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Teresa Chahine: Welcome back, everyone. We are continuing the conversation with social entrepreneurship for public health and health equity this semester. And today with me is Adrienne Abbate, who’s the Executive Director of Partnerships for Community Wellness, which is the latest title for the organization you’ve been leading in Staten Island, which has up till now been called Staten Island in Partnership for Community Wellness. Thank you for being here with us today, Adrian. What I was explaining to my students in class is that this course, this semester, is divided into three modules. We just finished the module on Capitalism and Health, which talked about startups that are getting venture-backed funding like Health in Her HUE and Liza Health and its predecessor, Iora Health, which were the past two episodes, and how their funders are navigating capitalism, capitalistic goals, and health equity goals, which may or may not be in alignment at certain times, and entrepreneurship means starting something new.
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Most people are familiar with the term entrepreneurship, which means innovating within the boundaries of an existing organization. But what we’re talking about in this module, which you’re kicking off today, is “extrapreneurship,” which means innovating beyond the boundaries of multiple organizations. And I think that’s what Partnerships for Community Wellness does, because you have demonstrated a collective impact model in your community. And one thing I didn’t mention is that this is not your first time on the podcast. You’ve been here before many years ago, I think it was like six years ago, but so much has changed since then, and your work has evolved. So what I want to do today is first start by, for those who don’t know, reminding us what collective impact is, and then I’ll ask you how it has changed over time.
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Adrienne Abbate: Great. So first of all, I’m so happy to be here. We’re always a treat to be able to speak to your class. They’re pretty smart, and problem solve with these young minds who are coming at it in a less jaded manner than maybe some of my colleagues. So yeah, so I’m happy to give a very high-level overview of collective impact. Collective impact is a framework for addressing sticky, complex, difficult social and health issues with the understanding that with these issues that we’re addressing, they were years, decades, centuries in the making, and that it requires a cross-sectoral approach, where you’re bringing in resources and perspectives of lots of different stakeholder groups. And collective impact is a framework to map out ways that these collaboratives can work together. So there are these five conditions. One is a common agenda, and that really sort of addresses this idea of, before we can even work on an issue, we need to name it and understand it, because I might have a perspective of what’s not working, and it’s very different from my neighbors and my colleagues. So coming to a consensus about what we’re trying to address.
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Teresa Chahine: What we’re coming together around.
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Adrienne Abbate: Yeah.
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Teresa Chahine: It has to be specific.
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Adrienne Abbate: Specific.... I mean, I think that the collective impacts that address very broad issues, it’s more of a challenge. Maybe you can expand. And when I talk about the evolution of TYSA, we have been expanding, and there are some challenges associated with that, but starting out with a targeted focus for us was very helpful. So just this common understanding of the issue and then a shared vision of what success would look like. What are we working towards? What is the road map that we are going to collectively be contributing towards in terms of getting to that destination? That’s the common agenda. The other piece is data sharing. So for us, we really looked at data, both qualitative and quantitative, to understand what the issue was when we were forming back in 2011. And it was very clear that it was around opioid analgesics at the time, and there was a sense of urgency among community members and stakeholders, and we were able to bring people in with some of this data. People were kind of anecdotally seeing things, but then when they started to look at trends and the number of prescriptions written, it kind of crystallized what the issue was, and people, they coalesced around it that what we started to do among the coalition partners was bringing in different data points so that we could understand the elephant from all the different areas that we’re touching to have a more comprehensive understanding of the issue. I think for me, the hard part when we were first starting up was, I thought that there needed to be live dashboards with data-sharing agreements, and I was already going to a place where, “Oh, I’m not doing collective impact correctly.” And I think what I’ve learned is that it kind of looks different for a lot of the different practitioners, and for me, just bringing in the partners to share these data points and coming to a consensus about what our metrics would look like was enough of a data-sharing pillar to move us forward. So that was really interesting.
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Teresa Chahine: Yeah, having a vision is so related to the common agenda, having a vision of what success looks like and how you’ll measure it. Such as shared metrics.
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Adrienne Abbate: Shared metrics, continuous communication. This is the piece where just for transparency, making sure people understand what we’re working on, the strategies that we’re implementing, how decisions are made. So it was also kind of tied to our power and governance, just making sure that we’re communicating across several platforms among the agencies and partners, but also to the community, the backbone, and I know that we named it at the beginning of this interview, but my organization has served as a backbone, and the backbone is this infrastructure that’s needed to create the space for lots of different partners to come together and work in this manner. And it really, I think, is a critical component. There are many different coalitions, but unless you have some dedicated people who are just focusing on creating the norms, facilitating, helping to pull some of this data, it’s a challenge. It’s not that it can’t work, it’s just a different level of collaboration and then mutually reinforcing activities.
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We have certainly dreamed together and created some new strategies as a coalition, but a lot of the collective impact premise is that I’m going to help you scale something that you’re doing really well. I’m not going to try and replicate what you’re doing in the schools. I’m going to help try and bring this to new settings and new populations so that we’re working in a way that is reinforcing each other rather than competition. There’s some competition, which is always okay, and that’s good for innovation, but for the most part it’s about collaborative leadership and really kind of supporting the partners and the different stakeholders in working towards this shared goal.
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Teresa Chahine: So it sounds like there’s so many different ways that one might bring people together in a network or coalition or just to work together. And collective impact is a specific formula that is distinct in the sense that it has this backbone organization where it’s someone’s job to orchestrate this. It has a shared agenda, no, a common agenda, shared metrics, mutually reinforcing activities, and constant communication. So your organization, Partnerships for Community Wellness, has been a backbone for TYSA, which is a collective impact initiative where your common agenda is, started out as being reduced, tackling youth substance use, reducing youth substance use in Staten Island. And then you came up with shared metrics around that and mutually reinforcing activities and continuous communication. And then it sounds like it has evolved over time where TYSA stands for so much more now than “tackling youth substance abuse.” So tell us how that happened over time, what it has evolved into, and what that has looked like.
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Adrienne Abbate: Sure. So we’ve moved away from spelling out the acronym also because it’s not very person-centered. We don’t really talk about abuse, but we talk more about misuse and also, to your point, because it doesn’t reflect everything that we’re doing. So we have always really followed the principle that we would be data-driven and look at what the trends are in our community and how that’s showing up. And when we first formed, it was specifically 12 to 17, and then as we started to collect more data and see how the issue was impacting the broader community, we realized it was also a young adult issue. And that’s really where we’re seeing a lot of the overdoses starting to happen. So we made a decision to extend to 25. We continued on that path, still really focusing just on substance use, prevention, treatment, and recovery, and then in 2019 started to bring in mental health, and that was something that as an organization I was pushing for, but the coalition wasn’t ready yet, and we needed to do some work together to understand the shared risk and protective factors for mental health and substance use are so intertwined, and we’re doing so much of the strategy, so why not name this broader behavioral health issue? But some of the partners were kind of siloed in the work of their agency, and in theory, they liked the idea, but it was hard to integrate.
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So it took us a while, but we were able to bring the folks along in this journey and started to explicitly work on mental health and substance use. We then evolved beyond that when we started to look at trends. So I would say in 2018, ’19, we started to disaggregate data to look at how behavioral health was showing up among special populations. So as an agency, we have always focused on allocating resources to the most impacted communities, the marginalized people who are disproportionately impacted by chronic disease, behavioral health, maternal health issues. So we started to look in TYSA, and although we were seeing some improvements in behavioral health outcomes, they were not being experienced universally.
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So if we saw reduction in prescription opioid use, instead of just patting ourselves on the back that we made this tremendous, which again, we should celebrate the winds too, but understanding that this was not seen across all populations so that we saw that prescription opioid use was going up among Black and Brown adolescents. So, okay, so let’s pivot and start naming this issue and developing strategies that lifted and created more protective factors for that special population. So it required us to do some work as a coalition to kind of understand the importance of disaggregating data, understanding what are the drivers of these differences, what are some of the structural issues that contribute to these disparities? And we’ve had some difficult conversations as a group, but we did a lot of learning together. And I feel like that’s also the beautiful thing about collective impact is that it creates a space for co-learning and growing together, and that it’s the tension, and this tension that really results in more meaningful and robust work.
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So 2019, 2020, we were really doing a lot of work in that area and named the structural issues in the mission of TYSA and started to really find dedicated funding to support these populations and these initiatives. We’ve continued to grow. We have received some funding, again from more special populations, maybe for non-English-speaking immigrants whose children are using more alcohol. Again, this was based on the data that we collected in our community. So it’s never like, “Oh, I think we’re just going to focus on that.” We do regular and extensive data collection, either ourselves or working with our local health department. And then we look at it to try and understand trends, and that helps us shape what we’re going to be focusing on in the upcoming period.
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Teresa Chahine: One of the things we really focused on today in class was thinking about, we talk about this so much in the course because part of the principles, the framework for public health entrepreneurship is design thinking and design justice. So building power for others and shifting the status quo. And so you shared an article with us as part of today’s readings about academic researchers who looked at multiple collective impact initiatives and evaluated them and found that there are different people with different power within any collective impact initiative. And sometimes it’s those people who drive the agenda. And so they’re really just propagating power inequities. And so I imagine as the backbone organization, that you are one of those people with the power, and I know that you’re very mindful of this. So talk a little bit about the ways that you have approached these power balances in terms of youth, having youth have a voice in terms of, you mentioned certain subpopulations are seeing different trends in substance use and how are they having a voice and then at the same time not alienating others, especially in the current point in time when everyone is so divided about everything and you can’t do collective impact in that environment.
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So it’s two kind of related questions. How do you build power and for whom? And how do you do that in today’s world while keeping everyone at the table?
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Adrienne Abbate: These are the things that keep me up at night.
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Teresa Chahine: Yeah.
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Adrienne Abbate: Well, when we first formed, we were very grasstops. And I think that aligned with some of the early work that was published around collective impact, that was what was, I mean, shaping the work that we were doing in 2011, 2012.
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Teresa Chahine: I mean, let’s face it, the term was coined by a consulting company.
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Adrienne Abbate: Yeah.
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Teresa Chahine: That’s not very grassroots.
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Adrienne Abbate: It’s not grassroots. And I think that one of the other criticisms of collective impact is that it was putting a bow or providing language around ways that communities have been working for a long time, and it’s not a cookie-cutter approach or a formula that people can like, “Oh, we’ve got the magic, now we can address all these complex issues,” but that these were conditions that were present in more successful collaborative structures. So in the beginning, we were very grasstops, and as we evolved and started to look at the data and think about equity and think about communities impacted, we did a lot of work to make sure that those voices and those organizations that represented grassroots groups were coming to the table to work alongside of the district attorney or our local senator. And we were mindful about creating space where people felt safe to contribute, and it was not easy.
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And I think that we created norms about stepping up, stepping back. We played around with not using titles so that we were level setting when we were working in a work group setting or in a coalition meeting. And I think that was helpful. And I think also the work that we were doing around some of the antiracist work was really kind of getting at some of these power imbalances and systemic issues that have contributed to some of these poor health outcomes.
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But one of the things that we struggled with since our inception was the youth voice. And in the beginning we had sort of a separate advisory council that felt very, I guess, separate from the work that the larger coalition was doing, and it was almost like an afterthought, and it wasn’t integral to shaping our strategies. And we struggled with like, well, what does that look like? Who’s doing it well? And started to read about how different groups were paying community members for their expertise and time. And we really love that idea because I have a salary that’s covering my time when I go to these meetings. But you want people from the community, or you want young people to show up. We should be respecting their time and valuing it and paying for it. So we were able to get some funding where we can pay young people to bring their lived experience in shaping the strategy. So they participate in the work groups, they participate in the steering committee, they give us feedback on what the issues are, our approach. And then they also have separate projects that they’re working on that look at. It’s a different one every year: One year they did food insecurity and mental health. Right now they’re doing political climate and mental health, and they’ll do research. They’ll go out and do a photovoice project or—
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Teresa Chahine: So they’re driving the agenda.
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Adrienne Abbate: They’re driving the agenda, and then they’re bringing it back to the stakeholders who might not even be thinking about these things. But if we’re a youth-serving coalition, we need that to be driving all the work. So it took us a while to get there, but I feel really good about this new model. And they also, the young people, the consultants represent the populations that we are trying to reach. So it is a beautiful mix of young voices and perspectives, and it’s just made the work much stronger.
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Teresa Chahine: I want to ask you more about something you mentioned along your way and your answer, which is that it’s not cookie cutter, right? Consulting companies like to make it sound like, “Here’s the formula.” And I know there’s a website collective impact forum that shares many different collective impact initiatives. So we have these five elements that we talked about, backbone organization, common agenda, shared metrics, mutually reinforcing activities, and constant communication. What’s not in that formula? What have—we’ve already called out something that’s not, right, like power balances, inequities. What else have you learned across the year as you’ve expanded beyond this starting formula, and how has that shown up in your community?
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Adrienne Abbate: Well, I think one of the things that maybe is not as explicit but was critical in our formation and also in continuing to do this work now, it’s been almost 14 years and people are still coming to the table and still feel very passionate about it. So we’re doing something right. But it was the creation of principles and values.
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Teresa Chahine: It says nothing about values. You have a common agenda, but not aligned values.
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Adrienne Abbate: And in our common agenda, we did name some of these non-negotiables, like this is how we’re going to work together. We tried to name evidence-based strategies, but then we’re like, “Oh, that’s so limiting because there are emerging issues and emerging strategies so that as much as we can, we want to follow best practice with limited resources.” We talked about respect, that we’re going to have opposing ideas, but that’s also what makes the work so rich. But just creating these values and articulating them so that when we had conflict, we could point back to this, “Remember, this is what we agreed to. Does that still resonate?” And that would be a moment where people would be like, “Oh, yes, okay.” Or they might push back and say, “Well, what do we mean here? Let’s kind of revise it and elaborate.” And so it’s been very helpful. So having that be part of it from the onset was incredibly important. And to your point, what we weren’t thinking about enough was the voice of community and equity in driving the work that came a little bit later and then has really shaped the way that we do everything now. But it wasn’t part of our formative process.
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Teresa Chahine: What do you find the hardest about doing this work? She’s like, “Where do I begin?”
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Adrienne Abbate: Yeah, it’s very rewarding work, but it’s also very challenging. The hardest part, I think actually the hardest part lately has been defining metrics of success because we’ve grown so much as a coalition and expanded our focus. In the beginning it was pretty straightforward. It was past 30 day use of substances. But now we’re addressing mental health and suicide prevention, and we’re talking about people getting connected to treatment. There’s so many different metrics and measures that it’s hard for us to find a set of five, like a constellation of stars, and then how do we... because of that, it’s hard to communicate the work that we’re doing as a coalition to the community. Somebody said, “You’re almost too complicated. You’ve got so many partners. You’ve got so many strategies. I mean, what?”
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Teresa Chahine: Seriously, how do you get anything done?
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Adrienne Abbate: I know, I know it is challenging. And because I’m a public health person, I’m like, “Well, everything’s connected. Can’t you see that?” But sometimes not everybody does see that. And the challenge is not taking on too much and staying focused and keeping those metrics, those core measures, driving the work when you can pull in everything. I mean, public health is everything. You can’t talk about youth, behavioral health. You’re talking about, “Yeah, we talk about housing and housing.”
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Teresa Chahine: That’s my tagline in life. I teach at School of Management. And so on the first day of class, I tell people, you’re getting MBAs. Some of you are getting MPHs. You might not all self-identify as someone who’s working in public health, but same as the people in your collective impact initiative. They might come from the Department of Justice, from NYPD, from schools, from hospitals. So they might not think of themselves as working on youth substance use, but something they’re doing is impacting it.
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Adrienne Abbate: Absolutely.
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Teresa Chahine: And everything is a driver of health where people live, what they eat, to what extent they can move the air they breathe, the schools. No matter what job you have, it’s somehow related to public health.
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Adrienne Abbate: It’s all connected. It’s all connected.
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Teresa Chahine: And in our minds, that’s how you do the work. But then it also presents a challenge of like, well, where do you draw the line? And who is in this collective impact initiative, and how are we going to get them all to agree?
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Adrienne Abbate: Yes.
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Teresa Chahine: I think you’re right about coming up with shared, with those metrics. Of course we need shared metrics, but how do we agree on them? Yes.
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Just yesterday, I was listening to a podcast about Housing First, which is a program that was actually created to tackle substance use because a lot of people who had alcoholism also were unhoused. And it was like, “Well, let’s house them.” You can do the pre-treatment, then work on housing. So this program was created to test out housing first, and it was for the high-risk ones, not just it was for a subset. And then the people who say it doesn’t work, and the people who say it do work, were all pointing to the exact same evidence. But their interpretation of it was like, “Well, this means it doesn’t work, and this means it does work.” And so that’s why I think when you think about extrapreneurship, broadly speaking, working across the boundaries of multiple institutions, it’s so important to figure out what success looks like, how we’re going to measure it, because that is your end game, right?
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Adrienne Abbate: Yes.
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Teresa Chahine: And another thing I think I would find challenging in your work, as I’ve heard you speak today, is that what success looks like is not only about the outcome metrics, which are already hard enough, as you’ve pointed to, but it’s also about the process in the sense that you might be able to get substance use down in a way that doesn’t incorporate community voice or youth voice. So is that a success or is the whole point to build trust and partnership, in which case the process is as important to finding success is the outcome?
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Adrienne Abbate: That’s true. Although no funder wants to hear anything about process outcomes.
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Teresa Chahine: They want results.
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Adrienne Abbate: Yeah, they want results. But you’re right, because when I talk about success, I talk about the new partnerships that we’ve developed over the course of the year, new ways of approaching the work. These are things that contribute to those outcomes, but not always captured or shared publicly. What does success look like to me? I think that that trust piece of it is critical. I’m very mindful of how we do the work and how people are reflected in the work. So we’ve done a lot over the years to kind of expand TYSA, who TYSA is, who’s coming to the table, and making sure that their idea of success aligns with some of the not old guard, but people who have been in TYSA for many years. I think that’s, TYSA has been evolving and new people are coming in, and there have been people who have been with it the entire time, and the new people coming in at different points, making sure that we are still remembering what we’ve committed to work on collectively. But the challenge has been how do we come up with a concise metric or body of metrics that will capture that?
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Teresa Chahine: It’s very challenging. I think I would like to end by asking what your advice would be for others aiming to work beyond organizational boundaries to bring together collective stakeholders around a common agenda using whether the collective impact definition or just a more expanded definition. What words of advice do you want to leave them with?
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Adrienne Abbate: So somebody asked me recently, “Are you still doing collective impact?” And I said yes. And I still firmly believe that it is an incredible way to bring people into work, into work that they might not have done together with these other stakeholder groups. So I think that for anybody who’s interested in building coalitions and building some sort of movement, it is a lot around trust. So I did spend a lot of time meeting with people, having coffee, hearing about the work that they are doing, and finding those common areas. To your point, they might not consider themselves in the behavioral health prevention treatment space, but understanding how they’re contributing to a protective factor, like providing a “Friday night lights,” that’s probably not the right term—Friday night basketball game keeps young people engaged and they’re not on their phones or they’re not smoking cannabis to self-medicate. So it’s showing where they are in the work and finding those areas of passion and intersection because we are all interrelated. And I know that different organizations and people have limited time and resources. So again, they could also participate in many different meetings. But kind of being strategic and thinking about who are the levers and stakeholder groups that need to be at the table to do this work.
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Teresa Chahine: I am wondering as you’re speaking, whether you think public health is something that can bring people together.
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Adrienne Abbate: Well, I never thought public health would be a public enemy, but lately it feels very politicized. And I think because public health has such a social justice approach to it, and that’s really kind of the frame that I’ve grown this organization to reflect and practice. So for us at the organization level, it’s all about addressing health disparities and thinking about equity and providing more resources to the groups that need more. It’s about naming vulnerable populations so that they feel seen and in the work, we can’t do work for populations without having them be in the work and at the table, and really just having community be centered in all of this. But it feels like it’s now become political in a way that is very unfortunate, because if you address the wellbeing of the most marginalized, it will improve outcomes for the greater society. It’s like the curb cut theory. You can cut curbs for the disabled and then everybody—
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Teresa Chahine: For wheelchairs or strollers.
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Adrienne Abbate: Strollers, but everybody benefits from it. So that’s the approach that we’ve taken at SIPCW, and it’s shaped the collective impact work. But I think that’s also what makes us a little bit different from other CI backbones is our public health approach. I think it’s made it very, very strong in terms of our CI model, but it also now feels like it’s putting us a little bit at risk in terms of naming populations and talking about those structural issues that contributed to these poor health outcomes.
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Teresa Chahine: Yeah, it feels like all of a sudden public health is, there’s something divisive about it, and potentially collective impact could be a framework to bring people back to the same room and the same table. One thing I told my students this semester is that most people agree on the problems. No one doesn’t think substance use is a problem. I mean, I think people just disagree on the solutions and how they want to tackle it. And so that might make collective impact harder than ever now. But it also might make it a really valuable tool to get people to sit down and talk about a common agenda and to find shared metrics and mutually reinforcing activities and continuous communication. And we need so much more of that in everything these days. That’s true. So thank you for doing this work, and thank you for taking the time to share it with us, and we’re excited to see where this goes. And anything we can do to support you, let us know.
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Adrienne Abbate: Well, I appreciate this opportunity, and I think you’re right. Collective impact does create this space for people with very different ideas. And to be honest, in our history of doing the work, we’ve always had people who came from very different political backgrounds, experience with their work, different sectors, but it does, I think, provide this opportunity for trust building and learning together that it has been really incredible. So I do hope that in this next period that we can continue to do this work and maybe even go deeper.
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Teresa Chahine: Lead the way, we will follow.
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Adrienne Abbate: I’ll try.
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Teresa Chahine: Thank you, Adrian. Thank you.
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Teresa Chahine: Welcome back, everyone. We are continuing the conversation with social entrepreneurship for public health and health equity this semester. And today with me is Adrienne Abbate, who’s the Executive Director of Partnerships for Community Wellness, which is the latest title for the organization you’ve been leading in Staten Island, which has up till now been called Staten Island in Partnership for Community Wellness. Thank you for being here with us today, Adrian. What I was explaining to my students in class is that this course, this semester, is divided into three modules. We just finished the module on Capitalism and Health, which talked about startups that are getting venture-backed funding like Health in Her HUE and Liza Health and its predecessor, Iora Health, which were the past two episodes, and how their funders are navigating capitalism, capitalistic goals, and health equity goals, which may or may not be in alignment at certain times, and entrepreneurship means starting something new.
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Most people are familiar with the term entrepreneurship, which means innovating within the boundaries of an existing organization. But what we’re talking about in this module, which you’re kicking off today, is “extrapreneurship,” which means innovating beyond the boundaries of multiple organizations. And I think that’s what Partnerships for Community Wellness does, because you have demonstrated a collective impact model in your community. And one thing I didn’t mention is that this is not your first time on the podcast. You’ve been here before many years ago, I think it was like six years ago, but so much has changed since then, and your work has evolved. So what I want to do today is first start by, for those who don’t know, reminding us what collective impact is, and then I’ll ask you how it has changed over time.
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Adrienne Abbate: Great. So first of all, I’m so happy to be here. We’re always a treat to be able to speak to your class. They’re pretty smart, and problem solve with these young minds who are coming at it in a less jaded manner than maybe some of my colleagues. So yeah, so I’m happy to give a very high-level overview of collective impact. Collective impact is a framework for addressing sticky, complex, difficult social and health issues with the understanding that with these issues that we’re addressing, they were years, decades, centuries in the making, and that it requires a cross-sectoral approach, where you’re bringing in resources and perspectives of lots of different stakeholder groups. And collective impact is a framework to map out ways that these collaboratives can work together. So there are these five conditions. One is a common agenda, and that really sort of addresses this idea of, before we can even work on an issue, we need to name it and understand it, because I might have a perspective of what’s not working, and it’s very different from my neighbors and my colleagues. So coming to a consensus about what we’re trying to address.
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Teresa Chahine: What we’re coming together around.
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Adrienne Abbate: Yeah.
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Teresa Chahine: It has to be specific.
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Adrienne Abbate: Specific.... I mean, I think that the collective impacts that address very broad issues, it’s more of a challenge. Maybe you can expand. And when I talk about the evolution of TYSA, we have been expanding, and there are some challenges associated with that, but starting out with a targeted focus for us was very helpful. So just this common understanding of the issue and then a shared vision of what success would look like. What are we working towards? What is the road map that we are going to collectively be contributing towards in terms of getting to that destination? That’s the common agenda. The other piece is data sharing. So for us, we really looked at data, both qualitative and quantitative, to understand what the issue was when we were forming back in 2011. And it was very clear that it was around opioid analgesics at the time, and there was a sense of urgency among community members and stakeholders, and we were able to bring people in with some of this data. People were kind of anecdotally seeing things, but then when they started to look at trends and the number of prescriptions written, it kind of crystallized what the issue was, and people, they coalesced around it that what we started to do among the coalition partners was bringing in different data points so that we could understand the elephant from all the different areas that we’re touching to have a more comprehensive understanding of the issue. I think for me, the hard part when we were first starting up was, I thought that there needed to be live dashboards with data-sharing agreements, and I was already going to a place where, “Oh, I’m not doing collective impact correctly.” And I think what I’ve learned is that it kind of looks different for a lot of the different practitioners, and for me, just bringing in the partners to share these data points and coming to a consensus about what our metrics would look like was enough of a data-sharing pillar to move us forward. So that was really interesting.
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Teresa Chahine: Yeah, having a vision is so related to the common agenda, having a vision of what success looks like and how you’ll measure it. Such as shared metrics.
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Adrienne Abbate: Shared metrics, continuous communication. This is the piece where just for transparency, making sure people understand what we’re working on, the strategies that we’re implementing, how decisions are made. So it was also kind of tied to our power and governance, just making sure that we’re communicating across several platforms among the agencies and partners, but also to the community, the backbone, and I know that we named it at the beginning of this interview, but my organization has served as a backbone, and the backbone is this infrastructure that’s needed to create the space for lots of different partners to come together and work in this manner. And it really, I think, is a critical component. There are many different coalitions, but unless you have some dedicated people who are just focusing on creating the norms, facilitating, helping to pull some of this data, it’s a challenge. It’s not that it can’t work, it’s just a different level of collaboration and then mutually reinforcing activities.
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We have certainly dreamed together and created some new strategies as a coalition, but a lot of the collective impact premise is that I’m going to help you scale something that you’re doing really well. I’m not going to try and replicate what you’re doing in the schools. I’m going to help try and bring this to new settings and new populations so that we’re working in a way that is reinforcing each other rather than competition. There’s some competition, which is always okay, and that’s good for innovation, but for the most part it’s about collaborative leadership and really kind of supporting the partners and the different stakeholders in working towards this shared goal.
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Teresa Chahine: So it sounds like there’s so many different ways that one might bring people together in a network or coalition or just to work together. And collective impact is a specific formula that is distinct in the sense that it has this backbone organization where it’s someone’s job to orchestrate this. It has a shared agenda, no, a common agenda, shared metrics, mutually reinforcing activities, and constant communication. So your organization, Partnerships for Community Wellness, has been a backbone for TYSA, which is a collective impact initiative where your common agenda is, started out as being reduced, tackling youth substance use, reducing youth substance use in Staten Island. And then you came up with shared metrics around that and mutually reinforcing activities and continuous communication. And then it sounds like it has evolved over time where TYSA stands for so much more now than “tackling youth substance abuse.” So tell us how that happened over time, what it has evolved into, and what that has looked like.
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Adrienne Abbate: Sure. So we’ve moved away from spelling out the acronym also because it’s not very person-centered. We don’t really talk about abuse, but we talk more about misuse and also, to your point, because it doesn’t reflect everything that we’re doing. So we have always really followed the principle that we would be data-driven and look at what the trends are in our community and how that’s showing up. And when we first formed, it was specifically 12 to 17, and then as we started to collect more data and see how the issue was impacting the broader community, we realized it was also a young adult issue. And that’s really where we’re seeing a lot of the overdoses starting to happen. So we made a decision to extend to 25. We continued on that path, still really focusing just on substance use, prevention, treatment, and recovery, and then in 2019 started to bring in mental health, and that was something that as an organization I was pushing for, but the coalition wasn’t ready yet, and we needed to do some work together to understand the shared risk and protective factors for mental health and substance use are so intertwined, and we’re doing so much of the strategy, so why not name this broader behavioral health issue? But some of the partners were kind of siloed in the work of their agency, and in theory, they liked the idea, but it was hard to integrate.
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So it took us a while, but we were able to bring the folks along in this journey and started to explicitly work on mental health and substance use. We then evolved beyond that when we started to look at trends. So I would say in 2018, ’19, we started to disaggregate data to look at how behavioral health was showing up among special populations. So as an agency, we have always focused on allocating resources to the most impacted communities, the marginalized people who are disproportionately impacted by chronic disease, behavioral health, maternal health issues. So we started to look in TYSA, and although we were seeing some improvements in behavioral health outcomes, they were not being experienced universally.
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So if we saw reduction in prescription opioid use, instead of just patting ourselves on the back that we made this tremendous, which again, we should celebrate the winds too, but understanding that this was not seen across all populations so that we saw that prescription opioid use was going up among Black and Brown adolescents. So, okay, so let’s pivot and start naming this issue and developing strategies that lifted and created more protective factors for that special population. So it required us to do some work as a coalition to kind of understand the importance of disaggregating data, understanding what are the drivers of these differences, what are some of the structural issues that contribute to these disparities? And we’ve had some difficult conversations as a group, but we did a lot of learning together. And I feel like that’s also the beautiful thing about collective impact is that it creates a space for co-learning and growing together, and that it’s the tension, and this tension that really results in more meaningful and robust work.
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So 2019, 2020, we were really doing a lot of work in that area and named the structural issues in the mission of TYSA and started to really find dedicated funding to support these populations and these initiatives. We’ve continued to grow. We have received some funding, again from more special populations, maybe for non-English-speaking immigrants whose children are using more alcohol. Again, this was based on the data that we collected in our community. So it’s never like, “Oh, I think we’re just going to focus on that.” We do regular and extensive data collection, either ourselves or working with our local health department. And then we look at it to try and understand trends, and that helps us shape what we’re going to be focusing on in the upcoming period.
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Teresa Chahine: One of the things we really focused on today in class was thinking about, we talk about this so much in the course because part of the principles, the framework for public health entrepreneurship is design thinking and design justice. So building power for others and shifting the status quo. And so you shared an article with us as part of today’s readings about academic researchers who looked at multiple collective impact initiatives and evaluated them and found that there are different people with different power within any collective impact initiative. And sometimes it’s those people who drive the agenda. And so they’re really just propagating power inequities. And so I imagine as the backbone organization, that you are one of those people with the power, and I know that you’re very mindful of this. So talk a little bit about the ways that you have approached these power balances in terms of youth, having youth have a voice in terms of, you mentioned certain subpopulations are seeing different trends in substance use and how are they having a voice and then at the same time not alienating others, especially in the current point in time when everyone is so divided about everything and you can’t do collective impact in that environment.
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So it’s two kind of related questions. How do you build power and for whom? And how do you do that in today’s world while keeping everyone at the table?
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Adrienne Abbate: These are the things that keep me up at night.
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Teresa Chahine: Yeah.
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Adrienne Abbate: Well, when we first formed, we were very grasstops. And I think that aligned with some of the early work that was published around collective impact, that was what was, I mean, shaping the work that we were doing in 2011, 2012.
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Teresa Chahine: I mean, let’s face it, the term was coined by a consulting company.
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Adrienne Abbate: Yeah.
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Teresa Chahine: That’s not very grassroots.
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Adrienne Abbate: It’s not grassroots. And I think that one of the other criticisms of collective impact is that it was putting a bow or providing language around ways that communities have been working for a long time, and it’s not a cookie-cutter approach or a formula that people can like, “Oh, we’ve got the magic, now we can address all these complex issues,” but that these were conditions that were present in more successful collaborative structures. So in the beginning, we were very grasstops, and as we evolved and started to look at the data and think about equity and think about communities impacted, we did a lot of work to make sure that those voices and those organizations that represented grassroots groups were coming to the table to work alongside of the district attorney or our local senator. And we were mindful about creating space where people felt safe to contribute, and it was not easy.
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And I think that we created norms about stepping up, stepping back. We played around with not using titles so that we were level setting when we were working in a work group setting or in a coalition meeting. And I think that was helpful. And I think also the work that we were doing around some of the antiracist work was really kind of getting at some of these power imbalances and systemic issues that have contributed to some of these poor health outcomes.
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But one of the things that we struggled with since our inception was the youth voice. And in the beginning we had sort of a separate advisory council that felt very, I guess, separate from the work that the larger coalition was doing, and it was almost like an afterthought, and it wasn’t integral to shaping our strategies. And we struggled with like, well, what does that look like? Who’s doing it well? And started to read about how different groups were paying community members for their expertise and time. And we really love that idea because I have a salary that’s covering my time when I go to these meetings. But you want people from the community, or you want young people to show up. We should be respecting their time and valuing it and paying for it. So we were able to get some funding where we can pay young people to bring their lived experience in shaping the strategy. So they participate in the work groups, they participate in the steering committee, they give us feedback on what the issues are, our approach. And then they also have separate projects that they’re working on that look at. It’s a different one every year: One year they did food insecurity and mental health. Right now they’re doing political climate and mental health, and they’ll do research. They’ll go out and do a photovoice project or—
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Teresa Chahine: So they’re driving the agenda.
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Adrienne Abbate: They’re driving the agenda, and then they’re bringing it back to the stakeholders who might not even be thinking about these things. But if we’re a youth-serving coalition, we need that to be driving all the work. So it took us a while to get there, but I feel really good about this new model. And they also, the young people, the consultants represent the populations that we are trying to reach. So it is a beautiful mix of young voices and perspectives, and it’s just made the work much stronger.
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Teresa Chahine: I want to ask you more about something you mentioned along your way and your answer, which is that it’s not cookie cutter, right? Consulting companies like to make it sound like, “Here’s the formula.” And I know there’s a website collective impact forum that shares many different collective impact initiatives. So we have these five elements that we talked about, backbone organization, common agenda, shared metrics, mutually reinforcing activities, and constant communication. What’s not in that formula? What have—we’ve already called out something that’s not, right, like power balances, inequities. What else have you learned across the year as you’ve expanded beyond this starting formula, and how has that shown up in your community?
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Adrienne Abbate: Well, I think one of the things that maybe is not as explicit but was critical in our formation and also in continuing to do this work now, it’s been almost 14 years and people are still coming to the table and still feel very passionate about it. So we’re doing something right. But it was the creation of principles and values.
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Teresa Chahine: It says nothing about values. You have a common agenda, but not aligned values.
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Adrienne Abbate: And in our common agenda, we did name some of these non-negotiables, like this is how we’re going to work together. We tried to name evidence-based strategies, but then we’re like, “Oh, that’s so limiting because there are emerging issues and emerging strategies so that as much as we can, we want to follow best practice with limited resources.” We talked about respect, that we’re going to have opposing ideas, but that’s also what makes the work so rich. But just creating these values and articulating them so that when we had conflict, we could point back to this, “Remember, this is what we agreed to. Does that still resonate?” And that would be a moment where people would be like, “Oh, yes, okay.” Or they might push back and say, “Well, what do we mean here? Let’s kind of revise it and elaborate.” And so it’s been very helpful. So having that be part of it from the onset was incredibly important. And to your point, what we weren’t thinking about enough was the voice of community and equity in driving the work that came a little bit later and then has really shaped the way that we do everything now. But it wasn’t part of our formative process.
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Teresa Chahine: What do you find the hardest about doing this work? She’s like, “Where do I begin?”
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Adrienne Abbate: Yeah, it’s very rewarding work, but it’s also very challenging. The hardest part, I think actually the hardest part lately has been defining metrics of success because we’ve grown so much as a coalition and expanded our focus. In the beginning it was pretty straightforward. It was past 30 day use of substances. But now we’re addressing mental health and suicide prevention, and we’re talking about people getting connected to treatment. There’s so many different metrics and measures that it’s hard for us to find a set of five, like a constellation of stars, and then how do we... because of that, it’s hard to communicate the work that we’re doing as a coalition to the community. Somebody said, “You’re almost too complicated. You’ve got so many partners. You’ve got so many strategies. I mean, what?”
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Teresa Chahine: Seriously, how do you get anything done?
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Adrienne Abbate: I know, I know it is challenging. And because I’m a public health person, I’m like, “Well, everything’s connected. Can’t you see that?” But sometimes not everybody does see that. And the challenge is not taking on too much and staying focused and keeping those metrics, those core measures, driving the work when you can pull in everything. I mean, public health is everything. You can’t talk about youth, behavioral health. You’re talking about, “Yeah, we talk about housing and housing.”
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Teresa Chahine: That’s my tagline in life. I teach at School of Management. And so on the first day of class, I tell people, you’re getting MBAs. Some of you are getting MPHs. You might not all self-identify as someone who’s working in public health, but same as the people in your collective impact initiative. They might come from the Department of Justice, from NYPD, from schools, from hospitals. So they might not think of themselves as working on youth substance use, but something they’re doing is impacting it.
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Adrienne Abbate: Absolutely.
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Teresa Chahine: And everything is a driver of health where people live, what they eat, to what extent they can move the air they breathe, the schools. No matter what job you have, it’s somehow related to public health.
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Adrienne Abbate: It’s all connected. It’s all connected.
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Teresa Chahine: And in our minds, that’s how you do the work. But then it also presents a challenge of like, well, where do you draw the line? And who is in this collective impact initiative, and how are we going to get them all to agree?
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Adrienne Abbate: Yes.
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Teresa Chahine: I think you’re right about coming up with shared, with those metrics. Of course we need shared metrics, but how do we agree on them? Yes.
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Just yesterday, I was listening to a podcast about Housing First, which is a program that was actually created to tackle substance use because a lot of people who had alcoholism also were unhoused. And it was like, “Well, let’s house them.” You can do the pre-treatment, then work on housing. So this program was created to test out housing first, and it was for the high-risk ones, not just it was for a subset. And then the people who say it doesn’t work, and the people who say it do work, were all pointing to the exact same evidence. But their interpretation of it was like, “Well, this means it doesn’t work, and this means it does work.” And so that’s why I think when you think about extrapreneurship, broadly speaking, working across the boundaries of multiple institutions, it’s so important to figure out what success looks like, how we’re going to measure it, because that is your end game, right?
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Adrienne Abbate: Yes.
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Teresa Chahine: And another thing I think I would find challenging in your work, as I’ve heard you speak today, is that what success looks like is not only about the outcome metrics, which are already hard enough, as you’ve pointed to, but it’s also about the process in the sense that you might be able to get substance use down in a way that doesn’t incorporate community voice or youth voice. So is that a success or is the whole point to build trust and partnership, in which case the process is as important to finding success is the outcome?
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Adrienne Abbate: That’s true. Although no funder wants to hear anything about process outcomes.
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Teresa Chahine: They want results.
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Adrienne Abbate: Yeah, they want results. But you’re right, because when I talk about success, I talk about the new partnerships that we’ve developed over the course of the year, new ways of approaching the work. These are things that contribute to those outcomes, but not always captured or shared publicly. What does success look like to me? I think that that trust piece of it is critical. I’m very mindful of how we do the work and how people are reflected in the work. So we’ve done a lot over the years to kind of expand TYSA, who TYSA is, who’s coming to the table, and making sure that their idea of success aligns with some of the not old guard, but people who have been in TYSA for many years. I think that’s, TYSA has been evolving and new people are coming in, and there have been people who have been with it the entire time, and the new people coming in at different points, making sure that we are still remembering what we’ve committed to work on collectively. But the challenge has been how do we come up with a concise metric or body of metrics that will capture that?
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Teresa Chahine: It’s very challenging. I think I would like to end by asking what your advice would be for others aiming to work beyond organizational boundaries to bring together collective stakeholders around a common agenda using whether the collective impact definition or just a more expanded definition. What words of advice do you want to leave them with?
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Adrienne Abbate: So somebody asked me recently, “Are you still doing collective impact?” And I said yes. And I still firmly believe that it is an incredible way to bring people into work, into work that they might not have done together with these other stakeholder groups. So I think that for anybody who’s interested in building coalitions and building some sort of movement, it is a lot around trust. So I did spend a lot of time meeting with people, having coffee, hearing about the work that they are doing, and finding those common areas. To your point, they might not consider themselves in the behavioral health prevention treatment space, but understanding how they’re contributing to a protective factor, like providing a “Friday night lights,” that’s probably not the right term—Friday night basketball game keeps young people engaged and they’re not on their phones or they’re not smoking cannabis to self-medicate. So it’s showing where they are in the work and finding those areas of passion and intersection because we are all interrelated. And I know that different organizations and people have limited time and resources. So again, they could also participate in many different meetings. But kind of being strategic and thinking about who are the levers and stakeholder groups that need to be at the table to do this work.
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Teresa Chahine: I am wondering as you’re speaking, whether you think public health is something that can bring people together.
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Adrienne Abbate: Well, I never thought public health would be a public enemy, but lately it feels very politicized. And I think because public health has such a social justice approach to it, and that’s really kind of the frame that I’ve grown this organization to reflect and practice. So for us at the organization level, it’s all about addressing health disparities and thinking about equity and providing more resources to the groups that need more. It’s about naming vulnerable populations so that they feel seen and in the work, we can’t do work for populations without having them be in the work and at the table, and really just having community be centered in all of this. But it feels like it’s now become political in a way that is very unfortunate, because if you address the wellbeing of the most marginalized, it will improve outcomes for the greater society. It’s like the curb cut theory. You can cut curbs for the disabled and then everybody—
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Teresa Chahine: For wheelchairs or strollers.
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Adrienne Abbate: Strollers, but everybody benefits from it. So that’s the approach that we’ve taken at SIPCW, and it’s shaped the collective impact work. But I think that’s also what makes us a little bit different from other CI backbones is our public health approach. I think it’s made it very, very strong in terms of our CI model, but it also now feels like it’s putting us a little bit at risk in terms of naming populations and talking about those structural issues that contributed to these poor health outcomes.
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Teresa Chahine: Yeah, it feels like all of a sudden public health is, there’s something divisive about it, and potentially collective impact could be a framework to bring people back to the same room and the same table. One thing I told my students this semester is that most people agree on the problems. No one doesn’t think substance use is a problem. I mean, I think people just disagree on the solutions and how they want to tackle it. And so that might make collective impact harder than ever now. But it also might make it a really valuable tool to get people to sit down and talk about a common agenda and to find shared metrics and mutually reinforcing activities and continuous communication. And we need so much more of that in everything these days. That’s true. So thank you for doing this work, and thank you for taking the time to share it with us, and we’re excited to see where this goes. And anything we can do to support you, let us know.
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Adrienne Abbate: Well, I appreciate this opportunity, and I think you’re right. Collective impact does create this space for people with very different ideas. And to be honest, in our history of doing the work, we’ve always had people who came from very different political backgrounds, experience with their work, different sectors, but it does, I think, provide this opportunity for trust building and learning together that it has been really incredible. So I do hope that in this next period that we can continue to do this work and maybe even go deeper.
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Teresa Chahine: Lead the way, we will follow.
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Adrienne Abbate: I’ll try.
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Teresa Chahine: Thank you, Adrian. Thank you.
