Vital Aging Network

Report date
January 2017

What has been most instrumental to your progress?

Forming and maintaining strong community teams.
Self-directed teams of olders can be a powerful source of leadership for community-based wellness initiatives. In each of our four pilot communities, team members were eager to imagine possibilities, engage community members and plan and implement activities and connections. Team members developed strong connections among themselves and many say that they have improved their own health and strengthened their social connections in their communities—experiencing the support and connection they attempt to foster among others in their communities. Building self-directed teams is a reliable pathway to ownership and commitment. Each of the four pilot communities took a different route—their approaches bubbled up from the grassroots rather than being imposed from the top down. As a result, the activities match the needs of the community and are woven into the fabric of the community. These activities and supports, born out of the community, are much more likely to be sustainable than outside- or expert-led programs.
Assigning a trained facilitator to support the community-led teams.
A trained facilitator working with each team to help members learn and integrate best practices for a grassroots effort was essential to success in the Wellness 50+ pilots. The facilitator (in some cases co-facilitators) helped the teams get off to a running start and provided leadership as the team worked through stages of “forming, storming, norming and performing.” At the start of the initiatives the facilitators led training sessions and helped the teams plan and implement activities and projects. As the pilot initiatives progressed, the facilitators changed their focus to handing off the leadership to the Wellness 50+ team members. While each of the facilitators was successful in that handoff, the role of facilitator continues to be important even as pilot communities complete the three-year pilot phase. The facilitator is the key link connecting the community-based efforts to the resources and supports that the Vital Aging Network (VAN) provides in the program and to the other Wellness 50+ communities
Providing opportunities for communities to learn from each.
VAN hosted three all-community gatherings for the Wellness 50+ teams. The community gatherings were all-day affairs, each with 20 to 30 participants. Participants evaluated the gatherings very positively. In the first two sessions people were reticent about sharing; many of them felt they were just figuring out what they were doing. By the third session, there was significant sharing and learning from each other. Teams found it helpful to see and learn about the different approaches the communities were taking. These gatherings provided the impetus for reflective evaluation of the work, both within a particular team and across teams. Team members have expressed the desire to work more closely with each other, suggesting more frequent in-person meetings and having VAN facilitate connections among individual teams. Building a strong network among communities both strengthens the fabric of the program as a whole and fortifies the individual community efforts.

Key lessons learned

Need to find the right balance between leadership and equality.
Wellness 50+ teams strive to engage community members as co-creators in their efforts. To the extent that the teams embrace equality—everyone has a role and a voice—in their activities they encourage widespread ownership. Yet, it is clear that these efforts require leadership. Some individuals must provide structure, direction and processes. Finding the right balance between the two is essential. The pilot communities have wrestled with this issue, both within the team and in the community. Ideally there is little distinction between team members and community members—both contribute to and benefit from efforts to increase wellness. We learned that the way the teams were structured—starting with 6 members and adding 6 in each of year 2 and 3—made it harder to build leadership capacity. It was jarring to add a large number of new members and the teams struggled with integrating them into the initiative. It was difficult to juggle training new participants and keeping the community work aloft. In the future, VAN would recruit a team of 10 to 15 members at the start of the initiative and only add new members as needed.
Training is an important component of the program but needs to be redesigned to be more effective.
Team members and facilitators agree that the content and quality of the training that VAN provided is excellent. Nonetheless, the training was not as effective as it could be. In the first year of the pilots, facilitators followed the training modules as recommended. Most who participated said that it helped them form a strong team, brought attention to research-based information and provided tools that helped them succeed. However, they also felt that the training was too separated from the community work. As a result, VAN re-developed the training modules and recommended changes in implementation. The changes were well received but moving into the second and third year of the pilots another issue surfaced: The model of recruiting and training a new set of participants in each of year two and three creates confusion around the training. In most of the communities the idea of training fell to the wayside. Training needs to be delivered at the time and depth that team members need in order to help them be successful in achieving their goals.

Reflections on the community innovation process

Wellness 50+ works to achieve an environment in which older adult community members can support each other in making positive behavior changes that further health and wellness. The iterative process of learning, generating ideas, implementing activities, and evaluating results is evident in all aspects of Wellness 50+. Being open to an iterative process and encouraging community teams to find their own paths was key to producing results. VAN was able to provide “patient leadership” in this process because the Bush Foundation provided “patient capital,” allowing for a focus on long-term results rather than short-term gains. In addition, developing solid, sustainable partnerships and building off of existing resources has been an important element of success in all four communities. For example: Community partners have provided dollars (the city of Oakdale has a $10,000 budget item for Wellness 50+), expertise (Alexandria Technical & Community College provided Senior Fitness Tests for program participants), access to space (Ebenezer provides prime space for weekly community gatherings in Phillips), access to resources (Hamline Midway Elders pays for a chef for healthy meals).

Progress toward an innovation

We are thrilled to say that all four pilot communities made progress toward the community innovation. Each has progressed in its own way and the results are different from community to community. Through the process we have found abundant evidence that people care about their health and that they want to support each other in improving it. Team members contributed more than 6,000 hours over the three-year period and engaged 640 community members with more than 3,200 contact hours. Teams have tracked participation, measured steps, done pre- and post fitness assessments and conducted surveys in order to measure change. The teams have found that building connection and community support is itself a form of measurable change. While the teams continue to strive for quantifiable measures in order to know they are making a difference, at least in the early stages of their work, they don’t want it to get in the way of community-building efforts. The teams have produced an abundance of anecdotal evidence of their progress such as, “I made a commitment to quit smoking because of this group. I am going to need everyone’s help to be successful.” “Being a part of this has changed my life.”

What it will take to reach an innovation?

While the Wellness 50+ pilot produced positive results, there is much more work to do. Some of the key changes that we would make to the program based on what we have learned include:
1. Provide additional training for our community-based facilitators and develop a stronger learning community among facilitators to support their work and needed course corrections.
2. Reconfigure team training to integrate it more successfully with the community work.
3. Start with a larger size team (10 to 15) and add new team members as opportunities and need arise rather than in large groups each year.
4. Provide a set of activities that a team could choose to implement. This provides an example of a pathway forward and may help teams spend less time re-inventing the wheel. Teams would be free to deviate from the pathway in any way they want but it would provide solid grounding for their specific innovations.

What's next?

Three of the four Wellness 50+ pilots—Alexandria, Oakdale and Phillips—are solidly situated to sustain and grow their efforts. The work in Hamline Midway will continue through their partnership with the Hamline Midway Elders, rather than as a separate entity. The Vital Aging Network plans to continue to support these efforts as a “backbone organization,” providing training, bringing community teams together, developing program-level partnerships and funding, and other supports. We are in active discussions with HealthPartners, Allina and HealthEast for continuing financial and programmatic support. Our goal is to expand the program to additional communities in 2017.

If you could do it all over again...

The most important change we would have made is strengthening the role of and support for the community facilitators. In retrospect we understand that the facilitator is the lynchpin to success in the communities. Acting in the role of civic leader is not intuitive to many (as a society we are not creating the muscle memory needed to make it instinctive). By providing additional training and supporting the facilitators through a community of learning, the facilitators would be able to help the teams excel, with fewer missteps and less anxiety. One of VAN’s goals in 2017 is to establish a strong facilitator team to fuel efforts to continue to build the communities and expand to new communities.

One last thought

We are convinced that this is powerful work and that older adults leading community-based initiatives to improve health and well-being can make significant and lasting change—benefiting both the individuals involved and communities as a whole. The long-term result will be better quality of life for individuals as well as lower costs—both social and economic—to individuals and communities. Better quality health in older adults—physical, mental, and social—reduces the need for costly medical interventions.