The first week of March, I attended the annual meeting of Grantmakers in Health (GIH), a national affinity group for foundations that fund health-related activities. Although I don't attend every year, I always come back from meetings with information that I can incorporate into my work. I thought that I would share what I learned this year with you.
• Many foundations approach prevention from an advocacy point of view: converting vacant lots to vegetable gardens, making sure a park is a safe place for walking and other activities, lobbying for better fluoridation of water, or smoke-free environments, etc. Here at the Health Foundation, we have developed the Assistance for Substance Abuse Prevention (ASAP) Center which approaches prevention from a different perspective. The ASAP Center is less about advocacy and more about teaching individuals and groups to use specific prevention practices. It was interesting for me to contemplate how we might use the other approach. One foundation shared a readiness assessment they use when working with communities that are trying to change their community environment or social norms. I wonder how this might be helpful for communities in the Health Foundation's region.
• One session was a breakfast meeting for the Behavioral Health Funders Network, a group of about 70 funders within GIH. John O'Brien, senior advisor on healthcare financing at the federal Substance Abuse and Mental Health Services Administration (SAMHSA), shared the SAMHSA strategic plan for 2011-2014. As a group, we discussed ways that the federal government might partner with foundations in behavioral health. Even though I had heard the SAMHSA strategic initiatives before, I recognized nuances of the SAMHSA strategic plan I had not seen before. This will hopefully turn into an improved ability to coach grantees attempting to get SAMHSA funds.
• In a session about "what keeps you up at night," I learned that many foundations are in the midst of transitions in leadership. Since we have just gone through a transition in leadership here, it was good to listen to others and offer some guidance from our experience. I was reminded of some transition practices that might be helpful for our grantees that are or soon will be going through transitions. These included developing a succession plan before the time for new leadership emerges, using both board and staff involvement in the search process for new leadership, and forming a transition team from all parts and levels of the organization to help guide the new leader in the first few months of the job. For new leaders, those present recommended taking at least a year to get situated before making major changes.
• In many of the sessions, I was reminded that as grantmakers it is important to start where our communities are. What works in Los Angeles or New York or a small rural community in Nebraska might not necessarily work here in Greater Cincinnati. It might sound great, but I can't push it on people here. I can share, but forcing people to do something "my way" rarely works.

Does any of this raise questions for you? What did you learn at your last conference that you want to share?

This week has been a real test of the Health Foundation's belief in sharing openly all of the public opinion polling data collected by our Health Issues Polls . I have received many calls from people on both sides of the issue, but especially calls from the smoking and liquor lobby thanking me for my groundbreaking work. They are also asking for more specifics about our poll that shows that Ohioans want the smoking ban in bars lifted.

First, let me set the record straight: our data show that Ohioans are split on support for the ban on smoking in bars. There is no great call to arms to repeal the ban based on our findings: 51% said they want to repeal the ban, 47% said they wanted to keep it in place. But the calls I've gotten from the public give me serious pause: How can I, a staff member of The Health Foundation of Greater Cincinnati, an organization that has given over $14 million in grants to reduce alcohol, tobacco, and other drug use in our region, be providing data to groups who want to encourage increased consumption of cigarettes?

My answer is transparency and reliability. The Health Foundation believes that we must provide high-quality, reliable, local public opinion data so people can make data-driven decisions. We know we cannot control public opinion, but understanding what people think is critical to the work that we do.

In order for the Health Foundation to be a legitimate source of high-quality, reliable data, we cannot just release the data we like best. This means that when we ask tough public opinion questions, we are not always going to get the answers that we hope for. But it is our responsibility to provide the data to the community.

One very important distinction that was not made in the media is the difference between public opinion data and research data. We used good polling techniques to obtain the opinions regarding smoking in bars, but that doesn't change the research data that shows that first- and second-hand smoke cause cancer of the lungs, mouth, throat, and other cancers in people who smoke in a bar (or anywhere for that matter) and, because of the prolonged exposure, people who work in bars. The poll data show that the public is divided on whether or not people should be permitted to smoke in bars. The research data show clearly that smoking causes cancer, emphysema, and many other unpleasant or fatal illnesses.

Unfortunately, while the media chose to spin the spilt on support for the smoking ban in bars into a cry for repeal of the law they have missed other stories that I think are much more interesting:

• The majority of smokers support continued ban on smoking in restaurants and workplaces
• A third of Kentuckians are uninsured
• Most Ohioans and Kentuckians support mental health and substance abuse treatment over incarceration for non-violent offenders
• Most of Ohioans and Kentuckians support healthcare reform

In March 2010, The Substance Abuse and Mental Health Services Administration (SAMHSA) announced their 10 Strategic Initiatives. As I read these over, I was reminded of how interwoven many of the problems that we face in our communities are. Employment and healthcare are linked, as we all know, but homelessness, addiction, returning military, trauma, and criminal justice are all connected to these issues as well. I have two reactions to all of this: despair and conviction. I am dismayed that all that we have done over the years seems to have had limited impact on these problems. But I am also convinced that we have the tools available to make an impact on the lives of individuals who have health and social concerns. Things can be different if we work together.

SAMHSA seems to be addressing some of these ills in a manner that makes sense...they are demanding collaboration across systems. A recently released request for applications for the Community Resilience and Recovery Initiative from SAMHSA requires the involvement of public leaders, behavioral health prevention and treatment providers, criminal justice systems, employment services, and veterans' services. Although it seems overwhelming to get everyone working together, I know that it can be done. I've seen it happen in some of the communities that we cover with our grants. And when everyone is working together, amazing things happen.

Think about what seems impossible in your community. Now, think about who has a stake in this problem. Start talking to them about what solutions might be. Share with them the strengths that you see in the community. Begin to gather a group. And if you need help getting started, call me.

Remember - "Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." - Margaret Mead

I spent the last two days in the Network for Improving Addiction Treatment (NIATx) Change Leader Academy. Aside from being impressed with my fellow students, the things that stood out to me are the characteristics of a good leader, particularly a leader of organizational change. Good leaders:

• challenge the status quo
• get results that are verifiable by data
• are persistent
• are respected and have influence across the organization
• focus their teams on the current objectives
• provide accountability
• involve the right people for the task
• motivate, inspire, and empower others
• create a process for short-term wins
• communicate, communicate, communicate

As I read these over, I am challenged to think about ways to improve my skills in these areas. If you want to learn more about the NIATx approach to process improvement and organizational change, go to their website.www.niatx.net.

This week I have been thinking about the unintended consequences of our actions. Sometimes these consequences are positive - I go to a concert to listen to some good blues and end up meeting the man that I marry. And sometimes they are negative - we build a wall to retain the hill in the back yard and it creates a creek running through the back of the house. When we are looking at systems larger than individuals and families, the consequences - positive and negative, intended and unintended - can effect many more people.

A recent policy brief from the Substance Abuse Policy Research Program supported by the Robert Wood Johnson Foundation provides us with some food for thought about intended and unintended consequences of public policy. This policy brief looks at the results of California's Proposition 36 and Arizona's Proposition 200. Both of these propositions were passed by over 60% of the voters and mandated treatment in lieu of incarceration for drug offenders. The authors of the brief suggest that those who draft such propositions in the future "pay close attention to the population that will actually be affected by the law." Since the vast majority of first-time drug possession offenders are not sentenced to jail or prison, a mandate for treatment with no teeth in it for a "carrot and stick" approach has the unintended consequence of filling treatment centers with people who have no desire to be involved and no consequences for dropping out of treatment. Also neither of these propositions took into account the programs that some communities had in place, such as drug courts. At times the mandates of the propositions were in direct conflict with the rules of existing programs, making the new laws difficult to implement.

What are the things that we need to do to be smarter about our public policy? Here is the link so that you can begin to think about unintended consequences - both small and large.

http://www.saprp.org/KnowledgeAssets/knowledge_brief.cfm?KAID=17

I am often asked the question, "What do you want to see in this site visit?" My answer is, "It's not 'what,' it's 'who'." The reality is that a site visit is really a people visit, because people make the project.

A good site visit, whether it is related to getting a grant or reporting on an existing grant, has some specific components:

• More than one person represents the project, whether it is collaborative or internal to an organization.
  
• All (or most) collaborators are represented and prepared to speak about the project.
  
• All collaborators have a copy of the proposal or report and have had time to read it.
  
• A program participant is present and willing to talk about what this will mean or what it has meant to them, if possible.
  
• It is located in one of the sites used in the project.

• a description of the proposed project or work done in the reporting period by the people involved,
  
• questions from those making the site visit (Health Foundation staff or board members),
  
• suggestions for improving the proposal or the existing project, and
  
• timelines for any follow-up from the Health Foundation or the grantee.

Site visits are not meant to be scary...they give grantees the chance to show us who you are and vice versa. It is important that we all feel free to share our thoughts, our dreams, our challenges in doing this work with each other. So look forward to your next site visit!!!

In my next blog – what is the difference between a proposal site visit and an annual or final site visit?

Over the past few days I have attended several luncheons and breakfasts, worked with groups of people on federal proposals, worked with others on local collaborative projects, and gone to some annual and final site visits for projects that the Health Foundation has funded. I have come away from all of these activities amazed by the passion people have for their work and the resiliency of the human spirit.

In each of these activities, there is someone leading the charge for the project. This person is passionate about either the specific project or the target population. This passion is obvious in the intensity of the conversations, the willingness to work long hours, the single-minded focus on the goal. Many times this passion is infectious...everyone else working on the project becomes passionate about the cause as well. Sometimes we see passion that is fleeting – like a love affair, the project dies when the initial burst of enthusiasm ends. However, some projects or agencies are like a lasting relationship – the passion is not always obvious but it is there under the surface to keep everyone energized and focused on the goal.

The other thing that I have noticed in this work is the resiliency of the people who work in and who come for help from these projects and agencies. These folks keep at it even when they see no reward at first. The staff see the potential of the people in the programs, even when those people don't see it themselves. The advocates focus on the work that could be done if things were a little different. The community members keep seeing the strengths in their communities and the need to connect with each other. And those who have been beaten down by addiction, mental illness, poverty, or homelessness, keep getting up, and, with the support of others, finally are able to stand and walk and look others in the eye with pride and a true feeling of self-worth.

Passion and resiliency – the reasons I love this work.