E

PowerUp in the St. Croix Valley (MN/WI) Case Study

Submitted by presenters
Marna Canterbury, Sue Hedlund, and Donna Zimmerman¹

PowerUp is a community-wide initiative to make better eating and active living easy, fun and popular, so that youth can reach their full potential. PowerUp focuses on children ages 3 to 11, and adults who influence their food and physical activity choices. The initiative reflects a 10-year commitment by HealthPartners and Lakeview Health (Lakeview Hospital; Lakeview Health Foundation; Stillwater Medical Group) to work in partnership with the community to improve population health in the St. Croix River Valley region (Minnesota/Wisconsin).

DESCRIPTION OF CROSS-SECTOR MODELS USED

The PowerUp Community Initiative Framework illustrates a multilevel, community-based approach. It is a simplified model that is accepted and clear among all stakeholders. It reflects that multiple levels of intervention are necessary for a comprehensive approach, based on a foundation of community leadership and engagement for success and sustainability. The levels of the framework represent (see Figure E-1):

• Community: Working collaboratively with and in the community
• Environment/Engagement: Community-level change and larger reach
• Programs/Clinical: Individual-level change and smaller reach
• Engage and Transform Zones: Relationship building across levels/sectors

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¹Reprinted as submitted by the presenters.

FIGURE E-1 PowerUp Community Initiative Framework.
SOURCE: HeathPartners, Inc., 2013. Reprinted with permission.

The PowerUp Framework is influenced by models focused on:

• Authentic community partnerships/Collaborative Leadership: Leaders and followers act as peers. Leaders have the credibility and integrity to set a direction, motivate and align people to work together toward a common purpose and goal.
• Community influences on behavior/The Social-Ecological Model
• Relevant messages/Social Marketing: Marketing approaches to reach the target audience and community.

SECTORS AND STAKEHOLDERS INVOLVED

PowerUp involves more than 130 community advisors, including both individual and organizational stakeholders. Community advisors initially developed the focus, vision statement, and advisory structure for the initiative. Through committees, workgroups and individual input, the number of advisors continues to grow. Advisors lead and guide the effort, support strategy development, set priorities, and hold PowerUp accountable for results. Community advisors live and/or work in the target communities, sharing a passion for the well-being of kids. Advisors are also key agents for change and advocates for PowerUp as they create opportunities to do what is “best for kids” in their areas of influence. Advisors represent multiple sectors including:

• Health care: Clinics; hospitals
• Government: Local health departments in Minnesota and Wisconsin; local and state government agencies
• Schools: District administration; schools; Parent Teacher Association/Parent Teacher Organization; afterschool programs; teachers/staff; booster clubs
• Early childhood: Preschools; early childhood programs; child care providers
• Businesses and worksites: Local employers; grocers; banks; restaurants; manufacturing
• Community organizations: Nonprofits; youth programs; food shelves; Rotary; Chambers of Commerce
• Faith-community: Parish nurses; child/family education
• Community leaders and members: Parents; other community residents

KEY LESSONS LEARNED

• A strong and collaborative lead organization is needed to convene the community, provide guidance and expertise and help leverage resources. A commitment by the lead organization to ongoing collaborative planning and decision-making is essential. Dedicated staff is essential to partner with a core group of community leaders to launch and sustain the initiative.
• The community shares leadership from the beginning and ongoing. Community advisors and HealthPartners/Lakeview trust and embrace a collaborative leadership process. This includes sharing power, decision-making authority, and recognition.

• Community advisors live and/or work in the community and are committed to and passionate about PowerUp goals. A core group provides essential continuity and momentum across sectors. Each advisor may be involved in a variety of ways, including partnerships, committees and workgroups and in advocating for change.
• A wide range of stakeholders, sectors and roles increase both innovation and sustainability. Many of the most innovative PowerUp ideas come directly from the community. Advisors may also offer specific skills as individuals (such as marketing), but may not necessarily represent a particular sector. Local health departments have provided leadership and contribute local health data. Partnerships with nonprofit organizations and schools help reach low-income populations.
• Authentic relationships, partnerships and collaborations take time. Adequate upfront time to develop a shared vision, purpose, roles and expectations is needed. Partnership development is people-intensive work, and a long-term commitment allows partnerships to grow and become sustainable.
• Smaller changes in institutional practices may precede and drive policy change. Changes in the food/physical activity environment at one school carnival, classroom or department are influencing change on an institutional policy level by demonstrating the positive effects to policy decision-makers.
• A strong, targeted communications strategy, including a community “call to action” is needed. PowerUp includes a communications campaign that resonates with the target audience, including kids and the “adult influencers” (parents, youth leaders, etc.). “PowerUp Countdown” messages are consistent with national 5-2-1-0 messages to magnify all efforts. Messages are positive, solution-based and invitational. The community call to action “We PowerUp” is well-received and PowerUp tells a “new story” about norms for kids in our communities.
• Practical evaluation methods are needed at the start in order to sustain over time with available resources. Gaining consensus on realistic expectations for short- and long-term measures of change is critical.

BARRIERS TO ESTABLISHING THE INITIATIVE

• Competing possibilities for action/priorities—Stakeholders needed to reach initial consensus on which community priority to address (chronic illness vs. prevention). PowerUp continues to set priorities

• and resources based on balancing the evidence of “what works” with the perspectives and insights of the community.
• Breaking through community perceptions—Initial perceptions were that PowerUp was a just a short-term program, “another collaborative,” or a funding source for existing projects. Therefore, PowerUp approaches partnerships with the question, “How can we work together to do what is best for kids?” PowerUp and partner organizations are each expected to bring resources, expertise, and time to the effort in contrast to a funding relationship.
• Navigating “turf” in partnerships—Determine shared objectives and where to work in parallel to other organizations.

WHAT IS NEEDED TO ACCELERATE MOVEMENT FORWARD IN YOUR CROSS-SECTOR WORK?

• Define what “success” looks like and communicate results: Practical evaluation models, methods, and measures are needed to evaluate progress, including documenting systems, environment and policy changes, marketing, education, and collective impact of multiple efforts in one region. Effectively communicating results to diverse stakeholders and the broader community is essential.
• Build capacity of current community advisors: Attaching and maintaining diverse representations to advise and lead the initiative. Development of more community members to fill leadership roles and be community spokespersons for the initiative. Increase effective provider engagement strategies.
• Involve/engage new stakeholders and sectors: Increased involvement from local governments and businesses as well as health care providers in the initiative.

WHAT ARE THE CORE FEATURES OR ELEMENTS OF YOUR INITIATIVE THAT ARE NECESSARY FOR SCALE AND SPREAD?

• Shared leadership and ownership with communities served.
• Communications include call for community-level change (not just individual-level change).
• Local, institutional change in practices and policies.
• Leverage learnings and resources from similar initiatives for collective impact.
• Evaluate, continually improve and share results.

WHAT ARE THE FEATURES THAT NEED TO REMAIN FLEXIBLE TO ALLOW FOR LOCAL ADAPTATION?

Shared leadership with community and welcoming new stakeholders and sectors continually strengthens community involvement and engagement. Flexibility is needed to change the structure, representation and priorities as community conditions and interests evolve and to respond when readiness/resources are present, which may be at unpredictable times.

For more information, visit http://www.powerup4kids.org.