ED: Using documented best practices to influence change

• WHAT IS A BEST PRACTICE?

• WHY PROMOTE THE ADOPTION AND USE OF BEST PRACTICES?

• WHEN SHOULD YOU PROMOTE THE ADOPTION AND USE OF BEST PRACTICES?

• WHO SHOULD BE INVOLVED IN PROMOTING THE ADOPTION AND USE OF BEST PRACTICES?

• WHERE DO YOU FIND BEST PRACTICES?

• HOW DO YOU PROMOTE THE ADOPTION AND USE OF BEST PRACTICES?

The Parkville Heart Health Coalition was concerned. A survey of families in the area had shown that most elementary school children spent much of their time watching TV or playing video games. Engrossed in these activities, the kids weren’t getting the exercise they needed.

Research had shown that introducing children to “lifetime” sports – tennis, swimming, hiking, skiing – was one of the best ways to instill in them a long-term commitment to regular physical activity. Members of the Coalition recognized this as a “best practice,” a proven solution to their problem. They realized, however, that they needed the cooperation of the schools, as well as local officials, to teach and promote these sports, as well as provide facilities for them. How could they go about convincing these indispensable partners to invest the necessary time, money, and energy? Was there a best practice for persuading a community to adopt good solutions?

Best or promising practices can help you solve community problems, and save you the trouble of reinventing the wheel. If someone else has already found an effective way to resolve your issue or advance your cause, it makes sense to use it.

The first section of this chapter discussed how to recognize and choose promising practices for health and community development. Sometimes, however, those are only the preliminary steps. Once they’re completed, there may remain the task of getting those practices actually adopted and used in the community. In this section, we explore how to do just that, as well as looking at what a “best practice” is, and how to go about finding one appropriate for your needs.

WHAT IS A BEST PRACTICE?

A best practice may be a particular method, or it may be a whole program or intervention. “Best practice” status is sometimes conferred either officially – by a government body, professional association, or other authoritative entity – or by published research results. In general, a method or program gains such status by being:

• Measurable. That means that its goals are clear and that progress toward them can be measured. A smoking cessation program, for instance, can find out exactly what percentage of the smokers it served quit, and remained smoke-free after a year. It can also compare that percentage to similar percentages for other smoking cessation programs and for the general population.
• Notably successful. The method or program not only gains good results, but makes more progress toward achieving its goals than most others with similar aims.
• Replicable. The method or program is structured and documented clearly enough so that it can be reproduced (“replicated” is the formal term that social scientists, health professionals, government agencies, and funders often use) elsewhere.

Best practices, in short, are those methods or programs that have been found to be successful in accomplishing their goals, and that can be used, or adapted for use, in your circumstances. The standards for choosing a best practice vary tremendously, depending upon who’s doing the choosing. In some cases, almost any program that can show some success is labeled a best practice. In others, the criteria are so strict that only a few are selected (more likely with professional associations that are trying to set or uphold research standards.)

Where the standards are relatively loose, programs designated as best practices may be only adequate, rather than truly the best the field has to offer. Where the standards are too strict, many superb programs may be passed over because they don’t collect enough data on themselves, or for other technical reasons. When looking at best practices with an eye toward using one for a local intervention, it’s important to keep in mind whose best practices they are, and how they were chosen.

Some other things to keep in mind when considering best practices:

• Fit with your community and population. Does the method or program make sense given the realities of your community? Can it be adapted to match those realities?

• Appropriateness to your goals. Does the best practice in question actually address your specific goals? The fact that it’s a best practice for the issue you’re concerned with doesn’t necessarily mean that it has the same aims you do. If it treats the symptoms of a problem, that may not be enough if you’re attempting to deal with the underlying causes, for instance.
• Fit with the structure and philosophy of the organization or initiative that will use it. A program all of whose authority is in the hands of organization staff would not be a good fit with an organization whose main thrust is to help participants take control of their lives, for example.
• Availability of resources. A sure way to make an effort fail is to approach it with inadequate resources, whether money, personnel, or skills. Make certain you understand exactly what a particular best practice will require in the way of resources – and that you can somehow provide them – before you commit to using it.
• Cost-effectiveness. If a program works well, but costs huge amounts of money or time to reproduce, it may be all but useless to most organizations or communities that want to use it. A program that works slightly less well, but costs a third as much might, in fact, be a much better candidate for the “best practice” label.

WHY PROMOTE THE ADOPTION AND USE OF BEST PRACTICES?

One answer to this question is obvious: employing a method or program that’s been tested and found successful increases the chances that you’ll accomplish your goals, and that life will therefore be better for the folks who participate. There are, however, further reasons why the use of a best practice can be advantageous.

• Using a recognized best practice makes it easier to justify the work. If an organization or initiative is starting from scratch, the community – and especially potential participants – may be justifiably skeptical about what it’s doing. Demonstrating that it’s using a practice that has been shown to be effective can relieve at least some of that skepticism and gain support.
• Using recognized best practices can bolster the credibility of an organization. It shows not only that the organization is using a tested process, but that it has been thinking ahead and conducting research to make sure it’s doing the best job possible.
• Using best practices can make it easier to get funding. Funders look more favorably on proposals that can demonstrate proven success.

• Using a best practice removes a lot of the guesswork from planning. Employing a program or method whose structure and process are carefully documented makes it easier to set up and implement, and increases the chances that it will go smoothly.
• The originators of the practice are known, and might be available to consult on how to best implement it. They can troubleshoot when there’s difficulty, or help to adjust it to fit the community or population. If the originators aren’t available, there may be others experienced with the practice who can help.
• Most important – and most obvious – we know that best practices work. They’ve been shown to provide the changes in behavior or conditions and the outcomes we’re interested in.

WHEN SHOULD YOU PROMOTE THE ADOPTION AND USE OF BEST PRACTICES?

Promoting the adoption of best practices should probably be an ongoing activity, but some times are especially appropriate for it.

• Before a new intervention or program begins. It’s easier to incorporate or adopt a practice for something new than to superimpose it on a program or intervention that’s already up and running. Those starting a new operation are usually more open to existing practices as well, especially if they hold out a reasonable promise of success. In addition, using a best practice starts a new operation out on the right foot politically.
• When there’s a serious community problem that has to be tackled. Nothing may have started yet, but the incidence of domestic violence, child abuse, tuberculosis cases, or homelessness has reached crisis proportions. The community and/or relevant organizations might be willing to entertain the idea of adopting a best practice to deal with the situation.
• When what’s being done isn’t working well. If a current intervention simply isn’t having the desired effect on an issue, it’s probably a good time to suggest a proven practice.
• When the community requests it. In some cases, publicity about a particularly effective program or process can mobilize community opinion, especially if citizens perceive, as in the paragraph above, that the community has a serious problem to address.
• When funders or officials request or demand it. As research results become more and more easily available through online sources, more funders insist that proven practices be followed by those they fund. A word of caution here: make sure that funders’ requirements don’t rule out adaptation to your specific circumstances. As mentioned above, strict use of best practices can sometimes get in the way of flexibility and new ideas.

WHO SHOULD BE INVOLVED IN PROMOTING THE ADOPTION AND USE OF BEST PRACTICES?

In trying to persuade a community or organization to adopt best practices, it’s best to involve as many stakeholders – those affected by the proposed program or intervention – as possible. If they have a hand in seeking out and researching best practices, they’re more likely to be excited about and willing to adopt them, rather than feeling that their work is being challenged. Those who might be involved include:

• Practitioners – health and human service workers, community developers, etc.
• Members of the population that will participate in or benefit from the best practices in question.
• Those who’ll be indirectly affected by the program. These include people whose jobs might change – police, social workers, etc. who are not directly involved, but who might have to deal with the effects of the practice – as well as landlords, business people, town boards, and others who might experience changes as a result of an intervention.
• Interested community members. It’s always wise to include the community at large. Inclusion leads to more community support, which in turn can translate into resources.
• Local and, if appropriate, county or state officials. If you’re seeking public funding, or, again, if you simply want community support, it’s crucial that you invite these people to be part of the process.

WHERE DO YOU FIND BEST PRACTICES?

To find best practices, try:

• The Internet. The Internet has over a billion sites, and grows by millions a year. Once you develop good search skills, you can find nearly anything.
• Networking. Talk to everyone you know, and find out what they know. They may even be able to provide introductions, or at least information, so that you can contact programs or initiatives and learn about what they’re doing.
• Libraries. Public libraries, as well as those at colleges and universities, are a great source, and librarians can be extremely helpful in finding what you’re looking for. Many journals or individual journal articles found in libraries can now be found on the Internet as well, but may also require subscription or a membership or user’s fee, whereas access to those items – whether in hard copy or online – is generally free in libraries.
• State and national advocacy and professional organizations. These organizations often give awards for best practices, or document them in journal articles and at conferences. The journals are usually available in libraries, either public or academic, and often on the Internet as well; conference proceedings are often posted on the Internet. You can contact the organization or go to its website to find out what’s available.

• International, state, and federal agencies. UNESCO, the U.S. Council of Mayors, HUD, and others have listings of “best practices” in programs they fund. These may be on the Internet (see Resources for several listings), in government publications, or available in print from the agencies themselves.
• Foundations and other private funders. These funders also may list best practices, or may simply describe projects they fund. Many of these lists and descriptions are also on the Internet, in libraries, or are available from the funders themselves.
• Academia. Local colleges and universities may have researchers looking at just what you’re concerned with, or know others who are. Furthermore, there may be graduate students who’d like to work with you on a project. Start by contacting the university department most closely connected to the work you do.
• Word of mouth from the community. Clergy, members of service clubs (Rotary, Kiwanis, etc.), business people, and other community members may know of successful programs or initiatives similar to the one you want to start.

USING THE INTERNET TO FIND BEST OR PROMISING PRACTICES

If you’re reading this now, you almost undoubtedly already have some Internet search skills. On the other hand, you may not know exactly what you’re looking for, or be aware of where it can be found. You may be looking for best practices in developing countries, or specifically in urban or rural areas of the developed world. How can you find exactly what you’re looking for?

There are a number of ways to search the Internet. The most common, of course, is to use a search engine, such as Google, or Bing. These are crawlers, or computerized searchers that scan the web and record information. (Although all search engines use computing power to scan the Internet, some others use people to organize their data bases.) Google is by far the most popular, and, in the minds of most people, the most effective of search engines for most purposes.

Most Community Tool Box users are familiar with Google and other search engines, and may well have originally found the Tool Box on one of them. A simple search is just that…but not all web searches, even those that may seem so, are necessarily simple. There are, however, some simple guidelines that can make a complicated search easier.

• Be as specific as possible. If you’re searching for best practices in child health, that’s what you should ask the search engine to find. If it’s best practices in child health in India – or Indiana – you should specifically search that. Tell the search engine exactly what you want, and you’re more likely to get it.
• Learn search engine language. There are really only four or five “words” that are necessary in order to speak reasonably fluent search engine.

• Try a number of different words or phrases if you don’t immediately get what you’re looking for. If “youth violence prevention” doesn’t work, try “preventing youth violence” or just “youth violence.” Think about how other people might phrase the same thought you have, or whether there are standard terms in addition to the one(s) you regularly use.

• Look for sites in the most appropriate language. If you’re searching for information about child health practices in Senegal or Mali, the sites with the most information might well be in French. You can ask many search engines, including Google, to search only for sites in a particular (non-English) language, and then ask it to translate the sites for you (both features are usually part of “Advanced search”).
• Use web sites’ internal search engines. Once you find a likely site – that of a foundation organization, for instance – you can use that site’s search function to find out if it has a “best practices” section.

You can find an up-to-date list of Databases of Best Practices on the Community Tool Box. It contains comprehensive web-based resources for exploring promising approcahes to promote community health and development, as well as resources by issue.

The Internet is undoubtedly the largest single source of best practice information available, but don’t ignore the others mentioned here. You can also find out about a program or method that will work for you by talking to others in the field and quizzing graduate students or other knowledgeable people. The Internet, for all its scope, doesn’t include everything, and is particularly unlikely to include small programs that may not have been thoroughly tested, but may be having tremendous success right in your own back yard.

HOW DO YOU PROMOTE THE ADOPTION AND USE OF BEST PRACTICES?

Once you’ve assembled a group of stakeholders to take part in helping to convince the community or organization to adopt best practices, you have to define what you’re doing, identify some possibilities that match your goals and circumstances, and do the job of persuasion. Even then, you’re not finished: you have to make sure that people have the proper training and resources to make the best practice a best practice for your situation, and you must continue examining what you’re doing to make it even better.

DEFINE YOUR ISSUE, NEEDS, AND GOALS CLEARLY, SO THAT YOU CAN DETERMINE EXACTLY WHAT KIND OF BEST PRACTICE YOU’RE SEEKING.

As mentioned above, not every best practice related to your issue is necessarily aimed at the same outcomes you’re working toward. In order to make sure that you’re choosing a practice that fits with your goals, your first steps should be to define what you want to do and how.

• Define your issue. What exactly is it you want to address? If it’s a broad issue, are you addressing the whole thing, or just a part of it? If the issue is violence in the community, for instance, are you planning to make that your focus, or are you going to concentrate on youth violence, or domestic violence, or certain kinds of violent crime? Remember, as we’ll discuss in more detail below, that you need resources that match what you want to do.
• Define the outcomes you intend to achieve. The best practice you choose should aim at the outcomes you’re interested in. If you’re trying to get at the causes of domestic violence, for instance, then you should be looking for a best practice that does specifically that, rather than one that simply reduces the incidence of domestic violence. The former is likely to include elements of community education, mentoring, peer support, counseling for abused children, etc., in addition to increased police training and enforcement and law or policy changes. A violence-reduction program might only include the training/enforcement and policy change pieces. It may be a highly effective program, but it won’t produce the outcomes you’re interested in.

• Identify the nature of your population. An exemplary model may nonetheless be aimed at a very different population, and may not work with yours (understanding such things is one reason for involving potential participants in searching for best practices). Does your population largely consist of a certain ethnic, racial, age, socio-economic, cultural, or other group? Does it have unusual or unique characteristics that would make a particular best practice suitable or unsuitable?
• Explore the context. Community history, geography (whether your community is urban, rural, isolated, etc.), attitudes, relationships, class structure – all can influence whether a method or program will be effective or not.

This kind of analysis should help you find a best practice that has been successful in producing the outcomes you want, in a way you approve of, with a population and in a community similar to yours

SEARCH FOR APPROPRIATE BEST PRACTICES.

Now that you’ve defined what you’re looking for, it’s time to find out what’s available. Once you’ve found several best practice options that address your issue, the next step is to narrow down your search by weeding out the ones that aren’t appropriate for your community, aren’t sensitive to the culture of your population, or don’t aim at the outcomes you want. (This is a good time to involve stakeholders, if they weren’t already involved in searching out possible best practices.) That should leave you with a manageable number of choices, and allow you to pick one that seems to most nearly suit your community and its needs. Be prepared to adapt it to your context if necessary.

PROMOTE THE USE OF BEST PRACTICES.

Under “When should you promote the adoption and use of best practices?”, we discussed some times when it might be relatively easy to convince the community or an organization to adopt tested ideas and processes. When there’s a new initiative, when it’s obvious that what’s being done is ineffective, when there’s an immediate problem to be solved, when the community or funders demand proven practices – all these are times when best practices might be advanced and embraced without much resistance.

But what about the far more common situation in which there is already a service or initiative directed at the issue in question? It may be just successful enough that people can argue that it’s unnecessary to change it, even though it’s been documented that other approaches gain much better outcomes. In addition, the group administering or delivering it – or the community, for that matter – may have an emotional attachment to it. They may have developed it themselves, and/or invested a lot of time and effort to start and maintain it. How do you convince them to change direction?

If you’ve put together a multi-sector group of stakeholders to study best practices, that group’s recommendations, because of its broad membership, will already carry a great deal of weight. Some actions you can take during and after this participatory research process can increase your chances of success.

• Mobilize community opinion. Publicize the best practices you’ve found that seem to address the issues in your community. Emphasize the diverse nature of the group that found and recommended these practices for local use.
• Alert funders to best practice possibilities. Pressures – or offers – from current or potential funders can help speed the adoption of new methods or programs.
• Bring some of the people who originated or who use appropriate practices together with people in your community, especially some of those who oppose adopting those practices. In the discussion that takes place, questions can be raised and answered from practical experience, and much of the resistance might easily disappear.

• Suggest that, rather than substituting a best practice for what it is already doing, an organization or group simply add it, perhaps on a limited basis. Having the two approaches running side by side may show them that the new practice actually does work better than the old.

ENSURE THAT ANYONE INVOLVED IN TRYING TO REPLICATE A BEST PRACTICE IS PROVIDED WITH THE TRAINING TO MAKE IT SUCCESSFUL.

People should understand both the assumptions behind the program or method, and the theory that explains why it works. In addition, it’s absolutely crucial that they receive any specific training needed to do the work of the program. Without either of these, those attempting to do the work of the program are like sailors trying to cross the ocean with no maps or compasses and no idea of where they’re going, let alone any understanding of how to sail a boat. The chances of success under these circumstances are slim, to say the least.

A final requirement for anyone replicating a best practice is the belief in its effectiveness. It’s been proven again and again that, without this belief on the part of practitioners, a method or program won’t succeed, even if everything else is in place.

PROVIDE THOSE WHO’LL IMPLEMENT BEST PRACTICES WITH THE NECESSARY SUPPORT.

It’s been explained both in the first section of this chapter and in this one that you can’t replicate a best practice without resources similar to the original. Those resources can embrace a number of different elements:

• Funding. This is probably the most obvious, but it’s often ignored. Trying to replicate a program with half the funding needed often means you get half a program…or less. Since the success of a program may be based on its operating as an integrated whole, trying to cut it in half can be a recipe for failure. Make sure adequate funding is available before you start.
• Volunteers. This may be an issue of fit for the community. In a community, for instance, where two-income and multi-job families are the rule, most people may simply have no time to volunteer, and volunteering may not be part of the community’s culture. A program that depends on volunteers may be difficult to run in such a community. Volunteers also need training and supervision, and those resources must be available as well if a volunteer-dependent program is to succeed.
• Space. This is sometimes a matter of funding, but just as often one of the availability of appropriate space in an area that’s easily reachable for potential participants. You have to consider access for people with disabilities, transportation, the size and character of the space needed, etc. If funding is an issue, the possibility of donated or shared space may have to be explored, and that raises its own problems.
• Time. Any new undertaking takes time to settle in and find itself. While there should certainly be accountability built into any program, there should also be a willingness to allow the time for experimentation and learning.
• The good will of local officials, other influential people, and the community at large. You should work to make sure that all those involved in a program, from line staff to participants, feel that the community is behind them and rooting for their success.

KEEP MAKING THE BEST BETTER, AND MAINTAIN THE COMMUNITY’S COMMITMENT TO BEST PRACTICES.

Finally, remember that once you’ve convinced the community to adopt a specific best practice or a best practice philosophy, your work isn’t finished. Even though it’s labeled “best,” any practice can be improved. Part of your continuing responsibility is to see that programs keep improving.

Best practices are only as good as their implementation. If the problem seems to be solved, or if people grow tired of doing the work, you’ll soon find yourself back where you started.

The other important thing to keep in mind is that community memory can be short. Keep pushing best practices, and keep looking for appropriate ones that can be used in your community. Without that continuing attention, you may find yourself having to do your work all over again the next time a need for a new service or initiative arises.

IN SUMMARY

One way to attempt to ensure that you address community problems and issues as well as possible is to promote the adoption and ensure the implementation of “best practices” – methods or programs that have been proven successful elsewhere, and that have the capacity to be reproduced, or replicated. While this doesn’t guarantee success – not every intervention works in every community, and you may already have successful programs operating – it beats the “stab in the dark” approach that many health, human service, and community efforts take when planning new programs or initiatives.

Persuading the community to adopt best practices requires building credibility by assembling a multi-sector group – including local officials and influential citizens, potential participants or beneficiaries of a proposed intervention or initiative, and others affected by it – to research best practices and make recommendations; introducing the community and/or relevant organizations to the new practices (by, among other tactics, introducing them to people already using them) and suggesting ways to incorporate them; and by providing the resources and support necessary to make successful replication in your community possible.

Once you’ve convinced everyone that the adoption and use of best practices makes sense, you have to make sure that they’re implemented. You then must continue to remind and educate the community about best practices, and maintain community commitment to using them. In addition, remember that any practice, even a “best” practice, can be improved, and that the effort to make things better should never end.