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Improving Health in the Community: A Role for Performance Monitoring
agree to work together in order to achieve common goals (Feighery and Rogers, 1990)—have become a popular vehicle for addressing complex social issues. Coalitions in the area of health tend to have a long-term and multifaceted focus and to be directed toward substantive and seemingly intractable problems such as violence and drug abuse. These coalitions are often action oriented. They serve as vehicles for bringing together public agencies, interest groups, and community members for planning, coordinating, and advocating in areas of mutual interest on behalf of the community. Coalitions can be based in a public agency or a community setting (Butterfoss et al., 1993).
Research on coalition building is under way, and factors that influence the success of these entities are being investigated. Early findings indicate that the maturation of coalitions into entities that can successfully carry out activities requires time, effort, and resources. Coalitions progress through a series of developmental stages that include an early stage in which members form relationships; a middle stage in which members prepare to take action; a mature stage in which members take action; and a final stage in which members disband or restructure. Development through the stages is not always linear, and some coalitions never reach the mature stage (Sofaer, 1992). Preliminary findings from the Massachusetts Community Health Network Areas affirms these conclusions (D.K. Walker, personal communication, 1996).
The ability of a coalition to undertake activities will be determined by its key dimensions such as its stated purpose; whether it is mandated by law or a voluntary entity; and its jurisdictional scope, membership, representation, available resources, structure, leadership, and decision-making ability (Sofaer, 1992).
Foundation-supported research and demonstration efforts will provide new information about coalition building and maintenance. For example, support from The Robert Wood Johnson Foundation and the federal Center for Substance Abuse Prevention has helped in the formation of local community partnerships and coalitions that focus on the problems of alcohol, tobacco, and other drug abuse. The development of practical tools for program evaluation and other essential activities has also been supported by foundations and federal agencies (Linney and Wandersman, 1996).
More recently, a large research and demonstration effort called the Community Care Network (CCN) has begun with funding from the W.K. Kellogg Foundation and The Duke Endowment. The program is being led by the American Hospital Association Hospi-