Louisiana's Turning Point initiative reflects the challenges and opportunities of  implementing a progressive health initiative in one of the most unusual and creative, yet  economically poor states in the country.  Historically, Louisiana has been at the  bottom of the list for many indicators of good health and is known for its fondness for behaviors that are not indicative of a healthy life. Despite these challenges, a growing core of health care professionals and community members have committed themselves to changing the health status of the people of Louisiana.

Through leadership development and strategic planning initiatives, this core group began the process that culminated in Louisiana's successful Turning Point application. Our Turning Point initiative has been the catalyst for implementing many needed changes and has challenged us to think  differently and to do things in new ways. Some of the key components of the Louisiana Turning Point initiative include the following:

Collaboration & Partnerships

Both our local and statewide partnerships have been successful in recruiting a diverse array of partners to participate in the Turning Point initiative. Although individual  organizations have collaborated separately in the past, this is the first time that a  partnership this broad has been organized at a collective and statewide level exclusively for the purpose of long-term planning. These partners are creating a shared vision for improved health in Louisiana and are developing a strategy for how they will work  together to achieve it.

Turning Point has also been the impetus for involving non-traditional public health partners, such as the business community, in re-developing the public health system and for strengthening relationships with sectors such as environmental health and consumer advocacy. As a result of Turning Point, public health is partnering in a qualitatively different way.

Training & Technical Assistance - Tools for Change

One component of our initiative which we are the most proud of is a leadership and skills development program called Tools for Change. The Tools for Change program is a series of forums to nurture and guide the process of developing state and community public health improvement plans. The program is being created by two of our key Turning Point partners, the State Office of Public Health and the Tulane School of Public Health. Unlike many workshops which rely solely on didactic presentations, the Tools for Change forums are real working sessions in which each partnership has the opportunity to work within their group as well as exchange information and knowledge with other partnerships. These sessions also include nationally renown experts in the field who provide technical assistance to the partnerships and provide them with tangible tools for use in their communities. Our first session on coalition effectiveness and stakeholder analysis was held in February and was quite a success. Our second session will focus on vision, futures thinking, and systems change and will feature Tyler Norris, Executive Director of the Coalition for Healthier Cities and Communities; Jonathan Peck, Vice President of the Institute for Alternative Futures; and Dr. Joyce Essien, Director of Public Health Practice at Emory University. As a result of our efforts with the Tools for Change  program, we are compiling a vast array of resources on community partnering and  strategic development including: speakers/consultants, articles, bibliographies, and a variety of practical tools and instruments.

Turning Point Initiative Workgroups

Statewide workgroups have been developed to work on key component areas of our initiative which will form the basis of our public health improvement plan. These components include: internal organizational change, building integrated systems of care, information and communication, and policy. Each of these workgroups is made up of a diverse array of partners who have a particular stake and role to play in that area. As new partners are brought into the Turning Point process, they select at least one workgroup in which to participate and contribute their time and resources.

Currently, our workgroup on Internal Organizational Change is working with the state Office of Public Health to strengthen performance of core public health functions through workforce development and organizational systems change. Part of our effort has  included working in conjunction with three other states in the south central region,  Alabama, Arkansas, and Mississippi, on the creation of a workforce development  resource center. As part of this process, we will be using the lessons learned from our Turning Point initiative as the basis for the development of a training curriculum on community collaboration and partnerships.

Another of our workgroups will focus on developing a model for an integrated system of care which will expand access to and improve the quality of healthcare for more people in Louisiana, particularly those in our rural regions. The group is working to bring together key players from public health, public and private hospitals, community primary care centers, and the Area Health Education Centers to begin a dialogue and develop a process for working together.

Creating a Learning Community

One of the primary goals of our initiative is to develop a forum for dialogue among different sectors, agencies, organizations, and communities both to help these groups come together to create a shared vision for improving health in Louisiana and to foster understanding, learning, and communication among these groups. We see each of our partners and collaborators as part of a statewide community that can share and learn from each other throughout this process. Much of the peer learning and information exchange occurs in person during our Tools for Change sessions. We have also developed a statewide newsletter to foster communication and are in the process of developing a website with computer conferencing capability. Louisiana is eager to learn from the experience of other Turning Point states, and we in turn are open to sharing information, materials, and lessons we are gaining from our efforts.

Although we are still in the initial stages of this initiative, we are proud of the many things that have already happened in Louisiana as a result of Turning Point. Our most important accomplishment is the development and strengthening of relationships  between organizations and across sectors. We are excited about the work ahead and are driven to move Louisiana from the bottom of the list to the top. We believe that Turning Point will provide the impetus and focus to get us there.

Ms. Usdin is a community health consultant and the lead co-coordinator of the Tools for Change program. Ms. Witmer, is Director of the Louisiana Turning Point Initiative. Three community partnerships in Louisiana are recipients of Turning Point grants: Healthy New Orleans, the City that Cares; the Northeast Louisiana Regional Partnership; and the Region V Turning Point Partnership.