In March of 1998, the Turning Point Portland Tri-County Local Partnership hosted a luncheon for fifty interested health system, public health, and social service agency  representatives. After an orientation and presentation regarding the goals of the  initiative, participants were asked to provide input regarding the Turning Point planning process. During this open discussion, the partnership received the following feedback from attendees:

• The strength of the Turning Point project depends on input from a diverse  and non-traditional audience.

• The partnership needs to ask continually the question, Who is missing and how can we get those missing engaged in dialogue around Turning Point issues?

• It is critical to use "active outreach" as a tool for involving diverse populations. Simply inviting someone from the community to a meeting is not enough. Active outreach involves physically going to the places where groups not traditionally involved in public health meet regularly, such as neighborhood association meetings, faith community gatherings, other forums for people of color, and local businesses, and becoming actively involved in their projects and meetings.

An Agenda for Active Outreach

Healthy Communities, which manages the Turning Point Portland Tri-County Local Partnership, analyzed this feedback from the luncheon and began strategizing how to perform active outreach. With a staff of only 1.75 FTE already dedicated to numerous Healthy Communities initiatives, time and resources are thin. Thus, active outreach, which is very labor-intensive, can seem overwhelming. An organization must ask itself three important questions before initiating this process:

• To what extent is the philosophy of an organization aligned with the concepts  of outreach (inclusivity, diversity, and non-territorial approaches)?

• To what extent is the partnership willing to give up an ethno-centric perspective?

• Are sufficient time and resources available to dedicate to active outreach efforts?

In response to these questions, Healthy Communities examined its principles and  approach and reached the following three conclusions. First, the philosophy of Healthy Communities is to endorse an all-inclusive and multi-sector approach. This philosophy drives the policies of the organization and allows staff the freedom and autonomy to engage in active outreach. If an organization's culture or philosophy does not create the policies to elicit active outreach, then barriers will present themselves.

Abandoning Ethno-Centric Perspectives

Second, the organization would have to continue to abandon any ethno-centric perspectives and biases. These include such things as insisting on formalized agendas without allowing for adequate social interaction, strict timelines based on a particular cultural definition of time, corporate dress, and an expectation of quick follow-up to phone  messages. Diverse cultures and groups represented in our community adhere to vastly different values and behaviors in terms of meeting processes, decision-making, and communication styles. Respecting these differences rather than assuming all groups interact in the same way in community building is a key to active outreach.

At a recent '98 Northwest National Service Symposium sponsored by the Northwest Regional Educational Laboratory in Seattle, Washington, two presenters - a Blackfeet Health and Safety Corp (BHSC) member and an AmeriCorp Leader - spoke about the importance of recognizing and then abandoning ethno-centric perspectives. The BHSC member and the AmeriCorp Leader recalled the initial difficulty they had in connecting when working on a joint project. The AmeriCorp Leader was frustrated after inviting several Blackfeet tribal members to meetings and never receiving responses. The BHSC member was unprepared for the forwardness and perceived arrogance of the AmeriCorp Leader's invitations. It was only when both parties were willing to try to understand the other's cultural and personal differences that their relationship flourished. Therefore, outreach is not just expecting groups to come to you; instead, it is going to where groups meet and listening and asking rather than talking and "leading." Active outreach is gathering insight into a group's cultural and organizational differences and sometimes joining another group's activities that may not be directly related to the Turning Point program. These efforts can be time-consuming, but the effort spent building a solid relationship will pay off in the long run and often lasts through numerous projects.

Reaping the Rewards of Active Outreach

Finally, although time and resources may appear to be thin, outreach actually can be a way to enhance staff time and resources. Initially, all of the outreach efforts of Healthy Communities increased the demand on staff. After scheduling a time to present the Turning Point project to the African American Health Coalition, the group asked Healthy Communities to join their organization and serve as a liaison for the Turning Point project. As a result of this new relationship, African American Health Coalition board members offered to run focus groups within the African American community - a need that had been identified but not fulfilled due to staff limitations in the Healthy Communities office. This connection to the community and the growing positive relationship with the organization provided Healthy Communities with a unique opportunity to enhance its resources. Through other outreach efforts with the Oregon Environmental Council, the Asian Pacific American Alliance, and the Refugee Consortium, Healthy Communities acquired four new representatives for the Turning Point Steering Committee and one for a working group. Outreach efforts can expand resources and achieve internal organizational goals for other projects.

In conclusion, active outreach may appear to be time consuming and overwhelming. However, an organization can use outreach as a vehicle for building long-term relationships, increasing resources, and achieving other future goals that require collaboration. Realizing that everyone does not operate in the same time-schedule, meeting formats, and quick response periods will help reduce barriers that might present themselves when attempting active outreach. Likewise, the extra effort it takes to go to another organization's office or meeting to gain insight into its culture and philosophy will only help to create a sustainable relationship. The most important piece of reaching diverse and non-traditional groups is to relinquish the ethno-centric perspective that all other groups act in the same way as your own.

Ms. Berkman and Ms. Harmer are the Project Coordinator and Project Director, respectively, of Healthy Communities in Portland, Oregon. Working with Oregon Health Systems in Collaboration, Healthy Communities manages the Turning Point Portland Tri-County Local Partnership. The State of Oregon and Josephine County Partnerships/Pathways to Care are Turning Point partnerships as well.