learned to deflect some
of these conflicts arising from differences in priorities
and approach by clearly differentiating respective roles
and functions and emphasizing mutual colearning and
responsibility. The community agencies developed a
peer oversight process to hold each other accountable
for contributing to progress in meeting project perfor-
mance objectives and for the quality of program services
and activities. School of Public Health project staff takes
the lead on facilitating administrative and fiscal matters
and preparing grant documents and deliverables. With the
support of the department and school administration, an
annual process was initiated for advancing funds to the
community agencies before execution of the contracts to
ease cash flow burdens.
Power differentials are addressed by having open
discussions about funding allocations and agreeing to
consensus-based decision making. All partners negoti-
ate the overall funding split between the University
and the community agencies. The community agencies
then decide how to divide their share. Funding, how-
ever, is an ongoing source of tension as any given
method of allocation places an agency at differential
advantage or disadvantage.
Domains of Independence
Some aspects of the collaboration reflect areas where
the partners operate independently of each other.
These facets are important as they influence the degree
to which an agency may perceive the collaboration as
beneficial and its willingness to participate. Because
each partner is an autonomous organization, each has
goals and spheres of operation that fall outside the
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purview of the project; Healthy Start is not the primary
endeavor for any agency. Project staff members at the
School of Public Health are less connected to the
service delivery, funding, and political worlds in
which the CBOs operate, and, therefore, the University
is not as well situated as other types of grantees to pro-
vide support in these areas. The Universitys promotion
and tenure system tends to reward basic research and
publications, the opportunities for which are more lim-
ited in a service-oriented project. This tension is not
easily resolved, particularly in a major research univer-
sity environment. However, basing the project in a
School of Public Health helps locate it in a unit of the
University that is more attuned to the projects service
purpose, and the project is a visible vehicle for fulfill-
ing the School of Public Healths service mission.
University teaching priorities are supported by the use of
student program assistants, who are masters of public
health students with a greater interest in obtaining expe-
rience in community program development than in
research. Other benefits to academic partners accrue from
a more grounded understanding of community health,
new avenues for future research, and improved commu-
nity relations and support for research.
From the perspective of the community partners,
they benefit from recognition of their organizational
autonomy and the shared visibility of all partners as
project leaders, which helps prevent the University
from dominating. Each agency is free to direct its own
affairs, including budget allocations, personnel deci-
sions, and program priorities as long as grant mandates
are met. Although at times there are disagreements
between the grantee and the CBOs, such tensions are
resolved by open discussion of the issues and mutually
agreed-on resolutions.
>CONCLUSIONS
DNYHS illustrates the benefits and challenges of
communityacademic collaboration on a service-
oriented grant program. Although trust and coopera-
tion evolved over time and areas of tension still exist,
all principal partners concur that the collaboration is
successful and benefits each participating organization.
This stems in part from the academic members com-
mitment to community-based work, willingness to
share resources, and procedural flexibility. CBOs gain
from the partnership because of formalized governance
sharing processes, which assist them in negotiating with
the university and that support their role as project
leaders. All partners benefit by the emphasis on capacity
building and roles based on unique but mutually rein-
forcing strengths. This approach facilitates management
of the grant and improved implementation of program
services as well as developing CBO capacity to sustain
activities.
DNYHS differs from many community-based collabo-
rations in several ways that can influence the nature of
interactions. The relationship between the University
and the community agencies is contractual rather than a
nonbinding federation of organizations. Many other
grant-funded community-based programs permit rela-
tively open-ended approaches to addressing a particular
health issue; Healthy Start has a number of very specific
program mandates dictating how communities must
respond to perinatal health disparities. Unlike a large
number of communityacademic collaborations, the pri-
mary focus of Healthy Start is service delivery rather
than research. Despite these differences, DNYHS shares
with other community-based partnerships the funda-
mental elements that are critical to the success of a col-
laboration. These factors include the importance of
having agreed-on goals that focus on a well-defined
issue, continuity and solidarity among membership,
strong leadership, ongoing technical assistance and feed-
back, and recognition of community resources and
assets (Israel, Lichtenstein, et al., 2001; Kreuter, Lezin, &
Young, 2000; Padgett, Bekemeier, & Berkowitz, 2005).
The DNYHS experience encapsulates a number of
specific lessons for fostering cooperation between CBOs
and a large institutional partner and helps make the
DNYHS experience relevant to others. These lessons
serve as recommendations for enhancing the practice of
public health collaborations. The commitment of all
partners to a collaborative and community-driven
approach is of primary importance. Partners can be
united by making shared goals and values explicit.
Establishing clear roles, responsibilities, and expecta-
tions is particularly important in the early phases and is
essential to engendering trust and enabling a collabora-
tion to move forward. A mission statement and bylaws
assist in formalizing the collaborative relationship and
are essential steps in helping a large institution earn the
trust of community partners. Respecting and under-
standing the differences in missions and roles helps
maintain the different partners willingness to partici-
pate. This means that community artners accept the uni-
versity as the authoritative agent for the project, and the
university respects agency autonomy and appreciates
the day-to-day challenges faced by the CBOs. Although
program mandates apply to all, implementation can vary
in accommodation of local needs. Recognizing and
drawing on the different assets of each partner is vital for
minimizing competition and suspicion. Finally, engag-
ing all partners in the process of developing program
capacity helps nurture the willingness to communicate
382 HEALTH PROMOTION PRACTICE / October 2007
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and share. Mutual support of each partners work creates
an environment of cooperation, teamwork, and trust.
These features are critical in supporting the collabora-
tive spirit and practice of DNYHS.
As university partnerships with community agen-
cies become more widespread in health promotion,
new approaches are needed that draw on the skills and
capacities of each type of partner and are supportive of
community priorities (Buchanan, 1996). Although
there are numerous models for successful commu-
nityacademic partnerships, all share an emphasis on
developing processes and structures that sustain
authentic community influence and leadership. Although
challenges remain, DNYHS demonstrates the poten-
tial for a positive alliance between community and
academy.
REFERENCES
Altman, D. G. (1995). Sustaining interventions in community
systems. Health Psychology, 14(6), 526-536.
Baker, E., Homan, S., Schonhoff, R., & Kreuter, M. (1999). Principles
of practice for academic/practice community research partnerships.
American Journal of Preventive Medicine, 16(3S), 86-93.
Brownson, R., Riley, P., & Bruce, T. (1998). Demonstration projects
in community-based prevention. Journal of Public Health Man-
agement and Practice, 4(2), 66-77.
Buchanan, D. (1996). Building academic-community linkages for
health promotion: A case study in Massachusetts. American
Journal of Health Promotion, 10(4), 262-269.
Center for Substance Abuse Prevention. (2000). Prevention works
through community partnerships: Findings from SAMHSA/CSAPs
national evaluation. Rockville, MD: U.S. Department of Health and
Human Services, Substance Abuse and Mental Health Services
Administration.
Cheadle, A., Beery, W. L., Wagner, E., Fawcett, S., Green, L., Moss,
D., et al. (1997). Conference report: Community-based health
promotionState of the art and recommendations for the future.
American Journal of Preventive Medicine, 13, 240-243.
Greenberg, J., Howard, D., & Desmond, S. (2003). A community-
campus partnership for health: The Seat Pleasant-University of
Maryland Health Partnership. Health Promotion Practice, 4(4),
393-401.
Hatch, J., Moss, N., Saran, A., Presley-Cantrell, L., & Mallory, C.
(1993). Community research: partnership in Black communities.
American Journal of Preventive Medicine, 9, S27-S31.
Israel, B., Lichtenstein, R., Lantz, P., McGranaghan, R., Allen, A.,
Guzman, J., et al. (2001). The Detroit Community-Academic Urban
Research Center: Development, implementation, and evaluation.
Journal of Public Health Management and Practice, 7(5), 1-19.
Israel, B., Schulz, A., Parker, E., & Becker, A. B. (1998). Review of
community-based research: Assessing partnership approaches to
improve public health. Annual Review of Public Health, 19, 173-202.
Israel, B., Schulz, A., Parker, E., & Becker, A. B. (2001).
Community-based participatory research: Policy recommenda-
tions for promoting a partnership approach in health research.
Education for Health, 14(2), 182-197.
Kreuter, M. W., Lezin, N., & Young, L. A. (2000). Evaluating
community-based collaborative mechanisms: implications for
practitioners. Health Promotion Practice, 1(1), 49-63.
Lasker, R., Weiss, E., & Miller, R. (2001). Promoting collaborations
that improve health. Education for Health, 14, 163-172.
Lythcott, N. (2000). Changing the research paradigm: Community
involvement in population-based research. Cancer, 88(5), S1214-
S1216.
Metzler, M., Higgins, D., Beeker, C., Freudenberg, N., Lantz, P.,
Senturia, K., et al. (2003). Addressing urban health in Detroit,
New York City, and Seattle through community-based participa-
tory research partnerships. American Journal of Public Health,
93(5), 803-811.
Nicola, R. (2005). Turning Points national excellence collabora-
tives: Assessing a new model for policy and system capacity
development. Journal of Public Health Management and Practice,
11(2), 101-108.
OLooney, J. (1994). Modeling collaboration and social services inte-
gration: A single states experience with developmental and non-
developmental models. Administration in Social Work, 18(1), 61-86.
Padgett, S., Bekemeier, B., & Berkowitz, B. (2005). Building sus-
tainable public health systems change at the state level. Journal of
Public Health Management and Practice, 11(2), 109-115.
Suarez-Balcazar, Y., Harper, G., & Lewis, R. (2005). An interactive
and contextual model of community-university collaborations for
research and action. Health Education & Behavior, 32(1), 84-101.
Thompson, L., Story, M., & Butler, G. (2003). Use of a university-
community collaboration model to frame issues and set an agenda
for strengthening a community. Health Promotion Practice, 4(4),
385-392.
Tjosvold, D. (1986). The dynamics of interdependence in organi-
zations. Human Relations, 39, 517-540.
Wickizer, T. M., Wagner, E. H., Cheadle, A., Pearson, D. C., Beery,
W. L., Maeser, J., et al. (1998). Implementation of the Henry J. Kaiser
Family Foundations Community Health Promotion Grant Program:
A process evaluation. Milbank Quarterly, 76(1), 121-147.
Merzel et al. / COMMUNITYACADEMIC PARTNERSHIPS 383
at University of New South Wales on June 3, 2012 hpp.sagepub.com Downloaded from